The long way round

Time passed quickly and before I knew it I was no longer the most junior doctor in the hospital. I had become a Senior House Officer, or SHO as we were known then, and life settled into a rhythm of six-month rotations. Every few months brought a new specialty, a new hospital, new colleagues and a new rota to learn. Some jobs I enjoyed more than others, but each taught me something different about medicine and about myself.

One specialty that surprised me was Accident and Emergency. Looking back, I genuinely loved it. For a while I seriously considered making a career of it. There was an excitement to the work that was hard to match anywhere else. You never knew what would come through the doors next. One minute you might be dealing with a child with a high temperature, the next a major trauma, a stabbing, a psychiatric emergency or somebody who had managed to injure themselves in the most extraordinary way imaginable.

Life in all its forms arrived through those doors.

I enjoyed the pace and the unpredictability. I liked making decisions, often quickly, and I became reasonably good at the practical side of medicine. I could usually find a vein when everyone else had failed. I enjoyed procedures and liked the challenge of working under pressure. I learned how to calm distressed patients, reassure frightened relatives and keep my head when things became chaotic around me.

For a while I thought perhaps this was where I belonged.

One particular shift at King’s Hospital stays with me. In those days we had to clock patients in and out. The aim was efficiency. Assess the problem, deal with it and move the patient on. There was always another patient waiting and a busy department depended on keeping things moving.

An elderly lady came in after a fall. Fortunately she had not fractured her hip and medically there was very little wrong with her. The obvious thing to do was assess her, reassure her and send her home.

Instead, I found myself sitting and talking to her.

I wanted to know where she lived, whether she had family nearby, how she managed day to day and what support she had at home. The more we talked, the more concerned I became about what would happen once she left the department. The bruised hip that had brought her to hospital seemed far less important than the fact that she was returning home alone.

None of that was really my job. My job was to assess the injury. Yet those wider questions were exactly what interested me most.

Later, during a feedback session, one of my consultants told me that I spent too long with some patients. It was fair criticism. In a busy casualty department speed matters and I wasn’t always as efficient as I should have been.

The funny thing was that the very things slowing me down were the things I enjoyed most.

I was fascinated by people’s stories. I wanted to understand not just what had happened to them, but who they were, how they lived and what would happen to them once they left the department. I realised that I wasn’t simply interested in diagnosing and treating problems. I was interested in people.

Looking back, that was probably the moment I started to understand where I belonged.

I continued working through a variety of hospital specialties, but my direction was becoming clearer. I started choosing jobs that would help me develop the skills I would need in general practice and before long I secured a position as a GP registrar in a local training practice.

Things were very different then. There were no national ranking systems, anonymous multiple-choice assessments or computer-generated allocations. One job often led naturally to another and opportunities frequently came through the relationships you built along the way. Looking back now, I don’t think I ever really had a formal job interview.

General practice felt like a different world altogether.

Compared with hospital medicine it seemed remarkably civilised. There were occasional Saturday surgeries, but the endless on-calls and sleepless weekends were largely behind me. I had longer appointments, my own patients and the opportunity to follow people over time. There were home visits too, which I loved, and I spent the year working towards my MRCGP, which I was fortunate enough to achieve during my registrar year.

When my training finished, I was offered a position in the practice where I had trained. It was a generous offer but I turned it down. The practice was large and, although I couldn’t fully explain it at the time, I knew I wanted something smaller. I liked continuity. I liked communities. I liked knowing people.

I started doing locum work in local practices, many of which I knew through Dad.

I think Dad always hoped that one day I might take over his practice. We never really talked about it directly, but I knew. Part of me felt guilty because for a long time I wasn’t sure what I wanted. Emergency medicine had been a genuine possibility and I didn’t want him waiting for me to make up my mind.

To his credit, he never put me under any pressure. Not once.

In fact, he did the sensible thing and planned his future without making assumptions about mine. He took on a partner with the expectation that they might eventually take over when he retired.

As it turned out, life had other ideas.

By the time I had completed my training and finally realised where I belonged, circumstances had changed. I joined the practice and worked alongside that partner for a period before they eventually moved on. In a rather roundabout way, the practice found its way back to me after all.

Looking back now, it seems strangely fitting. The journey was far less straightforward than any of us imagined, but somehow I ended up exactly where I had always hoped to be.

Taking over the practice was never something I was expected to do. It was something I wanted too.

It was a dream.

Of all the moments in my career, one stands out above almost all others. After his retirement, Dad occasionally came back to do locum sessions for me. We would run evening surgeries in adjacent consulting rooms in what had once been his practice and was now mine.

General practice was very different then. Most surgeries ran from 9 until 11.30 in the morning and then again from 4 until 6.30 in the evening. In between there were home visits, paperwork, phone calls and whatever else the day brought. It was busy, but it felt manageable in a way that medicine often doesn’t now.

After morning surgery I would usually finish my visits or administration and then head over to Dad and Mum’s for lunch. We would sit together, watch Neighbours, catch up on the news and chat about whatever was going on in our lives. Looking back, those ordinary afternoons are some of the memories I treasure most.

Later in the afternoon, Dad and I would drive the short distance down to the surgery together and spend the evening consulting in neighbouring rooms. At the end of surgery I would often walk home, which was only a couple of streets away from the family home, whilst Dad headed back up the road.

As a child I had watched him leave for work every morning. I had listened to stories about patients around the dinner table and grown up surrounded by medicine without really realising how much it was shaping me. Years later, after all the uncertainty, the hospital jobs, the on-calls and the doubts about where I might eventually end up, there we were, working side by side in the same practice.

I know Dad loved it too.

Looking back now, it feels like a dream.

And I loved every minute of it.