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.

67f7caa11c6a92df0d63d283d90ddcd7

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.

fullsizeoutput_146b
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.

The Best GP Advice I’ve Received: Part 1

 

a688ed40801953-578dfce25d18a
(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.”

General Practice is not exciting, but it is fulfilling

c89fb6abd83261bdd15693fb042e1f49
By Lauren Squires, with permission. Click image for her Instagram.

As I enter into my third month of General Practitioner work, I find myself reflecting. I started with private GP locums to fill the gap til I got the job I wanted. But now I’m signing a contract and I’m here to stay – for at least another five months.

One evening, my housemate asked, “So, did anything interesting happen at work today?” When I responded in the negative, we laughed about how my work had become almost mundane compared to working in hospital and coming home with fascinating stories of grotesque injuries and life-saving surgeries practically every day. Continue reading “General Practice is not exciting, but it is fulfilling”

On Poverty and Health: The Obesity-Conundrum

rich man poor man slimmer man fatEver since I started running (and enjoying it), I have been intrigued by the sociology and economics of health and fitness. It coincided with my “coming of age” in medicine, so to speak, so it has been in interesting and ongoing thought-experiment.

I want to address some pertinent falsehoods about health and fitness, and why the disenfranchised have such a hard time of it. Right now I intend to write a two-part series, but who knows.

Quick disclaimer: I would never suggest that being a student-on-a-budget is comparable in hardship to living in poverty. All the same, being a student on a partial scholarship and a heavy student loan certainly did teach me a little about struggling financially and its effects on health. Continue reading “On Poverty and Health: The Obesity-Conundrum”

War, Latin America and Pre-Eclampsia: A History

One of the biggest ongoing studies in the developing-world Obstetrics is the Calcium and Pre-Eclampsia (CAP) Trial. The hypothesis is that calcium supplements prevent the development of Gestational Proteinuric Hypertension – but if you like history, where this idea originated is a wholly fascinating story.

preeclampsia Continue reading “War, Latin America and Pre-Eclampsia: A History”

The Ultimate Book at the Start of a New Era in my Medical Career [Review]

The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol

What I thought this book would be about:

Doctors are too paternalistic, patients know better than doctors, FREEDOM TO THE PEOPLE YO, doctors are obsolete, welcome our overlords the computers who will heal you now.

What this book was about:

The inevitable changes in medical science that give us the choice: adapt or die. (Spoiler alert: adaptation is usually the preferable option.) Awesome technology! Awesome ethical discussions! Incredible advancements! Medicine is NOT stagnant! Awesome peer-reviewed research!

*  *  * Continue reading “The Ultimate Book at the Start of a New Era in my Medical Career [Review]”

Healthcare for LGBT Patients in South Africa

In our third year, a friend of mine had an upsetting first shift in Trauma Surgery: the first suturing she ever did was on a young woman who had just survived corrective rape. Rape is common in our country in general, and so is the “corrective” rape of gender non-conforming women.

A year later, we saw a transwoman being place in a single room, because the hospital had no policy for what to do with her. She did not want to be in a male ward, but strong leadership was lacking and so a patient with no infectious risk was placed in a single room. It did not sit well with us, but we were fourth years. We did not know what we could do.

Tonight I attended a fantastic talk by Dr Alexandra Muller from the University of Cape Town on providing healthcare for Lesbian, Gay, Bisexual and Transgender patients: why we should care and what we can do better.

health lgbt collage Continue reading “Healthcare for LGBT Patients in South Africa”

World AIDS Day 2012: Getting to Zero

Today is World AIDS Day. If you have been following this blog, you will know that HIV/AIDS forms a very big part of my daily work, and that I am passionate about finding solutions to this multifaceted problem (because it’s about more than just a cure). You can click here to see my previous posts about HIV&AIDS.

The UN Global theme remains GETTING TO ZERO. Zero new infections, zero discrimination, zero AIDS-related deaths.

https://i1.wp.com/img.scoop.co.nz/stories/images/1211/wad_2012_design_with.jpg

Continue reading “World AIDS Day 2012: Getting to Zero”