health

'Your vagina's gone from my memory in seconds.' 7 things a GP wishes every patient knew.

Dear Patient,

It’s been a while since we did this – so here are a couple of open, honest thoughts not often shared.

1. If you mention your nether regions, I am usually going to have to have a look.

If you mention a sore spot near your vagina, a lump in your testicle or blood loss when passing a bowel motion the reality is that I am going to have to examine you. Despite my super powers at sensing when there may be something more to the story you present to me, I cannot sense what is going on down there. I’m working towards going purely off the force but I’m not quite there yet. I need to do a rectal examination to ensure your rectal bleeding is from a haemorrhoid or anal fissure and not a less common rectal cancer, for instance. Only my trained fingers can tell me the answer, the “juju” sadly cannot.

When I do your cervical cancer screening test, or examine the lumps/bumps/scratches/sores that can occur on male and female genital regions I am not judging nor assessing you; I am literally on automatic pilot, checking I’m not dealing with something medically dangerous or concerning, and then I am out of there. Which brings me to point two…

Side note… how well do you know your ‘lady garden’? Post continues after video.

Video by MMC

2. No, I do not lock your private parts away in my memory.

It’s not uncommon for you to say “I so hope you forget about this” when I’m gearing up to do your cervical cancer screening test or breast examination. Honestly, and I am going to be very honest here – I have a thousand million thoughts running through my head whilst I’m in the clinic. When I’m seeing you for your cervical cancer test, I am also thinking of what else I need to think about in terms of your health to ensure you are up to date; have you had a recent sexually transmitted infections screening test? Are you planning a pregnancy? Have I checked in your mental health? Have you had a recent skin check?

On top of that, in my current pregnant state, I am also often thinking about food. I’m likely trying to remember if I packed an extra muesli bar or if I have time between consults to bother one of the GPs in my corridor and raid their snack drawer (yes, these drawers exist). I also sometimes daydream about finding a long lost Ferrero Rocher at the bottom of my bag (if my face is dreamy and I’m drooling then please know this is where I am in my head). So to confirm – no I do not lock your cervix/testicle/labia away in my mind – it’s gone from my memory within 1 -2 seconds of completing the examination because, food.

3. I am not here to judge you – it’s not part of my job.

Judgement cannot be part of the GP role because we see a lot and we see everything. Overdue for your bowel cancer or chlamydia test? It’s not my job to lecture you. I’m simply glad you came back at all. If you’ve forgotten to take your blood pressure or asthma medication, I’m simply wondering what more education I can give you to motivate you to take it. If you’re having an affair – again, it’s not my job to judge. Sure, for a brief moment I consider your partner and kids I also treat– because I am human – but at the end of the day I am your GP too and if you feel safe enough to tell me then that’s a testament to our therapeutic relationship.

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Confidentiality is our thing – 99 per cent of doctors nail the “circle of trust”. Robert De Niro in Meet the Parents would approve of our stance on this– and so know that whatever you tell me, as long as you’re not a risk to yourself or someone else, the information stays with me.

4. I honestly think I sh*t all over Dr Google so can we agree on that so I can stop competing?

I know you Google your symptoms – you’re often very open about it, which I don’t mind. Sometimes it comes out later in the consult when I tell you my thoughts and you respond with “oh, but Google suggested…” I promise you that over 10 years of training between medical school and specialty training has made me a better sounding board than your computer. I promise you that me actually touching you and examining your scalp/back/neck and hearing your story in the context of your history and everything else I know about you makes me a more reliable source than Bill Gates (I just assume he’s the guy who comes up with the responses on Google).

I’ve said it before and I’ll say it again – Google can’t offer you a tissue when you break down stressed and overwhelmed with life and it certainly can’t pat you on the back when you’ve nailed some healthy weight loss to reduce your heart attack and stroke risk. By the same token, if you really believe in Dr Google over me, then I dare you to try to get your haemorrhoids looked at by it INSTEAD OF me next time (to the soul who may attempt this, please know I was kidding).

