Non-GP specialists don’t always realise how sheltered they are by the referrals process and the assumption they have to be paid.
I speak up on my social media accounts (a lot) about healthy boundaries and their importance for longterm therapeutic relationships, as well as to protect us against burnout and resentment.
Colleagues who, like GPs, are accessible without the benefit of a referral – such as allied health and general dentists – are regularly frustrated by the general lack of respect for their time by patients, with typically at least one or two late cancellations or no-shows per booked day. This, as we’ve seen before, can add up to a lot in revenue over weeks and months.
Among GPs, with the decline in bulk billing rates and the cost of living crisis, some have complained of seeing even more late cancellations and no-shows than usual, and reluctance on the part of owners to implement late cancellation/DNA fees, which directly adds to contractor stress around income week to week.
When I talk about this I invariably get pushback from randoms who believe this is “wrong”, “unethical” etc. But what has been more surprising is messages in my inbox from friends who are non-GPs advising me to pull back or to calm down.
The first time this happened was a surprise, and discombobulating I admit.
I mulled on the advice and then kept doing what I believed to be right anyway, only to get more DMs in my inbox including how my posts might make someone, i.e. the patient, feel.
To be clear, there was nothing abrasive or offensive about any of my posts, simply reiterating my boundaries including around late cancellations, frequent rescheduling and my requirement for returning patients to book an extended appointment if they’ve been absent for 12 months or more. Yet this was somehow deemed to be too much – so much so that on one occasion I suggested to a non-GP colleague that they unfollow me on social media, since the posts didn’t apply to them.
It left me with the odd sensation of having done something wrong simply by stating my own values and terms of engagement. In discussion of this behaviour with a trusted friend, we arrived at the conclusion that this person had somehow personalised my post to be about them, and read into it something that was simply not there.
I also reflected on the fact that by projecting their feelings on my posts to me and advising me to pipe down, they’d done what a lot of women are routinely told to do – stay small to keep the peace; choose to be agreeable and nice rather than being kind by being clear and direct and saying no.
A fellow GP commented on these interactions: “Sure, I’ll take their advice when they [non-GPs] see anyone who walks in without prior triage, with the expectation of bulk billing despite agreement to pay a fee and with no clarity as to their problem. We are the ones who deal with everything off the street, face derision as to our skills based on their Google search and then an argument about the bill at the front desk, assuming they show in the first place!”
I concluded that non-GPs will never know the pain of being a speciality where people can simply self-refer, and where our numbers are much larger, so we cannot rely on our scarcity (even in today’s environment) to give us value in patients’ eyes.
Many if not most of the problems I speak of are problems non-GP specialists have likely never dealt with. So they are giving me advice on something they know nothing about.
As the response by psychotherapist Nicole Perrera goes, “Thank you for your concern, but I am not seeking advice on this topic right now.” I suspect that won’t go over well in reality if I say it out loud.
Nonetheless, it was interesting to reflect on the endless ways in which women are routinely held to unattainable standards of behaviour of “niceness” and “agreeableness”, including and especially by other women, adding to our stress.
For my part, I have continued to be vocal about my points of view.
I have continued to speak my mind.
I have continued my advocacy for healthy boundaries with patients for healthcare professionals.
I actively encourage any patients who are not looking for a longterm therapeutic relationship with the (preferably) one GP, at the one practice, to look elsewhere.
I have encouraged every single person who offers unsolicited advice to unfollow or even block me on social media because I am not interested in their opinions unless I ask, nor in stopping my advocacy.
In doing so, what I have found has happened is similar to when I stopped prescribing antibiotics for viral RTIs in 2012-14; after a while, these people either become convinced they do not need antibiotics, or they move on to someone else who will prescribe the medication they demand.
Either way, it is a win for me personally.
Neither the patients who are unaligned with the way you want to work, nor the well-meaning but ultimately clueless colleagues who’ve not walked a day in your shoes, need affect your confidence on a day-to-day basis.
“Not everyone you lose is a loss.”
“Other people’s opinion of you is none of your business.”
“People are allowed to be wrong about you.”
I have these and other choice quotes playing on high rotation some days. Your mileage may vary.
Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.