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.

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.

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Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps. Continue reading “Global Day for Safe and Legal Abortions”

Are We Secretly Our Own Worst Enemies?

If you’ve been reading South African news, you’ll know that at least 300 interns and community service doctors stand to be unemployed next year, due to a lack of funded posts at accredited institutions.

Perhaps you read about our inhumane working hours last year.

Perhaps you have read about the overflowing hospitals where patients pile up in the corridors.

These are not new problems, we just hear about them more because doctors and patients have phones with cameras, and social media accounts.

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Continue reading “Are We Secretly Our Own Worst Enemies?”

The Threat of Fun-employment

In final year, we thought that getting an internship post at our desired hospital was the hardest – and most coveted – thing.

Two years later, we all tried to find a community service posting that would give us a foot into the door to our future specialties.

But we didn’t know that those were the easy parts. Then, we still pretty much had guaranteed employment (most of us, at least).

Then came the end of Community Service, and reality hit us in the face: we were on our own.

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That’s where I am now. The government no longer “owes” me a job, and unless I find one, I’ll be unemployed come January 2018. People used to say, “There’s no such thing as an unemployed doctor.” These days, there are plenty of them, because freezing posts is a done thing. Continue reading “The Threat of Fun-employment”

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”

My Evolving Opinions About Doctors’ Working Hours

I started working on this post two days ago. Since then, I have received news of a colleague who died in an accident while driving post-call. She went to my alma mater and graduated last year, and though I did not know her personally, my heart breaks. A country with a shortage of doctors has lost a young doctor who was just starting in her career. She was well-loved, and we will all feel her absence.

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 * * * Continue reading “My Evolving Opinions About Doctors’ Working Hours”

Threatened By The People We Serve

A few weeks ago, the community around one of the hospitals where I work picked up their torches and pitchforks (well, sort of) and protested again. I’ve written before about South Africa’s protest state of mind, and about working during a riot.

As it stands, when this specific community protests, they protest right outside the hospital. No matter the reason for protesting, they block all entrances to the hospital and threaten anybody who tries to circumvent them.

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Police told us to turn around. We called our superiors. They told us to come to work. Continue reading “Threatened By The People We Serve”

Unrealistic YA Fiction Is Not Such A Big Problem

Young Adult fiction treads a fine line. On the one hand, it needs to be in touch with its audience. YA readers want to see protagonists who speak realistically, eat realistically, and act realistically.

On the other hand, reading offers us the opportunity to live different lives; to travel to places and settings and adventures that we may never have, and very few people want to read about a normal, boring setting. (Although I am told that Patrick Ness’ The Rest of Us Just Live Here addresses this very well, I’ve not yet read it.)

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Not the topic for this discussion, but I do want to read this book.

Continue reading “Unrealistic YA Fiction Is Not Such A Big Problem”