The best thing about general practice is also the worst thing about general practice.
If there is one thing that differentiates general practice from almost every other specialty it would have to be that we’re “in it for the long haul”.
While the surgeons might take all the life-saving glory, and obstetricians might be the object of unending devotion based on a brief moment in time, we are a constant. It’s the old cradle-to-grave stuff, which of course doesn’t always happen – people move, we move. But in principle this is how general practice works.
For the most part, it’s a positive but sometimes …
Just this week, I saw, for the umpteenth time my lovely, 30-year-old, completely rock-bottom alcoholic patient Angie. She was coming to see me after yet another emergency department presentation because she had been completely off her face and suicidal.
I have lost count of how many times we have been in this situation. She is classed as a frequent flyer at the local hospital. It just breaks my heart – because when she’s sober, she is the loveliest young woman – creative, clever, kind and so remorseful about the trail of destruction she has created. But the pattern goes on.
As you can imagine, this is not a straightforward case, and there are a number of issues such as anxiety, body image issues, depression, personality disorder. This is not a recent problem. A couple of years ago she took a massive overdose and was lucky to live – but even that hospital admission didn’t stop the pathological addiction and certainly didn’t see her accept any effective help. She has tried at least four psychologists, two psychiatrists, antidepressants, antipsychotics, anti-addiction meds, outpatient services, AA and more than a couple of inpatient stints – nothing has helped and she’s burned many bridges along the way through arguments, missing appointments and creating chaos while drunk.
The only medical constant in this sad and sorry tale is me – and a fat lot of good I am! I try to insist she come and see me at least fortnightly, preferably weekly, just to keep in contact and keep the focus on staying in the moment and off the wine – which does work until she spirals down, cancels appointments and starts drinking again.
But we have to keep trying, right?
Fortunately, a lifetime of general practice has granted me the experience of at least some patients who successfully overcame their addictions (not thanks to me – I just bore witness to their recovery). I keep telling Angie this as I encourage her to try yet another professional service.
So far, she hasn’t drunk for a week and she says, for the first time, she truly accepts she is an alcoholic and has a serious problem. She is attending online AA meetings daily and is taking one day at a time. She is lucky in that she still has incredibly supportive patents and siblings despite the hell they have been through.
So maybe this will be the turning point. I hope so.
The “long haul” is the best and worst part of general practice. While I might sometimes feel I have a ringside seat at a smash-up derby, the fact is, as Angie’s GP, I need to be there. Even if I can’t cure. Even if I only act as a conduit to help and offer support and encouragement. Even if she rejects my help when she needs it most as she spirals down. Even if this addiction proves insurmountable. I have to be there. Believe me, I’m no saint – I hate this situation – but this is just what we GPs do, isn’t it?
Sometimes the long haul is an Angie … and that’s the challenge.
