As a medical student and junior doctor in my hospital training years, I was often asked this question by friends, senior doctors and well meaning patients. It really grated on me, that one little word: “just”.
I always thought I’d become a GP. As a teenager, I was inspired to study medicine by my own GP who had always looked after my family with such care and compassion. As I went through my training I dabbled with the idea of other specialties; I was fascinating by the life stories of my geriatric patients, I loved the cute-factor of paediatrics, I was hooked on the emotional highs and lows of obstetrics, I enjoyed the team atmosphere of the emergency department. But I think, deep down, that I always knew I liked ALL of medicine too much and that above all I wanted to make a meaningful difference to my patients’ lives.
For me, GP was the obvious choice.
Nowadays, when I tell people that I’m a GP, they ask instead “So are you going to specialise in anything?” They don’t seem to understand that I HAVE already specialised. I’ve specialised in General Practice (and GP obstetrics) by doing an additional 4 years of training on top of my medical degree and internship. I am officially registered with the Australian Medical Board as a “Specialist General Practitioner”.
This has been a conscious decision; I haven’t just become a GP by default.
So to be asked these sorts of questions always seems so unfair. It implies that “GP” and “specialist” are two diametrically opposed alternatives, and that GP is the lessor of the two. If you’re smart, ambitious, passionate and successful you become a specialist. If you can’t get into anything else or if you want the easy option, you become a GP. It’s seen as a back-up option, not as a worthwhile career in itself.
The specialist vs “just a GP” dichotomy also perpetuates the idea that GPs are not “experts” in their own right; that GPs are the amateur doctors that do the easy bits of all the other specialties and then refer on when it gets too complicated.
I’d like to dispel that myth. GPs ARE experts. We are the expert in each and every one of our patients.
We are also the experts in:
· Preventative medicine
· Undifferentiated illness
· Chronic disease management
· Complex multi-comorbidity
· Judicious use of finite medical resources
· Coordination of the health care team
We do these things better than anyone else. In fact, studies (see here and here) have repeatedly demonstrated that an increasing number of primary care doctors results in better health outcomes overall, a higher quality of health service and at a decreased cost. Whereas an increasing number of specialists is associated with higher costs and poorer quality of care, including higher overall mortality. So, as a group, GPs do a far better job at improving health outcomes and for less cost compared to specialists.
The reality is that General Practice is an enormously rewarding, challenging and varied career and that no two days are ever the same. We have no idea what is going to walk through our door next and it could be anything from an infant with a fever, a pregnant lady with pre-eclampsia, an elderly patient with new onset atrial fibrillation, a young man suffering with crippling anxiety, a parent grieving the death of a child to a full-blown heart attack. And all of these medical conditions come with added layers of complexity from the patient’s personality factors, social circumstances, family situation, expectations, medical co-morbidities, values and beliefs.
To my patients: I know you may never understand the intricacies of medical training, but I want you to know that out of all the career paths on offer, I chose to be your GP; to be the person that you turn to in your time of need, to see you as a whole person and not just a diseased organ, and to be the one who helps guide you to health and wellness. I hope you know that I feel truly privileged to be your doctor.
In answer to the original question, no I’m not “just” a GP.
I’m a broadly-skilled, sub-specialised, expert GP, providing a damn fine health service to my patients and my community.
And I absolutely love it.
Dr Penny Wilson
September 16, 2013
Republished, abridged, with permission. Full version available here
