How consultation can change practice for the new generation of GPs

Martha Hughes is a Year 4 Medicine student who won the Society for Academic Primary Care’s Medical Student Prize for her short essay 'A Consultation in Primary Care that Changed My Practice'. In this article, Martha shares her insights on her journey into studying medicine and reflects upon her experiences on the pilot patient-doctor course, run by the Primary Care Teaching Group.

Family and friends have often said to me they can see me as a GP, but although that arm was the most I ever saw of medicine - not having frequented hospital for any personal reasons, and without family members in the profession – it was only come these clinical years I have begun to feel a pull.

Through the patient-doctor course, I found I enjoyed engaging with people. It made the very dense science of the first two years feel somewhat relevant and applicable – for many it kept us in touch with our 6-years distant end goal of being a doctor.

I then entered my name in for the random draw of students wanting to partake in the ‘Learning from Patients’ pilot course and was successful, so began following a patient longitudinally through the year. Staying abreast with how a specific person was doing, the impacts of health problems and their interventions, again helped align the mostly theory-based education side, with the career ahead. Through this, I could talk to the patient’s family members about the impact of the patient’s condition, and better flesh out a life outside of their healthcare involvement. Similarly, I saw for the first time how strong and personal a connection between patient and long-term carer could be.

Each term I met with my GP supervisor and a fellow student to discuss what we had learned, which was a great space for sharing our new experiences, asking questions and voicing any concerns.

Looking back, I can point to this course both opening up my ideas of what medicine could encompass and actually see myself fitting into the medicine sphere. It gave me some confidence to start applying interpersonal and clinical skills, which began to animate the picture of a future.

However, my encounter with the patient about whom I wrote my essay, was a product of the GP arm of the clinical course, taking place at the very beginning of Y4/GE2. We knew this would be the year we were finally entering the patient space with some, albeit extremely minor, responsibility. In the ‘MedEd’ course, Year 6 students taught us practical information like history-taking, and patient examination practices. All of us have work-experience stories from 18 years old and younger. But despite all this, very few, if any, students actually go into the scenario where you are alone with a patient, with no trepidation at all.

I do feel it was like the first time the training wheels come off your bike. You know you won’t go fast enough for a crash to hurt, and your adult is only a few paces behind while watching you the whole time. Even though it’s scary, you’re excited, and learning, and maturing.

You’ll still topple over though.  

And evidently, this is not only understandable but completely expected, even if it makes you feel hot all over and entirely out of control and time slows way down to extend the tension. No matter how much you prepare. And that was the surprising part, because I thought I was ready! Even if not specifically in the clinical environment, I believed I had enough generalised confidence and ease in speaking to people for this first to not be a problem.

My GP supervisor for this experience was so encouraging the whole week, we talked a lot about the holistic nature of medicine, and about considering our patients’ health in the context of their wider life.
For example, one lesson she highlighted during a phone appointment I sat in on, was how it generally would be the higher income, more highly educated patients that would more strongly advocate for themselves and their health, whereas there was frequently a greater need to provide healthcare for those in the opposite situation, that were also less likely (or less able) to prioritise these problems. How the price of a bus ticket could be the difference between someone being able to attend appointments/receive treatment or not.

There was also a great emphasis on mental health running through the week; I attended a conference call where a network of local GPs were talking about how to tackle an eating disorder problem in a local school.

I believe this priming helped me and the other medical student involved to connect with our patient like we did, as one of the problems that she’d been having included low mood. There is a lot of research showing that low mood affects many areas of health, including pain tolerance, ability to socialise, energy levels, body inflammation, physical activity capacity and more. Therefore knowing your patient’s mental health, and how powerful and widespread its influence can be, is part of their care.

Full credit to my colleague for introducing the idea of switching to French.

Both of us trying to learn the language was something he and I had been chatting about earlier. Our beginner level meant that there was some understanding, but there was also a lot of engagement from our patient’s side, helping bring us into her world and her mind. Finding that point of commonality that resonated so much with her transformed her in a clearly subconscious, but very noticeable way to a more open and excited spirit.

Another great part of this was being able to see for ourselves how different a patient is outside of their specific doctor visit. People have such full lives outside of physical and mental ailments!

I wrote about my experience here and was chosen for the SAPC national essay prize in a very surprising honour. It excitingly granted me a year’s membership to the association and a free ticket to their yearly conference in Brighton. Oxford University’s Primary Care Department very kindly subsidised my travel and accommodation to facilitate my attendance. I got to hear some great talks, including about healthcare for the transgender and travelling communities, as well as so many interesting presentations through the day. It was a very educational experience that only increased my interest in the field.

I’m very grateful for SAPC and the university’s Primary Care Department for providing these opportunities to find my passion within medicine, and will be continuing to seek out opportunities going forward, as I would recommend every student reading this should too! I don’t think many winners of these things wrote them ever thinking they would actually win, so give it a try!