It’s about time we had an honest discussion don’t you think?
Firstly, you’re not the first patient to say “you wouldn’t understand Preeya” when you try to justify your non- compliance with therapy, whether it be the tablet, exercise or meditation I prescribed. When you admit that you keep forgetting to take your iron tablets, how hard it is to remember your asthma puffers every day or that you’re finding it really hard to find the time to exercise; I get it. May I be completely honest without losing credibility? I had iron deficiency after breast feeding for 6 months. My iron levels were low and I was told to take a supplement by my GP (yes, I have my own GP)– I took them sporadically (insert sheepish face)– I kept forgetting, my guts hated it and I wondered if the universe had given me the nutritional deficiency solely so I would gain empathy for my patients who had the condition– well, it worked! I also have asthma – I take my inhalers 80% of the time. I counsel all my asthmatic patients that the condition is long term, cannot be cured but can be very well controlled. The preventer puffer, if you need it, is essential to keep the lungs stable – it stops the airways from over reacting to cold air, pollens, exercise – whatever your triggers are. The preventer is vital, even if you feel well, to keep the asthma under control. I give the spiel often. But when it comes to me –I am not as reliable as I would like my patients to be. I often forget my inhaler when I have been well with no symptoms. Life gets in the way. I get busy worrying about Miss S’ nappy rash, work outfits for the week, meal planning – who could give a crap about my asthma?
Please don’t forget I am human too. When you sit across from me and say I wouldn’t understand, I grimace, because I struggle with all the same stuff you do – taking my medication every day, fitting in exercise, not reaching out for a wine every night. Being a doctor certainly doesn’t make me the perfect patient.
When I talk to you about bumping up exercise to aim for 30 minutes most days, I know how difficult it can be. I face the same battle every day. I notice your face fall when I ask you how the lifestyle changes have been going (my patients and I often work on diet and exercise changes to treat high blood pressure and type 2 diabetes amongst other conditions). I am not here to judge or punish you. I am simply here to guide, motivate and help you take the steering wheel of your own health. I feel sad when you say “Preeya you don’t know how hard it is to fit the exercise in.” Do I become immune to life’s challenges because I sit in the GP chair? These days, I am very honest with my patients; I juggle (and whether I succeed or not is a different matter) my motherhood, work, home life, an attempted social life and marriage; and trust me, I struggle fitting it all in too. I cannot possibly do 30 minutes of exercise every day – so I don’t expect you to either. I do something active 5 out of 7 days most weeks and I don’t even expect my patients to do that; I only expect that you will TRY to take control of your own health will all the information and tools I give you. If you don’t succeed every time that’s OK; I don’t expect miracles. So please don’t be scared to tell me if you haven’t done a walk 3 times a week or reduced your pastry intake; being a human I face all the same challenges as you.
Running late makes me very stressed. I know you’re waiting out there wondering why its 2PM, your appointment was booked for 145PM and I’ve just called someone else in before you. When I look at my list on the computer and see 4 people waiting, time ticking away – I get a big knot in my stomach because I know unless someone comes in for a quick cold and sick certificate I will not make up time (and even a cold isn’t ever really a cold FYI, there’s always something else –a sexually transmitted infection, an ingrown toenail – it is never ever “just a cold”). Trust me, I know you’re in the waiting room peeved off, getting angrier as each minute ticks by. And I promise you that if I could always run on time I would, I try my very best but sometimes things get out of control. When a person comes in and answers “yes” when I ask if they have been thinking about harming themselves, that takes longer than a standard 15-minute appointment. Likewise, the new mother who comes in for mastitis but sobs, struggling to take a breath because she is just that exhausted – I can’t throw antibiotics at her and push her out the door. And that’s not the kind of GP I am anyway, which is likely why you are still sitting in my waiting room despite me running behind. So please understand, if I am running late it isn’t because I’m playing Candy Crush on my phone.
