Dr Alexandra Cobb shares her experience of working in primary care.

As I came to the end of my first Foundation Year, I was eagerly anticipating the new challenges that would come with promotion: a pay rise, more responsibility, and perhaps most of all the prospect of my upcoming 4-month ‘GP holiday’. As an aspiring obstetrician, I confess it wasn’t so much the work I was looking forward to, as the prospect of 4 months without on-calls, working weekends, or night shifts—absolute bliss! I imagined my life would become devoid of stress as I embarked on my GP placement in a leafy London suburb.
For my first few weeks I was eased in gently, watching the partners at work. I did the odd supervised consultation, which included numerous nervous glances to my supervisor when I felt out of my depth—being questioned about the best cream for haemorrhoids, or if that mole looked dodgy.
Then came the time for me to have my own clinic. I arrived early, armed myself with a hot cup of coffee, and awaited the arrival of my first patient. I heard them before they walked in and it made my heart sink. It was a screaming 10-week-old baby, who hadn’t been sleeping or feeding well for 24 hours. I racked my brain for a useful mnemonic for ‘how to assess a baby’ but came up blank. After running through my best paediatric history yet, it came to the examination. I awkwardly picked up the baby to ‘see how he handled’, took a temperature, had a look in his nappy, and then stood back, stumped. I was out of ideas. I made my excuses to the anxious parents (who clearly thought I looked far too young to have finished A levels—let alone a medical degree), crept to my supervisor’s room, admitting defeat at the first hurdle, and asked for help …
Not a great start! Next came in a 30-year-old chap with an abnormal, swollen, erythematous ankle. Ah-ha! I can handle this, it’s cellulitis … or is it? But what about septic arthritis, autoimmune arthropathy, or gout? Off I went to ask for more help.
Right, third time lucky. Surely this was going to be something I could manage? Another 30-something male with streaming, bright-red eyes and a completely blocked nose sneezed his way into my room, asking for help with his hay fever: 'I’ve tried everything, Doc and it’s not getting better.' After running through my limited personal formulary of tablets, nasal sprays, and eye drops, once again I sloped off for advice.
It dawned on me that, while I had learnt much during my F1 year, the skills I had developed were sweet-talking a radiologist into getting an urgent CT, creating beautifully organised lists, and writing discharge summaries in sub-5 minutes. I was wholly unprepared for the variety and uncertainty of general practice. For the first time, I have been expected to manage patients independently without someone looking over my shoulder. Consequently, I find general practice far more stressful than an acute hospital, so much so that I wake up wondering if that patient’s headache was really just a migraine, or if I calculated that QRISK2 correctly, or if that tympanic membrane was red after all. After a few weeks I reflected on the so-called ‘GP holiday’ I was promised. Holiday? No. Underestimated? Yes. A valuable experience enabling junior doctors to appreciate the work of GPs and their daily struggle of living with anxiety and ambiguity? Absolutely!
Right, next patient: a toddler with a vesicular, dermatomal rash. Do 2-year-olds get shingles? Never seen this before. Better get some help!
Dr Alexandra Cobb (F2)


Lung cancer awareness month

Saturday 1 November marks the beginning of this year’s global lung cancer awareness month. Lung cancer is the most common cancer worldwide, and in the UK around 41,500 new cases are diagnosed each year.
The Roy Castle Lung Cancer Foundation is one of the most active organisations in promoting this awareness month and is running a ‘Hair Dares’ campaign to help raise funds which will go towards vital lung cancer research and support for people living with lung cancer: fundraisers can share photos of their unorthodox hairstyles via Twitter, Facebook, and Instagram with the hashtag #HairDares.
For more information please visit: www.roycastle.org
Update your knowledge:
GP curriculum heading 3.01—Respiratory health
Read the Guidelines in Practice article on the management of lung cancer and the implementation of NICE’s lung cancer quality standard at: ginp.co.uk/sep_12_baldwin_lung_cancer