An open letter to non-GP specialists

7 minute read

GPs are consultants too, and it’s time respect and collegiality was a two-way street in order to help patients.

While every GP has spent time working in the hospitals, most hospital-based specialists have not worked a day in their life in general practice. It is a tough and wonderful job.

Our field of expertise is relentless and unending; literally, every part of the body of every person of every age. We know a little bit about many, many things, and a moderate amount about a moderate number of things. Our consultations are full of empathy, trust, patience, connectedness, patient-centredness, and meaningful decision making, which we try to weave throughout the “medicine”.

Think of all the common clinical presentations or conditions or complications you see in your speciality that you’d expect us to know. Now please extend that across the 20 or more specialties of medicine other than yours; that’s the scope of general practice.

I cannot do my job without non-GP specialists. When I have reached the capacity of safe problem-solving, I will ask a non-GP specialist to take over. When I have that “gut” feeling that something is wrong, I am seeking your reassurance. When I am unsure what treatment option would be the most financially feasible, safe, and effective option, I am grateful for your recommendation. When I am full of compassion for a patient with a miserable quality of life, I am asking you to empathise. And when I have diagnosed a serious or life-threatening condition, I am going to step back to let you step forward.

My friends are all non-GP specialists.

My best friend is a paediatrician at the local public hospital closest to my practice. He will answer my phone call or “can you help me?” text at any time without knowing if I need him to remove a spider from my living room, or if I need advice on how to manage a complex behavioural issue in an eight-year-old patient. Whether a personal or professional capacity, he will offer the same level of care and support.

My other best friend, a surgical registrar, insists that “for you, I am on-call anytime”and will help me with a patient even when she’s slammed at work with 14 emergency department referrals, or between cases in theatre, or sitting at my kitchen island.

My other friends: an anaesthetist who offered to stop by the clinic on a Sunday to place a difficult IVC for a patient I frustratingly couldn’t cannulate for an iron infusion, and an interventional radiologist who, several times a week, will help me decide the best imaging modality to answer my clinical question.

I don’t expect this level of support from other non-GP specialists. I get the VIP service from my friends because they are also rather prominent in my personal life. However, when you go out of your way to help me, I’ll always be grateful and remember.

The general surgeon this week who saw my patient with painful thrombosed haemorrhoids the next day just because I asked; thank you. I know this was not urgent, and I’ve lost count of how many times you have been so accommodating and compassionate.

The cardiologist who never replies to my texts because he just calls me immediately instead; our text chain is very, very one-sided because you are so reliably communicative.

The gastroenterologist who tells all my patients that he’s “good friends”with their GP; I’ve only met you one time but after so many years of referrals, letters, texts, and phone calls, I would certainly call us friends.

The orthopaedic surgeon who sends messages on long weekends or end-of-year holidays to let me know he’s working and available if I need anything; all the GPs I know preferentially refer to you because you’re so thoughtful.

The neurosurgeon who sees all my obviously non-urgent referrals within a week or two and sends letters back on the same day; not that I should have favourite specialists, but you know you’ve become a favourite.

But let’s say I’m nobody special to you, and you don’t have any obligation or personal interest or loyalty to some random GP in the south-eastern suburbs of Melbourne. Yes, that is perfectly reasonable. I don’t expect you to answer my texts on a Sunday morning while I’m at work and you’re not, and I don’t expect you to regularly overbook your list to accommodate my non-urgent patients.

However, I do expect a basic level of professional courtesy and understanding when I call you at 7.30pm on a Thursday about a rather unwell patient and you’re the on-call specialty registrar.

I don’t think “yeah” is a good way of answering the phone call that the hospital switchboard has put through to you, knowing the call is from a GP. I don’t think “yeah” is a good way of replying to “this is Pallavi Prathivadi, I’m a GP and I’m calling you about a patient with decompensated organ failure”.

I don’t think, at this point, I should have had to ask your name. I think you should have offered it.

When I said: “This patient is really unwell and needs to be seen and admitted”, I don’t think you should have said “well, maybe you should call an ambulance then”.

You have probably had a painful day, and perhaps you’ve had a couple of annoying calls and you’re put off. That’s tough for you but this was not a demonstration of good team care. I called you while I was the solo GP at the clinic with a woman miscarrying in my waiting room, a man with end-stage heart failure having chest tightness, and a fluvax clinic to oversee. This was my 12th hour of seeing patients that day and I was simultaneously helping my practice nurse manage a possible NSTEMI over the phone. I also had a painful day.

If I’m calling a non-GP specialist, I need help. My patient needs help. I’m not calling you to ask if you’ll come fix my coffee machine, although I know plenty of lovely specialists who would still come help me with that.

Medicine is a very small world, and everyone seems to know everyone by one or two degrees of separation. If you’re helpful, friendly, kind, and considerate to us, we will assume you are equally so to your patients and word will spread. We will refer to you, reach out to you, become friends with you, and trust and respect you. You will make our bad days easier. You will make the tough job of general practice a little less tough. You will help us feel supported and confident and ultimately all of this will help us to help our patients.

Please don’t make me feel embarrassed, frustrated, and mightily peeved off about calling you for help. Please don’t be the non-GP registrar with the attitude. I did you the courtesy of calling you first instead of your consultant. I am also the consultant, by the way, just not in your specialty. I cannot imagine any of the specialists I know answering their phone with “yeah?”or speaking so condescendingly to a GP.

My life is full of wonderful, loving, kind, considerate, friendly, and polite non-GP specialists. I know what it looks like we get this right. We work together. We are a team. You are important in my life, and I value you. Thank you for valuing me and valuing general practice.

Dr Pallavi Prathivadi is a Melbourne GP. She was a Fulbright Scholar at the Stanford University School of Medicine in 2020-2021 and the 2019 RACGP National Registrar of the Year. She has a masters degree in pain management and a PhD in safe opioid prescribing.

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