THE MEDICARE GENDER GAP: Female GPs penalised by our flawed system

The Australian Government has just proposed an overhaul of the Medicare rebate system to address the “troublesome issue of six-minute medicine”. This will create contentious debate, which can only be a good thing as the Medicare system has serious flaws. Did you know female GPs in Australia earn on average 25% less than male GPs, even after adjusting for hours worked? I believe the solution lies in the problem – we need to pay GPs in 6 minute blocksLet’s examine the current system, and explore why female GPs lose out.

The Medicare gender income gap certainly doesn’t surprise me, or any other GP I know.  According to Professor Tony Scott, the Principal Investigator of the national MABEL survey:

“This is something of a mystery… While such differences persist in other occupations, this is particularly difficult to understand in an occupation where men and women have the same high level of education. Our results have adjusted for differences in hours worked, years of experience, and a host of other factors. It could be that female doctors see a different mix of patients than male doctors. We are puzzled and are continuing to look into this.”

Anecdotally, these are the reasons female GPs see less patients in a day:

  • Female patients often self-select female doctors when they wish to discuss complex problems.
  • Many patients report using a male doctor for ‘quick problems’ and a female doctor for ‘slow problems’
  • Female GPs see more;
    • Mental health presentations, disclosure of domestic violence and sexual abuse/assault
    • Family dynamic problems and child behavioural issues
    • Patients presenting with long lists of multiple problems they wish to discuss
    • Patients with vague non-specific symptoms and the worried well
  • Some GPs laterally refer patients to their female colleagues when the problems are complex. “You should see Dr X, she’s great with hormonal problems and bloating”.

Rather than simply label Medicare as inherently sexist, I thought it was worth examining WHY the system fails female GPs. The issue at the heart of this is not gender based – it’s a symptom that female GPs are paid 25% less, but the diagnosis is a flawed payment system that favours rapid turnover ‘6 Minute Medicine’, instead of good quality thorough care.

The Medicare fee system means a GP is paid the same standard “Level B” consultation fee for a 6 minute consultation, as a 19 minute consultation. This means a GP who sees ‘quick problems’ every 6 minutes can churn through 10 patients per hour, earning $370.50 in Medicare fees. A GP who sees ‘slow problems’ every 19 minutes might see 3 patients per hour, earning $111.15.  Of course, these earning figures are significantly reduced by income tax and clinic overheads. But you can see the incentive for practicing 6 minute medicine, and who will be taking home more at the end of the day! This is why female GPs overall earn less – they simply see more ‘slow problems’ than male GPs – because of the type of patients who choose to see them, and some differences in how they practice a consultation.

Of course, there are many times when 6 minutes is all that is needed – for an ankle injury, treating school sores,  or tonsillitis. But at the end of the day, the Medicare system is failing patients and favouring poor quality care when it disproportionately rewards ‘6 Minute Medicine’. Counselling, education and preventative health discussions cannot be achieved in 6 minutes. Complex medical problems and care coordination suffer. The quality GP practice as the ‘central medical home’ that keeps patients healthy and out of hospital ceases to exist, and it becomes a service centre for acute drop-in presentations, saving the national health budget nothing in the long run.

Female GPs aren’t the only losers in this system – any GP, male or female, who practices ‘Slow Medicine’, is penalised.  GPs who take thorough histories, who are willing to dissect complex problems, who perform full examinations, who spend time listening and counselling and educating their patients about their conditions, will end up taking a pay cut at the end of the day.

