Overview
Hey everyone!
I’ve been a GP Registrar for 6 months now. I’ve had some time to reflect on the things I’ve learnt as a registrar in the past few months.
For the most part, I have enjoyed working as a registrar and being able to practice a wide range of medicine.
However, like any profession, general practice does come with it’s challenges.
Here are 10 lessons I’ve learnt in my first 6 months as a GP Registrar:
1. There is SO MUCH to know
The human body is a bloody beast. There’s a lot going on, which means there’s a lot for general practitioners to get their head around.
The sheer breadth of information in primary care is one of the biggest challenges registrars (and fully qualified GP’s) face.
We are meant to manage anything and everything that walks through the door. We diagnose cancer, manage heart failure, screen for melanomas, manage antenatal and postnatal care and are expected to have a diagnosis and management plan for your 2nd toe that tingles every Tuesday.
2. There is SO LITTLE time
We do #1 in 15 minutes, on repeat, 30 times a day.
That’s right. 15 minutes to take a history, perform an examination, come up with a differential diagnosis, order some (Medicare-appropriate) investigations and perform some educational and opportunistic screening for a patient. No OSCE can prepare you for it.
3. There is a BIG mental workload
Going from a junior doctor (who mainly types notes) to a registrar who sits in an office by themselves and makes hundreds of decisions every day is a BIG transition.
There is a monumental mental workload that comes with being a registrar (in any specialty). I regularly have a headache at the end of a workday and also find myself worrying about patients / decisions long after the clinic has shut.
4. There are GOOD things
One thing I’ve really enjoyed this year is performing antenatal care and doing baby checks! It is honestly such a rewarding experience to look after a woman throughout her pregnancy and to see her return with a little bub in her arms. I don’t think that feeling will ever get old.
5. …and NOT SO GOOD things
I’m going to be honest here.
Sometimes, I feel like a paper-pusher. I’ve had numerous patients come in with a strong sense of entitlement about the investigations (imaging, blood tests) that they feel should be ordered for their various ailments. They react poorly when I explain that their test isn’t actually necessary (and is indeed NOT funded by Medicare). They forget that I am a fully-qualified doctor and that there is a clinical decision making process behind each medication or investigation I order.
6. MONEY matters
When I used to work as a junior doctor in the hospital system, I didn’t give a second thought to money. I was on a salary that came into my bank account regardless of how hard I worked, or how much leave I took. In general practice, there is a big emphasis on money, business and Medicare billings. For most GP’s, the bottom line is: no work = no pay.
7. BILLINGS baffle me
Everything in General Practice is itemized. Each item has a ‘Bill’ attached to it, which the doctor charges Medicare.
It’s like walking into Woolworths but instead of picking out 5 apples, a loaf of bread and 2L of milk, you walking into a medical centre and leave with 1 ECG, 1 ankle brachial pressure index, a mental health care plan and a vaccination.
Aside from having to remember a code for each of those items, you have to know which items can be billed together (co-billed) and which ones cannot.
8. Decision-making with INCOMPLETE information
There is a lot of ambiguous medical presentations that will walk through your door in general practice (e.g. your 2nd toe that tingles every Tuesday). You will often be required to make a decision with incomplete information.
Examples include the lack of communication from a specialist or the absence of a discharge summary from the hospital or the patient’s own social, financial and cognitive barriers.
This is why it’s important to safety net the patient and provide education about what to do if things don’t go to plan.
9. My Peers = Amazing SUPPORT
Being a GP Registrar can be lonely.
You sit in an office by yourself all day, making decisions that require a lot of mental power (and second guessing yourself).
There are often other GP’s that will work alongside you, but many of them won’t be able to relate to the position you’re in (unless they’ve recently gained fellowship).
Those who will understand are your fellow GP registrars, who are living the same reality as you but in a different practice. I’ve been lucky to have some amazing co-registrars who are a great source of support and always eager to debrief. If any of you are reading this, you’re all legends!
10. It’s hard to find a BALANCE
It’s easy to be swept up into the vortex of medicine as a registrar. You’re expected to live and breathe medicine. Your job is medicine, you come home and study medicine (yay for exams!).
In addition to #pandemiclife, this doesn’t leave a lot of time to do activities you enjoy or spend time with the people who mean the most to you.
Sometimes it’s easy to forget that there is MORE to you than medicine. I have to remind myself of this constantly this year and I am still working towards finding a balance.
Final Thoughts
So there you have it. There are 10 lessons I’ve learnt in my first 6 months of general practice.
If you’re a fellow GP Registrar or GP, I’d love to hear about your experiences. Send me a message at askdoctornisha@gmail.com
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