The PAP tweet

mobile phoneNot so long ago, one of my young patients ‘tweeted’ that she was having a Pap smear.

During the actual procedure.

Yep, as I was scraping cells out of her endocervical canal, Miss C was busy tapping away on her iPhone. “@docs having pap smr atm, std chk 2, hope im clean … bfn” was posted to the internet for public consumption.

“I have, like, 100 followers,” she said proudly. I presume she meant on Twitter — she seemed unlikely to be the leader of a religious sect. I wondered how many of these had any interest whatsoever in her gynaecological checkup. Perhaps those with whom she had been sexually intimate would be interested, but I doubt they would have made up the entire hundred who’d received her tweet.

While I printed out her pathology form, Miss C updated her Facebook status to ensure everyone with whom she had ever had contact knew about her earth-shattering Pap smear news as well.

It got me thinking. When did getting a cervical smear go from being an embarrassing, secretive affair to one worth broadcasting? When was the mystery taken out of ‘women’s business’?

Quite a few of my under 25-year-old patients bring their friends and/or boyfriends into the consulting room with them when having smear tests. When I’ve politely suggested that Miss X might feel more comfortable if Mr Y waited outside, I’ve not uncommonly got a response along the lines of “It’s no biggie — it’s not as if he hasn’t seen it all before.”

I once had a very curious young man ask me to point out his lover’s anatomical landmarks. He particularly wanted to see her cervix, saying, “To see that would be totally awesome!”

The ‘secret women’s business’ divide is not cleanly split along generational lines. I had a 68-year-old patient request that her 15-year-old granddaughter be permitted to observe her Pap smear for educational purposes. “If she sees one being done, she won’t be as worried about it when it’s her turn to start,” my patient said matter-of-factly.

Later that same day, I had a 19-year-old look at me in horror when I gently explained that she would need to remove her underwear as well as her jeans. “Can’t you just, like, work around them?” she pleaded. “It’s, like, so embarrassing!”

My favourite Pap smear anecdote, however, involves a particularly self-conscious and nervous older lady and a mobile phone. After several attempts I had finally convinced this 52-year-old to have her first smear test in 20 years, and I was trying my best to make the experience as atraumatic as possible. To my horror, just as I was inserting the speculum, my mobile phone went off. The Beethoven ring tone seemed to go on forever but I tried to ignore it and continue seemingly undeterred.

At the end of the procedure the patient said: “Thank you so much for providing the lovely classical music — it was very thoughtful of you. It really helped me to relax. One thing puzzled me though — I couldn’t work out how you managed to start the music at the right time. Did you have a remote control or was there a switch on the speculum? Modern technology is amazing, isn’t it? A singing speculum — what will they think of next?”

Now, that’s the kind of Pap experience that would almost be worth a tweet if one was that way inclined.

Published in Australian Doctor on 22nd February, 2012 The PAP “tweet” http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word–on-pap-smears

False Dichotomies

“I’ve read those information sheets, Doc, but they don’t give me the answer. I just want to know, is PSA testing a good thing to do — yes or no?”

We all want things to be clear: yes/no, right/wrong, good/evil, 0/1 — a binary world. The trouble is, life is not that simple.

Right_or_wrong_

As children, our world is simplified: we’re told that it’s always best to tell the truth, that you can’t divide a number by 0 and that love will conquer all.

Growing up complicates matters, and it seems that the more you know, the fuzzier the boundaries. But we still like to put things in clearly marked boxes.

One of my out-and-proud greenie friends was boasting about how she was “taking every step possible” to reduce the world’s carbon footprint and asked me to sign a petition banning the sale of fruit and vegetables in major supermarket chains.

“You don’t ever buy fruit and veg from major supermarket chains, do you? Do you know how much CO2 we’d save if EVERYONE in the world only shopped at local farmers’ markets and only bought produce in season and grown locally? Plus, without transport and storage costs, prices would come right down,” she pronounced self-righteously.

I itched to point out that eating local fresh produce would prove difficult for people living in, say, Canada in winter, as my family does, and that on the price issue, interestingly, their local supermarket stocks very healthy looking and tasty bananas for less than $1.50/kg all year around. However, such a low price is dependent on under-paid Central American farm workers, amongst other things, so I refrained from opening that particular can of worms.

“It’s more complicated than that,” I replied.

“That’s just an excuse. If each of us did our bit and made sacrifices, the world would be a much better place. But most people are selfish — like those who drive around in big petrol-guzzling 4WDs just to amuse themselves or to make a statement.”

“Yeah, I know what you mean. Like dog owners.”

“Pardon?”

“People who keep dogs as pets, just to amuse themselves or make a statement. You do realise that a dog has a significantly larger carbon footprint than one of those petrol-guzzling 4WDs, don’t you? Have you still got your two labradoodles, by the way?”

“But, but … dogs are natural!”

