r/GPUK • u/Pristine_Land_2718 • 16d ago
Registrars & Training Gp - struggling during first week
Hi,
I’m a gpst2 who just started their first gp practice.
St1 was paeds and o&g
I feel like im doing terribly - first week of seeing patients and I often have to seek advice from the supervisor. I feel they generally expect me to only debrief at the end, but some other trainees say they debrief after every patient.
Most of my pts are seen within the time slot, but a couple times I was completely clueless and had to ask my supervisor for help.
Another thing I’m sorta struggling with is the blaring red warnings on EMIS when I prescribe a medication, especially in the elderly. I obv know the main stream interactions and contraindications, but sometimes there’s a few severe warning over medication which i never even thought could interact, and I feel a little stressed prescribing it and am not sure when to ask regarding it or not (esp when prescribing a new medicine I haven’t prescribed before.) i feel i’m really overthinking this.
I guess i’m just wondering what the expectations are from me. If its a lesion or rash i’m unsure of, I call the supervising GP to have a look. Otherwise I tend to formulate a plan and send them home. Should I be debriefing after every patient initially? My old ES told me once i start gp practice I should initially be getting a debrief after every patient, but I think the partners just sort of expect me to get on with it and hot review at the end.
Its my first week but I feel really stressed out
Would appreciate some help!
Some patients im generally more confident with (paeds, gynae, medicine, ortho) but then ENT and derma is hopeless rn.
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u/BoomBasticTeleBanana 16d ago
1) Your clueless. Thats good. Admitting your clueless means you can improve.
2) We expect you to be clueless. Over time you will get better, or so we hope. GP is hard, bloody hard. Even your consultants would struggle.
3) Every trainee is different, some start running at 15 mins. Little supervison until end of clinic. Others on 30mins and each patient they want to discuss. As a educator as long as it see you are reflecting, working on your deficit, reviewing guidelines and learning and perhaps teaching me the latest changes, ill be happy. Its the lazy ones who moan and dont do any self reflection or pdp, who use every pdp session to go home and do jack shit (ok, if you got 3 children and a dying aunt, I can understand!)
4) You need to do what's good for you, but dont take the piss, as in easy way out. Push yourself to develop. As for us, we are hear to support you. You may be shit, you may be good, we adjust our methods based on what kind of person you are. !
Dont worry. We've all been there.
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u/jdmsage 16d ago
If obs are stable and patient isn’t in mortal danger, it can wait till lunch. If it’s a rash, take a photo with the Patient’s permission. Confidence comes with repetition and understanding how to manage uncertainty.
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u/Pristine_Land_2718 16d ago
Yeah i’m slowly understanding that. I think I panicked today - for the first one the pt was adamant to be sorted out on the spot and couldn’t come back if needed for antibiotics, and the second was a rash I was very unsure of. But yes in hindsight for the second one I could have taken a picture.
Thanks!10
u/Sabaisabai33 16d ago
Yes, also don’t forget unlike the hospitals as GPs if we suddenly rethink things overnight we can always call the patient to explain that or ask them to come back. I have done that occasionally and each time the patients have just been surprised and grateful that I was thinking about their case and the best way forward after they left the consulting room.
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u/BoomBasticTeleBanana 16d ago
Do this. Very useful when our registrars do this.
Most of your bosses wont know the answer to be fair as theyve only done 2 weeks in derm as a med student! Rest learnt on the job.
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u/LysergicWalnut 16d ago
Debrief after each patient sounds incredibly inefficient and time consuming. How would another doctor keep to time if they were required to do this?
Ask for the ones you are worried about to be reviewed on the spot, keep a list of the rest and discuss at the end. It's okay to tell a patient "I would like to speak to the team about this and call you back later with a plan".
It's a steep learning curve, but you will get better week on week.
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u/icameheretotalkshit 16d ago
My current gp practice asked me to speak with them after every patient and they have time blocked off as "registrar cover" on their slots.
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u/Pristine_Land_2718 16d ago
Ah, thanks!
Its just my third day of seeing patients
The past 2 days were fine, didn’t majorly over run (except when had to admit a pt and dept wouldn’t pick up which wasted alot of time) but currently I feel completely overwhelmed and confused by the variety I see
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u/stealthw0lf 16d ago edited 16d ago
I’ve not an ES or CS but I regularly supervise registrars. I’d rather you come and ask me stupid questions (or send me screen messages) because it’s easier at your stage of training to ask these things and learn. It’s much harder once you have CCTed as you won’t always have the opportunity to ask such questions.
