“So, what is the most interesting thing you have learnt in General Practice so far?”

That was the question posed to me by one of the GPs. It is a known fact in that practice that i want to specialize in surgery, and not just surgery, but Trauma surgery. So everyone knows that i need to live life on the edge of my seat or i will be bored to tears. The GP consultants i sat with have all been absolutely fantastic – i have never met anyone more patient and more amicable than them. Sometimes, i wish i have not known them, so then one of them could be my GP instead, because a good family medicine doctor is hard to come by. Anyhow, whenever a patient walks in with something that vaguely requires a procedure done, the GP in charge would come striding down the corridor and tell me to haul ass into the treatment room because the fun is about to start! I really appreciate their kindness.

Anyhow, so this GP asked me this question; and i kept silent for a while – partly to rack my brains to come out with an answer that did not sound that i was bored to death (I was after the first two weeks, because the patients after the first two weeks were just a repetition – prescriptions, blood pressure, rashes, sniffles, antenatal questions etc etc etc). And then i just thought i might as well be honest.

“The most interesting thing i have seen so far is Shingles,” i replied.

And it is true. I have seen three cases of Shingles; one almost becoming a Ramsay-Hunt, but not quite there yet. Three cases, and all in different sites, different age groups and completely different-looking lesions. I have now learnt that if the skin rash is something i do not quite recognize, i swear i am just going to put my last dollar on bloody Shingles.

The consultant looked startled with my response so i hurriedly explained myself.

“I never see Shingles in the hospital settings; not on the wards and not in the Emergency Department.”

“You are right…” the GP replied in surprise as she mused over what i just said.

“The other condition that i see in GP practice but hardly in the hospital setting is acute bronchitis,” i continued.

Seriously guys, anyone who comes in with a cough; nothing but a cough and perhaps an occasional sniffle, just have the unspecific diagnosis of acute bronchitis. I ask my list of courtesy questions and will come out with nothing but just a dry cough irritating cough that persists day after day after day. The chest examination would be clear, there will be no fever, and really just nothing to find at all; except for a very expectant patient. They all expect to be prescribed antibiotics as though it was some sort of magical elixir that will cure them of all their ailments.

Theoretically, we should not be dispensing antibiotics when there is no need for it because we will just be encouraging bacterial resistance. In real life practice, it is just different. My consultants explained to me that some battles can be fought and some cannot. If the patient comes in, determined to get a script for an antibiotic, you are really helpless to do anything. You just need to pick your battles.

Then there were patients who google their symptoms. I think reading up about your condition is a good education for oneself but to take what you read on the internet over what the doctor says, can be plain ridiculous. For example, this lady came in with possible seizures. (We do not think so – there are none of the usual symptoms like incontinence, post-ictal confusion, focal neurological deficits etc. Plus it was the wrong age group; this lady was too old to be diagnosed with epilepsy.) Yet the husband comes striding it and says his wife has seizures because he read about it on the net. When we asked more specific questions to clarify the symptoms, he retracted his initial statements and phrased them in the medically-correct way to make it seem like epilepsy; except his attempt to appear genuine was poor and we could tell he was reiterating what he read on the internet rather than what his wife really exhibited. Then he said he tried to force-feed some diazepam pills to his wife in the middle of her so-called seizure but it was impossible. He wanted a faster-acting drug. I just stared at him incredulously. In all his internet searching, did he really lack common sense? Did he not know you should not be forcing anything down anyone’s throat who is in the middle of convulsing or thrashing or whatever lest they choke? Hmmm…see? Definitely not seizures.

I have no patience for this sort of people. I would just brush them off, and really they should give me a wide berth. I can imagine the scathing remarks some of my surgical consultants would have meted out had they been confronted with such patients.

So GP has be an eye-opener, but i am glad it is coming to an end. I am also relieved to say that i am NOT a convert. Phew. Needless worrying.

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