“So are fossil fuels. So is carbon dioxide, for that matter.”

The oft-attempted division of substances into “natural”/”organic” (good) and “chemical” (bad) is a particular pet hate of mine. Not only because it’s another false dichotomy, but because of the incorrect terminology. When I try to explain that food is, by definition, “organic”, and that every single substance on the planet is “chemical”, I’m usually met with, at best, blank stares.

But I digress. Back to canines. Before people start bombarding me with angry emails, I want to state, for the record, that I love dogs and I’m in no way advocating euthanasing beloved family pets in the name of helping the environment. Nor am I trying to say that it’s a waste of time for individuals to live more sustainably. And I’m a big fan of trying to eat more locally grown seasonal fresh food. I’m merely pointing out that it’s not a black-and-white issue.

On many of the big controversies, I’m a fence-sitter. I’ve found that it’s easier to see on which side the grass is greener when sitting in the middle, and frequently it’s neither. The only thing of which we can be certain is uncertainty.

“That hasn’t helped me with my PSA question, doc.”

………………………………………….

Published in Australian Doctor on 2nd February, 2012. On False Dichotomies

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word–on-false-dichotomies

Like being at your own funeral – without the inconvenience of dying

I’m sure there are times when we all feel under-appreciated as GPs — by our patients, staff, specialist colleagues or society in general. You can’t blame them for sometimes taking us for granted — it’s part of the human condition. People don’t value what they have until they lose it, whether “it” is the ability to walk or a domestic fairy who makes sure there’s always spare toilet paper.

It’s a common lament that we can’t be at our own funerals to hear how much we’re loved. Mind you, eulogies are rarely objective and balanced. As Andrew Hansen from the Chaser gang sang: “Even pricks turn into top blokes after death.” Nonetheless, it’s a pity we’re not around to hear the praise — deserved or otherwise — that is expressed once we’re gone.

As I’ve recently discovered, the long-serving, somewhat-taken-for-granted GP has a non-fatal way of bringing out the appreciation in his or her patients and staff: moving on.

moving-on

After 10 years of GP-ing in the Noosa hinterland and a lifetime of living in south-east Queensland, I’m heading south of the border. The hardest part of this move for me — harder than selling my house in a depressed market, harder than dealing with banks, builders, real estate agents, solicitors and Australia Post, harder even than trying to get rational answers out of my telecommunications company after they cut off my Internet and phone prematurely — has been telling my patients I’m leaving.

I knew many of my patients were very attached. I knew they’d come to me expecting to receive a loyal, life-long partner kind of doctoring, rather than the one-night-stand variety. But I had no idea how difficult it would be to break the “I’m leaving you” news again and again and again.

Hard as breaking up a relationship may be, at least you only have to do it once when you leave a romantic partnership. For me, telling patients I’m leaving has felt a bit like breaking up with hundreds of boyfriends, one after the other after the other.

You may interpret this as my being too close to my patients or not close enough to my boyfriends, but the fact is I’ve found the protracted process exhausting, emotionally draining and just plain horrible. The “it’s not you, it’s me” part goes without saying and I know I am far from irreplaceable, but seeing the tears well up in countless eyes because of the words I’ve uttered is enough to break my tender heart.

Looking on the bright side, as I am wont to do, if I’d ever felt under-appreciated, I sure don’t now. I’ve received more expressions of gratitude in the past three months than I have in the past decade. To hear how influential I’ve been in some of my patients’ lives puts a warm glow in my battered heart. And as much as it’s hurt me to see my patients upset, it probably would’ve hurt me more if they’d been completely indifferent to my leaving.

However, I did please someone. Mrs L had been trying for years to get her husband to agree to move interstate to be near family. His last remaining excuse was that his multiple complex medical problems meant that he couldn’t possibly leave me, his long-term GP. A grateful Mrs L rang me within hours of my informing them of my impending departure to say: “He’s finally come around. Thank you so much for deciding to leave us.”

It’s nice to be appreciated!

Published in Australian Doctor on 8th December, 2011: On Moving On

www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-moving-on-

Clock-watching during consultations – is it always a bad thing?

“What can I do for you today, Cheryl?”

“I want a full check-up, and I’ve got a few niggly problems.”

“Sure. How about you list them for me?”

“The first thing is I’ve been having trouble sleeping and I’m snoring a lot.  Second thing is that I’ve been getting pins and needles in both feet and my left arm goes numb. I also have this bladder weakness that’s getting worse.  My heart races at times and I feel dizzy. Oh and sometimes I get pains in my chest.  And in my head, especially behind my eyes.  Also pains in my groin area, as well as a rash which comes and goes.  And while you’re looking at the rash, I’ve got a heap if skin tags I want removed.”

“Hmm… anything else?”

