Dr Sam Hall left hospital medicine to retrain as a GP just before Covid. He describes what it was like to learn the ropes as a new GP during the pandemic at the same time as finding his way as a trans man.
Starting GP training at 45 years old was a big commitment, but one I will never regret. I emerged intact just 10 months before Covid arrived. At that point, none of us knew what was around the corner, but the impact of my decision struck me almost as soon as Covid hit.
One day early in the pandemic, I was watching ITU staff on the TV, faces wrecked from mask-rub, minds blown by the horror unfolding before them. I felt a pang of guilt; I should have been there. But in a rare moment of insight, my mother exclaimed: ‘Bloom where you are planted, dear!’
Of course, in primary care, we faced a more insidious front line of the advancing viral wave. Remember the unsuspecting nursing homes absorbing elderly and infirm patients discharged from hospitals? They consigned those people to death by making way for the ‘worthy’ sick and I spent the early stages of the pandemic mopping up after monumental failures in contingency planning and emergency supply chains. I signed more death certificates in those few months than I had done since my lowly house officer years in the early 1990s.
You might think the move from secondary to primary care would be relatively straightforward. It’s all medicine, after all. But I discovered that I may as well have moved to a foreign country and learned a different language.
In secondary care, I was accustomed to centring every clinical interaction around the patient in front of me and giving them all the time needed. In the anaesthetic room, safety comes first, and there is no care for the pressure of time.
A different culture
My GP training took me away from all that. In this new foreign country I’d entered, the language focused prominently on time. Entering general practice catapulted me into a realm where that singular focus – we call it n=1 at my workplace – has to be honed skillfully into a 12.5-minute interaction seated in the context of the patient’s everyday life.
Time is of paramount importance, not the safety of the patient. It isn’t comparable to the induction of anaesthesia, where a life can be lost through cutting corners. But still, in general practice, unless we are very careful, our patients feel this lack of care for their safety. That is especially true when it comes to patients’ psychological and emotional safety in these times of suffering.
All of this was made harder because my consultation skills were poor at first. I felt clunky and clumsy. And I cringed inwardly at the jokes people made about me not knowing how to talk to patients since my expertise had previously been putting people to sleep.
I also struggled with a sense of inauthenticity as a ‘passing’ trans man. On the one hand, I felt there was no need to complicate my life by having to explain myself. People took me as they saw me – a short, slightly round, middle-aged bloke with a cheesy grin. My colleagues and patients seemed to like me and were interested in my career change. I couldn’t bring myself to ‘come out’ all over again.
Yet, I knew that a lot of emotional energy was going into keeping my secret secret. Then one day a trans patient walked in. I forget the content of the consultation, but I clearly recall the moment of utter relief I felt when I disclosed to them. A giant weight seemed to lift for both of us. This one interaction taught me that it was better for my mental health if I brought my whole self to work.
Dr Sam Hall is a GP partner in Brighton
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