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Rage, rage against the dying of delight*

*apologies to Dylan Thomas
I was going to write a ranty diatribe about Malcolm Turnbull (who we all had such high hopes for- well, I’m sure some people did) and about just how horrible the debate and plebiscite will be for me, personally, to endure, but I must not go angry into that bad night. In other words, they go low, we go high. And I go long, apparently. Forgive me, I don’t have the energy to edit this. I’m saving it to apply to the strategies below.

How to not let the plebiscite break your spirit or smash your soul

1. Summon some buoyancy and benevolence into your manner when responding to internet trolls and evil doers (if you must respond, and sometimes, I know, you must). For example (based on real example of troll with typical spelling and punctuation errors):

Myrtle: As a true cristian I believe in loving my neybour. So, I am not a homophobe. But in the eyes of the lord homosexuality is an abomination. Sorry. So I’ll be votting no. Being gay is not normal or part of gods plan.

You: Hi Myrtle! How lovely to see you here in cyberspace. Thank you so much for taking the time to comment. Just wanted to update you as I was talking to Jesus the other day and he and his two dads told me they totally support marriage equality and they’ve even officially included it in the document God’s Plan Version #398 soon to be released! Isn’t that great? So I’ll be voting yes. I reminded him that being homosexual was an abomination and he punched me in the face, so, that wasn’t so fun for me, being smitten. Is smitten the right form of the verb ‘to smite’? Maybe you can tell me as English is defs your strong suit. Thanks in anticipation! Great talking to you! Ta ta, God bless xx Love from fellow True Christian. [Insert smiley emoji].

2. Turn off the television. Turn off the internet. Turn off the newspaper especially columns by Miranda Devine. Turn off the post/evil pamphlets that may appear in your letter box (except for the stupid postal plebiscite, which is stupid and should not happen, but if it does go ahead, do not boycott it!! Be clever, not counterproductive). I know it’s hard. It’s like a train wreck in which you were on the train. You will be tempted to investigate just how tattered and torn your entrails may become in the comments section. I’ve done it myself. So now I know. DO NOT READ THE COMMENTS. If you do, refer to point 1. 

3. All that talk of shutting things off brings to mind a different poet. W.H Auden. You know, ‘Stop all the clocks, cut off the telephone’ etc. Basically, that all should be silent and in mourning because this sucks. 

It will feel this way sometimes. You will be prone to feeling maudlin or disgruntled when people splash about on Facebook about wedding anniversaries or engagements that will not be Very Long. (Mine’s nearly ten years so far- Very Long). It’s all right for some, you may think. Your worth, value and legitimacy as a human person are not being decided by the bloke at work who hates you.You can get married as often and as enthusiastically (or not), as you like. You’ll be getting a telegram from the Queen before I even think of picking out a wedding dress. To wear in my coffin.

Yes, it is utterly cucumber (or insert epithet of choice). It is embittering (is that a word?), unjust and horribly unfair.

Hang on, I’ve forgotten my comforting words and suggested strategy…

This will do. Just think of that great thing Penny Wong said (insert great-thing-Penny-Wong-said of choice- there are many to choose from). Well, one of the things she said was to remember that your family and your peeps (and perhaps the Labor party) love and support you and that’s the most important thing. Or something like that. 

4. Remember that they are just plain wrong. Allow me to demonstrate. 

Person A: can I marry person B?

Law: Yep, sure.

Cool, right? Now…

Person C: can I marry person D?

Law: nope, on the basis of your gender. 

Hold on. What??!? On what planet can this be so? 

Yep. Leave aside all talk of religion, biology, political correctness (i.e. ‘not being a jerk’), family and the wellbeing of children (my kids are awesome, healthy and happy, thanks) and we come to this unassailable truth. Discrimination on the basis of gender is not lawful in our country. So eventually, things will be righted so that the Marriage Act also will not discriminate on the basis of gender. It’s unstoppable, says the person with an unwavering…wavering belief in our fine legal system. Yes, it’s delayable, thanks Mr Turnbull. But it will happen eventually. Probably.

5. Always carry a pen. The pen is mightier than the sword, quoth I. You may use pens for such ventures as voting Yes on a postal plebiscite, filling out the answers at pub trivia night, or correcting misinformation. Such as, if you walk past a poster that says ‘Children of same sex partnerships are totally going to be neglected and grow up to be losers,’ simply write NOT after the totally. Simples.

6. Eat nourishing food, get some fresh air and exercise, give up smoking and vaccinate your kids against whooping cough and self-hatred. I have to write this because I’m a doctor, but I also care about you, reader! I’m one of those people Penny Wong was talking about!!

