Thankful for what we have

Brushfield spots. If you don't know what they are, look it up.

General practice certainly is a different kind of work to hospital medicine. The community comes to you with their health concerns. For certain, some people are unwell. Some need antibiotics, most don't. Most are happy just to be checked over and reassured. In hospital, you order every conceivable test in the hope that something rare will show up so you can impress your boss. In general practice, you avoid ordering unnecessary tests in case something shows up that wasn't clinically related to the patient.

You have to bear in mind that if you're born and raised in the UK and have a moderate income, you're probably part of the healthiest 0.1% in the world. Dr Genesis considers himself part of the most privileged 0.1% in the world: very healthy, intelligent, financially pretty well off and the proud owner of a happy and loving family. But then again, Dr Genesis has a huge ego. He has nurtured it carefully since attending an expensive secondary school.

Every now and then something happens in GP which makes Dr Genesis glad he is in his job. Just the other day a busy mum of 2 came in for a relatively minor enquiry. Her young baby looked a bit odd. Cute, but odd. He had Down's syndrome. Mum was quite happy to talk about it. She had used IVF, and was told her risk of Down's syndrome was "moderate" (less likely than 1 in 800) and didn't proceed to amniocentesis wisely enough. She still had her little bundle of joy and thankfully baby didn't have any major cardiac abnormalities. She pointed out to me the baby's Brushfield spots, wide gap between big toe and second toe, and prominent medial epicanthal folds.

What a cutie.

Master of the universe (not Dr Genesis)

Most doctors have odd personalities. As one of my house officers remarked a few months ago: "we must all be a bit odd, to ask people repeatedly when they last opened their bowels". One of the most stressful things Dr Genesis found about working in hospitals was dealing with difficult colleagues. That's one of the reasons he went into general practice (although there's still difficult colleagues there too). Doctors are often quite forceful people, on the aggressive, thirsty to climb the ladder, and working under stressful conditions. All this makes for a brewing pot of defensive behaviour and irascibility.

There's nothing a doctor likes more than proving another doctor wrong.

Dr Genesis is one of the more placid types. Dr Genesis doesn't like confrontation. But equally he has an enormous ego. It is difficult for him to agree he was wrong. Usually he thinks he is right. There are often several different ways to do things in medicine and so far Dr Genesis hasn't done anything disastrously wrong. Except once, a couple of years ago. Perhaps I will tell you about it soon.

But still, Dr Genesis finds it hard to accept criticism. He will nod, agree, and mutter something about "useful feedback" but inside his mind is arace with reasons why what he did was actually a good idea and why the other doctor was wrong. But even the ego of Dr Genesis knows that when the criticism comes from a senior, it is better for all involved to simply agree.