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I'm not 'just a GP'

“Aren’t you JUST a GP” said someone to Dr Claire Denness, a GP.   
Here is her response…

By Clare Denness
GP, GP Trainer, Medical Student Trainer (Australia)

It was nice to see you. A familiar face from the school playground, someone I’d not seen for three months during Melbourne’s lockdown.
 
We exchanged our socially distanced niceties while our children played. The sun emerged briefly from the grey sky.
 
‘So, how’s your work been?’ you asked, before adding, ‘Aren’t you a doctor?’
 
I nodded and started with my standard response, mentioning ‘very challenging times’ before moving to ‘we are in a much better position than so many other countries’.
 
But I didn’t get to finish before you interrupted me.
 
‘You’re just a GP, though, aren’t you?’
 
I froze.
 
Had you really said that? Would you have said the same to someone male? To someone older than me? To someone who hadn’t trained overseas?
 
Yes, I decided, you probably would.
 
As I began to challenge what you’d said, you interrupted me again to dig the hole deeper.
 
‘Well, you’re not a brain surgeon, are you?’
 
The smiles behind our masks faded. I let silence make my point. You were grateful for the intervention of your son who needed help on the swing. Later, you slunk from the park without a word, your children shouting objections behind you.
 
So, dad in the park, here’s what I really wanted to say. Here’s why we’re not ‘just’ GPs.

It starts well before university
We work hard, and not just at science and maths. We need to be good at other things to stand out from the thousands of other hopefuls. Sports, voluntary work, expeditions, work experience.
 
We juggle teenage hormones, first relationships and friendships with cramming for exams and interviews. If we get to university, we’re suddenly surrounded by hundreds of other competitive straight-A students just like us.
 
As we navigate being away from home, often for the first time, we start to realise the reality of the path ahead. We see life – the raw, unedited version. Its gory beginnings, its undignified ends. The loops of pain, fear, grief, and joy that punctuate it along the way.
 
For some of us, that’s too much and other careers call. For those who finish the long years of medical school, there’s at least another four or five years of hospital shifts. For this, we’ll sacrifice holidays, family dinners, weddings, Christmases, Hanukkahs, Eids, Diwalis.
 
We’ll sacrifice relationships. We’ll fall asleep in cinemas, during dates, at roadsides driving home from a week of nightshifts. We’ll be haunted by our memories and experiences and wonder ‘what if’ and think ‘by the grace of God…’.
 
There’ll be songs we can’t listen to without crying. Mine is Wires by Athlete: it played on the radio as I drove home from my first – and unsuccessful – paediatric resuscitation. There’ll be faces and names and places and smells that haunt us. Our sleep will writhe and twist with dreams about things we omitted, things we did wrong. Mine is the accidental double dosing of lithium, prescribed at 3.00 am after seven sleep-deprived night shifts. The patient survived, but the mistake still frequents my dreams.

And then, we’ll be GPs
Not ‘just’ GPs. Not ‘non-specialists.’ Specialists in primary care.
 
We’ve chosen to be one of the few remaining generalists. Not because we couldn’t be brain surgeons, or gastroenterologists or cardiologists, but because we chose not to be. Because we wanted patients who were awake and could talk to us, because we know that consultation skills are the heart of medicine. Because we want to treat bowel problems and neurological problems and heart problems, and everything else besides.
 
So, dad in the park, we’ll care for you and your family at every stage of life. We’ll provide contraceptive care. Not just ‘the pill’ – we can insert contraceptive implants and IUDs, too (some of us even do vasectomies).
 
If the time’s right, we’ll provide you and your partner with advice before conception, as well as first-trimester screening and antenatal care. We’ll carefully check your brand-new babies head to toe. We’ll vaccinate them against meningitis, measles, whooping cough, and more. We’ll treat their nappy rash, eczema, constipation, and ear infections.
 
