Talking GP special interests with Dr de Lange
THERE are two types of medical students, according to Dr Krystyna de Lange—the ones who know their career trajectory from day one, and the ones who walk through the door and have no idea what they want.
“The latter was me,” Dr Krystyna de Lange laughs, “so in the hospital, I was really pushed towards doing a hospital-based specialty.”
“You don’t get a lot of exposure to general practice in the hospital…it feels very distant.”
“Often the tendency can be to just continue on the trajectory towards a hospital-based specialty.”
While Krystyna enjoyed obstetrics and gynaecology, she found herself sitting back and wondering, “is this something that I really want long term for my career?”
The continuity of care drew Krystyna towards general practice.
“I really yearned to develop those long-term relationships with patients. I really wanted to be able to make a difference to patients’ experience and journey through life.”
“Growing up we had a great GP who knew the whole family and she was very approachable and she was very thorough. That gave me an idea of what a GP could be.”
Nervous about entering GP training, Krystyna felt like she needed to know everything before she started.
“I stayed in the hospital for another year and I did six months of paediatrics and then six months of emergency medicine to really try and broaden my skillset. I felt more confident coming into general practice.”
Krystyna keeps her schedule busy by working at an Indigenous Health service as well as a sub-specialised gynaecology clinic in a tertiary hospital. She is also the Registrar Representative on the Royal Australian College of General Practitioners (RACGP) Board.
“The great thing about general practice is that you can change your career over time.”
“You might start off doing something really generalist, but then you might move into a more specialised area because that suits your stage of life and your career at that point, and then you might move back or keep a mix.”
The internet, particularly social media, has dramatically changed how patients select their GPs and how GPs develop their special interests.
“Through social media, quite quickly patients become aware of which GPs have an interest in a particular area. They generally select for that and vice versa.”
“Your passion and confidence for a special area transfers onto the patient…they tend to come back to see you for that issue for their family and then they’ll tell their friends and their families.”
“Before you know, it is on social media and then your practice very quickly builds up into an area that you’re interested in.”
“Even if you don’t necessarily select your special interest, patients just generally work it out.”
The benefits of sub-specialising as a GP
One day a week, Krystyna works at a tertiary hospital in a sub-specialised gynaecology clinic.
The clinic is designed to help reduce public waitlist numbers; many patients wait a long time to see a specialist for conditions that can be managed by a GP with extra training—GPs such as Krystyna.
“From the beginning, I really enjoyed doing obstetrics and gynaecology. The problem was that I didn’t want to just do that.”
“I also found that I enjoyed the things that the specialists didn’t necessarily get to do, such as contraception and menopause.”
While GP positions in hospitals are uncommon, Krystyna says there is an increasing scope in this area.
The key to pursuing any special interest, Krystyna says, is about putting up your hand early on and letting your interests be known in the hospital system.
“It’s very hard to go back to the hospital system once you’ve already left.
“Any experience you bring with you into general practice is invaluable.”
“When you come out to your general practice terms, look very closely at the practice that you’re choosing. Ask yourself, ‘Does this practice have GPs there that can support me in this special interest?’.”
While obtaining extra qualifications during your GP training can be a “juggling act”, Krystyna says that extra education is worth the effort.
“Put your hand up for things as well…you just don’t know what that door will open.”
Many doctors wonder, ‘Why sub-specialise as a GP when you can become a specialist in that area?’. According to Krystyna, being a GP with special interests allows you to do more.
“I love caring for a woman during a pregnancy. But I also want to be the one that helps the baby.”
“I don’t want to have to say, ‘Oh sorry, you’ve had your baby now and your care goes to someone else’.”
“I want to be the one doing the six-week check for the baby, the vaccinations, talking about the child’s development, and supporting the mum.”
Krystyna says GPs have more flexibility to tailor their career in the long term.
“As a GP I’m not stuck thinking, ‘I’m now in this specialty and I can’t really back away’. There is plenty of opportunity for me to then turn around and decide, ‘Well, actually I want to do extra training in dermatology and skin cancer and focus my practice there’.”
Our Nation’s First People and mental health
One of the biggest challenges in facing the health of Aboriginal and Torres Strait Islander is mental health—our Nation’s First People are overrepresented when it comes to the risk factors for mental health.
As a GP in an Aboriginal and Torres Strait Islander health clinic, Krystyna sees a lot of patients with mental health concerns.
“GPs are quite well-placed to help patients because we have a holistic view. We’re looking at mental health in the bigger context of someone’s social, medical, and physical context.”
“[GPs] are able to have a deeper understanding of what might be going on in their lives and what might be contributing to their mental health…we’re able to coordinate their care and help them navigate what is actually a very challenging healthcare system.”
Part of being a GP, Krystyna says, is helping break down the stigma around mental health, and trying to support a patient access culturally appropriate services.
“It is no good to say to a patient, ‘Why aren’t you taking your medication?’. How can a patient take their medication if they are homeless, if there are drug and alcohol problems, or if there are severe mental health issues?”
“GPs try to optimise not just one aspect, but someone’s whole health.”
“We need to try to have more women in positions of leadership to show other women that it is possible for them to do it and that it’s not just a boys’ club.”
A representative for GP registrars
Beyond the clinical, GPs have a lot of scope to take up roles in governance, policy, and advocacy—Krystyna likes having a mixture of clinical and non-clinical roles.
As the Registrar Representative on the RACGP Board, Krystyna ensures that the RACGP hears the voice of GP registrars. Krystyna was able to help establish RACGP’s National Faculty for GPs in Training and serve as the inaugural Chair.
“As we move towards college-led training, [the registrar voice] is going to become a bigger part…whenever you’re making decisions about GPs in training, you need to talk to GP registrars and hear their ideas and their feedback and try to engage and collaborate with them.”
“That’s why I saw such importance in establishing a Faculty for GPs in training.”
The biggest issue facing GP training at the moment is the decreasing number of applicants to the GP training program, Krystyna says. “Unfortunately, whenever overall numbers drop, we see rural and remote areas being squeezed.”
“We really need to be mindful of how we can not just increase overall numbers, but make sure that we get GPs into the areas where they are needed most.”
A first step is increasing the visibility of general practice in the hospital. “We also need to ensure that registrars are not financially disadvantaged coming out into general practice training.”
Krystyna says that more can be done to encourage women to take up positions of leadership in general practice—including setting targets and tapping more women on the shoulder.
“My position on the RACGP Board really came up because I was approached by two different people who said, ‘I think you should apply for this’. If they had not have done that, I probably would never have applied for the role.”
“We need to try to have more women in positions of leadership to show other women that it is possible for them to do it and that it’s not just a boys’ club.”
“There is parity in terms of the trainees that are coming into the GP training program. It is very reasonable to then think that we should have parity in terms of our committees and our leadership positions.”
Making more accommodations will go a long way to ensuring women are not locked out of clinical and non-clinical roles when they are raising children.
“There is a shift happening…I’ve sat in meetings where both sexes, a male and a female doctor, brought their children in with them.”
“We are only going to make true inroads into this issue if we make [flexibility] the norm for males as well…because if it is always the female this is being accommodated for that tends to lead to unconscious bias when it comes to employment and training opportunities.”
Banner photo by Brisbane Local Marketing
