What most of our work is about.
As general practitioners we provide complete care to individuals and families. This means that we must be able to address any medical problem the patient brings to us- which means in turn that we must have a deep understanding of physical and mental health problems and the family and social environments in which they occur. And that is why training a fully qualified GP in Australia takes around 8 years.
Patients come to us with a huge range of symptoms: loss of appetite, fatigue, abdominal pain, muscle cramps, dizziness, swelling, sweats, chills, anxiety, headache, tremor, blurred vision, diarrhea, indigestion, nausea, palpitations, cough, itching, rash, pelvic pain and so on and so on. The root cause of these symptoms is very often not at all clear. So we need to be skilled at excluding the irrelevant or misleading and cutting through to the core problem, using the best medical evidence and our years of training as our guide. Often we find that we have to treat problem complexes rather than a single, identifiable disease.
In many cases, we are able to diagnose and treat a patient’s illness ourselves but we must also know when we should refer the illness to somebody else for diagnosis or treatment. This requires an understanding of all the elements of the health system so that we can refer patients correctly. Our work involves a lot of co-operation with the many varieties of specialists, hospitals, psychologists, psychiatrists, physios, dieticians, occupational therapists, testing laboratories, imaging facilities, community groups and government authorities.
Increasingly we treat not only physical illness but also patients’ mental and life problems- depression and anxiety and events such as relationship breakdowns, bereavements, occupational stress and work/life balance. Our patients look to us as counsellors who can provide a sympathetic ear and impartial and wise advice and where appropriate prescribe medication. We may also act in the role of advocate when dealing with government, employers or the courts.
General practitioners stand at the centre of the health system since we have an overview of a patient’s health through time and across all the health issues that the patient has encountered. The GP is the only clinician who operates in the nine levels of care: prevention, pre-symptomatic detection of disease, early diagnosis, diagnosis of established disease, management of disease, management of disease complications, rehabilitation, terminal care and counselling. In short, other health professionals have a part of the picture but only general practitioners have the full picture. This is why we encourage patients to form a continuing relation with a particular GP.
A DAY IN THE LIFE OF A GP
So its lunchtime, I’m quite hungry and it’s been a fairly typical day in general practice……….
8am The day starts with a regular patient with long term lower back pain, hypertension and gastric reflux. He’s done very well to lose about 15kg over the last 6 months which has helped all 3 issues but his back pain is starting to limit his enjoyment of walking now which is affecting his weight. I’ve referred him to a good local exercise physiologist for some specific exercises to do at home for his back, organized a repeat gastroscopy with a specialist due to some cellular change he has in his oesophagus at endoscopy 2 years ago and we’ll continue his current dose of blood pressure medication with the hope that further weight reduction will keep that issue in check.