|FAMILY MEDICINE EXCHANGE
|Year : 2017 | Volume
| Issue : 4 | Page : 712-715
Diversity in family medicine: The art of thinking independently together – Reflections on the RCGP exchange 2016
Ana Beatriz Figueiredo1, Gabriella Pesolillo2, Sidra Kanwal3, Amelia Tezen4
1 Conchas Family Health Unit, Lisbon, Portugal
2 Local Healthcare Agency 202, Chieti, Italy
3 Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
4 “Sant Josep” Primary Care Center, L'Hospitalet, Spain
|Date of Web Publication||15-Feb-2018|
Dr. Ana Beatriz Figueiredo
Conchas Family Health Unit, Alamedas das Linhas de Torres, 5th and 6th Floor, No. 243, 1750 Lisbon
Source of Support: None, Conflict of Interest: None
This narrative summarizes the reflections of a UK conference exchange experience of four young general practitioners (GPs) from Peru, Portugal, Italy, and Pakistan. This article was written after participating in a RCGP exchange program in October 2016. This consisted of 2 days of observation in a GP practice in Liverpool followed by attendance at the RCGP preconference and annual conference. The exchange was organized by the RCGP Junior International Committee, which links to the Vasco da Gama Movement, a European network of new and future GPs.
Keywords: Exchange, general practitioners, RCGP, young doctors
|How to cite this article:|
Figueiredo AB, Pesolillo G, Kanwal S, Tezen A. Diversity in family medicine: The art of thinking independently together – Reflections on the RCGP exchange 2016. J Family Med Prim Care 2017;6:712-5
|How to cite this URL:|
Figueiredo AB, Pesolillo G, Kanwal S, Tezen A. Diversity in family medicine: The art of thinking independently together – Reflections on the RCGP exchange 2016. J Family Med Prim Care [serial online] 2017 [cited 2020 Apr 3];6:712-5. Available from: http://www.jfmpc.com/text.asp?2017/6/4/712/225552
"Everything is worthwhile if the soul is not small." - Fernando Pessoa
| Beatriz, Portugal|| |
It was a warm sunny Sunday when I left home, in Lisbon, to fly to Liverpool. A journey always brings about an exciting but frightening sensation. I wonder why that is, perhaps, because of being so caught up with everyday personal worries that stepping out of your daily life feels like diving straight into the unknown.
I had absolutely no idea that more than half a world way, my colleague Sidra, a family physician from Pakistan, felt the same way.
“A stranger is just a friend you haven't met yet.”
When she was accepted for the exchange, she had no idea what to expect. She would meet colleagues from different countries and backgrounds with a unique opportunity to shadow a UK general practitioner (GP) and explore the British health-care system as well as the chance to discover the culture and traditions of a different country. In her home country, women do not usually experience the freedom to travel independently, but Sidra decided it was time for a change. She had a keen desire to explore and learn about different systems, whereas in Pakistan, the health-care system is still developing and there is no formal GP training program. Unintentionally, her expectations and predetermined views toward western society were influenced by her background and the media; she was anticipating a “cold shoulder in a cold city.” In addition, her family members were concerned and actually advised her against participating, further exacerbating her anxiety. Sidra had no idea what to expect.
“One's own culture provides the “lens” through which we view the world; the “logic”. by which we order it; the “grammar”. by which it makes sense.”
On arrival in Liverpool, I first met the other exchange participants at a coffee shop near the apartment in which we were staying together. Sitting alongside Sidra, I met our lovely host Ula with a charming Scottish accent; Gabriella, devoted family doctor and proud mother of two young children; and Amelia, our Peruvian colleague currently living in Barcelona working as a GP trainee. Would we get along? Did they have any previous contact with the British primary care system? How was the primary health-care system organized in their home countries? I was pleased to discover that that we connected instantly.
When you leave home to meet the UK and you end up meeting Syria, Pakistan, Italy and Spain.
To make the most of the exchange, I decided to observe the GP and as well as the practice nurse, as most nurses in the UK have an enhanced clinical role with independent practice. I listened intently to the questions about patient's symptoms and therapeutic compliance in hypertension and diabetes. I watched while the nurse measured the patients' blood pressure and screened for diabetic foot. I noticed that these procedures felt very similar to the ones which GPs encounter in their daily practice, which made me contemplate what the GP's role is in UK general practice.
