An interview with Dr Jim Ropner, a General Practitioner

Q: Tell me a little about yourself!

My name is Jim Ropner and I’m a GP partner at Berkeley place surgery in Cheltenham. I come from a very medical family and am the 6th generation in an unbroken line of doctors, which just means that I have no imagination whatsoever for my own career path! I grew up in Cheltenham, went off to London for school and stayed on in London for university at University College London. I did a traditional medical degree but took a year out to do a BSC in psychology, which I thoroughly enjoyed.

I’ve always been interested in the mental health side of things and I think there’s a lot of that in General Practice. Through medical school, I always thought I would end up as a psychiatrist, following in my father’s footsteps. However, I did psychiatry for a while and I realised I didn’t want to do that as I think doing that full time is really hard. I decided to be a GP after having done a year as a pre-registration house officer and 2 years as a medical SHO. I then went off to New Zealand for a year, after which I came back and finished off my GP rotation as a registrar in Ramsbury. I’ve also worked in Cheltenham hospital doing Oncology and Ear Nose and Throat surgery in Gloucester.

In terms of my interests, I’m a keen musician and enjoy keeping fit. I’ve just taken up weight training, which is perhaps bizarre, but is definitely keeping me fit and stopping me from sitting on my backside all day! I’ve got a wonderful family, two daughters who are 12 and 14, and a gorgeous wife. I count myself lucky really!

Q: Could you describe your job as a GP and what your career path has been like so far?

My job has changed quite a lot over the years. I started off at Berkeley Place Surgery in 2007, initially as a locum1 and am now a full time GP there. I have a special interest in Palliative Care2 and did a secondary qualification in it, getting a diploma from Cardiff University, so I now do a lot of palliative care in the practice. I also sit on the Local Medical Committee, the council for the Medical Officers of Schools

Association3 and am the Medical Officer for Cheltenham College. I do a lot of work with adolescents, which I thoroughly enjoy! Additionally, I look after Windsor Street Care Centre, a mixed residential and nursing care home with 82 beds and a broad range of people with different needs. As part of that, we’ve agreed to start working with the hospital, to accept people who have been in hospital but are not quite ready to go home yet. These people would come to us for a 6-week period, to work with a team -myself, an advanced nurse practitioner, a physiotherapist, an occupational therapist and a social worker, with the goal being to try and get them up and about, to help them achieve their potential and then get home again.

1. Locum- A fully qualified doctor that stands in temporarily when other doctors are off sick or on holiday. They work in different practices instead of just one and are valued members of the medical community

2. Palliative care- looking after people towards the end of their lives, aimed at optimising their quality of life and mitigating their suffering

3. Medical Officers of Schools Association- an independent body which represent doctors and nurses that work in independent schools

K: Wow! You’ve really managed to do a lot with your time.

It certainly keeps me busy! As hard and challenging as it is, Medicine is a real privilege. I get to see people at amazing times in their lives and in some really challenging times in their lives. One of the things I like about General Practice is the longitudinal relationship you have with people. I’ve been at Berkeley Place for almost 14 years and there are people there that I’ve known throughout that period of time. I may well have looked after parents as well as their children! Seeing people grow up and their relationships mature and develop is really fulfilling.

Q: What does a typical work week look like for you?

At the moment, our work week is quite strange because of Covid. We have a morning and afternoon session, with a break in the middle for visits and paperwork4. In terms of the mix of patients, some will be pre-booked, while some will be urgent appointments on the day. On some days, I do triage, which is taking all the requests for urgent appointments from the morning and afternoon, either dealing with them then and there or organising some tests and arranging to see them afterwards. There’s a nice sort of variety!

4. Paperwork- letters from consultants and other people, blood results from tests instigated

The downsides at the moment are that I can’t see people face to face routinely. I really enjoy those interactions and will be very glad to resume them when the virus ends. On the plus side, there’s been an evolution in the way we do appointments at General Practice. We realised we could manage much more on the phone than we thought we could. There are pros and cons to this as I appreciate many patients enjoy face to face interactions, but equally many like the convenience of it, not having to take time off work to go to the practice. Striking the right balance is the challenging bit!

Q: Is it more difficult for you to do consults over the phone?

It’s a real skill to work safely over the phone. You have to ask lots of questions and checking a patient's understanding regularly is very important.

We’ve also got access to a piece of software for video conferencing which can be really good, as it’s nice to make eye contact even if it is over the screen. What I have learnt is that you have to have that little voice, that 6th sense on your shoulder to know when something is not right and that you need to see the patient. There’s still flexibility in work and you do have the ability to say “Let's stop this conversation. Come down to the surgery and I’ll see you. We can go from there.”

Q: What are some of the favourite parts of your job?

