To the patients who leave us in tears

Running a practice in an underserved, underprivileged region is hard enough without the daily abuse and threats.

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I’m the practice manager of a medical centre in Queensland’s Hervey Bay, where my husband is a GP.

Hervey Bay is the worst of all possible worlds for attracting and keeping medical staff: high levels of unemployment, drug use and mental health need, but not a Distribution Priority Area for the government and only MM2, or “inner regional” (despite being four hours from Brisbane), so we can’t employ GPs who need to work out their moratorium in a DPA area.

We are regularly abused at the clinic, receive anonymous letters and death threats, and have nasty social media posts written about us, because we cannot retain doctors.

Why don’t doctors stay in Hervey Bay? Why would they, when they get abused by drug seekers all day for pretty crap money? They’re here to begin with because big cities like Brisbane don’t want “GPs in training” – they want the qualified ones. Once they get qualified as specialist GPs, they all get the hell out – about 5% stay but most leave as soon as they can.

Patients also don’t know that the training college forces doctors to move practices at least once, so even if you find a lovely trainee doctor who loves working at your practice and who has a great rapport with staff and patients, they won’t be there long. This is not the medical centre “firing doctors” or “chasing away all our good doctors”. Now all the time and energy and expertise you’ve spent training these doctors goes straight to Brisbane or Sydney or Perth CBD, and your remaining doctors are now even more burnt out and exhausted as they have to take on those departing doctors’ patients. 

In Hervey Bay, we can either employ FRACGP specialist GPs (we have advertised on multiple platforms and have not had a single application in seven years; there are eight or nine in the area) or get registrars on the training program (who can stay only 12 months usually; registrar numbers in the area have collapsed from about 40-50 new registrars a year to about five now).

We could also hire international doctors, the catch being that any clinical mistakes they make falls on to the medical registration of their supervisor – extremely nerve-racking.

But to make things worse, the Australian government has now decided that Hervey Bay cannot import IMGs any longer and will not grant visas for them because we apparently have “an oversupply of doctors”. This means the existing doctors work longer and harder, squeeze more patients in and are more burnt out and exhausted – only to receive a patient complaint. Then we have to spend hours preparing a defence for the doctor who in most cases did nothing wrong but tried to help to the best of their ability. 

Greedy doctors

An average of seven years’ study and several hundred thousand dollars spent on fees mean huge debts for most young doctors, especially those from overseas. Many have had no social life, few friends and failed relationships because of the pressure of trying to get through medicine without an income.

If they then choose general practice, there are two years of hospital training for around $79,000 a year or $61,000 after tax, then two more years in practices, then $9000 to sit exams IF they pass them all first go.

So these “greedy doctors”, as I’ve heard them called, start earning an income only around age 30 and now have accrued about $500,000 in loans, and then: Welcome to General Practice, where the government can freeze your Medicare rebates for five years. What other profession allows this?

An IMG can bill Medicare $31 for up to 20 minutes of their time. They then pay the practice on average a 35% service fee to provide a consult room/staff/medical consumables and a nurse, so that leaves them $20.15 to pay tax on. For FRACGP specialist GPs, it’s $38.75.

We paid off my husband’s student loans and could afford to buy a decent car (a second-hand Mitsubishi Outlander) only when my husband hit 37. When we had our first baby, my husband was doing his hospital rotation before GP training. He got sent to a hospital out of our region so he got a whole three days with our first child before being sent back into training.

When he got into GP training, he had to leave Brisbane to work at a training practice in Maryborough. I had to leave my friends, family and support system and move with an eight-month-old baby. Three months into his training, at our seven-week scan for our next pregnancy we were told I had a suspected ectopic pregnancy and needed surgery the next day. His employer did not let him take sick leave and I had to leave my 11-month-old with a stranger. I was alone for that surgery and woke up without my husband, in pain and grieving.

The doctor’s always late

Yes, doctors run late. That’s because patients come in with their husband or wife (who did not have an appointment booked) and then go “Doc, while I am here hubby has terrible migraines” or “Doc, I want to kill myself” or “Doc, I am a victim of domestic abuse and don’t know what to do” or “Doc, I need my blood pressure pills but my daughter here has a temp of 39 degrees so can you please look at her”.

