Opinion
Being a GP: What you do or what you are?
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
newsGP weekly poll
What is your chief concern with role substitution?