Why I left private practice for the public sector

Some of the greatest psychological stressors are said to include breakups, death, moving house, and starting a new job. Sometimes we choose one or more of these willingly, and hope to hell that the payoff will be worth it.

For two years, I worked in private general practice in Cape Town. The benefits of this kind of employment were sizeable – I made a living on relatively few hours, and had no overnight calls. I got to sleep like a normal person! I had a flexible schedule, and could always increase or decrease my hours as necessitated by my needs.

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The cons, however, were not insignificant. Any leave I took – sick leave, vacation, or for a course/conference – was unpaid. I was paid by the hour (and that has affected my taxes, too). I was often the only doctor at a practice, sometimes one of two. The patient-pressure was immense – I never managed to get a grip on seeing 4-6 patients in an hour. I simply was neither able nor willing to compromise patient care, nor my medico-legal accountability.

On the other hand, I did get to live in Cape Town. Cape Town! Although the city can be scary and inhospitable to newcomers, there is so much to do. I could never tire of it. As Murphy would have it, I made a lot of friends and found communities to slot into during the final few months.

But why did I ultimately decide to pack it all up, and move AGAIN?

Because I was miserable.

I am not going to unpack that misery now (maybe another day), but I soon found myself completely out of love with my work. I missed the sense of a team. I missed being able to discuss cases with colleagues, and having someone with whom to commiserate. I missed the somewhat academic environment of public hospitals. I care a great deal about primary healthcare and public health, but I found that I was swimming against whitewater rapids, and treading water was becoming more difficult by the day. Although I wasn’t working very many hours, I found myself constantly low and tired. Often, I would delay leaving for work until the very last minute, and then arrive late. My career seemed hopeless; I felt heavy and inert. 

In short: I hated my job.

I do not use that term lightly. In previous jobs, I had certainly had days when I hadn’t particularly enjoyed working. This was not that. Hating my job is probably one of the worst things that has ever happened to me, and unless you have experienced it, you cannot begin to imagine it (I certainly could not). I have very clear memories of LOVING being a doctor before, so I know that this had little to do with my profession, and more with the direction I was taking and the environment I was in.

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And now I get to work scrubs to work every day!

So when the call came to offer me a job in anaesthesia, the scales weighed heavily in favour of the new job. There was the matter of the city and the people I would be leaving behind – and I did not make that decision lightly. Ultimately, being unhappy at work was negatively impacting on all spheres of my life. I had to get out, or it would kill me.

And so, I said yes. I packed all my belongings for the fourth time in three years, to move to a small city with significantly fewer resources.

But I think I am happy here. I have completed two months of supervised work, and I am starting to have my own independent theatre slates. It has been extremely high-stress, and my confidence has on numerous occasions hit the very bottom of rock bottom. I often fall asleep on my couch in the early evenings, because my brain feels so fried from all the mental exertion.

But I love my job again.

And I cannot begin to explain what a game-changer that is.

My Advice for Your ComServe Application

It’s almost time for the asynchronous community service applications in SA, and shortly thereafter the regular applications will begin. So I thought I’d take a break from dispensing medicine, and dispense a tip I could have used:

Apply somewhere that is going to challenge you.

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Zithulele, Eastern Cape, where I went in my final year for Family Medicine. A fantastic Community Service option.

Apply somewhere that you will be expected to work with a reasonable level of independence. Probably the best place to do community service, in my opinion, is somewhere that you can do emergency medicine, or at least your overtime in emergency medicine. Yes, even if you don’t want to do EM in the long run. Continue reading “My Advice for Your ComServe Application”

Read This Book: In Shock by Rana Awdish

“If empathy is the ability to take the perspective of another and feel with them, then, at its best, the practice of medicine is a focused, scientific form of empathy.”

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For the past few days I’ve been devouring In Shock in every spare moment I could find. In her narrative, Awdish recounts the experience of severe illness and near-death on the background of being a physician herself. She shares almost “crossing over”-esque insights into how and why medicine is failing its patients, as well as its doctors.