I find working with teenagers to be really positive. This may sound strange as it’s challenging work, but I think that the mental health side of things is phenomenally important. If it is done right and a person is given the time and support that they need, you can really make a big difference at a time in a person’s life when it is very easy for them to feel sidelined and judged. Conversely, I very much enjoy working with the elderly. Making sure that someone’s last days are as well supported and as comfortable as possible is so important. I found it very difficult as a medical SHO to see people being sent to hospital in the middle of the night from nursing homes to essentially die in A and E, because nobody had thought to have the conversations about advanced care planning; finding out how someone wants to be looked after at such a critical time in life is hugely important. Fortunately, as a whole, GPs are much better at that than we used to be. That is something I obviously don’t take pleasure from, but I find it very satisfying to make sure it is done properly. I count myself lucky that there are not many parts of medicine I don’t enjoy! I suppose it has to be said that paperwork is not very fun and that the hours are long, but I get a lot of satisfaction from doing something worthwhile with my time!

Q: What are some of the difficult parts of your job?

Dealing with complaints can be very challenging. In situations where complaints happen, and I’ve done something wrong, I’m a firm believer in raising my hand up and apologising openly and honestly. Equally, sometimes there are complaints that come in where you genuinely don’t think you’ve done anything wrong. Particularly at the moment, in this polarised time, some people’s views are very concrete. It’s then hard in that position to be able to talk to somebody and explain your point of view. I’m someone who takes complaints very much to heart. I get loads of lovely feedback and will almost ignore all that, just focusing on the one complaint.

Something else I find very difficult is telling someone who you’ve tried your absolute best to help, that you can’t make their pain go away or fix their problem. That can be a very challenging consultation and is very difficult. As a doctor, ultimately you want to help people and make them better, and having to admit you can’t is humbling.

Q: What have been some of the highlights of your career?

One that stands out is when I got my Distinction result in my membership exams to the Royal College of GPs. I was someone who didn’t always excel at medical school and just got the grades I needed, but nothing more. I was glad I’d found my niche! It’s very important to find something you can make a career out of, no matter what speciality or mixture of specialities that may be. For me, that was always going to be General Practice and the confirmation of me being actually not bad at it was really nice.

In terms of one with patients, there are things that happen from time to time, where you have interactions with people, that are not hugely significant from your point of view but have great impacts on their lives. Again, this harps back to that longitudinal relationship. I could be talking to them about something else entirely, and they’ll say “Dr Ropner, you won’t remember this but about 18 months ago you talked to me about my weight and it was a pivotal moment for me. I really took it on board and made huge changes. I feel so much better. I turned my life around! I owe it all to you.” Then I’d say “You don’t owe it to me. I was just at the right place at the right time, to just nudge you over the line. You were already 99.9% of the way there already!” It’s lovely to have call backs to the past, where you can actually take a step back and realise that you did something that made a difference. It may not be the same as a surgeon doing a lifesaving operation, or a cardiologist putting a stent into heart, but equally I think that as a GP, you have the ability to make a huge impact on people’s lives for the better. I take a huge amount of pride from this kind of thing and count myself as really lucky!

Q: Do you have any advice for teens thinking of going into medical school or becoming a GP?

My advice would be to make sure that you really want to do it, but then go for it! Medicine is challenging both academically, physically and emotionally. As a junior doctor you could be doing 18 or 24 hour shifts, with lots being thrown at you. Particularly so at the moment. My heart goes out to my colleagues at the front line in hospitals. They’re doing an amazing job! I’ve spoken to many of them and I know the toll that it takes on someone. You’ve got to be dedicated and prepared to work hard, but it’s tremendous fun as well.

Equally, I hugely encourage people to get involved. Medicine allows you to have a diverse career and allows you to travel! From my point of view, having gone to New Zealand to work for a year, there are not many other specialities where it’s so easy to pack your suitcase, go somewhere and be able to sustain yourself with a well-paying job and really enjoy it!

Experiencing other types of medicine is really interesting too. If you get into medical school and qualify, my advice is to experience many specialities before you decide what you eventually want to do. Finally, I try to fly the flag for General Practice because it's sometimes looked down upon compared to other specialities. Particularly, when I was in a London teaching hospital in training, to the professors there, General Practitioners were second class citizens. Whatever you do as a doctor, you can be good or not so good. Trying to be the best you can and adding value is a really positive way you can look at it. General Practice has a lot to offer!

Q: If you could turn back time, would you have done anything differently?

I’d definitely still have gone to medical school. I thoroughly enjoyed my time there! I made some amazing friends, had fantastic experiences and came out of it with a degree and qualification that set me up for the rest of my life. I do occasionally wonder what I would have been if I wasn’t a doctor. It’s a big question mark. So much of my personality and view of myself is linked to being a doctor and I can’t quite imagine anything else. I might have travelled a bit more, had things turned out slightly differently in New Zealand, I might have gone off to Australia and spent some time there as well. A lot of things happen for a reason. One of the difficulties of wanting to go back and change things is that you’re unsure what consequences that change might have had. I’ve made mistakes and missteps, but the important thing is that when things don’t go according to plan, to dust yourself off, stand up and try again!

Any last words?

The obligatory advice to wear a mask and social distance! Covid is bad news and there are many horribly unwell people as a result. We’re doing the right thing at the moment and hopefully if we all do our bit it will be over soon.

K: Thank you very much Dr Ropner! This was incredibly interesting and inspiring!


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