Fortunately, I had the opportunity to observe a UK-based GP, although originally from Syria the following day. Our first appointment was actually a family of Syrian refugees. Of note, I had no previous clinical exposure to caring for refugees in Portugal, as we do not have a large intake of refugees in Portugal. The family consisted of a couple with four well-behaved small children. They conversed in Syrian with the GP, but interestingly, I could understand what they meant by their body language. They had many concerns regarding their children's health and education and whilst observing, I felt they were developing a successful doctor–patient relationship. Next, it was the Mr. “never-goes-to-the-doctor” who had saved up a list of numerous complaints and clearly, not enough consultation time. The GP felt obliged to request another appointment to tackle the remaining issues. This challenge of multiple issues certainly resonated with me. However, in Portuguese primary care, there is a different approach. Patients understand if the consultation starts late, because they know that their GP will take the time needed to address all of their concerns, rather than be asked to reattend. Perhaps, the doctor–patient relationship can suffer if the consultation ends abruptly and fails to meet your patient's expectations. The remaining appointments consisted of a mix of bread and butter general practice from headaches, otitis media, gastroenteritis, urinary tract infection to concerns regarding new medication. It was very different from my daily practice, as GPs in Portugal work up to 40 h/week, are responsible for about 1900 patients, and would struggle to work without an appropriate number of nurses. In my practice, the GP has daily routine appointments and some vacant spots during the day to assist patients with acute problems. If the patient GP is unavailable, another GP covers. My first impression was that it would be a dream come true to have the nurses ease our workload by seeing chronic patients and routine appointments, but then I considered my patients with well-controlled diabetes or hypertension and how they like to come and talk to us family doctors directly: I would not like to give up on that continuity as it functions as a relationship reinforcement to build better care.
“Why I feel so lucky to work in (messy and disorganised) Italy”.
For Gabriella, the most surprising aspect about the practice was the structured and precise system organization. There were various health professionals working in the same clinic: GPs, nurses, the administrative staff, and the manager, each one with their specific role and responsibility. Moreover, it was impressive to see the array of available services and heterogeneous clinics in the same place [Figure 1]: phlebotomy clinic, cardiac clinic, orthotics, pharmacy, weight management services, COPD services, and leg ulcer clinic, just to name a few. She felt inspired! In Italy, the clinics are much more disorganized and patients have to queue to schedule appointments and vaccines, have blood tests, or go to the pharmacy. Furthermore, it is the norm for patients to request a consultation and wait, sometimes for hours, to see their GP. In Italy, like in Pakistan, family medicine is not yet a recognized medical specialty and depending on the region, the 3-year residency is organized differently. Gabriella thought to herself: “Why can't we be more organised? More like the British?” She remembers a specific appointment with the practice nurse and a 2-month-old baby scheduled for vaccines. Her parents were upset because they had arrived 15 min later than scheduled and had been denied access to the GP. Subsequently, the nurse apologized on behalf of the clinic, endeavored to resolve the problem, spoke to the GP and practice manager about the parents' wish to file a complaint, and seemed to forget about the baby needing vaccination. Gabriella was astonished to hear this, because, no Italian patient would simply accept a denial to see their GP due to late arrival primarily because 15 min late hardly fits the Mediterranean definition of lateness! The response would have been very different in Italy: the doctor – not the GP but a primary care pediatrician (who is responsible for children health consultations up to 14 years of age) – would have seen the family, despite their tardiness, blaming the system for the misunderstanding.
In Italy, both doctors and patients are used to uncertainty and chaos, compared to the UK, but the waiting is often balanced by the curious bond of trust between doctor and patient, which also accounts for the low medical defense rates.
Life begins out of your comfort zone, out of country for the first time and embracing your existence with breathtaking life adventures.
