First Day

So I can happily say that I survived my first day of being a GP registrar. I stayed back late too, and I wasn’t actually grumpy about that, unlike being in a hospital rotation. Which I thought was quite unusual actually.

After an awesome 2 days at an island resort attending official orientation with the GP training organization, I was a little apprehensive about starting today. Thoughts filled me with dread about what to do with the extremely difficult patient. What if the patient doesn’t like me? What if I bother my supervisor too much? What if I forgot to do a critical investigation?

So I went in this morning to the practice, all tensed up and nervous. I got the software training, and had a tour of the place. Can’t believe there is a CT scanner downstairs at the practice!

And when I got around to seeing my first patient, it wasn’t actually so bad. Having experienced ED at the hospital, the patients there had been very unwell, and it always felt like I was waiting for a consultant, and constantly waiting for someone to make a decision because I wasn’t experienced to make that call. And if patient’s had built up, the whole department got stressed, with team leaders pretty much yelling if you were too slow.

I didn’t experience any of that today fortunately. And the patients I saw were pretty lovely to be honest (which I guess I wasn’t really expecting working in a low socioeconomic status suburb).

My very first patient – menorrhagia after going off the implanon. This has been for 2 years since removal of the implanon. Should I put her on the pill, or should I refer her? When is the normal time frame after implanon removal when patient should have regular period again? All this I didn’t know, so asking the supervisor, he advised that I should refer her. And to do a speculum, since last one was done about 1 year ago when she had her pap smear.

And at the end of the day, I have a list of stuff I need to look up in more detail to fill my gaps in knowledge. Things like implanon contraception, hypertension management and investigations, and tinnitus.

My supervisor later told me how specialists would be well gunned for complex and really heavy illnesses, but for common things, would have no clue how to approach. He shared the example of a paeds consultant not knowing how to manage a child with VSD who got a simple finger laceration. The patient got stitched, and given gentamicin (which is overkill). But hey, in general practice, a good GP knows how to manage simple problems, and if its out of their scope or requires specialist intervention, a referral is appropriate.

In a way, that’s why I chose general practice. A specialist is excellent in their field of specialty, but for other things – they have no idea how to treat. A GP knows how to manage basic conditions for almost everything, but not to levels of expertise like a specialist. But for things like a rash or bump/lump, I can imagine the cardiologist telling a patient to “go and see the GP”.

Having worked in the hospital for the past 3 years, I can say that the first day of any of my rotations have not been as satisfying and bringing content as general practice.