How long does general practice take?

Tim Senior is a GP at Tharawal Aboriginal Corporation, Airds, Australia.

Somewhat to my surprise, I’ve become the sort of doctor that has been in the same clinic for 20 years. I’ve never been bored, I’ve often been anxious, and I’ve been privileged to witness some of the most amazing and some of the strangest stories, and been told several times by patients that they’d heard I was leaving! I know I haven’t seen everything yet. People will still bring stories that I can’t possibly imagine.

I think back to some of the patients I met early in my time here, and realise that what I have lost in medical knowledge I have gained in wisdom. Some of those patients I saw back then would have benefited from my improved understanding of the effects of trauma, or of my increased ability to sit with grief, or just my better understanding of the way that human beings work.

The thing about those 20 years, though, is that they slip by almost unnoticed. I just go to work each day, and then before you know it, the children I was immunising are having their own children. GPs who were my own registrars are now in leadership roles.

It makes me realise that perhaps units of time don’t do justice to the relationships we develop with patients over time. Time measured as number of years doesn’t really do justice to one of my patients who I first met by phone, well before COVID-19 and telehealth became routine, acutely suicidal. She’s still alive, and she’s away from drugs and abusive relationships now, with other challenges that stop health care ever being dull. But the significance of that relationship for me is in the witnessing of survival and change. The length of time is a byproduct of that, not the story itself. The consultations I have had with these patients aren’t consultations of 15 or 30 minutes. They are consultations of 2, 5, 10 years, split up into 15-minute chunks.

How can we teach the life-saving significance of these long-term doctor– patient relationships to our students and registrars? I certainly didn’t appreciate it as a registrar. Conventionally, GP registrar placements are 6–12 months, but maybe it’s more useful for us to understand this as a maximum of two to four glycated haemoglobins. It will be rare for a GP registrar to do more than one cycle of bowel cancer screening with one patient, let alone breast or cervical cancer. Even giving a patient more than one flu vaccine might be unusual.

The passage of time is the one thing we can’t speed up by doing more tests or seeing someone more frequently. It requires deliberate reflection and imagination to begin to understand the essence of longitudinal care that underpins the reasons general practice saves lives. While we must continue to teach ‘The Consultation’ as our unit of practice, we must also teach ‘The Consultations’, plural, in the way each consultation isn’t an isolated incident, but is joined on to past and future consultations. In narrative terms, we’re part of a movie, a mini-series, and a long-running soap opera!

So as my hair gets whiter and people start to give up their seat for me on the bus, I think I may still have another 20 years of practice in this clinic ahead of me. I’ve decided I won’t measure the second decade in years, but in cycles of bowel cancer screening, in registrars in leadership positions, and in new stories witnessed.

Featured photo by seyfettin dincturk on Unsplash.