Medical

Q&A with Dr. Knut Schroeder, General Practitioner

Dr. Knut Schroeder is a practicing  GP in Bristol, UK; a freelance medical author, and founder and director of Expert Self Care Ltd, a social enterprise which freely provides healthcare information via mobile apps. The company’s mission is to empower people to look after their own health and to know when to seek help. The ‘ESC Student’ app, which went live in June 2016, has been recommended by the Higher Education Policy Institute for use at all higher educational institutions.
Dr. Schroeder received his medical degree at the Free University of Berlin (1993) before training to become a GP in the UK. He passed his MRCGP with distinction in 1999 and became a Fellow of the Royal College of General Practice in 2008. He obtained his Master’s Degree in Epidemiology from the London School of Hygiene and Tropical Medicine (2000) and his PhD (2003) and Certificate in Medical Education (2006) from the University of Bristol, where he currently holds the position of Honorary Senior Clinical Lecturer in General Practice.
Dr. Schroeder has been published in several journals, including the British Medical Journal, British Journal of General Practice, Family Practice, and Archives of Internal Medicine. He has also contributed to book chapters in The Oxford Textbook of Primary Medical Care, and The Oxford Handbook of General Practice. He is the author of Top Tips for GPs – a Beginner’s Guide to General Practice; The 10-Minute Clinical Assessment; Diagnosing Your Health Symptoms For Dummies, and Sustainable Healthcare.
When did you first decide to become a doctor? Why?
I’m from Germany. At the time, men had to do either military or community service after school. So I chose to do community service, and I worked in a hospital as a nursing auxiliary for just over a year. You were part of the team, doing the very basics, and I really liked what I saw of the doctors’ work. I also liked biology and science, so that’s how it all started.
As a nursing auxiliary, I worked on a vascular ward. That was really interesting because people were admitted for lots of different reasons. Many of their conditions resulted from lifestyle issues, like people with diabetes and those who smoked. I just saw what those lifestyles did to them. There were many with amputated legs. It just ingrained into my brain how the way we live can affect our health and future well-being. If you live for years and don’t notice what you’re doing to your body, you find out the consequences later, and have to live with those.
How/why did you choose the medical school you attended?
I went to medical school in Marburg, which is near Frankfurt. I did my community service in another university town in Göttingen, and that was quite a nice place. I was keen to study in a small and friendly city, and Marburg was a small university city, with a fairly large university. So it was full of students, and I liked it when I visited. After my preclinical years, I moved to Berlin. Among German students, it’s quite common to start preclinical years in one place, then move to another for clinical years, and I thought it was a great opportunity to live in another city. I moved to Berlin three months before the wall came down. So that was an interesting and exciting time.
What surprised you the most about your medical studies?
What I found most exciting, I would say, was how varied the course was. I always thought, you know, “you study medicine to become a doctor”, and that was that. But just finding out how many different areas there were showed me that there wasn’t just clinical medicine. Being a doctor involves so much more: teaching, research, all the other career options open to medical students. I was surprised there was so much to learn and discover.
What information/advice do you wish you had known when you were beginning your medical studies?
In my time, a lot of emphasis was put on studying, passing exams, getting the grades, just sitting down and getting the work done. I think that, to become a good doctor, it’s just as important to make enough time to develop as a person. It’s not just about the academic studies, it’s maintaining outside interests, reading a lot, and maintaining your relationships, spending time with friends and family. I did those to a certain extent, but looking back, I wish I’d done those things more consciously.
Why did you decide to specialize in general practice?
I grew up in a small village, and we had a family doctor in our village who was absolutely lovely. As I wasn’t sure what to do, I decided to spend a few weeks doing work experience with her, and I got completely hooked on general practice. The concept of being a problem-solver and being presented with lots of different medical and psychosocial issues appealed to me. The relationship with the patient is one of the most important things. You’re not just treating illnesses, you’re supporting people with health and social problems. The person is always at the center, and they happen to have an illness or some other problem they need to deal with. You’re not treating diabetes or hypertension, you’re treating Mr. or Mrs. So-and-So who happens to have these conditions.
If you had it to do all over again, would you still specialize in general practice? Why or why not?
I’d always do it again. I absolutely love being a GP. I love the work. I also like the flexibility it allows. I’ve always worked part-time; I actually started off as an academic GP at Bristol University for a while, but then left 12 years ago to become a GP partner. As a partner, I was working part-time, so I was able to work and look after the kids with my wife. So I think having that flexibility was really important for me.
