What does it mean to be a doctor?

The General Medical Council defines a doctor as a professional who has the enormous privilege of touching and changing people’s lives. Being an effective doctor means balancing art and science to reach diagnoses, to manage uncertainty, and adapt to continual change driven by both research and public expectations. A doctor must consistently demonstrate their integrity and take responsibility for their actions.

The GMC’s ‘Good Medical Practice 2013’ outlines some key necessities for doctors. This is not what a doctor must be but more what they must do to be effective in their roles. A good doctor would ensure that they did the following:
a. provide a good quality of care
b. put patients safety first, ensuring safe and effective care at all times
c. treat every patient as an individual
d. act with honesty and be trustworthy. 1

What it really means to be a doctor can be answered by considering what their typical timetable looks like and their role in society. Whatever specialty you eventually end up in, whether as a hospital consultant specializing in geriatrics, pediatrics or cardiology, a thoracic surgeon or a GP, you will find yourself having different, although overlapping daily duties.

Why not jot down what the day-to-day roles of the doctors and other medical staff are on your work experience? You may surprise yourself with the reality of being a doctor and this simple action will help you gain some insight about your coveted career.

What types of doctors exist and how do I get there?

General Practitioner (GP)

A GP is the first point of contact within the NHS. They provide community care to a diverse range of patients- indiscriminate of age, gender or disease. They work in social, physical and psychological healthcare. Preventative care and health promotion are important parts of their work. Effective referral of patients onto specialist services is crucial.

Some GPs are partners within a medical practice – this means they own a share of the practice and play an active role in contracting services and overseeing how the practice is run. Salaried GPs or locums are independent to the practice and work as direct employees rather than as partners.

Working as a GP offers a fair amount of flexibility- you can work anything from quarter time – one and a half days a week to full time and can substitute your work with locuming or on-call shifts. There is also the option to pursue a specialist interest within a hospital 1 day a week.2

GP’s are part of a working primary health care team – they do not work in isolation and need good teamwork skills to thrive as part of their community team. 3 There are a huge variety of patients and cases that you will see as a GP. Many chronic conditions will form a significant workload– for example, managing hypertension, diabetes, asthma and chronic kidney disease. Psychiatric illness makes up a considerable workload too – GP’s need the ability to be able to cope with mild to moderate emotional/stress-related psychiatric illnesses.

After completion of the junior doctor years and acceptance onto registrar training it takes 3 years to become a GP. (There is a proposal in review to extend this to 4 years in the future).

Some facts about being a GP

• GP’s that work full-time tend to have 9-10 hour-long days, but this may vary with the particular practice you work at.
• There is the option to work out-of-hours, nights and weekends for extra experience and money.
• You can pursue a specialist interest in a hospital 1 day a week following training.
• A GP will see on average 30-40 patients per day and discuss or speak to more over the phone and via email. In addition prescription queries and results handling can double the number of patients contacted in one day.
• GP’s are based in the community in a surgery; they also attend visits in the community, visit patient’s homes and elderly care homes or specialist centers for chronic disability.
• Many may have portfolio careers – working on research project or teaching at medical schools or in education.
• The typical day is something like 8:00am to 6:30pm but many GP’s may arrive before 8am and carry on after 6:30pm depending on their workload.
• A GP is a generalist and will never have any two days the same.
• The advantages are the ability to work directly with patients in the community, building trust and relationships over their lifetimes, to deal with all sorts of patients, diseases and problems as part of a community team. In addition to this, having job flexibility and an input into the way their service is run is a considerable asset.
• The most challenging aspects are the sheer breadth of cases you may be presented with and the unpredictability of the patients you may see. Keeping up to date with an enormous range of conditions can be challenging as can dealing with psychosocial issues or complex problems in just 10 minutes of consultation time. 3

Hospital consultant e.g.Paediatrician

Paediatrics encompasses care for infants to teens and has a variety of sub-specialties. This includes immunology and infectious disease, diabetes, neurology and child mental health. It is an especially holistic specialty, which requires you to look at the child in the context of their family, life and development. The goals of any paediatrician are to minimize the adversity caused by the disease and allow as normal and healthy development of the child as possible. Paediatricians can work in the community (primary care), in small local hospitals (secondary care) or in large district general or teaching hospitals (tertiary care). Thus, there is a lot of diversity within different paediatricians’ roles. 4

The day-to-day responsibilities include providing 24 hour services for acute inpatient care and A&E, management of long term conditions and advocating advice to social services or educational agencies. 4

Training to become a paediatrician takes around 8 years. It involves starting specialist training after the foundation years before completing general paediatrics training followed by training in a chosen sub-specialty.

