Not that long ago, the family doctor was a cottage industry. Many GPs worked solo from a dedicated clinic attached to their residence.
That was my way of life for over 30 years, and I enjoyed the informality and low practice expenses. If a patient was late, I could go out and pull some weeds from the garden.
The other standard model was for two or more doctors to own a practice in partnership. Either way, the community knew who the doctors were and their particular interests. Dr Stork might be good at pregnancy and birth, but Dr Pelican was good with cardiac and diabetes. For drugs and mental health, patients gravitated to Dr Bamboo.
Most doctors would have a regular round of home visits also, fitting them in at the request of the local hospital while on call. It could be interesting. I recall answering a home visit request on the weekend from a woman with kidney pain. When her husband unexpectedly came home, he assumed I was visiting his wife for all the wrong reasons. In a fit of misplaced jealousy, he pulled out a knife and I had to run for my life as he chased me down the stairs to my getaway car. After that incident, I learned to always park in the escape position.
Home visits are less common today. Convenience and security are an issue. But the home visit allows the doctor to be a medical detective. A quick squiz in the fridge speaks volumes about nutrition in family life. The bathroom cupboard could be scary, a jumble of coloured pills providing evidence about the patient’s compliance and competence.
The modern doctor more commonly works under time constraints imposed by corporate employers. This shift has changed the landscape of family medicine. Doctors are not so much in charge, and medical treatment is more slanted toward the profit motive. Everybody knows about waiting for the doctor, sometimes for weeks. Getting ‘on the books’ with a practice can help if you ever do need help in a hurry because you belong.
In retirement and with increasing age, my role has shifted from being a doctor to being a patient. I wouldn’t say I like the less personal style, the white windowless row of rooms of today’s standard in consulting room architecture. But it is what it is, and I must adapt to a reverse doctor-patient relationship. But after conducting thousands of consultations, I do have some idea of not wasting the doctor’s time by rambling on and the importance of forward planning for the consultation. An experienced patient gave me his impression of the doctor’s attention span. ‘For the first problem, you get full attention, then about 50% for the next thing. After that, the doctor is wondering about the next patient.’ An insider’s view.
Nowadays a person is lucky to get the same doctor for follow-up appointments. Doctors in training rotation are here today, gone tomorrow, but computer practice programs can smooth this problem, as notes from the previous doctor on the screen can help the next one pick up the threads. And if there is another doctor in the practice who suits you better, no one takes offence or will even notice. A patient once told me she had a doctor she kept for essential things. She did not want to ‘use up the good one.’ For scripts and easy routines, anyone would do. It seemed a bit weird, but I got the point.
Another case amplifies a vital point. A friend told me of her consultation, ‘When the doctor said cancer, I don’t recall anything after that.’ If there is a takeaway from this article, especially for a consultation involving decisions about operations and treatment, take along a trusted friend or relative. That second pair of ears can pick up things the anxious patient may miss. At a subtle level, the presence of two people can balance out the invisible power structure, after all, the patient is a supplicant on the doctor’s territory. There is always an extra chair at the desk, and no reasonable doctor could object, but beware – some receptionists are fiery dragons protecting the boss. If this is your plan, don’t get separated between the waiting room and the inner sanctum. Asking permission may invite the response,’ We’ll call you in if we need to.’
There is much more to discuss in making the health system work for you or your family, about specialists, hospitals, emergency, vaccinations, bodywork and ancillary services. It can be a maze.
Dr Atul Gawunde, in his book ‘Being Mortal’, reckons that podiatry is an essential service for older people because a good pair of feet enables more activity. Health is not just about what others can do for you but about what you can do for yourself. You can’t deputise someone to take your walk. Moving the legs is as beneficial to the brain as solving a crossword puzzle. Socialisation, nutrition and sleep hygiene, so essential in maintaining health, are up to the individual. It is motivating to have a regular physical routine. There is such a wide choice of activity, you should be able to find something you like – circuit training, qi-gong, pilates, biking, walking, swimming, singing, dancing or the gym. For best results, you have to be your own doctor.
I recall a GP at a conference who remarked that the patients like ‘to feel they have a friend walking beside them.’ If you have a GP like this, you have found a great treasure.