Since the beginning of the year, I’ve been working semi-permanently for a private family practice. More recently, I’ve also started doing shifts in the emergency centres of both private and public hospitals.
While doing each of these separately comes with their own challenges, doing them together has proven to be a demoralising combination, because they highlight the failures of each field, and our inability to fix them.
Being a good general practitioner is damn hard. The pressure to see patients quickly is high, and spending 15 minutes per patient is the norm. This means that a lot of health promotion cannot happen. It takes a while to counsel about smoking cessation, when the patient’s reason for visiting is a stomach bug. Perhaps you tell the patient to come back for a Pap smear (because her consultation time is up), but she never does, because she can’t afford another consultation.
And if you want to do health promotion in the waiting room, all the pamphlets are sponsored by some or other pharmaceutical company, so that becomes an ethical grey area.
Emergent patients come to their family practitioner because they don’t want to sit in a queue at the local hospital. The GP sends them to hospital anyway, and the patient has lost R350 (at least).
In the world of Emergency Medicine, we are often faced by the failures of primary care (in state or private). We see the effects of uncontrolled hypertension and diabetes. We get flooded by inappropriate “green” referrals or walk-ins, because patients are tired of not getting results from their GPs. And seeing these “greens” takes valuable time from the very sick patients. (There’s that “distribute justice” they spoke about in medical school.)
The Emergency Centre isn’t there to fix the myriad problems our patients encounter. So we take their bloods and send them to their primary care physician to follow up – on their cholesterol, their high blood pressure, their smoking, their lack of recent Pap smear, their obesity…
To add insult to injury, their is a strong mutual dislike between general practitioners and emergency physicians. Working these two jobs results in a huge cognitive dissonance for me, despite the insight it offers.
I am increasingly desperate to get a more permanent job in a state hospital, in a department I like. Please cross fingers with me.