GPland

Ah...good ol' family medicine.

Everyone knows their GP and nearly everyone has an anecdote or a kind word about them (well, apart from those who don't mind who they see/keep changing practice/use A+E as an alternative).

I wanted a GP job as it was one of those careers which seem feasible, but I had not had enough experience to know whether it really was for me. All I knew when I started was that either I would really hate it: the over-anxious parents, the malingerers and the demanders; or that I would love it: getting to know the ins and outs of people's lives places their health in a context. In addition, I have always felt that the two hardest jobs are that of anaethesiology (needing to know complex physiology and having the patient's life resting in your hands - not the surgeons, as is widely believed) and that of being the gatekeeper to the NHS - the much-abused GP.

While GP's don't need to know all about mitochrondial diseases, they have to know a little of everything: dermatology, psychiatry, obstetrics, gynaecology, palliative care, paediatrics, care of the elderly, opthalmology, medicine, ENT, surgery etc etc etc. On top of that, they also need to be able to decide what is serious, and what is not, when to refer to secondary care and when to keep the patient in primary care. Then there's the government, with all their targets and guidelines. Not to mention the running of the practice itself, which is like a business...urghh.

On the bright side however, one has flexibility - with hours and training, and specialities one has an interest in. Then there's the notable abscence of nights and weekends - after all, we are humans, and nights are enough to turn ones life upside down (if only for a week....but it is still a week!). If one is more interested in the material side of things, there is the financial recompense - without all the on-calls, GPs still earn as much as hospital consultants.

Now can you see my dilemma.

Upto now, I had always thought that I wanted to stay in hospital medicine: it was 'safer': patients results appeared then and there, one could arrange admission if one was not sure, there were always other specialities to consult (then and there - no waiting for weeks) and there was the 'support' of others in the same position. But do I really want to be doing long hours and being worked to the bone for upto 10 years, to finally reach a position of responsibility - what about my life outside medicine? Granted, I don't have one at the moment, but surely its not going to be like that forever? If I stayed in the hospital, what would I specialise in? For a long time I've wanted to do palliative care: but have I really come to terms with the knowledge that all the patients I will see will die? and that my role will be a sort of 'death angel' - there to facilitate a 'good' death.

In addition seeing two SHO's from my last job, whom I greatly admired for their knowledge and skill, and their seeming commitment to medicine, leave it, one changing to anaesthetics and the other to general practice, has made me have second thoughts.

So, there it is: when job applications start next month, what do I try for? Hospital medicine? GP?

Help!