Carrying the mantle

As my daughter begins her career as a GP, I reflected on what has changed in general practice since I started – and what hasn’t

On 10 July 2024, my daughter, a newly qualified GP, took on the mantle of GP assistant with a view to partnership in Killenaule Surgery. The decision to be a GP in her hometown is unusual among her generation. Many GP registrars balk at the idea, imagining patients knocking at the door at all hours of the day and night and never again being able to go to the local pub for a drink. So, it is heartening to see that a doctor who knows the lifestyle, who has lived it vicariously since she was a child, would choose to follow in her parents’ footsteps.

Throughout her childhood the day-to-day work of general practice was so tightly woven into the fabric of family life that it was difficult to separate one from the other. Days revolved around surgeries, house visits, and nights and weekends on-call. Journeys home from swimming or dancing were frequently interrupted by a detour up a mountain or down a bog road where an illness or accident had befallen some unfortunate person. While her older brother avoided answering the door in case he might witness anything unseemly, she would be the one to usher the caller in, unfazed; crying babies, the gardaí, or even the man who came through the back field and over the hedge, whose neighbour had fallen off a horse.

The evening before she took up her post, I looked around the purpose-built building and remembered my first day there. My youngest son was four months old and I was returning from maternity leave. As I didn’t have a GMS list this leave was unpaid and I needed to get back to work. At that time the team consisted of my husband, myself, and one secretary. There was no registrar, no nurse, and no other doctor. My husband and I shared one room for the first few months as that was all that we could afford to furnish. Twenty-six years later the team consists of two principals, an assistant, a registrar, two nurses, two secretaries, and a practice administrator. The building has been extended over the years to include five consultation rooms, an upstairs office, and kitchen. The list of patients has increased. The work of the doctors and nurses has changed considerably.

Starting with a small GMS list, it was possible for me to grow with the practice. To gradually extend the services and get to grips with computerisation, becoming an employer, and managing a business. Today’s new doctors do not have the luxury of a long lead-in time and I’m sure that some must feel as if they are caught in the eye of a tornado, with no time to catch their breath.

Twenty-six years ago, most of my consultations consisted of examining patients as there was limited access to diagnostics, no blood collection service, and long waiting lists for surgeons and physicians who were mainly generalists. Nowadays, I spend more time looking at the computer than the patients, ticking boxes, calculating risks, and checking the results of ever-expanding blood tests and scan results.

 While in the past the secretary typed dictated letters on a typewriter, keeping a paper copy to put in the notes, nowadays I email completed templates. There are no longer trips to the post office with the post or the local health offices with an unapproved cool box to collect vaccines. Gone are the days when only consultants could order CTs or MRIs and the patients who spent years waiting for an appointment. Now scans are ordered at the click of a button and the result is in our inbox before the patient even returns home from the hospital.

My doctor’s bag lies neglected in the corner of my consulting room. It is unlikely that my daughter will get much value out of hers. I have not done a house call in a long time and it is even longer since I was called to the scene of an accident. These were frequent occurrences in the early years when there were very few emergency ambulances and no advanced paramedics asking me to step back while they plunge needles into bones or perform other unfamiliar procedures.

But while young doctors step into a much improved and effective health service, it is good to remember the things that have not changed. Kindness, consideration, good clinical knowledge, a discerning eye and ear are as valuable now as they ever were. The ability to be humble, to admit mistakes, to apologise, to teach with patience, to respect staff and treat them well. No matter how standardised or digitalised general practice becomes, the basic knowledge, skills, and attitudes expected of a GP have not changed. In the murky lowlands, new GPs will learn to sink or swim, and adapt their learning to what is right for their time, just like those of us who have gone before.