General practice

Throughout these years, I don't know how, or who is responsible for this, but more or less we all have a picture of the general practitioner really knowing their patient and family, talking in depth with them not only about the physical ailments but having abundant time to explain results and addressing their concerns. An epitome of work life balance, family friendly hours, and just a healthier working environment than hospital medicine.

Week one and two. In, out, in, out, an endless list of patients, one after another. I don't see how there's more time in these clinics than a public general medicine or surgical clinic. I don't see how churning people in and out, quickly dishing out the necessary paperwork, scripts, eyeballing a wound, performing a quick minor procedure, is any less fast paced than working in the emergency department. Consulting at a rate of six patients per hour for the entire day, skipping lunch, working until the sun sets, isn't my idea of work life balance. But it depends who you sit with, and clinicians do choose their working hours. Unfortunately they don't allocate medical students half days.

Seeing so many within a short span of time, I have noticed something completely new, and unfortunate within myself. I get sick of people, sick of talking, sick of engaging in small talk, and especially talking behind a mask, a persona. The time waiting for the doctor to finish with their patient before entering the room is agonising. It's the training grounds for random chit chat. Of course I love what I'm doing, of course I'm enjoying my rotation, of course graduating soon is so exciting! I muster up an unusual (and if you know me, unnatural) enthusiasm and smile; oh, how could I answer otherwise with those genuine smiles and innocent eyes looking at me expectantly?

"Do you want to specialise in anything? Are you planning to study after graduating? Or just be a GP?"  Do general practitioners get tired and frustrated with the public perception that somehow specialists are GPs but more senior, more qualified?

Then I tune out, and spend more time typing away into the computer program than listening to what the patient is saying. Which doesn't look as rude as it sounds, because I am simply imitating some of the clinicians at work. Never mind that I actually disapprove of this. It's just easier, mentally, to float in and out of the conversation. At times, I know without patients saying outright, and without asking, that they have a particular topic they want to discuss, which was the real prompt for their visit today. The underlying concern which we were always taught to ask about and address. But I ignore what I sense because I don't want to talk, or be engaged. Sometimes during the consultation, I feel a tug of guilt and am prompted to turn around, face the patient, lean closer, looking at them, and ask "how is that headache?" But the rest of the time goes something like this. Sorry I don't think I will be a very good doctor.

"Yes well, I had the sore throat and two days later I started the cough."
"Sorry, when did you say you started coughing? Did you say you had a sore throat?"

"I catch up with the doctor every few weeks or so. Just to update him on how I'm going." She said elusively, as I asked her what she was in for today. I've always been the last one to dismiss "health practice" and "ethical practice" as useless arts subjects, or scoff at a patient's multiple psychosocial issues. But perhaps the sheer ratio of non-medical to medical cases strains on my ears, and my sympathy.

He's a charming man to be sure, just the right dose of intelligence, wit, friendliness, and warmth. By the way, the doctor goes from being your standard doctor doing a conventional shoulder exam, cutting out skin cancers, to one who wields acupuncture needles from head to toe, blows a small piece of charcoal and places it on a woman's abdomen to focus the energy, or flicks muscle to work with fascial planes. He knows better than I know that they're not coming for healing with conventional medications, and not even the alternative medical treatments he offers. That afternoon there were a whole string of mostly female patients who were, I'm sure, drawn to something about being able to talk to someone, anyone, about their week. Being cheered up, and having their aches and pains magically fixed by a smile and a positive energy. Someone to flirt with, even if it's done within appropriate social bounds.

What a lonely society it is, an African doctor had commented. I agreed. The idea of a big fat Greek and Italian families, the classic Asian culture of filial piety, or the necessity of having many family members visit an Indigenous patient at the hospital is often ridiculed. Living with extended family members, or supporting and living with aging parents is often seen unfavourably, an intrusion, in an individualistic world. Yet the freedom and self sufficiency our society encourages comes at its own price. Since when has the doctor been the first and best point of call for emotional and social issues - at home, at work, with children, with spouses, with in-laws? For sure, we should be sensitive to those issues and there is a time for pills and treatments. But it seems that some people see doctors as an automatic solution, a healer mystical powers to charm away the weariness, pains and sufferings of life on Earth. I wonder if we roll our eyes and groan at "non-medical" presentations, not only because we are not called to utilise the little ability we have in aiding physical illnesses, but also because we are baffled at the enormity and impossibility of being a healer for the emotional and social sicknesses of our world.

I have a terrible attitude, and I don't mean to be so negative. I had always loved clinics, and had waited in anticipation for this rotation. I am trying to find some positives. The doctors are nice and I even came across an old friend. The endless supply of mixed dried fruits and nuts, simple stocks of tea, coffee, fresh fruits, bread, tuna, cheese, milk and crackers is absolutely delightful. I am really only less than ten minutes away from the clinic every morning. I could even nap for an hour every lunch time, but I don't. Putting clinical skills and the knowledge we've gained over the years into something useful, is good. Finding out that I can't suture neatly is, not so good. Children are adorable. The town is one of my favourite places, exercising here and only here is fun, fellowship is refreshing.

But I'm resentful. For the ringing of an alarm clock. For not having enough time to do all the things I planned to do after last semester was over. For being kindly lent the textbook but not having the opportunity to open it. For wanting to switch off every time I come home, then indulging too long in the world of my novel, and paying the price with not enough sleep. For having to quickly whip up a simple dish instead of cooking something which makes my eyes and heart light up. For leaving most days when it's too dusky to hit a tennis ball accurately, and becoming too dark to enjoy a walk around the beautiful swan filled lake. Not being able to sit down and write out these thoughts though I've been itching to do so since I started the rotation. Let alone create new posts for the food blog.

I hate it. Not general practice itself - I haven't crossed it off my potential career pathways list. But because I feel trapped, like a rat (any creature really, just arbitrarily chose my favourite), wearily then angrily pawing at the confines of its cage. I'm turning into a monster with evil red eyes, sharp claws and bared teeth. Worse still, knowing that the confines will only grow smaller, have less breathing space, be more inflexible, as this year rolls onto the next. It's frightening. How can you run, run, as fast as you can? And where, oh little rat, will you run to?



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