In Shock is definitively part-memoir, succinctly conveying the many complexities of Awdish’s illness and survival. True to its intention, it avoids the traditional stiff-upper-lip clinical retelling, and allows for range of emotions experienced by the critically ill individual. It is a narrative not looking purely outwards, but also in. What Awdish distills from her experience is both poignant and pragmatic.

“Illness is viewed as an aberrant state. It is a town we drive through on a journey home, but not a place to stop and linger.”

In Shock is about medicine’s broken telephone. It is about our inherent, but often unintentional, disrespect for patients and ourselves. It is about seeking comfort in the wrong ways, and about righting our bad medical habits. Continue reading “Read This Book: In Shock by Rana Awdish”

General Practice and Emergency Med: A Bad Combination

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. Continue reading “General Practice and Emergency Med: A Bad Combination”

Tips and Tricks: Planning Your Elective [Part 1]

Screen Shot 2018-11-20 at 14.17.59Since I’ve kind of started paying more attention to the blog again, my friend Caroline asked me to share some tips on electives. (Hi, Caroline!) You may remember the elective series I ran a few years ago. I haven’t exactly stopped the series, I just am not really in the position to seek out medical students for interviews anymore. (Guest posts welcome, hint-hint, nudge-nudge.)

I’ll give as much advice as I could gather from myself and friends, over a few days. Today, I’ll start off with the process of choosing your elective.

Disclaimer: This will be written with South African medical students in mind. For international students, note that some things might not apply to your program.

First: Start. Early.

If you think you’ve got plenty time, you’re wrong! I have a colleague who went to Oxford for her elective, and she booked her space for the program more than a year in advance. If you have a holiday between exams and rotations, use that time. Do not rely on the hope that things will just fall into place. (I speak from experience.) Continue reading “Tips and Tricks: Planning Your Elective [Part 1]”

The “Good” Intern

The October issue of the South African Medical Journal (SAMJ) published an article, ‘Going the extra mile: Supervisors’ perspective on what makes a ‘good’ intern (De Villiers, Van Heerden, Van Schalkwyk). The paper assesses the opinions of supervisors on interns’ practice readiness, which differs from most research on the subject, which has predominantly researched the interns’ own perception of their preparation.

The study reported on the results of interviewing 27 intern supervisors – a small, but diverse group of consultants, registrars, and medical officers.

What stood out for me was that the interviewees displayed a keen awareness of the challenges faced by interns. They recognise three areas of particular difficulty: transition from student to doctor, adjusting to a new environment, and long/hard working hours. Continue reading “The “Good” Intern”

Anatomy: my big mistake

I had a little giggle to myself while charting the notes of a patient with shoulder pain the other day. Specifically, I was thinking of this post of yore, and my belief that I could get by just knowing what anatomy looked like, and not necessarily its various descriptions and qualifiers.

Boy, was I wrong. (And young. And obstinate.)

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Image via dentalbuzz.shop

Continue reading “Anatomy: my big mistake”

The Best GP Advice I’ve Received: Part 1

 

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(c) Simon Prades

The night before my first shift in general practice, I frantically messaged one of my doctor-heroes on Twitter (@sindivanzyl). I think I was hoping for a cheat sheet, something about hypertension and diabetes, but the one thing she emphasised was, “Please, please, always examine your patients.”

For medical students that would probably sound absurd. Duh, how can one not examine the patient? 

But I learned quickly that, in an environment where there are always more patients to see, it is sometimes easier to make a quick observation from across the desk than to do as we have been taught. Continue reading “The Best GP Advice I’ve Received: Part 1”

Doctor. Counsellor. Freedom Fighter.

She was a healthy young woman who came to see me for a “complete check-up” before a holiday overseas. Although I tend to think “complete” check-ups are somewhat overkill, they do present a good opportunity for health promotion and disease prevention. As one does, I asked about sexual history and family planning. She hesitated just a split second before answering, “Well, my only partner is a woman, so I don’t have to worry about pregnancy scares.” And then, we moved on.  Continue reading “Doctor. Counsellor. Freedom Fighter.”