Has being a general practitioner met your expectations? Why?
I thought I had a fairly good idea of what to expect from my GP training. It cemented my view that I wanted to go into general practice. Actually becoming a GP has far exceeded my expectations. I’ve enjoyed it much more than I thought I would. I know there’s quite a bit of bad press out there, and some GPs are really struggling. But there are still many GPs out there absolutely loving their jobs, being part of great teams. At the moment, there is a big challenge for general practice, no doubt about it. But it is still a fantastic career, I think. There is not just one general practice, that’s the interesting bit. People always think you go into general practice and you simply become a GP. There are actually so many things you can do: teaching, research, politics, writing, becoming a GP trainer, getting involved in innovation work. You also choose how much work you do. If you’re happy to earn a bit less, you can work part-time, and you can create time to do really exciting things, either voluntary work or hobbies.
What do you like most about being a general practitioner? Explain.
I like the variety, I like the deep relationship with patients. I like the constant problem solving, the decision making. Every ten minutes, you’re solving something. Part of that is actually finding out why people come to see you, which isn’t always that easy. You just don’t know what’s coming through the door. Sometimes it feels like you’re Sherlock Holmes, trying to get to the bottom of a patient’s case within a short period of time, and trying to move people forward.
I also like the flexibility. I’ve never liked putting all my eggs in one basket. I have to do different things on the go. Being a GP allows me to also work on other projects.
What do you like least about being a general practitioner? Explain.
I think it’s the time pressure. Patients’ problems and medical treatments have become more complex, and hospitals continue to load more work onto general practice. When I started in my training practice, we did more of the stuff that GPs were meant to do. Now, there’s a lot of paperwork due to increased patient complexity, along with increased complexity in medication and management plans. Having to do all of that in 10 minutes is quite a challenge. So having more time with patients would be great. Finding ways of reducing paperwork and increasing efficiency would also be good. After a busy day, when you want to go home and put your feet up, many GPs are having to spend an hour or two doing mundane paperwork.
The other concern is GP politics and lack of government support. General practice on the whole doesn’t get the support it deserves from government. People often don’t realize we probably have the best general practice service in the world, or that we have fantastic training, with an advanced exam and the 1-to-1 training, which sets an example for other countries.
What’s your typical work week like as a general practitioner like?
I spend my time between being a locum GP and running Expert Self Care. Three years ago, I decided to work more flexibly, so I now decide when I do clinical sessions and when I work on my social enterprise. I do between 2-6 clinical sessions a week, so I choose when and where I work. So far, I’ve mainly worked in my old practice, where I see 16 patients in the morning, then 16 in the afternoon, plus a home visit. The typical day includes paperwork, such as referrals, or being in clinical meetings.
Expert Self Care work takes up 2-3 days a week; I mainly do that from home. It’s been a self-funded enterprise so far, but I enjoy it.
Tell me more about how you started Expert Self Care.
It wasn’t really about starting up a company. I got interested in writing, and in health literacy. A lot of people find it hard to make decisions about their health, and they base it on whatever knowledge they happen to have. My theory was: if we really help people have access to clear information to make that decision, they will be better off, and the NHS will be better off. It’s about knowing when to seek help, and knowing when to look after yourself at home.
I wrote a small book for the “For Dummies” book series called Diagnosing Your Health Symptoms. It didn’t do particularly well, but it was great, my first step into patient information. Then I got approached by a friend of mine, Dr. Dominique Thompson, who was the Director of Services at the University of Bristol Student’s Health Service. She told me that there is such a need for high-quality health information among young people who have just left home for university. She asked if we could write a book on this together. We started to talk to students who said they weren’t really interested in a book about it. Instead, they went: ” How about an app?”
That was about 4 or 5 years ago. I’m not technical and I had no idea what an app was at the time. I didn’t even have a smartphone! Once I was familiarized with apps, I thought it was a great idea. I had to set it up as a proper organisation to run this, to set it up as a company. We then spent some time getting certified by the NHS Information Standard, to make sure all our processes were in place. That’s why I set it up as a social enterprise to develop health information apps. We have the ESC Student app, which is free to download, and has been recommended by the Higher Education Policy Institute. It focuses on mental and physical health. We’re just about to launch another one for people who self-harm, and we’re working on a student well-being app, about anything that might affect a student’s well-being while at university. That would cover finances, accommodation, anything that might throw people.
What do you like most about running Expert Self Care?