“Umm… well I think I’m going through the change of life – I want to be tested for that. I also want you to find out why I keep putting on weight.  I haven’t had a PAP smear for 4 years – so I want one of those – and I’m heading off to do an African safari next week and they said I’ll need some needles.”

“We’re not going to have time to address all of your concerns in a 15 minute appointment, Cheryl.”

“But I don’t come to the doctor’s much – I like to save the little things up and deal with them all in one go.  And, I’ve been waiting to see you for 45 minutes. I haven’t got time to come back and wait again.”

Over my Weetbix that morning, I’d read about a recent US study* that looked at both doctors’ and patients’ perceptions of non-verbal cues during consultations. It concluded that although many doctors were highly aware of their body language, patients, in general, primarily focussed on those cues indicating that the doctor was running short of time, and that they were acutely sensitive to signs of time pressure. The implied message seems to be that patients know when their doctor is clock-watching and that they don’t like feeling rushed.

Clock

In an ideal world, GPs could spend as long as is needed with each patient, whether that be six minutes or sixty minutes, without having waiting-room backlogs and mutinous reception  staff.  Patients would never feel rushed, doctors wouldn’t feel any time pressures, and the working day would flow smoothly.  If only…

There are many scheduling systems which lead to substantial improvements in patient flow, but the fact remains, because of the very nature of what we do, it’s impossible to get it right all the time.  Forest Gump’s momma’s gem of wisdom,  “…like a box of chocolates, you never know what you’re gonna get,” springs to mind.

The cold hard truth is that on busy days, general practitioners need to clock watch to have even a remote chance of running to time. Managing consult length without having patients feeling like they’re being rushed or fobbed off is about the best we can do.

I don’t always reach this goal, much as I try.

After dealing with the urgent issues, organising tests and negotiating for Cheryl to come back to see me at least twice more, she turned to me and said, “In the time you spent explaining why you couldn’t do everything today, I reckon we could’ve knocked off at least half my list.   Oh, and I expect that you’ll bulk bill me for the other appointments – it’s not my fault that you were too busy to deal with me properly today!”

*Journal of Evaluation in Clinical Practice 2011; 17:933-939.

Published in Australian Doctor on 9th November, 2011: On Clock Watching

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word—8211;-on-clock-watching

Email gone astray

email pictureAn email gone astray can provide fascinating insights for an unintended recipient. Written correspondence has undoubtedly fallen into the wrong hands since homo sapiens first put pigment on bark, but never before has it been so easy to have a personal message go awry.

No longer is it a matter of surreptitiously steaming open sealed letters or snooping around in wastepaper baskets. Finding out another’s personal business is now just a click away. Even more conveniently, candid opinions can sometimes make an unscheduled landing in your inbox, making for intriguing reading — as I recently discovered.

I’m soon leaving the idyllic place I’ve called home for the past decade and moving to an equally idyllic part of regional Australia. Months ago, I’d sent out feelers regarding possible GP jobs and had emailed a particular practice principal a couple of times, expressing my interest. When it looked likely that I was going to pursue a different path, I sent a polite email explaining the situation and telling him I wouldn’t be seeking an interview for a job at his practice at present. An email bounced back saying that my not wanting to work for him may be “a relief” as I “sounded a bit intense”. It was sans salutation but, based on the rest of the content, was obviously intended for one of his work colleagues. It had no doubt been a simple error of his pressing ‘reply’ rather than ‘forward’.

I was chuffed: I’ve never been called “intense” before, at least, not to my knowledge. Perhaps there are several references to my intensity bouncing around cyberspace but this is the only one my inbox has ever captured.

I’ve never considered myself an intense person. To me, the term conjured up the image of a passionate yet very serious type, often committed to worthy causes.

Perhaps I had the definition wrong. I looked it up. The Oxford Dictionary gave me: “having or showing strong feelings or opinions; extremely earnest or serious”. Unfortunately, I couldn’t reconcile my almost pathologically Pollyanna-ish outlook, enthusiasm, irreverence and light-heartedness to this description — nor my somewhat ambivalent approach to politics, religion, sport, the environment and other “serious” issues.

At least the slip-up was minor. Several years ago, I unintentionally managed to proposition one of my young, shy GP registrars by way of a wayward text message. He had the same first name as my then-husband.

Scrolling through my phone contacts late one night, alone in a hotel room at an interstate medical conference, I pressed one button too many. Hence this innocent fellow received not only declarations of love but a risqué suggestion to go with it. Not the usual information imparted from medical educator to registrar!

It took me several days to realise my error, but despite my profuse apologies, the poor guy couldn’t look me in the eye for the rest of the term.

If I was “intense”, I would conclude on a ponderous note — with a moral message that would resonate with the intellectually elite. Alas, I’m a far less serious kind of girl and, as a result, the best I can up with is: Senders of emails and texts beware — you are but one click away from being bitten on the bum.