Important skills for this career include excellent communication skills, enjoying working with families and their children, being a great team player and a good diagnostician. Emotional resilience, patience and sensitivity are also key. There are countless opportunities to work with a wide variety of other professionals including teachers, social workers and speech therapists, dieticians and physiotherapists. 4

Surgeon

Surgery is a broad term and the training pathways into different specialties are all varied. It is often highly competitive and provides a challenging, demanding and exciting career. There are 10 main surgical specialties and there are options for further sub-specialization. Surgeons will not spend their whole day in surgery- they also go on daily ward rounds, attend outpatient clinics and often teach or spend part of the day on administrative tasks. 5 It is worth mentioning that there is a national initiative to promote surgical careers for women in medicine known as ‘Women in Surgery’. This supports eager young female medics in accessing surgical careers. 6

After the foundation years, most surgical specialties involve a 2-year core surgical training. Core surgical training maybe linked with a specific specialty or may be general surgical training, which develops general surgical skills. 5

The 10 specialties within surgery are:
1. Cardiothoracic surgery
2. Oral and Maxillofacial surgery
3. Plastic surgery
4. Vascular surgery
5. Neurosurgery
6. Otolaryngology
7. Trauma and Orthopaedic surgery
8. General surgery
9. Paediatric surgery
10. Urology.

For example, neurosurgery involves treating and managing patients with conditions of the central and peripheral nervous system – this encompasses the brain, spinal cord and other nerves in the body. The total years of training after foundation years is usually about 8 years. An initial 3 years specialty training – one year core neuroscience then initial neurosurgery training – followed by 2 years of full time general neurosurgery and a final 3 years of specialist interest training. 7

Taking paediatric surgery as a second example, this field encompasses malfunctions, disease and trauma of children from babies to teenager patients. Within this field you can sub-specialise in neonatal surgery, trauma surgery and cancer surgery, as just a few examples. The training pathway is similar to neurosurgery, with an overall 8-year pathway. 8

There is huge variety within surgery but a key similarity between all these specialities is that work is based in hospital, with time spent in the operating theatre and outpatient clinics. Out-of hours work and seeing between 8-12 inpatients per day is commonplace. The most enjoyable part of this career is being able to meet patients and make a genuine and fairly immediate difference to their lives. There are also opportunities to conduct research with flexible working hours to facilitate this. The toughest aspects can be the technically challenging, long and emotionally draining surgeries and the cases where a goal cannot be achieved despite best efforts. 5

What is the best and worst thing about being a doctor?

This is subjective and varied; of course this is no one single correct answer. Most people go into medicine because they want to help people using scientific knowledge and effective communication skills – so often the best thing is making a genuine difference to people’s life’s and supporting them through vulnerable and difficult times. To be a doctor is a privileged position in which you meet and help an enormous variety of people.

You may save someone from a fatal cardiac arrest in acute medicine, vastly improve the appearance of congenital deformity in neonatal surgery or brighten the life of an elderly patient by giving them a new hip replacement in orthopaedics. You may help fight for social support for a child who is vulnerable, you may help a young teen with suicidal ideations receive the support they need, work with a patient to manage their bipolar disorder or help oversee the safe delivery of twins. You may prescribe the drugs to relieve crippling migraines or correctly identify a nasty skin rash subsequently treating it with the right therapy. Whatever it is you end up doing as a doctor, the opportunity for hands-on, highly rewarding and challenging days will certainly feature. 9

The sailing might not always be smooth: you may not always be able to save a patient at times or accurately predicting the progression of a condition can be challenging. High emotional stresses and physical demands are also part and parcel of being a health professional.

Ultimately it is up to you whether you decide to embark on a career in medicine – it isn’t an easy choice, it will be highly rewarding but not without considerable challenges too. Speak to doctors and see what they have to say – many say how much they love their jobs and wouldn’t want to be doing anything else; just remember whatever you decide, make sure your decision is informed and honest.

References

1 The launch of Good medical practice (2013) [Internet]. General Medical Council. General Medical Council; 2015 [cited 2015 Jul 30]. Available from: http://www.gmc-uk.org/guidance/news_consultation/20477.asp

2 Postgraduate Training Pathway [Internet]. Medical Careers. [cited 2015 Jul 20]. Available from: https://www.medicalcareers.nhs.uk/specialty_pages/general_practice/postgraduate_training_pathway.aspx

3 General practice [Internet]. NHS Careers. [cited 2015 Jul 22]. Available from: http://www.nhscareers.nhs.uk/explore-by-career/doctors/careers-in-medicine/general-practice/

4 Paediatric Surgery [Internet]. Medical Careers. [cited 2015 Jul 16]. Available from: https://www.medicalcareers.nhs.uk/specialty_pages/surgery/paediatric_surgery.aspx

5 Surgery [Internet]. Medical Careers. [cited 2015 Jul 12]. Available from: https://www.medicalcareers.nhs.uk/specialty_pages/surgery.aspx

6 Women in Surgery — Surgical Careers | The Royal College of Surgeons of England [Internet]. Royal College of Surgeons. [cited 2015 Jul 13]. Available from: http://surgicalcareers.rcseng.ac.uk/wins

7 Neurosurgery [Internet]. Medical Careers. [cited 2015 Jul 12]. Available from: https://www.medicalcareers.nhs.uk/specialty_pages/surgery.aspx

8 Paediatric Surgery [Internet]. Medical Careers. [cited 2015 Jul 12]. Available from:

9 Rizo CA, Jadad AR, Enkin M. What’s a good doctor and how do you make one? BMJ Group; 2002 [cited 2015 Jul 30]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124230/
https://www.medicalcareers.nhs.uk/specialty_pages/surgery/paediatric_surgery.aspx

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