What’s my proposed solution? 6 Minute Medicine. Let’s call it for what it is, and pay accordingly for time spent. Most other professions, like lawyers and accountants, break their day into 6 minute allocations.  If you spend more time with a patient, you are paid more for that time.  There is no incentive to seeing either ‘quick medicine’ consults or ‘slow medicine’ consults – rather, the GP is paid appropriately for the length of time they spend with their patient. Compare our current system to my proposed ‘6 Minute Medicine’ breakdown:


Level A 0-5 mins = $16.95 / Level B 5-20 mins = $37.05 / Level C 20-40 mins = $71.70 etc


Each 6 minute block is paid at the flat rate of $ 16.95

Level A – 0 to 6 minutes.  $16.95 / Level B – 6 to 12 minutes. $33.90 / Level C – 12 to 18 minutes. $50.85 / Level D – 18 to 24 minutes. $67.80 / Level E – 24 to 32 minutes. $84.75

I’d love this system – I’d take home similar pay to my male colleagues. I also feel in the long run it would also raise standards in GP care by removing the financial incentive that favours ‘quick medicine’. Hopefully, it would encourage everyone to take just as much time as the patient and doctor needs, knowing they will be fairly recompensed. (Of course, the payments MUST fairly recompense the GPs for their time, expertise and overheads, which is an argument for another article!)

You may be reading this thinking, “But this would make my General Practice financially unsustainable!” Spare a thought, then, for female GPs who’ve been 25% less sustainable than you for years. Let’s keep the Medicare discussion open until we find a financially equitable and patient-centric system – after all, good primary health care must put quality of care first.



ATTRACTING GEN Y DOCTORS TO THE BUSH: Do we need to breed GP Chameleons?


The face of the future rural workforce?

Health outcomes in the bush, while significantly better than decades past, remain the worst in Australia. Rural health care delivery is impeded by geography, attitudes, government funding, health workforce issues and other social determinants of health. I’ve been ruminating on rural GPs – how do we create a future sustainable rural workforce in Australia?

These common thoughts stop young GPs going bush:

It sounds intimidating out there, I don’t have enough skills to cope.

There will be crazy breech deliveries and airway emergencies everywhere!

I don’t know if I want to commit to a life in the bush.

I’m scared of ‘something bad happening’ and finding myself out of my depth.

I can’t face another few years in the hospital upskilling, I need out of the hospital – NOW.

We all know a capable, immensely experienced rural GP who’s seen and done everything, who’s as handy with a pair of obstetric forceps as they are with a tonsil snare, or a gas machine. Who’s worked around the clock, in the clinic and on call, for most of their working life – and has made an enormous contribution to the wellbeing of the local community. I was lucky enough to work with one such GP, Dr John Menzies from Camperdown, who was recognised by ACRRM for his outstanding service as a rural generalist.

Such skilled generalists are less common than they used to be, and they often have difficulty retaining younger doctors to fill their (formidable) shoes. In the traditional job description of the Rural Generalist, it lists long hours, relative professional isolation, and an intimidating list of competencies. I suspect it’s a generational thing: it’s hard to attract young doctors to such a career, particularly given Gen Y’s proclivities for a work-life balance, expectations of a satisfying intellectual career and multiple job changes during their professional life.

How then, do we attract young docs to the country? The Rural Generalist Pathway has a role. At the very least, it offers a certain ‘frontier allure’ with a no-ties-here-sleeves-rolled-up kind of attitude towards medicine, attracting bright young things back to the bush again. It also recognises that a different skill set is required by the true rural generalist. However, I suspect it also intimidates the hell out of many young GPs, who now think they can’t go bush because they haven’t stocked their saddle-pack with every Cert. and Dip. known to humankind.

How then do we encourage more young GPs to give the bush a go? There is a simple truth worth considering – you can’t be an expert in everything, all the time. No matter how many scout badges you’ve earned prior to leaving the hospital system, if you don’t deliver any babies for the next 10 years your Dip.Obs is next to useless. If you only tube 1 one patient in a crisis every year, you’re hardly an airway expert anymore, despite your Dip.Anaes.  If you don’t have the opportunity to continually practice in these specialty areas, your skills will wane. It’s not a realistic solution to train up large numbers of GP registrars before they leave the hospital, disperse them across the countryside and expect the skills to last them a lifetime. Continuing education and professional development is key, and its vital to be able to access it at all stages of your career.