7. If all else fails, make jam. An excellent young person I know and love posted a video yesterday: ‘On today’s episode of Angry Cooking I’m making some jam to distract myself from the plebiscite! You’ll need 1kg of strawberries, 2 1/2 cups of sugar, 1/4 cup of lemon juice and some injustice and inequality to get it all started!’ 

Distraction is an excellent strategy, (thanks GB). The times when you feel the debate creep in around the edges of your mind and start to seep into your soul with its icy tendrils, that is the time to throw open your door and go for a walk, to bake cupcakes with sprinkles to take to work to show how festively gay you are, to write a blog post or a sonnet or a symphony, or to take up a new hobby such as hobby horsing (look it up, it’s insane!!!)  

Please comment with any helpful strategies, morale boosting tips or words of comfort and solidarity. Any unhelpful or nasty comments should not be posted but rather inserted into an orifice of your choice. Or post them and I’ll cheerfully delete them. Because we are, apparently, politically correct and opposed to free speech and jerks. Thank you and good night.

  

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Just get back on that horse

“Tom Wolfe was right. You can’t go home again because home has ceased to exist except in the mothballs of memory.” (John Steinbeck, Travels With Charley)

Once you leave something, can you ever truly come back? Yes, you can physically return but even if things are the same as when you left, you will surely find yourself altered by your leaving, your being away and the often difficult path of coming back.

I know from the experiences of friends that after long periods of sick leave, maternity leave and other career breaks, that it can be hard getting back on the medical horse.

I didn’t work a lot last year, and the financial repercussions of my lighter work load eventually caught up with me and my family. This prompted me to look for a way to catch up. And so I came to sign up for two weeks of locum work up north. 9-6, five days a week, plus a busy Saturday morning clinic on one of the weekends. 

As well as the financial motivation, I was also getting sick of being out of the game, and worried that the longer I stayed away, the more likely I would lost all my confidence and would never be able to go back. This was, in some ways, a test. 

I chose a locum in the same town in which my mother (also a GP) works, so if I got stuck I could ring and say ‘where should I send this patient?’ or ‘does this plan sound reasonable to you?’ 

Happily my good friends would also be holidaying near there, my parents live there of course, and other supportive friends had said to ring them if I needed to at any time. My own family would be far away- but there was Facetime. 

The anticipation of the long hours and stress, along with feeling uncertain of whether I still had the requisite knowledge and skills had me wondering if I was making a huge mistake. I imagined all sorts of situations where I would be helpless. The ‘drug seeking patient’ was one scenario I doubted my ability to manage in a way that would leave me and the patient not too shaken by the encounter.

I asked colleagues how they would prepare themselves for returning to work after being stranded on a deserted island or similar, for the better part of a year. Their tips included sitting in with a colleague for a session, which I did. I asked a colleague whose work embodies the kind of practice I aspire to myself if I could observe her, and this proved very valuable. 

Watching and listening as she saw her patients reminded me that this was all still familiar. I would not be at a complete loss. As an esteemed GP e-friend said this part of me would always be there; it could not be forgotten. This part, the doctor part of me, will always know how to develop rapport, engage with a patient, hear them (truly hear them) and respond. To prioritise clinical issues. To weigh up risks, and set out a plan. 

Any small factoids of clinical knowledge that are forgotten or simply hidden from the conscious mind can be looked up, re-learned. 

Another friend of mine, handily also a psychiatry registrar, gave me some mantras to recite to myself as I navigated my way through the nervousness on the first days of work. One of these I think we could all benefit from:

Feelings are not facts.

You may feel out of your depth and as though you aren’t coping, but just because you feel this, doesn’t mean it’s real. Look at what is real. See, you just saw three patients. You’ve finished your notes, you’re walking to the waiting room to call another. You smile at the nurse in passing. Look at you. You’re coping and you’re getting things done, despite the way you feel. As the hours and days pass, the feeling lessens, because it is no longer relevant. It is a false clue, pointing to a false reality.

Because you can come home. It’s different and you are different, but it’s still home and you’re still you. And you’re not alone.  

When the time came, I did just fine.

Excuse my moodiness, I’m a tortured creative type

Apologies that all has been quiet on the blogging front for some time. My current excuse is that I belatedly signed up to NaNoWriMo (National Novel Writing Month) where you commit to writing 50,000 words, for better or for worse, of your novel. This is a worldwide movement taking place each November. There are write-ins, online word wars, forums for character and plot advice and a spirit of frenzied industriousness. 

