AUTHORS: Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov
In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.
Today, the subject is Professor Dame Clare Gerada, a GP and former president of the Royal College of General Practitioners. Professor Gerada has had a life-long interest in managing drug-users, founded Practitioner Health, a service for healthcare staff with mental health or addiction problems, and is chair of the charity Doctors in Distress. In 2020, she was made a dame for services to general practice.
This article is an abridged version of the interview. The full podcast is available here:
“I feel sorry for today's generation of doctors, it's that we forced you into choosing your specialty way too early.”
How did you get to where you are today?
I wanted to be a doctor for as long as I could ever remember - from about the age of six - mainly because my father was a GP and I admired him so. I trained at University College in London, and from there I did a series of house jobs. I wanted to do psychiatry and got my MRCPsych.
Why did you switch to general practice?
I really missed seeing patients who got better so I secretly applied for a GP post. I did a supernumerary senior registrar post in addiction and became a GP and a psychiatrist focusing on a very small area — addiction. I was a very big fish in a tiny sea. I helped transform the way substance misuse patients were managed in England, and in fact, in the United Kingdom.
So you are a GP who specialises in mental health?
Yes. I joined a very progressive partnership in South London, and started caring for drug users, the mentally unwell, patients who were homeless, refugees, asylum seekers — anybody that was hard to deal with. I became this mental health GP. I've always had this parallel path of being a GP grounded in clinical practice, a normal GP, but also with this special interest and expertise in mental health.
What did you learn about switching from one specialty to another?
If I was to say one thing that I feel sorry for with today’s generation of doctors it’s that we forced you into choosing your specialty way too early. There is absolutely nothing wrong with meandering through what we used to call ‘SHO jobs’ - gaining experience, tasting different areas of work.
So, what’s your career advice for newly qualified doctors?
It doesn't matter what specialty you're doing now, it all adds value to whatever you're going to be in the future. Whether you're going to be a histopathologist, a neurosurgeon, or a general practitioner, don’t rush into subspecialty and specialty training just because you feel that’s what you should do.
What’s your tip for choosing a specialty?
Follow your interest, and not what you think you should be going into because somebody said: 'That's a good career’. Follow your interest, and work hard.
Do you consider general practice an attractive career?
If I was deciding on a specialty today, I would go into general practice, because in a way it's a bit like it was in the 1970s — a mess. But it regenerated and it thrived for 50 years, and so it will again. If there's one area of work that allows you to adapt and be flexible, change every five years, not become bored, and be a master of your own destiny, it's general practice.
How would you describe a GP’s essential skills?
The skills of the GP are immense — our generalist skills, leadership skills, our skills at education and training, at chronic disease management, at leading multidisciplinary teams, at commissioning, and everything else. We are so flexible in what we do.
What has shaped you as a physician?
So many things have influenced me as a physician, but I think, fundamentally, it's listening. You listen with your entire body. You listen, you feel, you see, you touch, if you need to. Your entire medical self is focused on the patient, who is telling you what's wrong with them — and they will tell you within 60 seconds. Evidence shows that. Most American doctors interrupt a patient after ten seconds, and most UK doctors interrupt after about 45 seconds.
Are doctors a strange group to care for?
Yes doctors make impossible patients. They are fearful, not just about the fear of death, but about losing their job if they admit vulnerability. But I think the latest generation of doctors are better. They’re much more professional. They’re much more in touch with themselves. They’re a much nicer generation than my generation, so maybe things will change.
How do you survive and thrive as a doctor?
Your best way is to get the three bases right. Get a friendship network, stable accommodation, and a job that you enjoy. If you get those three right, then you can be safe enough within that to experiment with your career.
The new generation of doctors is much more fluid — you will move around more - but don't forget the fundamentals of what being a doctor is about: listening, being there, and knowing what to do - in other words, understanding the science of what you do.
Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.