My Plea to GPs

It was one of those chaotic days. I was ‘running’ from one thing to the next, no breaks, just trying to keep up. That day was a Thursday. I arrived at my office a little later than usual at 8am; I marked a paper, set a vocabulary test, reviewed what I would be teaching for the next three hours, set up for a postgraduate intensive day, and made notes for a later meeting. At 9am, I was in the lecture room, the beginning of a three hour lecture block. After lectures were finished at midday, I had less than ten minutes to get to a student formation group and facilitate that session. By the time we finished, I had twenty minutes to shovel down some lunch, get changed into my Pilates clothes, and order a taxi to take me to Calvary Rehabilitation Hospital for physiotherapy and hydrotherapy. I started Physio at 2pm. I knew that I only had 25 minutes to get from the hospital to my workplace  for a meeting with an interstate lecturer, so I booked a taxi in the ten minute break between physio and hydro. By this time, I was wondering whether I should cancel my GP appointment for that afternoon at 4:30pm. I had booked the appointment earlier than I could possibly arrive, on the advice of the receptionist, because the appointment will always end up being an hour and a half later. I decided not to cancel because I needed to deal with an issue that had been rather troublesome for three months. I finished in the pool by 3:45pm, the taxi was waiting, I got into the taxi, and made it back to College one minute to spare before I was due to be in my meeting.  I quickly changed back into my work clothes, got into the meeting five minutes late, and raised the issues that I had written down earlier in the day. At 4:45pm, I cut my meeting short, I needed to get to the medical centre for my GP appointment. I made it by 5:15pm. I checked in with the receptionist and I took a seat. I had more papers needing to be marked, so I took out my MacBook, and I started marking. Two papers later, at 6:15pm, I heard the GP call my name. I smiled, put my MacBook away, and walked into his room. He was walking behind me.

Sitting down, he asked me, ‘what would you like to talk about?’ For a brief moment, I thought it was an odd opening and the question stumped me a little. A bit off balance, I raised the issue that had been troubling me, which is now the third time in as many appointments that I have raised this particular problem. Hearing that the plan b hadn’t been effective, the GP quickly laid out plan c. Then he said, ‘Is there anything else you would like to raise?’ It was a leading question. I hesitated. There was something bothering me. I took a deep breath. And I launched into giving voice to my concern, ‘Two weeks ago I experienced sudden leg weakness again. The surgeon, who had been concerned about the sudden deterioration, had asked for a MRI, but the MRI had come back as acceptable. But I have questions. How can my legs suddenly become weak again and yet the MRI be acceptable? I don’t understand what is going on.’ My issue was not the MRI, but that something must be going on. I genuinely didn’t understand the discrepancy. The GP responded defensively, ‘I don’t make a habit of questioning the professional opinion of surgeons. I respect the opinion of your surgeon. And there is a discrepancy between what you have just said and what he has written to me in a letter. He has said that the MRI is fine. Can you please explain to me why what you have just said is different to what the surgeon has said?’ I was a bit speechless. Didn’t I just say that the MRI is acceptable? All I could say was, ‘I’m sorry but I don’t understand’. He repeated, ‘What you have said and what the surgeon has said is different. I have the letter from the surgeon right here, he wrote to me. He says that there is a dissonance between conscious and unconscious observation. He’s raised the problem with me. Do you understand what I mean by conscious and unconscious observation?’ ‘Yes’, I replied. ‘Well, conscious observation is when he tested your legs and they were weak’, the GP continued, ‘but when he was watching you walk, sit, stand, there was no loss of motor function. Do you understand what motor function is?’ ‘Yes’, I replied. The GP kept persisting, ‘Well let me demonstrate what he means. Walk over to the bed.’ I pick up my walking stick and I walk to the bed. The GP, standing up, then asked, ‘Get up onto the bed and lie down’. I stood my walking stick against the bed. Putting all my weight on the bed through my right arm, I stepped up onto the step with my good leg, the way the occupational therapists tell you in rehab. I sat on the bed, then rolled down onto my back. Knees still bent up. I knew what was coming next. ‘Straighten your legs and lift the right off the bed’. By this point I felt humiliated. The GP knew that I wouldn’t be able to lift up my right leg off the bed. I tried, the leg didn’t move. This seemed to prove a point for the GP. Standing a metre from the bed, his hands on his hips, he said, ‘In my professional opinion, it’s hysterical.’ I was stunned. I sat up from the bed and the only response I could verbalise was ‘Really?’ I made my way back to the chair, using the time to quickly process what the GP said. He replied, ‘I think you have a fear of recovery and you need the help of a psychologist. Can I refer you to someone?’ To which I replied, not wanting to add yet another specialist to the list, ‘I already work with a psychologist since my fiancé was diagnosed with cancer and passed away, so I don’t need a referral. I will raise your diagnosis with the psychologist.’ The GP responded, ‘You didn’t tell me that you are seeing a psychologist. Well, that’s all I’m interested in doing for you.’

If you are a GP reading this, please let me explain further. Three months ago, I woke up with searing back pain. I tried to ignore it and tried to get on with life. I went to the Physio, he suggested that I see a GP, I couldn’t see the point. The day after, my right foot dropped; I still tried to continue on with life. I went to see my Physio again, he told me to go to an emegency centre and get a CT scan done that evening. The emergency centre, after seeing the CT scan, contacted a spinal surgeon directly. I was admitted into hospital that night and the surgeon operated within 48 hours – a Laminectomy, Microdiscectomy, and Rhizolysis (L5/S1). Soon afterwards I was transferred to a rehabilitation hospital for three weeks to relearn how to walk and get on with life. I was back at work within a week of being discharged, back lecturing within two weeks, and I have been balancing full time work, doctoral study, and rehabilitation, since. I was true to my word, I did raise the GP’s diagnosis with my psychologist. She did not agree with the GP. She pointed out that I’m a highly driven and stubborn person. My fear is not getting better; I was living my fear, progress going backwards. I know that the MRI is fine, that there is a discrepancy. It’s been two weeks now and I have lost motor function in both my right and left legs. There are a lot of unanswered questions and my physio team is really confused. My physios are wanting me to see a different GP, but I know I can’t. I think it’s important that I persist with the same GP.

If you are a GP, thank you for reading to this point; please hear my plea to you. Please don’t pre-judge those who come looking to you for help, especially if they don’t naturally tend to go to a GP. Please don’t fit people into predetermined boxes. You may miss something and do more damage than good. If you think that what is going on is psychological, please make another time to talk it through gently with your patient, ensuring that you are not jumping to conclusions. If you are feeling burnt out, then please, for the sake of your patients, take a long holiday and rest. You are no use to your patients if you have stopped listening and are too grizzly to be interested in what is really going on. I know that you are busy, seem to run from one patient to another, and patients may get narchy because you are running behind schedule. Please though, try to see life from the perspective of your patient; they too may have had a similar day to you, yet they have come to you. But above all, please let your patients ask questions. I’m a lecturer, I would be wrong not to let my students ask questions and to question my own arguments. Questioning is how we learn. If a patient is asking a question, they may not be being critical, but rather seeking understanding. Please let your patients question, and then help them find the answers, if indeed they can be found. Please be an advocate, not an antagonist; this is my plea to you.