Something Only Family Physicians Experience

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I had such a lovely experience last week. I was working Accident and Emergency overnight, as I have finally completed my surgical posting and moved on to Family Medicine.

A mother brought her nine-month old baby in with a chronic cough. Now, it was probably the happiest baby I had seen all night and probably could have just waited to go to the clinic the next day, but whatever: she was there, so I saw her.

In among the questions of TB, smoking relatives, and pets, I asked if Baby was born term, and how. Her response, “Yes, he was a big baby! You did my Caesarian Section!”

pediatrician-and-baby

I checked the baby’s date of birth, and correlated it with my call roster during obstetrics, and  I had indeed been on call at this hospital on that night.

How cool is that?!

It was a happy and healthy baby. No HIE. No CP. No missing ear from my scalpel!

I had the opportunity to carry the child around because he handled so well, and while they were there, the nurses all jokingly call him “Doctor M’s Baby.”

I looked through the vaccination record with Mom and noticed that Baby was behind. In this area, many children are looked after by their grandmothers during the week, and this was the case here. Granny had either forgotten, or was too exhausted from looking after her grandchildren. Mom promised that she would go to her clinic in the morning to catch up on vaccinations, and although there is no way to know for sure, I think she did.

It was such a fantastic experience catching up with a child whom I had delivered. I had seen his late decelerations on CTG, I had consented Mom to the C-section, and I (with some help) had delivered the child. And now I got to see him and his mother again.

It’s a rare opportunity, really; and I think the only doctors who get it are the interns who rotate every four months, and the true family physicians.

I don’t want to be a GP who sees strep throat all day, and has no real continuity of care.

I feel like the world of medicine has really disempowered general practitioners. Why do I have to go to an OBGYN to get a Pap Smear and a Copper T? I know how to do it – gosh, a fourth year medical student knows how to do it.

For that matter, why do all paying patients go to an OBGYN to have their babies delivered, when again: it is something that interns do for public patients all the time. Of course, I am talking about low-risk patients here. If I had a high risk pregnancy I would hasten myself to a specialist, too.

But the only South African family doctors who still get to do this – deliver babies, do Pap smears, perform childhood assessments, and so on and so forth, are those in the very very rural areas of our country.

In the rest of the country, medical care has been so fragmented into specialties and sub-specialties that it’s hardly any wonder that our patients suffer under polypharmacy, and miss appointments because they have SO MANY to remember!

When my aunt died, the pastor remarked what a privilege and a tragedy it was that he was there for her Christening, her wedding, and ultimately her funeral.

I want that kind of continuity of care with my patients; but I just don’t think I’m willing to spend my life in a one-horse town for it.

 

6 thoughts on “Something Only Family Physicians Experience

  1. ncoow this is soooooo sweet I guess u should have gave the kid a second as ” Megz ” lol o b his god mother … inspiring post thanks barefoot

  2. Wow. That is cool. I bet it was cool for the mom too!

    It’s the same in Canada by and large even though it’s all public case here. You can’t find a handful of family practitioners who deliver anymore in any big cities. In part it’s because the premiums for coverage if you do deliveries is so disproportionately high (because payouts for “bad baby cases” as we call them in medical malpractice defence) can be radically higher than in many other practice areas (general surgery being another higher risk qua higher premium practice as you can imagine). So I blame it on part on the fragmentation of the medical *industry*, in part on the industrialization (good old division of labour!) of medicine and in part on the cost of “insurance” for high versus lower risk practices.

    • I had a feeling you would have something valuable and insightful to say on the topic, given your background! Thank you. I agree with you. Even in South Africa, insurance for doctors who do deliveries are incredibly high (though strangely, not for interns, yet we do so many solo deliveries). I find it sad, in part for personal reasons: I love delivering babies, but I don’t really have a desire to be an OB. My grandmother’s GP delivered all three her babies, and when she had a life-threatening heamorrhage with the third, he operated on her, and called in the Gynae while he was opening her up. He also performed any basic surgical procedures the family needed, and they speak so fondly of him.

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