I didn’t start till the 10th and am a bit slow, so it seems unlikely I will get the 50 thou down. It’s an interesting process though and I’m glad to be doing it. One reason is that it gets rid of any excuses. ‘Oh, I’m not sure this plotline is working,’ ‘this character lacks depth,’ or ‘this is going nowhere, it’s a crap idea.’ You think these things but keep writing anyway. With the aid of caffeine.
  
The point is to get out some sort of draft. It’s not likely to be much good, but it’s a start. Even if its ultimate destination is indeed the bin (or its electronic equivalent), you’ve still got something out of it. You have had countless hours of practice at being a productive writer, at over-riding your inner editor and letting yourself be creative without fear or fetter. Well- plenty of fear, but you turn the volume down on that and bid your fingers to keep clattering away on the keys regardless. 

It’s a lonely process. Writing by its nature is isolating, but in a way it is also a fine remedy against loneliness. It gets you involved in a big way. Yes, in an imaginary world with people of your own creation, but it’s still satisfying. The people you create are likely to be of interest to you, otherwise how could they arise from your grey matter?

It is all great fun. However, here I am writing a blog post. Yes. I am an expert procrastinator. 

I’ve done 8600 words so far so have quite a way to go. If I do finish it and it’s not unsalvageable, I will cut it into pieces, stitch it up again, paint it a lovely hyacinth blue, and make an e-book or some kind of cake and sell it to you all for 50c a slice. 

GPs- up to their elbows in humanity

In medical school we made paper fortune tellers (a hark back to primary school) to see which specialty we’d end up joining. I highly recommend paper fortune tellers as a decision making aid.

I got psychiatry, which pleased me as it’s human brain-related and I was all about neurology back then. My tutor said ‘Yeah I can see you as a shrink. You’re quite… laid back.’ I’d wondered if she was commenting on my near horizontal position in my chair. At early morning sessions I was so laid back I’d be nearly asleep. I’m an afternoon kinda gal.

We discussed our fortunes and our wishes with another tutor, who commented that cardiology, as one of us wanted to do, was ‘pretty sexy.’ I’m glad to say he really was talking about the specialty and not my good-looking friend, or this’d be a whole different post.

When the sights, sighs, secrets and smells of the GP consulting room threaten to overwhelm, well might we think ‘there’s nothing sexy about general practice.’

We’d be wrong.

I grew up with a GP parent and thought of her colleagues as extended family, so my early impressions of the career have been impossible to shake. These were grass-roots country doctors, stitching cuts, taking blood, delivering babies, counselling and empathising. All with a twinkle in the eye and an air of tired-but-calm patience.

Now a GP myself, I am well aware of the challenges and frustrations of the job, but I like to think about its good points as much as possible.

The beauty of general practice, lies partly in its breadth and thoroughness. GPs get their hands dirty. We don’t just adjust our pince-nez and peer down at your new mole. We’ll measure it, feel its surface, get out our dermatoscope and ogle it. Got a sore foot? We’re down on our knees. Got pus? We’ll be there with a swab. Got an itch in your ear? Never fear, your GP’s here, otoscope in hand. No problem is too big, or too small.

If you look at our faces as we examine something you deem shameful or embarrassing, you’ll see interest, curiosity and concern, not horror or disgust. It’s comforting and reassuring to know your doctor accepts you, warts, pus and all.

We love the variety of our jobs. You can come in to discuss your OCD and we’ll happily look at your rash as well (if there’s time- please book a long appointment if you want the full service)!

Another plus is the GP’s versatility. We can see your baby, your partner, your father, your eccentric great uncle- and some suitably qualified GPs will even see your dog. We’ll see babies grow up, see people retire, watch as an illness wreaks havoc on lives, watch recovery unfold gracefully and hope return to sad eyes.

We’ve got skills. We can wield a speculum, insert contraceptive implants, biopsy your skin, help you quit smoking, check your prostate, and teach you relaxation techniques (which come in handy if you’re having your prostate checked). We can question you gently but in a way that uncovers hidden issues.

We are the ultimate holistic practitioners. We’re at home with the foibles and vulnerabilities of the human mind; the functions and malfunctions of the human body. The good GP is approachable, understanding, capable and wise.

Now that’s pretty damn sexy.

Photo from Wikipedia page ‘Paper Fortune Teller’.

Please comment below if you’d like to mention anything else that’s fabulous about general practice! Or to correct my spelling.

Care Factor

I would like to take this opportunity to address some ideas I’ve found floating around about doctors that are not only incorrect but also downright offensive.