What if we focused on trained every cohort of GP Registrars to be ‘GP Chameleons’? A GP Chameleon who is taught to be adaptable, practical and confident with uncertainty. A continual learner, who is capable of utilising the resources available to them to up-skill as the need arises, depending on the community they’re in.  This would suit Gen Y down to the ground, of course.

Gen Y loves an unplanned adventure, an Odyssey – they’re always off backpacking around the world, hiking in far-flung mountains and roughing it in desert villages. How do we tap into this desire for an experiential existence, coupled with itchy feet, and use it to tempt young doctors to the bush? We have the ability to metamorphose in General Practice, more so than our specialist colleagues.  Rather than labeling it a ‘failure’ of this generation to commit to one long career for the next 40 years, we should be embracing change and encouraging more adaptability and flexibility in rural General Practice.

Besides, across all fields of medicine, there is a rapidly expanding knowledge and evidence base. It’s impossible to ‘know’ everything, because ‘everything’ changes rapidly these days. With the advent of FOAMed, rural GPs may even find themselves outpacing of some of their specialist colleagues in evidence-based practice. The modern rural GP must have the personal and professional resources to adapt and upskill as required for the community they are working in.

It would be great to open up the bush to more GPs – through confidence-building, and professional development. Ideally the options would be wider for upskilling in specialty areas at any point in your career, including on a part-time basis. It would be wonderful if the State and Federal powers could improve the accessibility of the hospital learning environment for GPs.

Attracting capable GPs to the bush is critical.  However, applying historical expectations onto young doctors is likely to be a fruitless exercise in solving the rural workforce shortage.  I don’t claim to have the answer, but I suspect we need to re-brand rural medicine. If we can train all our Registrars to be adaptable, practical and confident GP Chameleons, we can then sell rural medicine as an exciting – not scary – adventure.

Thoughts, y’all? *chews on a piece of straw*


I have the good fortune of starting work in a brand-new, shiny clinic next week. And not just any clinic – a Superclinic (probably the last of its kind funded before the government changed). It’s an exciting time, particularly for the founding clinical team. The atmosphere is brimming with ideas about innovation, holistic care and creating a workplace we’ll all enjoy sharing.  We sit in planning meetings and each bring our ideas and experience to the table about how to make this General Practice clinic a model of gold-standard primary health care.  It got me thinking – what’s on your wishlist for the ‘perfect’ General Practice?

I was lucky to work in an extraordinary country practice in Camperdown, VIC with a set-up I’d love to emulate. This clinical team had effectively created their own multidisciplinary ‘Superclinic’ with Allied Health on-site, visiting specialists, procedures, and nurse-led preventative health and chronic disease clinics. I only hope we can replicate the exceptional care they offered the locals. While having the government-funded Superclinic infrastructure obviously assists with this endeavor, it’s still up to the individual members of the clinical team to create a workplace that hums.

This is my wishlist for my ideal GP clinic. What’s yours?

1. ‘Gold-Standard’ General Practice Culture

A practice that values evidence-based medicine, continuing medical education and gold-standard practices amongst the doctors and nurses on site. The clinic would be well-regarded by our general practice peers, specialty colleagues and referral hospitals for the quality and standards of the medicine practiced on-site.

2. Integrated Education

A practice set up as an integrated training site with medical students, nursing students and GP registrars. This is not just for the benefit of the students – when we have external observers there to learn, we critique our own knowledge base and skills, and are encouraged to stay up-to-date with our own education in order to offer the best teaching.

3. Supportive & Open Workplace Culture

An open culture of reporting safety issues, complaints handling and disclosure of adverse events is critical. In my ideal clinic, the clinical team would sit down on a regular basis and ‘iron out the creases’ in an open, non-adversarial manner – and would value all staff members’ contributions at the table. It would also encourage debriefing when staff have had upsetting events happen to them.

4. Friendly & Patient-Centred Staff

A practice that encourages friendliness and makes individual patients feel valued.  From the moment they walks in the door, at the reception desk, with the nurses and with the doctors; they feel important and that they will have their needs and worries addressed. We often forget how much ‘healing’ can be achieved simply being listened to and understood.