Published in Australian Doctor on 13th October, 2011: On Being Intense

http://www.australiandoctor.com.au/articles/4F/0C07324F.asp

PGPPP – Sending junior doctors out into the big bad world

Aust GovtAbout seven or eight years ago, some smart cookies came up with a grand plan, called the PGPPP. They had managed a trifecta.

First, they’d come up with a solution for the escalating problem of there being too many medical graduates for too few hospital jobs: namely, send the junior docs into general practice.

Second, the program would create new and challenging jobs for administrators. Trying to get private GPs, public hospitals, Medicare and GP training organisations to communicate and work effectively together would require not only a magic wand, but would also generate more administrative hours than one could poke a stick at, and enough hot air and paperwork to significantly increase Australia’s collective carbon footprint.

Third, and most importantly, they had an alliterative name. Prevocational General Practice Placements Program — P, G, triple P. With such a rollicking, rhythmical ring, the program was surely guaranteed to be a hit.

AGPT

Yes, there is nothing that health authorities like better than a catchy initialism. The lettering was new but the concept of sending underprepared junior doctors out into the big bad world of Medicare-controlled private general practice was not. Public hospitals have been doing it for years.

I was a junior doctor at the turn of the century. Keen on rural general practice, I volunteered for two five-week rural relieving terms, and at only 14 months out of medical school, was sent to run the hospital and the general practice in a one-doctor town in country Queensland. There was no pharmacy, no radiology and no handover.

The practice medication cupboard had been locked and the key hidden, as the doctor’s dispensing rights didn’t extend to me. The trouble was that items such as aspirin, Maxolon, Ventolin and adrenaline had also been locked away. The only medication available was methadone: I found a half-full bottle in the doctor’s top desk drawer. Hmm.

A particularly nasty gastroenteritis epidemic swept through the town during my stay, depleting the hospital’s meagre supplies of IV fluid and anti-emetics. One memorable Sunday, sick as a dog myself with gastro, I’d dealt with a farmer’s compound fractured leg, a child with severe facial lacerations and an inebriated fellow with haematemesis, when a teenager presented with symptoms of meningitis. It took five hours for the retrieval team to collect her. As I sat waiting, dehydrated and nauseated, watching her Glasgow Coma Scale drop steadily, I had an epiphany: this is not particularly enjoyable.

My second term was not much better. On the upside, a particularly traumatic sequence of events gave me the impetus to take up writing to debrief. I later penned a story loosely based on the incidents, What Would the Coroner Think?, which earned me an OzDoc award in 2008. I subsequently translated it into a short film that is used in medical education throughout Australia.

Wondai pharmacy

I’ll always be grateful to Queensland Health for throwing me in the deep end before teaching me to swim. It might have turned me off rural general practice but it sure gave me great writing material.

Thank goodness the creators of PGPPP didn’t adopt that sink-or-swim approach. Bureaucracy notwithstanding, its heavily supervised and structured general practice attachments are educationally sound and proving beneficial all-round. Not so good for dinner-party horror stories, though.

Published in Australian Doctor on 15th Sept, 2011:  On Placement Programs

http://www.australiandoctor.com.au/articles/b3/0c0725b3.asp

Surprises – in life and in medicine

Last night I attended a surprise 30th birthday party for my friend Caroline. I had been somewhat reluctant to go. My disinclination had nothing to do with Caroline, who’s a lovely lass; it was because I have a strong aversion to such ambushes, in both concept and execution.

birthday_present

Why? Like many of our favourite patients do, let me present you with a list.

First, as much as beloved partner/parent/sibling/friend thinks they know who to invite, friendship nuances often elude them. This can make organising the guest list a treacherous business, akin to playing leapfrog with a rhino. Oh, and a word of advice to the social-network-naïve: Facebook “friends” are not actual friends. Accepting a Facebook friend invitation from an old schoolyard tormentor may be a sign of maturity and forgiveness, but it doesn’t mean you want to see him or her in your living room.

Second, most members of the fairer sex like to spend a considerable time preparing their external surfaces pre-party. To arrive, as poor Caroline did, in sweaty gym clothes, with dirty hair and not a scrap of make-up, at a room full of primped and preened women in party dresses, can be rather disconcerting, to say the least.

Third, for those of us who enjoy the lead-up to social gatherings as much as, if not more, than the event, being cheated out of the anticipatory excitement substantially decreases the overall enjoyment quotient.

Finally, unsurprisingly, courtesy of an inadvertent (or advertent) slip, the surprisee often finds out about the party, and then the dilemma arises — does one drop the “surprise” and just go with “party” or does the surprisee feign astonishment when friends jump up from behind couches?

There was no pretence on Caroline’s face when she stepped, tired and smelly, through her front door last Friday night. It crept in later, as she tried to be a gracious host to her guests. I suspect that she felt more like a hostage, doing her best to make people feel at home, while wishing that they were all at theirs instead. “All I wanted to do tonight was eat pizza, watch crappy TV and sprawl on the couch in my PJs,” she confessed.