I enjoy being able to make things happen without the red tape. In the GP surgery, you have to make proposals, and it is quite difficult to get bigger initiatives through and get things done.
I really enjoy working with amazing people. I can choose who I work with, and it is great fun working on exciting projects. I enjoy the hope that what we do might make a difference for people. That’s what keeps me going.
What do you like least about running Expert Self Care?
I enjoy every aspect of it, even the hard parts. It gets tough sometimes, but that’s part of the fun. It’s all about learning. You learn, and you move on – I find that absolutely fascinating. The only thing I dislike is that I have so many ideas, and I’d like to do so many projects, but I don’t have the time or money to do all of it. Otherwise, I’m quite lucky.
On average: How many hours a week do you work? How many weeks of vacation do you take?
I spend 24-32 hours a week on clinical work, and 20-40 hours on Expert Self Care, but it’s quite flexible. My GP work is done in school hours, whereas I can be quite flexible with the time spent on Expert Self Care as I work from home, except when I have meetings. I like getting up early in the morning, sometimes 4:30 am, then working for a couple of hours when everything is quiet at home. I can then have breakfast with the children, once they’re up. If things get busy, I might work late, but then take half the next day off. I take between 4-6 weeks holiday a year.
How do you balance work and life outside of work?
We’ve got two teenage sons, 15 and 17. I never know when they need me. If you’ve ever been on a labour ward shift, you know the feeling of not knowing when the action will happen; you have to be there, probably hanging around for hours and hours. Suddenly, it’s all hands on deck! I find the same to be true with raising teenage children. They don’t talk to you, but suddenly they need you to be around.
I like my exercise, and find it important for my mental health. I run, I cycle everywhere within cycling distance, and I swim.
What types of outreach/volunteer work do you do, if any?
I’m a voluntary board member for the Self Care Forum. The charity’s mission is to enable people to improve their self-care skills by looking after common, but harmless, medical problems at home, and to know when to seek help. We promote health literacy in schools. We have lots of projects going.
I also work with Student Hub; we’ve just started setting up student internships in our social enterprise. I really enjoy supporting students with career development and getting students involved in Expert Self Care. We just had two interns over the summer for 6 weeks. We’re about to work with students taking part in another internship scheme in Bristol, in which groups of students are being paired up with local businesses and get sponsored for business work.
From your perspective, what is the biggest problem in healthcare today?
I think it’s the lack of government funding and support for the NHS. They’re not realising that the NHS will be in even more trouble, without more support. So many are working really, really hard within the NHS, much more than their contract demands. So many believe in the NHS and I think many don’t realise that if it’s lost, private companies would not have the same level of commitment to service.
On the other hand, I think we can improve the NHS, as is true of any organisation, and we need to move with the times. We need to embrace change more, to make sure we’re at the top of our game in terms of efficiency and technology use to help us provide better care.
Where do you see medicine in five years?
One of the most important things is to improve health literacy, and that needs to start in schools. We’ve started getting round to the idea that people should know first aid. In fact, everyone should also know how to self-manage coughs and colds and mental health conditions, and when to seek help for these.
We’ll probably be using technology even more in five years’ time. We’ll see more care in the community. We’d hopefully see an improvement in hospital discharge procedures.
Where do you see general practice in five years?
The core role of the GP would still be the same: we’ll still be the first port of call in many ways. There also needs to be more teamwork between other healthcare professions, who are often much better placed to deal with problems than we are. We have physiotherapists, nurses doing minor illness clinics. On the whole, practices will probably become larger, which is not necessarily a bad thing; we’d be operating more like health hubs that embrace other specialties and provide more tests, investigations, and procedures in the community. This is already happening in the practice where I work. From what I can see, this is for the better.
What is your final piece of advice for students interested in pursuing a career in general practice?
People often think that choosing GP is the easy option. This is far from the truth. It is hard work, and it’s at least as intellectually demanding as any other job in medicine. I’d argue you need to know just as much or even more, because you have to keep up to date with developments in all the different specialties.
With a few people from Bristol, I’ve written a freely available document called Surviving as a New GP, available on the Royal College of General Practitioners website. It’s about what to expect when you enter general practice, what the options are, and how to figure out what you like and dislike.
For me, being a GP is a great job. It’s fairly easy to become an average GP, but if you want to become a great GP, you need to be on your toes, know your stuff, and continually improve. Consider shadowing GPs in different practices. They all get similar training, but are all very different and have different styles. By sitting in with a few different GPs, you get a feel for the kind of GP you might want to become.