Pramod with his family – Dr Meena Kumari and 2 sons (Pratham and Tejas)

Many years back I read this wonderful quote that has stayed with me ever since: ‘The only impossible journey is the one you never begin.’

I am glad that I have no such regrets of not taking the first step forward or not choosing the road not taken. I, in my professional career, have had a wonderful rich journey.

After rotating through six Irish hospitals and working in four different countries, I finally came across my niche: to train as a GP. At present, in the fourth year of my training (the longest I have been in one specialty), I have no further plans to change. I can confidently say that where I am at the moment feels like I’m in the right space.

Born in India, at a very early age of 17 I found myself traveling to Romania to pursue my medical studies. As an Indian fellow, raised for seventeen years in a completely different cultural and social environment,
it was quite a challenge to blend in the new culture and setting, Romania provided me with. From language to cuisines everything was different, yet the experience was quite fulfilling. It was just the beginning.

After finishing medical school, I went to the Netherlands to complete a Ph.D. in renal transplantation. I was then offered my very first Irish job in Wexford Hospital in surgery in 2013, around the time Ireland was experiencing a serious recession.

I soon got the opportunity to work as a surgical tutor with the Royal College of Surgeons in Ireland. However, something did not feel right. I felt misplaced. It felt as if something was constantly nagging me and telling me that surgery was not for me. Soon, I then started Basic Specialist Training in Medicine).

I worked as a hospital registrar for two years: one year each in St Vincent’s University Hospital and Naas General Hospital. During one of the registrar’s years in Naas, I got a chance to work as Lead NCHD. At
that stage I had worked in three different health systems – Romanian, Dutch, and Irish. For many, it would mean quite a diverse experience and a great run in the medical field, but my real career breakthrough was when I applied for the GP training. I soon realised the significance of this wonderful job and opting for GP training is one of the best choices I have ever made. I am delighted and privileged to be a GP trainee and soon be a GP in July 2022.

Hospital GP trainee role

With a clearer goal and definite learning objectives, I was finally seeing the light at the end of the tunnel.

The ICGP training programme is designed to cover the essential aspects reflecting GP work needs. Having a half-day away from clinical practice per week also provided me with great learning opportunities. During that time, we were challenged to train our brains for the upcoming transitions when the hospital rotations were over. One of my hospital placements was in the Emergency Department (ED). Working there as a Senior House Officer on Duty, I used to think why do GPs refer so many patients to the hospital. Retrospectively I was unaware of the fact that only very few patients are referred to the ED.

Into the final six months of my hospital posts, the COVID pandemic hit and so began an era of remote learning. Although adaptations had to be made, the teaching did not stop.

What was important was to quickly adapt to the new normal and getting back on track. One of the main attributes of a GP is to embrace the unexpected and prepare for a quick transition. There are pros and cons of remote teaching but hopefully, we will soon be back to an on-ground or hybrid model of teaching.

One thing that has struck me, in a good way was the readiness and rapidness with which the system adapted itself to the pandemic. The bigger question that crept into my mind was that why we needed a
pandemic to teach us to do things differently? Why wait for the fire to make provisions for extinguishers?

Performing simple but necessary simple tasks like taking vitals became second nature. The case mix was also amazing and diverse. On a usual day my work could vary from phone consults, mental health
consults, to doing home visits.

The most striking feature was the fact that most of the GP practices were fully computerised and managed by practice management software. This greatly facilitated navigating through the patient’s medical history. Also, the advent of electronic prescribing in March 2020 was significant and reduced the chances of prescription errors.

The variability and diversity in a GP’s work also fascinated me. On a typical day, I may be managing osteoporosis, doing medical fitness for driving licence, dealing with women’s health issues, performing
ear-syringing, and on others, I may be doing a motivational interview or bereavement counselling and dealing with chronic diseases and doing health promotion. I am in no doubt that GPs are the gatekeeper
of the Irish health system.

Usually, a consultation lasts about 10 minutes but the feeling of achievement during this small timeframe is unbelievable. Between consultations, I had to switch between being a communicator, healer, surgeon, psychiatrist/psychologist, or at many times one who accepts uncertainty and admits the same. Above all, in the end, I would have felt I was working as a generalist who practices holistic medicine. The bond we develop with the patients also helps us in keeping ourselves focused.

Next to the clinical works is the huge responsibility of doing audits/research. I have completed an audit on the PPV23 vaccine. I am looking forward to doing another audit on Prostate-Specific Antigen. I am currently the HSE/NDTP Lead NCHD for the GP trainees. I am also doing an advanced diploma in Medical Law. At all times, the library service from ICGP is fantastic and very useful.

Media influence

Recent reports of GPs being understaffed, with increased workload and less funding, are true to some extent but I think general practice is still the best professional choice. There is no better time to graduate as a GP with GP training transitioning to ICGP, reversal of FEMPI and the huge trust people have placed in their GPs that emerged during this current COVID 19 pandemic. As reported in a recent report by Dr Claire Collins, about 25% of the current Irish GPs are 60+ years and therefore due to retire within the next 10 years. There is not going to be any shortage of jobs for you when you qualify!

Personal life

Being working professionals, both me and my wife Dr. Meena Kumari, found it a bit difficult with two children and closed creches during the pandemic. Shift adjustments didn’t work every time.  I remember mornings when one would finish the night shift and the other had to start the morning shift and if one got late finishing, we had to meet at the hospital car park and swap cars with children in and continue. Thankfully the hours are more predictable in General Practice so it’s great to balance family life and recuperate those missed hours now to spend time with the children. 

Given the fact that I am such a vocal promoter of GP training, I hope Meena would join the GP training too soon.  She has agreed to apply this year, thanks to the implementation of the long-due changes in training specialties like eligibility for non-EU medical graduates to be on the Trainee Specialist Division of the Medical Council.  

Summary 

As a GP trainee and afterwards in my GP career, I will continue to treat patients, of dealing with patients from multiple cultures and ethnic backgrounds. As a GP every single day is different and challenging. I can guarantee you that it’s the uniqueness of GP, that you will love and cherish forever and never regret.

Deadline for online GP training application is 17 November 2021 #BEAGP

Pramod Agarwal is a fourth year GP trainee and is and NCHD Lead for GP trainees