The journey into general practice
When deciding to make the switch from a ten-year career in nursing to studying medicine, Dr Bree Wright thought that having kids was off the cards.
“Then,” Bree says, “I met someone who was a single dad of three kids and I thought ‘This is great, I’ve got the kids, I’ve got the medicine…this is all happening’.”
Against the odds, Bree fell pregnant not once, but twice—a manageable family of five became a large family of seven—all while Bree was working in the hospital sector.
“I was finding the long days too much—and the mummy guilt was fairly significant.”
“General practice had always been an option for me but it became even more attractive when I was trying to find a good work/life balance.”
Bree is sure that the key to making family life and a career in medicine work is compromise.
“There are a lot of sacrifices to be made…jumping into general practice land, financially you do initially take quite a hit, but I look at it as the payoff for investing in a future that is going to allow you a bit more balance.”
“[In general practice] you can often find flexibility you would not find in the hospital system. I have been known to block off a little bit of time to dash out for an event at school for an hour, and then pop back in. That kind of convenience is hard to put a price on.”
Despite ten years of medical experience, Bree found the change from a hospital ward to a consulting room daunting.
“GPT1 was actually quite terrifying,” Bree recalls, “that sudden realisation that I did not have my back up of specialists to call on within the hospital, I could not get my pathology results within half an hour of blood being drawn, and I did not have a whole posse of other interns, residents, registrars or consultants to turn to at the drop of a hat.”
“General practice is a really different playing field where suddenly you have to be able to make the call on whether this is something that can wait or whether you need to act now, and how you manage things like that—it is quite a quick learning curve.”
The key, according to Bree, is time and asking others if you are unsure.
“I actually found that patients respond really well if you say ‘Look I’m really not sure what’s going on here but I’m pretty sure it’s not A, B and C—’ (all the sinister nasty diagnoses) ‘—so we’ve got time to work through this’.”
Good patient management and clear communication are Bree’s key aspects of being a great GP.
“I’m really big on making sure my patients are aware of what the red flags are to watch out for…we make a plan and I want them to know what things they need to take themselves off to the emergency department for if it is the weekend, or what they need to come back and contact me ASAP for.”
Like many GP trainees Bree found that there was a big gap between GPT1 and GPT2.
“I really found my feet in GPT2, having regular patients starting to filter in, getting my routine down, and finally feeling more comfortable with uncertainty,” Bree says.
“I think we are so programmed, especially when we are in the hospital system, to need an answer or a definitive plan…in general practice, it was quite a shift to suddenly say, ‘Let’s see how this goes, it is probably going to do X, Y and Z, so come and see me in a week’.”
Finding the right training practice
After a number of phone calls and emails, Bree found a home at Melville Family Health.
The privately owned, private billing practice is located south of Perth’s beautiful Swan River and has serviced the Fremantle and Melville communities since the 1970s.
The clinic features traditional and antique displays, such as museum collections, fish tanks and water features.
Bree completed her GP training at the clinic in 2019, and enjoyed her time there so much that she continued working at the clinic post-Fellowship.
“I’ve never been a fan of five minute medicine…I like that I can put time and effort into my patients without feeling like someone is breathing down my neck,” said Bree.
From the very young to the very old, Bree is able to see a broad range of patients—sometimes treating the whole family—and is able to travel with a patient through their entire medical journey.
“I’ve seen patients when they started considering conception, have fallen pregnant, and I’ve held their hand through the pregnancy journey. Now, they bring their babies to see me. I love it.”
“You see families in GP land—the grandchild all the way through to the grandparent, and you know the family story—the collective history—which really makes it quite personal.”
The highlights are the relationships Bree has formed with her patient cohort.
“I had a patient who, whenever she came to see me, brought me flowers from her garden. She loved bringing me her camellias because she knew that my husband gave me camellias while we were dating.”
“The camellias have such a short season though, so when roses are in she brings me roses. I had another patient that always brought me a coffee when she came in. I have been very spoiled.”
General practice is a specialty full of great heights and challenging times.
“General practice is hard work, but enjoyable. It is a real privilege to be involved in people’s lives as their GP…you can be with people at their best and their worst moments, and to be able to sit with that is quite a special thing—thinking about it makes me quite emotional,” says Bree.
“You can be the person that gives someone the best news of their life or the worst, but to be okay with that, and to be that person who handles it with the sensitivity that it deserves, that is the special thing about general practice—you are able to follow your patient’s journey all the way through.”
An array of opportunities
As well as having more control over the balance between work and personal life there are many aspects to the specialty that Bree finds attractive.
“In general practice, you are not just seeing someone to treat them for a disease in the moment, it is all about the person—the story behind the condition—and about investing in their long-term health.”
“Plus, I wanted to be able to practice a very broad range of medicine,” Bree says, “and I like the phrase, ‘If you can’t do great things, do small things in a great way’. That, to me, is general practice in a nutshell.”
“If you like an adrenaline rush combined with aviation you can become an RFDS (Royal Flying Doctor Service) doctor! If you like cosmetics, you can do cosmetic training or skin checks.”
Another benefit to general practice is the ability to pursue your clinical interests.
“Almost anything you could dream to do in general practice, you can do,” says Bree.
“If you’ve got an interest in aviation you can do aviation medical checks, if you like an adrenaline rush combined with aviation you can become an RFDS (Royal Flying Doctor Service) doctor! If you like cosmetics, you can do cosmetic training or skin checks.”