5. I actually give a real crap.

Like lots of my colleagues I invest heavily in my patients. I really, really do care about your mental health, your relationship, your work stressors. I really want your pregnancy to work out. I really want your mammogram and breast ultrasound to come back showing no signs of cancer. I desperately want your anxiety to improve with the exercise, meditation, sleep hygiene and psychology I have prescribed. My heart sinks when you’re hurting, stuck in the dark tunnel of depression, anxiety, workplace bullying. I think about you when I leave the clinic and I hunt for your name on my booking list to ensure you are in fact coming in to follow up to ensure your mood/sleep issues are not worsening. I care – a lot.

Mia Freedman chats to Dr Jodie Lowinger, the founder and Principal Clinical Psychologist of the Sydney Anxiety Clinic, about what causes anxiety and what people who suffer from it can do to treat it. Post continues after podcast. 

6. I’m not a unicorn or oracle.

I don’t have all the answers. I can’t always know what’s going on. I check guidelines (not Google) and other reputable resources when I need assistance with what investigations to order or what drug would be best to prescribe. I can’t always tell you what makes your left eye flicker on Tuesday afternoons between 2 and 3pm. I can’t always tell you what the cause of your two days of abdominal pain was. But I promise you I try my best, I’m open when I don’t know – if you hear me say “look I’m fairly certain it’s nothing nasty but I can’t tell you exactly what it is” that I have done a very thorough assessment in my head whizzing through all sorts of possibilities.

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Please also know things can change. Sure it didn’t look like tonsillitis when I saw you but things change, things evolve and if I tell you I’m right 100 per cent of the time, or even 90 per cent of the time, I would be lying. I would also be lying if I told you I knew everything about medicine – GPs are awarded the task of knowing a bit about everything, having a wide breadth of knowledge about the entirety of medicine. Yes, I know lots of it, but please know I am not Dustin Hoffman from Rain Man, I have my limits.

7. The little interactions and banter are what make general practice awesome.

The time we actually have together in a consult is short – if you book a regular 15-minute appointment it usually means 12 actual minutes with the GP. Being a regular patient of mine, you know me well by now. You know when you need to book a double appointment, what I can and can’t realistically do in a single appointment. You know I don’t like rushing through your medical problems, that I do take time examining and explaining and you know that I pride myself on running on time, or 15 minutes late, which I still consider running on time!

But I love hearing the little tidbits about you and your life – it’s what makes our relationship as a GP and patient unique. We have continuity of care, we have a long-term therapeutic relationship that evolves over time. I love hearing about your recent holiday (we did all the vaccine and mosquito spiel before you left, but I do want to know if the beaches were beautiful and if you did end up packing five pairs of bathers or just the two). I love hearing how your wedding went, how your first child-free date night panned out and your opinion on the book you were reading in the waiting room (I often write down your book and podcast recommendations – so thank you!)

When I abandoned physician training years ago (and my desire to be a rheumatologist or geriatrician) I never knew I would love general practice so much. I love that I get to meet your kids, partner, parents and friends. I love that I get to see you before your pregnancy, during and after. I love that I get to see your kids grow up, and you grow with them. I love the longevity of it all – the stories, the giggles, the dark moments of stress, depression, anxiety, marriage breakdowns and family deaths that often become light again with time. I love it all. I’m honoured to be your GP – and I know how privileged I am to be the person who gets the unique, deep and personal insight I get into your life.

I’ll leave it there having adequately covered nether regions, unicorns and everything in between. Peace out (I bet Dr Google wouldn’t sign off with that).

Your GP, Preeya.

Dr. Preeya Alexander aka The Wholesome Doctor is a GP based in Melbourne. She is passionate about all things ‘prevention’ in medicine. You can follow her on Instagram, via her blog and her Facebook

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