Left medically ‘homeless’ by covid, a GP’s sense of duty is put to the test.
I still recall the week that news of covid-19 began to take hold here in Australia, as news of the devastation in Italy was in daily news.
Within days, the CBD practice in which I was established as a GP was set to close its doors as workers were given instructions to work from home. At the same time, well ahead of any mandates, I chose to voluntarily close doors on Skin Essentials, my skin clinic in Liverpool that I had opened merely eight months prior.
In the space of mere days, I found myself from working full time to having no work, and my income effectively dropped to $0 as we were all sent home while management tried to set up remote consulting services and GP groups lobbied the government to allow us to bill for teleconsults.
Eighteen months on, I remain without a GP home.
The practice never managed to get back on its feet and eventually made the decision to close for good after 30 years of service to the community. We were offered the chance to join sister services or to go our own way.
My own clinic limped along because of the dreadful South-West Sydney cluster around Casula for most of the year between May and October or so.
Out of necessity, I therefore found other work – all manner of GP locum work, all covid-19 related.
As a sole parent with four kids all under 18, when I was first offered this work in March 2020, I sought advice from my financial advisor on my standing should I catch covid-19 and die, or worse, end up permanently injured.
Several doctors I knew were vocal in their views that it was foolish to take the risk, but for me, it was a combination of need (I had had no income for two weeks at that stage) and ethics: I went into medicine to serve, even though, as some have said, none of us signed up for this.
Since then, I have done all kinds of covid-19-related work, from respiratory clinics, seeing face to face (in full PPE) covid-positive and deteriorating patients, to vaccine advocacy as the months have gone on. More often than not, all this work has been in tandem, rather than sequential.
What has it taught me?
Medicine is still the career choice I would make, even if none of us signed up to work through a pandemic with an airborne virus.
As the pandemic has dragged on, and many of us work from home, I have noticed a definite weakening of already-weak boundaries around contacting people out of rostered hours for non-urgent matters, including on days off and at unsociable hours, about patients that pre-pandemic would have simply resulted in a message in my pigeonhole.
There is a small but not insignificant minority of us (doctors) who have been openly able to express that they did not sign up for medicine to be amid a pandemic and I have seen some of them struggle with the lack of a sense of duty (and occasionally be picked on for it).
The way in which the federal government, in implementing mandatory bulk-billing for GPs around teleconsults, then vaccine consults in addition to the vaccine itself, has created a lot of anger, especially when we know general practice is the most efficient arm of the system and we work at a fraction of the cost of vaccine hubs to administer vaccines.
Among the better parts is the gratitude to have work, to be able to pay bills on my non-essential clinic while paying overheads from my essential Covid work, when so many businesses are beginning to fold for good – and of course hearing my teens talk about what a “gun” their mum is, and listening to them occasionally talking to vaccine hesitant friends about why they should not listen to propaganda, but instead listen to science. I have gratitude also for their teachers who have pivoted ethics lessons to talk about the inequity of the lockdown as well as science lessons to discuss many of the concerns raised by the anti-vaxxer movement on how the vaccines are unreliable.
Lastly, I miss general practice work. I miss my regular patients, who are no longer my patients (some of whom reach out via social media, to say hello and ask where I am now). As hard as it is to be a GP at the moment, I have realised that being a true generalist is where my heart lies; in whole-person, holistic, patient-centred care, from cradle to grave, in which relationships are built and flourish.
As much as I enjoy the covid-19 work (apart from the periods of regular abuse from patients), I am looking forward to a time when the pandemic is behind us and I can once again look forward to finding my medical home and developing new relationships as someone’s specialist in, and for, life.
