Rebecca Warin, 27, a specialist training doctor at Blackpool Victoria Hospital

“At school I was good at science and medicine is a very practical science that allows you to work with people - something else that I was very keen to do - so I decided to become a GP. Working at the Blackpool Victoria is part of my training. So far, I've completed a six-month stint in the old-age psychiatry unit and I've been working in the accident and emergency (A&E) ward for the past two months.

“There are three parts to A&E here: the paediatric area where we treat children who are poorly; minors, where we treat adults with bumps and scrapes; and majors, where those with serious problems are treated. There is also an emergency room into which we rush people with potentially life-threatening conditions. I'm given a day, night or twilight shift and allocated to an area. The hours vary and are longer on weekends. The shift patterns are 9am to 5pm, or 9am to 9pm; 5pm to 1am, or 1pm to 1am; and nights are 9pm to 9am. In all, I work 56 hours a week to comply with the European working time directive.

“Different areas are busy at different times. It's unpredict-able. You would you think that a Friday night, when people are out drinking, often on stag and hen parties, is going to be horrendous, but it turns out to be busier on a Sunday afternoon. Anything can come through the door: I have seen patients with with everything from dog bites to heart attacks.

“I was very apprehensive before I started my first shift here. Working in A&E is something that many junior doctors do early on in their career because you grow up very fast - it's such a steep learning curve. You have to make a

decision on what course of action to take for a patient in a relatively short period of time. Although I see patients on a one-to-one basis I can discuss any treatment with more senior staff. It's good to have that back-up. Quite rightly, there is a lot of emphasis on doctors being good communicators. If you can really talk to a patient it makes a world of difference to their experience.

“I really enjoy working in the hospital. Part of me will be sorry to leave but it's tough staying in hospital medicine. It's hard work and a very competitive environment compared with general practice, which is more supportive. I want to have a family and while I have learnt a great deal working in hospital medicine, the decision to leave is one that I'm going to stick to.”

A second opinion

Anthony Cunliffe, 33, a GP at Sameday Doctor, a private clinic, and an NHS practice

“At the moment I work part-time at a private clinic and at an NHS general practice, but before that I worked as a medical registrar at a hospital. The change to general practice was partly a lifestyle choice: I had worked on weekends and evenings at the hospital for six years and I was no longer getting a buzz out of it. It became more important for me to be in control of my time so I decided to become a GP.

“I really enjoy the continuity of care that I'm now able to offer my patients. There's a stereotype that all you do as a GP is treat colds and coughs but that's not true; you see a range of illnesses. At the private walk-in clinic, patients visit to discuss issues that they don't want to ask their own GP about, such as sexual health problems.

“It sounds obvious but you need good people skills to be a GP. The way that you consult has a great impact on how successful the ten minutes that you're able to spend with an NHS patient can be. Sometimes you've got to read non-verbal cues and body language to get to the bottom of what's really troubling a patient.

“Nowadays, people think that GPs work for a few hours in the morning then play golf all afternoon but it's not like that. At the NHS clinic I have my first consultation at 8.45am and typically see up to 40 patients a day by the time I finish at 6.30pm. When I'm not in surgery seeing patients, I'm doing paperwork, checking test results and making home visits. I don't work evenings or weekends but work is still all-consuming. Over time you build up a more intimate relationship with your patients and their families, so emotionally it's very consuming as well.

“Being a GP is fairly paid, on a par with hospital medicine. If you ... become a partner in a general practice then it's finan-cially more rewarding. However, partnerships are few and far between these days and most new GPs are salaried.”

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