I’ve never been fond of fabricated surprises of any sort. I like to know the who, how, what, when, where and why in advance, whenever possible. Some may say this indicates that I’m a control freak, but I choose to think of it in Boy Scout terms: I like to “be prepared”.

Luckily, I have a much more open attitude towards unplanned surprises — the type we encounter in general practice on a near-daily basis. The discovery of a suspiciously hard breast lump in a routine health check; the BSL reading of 24mmol/L in an unwell four-year-old; the well-dressed, articulate 50-year-old woman speaking of a 20-year history of domestic violence; the vasculopath giving up cigarettes, alcohol and fatty food after years of seemingly pointless encouragement … these surprises make our work the interesting, challenging and unpredictable beast that it is, and I relish them.

Surprises in general practice go both ways. Patients throw us curve-balls but we give as good as we get. In general, I like to prepare my patients the best I can, minimising the surprise element, especially when it comes to delivering bad news.

However, I must confess that at times I deliberately surprise my patients. I’m in favour of springing a smear on a Pap-avoider or an overdue immunisation on a needle phobic, for example … as long as no one tries such trickery on me!

Published in Australian Doctor on 18th August, 2011:  On Surpises

http://www.australiandoctor.com.au/articles/6f/0c07206f.asp

How I became a better whore

“You’re a boring whore! Fix it.” The barked criticism came like a slap in the face. The director of Les Miserables was right, though. I was a boring whore.

Two whores and a sailor

Two whores and a sailor

Actors need to immerse themselves in their roles, shed inhibitions and squelch embarrassment. I was not managing to do this while rehearsing the Lovely Ladies prostitute scene. My performance was overly self-conscious and restrained.

Three days later I found myself at a medical education conference, attending a session discussing learning plans. A popular tool in adult education generally, and a training requirement for all GP registrars, learning plans are actively disliked by many. Done purposely and thoughtfully, they can be of great benefit; completed hastily or reluctantly because they are compulsory, they are next to useless.

I have to confess that, as a registrar, my own learning plans were dashed off with little thought, submitted and then promptly forgotten. I’d never thought this technique would work for me.

At the conference, the attending educators were instructed to each write a learning plan that addressed an aspect of their non-medical lives. We were asked to choose something that we genuinely wanted to improve. I instantly knew what I’d write about, and completed the task with seriousness and sincerity.

The facilitator randomly picked a few participants to read out their learning plans. The topics were predictable: “I want to exercise each morning”, “I want to get at least seven hours of sleep a night” and the like. Yes, you can see where this is leading …

I should have anticipated being called upon, but when the “We have time for one more, how about you?” came, along with direct eye contact and a kindly smile, I momentarily panicked. Surveying the room of mostly middle-aged, male faces, many of whom I didn’t know, I considered making something up on the spot. Instead, I stood up, took a deep breath and read out: “I want to be a more exciting whore.”

I then outlined my proposed methods for achieving this objective and how I intended to measure my progress. Without explanation, I then sat down.

Silence. Not a sound. Most eyes were glued to me, the others looking anywhere but. The atmosphere was thick with shock, amusement, confusion, suspense and fascination.

I didn’t leave them hanging for too long. After my disclosure as to why I chose the topic and the context in which I was “whoring”, there were audible sighs of relief and a sprinkling of laughter throughout the room.

It was memorable for those present. Four years later, I still get the occasional question about my “whoring” when I run into certain educators at conferences.

I am pleased to report that my learning plan well and truly achieved its aim. I enacted my plan exactly as written and practised diligently. I knew I had been successful when the director instructed me to “Tone it down a bit. This is a family show, you know!”

Not high-class hookers!

Not high-class hookers!

I now feel a lot more comfortable extolling the benefits of learning plans to unconvinced registrars. I tell them: “I used to think that I wasn’t a learning plan-type person either but I’ve discovered that if you choose a relevant and important objective and spend time and effort working out how to achieve it, the technique can really work.”

I tend to leave out: “It didn’t do much for my medicine, but it turned me into a fabulous whore.”

First Published in Australian Doctor on 21st July, 2011: On Becoming a Better Whore

http://www.australiandoctor.com.au/articles/10/0c071810.asp

Coming Out Of The Medical Closet

The actor fell three metres, hitting his head on the stage floor. I ran over to assist. “Would it be OK if I take a look at you?” I said quietly, “I’m a doctor.”

“You’re a doctor?”

“A doctor doctor? No way!”

The small crowd that gathered seemed more interested in my career than their fallen comrade, who, thankfully, was not seriously injured.

“I thought she lectured at uni.”

“She told me she taught music.”

“She’s way too … normal … to be a doctor.”

I had no choice but to be upfront.

