. Like the general population, our GPs are aging and stepping back from general practice. The average age of retirement is 59.
Dr C is in his 76th year.
While affirming his decision, I still feel a sense of loss.
The relationship between a patient and doctor is unique. It involves vulnerability, trust and consent to poke and prod in the most private places. It also involves sharing intimacies, fears and secrets that may have not yet been disclosed to family or friends.
Dr C has heard all my fears plus opinions on conditions diagnosed at midnight when I couldn’t sleep.
Postnatally, I fretted about breastfeeding, lack of sleep and children’s illnesses. Later, it was overwork, OOS, and stress-related headaches. As I have aged, my fears have turned to high cholesterol, joint pain and the gene pool I inherited from my father who died at 59.
My concerns are fuelled by a propensity to fear the worst.
Anatomy books can help patients understand how the body works.
Ann Huston
I was convinced a scab on my back was melanoma, only to have it slough off in the shower. I also deduced ongoing stomach cramps were giardia despite not having accessed a contaminated stream.
“Am I what you term ‘the worried well?’,” I asked Dr C at my last visit.
He doesn’t like the term, which he refers to as “medical sarcasm.”
“Is the person with symptoms of non-serious conditions any less deserving than someone with symptoms of bowel cancer. Any visit is an opportunity to reassure, educate and advise people what is within a normal range.”
But he concedes it’s hard when people won’t accept there is nothing wrong despite a raft of tests and checks.
That’s when he will often bring out a book with illustrations of bones and internal organs to illustrate how the body works. “Using props sometimes helps to show how systems function and takes their attention away from that which they are fixated on.”
Some might call him an old-style GP.
He makes no apology for that. He became a general practitioner because he was interested in the whole being, rather than just parts that need healing. For some doctors, he says, medicine is the focus. “For me, it’s always about the person first.”
His appointments always run over time. That means he sees fewer patients (around 20 a day before he retired). But for the patient it is gold. My appointments have often included views on world events or on stories I am working on.
“I try not to keep people waiting too long, but 15 minutes is not enough time,” he says in his defence.
He has continued to make house calls. The last was the day before he left his practice when he visited a terminally ill patient
I ask him how he imparts bad news to patients. “Initially, you have to be able to put up walls while still retaining humanity. You have to be constrained to a certain extent. But, in the aftermath, you can be more human.”
This was how he told my husband he had prostate cancer more than 20 years ago. He also counselled my younger son about having regular checks after his older brother contracted the disease.
Knowing our family’s history has been crucial in keeping us well.
The research around continuity of care is incontestable. A University of Cambridge study l ast year (the largest of its kind)found seeing the same GP improved patients’ health, reduced doctors’ workloads and freed up millions of appointments. It meant people waited longer between visits, compared with patients who saw different doctors and patients took up less time in each consultation, particularly older patients, those with multiple chronic illnesses and those with mental health conditions.
And yet the trend now is towards practices where patients see any doctor available.
Dr Bryan Betty, chair of GPNZ, says given the evidence that seeing the same doctor leads to better health outcomes – especially for the chronically ill – he hopes GP practices will work towards systems where continuity of care is core. But he concedes there are challenges. “It’s not just cost. It’s also workforce. We don’t have enough GPs in New Zealand. A substantial number are due to retire in the next five to 10 years. We are under-resourced, which has led to the system developing as it has.”
GPNZ chair Bryan Betty.
Supplied
Dr C says making the decision to retire was not easy. “But it was time to spend more time with my wife and family.” (He has three sons and four grandchildren all living overseas). Leaving patients was much harder. “They taught me so much. Women patients particularly taught me how to listen. I learned from them that I don’t always have to fix things. Listening is the best medicine of all.”
He is looking forward to less paperwork and not waking in the middle of the night to consider if he has missed something or should have done something differently. “Your mind doesn’t really switch off.” If he sees a person limping, he will still wonder about the cause.
I tell him the thing I have valued most about our consultations is that they have never felt transactional. I have always felt like we are two people invested in the same good outcome. He looks a little teary-eyed. He’s had many of these conversations since the email went out to patients, some from multiple generations.
Then I ask him if he remembers being at my son’s birth. But the event has been lost in the annals of time and thousands of encounters with patients, including births. “Sorry,” he says. “It must have been a straightforward birth. I only remember those that had complications.”
It was, I say . But I’m pleased you were there.