Myth 1: Doctors are all being paid by Big Pharma to cover up the truth about drugs/vaccines.

Fact: I’m still waiting on my incentive payment… and I haven’t met a group more sceptical and hard to convince about new medications than doctors- well, aside from conspiracy theorists and people who are anti-conventional medicine. As any drug rep could tell you, doctors ask the hard questions, because, shock-gasp, we actually CARE about our patients. That’s if we actually will speak to a rep. Many doctors refuse to (or are just really obstructive and rude to them as discouragement- not saying this is the right approach!).

Myth 2: Doctors don’t want people to get well because we’d be out of a job, so we have a vested interest in keeping everyone sick.

Fact: Most doctors genuinely care about their patients!! If everyone suddenly recovered from their health issues and never needed a doctor again, we’d be delirious with joy. We’d retire early and spend our days golfing, or make an exciting career change, or finally take up sudoku.
I would like to take this opportunity to address some ideas I’ve found floating around about doctors that are not only incorrect but also downright offensive.

Myth 3: Doctors don’t want to use ‘natural’ remedies because we can’t make money out of them and/or they work too well and we want our patients to stay sick (see above).

Fact: We don’t make any money from the treatments we use. If we write you a script and you go and buy a medication- we don’t get a cent from that sale. You know who DO make money on the remedies they concoct without any quality assurance and regulation and sell directly to you to fix a condition that they’ve just ‘diagnosed’ you with- naturopaths. If your doctor advises you to not use a ‘natural’ remedy it’s either because we think you’re wasting your money or that it could actually be doing you harm (directly, or by delaying the appropriate treatment). If there’s a ‘natural’ remedy that is safe and effective- we’ll tell you to go ahead and take it!

Myth 4: Doctors don’t know anything about nutrition or healthy lifestyle in general.

Fact: That’s false and really, quite insulting. We do know quite a bit. We are generally a humble bunch though, who don’t claim to know it all and we won’t make up our own ‘facts’ to fill the gaps. If we are saying something with limited evidence, we will tell you, instead of just coating it in random scientific sounding terms to impress you. What’s more, we acknowledge the limits of our knowledge and refer you to someone with specialised knowledge when needed, eg. a dietitian. We care about you getting the best care possible.

Myth 5: Doctors’ knowledge is limited because the whole of medical education has been infiltrated by Big Pharma.

Fact: Most of medical education is about clinical sciences and the art (and ETHICS, hello) of good patient care. Any drugs we learned about in med school went by their generic names. Along with the actions of drugs we learn all about their side effects and risks. Again, I’ve never met a tougher audience then doctors at a so called ‘drug dinner’. We really put the reps through their paces. We tear through their data and expose any shoddy results. We decry unacceptable side effects and query the actual benefit of any new treatments. These are not the actions of a group that has been ‘brainwashed’ or duped by evil corporations. Repeat: Doctors care about their patients!!

Myth 6: Doctors can’t be trusted because they are paid for what they do. It is better to trust someone who isn’t getting paid, for example, a celebrity chef on the internet or a random stranger on an online forum. These people don’t make a living from health therefore you can trust them to tell the truth.

Fact: This makes no sense to me. Your health is kind of important. Someone who makes a living providing health care is forever continuing their education and updating their knowledge. They care about your health because they care about you, AND because it’s their job. Their livelihood depends on giving you the best care they can, so why wouldn’t they want to do a good job? They aren’t after fame or fortune. Unless it’s Dr Oz- that’s a whole other blog post.
You should think of the pilot analogy here. Who do you want piloting your healthcare? A trained professional who does it all the time, or someone who just dabbles in it and makes it up as they go? Here’s a fun article about that.

Thanks for reading. I don’t hold out any hope that anyone who believes in these myths would even read this post let alone change their mind. I just wanted to get it off my chest. It hurts to be misjudged, to be called corrupt or untrustworthy when you are doing your damnedest to give good care.

Image: Crepes with icecream: a timeless natural remedy against hurtful rumours.

Those who can, teach #2

Last week I spent a session sitting in with a GP who works in bariatric medicine- similar to me, but she has been doing it for seven years. I learned a lot during the session. She involved me in the consultations and spent a good amount of time answering my questions and discussing cases. Since then I have received emails from her with useful references and resources. She has also offered to talk with me over Skype about my own cases.

This was all pro bono.

I know. I am duly humbled and very appreciative of the valuable time I have been given.

One of the lovely aspects of the medical profession is our propensity to mentor each other; helping shape junior doctors into kind and expert clinicians who will give their patients the very best of care.