Before leaving for the RCGP annual conference in Harrogate, the five of us explored Liverpool [Figure 2]. For Sidra, the most exciting moment was when she visited the Liverpool Cathedral as this was her first time inside a Catholic church. She described it as a “place to pray with a relaxing ambience, breathtaking views and noteworthy wisdom on the walls, like how to speak with kindness to everyone.” I provided an overview about Catholicism and the Bible to Sidra. By the end of the day, I was just starting to learn about how the same things are done differently in our different countries. Take tea for example [Figure 3]. I was happy to sit down for afternoon tea and relax after a long day. The place was great, a strong smell of spices filled the warm air inside the tea room. There were so many details about the day I wanted to discuss, but somehow we ended up discussing eclectic subjects, such as religion or food. Amelia commented that young doctors should be encouraged to follow their own beliefs and special interests, to offer the best care to patients, regardless of low income, long shifts, excessive workload, or lack of recognition. Moreover, she felt that UK GPs have a much easier life compared to GPs in Spain, considering the difficulties in Spain, such as growing unemployment, the lack of incentivized payments, and the absence of nurse practitioners. I realized, despite our diverse GP training programs, the difficulties and barriers encountered in practice were very similar. Our responsibilities varied though. For instance, in Pakistan, Sidra and other GPs perform circumcision in small children in primary care as well as family planning. It was fascinating to compare and contrast our roles. Even though we had just met a few days earlier, it felt like we had known each other for years.
|Figure 2: Ana Beatriz Figueiredo, Gabriella Pesolillo, Sidra Kanwal, Amelia Tezen, Ula Chetty and the Beatles|
Click here to view
In the Harrogate preconference, I met the Japanese delegates and shared a whole day of workshops with keynote speakers, such as Clare Gerada, which allowed me to reflect on the importance of our own feelings, emotions, and resilience when practicing medicine. I was quite surprised to hear of the impact of heavy workload on the well-being of young GPs in the UK. Burnout is a real threat to UK General Practice as a profession.
In the RCGP annual conference, I had the opportunity to present my poster, together with the other exchange delegates, to our colleagues from the Junior International Committee (JIC) [Figure 4]. We enjoyed delivering presentations on various topics from an interesting clinical case, for example, to raise awareness of depression in rural areas and to make attempts to improve compliance to guidelines in clinical practice. Amelia emphasized the hardwork of the JIC supporting trainees and young doctors in their first 5 years of practice. All of us learned something new from the workshops and the lectures taking place at the conference. Sidra felt enlightened by the experience of a midwife who had to undergo a C-section and obtained new insights into what the procedure felt like from the patient's perspective. “We, as caregivers, have a hard time accepting our vulnerability,” she thought. Gabriella, on the other hand, was surprised by how kind and modest the head of the National Institute for Clinical Excellence was, how easy it was to listen to multimorbidity, and how much there was to learn from his experience.
|Figure 4: Claire Marie Thomas, Amelia Tezen, Gabriella Pesolillo, and Beatriz Figueiredo, Sidra Kanwal and Ula Chetty at the RCGP AC 2016|
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Simply put, exchange abroad opens a lot of doors you would otherwise not even think about
By the end of the exchange, I could not even remember how life was before this experience and I wished the fabulous memories and multicultural exchange of that week would last forever [Figure 5]. The best part of this exchange was meeting new friends, who were willing to participate fully in the experience, sharing personal thoughts on medicine, culture, and life, whilst sipping tea. I was fascinated to learn about how Japan was trying to build primary care for their elderly population; how emotionally challenging it is to work close to a Syrian doctor; and how Spain, Portugal, and Italy struggle in their own different ways in primary health care.
|Figure 5: Sidra Kanwal, Gabriella Pesolillo, Amelia Tezen and Ana Beatriz Figueiredo at the RCGP Gala Dinner|
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This RCGP conference exchange provided an invigorating opportunity to experience something completely different from everyday routine practice. If you find yourself facing a new challenge and worry that you will encounter cultural barriers, we would recommend opening your mind, reflecting on how your culture shapes inner feelings, and trying to understand the other people's perspectives. I have absolutely no doubt that the experience we shared will make me a better person and also a more innovative and open-minded doctor.
“You think the only people who are people, are the people who look and think like you, but if you walk the footsteps of a stranger, You'll learn things you never knew, you never knew.”
The authors thank Dr. Ula Chetty for the inspiring guidance and support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]