‘As GPs, we can only try to give hope’

Nothing quite prepares you for the sudden death of a patient.
 
They share so much about themselves with us, information they may have never told anyone, that we inevitably end up feeling close to them.
 
In this way, being a GP connects you to people unlike any other career I can imagine. It is a privilege that comes with great responsibility, but also potential heartbreak.
 
Last week I found out one of my regular patients had suddenly passed away. This young woman, bright, smart, ready to face the world, had her life cut short for reasons I may never understand.

I’d been working with her almost since I first became a GP, and for the past 10 years, had gotten to know her family, her siblings, her friends.
 
She would come to me for her usual health checks and follow ups. But importantly, she would also come when things weren’t going well. This young woman was an example of how important the relationship between GP and patient really is.
 
We would debrief, problem solve and do our best to work on the best path forward. Like many other young people, she had her own battles and was a victim to some really difficult times in her life.
 
I used to tell her she was brave, and that she could handle it. And after getting through some of the hardest experiences imaginable, she started studying and working and making a path for herself.
 
Throughout the good times there would be weeks, sometimes months between visits. But when it was tough, I would see her weekly to make sure there was a chance to debrief and treat anything that was not going well.
 
Of course, the loss of a patient doesn’t only affect me, the treating doctor – it affects the whole clinic.
 
By the end, our whole team had gotten to know this amazing patient. Our nurses, the other GPs, our receptionists, all bonded with her and when her mental health was really poor, we would do our best to get the right help.
 
Unfortunately, this sometimes meant going to hospital, an experience she told me made her feel worse. Rather than be treated like a patient, she was generally put into an isolation room and managed like a prisoner.
 
She described staff peering through a window to check she was still in there, but said it was rare for them to actually check that she was ok.
 
I know patients can exaggerate and everything seems so hard when you’re unwell, but to an extent I still believed her – hospital ED is not an ideal place for someone who is mentally feeling vulnerable.
 
Not that I place blame at the feet of the hospital or its staff.
 
From their perspective, there is no time to handle a vulnerable teenager who was probably vocal and irritated, other than to contain and isolate for safety. To the hospital EDs, this was yet another presentation of the same thing – a stressed out, or drug induced, or drunk teen who needed a night of sleep and sedation.
 
Meanwhile, for staff, who see so many difficult and confronting patients, the lack of beds and other resources, combined with the need to deal with them reasonably quickly, would be incredibly challenging.
 
I still don’t understand why there’s no middle ground for times like this – a safe and comfortable environment that is not threatening, and not ED.
 
These settings aren’t designed well for mental health emergencies and so we vowed to avoid them wherever possible.
 
Instead, I wanted to build a team around her so we could share her care and so she had backup from multiple healthcare providers when times were tough. She had a psychologist, loving family and friends, but I felt it wasn’t enough.
 
I figured at this stage a psychiatrist was essential. I referred, and referred, and referred. I called, she called. We never got accepted. I remember getting letters saying her case was too complex, not suitable, or that the psychiatrists were all full.
 
I changed the referral to sound ‘less complicated’ but still didn’t get anywhere. I’ve never quite understood how psychiatrists screen patients, but I do understand that they, too, are at absolute capacity right now, and mental health services are in a state of crisis.
 
This experience, alongside many others I’ve had recently, has reinforced the role that we play for these patients.
 
Quite often, we are not only their GP, but also their psychiatrist, psychologist, social worker, friend – anyone who they might need at that time when they visit.
 
Sometimes I get to the end of a consultation and realise I’ve done nothing, just listened. No medication. No tests. No mental health treatment plan.
 
Our role is so dynamic and varied. So, while there is little I can do about the mental health system right now, I still feel that we GPs can give patients hope when they are lost and be a guiding light to better times ahead. We can only try.
 
Losing a patient I got to know so well has made this such a hard week.
 
We are taught to protect ourselves and not take on the problems of others, to not take work home with us – and all of these tips are important.
 
But there will be times in our career where it is simply not possible, and where we are deeply impacted because we cared so much, and did so much, that it is hard to let go.
 
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mental health suicide