ReadingRoom

The doctor will see you now

Auckland GP Himali McInnes makes a plea for anyone needing medical care to call their doctor.

Last week, I wrote of the Covid-induced frenzy in our general practice waiting room in Three Kings, Auckland. Anxiety flurried in and out, bringing on its coat-tails the marginally unwell. Patients avoided eye contact with each other, as if this invisible disease scourging our world was transmitted via gaze. We fielded calls, we administered hundreds of flu vaccines, we frantically tried to source extra personal protective equipment (PPE) for staff. We swabbed potential Covid-19 patients.

Then, in response to an unprecedented directive from the GP college, our GP clinics scrambled to make 70% of consults virtual to prevent Covid-19 spread. It was a gargantuan shift. Desperate times, desperate measures. Many practices set up new tele-health systems within days.

After an initial inundation of phone scripts, however, the tide has gone out. Our waiting rooms post-lockdown are now almost empty. Our inboxes are empty. There are no blood tests to check, no hospital clinic letters. Only our phone lines chitter with traffic. It’s surprising how much can be done over the phone. Patients have been incredibly kind, asking repeatedly after our welfare.

But the comparison to our normal practice is like a chiaroscuro: light to dark, dark to light. It’s a profound and - for some - unsustainable change. The huge shift that Covid-19 forced upon GPs has exposed raw, uncomfortable truths that have simmered under the surface for years.

At the very time when costs due to pandemic preparation have sky-rocketed, income has plummeted. Whangārei GP Dr Geoff Cunningham says, “If your over-the-counter cash drops for three to two weeks, you’re insolvent. Some GP practices are on razor-thin margins.”

The pendulum for general practice is swinging wildly at the moment. Dr Richard Powell says, “If the business loses money for a few months, that is life. A lot of businesses are doing it tough.” As I write, temporary government financial help is being organised for GP practices. It's likely that in the long term, we will need a systematic re-evaluation of our profession. Out of disruption and chaos can come improvement. A flourishing primary care system should be a country’s frontline medical rampart. As Dr Kate Farmer says, “There is a lot to lose, and GPs have a lot to give.”

It benefits no-one in society to lose good medical services. Some GP contractors have had their hours terminated under ‘force majeure’ clauses. Practice owners have worked absurd hours for no pay to get systems up and running. Flu vaccines that were ordered have been diverted to pharmacies. Swabbing for Covid-19 has been taken out of the hands of GPs and centralised to community based centres (CBACs). This is sensible in some ways, given the limits on test availability. However, there are anecdotal reports of patients who meet clinical judgment criteria for swabs having to spend hours in line at CBACs - only to be declined a swab.

Everybody is affected by this pandemic. Many small businesses have closed; the elderly are marooned in their homes by fear. The pain for general practice is multi-pronged. It’s the largest medical speciality in the country, but often not recognised as such. It’s chronically under-funded. Unlike our hospital colleagues, most of us don’t get sick pay, or paid conference or holiday leave. We don’t get equitable treatment from our district health boards, but are often encouraged to fend for ourselves. We don’t have a union, but we do have a GP College that is fighting hard for us right now (Dr Sam Murton and Dr Bryan Betty have been surviving on intravenous infusions of caffeine).

The depth of feeling rippling through social media is indicative of medics who are over-worked, under-resourced, and are now faced with a virus we can’t yet cure. Our stores of personal protective equipment in general practice are meagre. We need to act on overseas data, which show health care workers being infected by sometimes asymptomatic patients.

All these factors cause chronic stress to practices, yet they carry on. There is a duty to care for patients. General practice truly is an extraordinary career, and I love it. I trained initially in paediatrics, but I don’t miss hospital medicine one bit. Being entrusted with someone’s story, acting as their advocate, caring holistically for them - these things are a privilege not to be taken lightly. I often hear Maya Angelou’s words whispered over my shoulder, in her gorgeous gravel-tar voice, as I work: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

We receive so much from our patients in return.  Small pottles of tamarind chutney redolent with spices. Beautiful plants, rose-tipped with spiky leaves. Grateful words that cost nothing but are priceless.

The hallmarks of a good GP are often discrete and tangible. Up-to-date knowledge is important, in a plethora of fields: wheezy babies, schizophrenics with delusions of grandeur, menacing cancers, clots of blood that must be stopped before they bed down in brains or lungs. Efficiency is also important; there is much that must be done in each consult, even after the patient has left the room. Skills such as joint injections, skin lesion removal and long-term contraceptive fitting provide a fantastic service that complements secondary care.

However, it’s the intangible qualities - kindness, encouragement, compassion - that elevate a good doctor to an excellent one. Patients are healed as much by knowing that someone cares for them as by pills and procedures. Kindness releases a beneficial cascade of chemicals - oxytocin, serotonin, others. A colleague tells of a GP who rang a 73-year-old patient during lockdown to sing her happy birthday. The patient cried. She didn’t think anyone would remember or care. Who can put a price on such a thing?

If you are needing medical care, please call your GP for a virtual consult. We are open, and we really want to hear from you.

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