From the ED to GP
Thirty-five minutes out of the heart of Perth, Dr Winny Santa Maria lives in a beautiful house on two and a half acres of land. Her two sons run free with their giant golden retriever cross poodle, Woofy, and the whole family enjoy the space to grow vegetables and look after chickens.
“It is nice not being bound to a hospital,” says Winny, “you can work anywhere and it is amazing.”
Although it is general practice that makes this idyllic lifestyle possible, the specialty was not Winny’s first—or even second—specialty in which she trained.
“I had no idea what I wanted to specialise in through university,” says Winny.
“Lots of people very early on picked out that they wanted to be surgeons or knew they had an interest in X, Y, or Z. I liked everything.”
After finishing both an engineering degree and a post-graduate medical degree at the University of Notre Dame in Fremantle, Winny briefly considered general practice.
“I actually called WAGPET and asked them about GP training. The big concern at that time for me was that general practice didn’t support maternity leave.”
Eventually, Winny chose to enrol into the Basic Physician Training (BPT) program.
“I was in the BPT program for a year,” recalls Winny. “It is hard as a prevocational doctor because you’re running around a lot of the time just doing errands for the team. You don’t have that connection with the patients…I think that is what drew me to the ED (emergency department) because in the ED you are there on the front line talking to patients.”
“I actually loved all the time that I was in ED so I changed over to ED training.”
With baby number two on the way, Winny’s perspective began to shift and change.
“I did ED night shifts with a one-year-old baby and I was also pregnant…it was a complete disaster and impossible. There was no work/life balance.”
“I actually stopped work in the ED when I was 27 weeks pregnant because it was just too hard.”
“Between baby one and baby two, that’s when I worked out that the ED is too hectic and not right when you have children and a family…I thought that maybe general practice was something I should try.”
After seven months off to care for her second child, Winny jumped headfirst into general practice training.
“Honestly, it sounds really silly but I loved (general practice training) from the first day.”
“I now work two and a half days a week so I start late a couple of days a week so I can drop my son at school and then finish early one day a week so I can pick him up…I choose when I come, I choose when I go, I choose how many patients I see each hour.”
The benefits of general practice reach far beyond the flexibility offered.
“It is not just the hours that make general practice good for having a family, it is the fact that when I get home from work I’m not exhausted like I was when I got home from work in ED. I have mental space to interact with my family and talk to them.”
“During the day I actually get a proper lunch break so I get time to organise things, make phone calls, do all that sort of stuff that I didn’t get time to do when I was in the hospital.”
For Winny, forming ongoing relationships with a wide range of patients is a key attraction of general practice.
“The thing that I’m loving about general practice is the relationships with the people and being the person that takes the time with those people to sit down and talk to them.”
“I like the women and children patients because I find that I can relate to them…usually the mums bring the kids in and because I have kids myself, I’m able to give them practical advice as well as medical advice. I also find mental health quite interesting.”
“I wouldn’t say that I’m a people person…I’m definitely not the extroverted one in my family…I’ve got my work hat and my home hat…but when I step into the room it is not me that is talking to the patient, it is me as the doctor.”
Winny’s advice to those considering general practice is simple.
“There are a lot of people who’ve started other programs and feel a bit lost or unsupported or find that it is not quite what they were expecting and so it is nice to know that it can change.”
Dealing with negative perceptions
In the hospital system Winny experienced perceptions of general practice, both negative and positive, which she saw influencing a prevocational doctor’s decision to pursue the specialty.
“In the ED you get referrals from GPs every day. It is not uncommon for people to say, ‘look at this ridiculous referral’. I was probably a little bit similar in some ways,” Winny admitted.
“Having not actually ever worked in general practice it is hard to know what it’s like.”
“I wasn’t putting myself in the point of view of the GP who may never have met the patient before and has four people in the waiting room, and only has 10 minutes with this patient to decide if they need to go to ED.”
According to Winny, a lot of the negative attitudes stem from lack of exposure to positive GP role models during general practice rotations. However, attitudes towards general practice are slowly changing.
“I think ‘I’m not just a GP’ is a good catchphrase because it just reinforces to people that it is a choice to become a GP and GPs are specialists.”
Winny is familiar with the challenges within the hospital system.
“The hospital has a culture of some unreasonable expectations from other doctors which create a lot of guilt.”
“Calling in sick in the hospital is often looked upon as something that you would never do even when it is necessary. Especially when you have kids, if they’re sick and they can’t go to daycare then sometimes you’re stuck.”
“Historically, the hospital system is quite hierarchical…there is a structure going down from the consultants to the registrars to the junior doctors, and that is the way the teams are run and so naturally, with that division of power, you get an interesting dynamic in the teams—people sucking up to the bosses to get points for their CV.”
“I wasn’t really interested in participating in that.”
For Winny, general practice was a breath of fresh air.
“If I’m on leave the receptionists just block out the day…I don’t get that guilt from calling in sick…the receptionists just do a ring-around and move all the patients across.”
The challenges of general practice
Coming out of the hospital system as a PGY7 Senior Registrar in emergency medicine, Winny had a lot of experience under her belt.
“If you’re PGY2 or 3 going straight into general practice land I think it can be a bit of a shock to the system…you have always had someone else to defer to for each decision and now you’re in a room by yourself with a patient and you’re making the decision. You have to be confident to manage whatever comes through the door,” says Winny.
According to Winny, one of the exciting aspects of general practice is having a breadth of knowledge and skills.
“I do see lots of interesting things and I do manage emergencies occasionally and do suturing, obstetrics and gynaecology, and paediatrics.”
While the variety and flexibility drew Winny into the specialty, it is the people moments that stand out to her.
“I had a woman who was a new patient who came in for a script for antihypertensives and she had a husky voice and smelt like cigarettes and I said, ‘have you thought about quitting your smoking?’ I planted the seed in her head and gave her an information sheet about one of the medications to help quit smoking.”
“She came back a week later and pulled out this little bag that she had made which was her quit bag and said, ‘I’ve read all about that medication, I want to try it and I want to quit’. We had a big chat about the techniques to quit and medication.”
“She came back eight weeks later and basically skipped into the room with a big smile on her face and gave me a big hug and said, ‘you’re the first person who’s ever actually helped me to quit and you’ve changed my life’.”
“That was a pretty pivotal point. I had never had a patient before like that so that was pretty special.”