5. A Non-Judgmental Attitude

Staff who are empathetic and understanding, who understand that patients come from all walks of life, all education levels, and have complex life-stressors. A patient’s frequent non-attendance doesn’t necessarily mean they’re a slack pain-in-the-neck, but perhaps are more in need of the clinic’s support than the tertiary-educated well-dressed gentleman who arrives 15 minutes early for every appointment.

6. A Multi-Disciplinary Clinical Team

A practice that values and exploits the various skills of all of its team members, particularly the practice nurses. My ideal clinic would acknowledge the valuable role of skilled nurses in preventative primary care like asthma education, diabetes education, chronic disease management, wound care and screening programs.  Of course, having Allied Health on site – like psychologists, physios, podiatrists etc – is a wonderful boon to any general practice trying to offer holistic primary care.

I haven’t been working in General Practice all that long – but I’m excited to be in it for a long time to come! For those who have more experience, and have worked in various models – what else would you add to the wishlist?

WE RUN THE NIGHT: an ode to hospital night-shifts

I just completed my 7th night-shift in a row.  It may have been the post-nights delirium setting in, but I found myself reflecting wistfully on the strange, scary and unique experiences a hospital night-shift can provide. What else to do, but write an ode to night-shifts, and the staff who keep the hospital alive overnight?

Screen Shot 2014-01-02 at 4.58.55 PM

Now I’ve used up all my delirious creativity, it’s back to bed to recover. These night-shifts are doing me in! I’m training for my Diploma in Obs & Gyn, and it’s been an interesting experience to re-enter the hospital after a few years in General Practice. Makes me glad I’ve chosen a career that can be 9-5 if I want it to be. More frequent posts promised when I’m back doing a day job in GP!


I’ve long felt that the art of General Practice is being comfortable with a moderate degree of uncertainty.  In my first term in General Practice, I frequently called my supervisor for advice, because I just couldn’t diagnose the patient based on the available information.  The advice was usually, “Hmmm… get her back in a few days. It will declare itself one way or another.”  This was difficult at first, and I’d fret about the patient leaving without a diagnosis.  But it worked a treat!  When they’d return, the issue had either resolved, or progressed to some recognisable clinical entity, and I could work them up appropriately.

In medical school, we learn the art of textbook diagnosis.  A patient has a collection of symptoms and signs that neatly correspond to a diagnosis, and we rote-learn the appropriate treatment to offer.  It’s easy to memorise, because A symptom + B sign = C diagnosis and we treat it with D cure.  If your only experience of health and disease is from a book, this is the way you expect medicine to work.

In our junior doctor years in the hospital, we learn the art of clinical diagnosis.  It rapidly becomes clear that in the real world, patients don’t fit into neat diagnostic boxes.  Instead, within our various specialty terms, we learn to fit cases into algorithms, and process them along a diagnostic pathway.  For example, a patient who presents with any form of chest pain will fall into the ‘chest pain algorithm’ and promptly be given aspirin, an ECG, a chest X-ray and blood tests, all before we have decided if they truly have cardiac chest pain.

The benefit of this approach is the ‘safety-net’ to capture mild atypical presentations of serious disease.  It also provides rapid case turnover in a busy public hospital.  The downside is over-investigation, over-treatment and the risk of wearing blinkers to alternative diagnoses.  For example, once a child with a wheeze is on the ‘asthma algorithm’, it’s easy to miss that the reason they aren’t responding to escalating asthma medication is because they actually inhaled a small plastic toy.

Once we enter General Practice, the diagnostic situation becomes even murkier.  We see things first in General Practice, before they evolve into symptoms worthy of the clinical algorithms we are so comfortable with.  We see conditions at the start of their clinical course – like early appendicitis, when it just looks like a central tummy ache.  We see pneumonia, when it’s a new chesty cough.  We see bowel cancer, when it begins as vague tiredness and constipation.  We see things evolve, and this ‘window’ of early disease is often not experienced by other specialties.  For new GP Registrars, this can be the hardest transition to make from hospital medicine to General Practice.

