BGS Member Profile: Lloyd Hughes, GP
Lloyd Hughes is a GP registrar in his final year of training in Fife in Scotland and is a GeriGP committee member
You’re a GP trainee with a twist, is that right?
Yes indeed! I have been very fortunate to be supported by the South East Scotland deanery to reduce my GP training commitment to 80% and work one day a week in local geriatric medicine settings as a staff grade in geriatric medicine. This has been an excellent opportunity to develop GP competencies alongside broader medical skills. I have been exposed to numerous different clinical settings relevant both to care of the elderly and general practice, including Hospital @ Home services, geriatric medical assessment clinics, frailty acute medical rounds, rehabilitation medicine and community hospital ward work.
What made you want to work in older people’s medicine?
When working in geriatric medicine, you are concerned with the clinical, preventive, remedial, anticipatory care planning and social aspects of illness in older people. More broadly you are part of a team delivering care, and considering the broader aspects of a person rather than simply a disease. I also find the detective work of establishing a cause for vague presentations ‘falls’, ‘confused’ or ‘delirium’ is really enjoyable and is a collaborative endeavour.
Why did you decide to train as a GP?
I always loved the idea of family medicine. The fact you can facilitate care and support for patients within a small community, with continuity is something that I really value. Although this continuity is becoming an increasing challenge with staffing issues, it is something that I really enjoy. I feel general practice challenges me on a daily basis and was overwhelmed by the breadth and depth of GPs knowledge when at medical school on my placements. It also helped that I was simply inspired by fantastic GPs throughout my training!
What is the best part of your job?
The main reason I enjoy general practice and geriatric medicine is the variety of the presentations that we see in clinical practice, alongside opportunities for research, clinical management and policy work. No day is ever the same!
You’re particularly interested in community geriatric research, how did you get involved in this?
As a medical student I worked in nursing homes. In this environment, behavioural and psychological symptoms of dementia were a constant challenge and many of the staff despite being on the receiving end were keen to avoid chemical sedation of residents. With one of the local care home managers, we sat down and really thought about how we could reduce the impact that this was having upon staff and we performed a research project looking at maximising sensory awareness (hearing aids / glasses etc) for our residents and making some adjustment to the home environment, and we reduced episodes of verbal and physical aggression. This whole process of isolating a research questions, performing a study and improving clinical practice really excited me and has stimulated my interest in community geriatric research.
Do you have any advice for people wanting to get involved in research?
Say 'Yes' to opportunities and speak to local academics about research you are interested in! I remember at medical school that there were opportunities to get involved in geriatric and primary care research through local scholarships over the summer recess. I thought I would go for it and was awarded scholarships and was able to perform useful and clinical useful research. These summer research projects stimulated my interest in clinical research and asking research questions. I have been incredibly lucky to have worked with Professor Bruce Guthrie and Professor Miles Witham, from a GP and geriatric medicine background respectively, when they were at Dundee and they provided inspirational and have helped shaped my academic interests.
Which piece of research are you most proud of?
I published some work as a medical student with Professor McMurdo and Professor Guthrie in Age & Ageing titled ‘Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multi-morbidity’. The paper discussed the challenges of single disease guidelines for managing older and commonly multi-morbid patients. Current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions, nor to allow comparison of relative benefits or risks. Locally the paper changed clinical practice, and there has been extensive work and a new NICE guideline regarding multi-morbidity. It was hard work but was so proud to have the work published!
What has been the biggest challenge in your career so far?
One of the biggest challenges for me personally related to working as a Foundation Year 1 doctor. After an enjoyable 4 months in general medicine and stroke, I moved to surgical specialities. I found the 8 months of surgery extremely difficult despite lovely colleagues due to wide variety of staffing and local factors. I felt constantly that I was firefighting and not in control of the ward and patient care as I would have wanted to be. Speaking to the new FY1s this month, I certainly am acutely aware of what a step-up it is from medical clerkship as a student to being the FY1 bleep holder! With working 80 hours most weeks and never switching off when at home, it made me rethink what I was doing with my career. I seriously thought about doing other things, but I was fortunate that my first FY2 was geriatric medicine and the rest as they say is history! I certainly could not have imagined being so content with my career choice when I think back to my FY1 jobs.
What changes would you like to see in older persons medicine in the next 5 years?
I would love to see an expansion in community geriatric teams and Hospital @ Home teams. As a future GP, the option of managing patients at home has really changed the management of unwell older patients in the community.