Trying to be more than just a referral service
BEING a GP gives one an opportunity to experience rejection on a daily basis. Consider the patient who plops down and informs you: “I just need a referral to a psychologist.”
You look at your notes. She last attended your surgery a few years ago. You probe further and hear that she “needs to talk to someone”. You feel like waving your hands and saying: “What about me? I’m someone – or at least, I used to be someone.”
You take a quick survey of your body: upper limbs, trunk, lower limbs, all accounted for. You confirm that you are a definite presence, that you are not invisible, even if your patient speaks as though you don’t exist.
“I think I may be able to help you myself,” you suggest tentatively.
You still recall the golden age of general practice, when seeing a doctor was a valued service and not merely the default position.
“But my friend saw a psychologist who really helped her. I want to see that psychologist, too.”
Your heart sinks. You start to explain that it’s not a simple referral. And the rebate won’t necessarily cover the psychologist’s fee.
“Oh, I’ve already investigated that. I know it’s not cheap.”
You learn that the psychologist charges $190 an hour, while you bulk bill.
You explain the intricacies of the mental health care plan before your courage returns.
“I’d like to suggest another approach. I want to see how much progress we can make together first. If we need a
psychologist to help out down the track, that is always an option.”
You wonder whether your patient’s expectation that she will be healed by someone else will undermine your attempt.
You are exhausted by your efforts to get an opportunity to help your patient directly.
Your next patient enters, a young woman. She starts by asking for a repeat prescription for the pill. Three other important health issues surface during the course of the conversation.
“Isn’t it great that I’ll just be able to go to the pharmacist and get the pill from now on,” she says.
“That’s only as an emergency, if you haven’t got a script. You still need to return to the doctor and get another script before more can be dispensed.”
I see her face drop. “I don’t see why,” she says.
“Well, we talked about three other problems today,” you remind her.
“Oh,” she nods half-heartedly.
I used to think it was a challenge to provide quality health care, but now I find my most
difficult task is to be accepted in my role.