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I munched on a fistful of Hula Hoops, and the Crunchie bar convulsed its last in my other hand. The police smiled as they strolled through the crowds at Heathrow—it was good to be home. We had taken a six month career break and jetted around the world. Before we knew about climate change, this was guiltless travel, with no token planting of a small tree in the garden as “carbon offsetting.” We were lost in the world, long before the relentless intrusion of the internet felled the magnificent remoteness of the Asian jungles.
Huddled in rain battered bus shelters across South East Asia, we joined the ragbag of travelling Brits: lorry drivers, miners, hairdressers, and the ubiquitous Oxbridge gap year kids. We had been released from our respective social shackles, and we found camaraderie and humour. I had space to reflect. At the time I was a career obstetrician, but I knew this was mere denial: I wasn't emotionally robust enough. So I had come home to fulfil my destiny and start training as a GP.
Professor John Tooke has been leading a comprehensive review of Modernising Medical Careers, sparked by the debacle over the medical training application service (MTAS) (BMJ 2007;335:737 doi: 10.1136/bmj.39363.596273.59). Its suggestions are to add more flexibility and local accountability and to reinstate traditional assessments of “excellence,” while rationalising the duration of training—all for the good. Training of GPs receives only a couple of footnotes, as it was largely untouched by the MTAS problems—mainly, I suspect, because it remains unpopular with upwardly mobile young medics. I could say that it doesn't bother me that general practice is seen as a last resort for the medical elite, but this would not be true. “You're too good to be a GP” was one of the most insensitive remarks anyone ever made about my career choice.
The review recommends extending GP training to five years—this is long overdue. But any extra training must take place in our specialist setting: general practice. Otherwise the suspicion is that our registrars will be used as ever to plug holes in hospital rotas. The review also repeats an aspiration that all specialist registrars should join us briefly in GP land. This may cause much eye rolling from certain hospital colleagues, but the community can teach much about patients' health seeking behaviour and the dangers of medicalisation.
This review still carries a faint whiff of hospital elitism, but we doctors no longer stride the medical plantation in pith helmets. We are all huddled together in our corroded professional shelter, battered by the constant deluge of political interference and unrealistic expectations. From the jungle come the roars of no win, no fee lawyers. This is a time for camaraderie and breaking traditional medical shackles.