We’ll manage risk and uncertainty to weave a safety net around you and yours. We’ll manage your anxiety, your sleep deprivation, your post-natal depression.
 
As your children hit their teenage years, we’ll manage their sporting injuries, their acne and their period problems, as well as sexually transmissible infections, mental health problems, migraine, asthma, and allergies. Day or night.
 
And you won’t need to ask for a referral letter, meet referral criteria or get insurance because we are the specialists that deal with all these problems. We’ll advise, educate, listen, and care. Sometimes we’ll prescribe, sometimes we will refer, but we’ll remain at the centre of your care.
 
We’ll steer you away from unnecessary, harmful, and expensive tests and medications while managing our precious stocks of antibiotics to protect our communities from antibiotic resistance.

Not ‘just’ GPs. Not ‘non-specialists.’ Specialists in primary care.

We’ve chosen to be one of the few remaining generalists. Not because we couldn’t be brain surgeons, or gastroenterologists or cardiologists, but because we chose not to be. Because we wanted patients who were awake and could talk to us, because we know that consultation skills are the heart of medicine. 

As the spine running through our healthcare system, GPs are dynamic and flexible. We respond to public health crises. We have adapted to work through pandemics, bushfires, and floods.
 
When other facilities close, or become telehealth-only, we’ll still be there. We can still see you face-to-face, through our face masks and misted face shields. We’ll test you for COVID and, if you have it, we’ll work with other specialists to assess your risk and manage you accordingly. And we’ll treat all your other illnesses and needs during COVID. We’ll still listen to your chest, check your ears, palpate your abdomen.
 
And as your body begins to fray as you age, we’ll treat your hypertension, arthritis, diabetes, atrial fibrillation, high cholesterol, and kidney disease. We’ll bring in a team of allied health professionals around you. We’ll work with you to manage your conditions as if it’s a meeting of specialists. You, the expert in your own day to day illnesses, and we, who specialise in managing it.
 
Our early preventive work may well save you from strokes, heart attacks, diabetic complications, influenza, shingles, pneumonia and more. We’ll help screen you and your family for cervical, breast and bowel cancer. We’ll do your skin cancer checks and remove suspect moles, lumps, and bumps. We’ll help you lose weight, stop smoking and reduce your use of alcohol and other substances.
 
If life takes some tough turns, we’ll still see you, regardless of your income or insurance. We’ll still treat you with respect and dignity if you’re homeless, depressed, substance-dependent or live with schizophrenia. We’ll listen without judgement, counsel and help you make safer choices. We’ll prescribe and manage your clozapine, buprenorphine, methadone, antivirals for hepatitis or PREP for HIV.
 
And as you enter the autumn of your life, we’ll still care for you. When your hair is white, your eyes milky blue from cataracts and your skin translucent and peppered with the blemishes of age, we’ll listen to what care you want and what you don’t.
 
If other specialists say you’re now too frail or too confused or too complex to come to their clinic, we’ll still treat you. We’ll help you with your dementia and your falls and your incontinence. We’ll handle your comorbidities and multiple medications and spot drug interactions and side effects. We’ll plan your end-of-life care and, when that time comes, we’ll care for you at home, if that’s what you want.
 
And we will care. Not in a commodified or profit-driven way but because we know you, your values, your family, and there was always something we liked about you – because there is in all our patients – even though you dismissed what we do.
 
When it’s over, we’ll embrace your wife and children, and we’ll sit and listen as they press tissues to their eyes. And one day we may care for your grandchildren, too, remarking on how alike they are to you.
 
And as we get older, we’ll pass on our specialist skills and knowledge and attitudes onto medical students and registrars. We’ll teach them to be proud of being specialists in general practice. We’ll help them to practise justly, and to provide care to everyone regardless of age, ethnicity, sexuality, gender, education, or income.
 
And we’ll teach them they are not, and never will be, ‘just’ GPs.
 
Yours,
The mum in the park who’s very proud to be a GP

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