There’s a lot of it going around
Scoring a hole in one is an achievement for any golfer at any stage in life. What made Bessie’s achievement more noteworthy was that she was 84 years old and being treated for cardiac failure and osteoarthritis of her hips and knees.
Leon Piterman weaves many anecdotes about his patients into his critical account of contemporary General Practice. They are not mere case studies but show the compassion which is an element in the make-up of a good doctor as vital as medical training or diagnostic skill. “There’s a lot of it going around” has information, stories and advocacy. It is a book to enjoy and learn from.
I have often heard it said that whoever is in front of you is your teacher. If reading these fascinating, touching and often humorous tales from general practice is anything to go by, Leon Piterman has accumulated more than a lifetime’s wisdom from his patients.
Associate Professor Craig Hassed OAM
I loved reading A GP’s Odyssey. All doctors and medical students will identify with this precious book from an inspirational GP. It will make you laugh, cry and celebrate the unique and valuable role of the generalist in comprehensive patient care. You will love it too.
Clinical Professor Leanne Rowe AM
Sometimes poignant, sometimes hilarious the stories in this GP’s odyssey are filled with what makes general practice unique—pumpkin scones, family tragedy, those determined to live and the stoic humble elderly coming to terms with their fate. Ever the great educator, Leon Piterman’s stories has learnings for us all.
Professor Danielle Mazza
“There is a lot of it going around.” A GP’s Odyssey
I have been a general practitioner (GP) for 40 years , 15 of these years in full time general practice and 25 in part time general practice, blended with an academic career, mostly at Monash University. I have estimated that during these 40 years I have engaged in some 140,000 consultations. My colleagues in full time practice over the same period will have engaged in over 250,000 consultations. I cannot think of any other profession whose members engage in this many consultations over a lifetime of practice. Knowing that I work predominately in an academic environment, I am often asked by friends and colleagues if I still see patients or if I do is it “just to keep your hand in”. I see patients because I need to be grounded in reality and in real life experiences which patients continually provide.
I enjoy interaction with my patients, many of whom I have known for more than three decades. Having worked in the same practice for most of my professional life I have had the privilege of caring for families over several generations. Patients who were in their thirties or forties when I first met them are now in their seventies or eighties. Those who were young parents are now grandparents. Continuity of care, an essential ingredient of general practice, affords us a unique opportunity to share in our patients’ life journey, and for some, to also share in ours. I also maintain that blending clinical practice with academic activities has prevented me from suffering professional burnout.
Patients continue to be a valuable source of learning. Not so much hard core evidence based biomedical learning, but deeper learning about the nature of the human condition. This happens when patients share their innermost thoughts and secrets as well their worries, fears, anxieties and apprehensions, whether it be in response to their own illness or illnesses that involve their families or close friends. In fact clinical consultations may not focus on illness at all but on changing social circumstances. Separation, divorce, job loss, bankruptcy, loss of a pet, all may occupy a considerable component of a GP consultation.
My patients’ emotional journey has been accompanied by my emotional response, be that overt or covert. I have laughed with my patients and I have cried with my patients. It seems only natural that this should occur. It is what we call in general practice “the connexional experience.”
General Practitioners , both established as well as those in training are encouraged to be reflective in their day to day practice. This involves reflecting on each consultation from a biopsychosocial perspective which includes asking some “meta-questions” such as “why him or her and why now”.
As I reach the twilight of my clinical career, I have had an opportunity to reflect on my time as a GP and recall patients and clinical encounters that have had a lasting effect on me at least to the extent that I have been able to readily recall the encounter and subsequently to make some sense of it. I believe I have been able to recall these events because they have generated an emotional response which has varied in nature and intensity, and has remained indelibly imprinted in my psyche. These responses (on the part of the patient or on my part) have included the following, for convenience, in alphabetical order: anger, acceptance, betrayal, confusion, denial, despair, elation, frustration, gratitude, guilt, happiness, hope, humour, indifference, joy, outrage, pathos, resignation, resilience, shame.
This book of short stories, based on real but de-identified clinical encounters, is designed to capture aspects of patients’ stories, their emotional response and to explore my own parallel response as their treating doctor. As GP readers engage with these stories I believe that they will experience a sense of familiarity and a sense that my emotional responses are by no means unique. All GPs will at some time experience similar responses triggered by a variety of clinical encounters. That is why I have given the book the title “There is a lot of it going around.” A GP’s Odyssey.. Not all responses will be the same. We are after all different.
These cases have previously been published on a monthly basis between 2016-2018 in “Medical Republic”. I wish to thank that journal and its editor Grant Holloway for giving me permission to publish them in this format. I also wish to thank my colleague, mentor and friend Professor John Murtagh for agreeing to write the foreword to this book.
Leon Piterman AM
1 Muscle Soreness?
Maria and Giuseppe had been long standing patients of the clinic. I took over their care when my colleague retired. They were in their 50s when I first met them. Giuseppe was a bricklayer and apart from occasional back pain and problems with an arthritic knee he rarely attended. He was a solid, burley looking man, seldom cleanly shaven, had the large roughened hands of a seasoned bricklayer and an evasive demeanor. Maria was a more frequent attender. She was slim, always neatly dressed, softly spoken. She ran a small clothing repair business from home. Her son and daughter were married and had left home. She had mild hypertension which required medication, had regular Pap smears, mammograms and flu shots. What troubled me most were her peculiar muscle aches and pains for which I could not find a cause. On some occasions when I examined her the pains were accompanied by bruises and I wondered if she may have a form of vasculitis. Repeated tests for inflammatory muscular, joint or vascular conditions were normal. She looked well, generally felt well and denied any emotional problems.
Having remained diagnostically destitute for over a year I suggested she see a rheumatologist. He was so impressed at clinching the diagnosis he felt compelled to phone me.
Maria was being physically abused by her husband and this had gone on for over 20 years. He had a drinking problem and when inebriated he became violent. The muscle aches and pains and occasional bruises were the aftermath of the abuse.
Maria was too embarrassed to tell me because I also looked after her husband and she thought I would raise the matter with him which would make matters worse for her. She felt comfortable in telling the specialist. She was unaware that I was bound by patient confidentiality. This was a secret she could not share with me.
So much for Family Medicine! I felt hopelessly inadequate. Should I have asked the right questions and even if I had been insightful enough to do so would I have received truthful answers?