Tag: healthcare

The opportunity that came along was almost too good to ignore and what happened next changed the course of my career.

A local GP was approaching retirement and was looking for somebody to join the practice with a view to taking over when he stepped down a year later. His son had originally been expected to take over but had decided instead to move to Australia, leaving the future of the practice uncertain.

For me, it felt like a remarkable opportunity.

The surgery was within walking distance of home. The children were older, life looked very different from when I had made the difficult decision to let go of my first practice and, for the first time in years, I could see a way of combining practice ownership with family life.

It wasn’t a decision I took lightly. Taking over a practice meant increasing my hours considerably and accepting a huge amount of additional responsibility. As a family, though, we talked it through and decided it was an opportunity too good to miss. In many ways, it felt as though life was giving me a second chance.

My husband, who had been made redundant and had started his own management consultancy, initially agreed to spend a couple of weeks helping me review the business side of the practice. Two weeks became a month, a month became several months and before long he had become an indispensable part of the team. Eventually he gave up the consultancy altogether and became my practice manager.

Looking back now, I honestly don’t know how I would have done it without him.

Together we developed the practice and gradually grew the patient list. By the time I eventually left, we were caring for around 4,000 patients with a very small and dedicated team. It was general practice as I had always known it and I loved it.

The children spent a lot of time at the surgery. We were both working and there were many afternoons when they would arrive after school, appearing in reception, doing homework in spare rooms or helping themselves to biscuits and cakes that patients had baked for us. At times it felt strangely familiar and I would often find myself remembering my own childhood.

Without consciously planning it, I had recreated something remarkably similar to the world I had grown up in. It wasn’t just a practice. It was part of family life.

There were a lot of hats to wear. On any given day I might be a GP, a practice owner, a wife, a mum and a daughter to ageing parents. Like most working mothers, I spent years juggling surgeries with school runs, parents’ evenings, sports days, packed lunches and trying to work out what everyone was going to have for dinner.

It wasn’t always easy. Running a single-handed practice was hard work and the responsibility never really left you. We rarely took proper breaks, the days were often long and there was always another problem waiting to be solved. Yet there was also a freedom that came with it. I planned my own diary, I knew my patients well and, although there were difficult days, there were many more good ones.

The practice gradually became our second home. More than that, it was ours. We grew it together and, despite all the challenges, there was something deeply satisfying about creating something that reflected our values and the way we believed general practice should be.

Over the years it became increasingly difficult to find locums willing to provide cover as general practice moved steadily towards larger organisations and group practices. I found a couple of old-school colleagues who were happy to cover sessions, which helped build a little resilience into the system. Being the only doctor on site still meant there was nowhere to hide. If an emergency arrived, you dealt with it. If several problems landed at once, you prioritised and managed them. There was no colleague in the next room to ask for help.

You learned to stay calm, make decisions and carry responsibility and, with all of that in mind, very little really fazes me these days. I rarely get stressed or panicked about anything. I’ve always told my children that they can tell me absolutely anything and I will never be shocked because, between life and medicine, there is very little I haven’t either experienced myself or heard about from somebody else. And they do.

What I loved most, though, was always the patients.

Not once in my career have I stopped feeling privileged when a patient walks into my consulting room and trusts me with their story. It is the first lesson I teach medical students. Never lose sight of what a privilege that is.

There are very few professions where people sit down in front of a stranger and tell them things they may never have told another soul. Perhaps only priests experience something similar.

People never cease to amaze me. Over the years I have listened to stories of courage, resilience, humour, heartbreak and despair. Some have been uplifting, some tragic and some so complicated and extraordinary that they could easily have come straight from a television drama. General practice gives you a unique window into people’s lives and sometimes I would leave a consultation thinking that no scriptwriter could possibly have invented a story quite like it.

So the second lesson I try to teach students is that patients will teach you far more than any textbook ever can if you take the time to listen. Looking back, much of my real learning happened on the job. Not just the social side of medicine, but the practical side too. The clinical decision-making, the examination techniques, developing my own style of consulting and learning how to navigate complex symptoms all evolved over time. I often found myself creating mental maps to help make sense of seemingly unrelated problems and gradually learned that medicine is as much about pattern recognition and curiosity as it is about knowledge. Patients were some of my greatest teachers.

I realise that what I valued most about those years wasn’t the ownership, the independence or even the flexibility. It was continuity. It was the privilege of knowing people over years and sometimes decades, of understanding not only their medical history but also something of their lives, their families and the things that mattered to them.

Perhaps that is why I struggle with some of the changes that have taken place in general practice over recent years.

People often ask why I chose not to continue working in the way modern general practice is evolving. The answer is complicated, but at its heart it comes down to relationships.

I have never really believed that people can be reduced to a ten-minute appointment or a list of isolated problems because life simply isn’t that neat. One appointment, one problem sounds sensible on paper, but how do we know that problem number two isn’t connected to problem number one? How do we know that the tiredness isn’t linked to the bereavement, the headaches to the anxiety or the stomach pain to the stress of caring for an elderly parent?

Continuity matters because it allows someone to join the dots. It allows a doctor to know what happened last year, what happened ten years ago and what might be happening beneath the surface today. I worry that something important is lost when nobody holds the whole picture.

Patients need somebody who knows them, advocates for them and takes responsibility for helping them navigate increasingly complicated systems. Someone who notices when things don’t quite add up.

At least, that is the sort of doctor I have always tried to be.

I am a very emotional person. At happy times and sad times, at weddings, family speeches and all sorts of occasions, any member of my family will tell you that I am almost guaranteed to cry. My husband carries a hanky just for me whatever the occasion. The same is true in the consulting room and over the years there have been many occasions when I have sat with a patient and cried alongside them, not because I lacked professionalism, but because sometimes being human is exactly what the moment requires.

Perhaps that is what I value most about general practice. The privilege of sharing in people’s lives at their best and at their worst.

That is what drew me to medicine in the first place and, all these years later, it is still what keeps me there.

The practices have changed. The NHS has changed. The way medicine is delivered has changed beyond anything I could have imagined when I first started out. But the things that matter most have remained remarkably constant. People still need to be listened to. They still need kindness. They still need somebody willing to walk alongside them when life becomes difficult.

The story of what happened next is, in many ways, the story I told in my very first post. Perhaps I wrote the ending before I wrote the beginning.

Looking back now, I realise that the practices, the buildings and even the different chapters of my career were never really the important part. The important part was the relationships I built, the people, their stories and what a privilege it has been to hear them.

In the end, that is what mattered most.