Being a GP: What you do or what you are?

Gillian Riley

21/06/2019 1:11:51 PM

A long-time GP reflects on her relationship with her profession and asks the question, is medicine a vocation – or a job?

A life in medicine is often seen as a vocation, but that can bring a hidden toll.

A person at my son’s school recently asked me what I did for a living. I found myself saying, ‘I work as a GP’.
It’s an innocuous statement, but it made me pause to consider.
Because, not long ago, I would have said, ‘I am a GP’.
Prior to interviews for medical school, you are told that you need to have an answer for the question, ‘Why do you want to be a doctor?’
‘I want to help people’ is a cliché that you must avoid saying directly, but that’s what they actually want to hear.
The advice given to prospective doctors is to be creative and find a way to centre the patient in your response. Related: never, ever say you’re in it for the money.
Helping people. This is the narrative that underlies our work. The patient comes first. With that comes the expectation that we will work the hours we work, frequently without pay, and sometimes long past it being safe.
The wrinkle in this patient-first focus, of course, is the considerable mental health burden on doctors.
It’s hard to know why medicine in particular seems to bring with it such a strong enmeshment with personality. Some of it is probably that culture of being a doctor, rather than being employed as one.  Some of it is probably why we embrace medicine as a career in the first place. We who choose medicine, as a generalisation, seem primed to be those who will adopt it as an identity.
I did those medical school interviews 17 years ago and obviously said what they wanted to hear. I then dived into a soup of training, where to suggest that medicine was a job, not a vocation, was heresy.
I remember the consequences – when 16-hour days weren’t just commonplace, they were rostered. When overtime on top of that was not claimed because to do so was a sign that you simply weren’t good enough.
I later moved to rural general practice. Even there, the mentality persisted. The idea that I might want to see my young son was scorned:
‘I’m not covering her because she’s had a baby. I’m not her babysitter.’
So I stayed up all night and resuscitated other people’s babies while going home to breastfeed my own, then went to the rooms the next day because cancelling patients was just not done. Their needs were greater than mine. 
Their needs are always greater than mine.
Reflecting on those unnecessarily hard years of training is interesting now that I am secure in my career. Because now I can say that the reasons I continue with my general practice career are to do with money.
I do like my job. I like that I get to exercise my brain. I like that I get to be involved with learning about human beings who are, on the whole, fascinating, each with their own unique stories. Exploring their lives is challenging and never boring. Using my skills to help patients achieve outcomes they consider helpful is professionally very satisfying.
But I don’t like the pressure of the job. I don’t like the political interference. I don’t like the contractor lifestyle and the lack of super, sick leave benefits and the rest.
The reality is that there are many jobs I would enjoy in a similar way. Two things swing general practice for me.
First, there are few jobs with such a high degree of professional flexibility in location, type, and style of work and hours.
And, secondly, there is the financial aspect.
There are very few jobs where a single parent such as myself can work less than full time and sustain a good income, above the combined incomes of most Australian households. I am extraordinarily grateful for the safety it now provides my family.
What I have learned, in sum, is that medicine is just a job.
Like many, I learnt this heretical attitude the hard way. I had a bout of illness, one of those stigmatised illnesses that no one likes to talk about. It changed my perspective on what was important. After several years of therapy, I am now well aware that I can simply no longer use my job to derive a sense of identity. Or, more correctly, I will not.  
If we lived in a world where a person’s drive and vocation would automatically be their occupation, I would be an artist. But art does not pay the bills in this world. So I work as a GP.
It is not that I am not committed to my job or my patients. Far from it. It simply means I am also committed to myself.
In the patient-first mentality, I should be working 50-hour weeks and putting in unpaid overtime. I’m not supposed to be working half days or taking time off to go to school assemblies. Part-time GPs aren’t lucrative for practices. So goes the mantra.
But, you know what? Burned out GPs aren’t lucrative, either.
So, I’m not a GP. I work as one. Language is important.
I take my job very seriously. My patients are important. But it is exactly that, a job.
If I want to identify myself today it would be as a mum. As a friend. As a slightly deranged cyclist. As a keeper of chickens. As an amateur visual artist. As a student and writer of history. Oh, and someone who works as a GP. We are just as complex as those patients we see every day.
I would argue that we need to start teaching this type of self-care to our juniors from the start, alongside the ABCs, before they, too, buy into the dangerous idea that patient needs always outweigh their own.
We have to put our own oxygen masks on first.