Bree’s clinical interests rest in women’s health, youth health and paediatrics. She has completed an Extended Skills Term (EST) where she obtained a certificate in Sexual and Reproductive Health, and has completed training for IUD and implanon insertions.
Bree holds a Certificate in Women’s Health, and is also registered with the Australian Medical Association (AMA) as a Youth Friendly Doctor. She is passionate about providing patients a safe space to discuss their concerns.
“When it comes to sex a lot of people are often really hesitant to discuss it…I have always been quite comfortable talking about it. There is certainly a need for GPs who don’t shy away from it and who can talk to men and women alike, the elderly and teenagers, and give them a safe space.”
According to Bree, female GPs naturally attract patients looking for sexual and reproductive healthcare.
“Having clinical knowledge of sexual and reproductive health comes very, very much in handy. You are faced with everything from conversations with teenagers who are contemplating their first sexual activity all the way through to surprises in your elderly cohort, and you simply can’t afford to look shocked or surprised by anything.”
“My favourite was one of my elderly patients in their eighties, who had ‘recently discovered the joys of cunnilingus’—as they termed it—and wanted to know about the health and safety risks associated.”
“It is these quirky little surprises (and discussions) along the way that make being a GP interesting.”
Advocacy and medical education
With an interest in advocacy, the Registrar Liaison Officer (RLO) role naturally attracted Bree.
“I feel strongly about good training and support for GP registrars…it is really important for registrars to feel like they have a safe space to talk through new issues while starting out on their training journey, because it is such a change to the hospital environment, even down to suddenly having to negotiate your own employment agreement.”
“Sometimes a GP registrar does not want to directly approach their training provider if they have concerns, and they are often not quite sure how to approach things with their employer, so their RLO is a really great midpoint.”
Now a GP fellow, the future is full of opportunities for Bree. She is the Future General Practitioner (FGP) Advisor for Western Australia, and performing External Clinical Teaching (ECT) visits for Western Australian General Practice Education and Training (WAGPET).
Creating community change
With over 43,000 GPs in Australia according to the latest census data, GPs are a huge force for improving the healthcare outcomes of all Australians.
According to Bree, changing Government health expenditure should mean investing in grass roots primary healthcare—particularly in the areas of health education, health promotion, and increasing Medicare rebates.
“If you can manage a patient’s diabetes well—or even put it into remission—that is someone who may not wind up with a foot amputation or on dialysis in twenty-five years, which equals a huge saving to both our health services and our community,” Bree says.
“But patients will not make sustained changes if they do not understand why, nor will they continue with medications or be compliant with your recommendations if they lack understanding. However, if they do understand enough to take what you say on board, then they potentially also become a health advocate to families and friends by role modelling.”
The key to creating community change, according to Bree, is a better-funded primary healthcare system.
“I believe we have problems with primary care funding in Australia because no political party wants to invest in something that they are not going to see any great results for during their term of election, let alone the next ten to twenty years,” says Bree.
“There needs to be improved financial remuneration for longer consults to allow time for health education, health promotion, early identification of risk factors for chronic disease, and early intervention…by the time someone has the chronic disease, you have missed the boat. “
“GPs need to be able to spend time educating and counselling patients, instead of rushing them in and out in five minutes, and we are in the best position to do this—we have a rapport with our patients and they trust us.”
“Ironically, and unfortunately, we also need increased remuneration for longer consults so we can appropriately manage our complex patients, of which there are an increasing number.”
The challenges of being a GP
According to Bree, society is changing, and with it, the issues triggering a patient’s visit to the GP. In Bree’s clinical experience, mental health issues are the most common reasons patients visit their GP.
“I think as a society we have become quite disconnected…Media and technology saturation has led to a cognitive overload and social media simply sets us up for an expectation or subconscious belief that we should be able to achieve everything,” Bree says.
“We used to have enforced Sundays off—no petrol stations open, no shops, no phones pinging, no work emails coming through, no nothing. We would actually have time to mentally unload and wind down. I think as a society we have very much lost how to do that, and I believe we are paying the price for it with our mental health.”
“Personally, I’ve realised that full-time consulting hours are not sustainable for me long term, as I do see a lot of mental health patients and I find it quite taxing. I’ve had to learn my limits.”
Sometimes there are moments of heartbreak.
“I came back from a Christmas break and found out that one of my patients had attempted suicide while I was away, and I was devastated.”
“Whilst everything had been done within my control, at some point you just have to accept that you can really only do what you can do.”
There are also moments of celebration though.
“You have amazing wins where a patient has been in a bad place and a year later things are just going great, and they say to you ‘I couldn’t have done it without you’. General practice is all swings and roundabouts like that.”
Bree’s management of patients with mental health concerns take time, patience and involves a creative approach—from relaxation strategies to mindfulness techniques, the key is resetting a patient’s expectations.
“I’m continually amazed at the human spirit—the resilience that some people show. It is incredibly humbling to sit and listen to the stories of trauma that some of my patients have survived, and to see their vulnerability as they share it with you when they’re asking for help,” says Bree.
“Most of us can’t even imagine what goes on behind other’s closed doors, but some people have really horrific times and they are still pushing on with life. It really is quite a privilege and an honour when patients feel safe enough to open up to you and allow themselves to be helped by you, and an equally great buzz when you start turning things around together.”