My Journey to General Practice

After completing my medical degree at the University of the Witwatersrand in Johannesburg, South Africa in 1998. I did my internship or Foundation Year 1 equivalent at the Baragwanath Hospital as I was inspired by the doctors I had met who trained there. I knew it was going to be a challenging year, but I was up for it as it would provide me with a solid foundation for medical practice. It was during this year that I first heard about doctors going abroad to the UK to work. After a year of compulsory community service at Mapulaneng Hospital in the Northern Province of South Africa, I moved to the UK to work as a Resident Medical Officer in Private Hospitals. This was arranged via an agency that was recommended by colleagues who had embarked on this journey before me. 

I was slowly starting to eliminate specialities at this stage. I did not want to do any of the surgical specialities or anaesthetics. Internal Medicine was a possibility but Psychiatry and General Practice absolutely did not feature as options. This is an example of the dictation that needs editing:

Working as a resident medical officer was mind numbing work as it seemed that I was not using all the medical skills I had worked so hard to acquire. I was basically an on-call doctor prescribing routine medication as requested by Consultants who had primary responsibility for their patience. It was a good experience of private healthcare in the UK though.

After three months I had an opportunity to leave and guided by doctors I knew from medical school who were working in the UK as well, I registered with medical agencies and started a long term Locum position in internal medicine at the Royal Cornwall Hospital. I did not realised how lucky I was as this is a beautiful part of the country where I effectively experienced an Internship on the NHS. I applied for a substantive post at The City Hospital in Birmingham and did three months of cardiology. As with many substantive posts this was not paying enough and as I had a student loan still to pay off, I decided to go back to locuming.

The only other long-term position that was available was in child and adolescent psychiatry. I decided to give it a go even though it was not what I did not have this speciality anywhere on my radar. I had no psychiatry experience in the UK but the hospital took a chance on me as the Doctor currently in the role did not have any experience either but had done the job well due to her training in psychiatry in South Africa. She was leaving to go back home. It was a private hospital in East Sussex and I worked there for one year. It was an amazing experience and set the foundations firmly in my mind on the importance of mental health and the role of family and a stable home life for good health and well-being.

I moved on after one year as I felt it was too early on in my career to continue as in my mind I was still in the learning and gaining experience phase of my career and not in the settled phase. In fact, I should have left after 6 months. I did a few short-term psychiatry jobs in old age psychiatry and adult psychiatry before taking on another long-term locum role in Forensics Psychiatry which I got dut to my experience in Child and Adolescent Psychiatry. This was a difficult job and once again reinforced the importance of a stable home life and the impact that child abuse and discordant family relationships can have in adult life. It was a medium secure unit and a lot of the times it felt more like we were keeping people out who were no good for these patients rather than them being locked away. We were protecting them from the harsh environment that they came from.

It was a blessing in disguise when my work permit expired and I could not renew the same one so I had to leave this role as it was as forensics psychiatry is mentally and emotionally challenging. I fully understand why Consultants in this field are given the option of early retirement as standard. I went to South Africa for a few weeks while I applied for other jobs and the next role that came up was in Outpatient child and adolescent psychiatry in Durham.

This was my first experience of doing the same job while working at two different locations, under the supervision of a consultant. I gained first-hand experience of working for two teams who operated differently and soon realised which I preferred. The latter part of the week was like a respite and a breath of fresh air compared to the first. I gained an appreciation for not working in the same place throughout the week. This was a very interesting role and gave me an opportunity to look at children’s behaviour, Autism and ADHD and the importance of positive reinforcement and how managing children’s behaviour can impact their mental health and self esteem.

After six months in this role I decided to go back to South Africa for three months to reassess what it is that I wanted to do with my life and my career and I had to choose a country before I made commitments in any one area. I explored working in South Africa and was already considering health from a holistic point of view but it would not be with Psychiatry as a foundation, but I never considered becoming a GP at that stage. I got a call from an agency After the Festive season in 2004 about another role in Adolescent psychiatry in Oxford. I was keen to change specialities back to internal medicine but it would be easier to find these roles once I was back in the UK due to the gap so I went to Oxford for 6 weeks. This turned into 2.5 years as after 3 months in Psychiatry and a few short internal medicine roles, I applied for a job in Accident and Emergency at the Horton Hospital in Banbury. I liked the variety that this role provided so I applied for a training post which took me to the John Radcliffe Hospital in Oxford following which I applied for an interim training role at Kings college hospital in London. It was during this role that I did the part one exams and after failing twice by just 2% each time, I had to have a serious talk with myself as I did not appear to be committed to preparation and passing the exams.

I had to ask myself if a career in A+E iwas really what I wanted and the answer was no. My partner suggested General Practice but as I have always been rather ambitious and being a GP in South Africa was not highly regarded so I never considered it an option. I did not have any experience of working in general practice in the UK but what sealed my choice was the sociable hours and not wanting to be walking around an A+E department at 2 o’clock in the morning when I was 50 years old so I applied for the training, did really well in the exams for the application process and got my first choice for vocational training – Hillingdon Hospital. Hillingdon was easy to commute to from Oxford and London and I would still be living in Oxford for another 6 months. After three years of training and I willingly did an extra six months as my registrar training had been a challenge and I did not want to have that as my only experience of general practice. I really wanted to be a GP and I obtained my certification in February 2011.