identity mental health vocation

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Dr Elizabeth Lee Clark   22/06/2019 7:08:16 AM

Well said

Diver Bob   22/06/2019 7:11:30 AM

Brilliant writing. Thank you so much for putting your lessons learned into words.
I bet your patients say “she’s a great GP”.

Dr Heather Anne Stevenson   22/06/2019 7:19:30 AM

I do so agree.well said

Dale van der Mescht   22/06/2019 7:28:23 AM

Best thing I have read in these emails! Ive been saying this for years. PREACH!!

I like my job but I love my life the purpose of my job is to pay the bills and make money, this doesn’t mean I don’t try help and care for my patients, but when the clock hits 4pm, I am out!

Again, great article, well written and more true than most people are willing to admit!

Will Patterson   22/06/2019 8:51:52 AM

Brilliant, as it is, and down to earth. A GP’s life can be many things but for many, it is hectic, full of stress and foreboding. We look after the worried well while are family are in the midst of crisis. We have more guilt that catholic guilt and carry the world on our shoulders. I gave up on this many years ago and decided that General Practice is a business, you live and die on the high street selling your wares, patients do not miss you when you’re gone, from burn out, cancer or just ill health. The most important realisation for a GP is to admit they are human, that life is not eternal, and that the most important thing is family and relationships. If you structure your career around that, protect your relationships, leave your job at the surgery, keep control in all your aspects of your job including demanding patients, you may just survive. Patients are responsible for their health, not you. You can be their mentor, not their shoulder to cry upon.

Dr Mattias Faldt   22/06/2019 8:58:44 AM

Natuarally one agrees wholeheartedly with the article.
My only concern is the forum. Does any students or interns or young hospital doctors read this, where it truly would be beneficial? Once a VR GP most probably start looking after themselves a bit better (because they can, financially as well as less pressure from bosses/ training organisations etc)
Would be great if the author have a chance to publish this in other forums as well to benefit younger colleagues.
Dr M Faldt - GP registrar

rural GP   22/06/2019 9:20:06 AM

A well written article which states what we should all remember--you have to realise that you are in a business that will hopefully provide for your later life, and make your patients (?clients) realise it too. Forget Medicare rebates as being your income--my last patient (at 5pm Friday) wanted a driving assessment, BP check, referral to a medical oncologist, a separate letter to the oncologist wanting to ask if treatment could be carried out locally, and a series of questions about his lovely demented wife who is in a RACF. His eyebrows went up when I mentioned that this was a longer consultation but went down again when I said that I do have to pay my staff and I do have to run the practice as a business. He was in business and was able to retire at54 54!!

Dr Praveen Kallimath   22/06/2019 9:23:02 AM

Brilliant article. You definitely have a great flair for writing. Sometimes, found myself in the article.

Prof Max Kamien, AM   22/06/2019 9:34:05 AM

To Dr Will Patterson: Is a mentor the equivalent of 'an advisor in life'?

Dr Annette Hackett   22/06/2019 10:17:55 AM

Beautiful piece of writing, with sentiments that should be scattered amongst all medical people. Please keep writing - you have another activity you can add to your resume. I agree with Mattias - this needs to be made available to medical students and all those starting their careers - and to those of us who are somewhat older.

Rob Anderson   22/06/2019 10:42:36 AM

Excellent and all very true.
Good from MDA about boundaries. Tell neighbours friends I can either be your friend or your doctor, invariably they want to stay as your friend. Has helped me a lot in defining and limiting my working day.