Or, our doctors walk in the door and check results and find a 44-year-old man with bone cancer, whom they need to inform has two years left before he leaves behind his wife and two kids. Now their screen has 3/4/5/6 patients backing up and the patients are getting angrier and angrier – how dare my doctor make me wait?

The irony is most of these people complaining about “waiting” for a bulk-billed appointment with a specialist GP are also on WorkCover or Centrelink benefits or are retired so don’t actually have anywhere pressing to be, but just feel like their time is valuable.

So, they go up to the poor 22-year-old receptionist, who is trying her best to smile and be helpful, to swear at and insult her. This is after she’s just taken four phone calls all insisting “the issue is urgent and I need my doctor now”. The poor woman gets a knot in her stomach staring at the booking screen: the doctors and nurses are not only all fully booked but the urgent result cases have now also been squeezed in and she knows that these doctors and nurses won’t get lunch breaks and will be working way past closing time again and a patient is on the phone crying “because their issue is very serious and needs to be addressed NOW”.

I have not worked a single week where a doctor (male and female), a nurse or a receptionist hasn’t come to me behind closed doors and sobbed because it’s all just too hard. The doctors are exhausted, the nurses don’t get to eat their lunch and the admin staff are yelled at all day long – and the sad part is most patients then just complain and criticise, putting up nasty comments on Facebook pages, naming doctors for “mismanaging them” or for “not seeing them when it was urgent”. These doctors read those pages, they have feelings, they are human and they hurt, too.

Suck it up

In my 10 years I am aware of four GPs who have committed suicide. Do patients know what happens if a doctor goes to see a psychiatrist to get help for depression or anxiety? That the psychiatrist has a legal duty to report this to AHPRA if they think the doctor is “at risk”? How many doctors will seek help if they know their medical licence is on the line?

There is also a deeply embedded professional culture in which doctors are often expected to “suck it up” and build resilience, with anything else seen as a sign of weakness. The stigma, fears around privacy, fear of deregistration and the desire to continue helping patients are major barriers in accessing mental health care.

We have ALL been threatened. Patients have told staff “I will hunt you down and hurt you”, a doctor had a patient say “I know your wife is pregnant and I know where you live and I will burn your house down in the middle of the night” (surprising that this doctor then moved out of Hervey Bay a week later). Another patient said “I will burn your f*cking practice down to the ground” (because we couldn’t give him an appointment).

We’ve had patients masturbating in the car park after seeing our younger receptionists, patients kick our doors and tell doctors who refuse to give opioid scripts “I know where your wife and children live and I will hurt them”’, doctors who find out a beloved patient has passed away and then cannot take two minutes to grieve because there are two urgent “squeeze in” patients shoved first thing in their morning so that they now have four patients waiting to be seen and it is only 8:30am.

Patients tell their doctor “because you won’t give me what I want I am going to kill myself” and then they hang up the phone and that same doctor is supposed to call in their next patient and act like nothing is wrong. We have had to come to work leaving our children at home extremely sick, we turn up to work sometimes so sick ourselves we can hardly stand.

We love our team but some patients make us hate what we have to do every day.

To the beautiful patients we have that are kind and compassionate and caring and grateful, I say THANK YOU – for showing us you care, dropping some homemade biscuits in, bringing in a thank you card of appreciation or going out of your way to let us know that one of our doctors saved your life or helped you in the middle of your crisis.

To the others, we have no choice but to take it – to smile when your viciousness makes us want to cry, to try to placate you even while you call us names, to find solutions to your problems even though you spit at us and say we are pathetic at our jobs and we have wasted your time.

I want to thank my amazing team of incredible doctors who inspire me every single day, my reception staff who hold their heads up high and keep going day after day despite all the abuse they take, the nurses who skip their lunch breaks to help those extra patients because they know these are elderly patients who have no one at home to care for them.

I know how much hard work, passion, care, commitment, dedication, stress and sacrifice goes on behind the scenes every day. You are what maintains my faith that the good outweighs the bad and I salute you. I would simply ask that patients sometimes do the same.

Carrie Norval is practice manager at the Family First Medical Centre in Urraween.

This piece has been adapted from a post on a local Hervey Bay community Facebook page that received an enormous response from locals. Since it was published, the author reports a remarkable rise in deliveries of home-baked biscuits, flowers, handmade teddy bears, positive comments for the practice and support from other local medical centres. She is grateful and a bit overwhelmed.