Work Experience in a GP Surgery: The Joy for an Aspiring High School Medical Student

Foreword

Last month, I received an email from Meghan Ray, a high school student from Glasgow who had spent part of her holidays working in her local GP surgery. She had written a short article on her experiences in the practice and asked if we could publish it on our blog.

After reading through her article, I was struck by Meghan's drive, ambition and the obvious delight she took in being a part of a team dedicated to helping others. I hope you find her account and insight into life in a modern GP surgery as interesting and inspiring as I have.

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Hello, my name is Meghan Ray. I am 14 years old and I live in Glasgow, Scotland. During the Christmas holidays, I was fortunate enough to have the opportunity to spend a few days at my local GP surgery to observe what really goes on and with a wish to develop an insight to primary care and see whether medicine is really a career I want to pursue.

Before I started my work experience at the surgery, I met the practice manager in early October where we set up some realistic goals for my tenure at the surgery.

I guess what I really wanted to observe over the few days at the surgery was what the patient’s journey is like in primary care from start to finish. If I was going to be completely honest with you, I had no clue what really goes on behind the scenes of a GP surgery other than the general idea of “the receptionists organise, the doctors consult, the patients leave with a solution to their problems”.

I didn’t get an opportunity to shadow any of the doctors during patient consultations due to the surgery being extremely busy after reopening, as it was closed for four days during the festive season; however, I still got a real feel for life in a doctor's surgery after sitting with the receptionists and the nurses. This is the real NHS frontline.

At this busy surgery in North Glasgow, I was astounded to see all the same day appointments gone within a few hours. From changing plasters, taking bloods, annual reviews, answering calls, booking appointments, managing travel applications, prioritising patients, to advising patients what to do without using clinical information, the stereotypical “Receptionists gossip all day and look into patients’ medical files” image was broken, and an image of an extremely tricky and stressful day for the team was clearly set out for me.

It's a cold, crisp, winter morning and the first of three days I am being allowed to spend at the surgery. After an hour of observing the stress in the reception, it is now 11:00 in the morning and everyone has gathered for a quick tea break. The surgery has four doctors, one registrar, two nurses, one sister, full and part-time receptionists, four admin staff as well as a assistant practice and a practice manager.

This is when I take the opportunity to ask one, single question that I have in my mind:

“What one thing at work makes it a good day?”

What I like the most about this question is that it is an open question, as “a good day at work” can be interpreted in so many ways by so many people. By talking to each staff member over the few days I got a variety of different answers, ranging from the nurses talking about patient interaction, becoming part of a patient’s life, to a trainee receptionist talking about gaining respect from colleagues.

Answers from a registrar included “not being assessed”, doctors mentioned “knowing you’ve made a difference”, “when thanked by a patient”, “when a patient expresses relief”, reception touched on “remaining in a stress-free environment (not fainting)” and those in admin also talked about “being able to finish off the patient’s journey” and “being able to ease the stress and work for everyone else”.

Here is a wordel I created and the most common answers were highlighted:

The answer I received from the admin staff made me realise something extremely essential in the surgery. Although everyone has different roles, everyone is constantly working hard and doing the best they can in their speciality to contribute for the team in order to give patients the best solutions and ease the work load on others, because everyone has the same aim. At the same time, they would like their work to be valued and respected by the team members.

Another element of teamwork was demonstrated to me when I heard about the multi-disciplinary meetings that take place once a month during lunch hour, where many people from different units gather to discuss and choose what the best decision is to take for the patient after hearing the pros and cons from each aspect.

As well as being looked at as an essential bio psychosocial model in our society, the practice manager showed me his role in the surgery and the reality that unfortunately the practice is also looked at as a business.

The practice manager is responsible for running the business affairs of the practice, providing adequate premises and infrastructure to provide safe patient services and employ and train practice staff to ensure the whole process runs smoothly with the 6-7% budget provided by the NHS.

I then did my research at home about this and found that over the recent years there has been a steady increase in the number of large partnerships resulting in the consolidation and growth of a number of GP patient lists. In turn, the traditional staff roles have expanded and developed to meet the needs of the practice.

Health secretary Jeremy Hunt has been accused of waging war on GPs recently, accusing them of being more interested in making money than treating patients, demanding they take back out-of-hours and weekend services from the contractors currently supplying them”, but the few days I have been at the surgery I have been shadowing staff who genuinely enjoy their job and are putting themselves in the patient’s shoes and trying to take all of their views into account.

Another thing I have learnt during my time at the surgery is the importance of confidentiality. It is important that patients can trust a doctor or anyone at the surgery as it can make the doctor’s diagnosis during a standard 10 minute consultation a lot easier. As it was a local surgery, I had an even greater chance of knowing patients so I had to sign a confidentiality contract before I started.

The Concise Oxford Dictionary defines confidentiality as: ‘spoken or written in confidence; charged with secrets’. In the ethics literature, confidentiality is commonly viewed as privacy. To assure a patient of confidentiality means that what has been discussed will not be repeated, or at least, not without permission of the patient and doctor. I realised that staff have the privilege of confidentiality, but they respect it at all costs.

During my time at the surgery, although I didn’t get time to sit with the doctors and observe consultations, I still learnt a lot more than I did know about the process. I watched the beginning to the end of a patient’s journey and expanded my knowledge in primary care. Most importantly, I found this a great experience, I still wish to pursue a career in medicine and I am ever so thankful for getting the opportunity to shadow very loving and hard working people for a few days over my Christmas break.

Initially when I had received my dates for the surgery, I had asked a teacher in my school’s careers department to give me a letter of permission, and they had told me that “it was too early and unprecedented”; however, it is never too early. At my age, you are still young, free of stress with writing personal statements, CVs, university offers and interviews, exams etc.

Do yourself a favour. Before it’s too late, without thinking too much about it first, contact a surgery, a hospital, a hospice or even an elderly care or nursing home and see as much of the world of medicine as you can. You won’t regret it, and one day it could be too late…