I’d hope that our specialist colleagues respect the vital role GPs play in sorting out these early presentations.  I’m quite sure the Surgeons don’t want to see every tummy pain in case it might turn out to be appendicitis – that would be an enormous waste of resources.  I’m also quite sure that a Surgeon wouldn’t necessarily be as skilled in managing the problem of early tummy pain – simply because they’d have their specialty blinkers on.  Would they give full consideration to the multitude of gastrointestinal, urological, gynaecological, endocrine, neurological, vascular and psychological causes of a bit of tummy pain, like a GP must?  Would they be comfortable not doing a diagnostic CT Abdomen, and simply asking the patient to return the following day?  The skill in General Practice is not just identifying who might have a serious specialty problem, or need an operation – it’s also diagnosing simple but bothersome things, identifying safe things, avoiding unnecessary tests, rationing public and patient dollars, reassuring worried well and educating patients on normal bodily symptoms.

Of course, if we make a diagnosis of something that needs further specialty input, we initiate the relevant investigation and treatment algorithm.  It’s always nice to ship off our patients to the specialist in neat diagnostic bundles, like ‘acute PR bleeding’ or ‘likely pneumonia’, with some relevant tests completed and a succinct summary letter.  It’s far less satisfying when intuition is telling you something serious might be evolving in this patient, but you can’t quite fit them into a diagnostic box yet.  All of us in General Practice have made those unsatisfying referrals of ‘vague neurological symptoms’ or ‘sub-acute abdominal symptoms’ and winced thinking of our specialty colleagues criticising our clinical prowess on the receiving end:

Summary Letter: “This patient is complaining of these vague symptoms late this afternoon, and I have no idea what’s going on but my gut is telling me something’s wrong, and to be on the safe side I’d appreciate it if you’d work them over up there will all your fancy gadgets and rapid access to bloods and imaging because I don’t feel safe about them going home tonight.”

Specialty Registrar: “Bloody GP. No idea what they’re doing. This patient doesn’t need to be in hospital”After the appropriate hospital workup has come back negative, and you’ve had a chance to observe them for 6 hours, of course.

I was recently amused to hear from an ex-Emergency Registrar, who had just begun in General Practice.  She hated having to send in these ‘crap referrals’ lest the ED staff criticise and judge her – as she knew they might, having worked there.  She was finally seeing it from the clinical reality of the referring GP’s side.  It’s all too easy to criticise the handling of incoming patients when you’re holding the position of knowledge and expertise, especially when these patients are sent to you for your expertise.  Of course they’re not exactly worked up as you’d like them to be, that’s why we’re sending them to you!

I greatly appreciate my specialist colleagues, and happily call on their wisdom and clinical expertise when I have a complex case, a seriously unwell patient or a patient with a specialist problem.  However, I do come across the common scenario of ‘if all you have is a hammer, all you see are nails’ when it comes to specialists looking at problems outside their field.  I sometimes think how hard it must be, both for patients and doctors, in countries where a GP isn’t involved in diagnosis and patients self-refer directly to specialists.  A patient with vague pelvic symptoms could be shipped between half-a-dozen different specialties, rack up huge bills, and probably have a lot of unnecessary investigations in the process.

I also wonder if our culture-based desire for a ‘diagnosis’ when unwell is contributing to the huge upsurge in patients seeking out alternative health providers.  Far too often, I have a patient tell me they have been ‘diagnosed’ with all sorts of odd conditions, that either don’t actually exist, or aren’t there when I test them.  Patients like to have a ‘diagnosis’ for their peace of mind.  If a shonky alternative healer tells you assertively that “You have X condition. This expensive cure I sell will definitely fix it”, you’ll feel satisfied and hopeful – even if it’s complete nonsense.  If your GP tells you, “I can’t give you a specific diagnosis, but I’ve ruled out all the serious or fixable things, and there’s been no scientific evidence that any treatments will help your symptoms, they’re all just a waste of money”, you’re likely to leave the doctor’s office feeling completely unsatisfied, and not healed at all.