Whilst on the topic, there are some things that most GPs struggle with and I’m ready to tell you what leads to many of us running late (and I haven’t seen anyone share this with patients before) – “The list”. The dreaded list. When you have booked a single appointment, which is 15 minutes for most GPs, and you have a list of 5 topics you want covered, there is no way humanly possible I can take care of your period problems, acne, pap smear, breast lump and anxiety properly in a standard appointment. So please don’t be offended when I say “can we choose the 2 things that are most important to you and deal with them today?” I need time to do my job properly and do justice to all the issues on your list and if you think you might need more time book a double appointment.
On a more awkward topic, let’s talk money. Doctors are shocking when it comes to talking about finances and billing. But, given we agreed to an honest discussion, let’s do this. It has taken me 4 years to know my worth, even then, I often struggle with billing people. Unless we have an agreement (like you’re financially struggling or you have a health care card for instance) I will privately bill you. And please know this, I have a toddler in childcare, I have bills to pay too. The notion that all doctors are rolling in it is far from the truth – I work hard for my pennies I can assure you, so please understand that just as you pay your dentist, physio, beauty therapist, personal trainer – the service we provide as GPs is also fee for service. The money you pay at the front desk doesn’t just go into the GP pocket either – we get a percentage; the rest goes to the clinic to pay admin and room costs and from the pennies we do get we pay significant medical indemnity insurance, college and medical board fees. Having said if you tell me you are unemployed, struggling to make ends meet but you need regular appointments for your Depression – I will always agree to bulk bill you (and I have many patients in that boat).
A few key things I want to share with you:
- You never need to apologise when you need an examination of your nether regions – whether it be for a rectal examination, rash or cervical cancer screening test. I’m not ever “grossed out” – your words not mine, and you don’t need to profusely apologise as you climb onto the examination bed. Likewise, ladies, when I examine under your armpits in a breast examination (for lymph nodes) you don’t need to worry– I’m not judging you on how sweaty you are; my mind is completely preoccupied on ensuring I cannot detect a breast cancer.
- When you ask “door open or shut Preeya?” as you leave the consulting room my heart swells every time. It’s kind and my decision changes constantly depending on the room temperature.
- I don’t have all the answers all the time – no doctor can know everything and there are so many things in medicine (tummy aches, bouts of nausea, strange tingly feelings in your left big toe every Tuesday) that we can never explain and they disappear on their own. If I say “it is nothing sinister, I can assure you of that, let’s watch and wait and see each other again in 2 weeks’ time” know that I am not blowing you off – I’m using the power of time (the greatest weapon in general practice) to help us find the diagnosis. And usually, your symptoms are gone in 2 weeks anyway, and if they’re not we will look into it with whatever investigation is needed.
- My tissue box is there for a reason. Please don’t worry about apologising, “sorry Preeya, this is embarrassing,” as you break into tears. You’re not the first person, and you won’t be the last. Ravage the tissue box, that’s what its there for. On that note, you don’t need a medical reason to see me either. Loads of patients book an appointment to debrief, have a cry, unload their worries – that’s part of my role as a GP so don’t feel guilty. You don’t need a cold, headache, sore ear– if you’ve had a bad day at work, the marriage is crumbling – I am here.
Finally, you should know this. I often think about you when you leave my consulting room when the sun has set and you’ve well and truly forgotten your appointment with me. If I’m worried about your diagnosis, your mental health, your stress levels or anxiety – I think about you. You pop into my head and I think “I just hope he/she is going OK.” You’re more than a number or a ‘patient’ to me – you’re a person. Like many GPs, I don’t just switch off and forget the story you told me that day about your recent relationship troubles, bullying at work or family violence issues at home. I do think about you – a lot.
Perhaps now, the next time I’m running late you’ll know just how anxious I really am. Perhaps you’ll modify your list so that the 10 issues are whittled down to a more achievable 2 for a single appointment. Maybe now realise I’m just a regulation human who doesn’t have all the answers and doesn’t live the perfect “healthy” life.
See you soon (but for your sake, hopefully not because if you see me it means something is wrong).
Your GP, Preeya Alexander