I’ve been chastised by an old GP before for not routinely doing home visits.
He told me “you new generation GPs are all about the money – when did you guys give up on compassion?”
This has come up again today, and of all places in an email chain between GPs in the Newcastle area. It’s a weird group – a legacy communication tool (from the Hunter GP Association) in a world that’s moved on to WhatsApp and other platforms.
What’s clear is that there are two fundamentally different approaches to what being a good GP is.
The first is the Boomer worldview. General practice is a calling and an act of service. This is shaped by the romantic notion of what the clinic down the end of the street meant. It’s tonsillectomies on kitchen tables and routine reviews of five kids all with measles. The GP knew everyone in the family, stayed back when they needed to, dropped into the nursing home on the way home and did a house call because that was just what a good GP did.
And I don’t actually think that worldview was wrong, but I do think the world that allowed it to exist has largely disappeared.
My job is different to what old Doc Boomer did. The medicine is more complicated. The expectations are higher (in a different way) and there is an enormous amount of work that now happens outside the consultation.
I have a different set of liabilities, a different set of expectations and probably a very different relationship with what I owe the profession and society.
The old model came with a social contract. Being the local doctor meant something. There was status, autonomy, continuity and a community that genuinely valued having you there.
In return doctors gave a lot of themselves back. They entered that contract knowing there were pros and cons and chose to have an unhealthy relationship with their community.
That contract has changed.
General practice now exists in a perpetual conversation about who else can replace parts of us. Pharmacists can do this. Nurse practitioners can do that. Urgent care can take these patients. Telehealth companies can pick off another bit.
Continuity and prevention remain incredibly important right up until someone has to decide what they’re actually worth.
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Government is quite happy to pick apart our offering piece by piece.
Don’t get me wrong – I don’t actually expect the government or society to particularly care about me. If I dropped dead on the doorstep of my practice tomorrow the healthcare system would continue on and somebody would eventually work out who was going to see the patients.
But that cuts both ways. And you can’t continue to ask for selflessness from me while taking away all the reasoning it was there to start with.
I don’t feel like I owe society my weekends simply because previous generations of doctors did.
I have two young children. So if Saturday morning involves choosing between watching one of them play soccer or driving across Newcastle to Mavis’s house to look at her lame back, I’m going to the soccer game.
You can’t dismantle the status, autonomy, economics and reciprocity that supported the nostalgic family GP, distribute increasingly large parts of our role to anyone willing to have a crack, and then suddenly wheel out the old social contract when you’d quite like me to sacrifice my weekend.
You don’t get to take away all the good bits of the nostalgic GP and still expect me to slave at its altar.
Maybe that does make my generation different. I’m just not convinced it makes us less compassionate.
Dr Max Mollenkopf is a GP and practice owner in Newcastle, NSW.
The post The world’s changed, Dr Boomer appeared first on Medical Republic.
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