1. Dr. Ylli Hasani GP ST3, Torkard Hill Medical Practice, Hucknall, Nottingham

2.  Qualified in 1987 in Albania  1987-88 Hospital doctor – equivalent of Foundation Year 1 in the UK  1988-1992 general practitioner in Albania – distinctly different from a GP in the UK!  1992 – came to the UK, initially invited by the BBC TV  1993-1995 senior medical student at University of  Wales College of Medicine, Cardiff  March 1996 – Licentiate of the Royal College of General Physicians, Edinburgh, Scotland

3.  1996 -2007 hospital doctor in the UK, the last 4 years as Staff Grade doctor in cardiology  December 2007 joined the Nottingham VTS as part of a career change, when at last it became possible for me to pursue my old ambition of becoming a general practitioner – my first interface with primary care in the UK

4.  December 2007 – April 2008, GP ST1, Brooklyn Medical Practice, Heanor, Derby  April – August 2008, SHO respiratory medicine, Nottingham City Hospital  August – December 2008, SHO paediatrics, QMC  December 2008 – April 2009, GP ST2, Church Walk Surgery, Eastwood, Nottingham  April – August 2009, SHO obs&gynae, QMC  August – December 2009, SHO ENT, QMC

5.  Changing the habitat and having to operate outside my area of comfort after a long time  Changing the consultation style from the traditional problem-focused and doctor-centred model to the modern patient-orientated model  Getting to grips with the e-portfolio and having to overcome the initial phobia and scepticism that is a natural reaction to anything new when you are getting old!  Learning the non-clinical skills of a GP’s work, including, among others, the role of counsellor and social worker

6.  Developing the business nous and the community orientation – so important in the work of the GP  Having to work under the hierarchy of colleagues who were much younger and, on occasion, less experienced than me (as was the case during my SHO medicine placement)  Having to change the placement and colleagues every 4 months in order to learn “a little about a lot” (as opposed to “a lot about a little” as a hospital doctor)  Moving into a new and relatively unknown area with its own linguistic peculiarities ( albeit thankfully not a strong dialect!)  Finally, being away from the family most of the time with the inevitable stress and anxiety resulting from this

7.  Radical change in consultation style, embracing the patient-orientated models – perhaps, the most valuable acquisition  Ability to perform in the context of limited clinical investigations, use time efficiently and prioritize  Ability to view and address patient’s problems holistically, rather than in isolation, and to consider the non-clinical aspects of illness, in addition to the clinical signs and symptoms

8.  Educating patients and actively involving them in their management plans and treatment options  Balanced view of complementary and alternative medicine, acknowledging, perhaps begrudgingly, its role along with modern medicine  Visiting patients at home, as against hospital or surgery, has provided new insights into the social aspects of medicine and the special role of primary care as the first port of call

9.  Special rapport with the patient and the trust many patients place on their GPs  Ambience of camaraderie and togetherness in GP surgeries (and the odd sandwich!)  Diversity of problems the GP has to deal with and the frisson of not knowing what is coming next  Occasions when I have been asked by my senior colleagues for my opinion on patients with heart problems

10.  Having to sit glued to the chair for up to 10 hours a day – might consider cycling or even walking to patients’ homes! No wonder many GPs retire at 60!  Getting to know the geography of the catchment areas on my own - and often ending up miles away from patients’ residence due to the satnav developing cognitive impairment!  Becoming familiar with the body language of the patients – both verbal and nonverbal – and the fact that many patients often leave the most important fact until they are about to leave the consulting room!