As the first day of your general practice placement approaches, it’s likely you’ll feel a mixture of excitement and apprehension. We spoke to some GPTQ registrars about their first day experiences and gleaned their best tips for that first important day and beyond.
1. Pay attention at your orientation
Dr Dan Faux, a GPTQ Registrar at Granite Belt Medical Services in Stanthorpe (12 tempting reasons to complete your GP training in Stanthorpe) believes ‘a thorough orientation makes a huge difference to your first few weeks of placement’. Most practices will start your day with such a session so try to soak up as much as possible. You may feel overloaded with information so take notes. You can always go back to them at a later stage and ask any follow-up questions you didn’t the first time.
2. Ask your supervisor how they want to be contacted
Your supervisor will be your lifeline during your GP placement. They will be the first port of call when you need advice about a patient. GPTQ Registrar, Dr Colin Case recommends finding out your supervisor’s preferred method of contact when you need their help.
“Some of them have an internal messaging system on their computers, some of them want you to call, while others prefer you knock on their door. If you establish this at the start, then there’s no miscommunication. You’ll find things flow more smoothly this way,” he says.
Another tip Colin’s first supervisor gave him when she was too busy to take his query, was to put the patient in the treatment room until she was free and see his next patient. That way he didn’t waste time ‘trying to make small talk with the patient’ and fall behind in his patient load.
3. Fully settle in before you call in your first patient
You may be really excited, albeit a little nervous, to see your first patient but Dan recommends taking your time.
“Make sure you don’t see any patients for the first half of the day. Instead, use this time to familiarise yourself with the computer programs and office layout,” he says. “This includes having some key resources at hand prior to starting. Things like John Murtagh’s General Practice, eTG complete and the Australian Medicines Handbook.”
Dr John O’Bryen, a registrar at Downs Rural Medical in Oakey, adds: “Work out how to print a script, print a pathology and radiology request, how to write and send a referral letter. Keep a common MBS item cheat sheet in your room so know what item numbers to bill.”
4. Get to know all the practice staff
GPTQ Registrar, Dr Jamie Nuttall emphasises the importance of introducing yourself and getting to know all the practice staff at a very early stage.
“Take a note of their names, write them down if you have to. It’s very important because they are the people that will save your life and really help you.”
Dan offers a unique yet effective tip.
“Take morning tea in for everyone once a week or so. It’s a great way to get to know all the staff.”
John also recommends you introduce yourself to your local pharmacist and allied health personnel as soon as possible and ideally, in person.
Tips for the remainder of your GP placement
These suggestions are great for getting started but our registrars also offered some fantastic suggestions for beyond this time. Some of them are straight forward and others are a bit ‘out-of-the-box’ and give you the chance to benefit from their inside experience.
5. Think about the best ways to manage your time
Being methodical in your day-to-day working life during your placement can help ease any time pressures you may feel.
Dan says: “Turn up 15 minutes earlier than you need to each day to review pathology results and also see which patients are booked for the day. I find this greatly improves your time management.”
6. Look after your physical and mental health
It’s very easy to overlook the easy stuff in the excitement of your GP placement but Dan is adamant you need to look after yourself to ensure you make the most out of your practice experience.
“Eat well, exercise and get plenty of sleep. Take your morning tea and a lunch break every day. It’s vital to refresh between patient sessions,” he says.
On this point, John agrees.
“Make sure to take toilet breaks and tea breaks even if you’re running late. It’s not safe to make clinical decisions if you’re hungry or have a full bladder,” he says. “I recommend keeping some nutritious snacks stashed away in your room to eat between consultations too. And it doesn’t hurt to bring in your favourite coffee and mug as well.”
7. Utilise a wide range of resources
General practice clinics all subscribe to an array of medical databases. You’ll use these on a daily basis to accumulate the vast amounts of information you need during your GP training and consultations. But Jamie says there are other options available that may be a better fit for you.
“After I’d been working for a couple of months, I paid for a subscription to ‘UpToDate’ which is a medical reference website. It costs a few hundred dollars a year but it made my life 10 times easier. The format suited me better than the resources I had access to,” he says.
Dan offers some further options.
“I’d recommend reading the Australian Family Physician and access Check (available through RACGP’s online learning) throughout your training so you’re always gradually learning what you need to for general practice. The Facebook group, GPs Down Under is also a great place to learn and feel connected to other GPs.”
Don’t forget the GPTQ registrars’ Facebook group. It is a closed group that offers a safe place to sound out clinical and interpersonal conundrums.
8. Don’t be afraid to ask questions … ever
Asking questions – and lots of them! – will help you settle into your practice placement. You may feel a bit apprehensive to ask but Jamie says ‘the sooner that feeling wears off, the better.’
“If there’s anything that you’re unsure of at all, you need to be talking with your bosses and asking them, otherwise you’re just going to be worrying about it in bed that night,” he says. “After my first month, I was asking a lot more questions than when I first started and I was a lot less stressed as a result. The sooner you start talking to your supervisors every time you’re unsure about something, the sooner you’ll feel a lot more confident in the job.”
9. Realise you may feel out of your depth but that’s okay
It can take a bit of time to adjust to the general practice environment as it requires a very different body of knowledge to hospital medicine.
Jamie says: “It’s only natural that you can get a shock at how much you don’t know when you’re coming to general practice because you’ve come from being a really confident hospital resident to suddenly feeling like it’s your first day again. It’s a totally different model of care.”
If you identify areas where you have knowledge gaps, John says you should take prompt and proactive steps to address them.
“Check if any of your practice colleagues have special skills they can teach you such as steroid joint injections, IUD insertions, relaxation techniques or psychological interventions,” he says. “Don’t be afraid to ask for help to learn and practice basic skills such as intramuscular injections, ECGs, speculum examinations, ear syringing or suturing.”
10. Debrief with your supervisors or colleagues
Dan believes taking the time to talk over difficult cases with your supervisor is vital to avoid burnout.
“Debrief with your supervisor or colleagues about ‘heartsink’ patients, the ones that don’t follow your advice but continue to come back with the same symptoms. It can be disheartening as you are doing everything you can to help them but talking about it can help combat any frustration you may feel,” he says.
11. Billing is part and parcel of being a GP
One of our Medical Educators, Dr Sidya Ragahavan, says she focuses on teaching her registrars about billing as many of them ‘hate the fact that they have to charge people’.
“I think that it’s important that they [registrars] understand the system side of general practice as well. Often it’s a hidden thing or something they don’t want to learn about,” she says.
Jamie agrees and offers some more advice about the issue.
“It’s easy to be really timid about billing at first. You may feel embarrassed you’ve spent 25 minutes with a patient when you feel like it should have only taken 10 minutes. But if you’ve done the clinical work with them, you need to bill that time. You shouldn’t sell yourself short or tie yourself up in knots about it.”
12. Think of ways to enhance your patients’ experience
John says the best way to build a rapport with your patients is to take an interest in them.
“Don’t be afraid to indulge in some non-medical conversations. Your patients want you to take an interest in them and they will probably want to learn about you too.”
Another good tip John offers is to keep a range of toys for kids in your room to occupy them and allow parents to concentrate on the consultation. He says it has the added benefit of discouraging little ones from ‘playing with your medical equipment’!
John’s last important suggestion is to keep visual resources in your room to aid in your clinical discussions.
“Provide a high quality, printed patient information sheet every time you give a diagnosis. Patients may not recall much of what you say so you want them to read reliable information when they get home. Write down any extra pieces of information or steps they need to take.”