Rachael (med student)   22/06/2019 3:53:28 PM

Hello! Just in response to some of the comments I wanted to say that this article is available to juniors (I am a final year medical student myself and we can subscribe to these newsletters) but agree it would be wonderful to disseminate in a more student-focused forum.

Thank you for this piece of writing. Rural general practice is where I think I am headed myself. When I first started reading I felt taken aback and slightly uncomfortable with the idea that medicine is like any other job which provides an income, but you write beautifully and I think you have conveyed your message well. This is really interesting and certainly something I will reflect on. I think a lot of my peers would benefit from it too - including those who are keen to pursue some incredibly demanding pathways such as orthopaedic surgery, ICU etc.

Well written and interesting to read the comments.

Dr Pamela Judith Hendry   22/06/2019 5:52:44 PM

Thank you for sharing these insightful words of wisdom born of experience. I hope the RACGP and others do provide a forum for GPs to share such reflections with all age groups, both junior doctors contemplating a GP career and also those of us already clinging to the coal face. It shouldn’t require a serious personal health crisis to grant us a “get out of (GP) jail free” card and permission to continue working in a privileged profession with a healthier fresh perspective. Physician heal thyself and lead by example in caring for ourselves as a priority when caring for others.

Dr Jitendra Natverlal Parikh   22/06/2019 8:43:34 PM

We all are different. I a. on the interview panel and have heard all these spoon fed answers I think that I can still pick up so called liars quickly due to training Going back to what we arse discussing it is vital thet you enjoy and are committed.Money weill come without worrying too much.What is vital is maintaining excellent health and happy marriage and family.Rest is fine.I have survived over 40 years and still enjoy every bit

Dr William James Patterson   25/06/2019 3:56:04 AM

Hello Max. Very good to hear from you and as you probably know, I would hesitate to give anyone advice on their life choices, especially regarding their health, as I'm a firm believer that we are all responsible for our own decisions, accept ownership and live by them. That way we can avoid the victim mentality that seems to permeate the breadth of General Practice where someone else is to blame for predicament. In contrast, I would view mentoring as the provision of supporting information that facilitates decision making, for good or for bad, most often in the context of motivational interviewing. It's about expanding the range of choices for patients that want to learn more but not coming down on any one side or the other. I guess you'd support this approach and concept. With best regards, Will Patterson

some other doctor/GP   25/06/2019 4:09:39 PM

Definitely IT IS JUST A JOB, but with this kind of job it brings us very close to aspects of humanity we may find to be traumatic and naturally difficult and stressful to deal with, just as what would a first responder, police officer, soldier, social worker etc sometimes deals with and may be different to what say an astronaut deals with perhaps (may be just as stressful and difficult)... the job itself and our patients, and tradition of it all keeps us thinking that it forms our identity - this culture within the profession sometimes engrosses some of our lives and it is hard to step away and define ourselves differently and mentally compartmentalize it as just a job. I think it is healthier to define it for yourself as it being just a job... Many jobs come with ongoing learning, CPD etc and many are stressful and have long hours. It is not that different from many other jobs.

Lucy Rowlands   29/06/2019 8:36:18 AM

Great article! Well done

Yehia EL-BAKY   29/06/2019 8:38:08 AM

The most important lesson of this beautiful article that your patient will not miss you when you are not around
You need to look after yourself first, second and third

Susan Davis   29/06/2019 12:47:01 PM

Great article! Well done.
After 34 years in practice most of it part time to cater for family commitments I agree .
I still say I am a GP but since becoming a contractor it has seemed more appropriate to say I work as a GP.
It is still a substantial part of my identity though wife and mother and mentor are also part of that identity.
I still enjoy the patients and their stories but the changing technology and management demands do reinforce it is a job.
To help people was always the intent.

