But some days I felt I was just running a Pap smear clinic.
I have very, very few adult male patients. Perhaps only a handful each week, and nearly all are husbands or boyfriends or young adult sons of well-known female patients.
Most days, I will not treat a single adult man – not for my refusal, but because I just overwhelmingly treat women and not many men come to see me.
That is not unexpected for a metropolitan-based woman GP in her mid-30s.
When I joined this practice as a GP registrar, I was the first (and initially only) woman doctor at the clinic, and my appointment books were packed from the first weeks.
Some days I felt I was just running a Pap smear clinic. My personal best is still 17 Pap smears in one clinic list – largely women who had delayed their procedure for years, seemingly waiting for the arrival of a female GP.
The male GPs were quick to refer women’s health procedures to me, too; Pap smears, Mirena removals, Implanon insertions, so “women’s health” became my entire list.
I had moved to general practice after two years as an O&G resident, so I had no issue in my GPT1 term. I was confident in this area, and general practice felt very comfortable.
But when I completed the mandatory patient log for training purposes – a de-identified list of ages and sexes of patients and their clinical issues – we realised how un-general my general practice training was. The training provider flagged with some concern the massive gap in my practice – I wasn’t seeing enough male patients – perhaps it was 5% or even less.
For the following months, the receptionists tried hard to intentionally book more male patients, but it was impossible to enforce. The older male patients already saw and trusted the established male GPs, the younger male patients usually didn’t have chronic or repeat health issues – knee pain, or simple gastro was more likely, and only needed a single consult. The women patients would book online anyway and fill up available appointment slots.
I stayed at the practice and now it’s been eight years, and the appointment book is identical. The same lovely women patients have stayed with me, and we’ve aged together another decade almost.
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The young women have made me the GP of the men they started dating then married, and then the baby and second and third babies that they had with them. Then later when their parents’ GPs retired, these young women came into my clinic room accompanying aging fathers or mothers-in-law.
Now I’m treating two or three generations and whole families, all of which has grown from the single young women who started seeing me back when I was a registrar.
I still think about half to two-thirds of my patient load is women of reproductive age, but that’s surely because the population reflects the GP. As I age, so too will these patients and in three decades we’ll all be postmenopausal and in four decades perhaps arthritic and a little frailer.
This brings me a great sense of joy and satisfaction. I truly love treating women patients. I love seeing young women grow and succeed, smashing patriarchal barriers. I love telling them how proud I am to be their GP and see their journeys, and how often they get teary and say it’s really nice to hear that.
I like talking to them about building communities of female friends and fighting societal expectations of beauty. I love seeing the confidence of the gen Z women especially, who do strength training to be strong, and wear genderless clothing because jumpers really don’t routinely need to be gendered with a pink tax. They fight gender stereotypes with much more bravery than the women before them. I love seeing that – it’s inspiring and contagious.
But if you’re reading this as a woman GP, you’ll understand immediately what the cost is of having predominantly women patients.
Women have very complex needs, and the appointments are not short or simple. They are overlapping messy presentations of biopsychosocial models of healthcare in the purest form. I cannot separate out the issues, and I cannot easily treat or fix many of them, even if I try my absolute best.
Let me present to you a generic amalgamation: a young mother who had a tough fertility journey, high achieving in her career and struggling now to accept that her previous skills do not automatically translate to parenting. Her success as an accountant or pharmacist did not ensure a smooth, easy run with this new baby who won’t sleep, won’t feed and won’t stop crying. The mother is struggling to bond and struggling to latch and firmly fixated on Breast is Best – formula feels to her like a failure.
Her husband has promptly returned to work after a month of leave because they have a mortgage to pay and are now down to one income, and the mum wants to stay at home for 12 months with the baby. She’s frustrated by the significant weight gain from the pregnancy and feels, in her words, “fat and ugly”.
She’s sleepless, dehydrated and exhausted. There’s conflicting advice from her mother, her mother-in-law, the doctors, the nurses and well-meaning friends. She’s getting tension headaches, too tired to exercise and no time or disposable income to see a psychologist.
She’s desperate for an iron infusion or weight-loss injectables or something that will, again her words, “help immediately and permanently”. Something to help the baby sleep or stop the PURPLE crying. Her periods come back early, the endometriosis pain rears ugly, and the menstrual migraines and PMDD have callously returned with no consideration of the already dire situation.
Suddenly she learns that her husband has been having an affair with a colleague at work, or that a sister-in-law is bad-mouthing her parenting on social media, or worse an even bigger issue like financial instability or family violence, and wellbeing completely tips her over the edge.
Find me a GP who hasn’t had this exact consultation, and perhaps already several times today. It gets quite hard to hold, because so much of it is societal and psychological.
If she had picked a better husband or had actually helpful parents to give her a village, wouldn’t things be easier? If she had consistent messaging from her healthcare team – feed the baby however is best for you. Make time for yourself and see a psychologist. Babies are chaotic and uncontrollable – let go of your expectation to “succeed”. Start with small steps for exercise. Have patience and forgiveness for yourself. Be proud of your body – you carried and birthed a baby, the weight gain is normal, and you can manage it in time, but yes, slowly.
In the end, the appointments take 30 to 40 minutes and I’m unsure if I’ve done anything at all to help her. Maybe listening was enough, or the small reassurances that she and the baby are doing fine, or the list of resources I give her to consider – psychologists (waitlists of months) and pelvic floor physios (unaffordable) and scripts for contraception (sorry fertility has returned so soon) and path forms for STI screening (the stark consequence of a cheating partner).
But she leaves a little less burdened anyway. Maybe now she feels like she has more options and control than she thought? I don’t know.
I wouldn’t change my patient load one bit – I find the complexity of caring for women meaningful and satisfying. The joy of seeing my women patients happy, supported, safe and succeeding is immeasurable, and increasingly with time.
Although I cannot pretend it’s easy or simple and certainly my patience is tested during a long day with complex women’s consults, I do very firmly believe that having predominantly women patients makes me a better woman. I understand women more – including my own loved ones like my mother, best friends and mentor. I learn from the blessings and the difficulties of the women patients and selfishly use the lessons from my practice to give myself an exceptionally happy and beautiful life.
Then what I return to my patients is confidence, celebration and connection, and even if their lives get more difficult and complex, our therapeutic bonds still strengthen appointment after appointment, year after year, more and more.
Dr Pallavi Prathivadi is a Melbourne GP, member of the Eastern Melbourne PHN Clinical and Practice Council, and GP Lead of the RACGP Academic Post cohort support and education program. She holds a PhD in safe opioid prescribing and was a Fulbright Scholar at the Stanford University School of Medicine. She is studying creative writing at Harvard University’s Division of Continuing Education.
