Dr Michael Brookes
Armed forces and veterans health, North Yorkshire
When I left medical school, I had absolutely no intention of becoming a GP. I joined the Army as a Medical Officer with my sights firmly set on becoming a trauma surgeon. After house jobs as was the custom at the time, I was to serve for two years as a regimental medical officer (RMO), before re-joining my training programme. The RMO looked after several hundred soldiers and was the go-to person for anything vaguely medical from the ‘usual’ GP problems to environmental health to chemical warfare protection. Shortly after taking up my RMO job, my Commanding Officer invited me to take part in the invasion of Iraq. Needless to say my medical skill acquisition went into overdrive. Initially the thoughts of responsibility for training a team of medics, preparing a unit for deployment as well as taking on responsibility for all their medical care was overwhelming. However, as we busied ourselves with preparations, I found myself enjoying the responsibility and learning new skills.
During the deployment, we dealt with traumatic injuries, run-of-the-mill medical issues as well as more esoteric problems, such as a new diagnosis of a brain tumour in one of the soldiers. Having limited equipment, which on most cases had not changed since our forebears 50 years ago, meant that increasingly I had to rely on sound history taking and good bedside examination, along with a general knowledge of my patient, rather than imaging and lab tests. Following up these cases after they left my care was especially satisfying when a secondary care colleague was able to confirm that my ‘hunch’ was correct.
On my return to the UK and hospital medicine, I found that I missed the challenge and relational care nature of my brief insight into general practice, so decided to change course. After qualifying as a GP 11 years ago and leaving the services, I took over a small, single-handed rural general practice, which in many ways mirrored my first experience of responsibility and relational, rather than transactional(1) care . I am still amazed to discover the hidden agendas behind seemingly ‘trivial’ presentations teased out over time, for example the mother who always brought her children with the most trivial of viral upper respiratory infections (she lost a baby a decade prior due to pneumonia in the first few months of life) or the woman who woke in the night with palpitations (a childhood friend died of an arrhythmia). Understanding patients beyond the biochemical level and engaging with their hopes, fears and tribulations as we all make our journey through life is an incredibly rewarding privilege. I am still humbled to receive calls from patients in hospital who want to speak to ‘their’ doctor to discuss what to do when presented with a choice of treatment or an important decision to make.
For more information on this, search for ‘Professor Kieran Sweeney’ who features in an insightful YouTube video shortly before his death from mesothelioma.