As the millennial adage goes, ‘don’t ever Google yourself’—in a world full of social media and online reviews, patients often do a doctor’s work for them by writing recommendations online.
“One of my patients told me that I’m recommended in a Facebook group and I’m internet famous,” Dr Jess Tidemann laughs.
“My first reaction is always to feel a bit self-conscious…because I feel like I’m just doing my job, so I think sometimes I struggle because a lot of my patients are very grateful.”
“It was just word of mouth in a small town, then all of a sudden you have got more patients than you can keep up with.”
One of the things Jess has learnt as a GP is how much patients value the small things which may have seemed insignificant at the time.
“You think, ‘It’s just my job and it was just an average day’ but for the patient it might have made a huge difference.”
“I had a patient of mine die in the last couple of weeks after having cancer for a long time. I’ve looked after him and have got to know his family, and I was able to support him through palliative care.”
Ultimately, it is the realisation of what a big difference you can make in someone’s life, which makes you go back and do it again, Jess says.
“It’s very challenging and some days it feels like a heavy load…It takes a lot of my emotional energy, not necessarily in a bad way, but to provide compassionate ongoing care. I try to be compassionate and connected, but distanced enough to be able to be professional.”
Dealing with frustration is a part of the job, Jess says.
“You can feel a bit impotent because you can’t change what is going on in people’s lives…in general practice, you just walk with the patient.”
“It feels like you’re not doing very much, but by being available and being that person who supports them through it is more important than jumping in with some heroic magic solution.”
Having previously worked at the Canberra Sexual Health Centre, Jess’ move into transgender medicine happened naturally—now, a proportion of her patients are transgender.
“I’ve gone into general practice at a time where trans and gender diverse people are feeling more able to be themselves and there is more of a dialogue around what that means,” Jess says.
“A lot of my patients have felt a certain way for their whole life, but they didn’t have a reference point because [being transgender] just wasn’t something that was in public consciousness.”
General practice is providing the space for a grassroots movement towards greater recognition of transgender medicine, Jess says.
“Where do people go when they don’t know where to start? Their GP. And hopefully they are received positively and have a good experience.”
While there are difficulties practising medicine in this space, Jess says, it is rewarding to look after people who may not have received good care elsewhere.
“A lot of my transgender patients have experienced outright discrimination, or discomfort, or minor things of seeing other doctors who just aren’t very well informed, right through to people who are quite unpleasant.”
To Jess, it doesn’t make sense for a patient to have one GP for certain health matters and another GP for transgender health matters.
“Where possible, I think as GPs, we should be able to look after the whole person.”
“One of the things I would really like is for gender-affirming hormone therapy and transgender care to be part of mainstream general practice.”
“I think a lot of people are concerned about practising in an area that has limited evidence, and is new, but trans and gender diverse people have healthcare needs like everybody else, so I feel this is really the only way forward.”
Policy and politics
Jess has always been interested in the bigger picture and having lots of different things “on the go”.
“General practice appealed to me because I could combine clinical medicine with being able to do other things—and to be able to change that over time,” Jess says.
Living in Canberra, Jess is well-placed to get involved in advocacy and political change.
“There are people working in other areas of medicine who do [advocacy], but it is often much further down the track in their career, and there is often a lot less opportunity.”
“Whereas in general practice, very few people work full time in clinical general practice, because they are teaching, or in advocacy roles, or public health, or government.”
The two areas for change which Jess is most passionate about are finding a sustainable way forward for general practice as a profession, and better supporting GPs in training.
“Australia needs to continue to have a public healthcare system that provides adequate care for our population as a whole, we need to focus on how to strengthen Medicare, which is currently the backbone of our public healthcare system.”
Jess says that the way we practise medicine is changing, and with it, the system needs to change.
“We have a transactional model working with a less transactional type of medicine…the demands and the expectations have increased, particularly with mental health care, but not the time, support, or remuneration.”
One of the biggest issues in general practice going forward is funding, Jess says, and often the national conversation focuses on hospital funding and reducing surgical waiting lists.
“[As a GP] saying, ‘I saw this person every fortnight for five years and helped them through a very dark time in their life’ isn’t catchy. I think in that respect, general practice probably needs to do better at promoting itself politically.”
Creating change in a national system is tiring, Jess says, and she regularly feels “defeated”.
“In advocacy, you have to be able to push past that feeling like you’re not getting anywhere. Because you might not have got to where you wanted to, but you might be a little further down the road and maybe somebody who comes after you has more success.”