Dr Marlene Wessels   29/06/2019 1:19:58 PM

Well said and entirely true.But patients do remember you ! I left a practice 20 years ago after working there for 10 years. Great was my amazement when I met a current partner in the practice that said "hey patients still ask about you, how are you?" It brought tears to my eyes,so all the happiness ,sadness, delivering of babies ,walking the road to the end with cancer patients where in fact worth the incredible EFFORT it took to be a good GP. Thank the Lord for giving me the chance and the ability to have made a positive change to a few lives on this earth.

Dr Doug Mckenzie   29/06/2019 11:24:09 PM

You're right....Over 30 years, General Practice has been transitioning from a profession to a service industry , where the customer should feel satisfied lest they not return and visit the local bulk-billing clinic. With an hourly billing rate less than half of a junior solicitor, dentist or accountant the future is not promising, but your stress levels will increase.

Dr H Ross Jenner   30/06/2019 9:21:54 AM

Well said Gillian.

I agree with every word of your article.

If we die young for mental or physical reasons, it does no good to our families, our friends, our patients or ourselves.

Take care.

Ross Jenner.

Deborah Sambo   1/07/2019 12:23:36 AM

Last year I presented a talk on behalf of the RACGP QLD council to Police women and men including their spouses who are on the cusp of retirement.
One of my opening lines was " who are you without your uniform or your badge?"
Are you your work?
Does your work define who you are?
Who are you without your work.
I gave them time to ponder these questions.

Most of us think our identity is in our work.
When that identity ( work) is removed or no longer there what next?

Many of us find ourselves lost and without a purpose and without identity and so on on and so forth.

It made for a very interesting discussion especially around MH etc
Off course we went on to talk about other physical issues and necessary checks and preventative activities.
We as GPs need to have and identity outside of work.
General practice is a job we do but that should not define who we are as human beings.

Gillian riley   1/07/2019 7:07:56 AM

Thank you everyone for the kind comments.

I wish only to make a comment regarding one statement from Dr doug mckenzie that General Practice “with an hourly billing rate less than half of a junior solicitor, dentist or accountant...”

I would remark that these figures are exceedingly untrue, that while there has been a downward pressure on our incomes so too have other professions suffered and we at least unlike them have a safety net of the MBS.

I genuinely understand the frustration but I do wonder if it is helpful to make these kinds of comparisons, particularly when they are untrue.

The reality as I remark is we are still lucky compared to many Australians with regards to our incomes. Wage suppression in Australia is not just confined to general practice.

gavin   6/07/2019 3:05:49 AM

Much respect for the hard work, comittment shown due to long hours etc, I applaud doctors who show a general ability in building a trust and providing geniune support for there patients,no question tough.In saying so your not the only industry under pressure.Whilst many of you are noticeably geniune,seems alot are not and the public are the ones suffering cause some doctors are only in it for the money.If you dont agree this is the case,maybe take a look at the possibity like alot of industries that maybe you constantly pick up the slack for those who take their position less serious,& very cautious covering up there lazyness,lies and malpractice towards certain, some,maybe all patients...for simply none other than $$$$$,and pay no attention towards a patiens feelings.If hours are conflicting then one thing id suggest is pay more attention in reducing the thousands of patients (that prolong your lengthy days)having surgery etc due to malpractice & misdiagnosis.

Umm..may be not.   17/09/2019 12:58:38 PM

Each to their own, but sounded bit like knee jerk response to me, or may be I am a bit different - Well, not totally different, because I also identify as being a parent, a friend, a writer, etc, but I am also a doctor too, not just work as a doctor. Yes, I went through that period too, when i felt medicine was consuming me too much and burning me out, so I gave it up for 8 years - did other things over those 8 years, which gave me more control on my time, more money, power, fame, fun, freedom ( I was able to spend enough time on golf course to bring my handicap down from 32 to 10!) - but then I returned to medicine, because I realised that I was a doctor too! I am part time GP, but if I have time and energy, and I can provide medical help to someone who needs it when I am not in my clinic, or when my "paid" clinic time is over, I don't refuse it on the basis that I am not working as a doctor at that moment. Why? because I don't just work as a doctor - but I AM a doctor too.