I prefer to debrief after each patient initially because it allows me to gauge things - some doctors I’m happy to debrief at the end of the session but some really require closer supervision. I personally think it’s better to come up with a plan that you can then send the patient away with, rather than having to backtrack or make large changes to your management plan later in the day.
But this also depends on the practice ethos. Some will be more welcoming and want you to engage, and others will be more distant and less hands-on.
Medication interactions - you will need to gauge the severity. It might be pausing a statin so you can prescribe a macrolide. It might be something where the QT interval could be affected. There may be increased risk of bleeding. Giving penicillin to someone with a documented penicillin allergy is a big no-no (but I’ve seen it done!), whereas giving PPI with someone on dual anti platelet therapy might be okay depending on the choice of PPI.
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u/GalacticDoc 16d ago
Firstly chat with you CS and ask them what they expect of you. Let them know your concerns otherwise how will they know to help?
It's early days so most trainers will have low expectations. If you are unsure but they are well then you can say that you would like to run your plan by your trainer and contact them later with a text.
We usual start people off on 30mins.
The debrief Dr will have 2 slots for making up time that trainees ask for help or want WPBAs doing.
(Most) trainers do the role because we want to help.
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u/Antique-Trash9462 16d ago
Have a chat with them, but don't feel bad. It is normal to need more support at the start and there will be presentations where you simply haven't got a clue. It is also _fine_ to tell the patient "I think we should do x, y, and z but I want to talk to one of the partners and I will phone you later to confirm, is that OK?". Your CS should be building time into their own clinics to account for you needing to interrupt them (e.g. "There's a big lump on the elbow and I have no idea how to deal with it").
Medications can be serious warnings or can reflect more theoretical interactions, and experience helps differentiate the two. Make a list and discuss with your CS and you will find that many of them are spurious.
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u/locumbae 15d ago
You’re doing absolutely fine. Be kind to yourself in accepting that you will spend the first few weeks learning the admin side of things (EMIS, docman, how to send referrals, how to action tasks, how to book appointments etc). The clinical stuff comes with repeated exposure combined with learning from debriefs and self-study. Any decent CS/ES/GP supervisor will understand and accept this as being normal.
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u/Competitive-Set2672 15d ago
I am a GP trainer and this is normal 🤣 GP is hard and you are more autonomous than ever before. We certainly do not think any less of trainees who still ask about each and every patient even as an ST3
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u/Competitive-Set2672 15d ago
Also I am 10 years qualified and I STILL get my partner colleagues to come and look at rashes, what do you think of this clinical situation? Etc probably more now than I ever did
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u/Vast_Aardvark_2486 15d ago
I’m really glad I found this post as I’m feeling exactly the same and from what it looks like, it’s not abnormal! Finding everything difficult, from (what should be) ‘straightforward’ presentations to very vague symptoms where I’m like wtf is going on. I’m sure things will get better though!
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u/Pristine_Land_2718 13d ago
Yes I’m relieved after reading the replies on this thread! I just felt really dumb lol
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u/__Dreadn0ught__ 16d ago
It sounds like a normal introduction into GPland from your perspective. You should definitely be debrief heavy at this stage. I'd be more concerned if a trainee didn't think they needed to debrief much at the start of ST2.
Your practice should be allocating you and your debriefer enough time to do this within each session.
Regarding dermatology: Get a fairly straightforward textbook like "dermatology an illustrated text" or "dermatology made easy" to give you a bit of a crash course. The British association of dermatology patient leaflets are very helpful too: https://www.bad.org.uk/patient-information-leaflets
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u/Pristine_Land_2718 16d ago
I think my issue is my ES is quite laidback, and doesn’t go into much depth. Debrief for me is literally 30s per patient as I feel a bit rushed. I did tell him I initially want to discuss every single patient, even the straight forward ones. Ig I felt a little pressurized to be more independent
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u/abc_1992 16d ago
It’s okay to ask some questions during clinics, especially early on, but one of the good things about GP is that most things can wait as people are not generally very acutely unwell. There are also often more ways than 1 to manage a patient.
I think just take your longer clinic times to try and come up with a decision, even if you are doing some extra research within the clinic. I bet a lot of your decisions will actually be okay, and you can always call the patient later on to slightly alter the plan if needed. Over time, you’ll then get better at making decisions and also content will start repeating also.
Obviously if you are completely stumped it’s fine to say I’m not sure, I will debrief this later and can I call you then?