Living with complexity
Dr Janet Frater talks about her life as a GP, and concerns for the future.
I am very privileged to work as a general practitioner. I have a wonderful group of patients, some of whom have been with me for more than a quarter of century, who share their life stories with me. They teach me a lot about living and my work is never boring. However there are are a couple of issues concerning me at present.
Poverty
The first is the limited time we have to deal with complex health issues. For example, there is a lot of talk about our increase in diabetes and obesity. Recently I observed one of our younger doctors’ consultations. A lovely, quietly spoken Polynesian woman came in. She had a badly infected leg, was six months overdue for her diabetes tablets and as a result her recent blood test had shown high sugars which would be causing complications.
The doctor very gently asked the woman about her life and the reason why she had not come back to get her medicines. It emerged that she had 7 children and had to work all day in a factory to supplement her husband’s income. I realised it was not just the cost of coming to the doctor that would be an issue (though this practice had benefited from the increased government funding to high needs areas so fees were low) but she had little time or energy for her own health needs. She would have to get time off from work and find transport to get to the doctor. She would need time and energy to shop wisely for her diabetic diet on a low income and to fit an exercise programme into daylight hours.
Initially I was judging her as a ‘noncompliant patient’. But when I heard her story I could understand better why she seemed to neglect her health – it’s still poverty. As people try to escape financial impoverishment they struggle with time impoverishment. A lot of my patients tell me they have difficulty finding time for their own health needs.
Sometimes by talking about boundaries and engaging agencies which may help we can make differences. The trouble is that in our general practices the time it takes to explore these issues is also a scarce commodity. Good practice nurses who help
us a lot are hard to find, GPs are ageing and becoming scarce too!
The next generation
I am fortunate to be involved in teaching some of our future general practitioners. This year only a fifth of those in my group are NZ-trained, and they are all women. Overseas-trained doctors are wonderful people but many are older and have worked in very different cultures and health care systems.
Where are our NZ-trained doctors, particularly the young men? Some medical students finish training with $70-80,000 loans. They naturally look to a high-paying specialty or go overseas for a higher salary so they can become debt-free sooner. Reducing fees for medical students would help reduce loans. I also suspect that hospital specialisation is perceived as more glamorous and exciting than coal-face general practice – think of all the hospital
based TV dramas!
GPs are now getting better paid with the increase in primary health care funding under our current government. More funding for training is also promised. Nevertheless the low morale in the GP workforce will take a while to recover and there are still issues such as the burden of paperwork which need addressing.
Rewarding
In spite of all that general practice is a very rewarding job. It requires great breadth of knowledge and we deal with very complex medical problems which the hospitals can no longer handle with their limited resources. We can be an advocate for the poor and marginalised. We get to know our patients well over a long period of time and stand with them in their struggles. What is more, we have the example of Jesus himself who dealt with crowds of sick people in their communities with great compassion and wisdom.
So if you are doing medicine I challenge you to look seriously at general practice as a specialty. And next time you go to the GP and you have to wait and they seem to rush you, think of the dwindling workforce and give support to policies which improve funding to GP training and their practices.
Janet lives in Auckland and has worked as a GP in Balmoral Doctors for 26 years. It is an urban, multicultural, group practice. Janet also helps train GPs in the Auckland GP training programme. She worships at St Georges Church in Epsom, Auckland.
Comments via Facebook