Often this guidance is unpaid, yet many doctors give so generously of their time and wisdom for the sole reason of improving the care of future patients. Part of being a doctor is looking after our colleagues and aiding each other’s learning. As we work for the benefit of our patients above all, their wellbeing is often the only incentive for our efforts.

I’m a member of the Facebook forum GPs Down Under. This is a cluster of GPs in Australia and New Zealand who offer each other advice and support online. It’s a fantastic group. One GP on the forum said she was talking to a lawyer friend about our forum, who was apparently stunned that we were ‘giving our time and expertise away for free’ (or similar).

I wrote recently about my dear friend in Virginia who passed away last month. She was a shining example of a clinician who was dedicated to fostering the learning of her colleagues and students. She would stay up in the evenings coaching residents for their vivas. She tirelessly taught me, fed me, nurtured me, all out of the goodness of her heart. I know she cared for others in this same way, friends and colleagues alike.

The time I spent with her and the rest of the team at Atlantic Anesthesia was so valuable. And they weren’t paid a cent. It’s not like I was a US med student and a potential future member of their team. I was an Aussie med student and future Aussie doc. What was in it for them?

Knowing that some patients somewhere, some day, will receive better quality care as a result of your careful instruction- this is one incentive. The other? Genuine care for our colleagues, wanting to support them in their development as clinicians and help them flourish.

I think that’s pretty damn amazing.

I would love to hear your stories about memorable mentors and caring coaches, who I know are not limited to the healthcare professions.

Image: Dr De Loony as an impressionable med student far from home, in Virginia USA.

Look But Don’t Touch: Sexy Food

I’m doing an experiment.

Well, there’s an ‘n’ of just 1, so it won’t be appearing in any peer reviewed journal anytime soon.

I have bought a whole lot of chocolate and I am sitting here trying not to eat it. I ate some yesterday. And the day before. I’m well and truly hooked. I’ll probably eat some tomorrow, but for today I want to know how hard it feels to deny yourself something, especially something addictive.

It’s calling to me. It’s hidden away from sight (to reduce its power) in a tin at the top of the cupboard and I am the other side of the room, but I can almost hear it whispering ‘eat me! eat me!’

At the eating disorders and obesity conference last month I learned about the effects of ‘food porn’ on our brains. Advertising happens for a reason. Our neurons light up in response to these stylised, more-delicious-than-life images. We want it. We eat it…and are often left dissatisfied as the real thing doesn’t compare.

I also heard about food addiction, particularly junk food addiction; how it is an underrecognised problem and is a major factor in obesity

The types of food that are particularly addictive are the high-energy low-nutrient processed foods. They were designed especially to make our reward pathways go ‘zing!’ and to make us seek them out in preference to lower energy foods that provide vital micronutrients- read, fruit and veg. We have evolved to seek out energy-dense foods, our lives used to depend on it. Now kilojoules are abundant. We just about breathe them in down at the shops. Then we stack them on around our waistlines in case of famine.

I’m going to take a photo of the chocolate now to put up with this post. This will be the hard part. I will have to look that glistening wonder-substance in the eye, handle it, probably accidentally smell it- but then put it away uneaten. Hide it again in a tin (though the tin is decorated with pictures of tiny cakes, which probably defeats the purpose).

….

Gah! ‘Accidentally smell’? That seductive aroma bloody filled the room! My mouth watered. Maybe my eyes even watered. But I did it! I think only cos I didn’t want to ruin the blog post- I feel like all your beady eyes are watching. Thanks for the support. Couldn’t have done it without you.

I am famous in family circles for my sweet devouring abilities. I wanted to see just how strong a pull these foods could have, and get an idea for what it must be like for some of my bariatric-surgery patients. Those with a family often feel they need to buy things like ice cream, chocolate, cakes and so on as they want to give their kids dessert. Knowing it is in the fridge however, they are so vulnerable to eating it and if they’re like me, once they start, they just keep on eating.

I am blessed with a constitution that means I don’t stack on weight as readily as some- I would have been among the first to die in a famine. But I know what it is to feel out of control when eating.

Some of my patients have another problem- family saboteurs. The person who doesn’t want you to lose weight and sometimes says so outright. They present you with a slab of cheesecake on a plate, with a scoop of ice cream leaning just so against its creamy edge. They sit down with theirs and act mortally wounded when you say you don’t want it. They say ‘go on. One bite won’t hurt’. So hard to say no again when it’s sitting right there.

The chocolate is sitting right there…right there…right there…