Today in Melbourne, Australia, I had the chance to spend a day learning from the experienced and compassionate clinician Dr. David Ringelblum of the practice Wellness on Wellington. [More about my trip to Australia soon in other posts.] Here he talks about what makes a good GP, or as we say in America, family practice doctor.
I have recently elebrated my 15th anniversary in the same practice. Apart from pondering on the long-service leave that I would be entitled to in most other settings, but which seems mysteriously absent from my life as a practice principal, it also has been an opportunity to reflect on my concept of being a GP.
During my first term in general practice as an FMP (Family Medicine Program for those who missed that era) trainee, I spent three months learning about item numbers, the blue book (which is now the yellow book) and the management of common presentations. They had to be awfully common presentations because in the space of a three month term nothing that was uncommon presented often enough for me to recognise or review.
Nevertheless, that taste of general practice was enough to set me on my career path, and in my brash naivety, think that I knew what family medicine was about.
Fortunately, though I left the practice to do a term of geriatrics, I was asked to come back two or three nights a week to do a few hours helping out during the winter rush. (No provider number hassles in those days!) I got to see a few families more than once; started to even recognise a few faces and names, and felt that now I had a true understanding of what being a GP would entail.
Fast forward past a few more hospital terms, another couple of two and three month GP stints and a trip overseas. I returned to my “home practice” to do what would now be called subsequent training. I spent 15 months learning from wonderful role models and from tolerant patients. I even developed enough of following of patients to make me think I could make it out in the world on my own. After a year in the same practice, I felt now I really knew what being a GP was about.
So I found a smaall group practice, and talked my way in. I spent a year getting back to the level of familiarity with the patients and neighbourhood that I had had in my previous iteration, and again felt the flush of confidence that now I was a GP.
But a funny thing happened over the next few years. I started to put together parents and children. Family history became more than just a routine question – I could see patterns of illness repeat across the generations. And I could see how a child’s illness impacted on the parent’s health, or how the disease of a parent affected the child.
After 5 years, I recognised how much more profound was my appreciation for the depth of General Practice. This, I thought, is what it means to be a family doctor.
Another five years passed. Families moved in, grew and some moved out. Relationships formed and split up. Gradually a new set of connections fell into focus. I recognised adult siblings with different surnames, but with the same matriarch (rarely, upon reflection, was it a patriarch). Illnesses, patterns of behaviour, similarly dysfunctional families spread across three or four generations and with multiple branches. Watching children grow up and turn physically, emotionally and behaviourally into their cousins, their aunts and uncles, their grandparents. I heard both sides of marital breakdowns; sympathised with both the Hatfields and the McCoys.
The connection between individual and family had long been clear to me. Now it was about the relationship between family and family; between family and community. At last, I pondered, this is the true meaning of being a GP.
And now, after 15 years, I have a different view altogether. Being a GP is not about the length of time one works in a practice, or even how long one provides scripts and referrals for a family. All that is necessary, but far from sufficient.
You become a GP when a family suffers its second major health crisis. The first crisis is not enough – that is when they turn to you not knowing who to turn to. But see a family through one calamity with skill and compassion and the nature of the relationship will change. Upon their second misfortune – real or perceived but real enough to them – and they will turn to you not in hope, but in confidence. “Our doctor will see us through again”.
Thus does one become a GP – not through the passage of time, but through the passing of crises; one extended family at a time, until you build a practice of those whose lives you have touched at their most vulnerable moments. Then you can call yourself a Family Doctor.
That at least is my theory for now. Ask me again after I’ve done it for another five years.
During my first term in general practice as an FMP (Family Medicine Program for those who missed that era) trainee, I spent three months learning about item numbers, the blue book (which is now the yellow book) and the management of common presentations. They had to be awfully common presentations because in the space of a three month term nothing that was uncommon presented often enough for me to recognise or review.
Nevertheless, that taste of general practice was enough to set me on my career path, and in my brash naivety, think that I knew what family medicine was about.
Fortunately, though I left the practice to do a term of geriatrics, I was asked to come back two or three nights a week to do a few hours helping out during the winter rush. (No provider number hassles in those days!) I got to see a few families more than once; started to even recognise a few faces and names, and felt that now I had a true understanding of what being a GP would entail.
Fast forward past a few more hospital terms, another couple of two and three month GP stints and a trip overseas. I returned to my “home practice” to do what would now be called subsequent training. I spent 15 months learning from wonderful role models and from tolerant patients. I even developed enough of following of patients to make me think I could make it out in the world on my own. After a year in the same practice, I felt now I really knew what being a GP was about.
So I found a smaall group practice, and talked my way in. I spent a year getting back to the level of familiarity with the patients and neighbourhood that I had had in my previous iteration, and again felt the flush of confidence that now I was a GP.
But a funny thing happened over the next few years. I started to put together parents and children. Family history became more than just a routine question – I could see patterns of illness repeat across the generations. And I could see how a child’s illness impacted on the parent’s health, or how the disease of a parent affected the child.
After 5 years, I recognised how much more profound was my appreciation for the depth of General Practice. This, I thought, is what it means to be a family doctor.
Another five years passed. Families moved in, grew and some moved out. Relationships formed and split up. Gradually a new set of connections fell into focus. I recognised adult siblings with different surnames, but with the same matriarch (rarely, upon reflection, was it a patriarch). Illnesses, patterns of behaviour, similarly dysfunctional families spread across three or four generations and with multiple branches. Watching children grow up and turn physically, emotionally and behaviourally into their cousins, their aunts and uncles, their grandparents. I heard both sides of marital breakdowns; sympathised with both the Hatfields and the McCoys.
The connection between individual and family had long been clear to me. Now it was about the relationship between family and family; between family and community. At last, I pondered, this is the true meaning of being a GP.
And now, after 15 years, I have a different view altogether. Being a GP is not about the length of time one works in a practice, or even how long one provides scripts and referrals for a family. All that is necessary, but far from sufficient.
You become a GP when a family suffers its second major health crisis. The first crisis is not enough – that is when they turn to you not knowing who to turn to. But see a family through one calamity with skill and compassion and the nature of the relationship will change. Upon their second misfortune – real or perceived but real enough to them – and they will turn to you not in hope, but in confidence. “Our doctor will see us through again”.
Thus does one become a GP – not through the passage of time, but through the passing of crises; one extended family at a time, until you build a practice of those whose lives you have touched at their most vulnerable moments. Then you can call yourself a Family Doctor.
That at least is my theory for now. Ask me again after I’ve done it for another five years.
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