“Yes, I’m a doctor — a GP. I’m also an educator. I teach doctors-in-training, and I do a little bit of violin teaching on the side.”

“Why didn’t you tell us? We’ve been working on Les Mis together for two months!”

“It didn’t seem important. I’m here to act and sing, not to talk about work.”

At the time, I was new to this theatre company and was enjoying the relative anonymity. Being judged solely on my (rather unimpressive) performance skills, I could forget all vestiges of my working life during the twice weekly rehearsals. I was Genevieve-the-also-ran-actor, not Genevieve-the-doctor-educator-musician-writer. I blended into the crowd. It was liberating.

I never lead off with the “I’m a doctor” line when introducing myself in a non-clinical context, unless directly relevant. I’ve found that it comes attached to a swag of assumptions including being a workaholic and having a penchant for golf.

Conversation tends to go off on the “she’s a doctor” detour, which can start with questions about little Johnny’s ADHD treatment and end with the removal of a shoe for an opinion about a diseased toenail.

If I’m lucky, a few jibes about the medical profession are thrown in along the way to lighten the mood. If luck is nowhere to be seen, I’ll receive a lecture about why immunisation is a government/drug company conspiracy and then get the “I’ve been looking for a nice lady doctor who’ll listen to my point of view — I think I’ll start seeing you” line.

The outlook is even more dire in the dating stakes — for we girls, that is. For many, a female’s medical qualification can be as big a turn-off for a prospective male partner as it is a turn-on when the genders are reversed.

I learnt this hard life lesson while at university.

Male medical student meets girl … She thinks: “Soon-to-be-doctor = strong-minded, intelligent, powerful, will make more money than me, mum will be overjoyed … YES please!”

Female medical student meets boy … He thinks: “Soon-to-be-doctor = strong-minded, intelligent, powerful, will make more money than me, mum will be overjoyed … run for the hills!”

I did a lot better after I changed my game plan and introduced myself as a music teacher (which is how I derived my income during medical school).

One of my male colleagues recently explained this glaring gender inequality by saying: “In general, intellectually and professionally, men like to be admired while women like to admire. Don’t take it personally. At least you’re just a GP. It would be far worse if you were a specialist.”

After my being outed during Les Miserables rehearsals, the director, who’d hardly spoken to me previously, became downright chatty. Rather amusing, really. There was a definite advantage bestowed on me, though: leniency when I occasionally arrived late to rehearsals.

“It’s all right; she’s a doctor. They’re busy people. Deal with life and death. Can’t help running late. But heaven help the rest of you if you don’t turn up on time!”

Adapted from a column published in Australian Doctor on 23rd June, 2011: On Coming Out

http://www.australiandoctor.com.au/articles/45/0c071145.asp

Male Postnatal Depression – a sign of equality or a load of nonsense?

Storylines on popular TV dramas are a great way of raising the public’s awareness of a disease. They’re almost as effective as a celebrity contracting an illness.

For example, when Wiggles member Greg Page quit the group because of postural orthostatic tachycardia syndrome, I had a spate of patients, mostly young and female, coming in with self-diagnosed “Wiggles Disease”. A 30% increase in the number of mammograms in the under-40s was attributed to Kylie Minogue’s breast cancer diagnosis. The list goes on.

Cast of Desperate Housewives

Cast of Desperate Housewives

Thanks to a storyline on the current season of the TV drama Desperate Housewives, I’ve recently received questions about male postnatal depression from local housewives desperate for information:

“Does it really exist?”

“I thought postnatal depression was to do with hormones, so how can males get it?”

“First it’s male menopause, now it’s male postnatal depression. Why can’t they keep their grubby mitts off our conditions?”

“It’s like that politically correct crap about a ‘couple’ being pregnant. ‘We’ weren’t pregnant, ‘I’ was. His contribution was five seconds of ecstasy and I was landed with nine months of morning sickness, tiredness, stretch marks and sore boobs!”

One of my patients, a retired hospital matron now in her 90s, had quite a few words to say on the subject.

“Male postnatal depression — what rot! The women’s liberation movement started insisting on equality and now the men are getting their revenge. You know, dear, it all began going downhill for women when they started letting fathers into the labour wards. How can a man look at his wife in the same way if he has seen a blood-and-muck-covered baby come out of her … you know? Men don’t really want to be there. They just think they should — it’s a modern expectation. Poor things have no real choice.”

Before I had the chance to express my paucity of empathy she continued to pontificate.

“Modern women just don’t understand men. They are going about it the wrong way. Take young couples who live with each other out of wedlock and share all kind of intimacies. I’m not talking about sex; no, things more intimate than that, like bathroom activities, make-up removal, shaving, and so on.”

Her voice dropped to a horrified whisper. “And I’m told that some young women don’t even shut the door when they’re toileting. No wonder they can’t get their de facto boyfriends to marry them. Foolish girls.

