This post was first published on the blog of CM Health CEO, Geraint Martin. To read more from his blog, visit: www.cmdhbceoblog.wordpress.com
I don’t design health systems or even know how they work really. Most of my practising life (coming up to 17 years) has been spent either in small town or rural New Zealand, as far away from big think tank, urban medicine as it’s humanly possible to be. I just work within the system, on the ground floor, seeing patients.
One of the problems is that when I work as a GP, I’m expensive. Under usual circumstances patients have to come to me and they get a 15 minutes consult at best. In Horowhenua, it costs about $30 to see a GP if you’re registered, $40 if you’re not or $60 after hours. This is a big ask for many locals. The median income is $18,500 a year and most people have less than $100 each week after paying rent and power. Even if they scrape together the money, they’re only going to get an acute problem sorted. Underlying causes are left untouched.
It’s as if doctors have priced themselves out of the caring market. I’ve become so expensive to employ that most health centres can’t afford me talking to patients. I have to see them faster, which makes medicine much less enjoyable as a practitioner and much less effective for a patient. If you’re paid between $100 to $150 an hour, you see as many patients as you can because you represent a large part of the practice’s outgoings. But the car is already being driven as fast as it can. It’s time to slow down.
At the end of last year, I did just that. I began working as a youth worker employed by a local trust two days a week, while retaining employment as a GP in general practice for another two days a week. I maintain my medical links so that my practice is safe and I’m under the usual supervision. I actually do the same job all week but it’s accounted for differently by two different organisations and with very different salaries attached. Working as a youth worker is worth about 1/5th of what I would be earning for the equivalent time as a GP, but I’m free. I can do the job I was trained for. Pay me less and all of a sudden I can spend time with people.
Now I leave the clinic and work with patients in their setting – the library, school, home, around town or even by text. Most of the young people I work with have my number and say things in text in a way that they wouldn’t face to face. There’s no waffle, a lot less shrugging of shoulders and it gets to the nub of the problem. I can also sit down and spend an hour with people who have complex issues to really start unwinding what’s happening. I’m working with kids that professionally fail, at school and with their families, so failing with the doctor is no skin off their nose. It’s hard to see them in 15 minutes and expect that they’re going to understand what you’ve just talked about and go to the person you’ve asked them to see. They can’t afford it, they can’t get there, they get confused, they don’t really want to or they don’t want to repeat the story they’ve just told you to somebody else.
Working the way I do now, I can refer them to myself in general practice or go and knock on the door 15 times instead of writing them off as a DNA. The root cause of many of the problems I see is that the kids have had the confidence knocked out of them. Often you just need to tell them they’re ok and that they’re worth spending time with. Go back, and back, and back, and back until they relax and stop seeing you as the health police. Sometimes it works and other times they’re not ready, but the difference is you feel like you’re trying.
This is a personal rebellion not a crusade. I know a lot of people wouldn’t work for a youth worker salary and it’s not an answer to the health system either because you need lots of people to make it work on a bigger scale. It’s simply my own response to the frustration of being sidelined by how expensive my profession has become. The only way I can do this is to de-couple myself from being paid so much.
A lot of the fulfilment stems from the acknowledgement that it’s my patients who actually look after me. As doctors, we tend to hold back a lot from our patients out of respect for boundaries and professional fears. I understand that there’s reason to be sober but I think we often overlook the joy of being sustained and trusted by a community. In some communities we’re losing contact and relevance, and often it’s these communities that need it more than anything.
My new role is very old medicine. It’s about walking alongside people, being part of their lives, somebody to call if there’s a problem. It’s a steadying of the ship. Not flash medicine or big medicine, just the pastoral element of being a doctor. It’s painstaking and it takes a lot of time but I sleep straighter in bed knowing that I can authentically connect with my patients. For the first time in a long time, I’m practising medicine.
GP, Poet & Children’s Writer