Career Stories - Dr Joshua Tognarelli
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Dr Joshua Tognarelli

GP ST2 London

General practice is an incredibly diverse, exciting and stimulating specialty to work in. Before choosing GP, I considered careers in several other specialties including surgery and emergency medicine. I think it is important for all doctors to take the time to consider what they want from their career as a whole and to be well-informed on what a specialty truly is like to work in.

After gaining clinical experience in my areas of interest and after a particularly enjoyable rotation through general practice in my foundation years, I knew GP was the choice for me. Why?

Relationships – Working as a general practitioner, you form lasting relationships with patients who appreciate and come to rely on your advice. You are not just a doctor, you are “my doctor”. Every action you take and agree upon together contributes to the patient’s relationship with their health over time. This is a huge responsibility but can be extremely rewarding. Comparatively, hospital medicine can feel more transactional, treating the patient’s disease in an isolated episode of care.

Pride – During my rotation in A&E, I was called to see a breathless patient. Anxious and unwell, they visibly relaxed as they realised who I was. By chance, I knew them very well, having cared for the patient and her family just weeks before in general practice. I was no longer just another hospital doctor to the patient. I was her GP. A familiar face already aware of her complex medical background, providing comfort and reassurance beyond just the medical treatment prescribed. This understanding of our patients and the trust they place in us makes me proud to be training to be a GP.

Training – GP registrars are unique amongst specialty trainees, we meet every week with our programme directors and colleagues across all stages of training. This time is invaluable, allowing a dedicated space for shared clinical learning and discussing issues of the day whether it be upcoming exams or PPE availability. In addition, whilst working in primary care we have one to one supervision with our trainers, allowing for rapid and focussed clinical development. There is also a welcome emphasis on trainee wellbeing from the GP school, with frequent time for reflection and Balint groups. Altogether, this provides a very supportive environment to help you progress through to CCT.

Opportunity – General practice is not “one size fits all”. Opportunity to diversify your work life is almost endless. Within primary care alone, options range from traditional single-handed practice to larger primary care organisations caring for huge populations with multidisciplinary teams on site. You can choose where and how you want to work - rural or urban, partner, salaried or sessional. That’s before considering urgent care, out of hours, specialist clinical interests and intermediate/secondary care services, expedition and events medicine or working in the prison and police service. GPs are also vital to work that is not directly patient facing including roles within medical education, academia, public health, healthcare management and leadership, entrepreneurship and much more. General practice gives you the flexibility to carve your own path, enabling you to form the career you want.

My journey is only beginning, though I have been lucky to be able take on roles in undergraduate teaching at my local university, represent my fellow GP registrars to Health Education England and engage with senior GP leaders and procurement services to help shape the future of GP training in London. Another colleague may engage with a completely different set of interests, such is the variety of opportunity. Crucially, we are all bound together by the core of what we do, caring for our patients on the NHS frontline.

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