In the first month of my GP registrar year, I remember sitting in on a soporific meeting with the accountants who looked after the practice's books. It was over lunch, and, just as I had begun to drift into the first of many microsleeps of the afternoon, one of the two money men thought he'd try to make polite conversation with me: “So, you're learning the ropes of general practice are you? How are you finding it?”
I gave him a stock answer, hoping he would leave me alone. “Yeah, it's great actually... really enjoying it, thanks,” I replied unoriginally. I was too jaded to ask him anything in return, like who or what “Super-Ann” was or why they kept referring to “drawings” when there wasn't an architect in sight.
Not comfortable with the silence, he changed thread. “So, are you hoping to settle in this area then?”
I wanted to bail out of this conversation quickly. It was time to blame it all on the wife and achieve closure. “Well, probably not. My wife works in London, and she eventually wants us to move to the south coast. In any case, I'm not sure I would want to work permanently in one particular area.”
However, this last statement was seemingly too hot to handle. Here was an old school professional, used to the idea of general practitioners being long term community figures, being told by a newbie that he wasn't willing to settle down in one area. A lambasting followed. “Now hang on a minute, that's ridiculous... I mean surely you knew when you signed up for general practice that you'd be in one area for 40 odd years—that's what GPs do. It's an intrinsic part of the job isn't it?” he said, chortling with displeasure.
My blood started to simmer. I wanted to explain to this dinosaur that general practice was changing fast and that not everyone had to be a profit sharing partner or work and live in one place forever any more. I wanted to educate him about increasing feminisation within primary care, flexible training, the myriad of salaried options available to us, the fact that many young GPs locum for a while, the concept of non-principals, walk-in centres, private clinics, work-life balance, job sharing, portfolio careers, etc. All of this, and a fleeting thought that perhaps I could run update courses for out of touch medical accountants, passed through my somnolent head in about three seconds, but I simply couldn't be bothered. “Mmm... I suppose you're right.” I faked a defeat just to get him off my case. I could have just said that there were lots of other options for GPs these days, but that would have simply protracted the conversation.
Recently I experienced a bout of “esprit de l'escalier” regarding that day—that is, I recalled that particular conversation, how irritated I had felt, and thought about what I would say if I could ever replay it. It went something like this: “If you came round for dinner, and I told you that we were having apple crumble for dessert you'd probably go with the flow and have some, wouldn't you? But if I told you that you had a choice out of the crumble, home made chocolate brownies, a tiramisu dripping with brandy, and a rich crème brûlée, you might find that you didn't want the crumble after all. And that, sir, is my point.”
We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.