“Men need some mystery. Even when you’re married, toileting should definitely be kept private.”

I have mixed feelings about male postnatal depression. I have no doubt that males can develop depression after the arrival of a newborn into the household; however, labelling it “postnatal depression” doesn’t sit all that comfortably with me. I’m all for equality, but the simple fact of the matter is that males and females are biologically different, especially in the reproductive arena, and no amount of political correctness or male sharing-and-caring can alter that. Depressed fathers need to be identified, supported and treated, that goes without saying, but how about we leave the “postnatal” tag to the ladies?

As one of my female patients said: “We are the ones who go through the ‘natal’. When the boys start giving birth, then they can be prenatal, postnatal or any kind of natal they want!”

Published in Australian Doctor on 28th April, 2011:  On Male Postnatal Depression

http://www.australiandoctor.com.au/articles/77/0c070477.asp

Socks, Kiwis and Surgical Removal (of socks, not Kiwis)

I’m a klutz. Always have been, probably always will be. I blame my clumsiness on the fact that I didn’t crawl. Apparently I was sitting around one day and toddling on two feet the next.

Whatever the cause, it’s a well-tested fact that I’m not good on icy footpaths. Various parts of my anatomy have gotten up close and personal with frozen ground on many an occasion. Not usually an issue for a born-and-bred Queenslander, except when said Queenslander goes to visit her Canadian family during the northern winter.

Earlier today, I found myself unceremoniously plopped onto slick ice while my two-year-old niece frolicked around me with surefooted abandon. I thought: “There has to be an easier way.”

As freezing water seeped through my jeans, providing a useful cold pack for my screaming coccyx, my memory was jogged.

Last year, a lateral-thinking group of New Zealand researchers won the Ignoble Prize for Physics for demonstrating that wearing socks on the outsides of shoes reduces the incidence of falls on icy footpaths. To the amusement of my niece, I tried out the theory on the walk home.

image socks 2

I don’t know if I had a more secure foothold or not, but I did manage to get blisters from wearing sneakers without socks.

I love socks. They cover my large, ungainly stompers and keep my toes toasty warm almost all year round.

I’m not, however, as attached to my socks as a patient I once treated. As an intern doing a psychiatry rotation, one of my tasks was to do physical examinations on all admissions. Being a ‘dot-the-i’s kinda girl, when an old homeless man declined to remove his socks so that I could examine his feet, I didn’t let it slide.

“I haven’t taken off my socks for 30 years,” he pronounced.

“It can’t be that long,” I countered. “Your socks aren’t 30 years old. In fact, they look quite new.”

“When the old ones wear out,” he replied, “I just slip a new pair over the top.”

I didn’t believe him. From his odour, I would have believed that he hadn’t showered in 30 years, but the sock story didn’t add up.

He eventually agreed to let me take them off. The top two sock layers weren’t a problem, but then I ran into trouble. Black remains of what used to be socks clung firmly to his feet, and my gentle attempts at their removal resulted in screams of agony. I tried soaking his feet. Still no luck. His skin had grown up into the fibres, and it was impossible to extract the old sock remnants without ripping off skin.

In retrospect, I probably should have left the old man alone, but instead got the psych registrar to have a peek, who then involved the emergency registrar, who called the surgeon and soon enough the patient and his socks were off to theatre.

The ‘surgical removal of socks’ was not a commonly performed procedure, and it provided much staff amusement. It wasn’t so funny for Mr Sock Man, who required several skin grafts.

From my present perspective here in Canada, while I thoroughly commend the Kiwis for their groundbreaking sock research, I think I’ll stick to the more traditional socks-in-shoes approach, change my socks regularly and work a bit on my co-ordination skills.

Published in Australian Doctor on 3rd March, 2011: On Removing Socks

http://www.australiandoctor.com.au/articles/58/0c06f058.asp

Is there a doctor on board?

Qantas plane“Is there a doctor on board?” I used to wish a call like this would go out while I was flying. I had this romantic idea of saving the day, being showered with praise and upgrades, the cabin bursting into spontaneous applause; joining the medical equivalent of the mile-high club.

On a return trip from Canada, my dream was put to the test: LA to Brisbane, 13 hours of economy-class hell, barely a spare seat on the plane and surrounded by more energy reserves than needed to sustain an African village for a year. Yep, morbidly obese Americans — in front, beside and behind me.

The three seated behind me took the cake (actually I suspect they’d taken many a cake in their time). Dad was as loud as he was wide, and his demands and complaints kept the poor flight attendants on their toes.

“I’ve heard this called ‘cattle class’, but I own a big ranch in Texas and, let me tell ya, my cows have more room when they travel than we do here.”

I wanted to point out that most humans were smaller than bovines, and require less room, but I resisted.

“My wife is pregnant and these here cramped conditions are dangerous for the baby. Never flown ‘coach’ before.”

