What should new GPs read?

There are many doctors around Australia who have just started their higher professional training to become a GP, the most effective of medical specialists. The learning curve from hospital to primary care is often steep. People can present with anything, everything and nothing, the medical is intertwined with the social, cultural, economic and political, and working out what to do can be quite unclear. All of this happens in a room with a closed door and no one else around, unlike in the hospital wards, which are far from private. It's testament to the quality of doctors choosing to do GP training and the quality of GPs doing the training that so many do so well.

So, with this in mind, and now a couple of weeks in, it's worth thinking about what would be ideal introductory reading for a new GP?

I received a few very interesting suggestions on Twitter.

@timsenior diving bell and the butterfly
— madhu singh MD (@thinkalot) January 30, 2013

@timsenior The Other Side by @grangerkate so that they realise how small actions can have a big impact
— Elin Roddy (@elinlowri) January 30, 2013

@grangerkate @timsenior Yep! It's not a rant - it's a really good book! I also love Intelligent Kindness by Ballard and Campling.
— Elin Roddy (@elinlowri) January 30, 2013

@timsenior @atul_gawande 's Better. Improving health care from both patient and systems perspectives.
— Melanie Thompson (@dr_mel_thompson) January 30, 2013

@timsenior Advice on learning how to access and use social media eg mashable.com/social-media/ Why-this is the future wrt information streaming.
— Deborah Verran (@VerranDeborah) January 30, 2013

 It's interesting that when people want to recommend reading to produce good GPs, they don't go for writing about diseases, they go for writing about understanding humans in difficult circumstances, often serious illness.

(The obvious exception is Deborah Verran's suggestion. Will the use of social media be so crucial that we all need to know it? Is it comparable with, say, skills like minor surgery, breaking bad news or clinical audit - whether we like it or not we are just going to have to do it? I'd love to hear your thoughts on this - comment below or tweet on the #supertwision hashtag)

What would I suggest? Here would be my top 3 suggested readings. Of course, I might change my mind, but these are today's thoughts. And, somewhat to my suprise, this is all core general practice literature. But all three have changed my practice for the better.

3. General Practice by Prof John Murtagh
What Australian GP could go without Murtagh? Just about every GP I know has one close at hand. Though the clinical chapters are excellent, the safe diagnostic strategy outlined in the early part of the book is gold for any GP at any stage in their career.

2. The Doctor, his patient and the illness by Michael Balint
Excuse the inappropriate gender specific pronoun here. This book was published in 1957, and is arguably the best book on general practice ever written. This was the book that moved general practice away from a purely biomedical paradigm and made the profession take an interest in the dynamics of what was happening when a doctor and a patient meet in a room. There's been a lot of other work done on this since then, but Balint is still a cracking read, full of mind-expanding insight. You can get a taste of the ideas here. ("the most frequently used drug in general practice was the doctor himself”). Don't rely just on this summary - do read the book. And don't worry if you're not sure about the group methodology - the insights are still valuable.

1. The Mystery of General Practice by Iona Heath
This is the best, and most beautifully written, description of general practice I have come across. It's a must-read for anyone interested in what your family doctor does. It's short (easily the shortest of these threee recommendations) and you can download it for free at the link above. You might start reading and worry about the relevance of commentary on 18 year old health reforms in another country. But don't worry. It's highly relevant still, and the description of the role of a GP in a community and in reducing health inequalities will make you proud of your chosen profession.

Those are my top 3 picks. I'd love to hear your suggestions, either tweeted on the #supertwision hashtag, or posted as comments here. And if you don't post your suggestions, Michael Bonning will have to read what I suggest. Is that really fair?

Supertwision! Join a new experiment in social media and medical education

This week Dr Michael Bonning and I started working together in our Aboriginal Community Controlled Health Service as supervisor and GP registrar. Over the next 6 months we will work closely together to learn about working as a GP, particularly in an Aboriginal Health setting. I say we, because, though technically I am the supervisor and Michael is the learner, I will learn just as much as he will. Most GPs I know involved in teaching would say the same.

Over the next 6 months, we will cover the medical conditions often seen in general practice, we will learn safe approaches to any and all combinations of symptoms that people might have. We will learn about the crucial nature of communication and interaction the consultation and how to do this effectively. We will learn about listening and giving voice to people who often aren't heard in a complex medical system.

However, that's just my perspective. And given that both I and Michael are interested in the use of social media in medicine and medical education, this is a wonderful opportunity for an experiment. Over the next 6 months we will ask questions, link to documents and resources and invite discussion about being a better GP, particularly in the context of an Aboriginal community, and most likely other communities traditionally underserved. We would invite anyone interested in  the subjects discussed to join in and contribute. We only have 2 perspectives, and you will have others. You'll be aware of guidance and discussion we've not come across, perspectives new to us. I would imagine that GPs, patients, Aboriginal and Torres Strait Islander people, communities and organisations, educationalists, other medical specialists, other professionas allied to medicine would all have something to contribute to our discussion.

The other purpose is to lift the lid on what doctors do, especially GPs. Is it just about diagnosing? How do we think about doing the work better? Where do we go to learn new things? What disciplines are relevant? I hope that seeing GP apprenticeship happen in real time will enable people to see the complexity of what their doctors are doing, and enable them to have more productive conversations with their doctor.

It's worth pointing out what Supertwision won't be doing. We won't be idientifying any patients we see, or discussing the service we work in in any more than generalities. We won't be providing any medical advice on Twitter or on this blog. And do not think for one moment that what you see on Twitter or on the blog is all the teaching that is occurring. We are meeting regularly in practice and talking by phone and e-mail and you won't be party to any of that conversation. We will be involving our practice nurses, Aboriginal Health Workers other professionals and, yes, patients. To mobilise an old metaphor, what you see will be the tip of the iceberg.

So. Here we go. I hope this is a go at seeing a real innovative use of social media in health care, particularly in medical education. It may all go horribly wrong, but at the moment I'm optimistic and think we have something that many will find very interesting. You can join the conversation by following myself (@timsenior) and Michael (@michaelbonning) on Twitter and following the #supertwision hashtag. We'll be posting more long-form thinking on this blog, and would love to hear your comments and suggestions.