Why did he start doing so now — on a long-haul, trans-Pacific flight with a pregnant wife and, more importantly, me in the next row?

“But now that I’ve been jammed into this damn midget seat, I intend to take up the matter with the airlines — and my lawyer! It shouldn’t be legal!”

Mom’s mouth was mostly occupied with chewing, but in between mouthfuls she let forth a lungful or two. Their four-year-old butterball rhythmically kicked the back of my seat but I didn’t feel I should admonish him — after all, he was exercising!

In the end, I could take no more. I can count the number of times I’ve ever taken a sedative on one hand, but these were desperate times, and a Stillnox allowed me to sleep.

The word ‘doctor’ penetrated my groggy haze.

“She’s got a lotta pain in her belly. We need a doctor — now! It could be the baby! I told you these tiny seats were dangerous!”

Soon enough, the call for medical assistance came over the PA.

“How pregnant?” I wondered. It was impossible to tell from her body habitus — as in the song from Oklahoma, she was “as round above as she was round below”. I had visions of trying to deliver the premmie baby of an obese, litigious American on a crowded plane and half-asleep, I decided discretion would be the better part of valour. I lay in wait, fervently hoping I’d be beaten to the punch.

Luckily, three altruistic medicos swooped in as I watched from my seat. The ophthalmologist and psychiatrist from business class weren’t particularly useful, but the third-year resident from the rear of the plane was marvellous. How he examined her in the space confines I have no idea, but efficiently and professionally he was able to reassure her that her burning epigastric pain was unrelated to her seven-week pregnancy. An antacid was produced from somewhere and the pain settled rapidly.

He was proclaimed a hero and upgraded to business class for the remaining nine hours of the flight. Meanwhile, now wide awake, I was left in the company of my still-whining neighbours, to pay the penance for my inaction.

First published in Australian Doctor 31st March, 2011: On Airline Anguish

http://www.australiandoctor.com.au/articles/8b/0c06f98b.asp

I hate being on-call – I’m just not good at sleeping on the job

BOXING Day, 2010, 1.30am. “Are you the doctor on call?” I wrenched my reluctant brain from its REM state. “Yes.”

“I’m worried about my wife. She’s 16 weeks pregnant and very gassy.”

“Gassy?”

“Burping and farting. Smells terrible! It’s keeping us both awake. I’m worried it could be serious.”

By the time I ascertained that there were no sinister symptoms and that the likely culprit was the custard served with Christmas pudding (the patient was lactose intolerant), I was wide awake. My brain refused to power down for hours, as if out of spite for being so rudely aroused.

I have a confession to make. When the Federal Government announced last year that it was planning to abolish after-hours practice incentive payments, I was delighted. I know, I know, I should have been outraged along with the rest of you. After all, the RACGP predicted that after-hours care would be decimated if incentives were removed. Comparisons were made with the revamp of the UK system in 2004, which led to 90% of the profession opting out of after-hours work. Much as I sympathised, I was secretly rubbing my hands together with selfish glee. Surely this would mean that our semi-rural practice would stop doing all of our own on-call and free me from my after-hours responsibilities?

I detest being on call. I loathe it with a passion completely out of proportion to the imposition it actually causes. I’m on call for the practice and our local hospital only once a week and the workload isn’t onerous. Middle-of-the-night calls aren’t all that frequent, but my sleep can be disturbed by their mere possibility, leaving me tired and cranky. If I’m forced suddenly into “brain on, work mode” by a phone call, I can kiss hours of precious slumber goodbye.

I love to sleep, but, as with drawing and tennis, I’m not very good at it. I gaze with envy at those lucky devils who nap on public transport and fight malicious urges to disturb their peaceful repose. If I’m not supine, in a quiet, warm room, with loose-fitting clothing, a firm mattress and a pillow shaped just-so, I can forget any chance of sleep. Let’s just say I can relate to the Princess and the Pea story. I bet she wouldn’t have coped well with being phoned in the middle of the night either.

If these nocturnal calls were all bona fide emergencies, I wouldn’t mind so much. It’s the crap that really riles me. I’ve received middle-of-the-night phone calls from patients who are constipated, patients with impacted cerumen (“Me ear’s blocked, Doc. I can’t sleep”) and patients with insomnia who want to know if it’s safe to take a second sedative. The call that took the on-call cake for me, though, was from a couple who woke me at 11.30 one night to settle an argument.

“My husband says that bacteria are more dangerous than viruses but I reckon viruses are worse. After all, AIDS is a virus. Can you settle it for us so we can get some sleep? It would really help us out.”

I kid you not. In what’s rapidly becoming its modus operandi, the government has performed a policy back-flip and is now planning to delay any changes until 2013. I’ve got a long wait ahead.

Published in Australian Doctor on 3rd February, 2011: On Being On Call

http://www.australiandoctor.com.au/articles/d4/0c06e7d4.asp