I’m not advocating a shift towards over-diagnosing or over-investigating patients just to given them a label and make them happy.  We’d be taking advantage of vulnerable people if we did so, because we know better and we aim to offer healing based on science and ethics.  However, we must keep in mind that while professionally this skill may be lauded, our patients may not always appreciate uncertainty, and may look elsewhere for someone, anyone, who will tell them that something’s definitely wrong with them.  All the more reason to celebrate those skilled General Practitioners who acknowledge this need, who seek out and address patients’ fears and educate at every appointment. Uncertainty is certainly an art in General Practice.

A Little Story About Postnatal Depression

This week, September 12 is R U OK? day, reminding us to check in regularly with family and friends and support those who are struggling. I thought it only fitting to write a mental-health themed blog.  Australian Doctor magazine recently held a short story competition entitled From Where I Stand, and while I wasn’t the winner, I was happy with my little tale.  I should point out it’s fictional, a blend of stories from women I’ve treated over the last few years. I hope you appreciate it too. 


I sit on the ground next to her, on the cold concrete outside the hospital wing. She’s sobbing, hunched in a tiny ball, clutching her chest like it’s the only thing keeping her from falling apart. She thinks she’s failed.

She came to see me in my clinic this morning, two rowdy kids and a three-month-old baby in tow. Dark circles under her eyes, a slight tremble in her hands. Eyes flicking everywhere like a hunted animal. “He just won’t stop crying! I don’t know what else to do!” It’s the fourth time she’d seen me in a fortnight, each visit a different, minor thing, and my alarm bells were ringing.

I ask her how she’s doing, leaning in, giving her my best ‘I’ve got all the time in the world’ look. Our eyes lock, her chin trembles with a brief hesitation, then a brush-off as she glanced away. “Oh, you know, just sleep-deprived I guess.” She snaps at one of the kids as they ransack my drawers. “I’m alright.” She visibly gathers herself in the chair. I try again, “It looks like you’re having a really hard time.” Then her eyes brim with tears, against her volition. And the floodgates open.

Her five-year-old daughter starts crying because Mummy’s crying. Her seven-year-old puts his serious man-face on, and looks to me for help. We comfort her together (he pats her on the knee) as a few distraught sobs break loose. I ring for the practice nurse, who takes the kids for a biscuit and some distraction “while Mummy talks to the doctor.” The five-year-old is won over by the bribe of sugar, but her little man leaves us warily, glancing back over his shoulder as he’s towed outside.

I want to explore things further with her. I want to see how far down the rabbit hole she’s fallen. I start with easy questions to break the ice, and push my box of tissues in front of her.

She’s never been like this before. Usually she’s pretty happy and well. Her partner is trying to establish himself as a dairy farmer and he works long hours outside the house. She’s cooped up with the kids all day. They moved interstate for this chance two years ago, leaving her family thousands of kilometers away. They live forty minutes from town, and it’s not worth the effort of packing up three children just to drive in for a mother’s group – she can barely manage a supermarket trip.

This baby, things have been different – and it began with the birth. He was facing the wrong way, so she had to have a caesarian. She was sore for weeks, longer than she expected. Her milk came in late, and this baby doesn’t seem to feed greedily like the others; he’s been fussy from the start. She’s been secretly topping him up with formula because everyone kept commenting on his skinny little arms. She felt dreadfully guilty doing it, and avoided the child health nurse because she was afraid of being told off. She’s read all the books, she was desperate to breastfeed – but after three months her milk’s dried up, and every time she makes a bottle of formula for him she feels like a failure.

And now the colic! Every evening now the screaming starts. Three solid hours of inconsolable, purple-faced baby. Right when she’s trying to make tea for everyone, and put the kids to bed for school. Her husband comes in exhausted from the milking sheds at 7pm, expecting dinner on the table before he rolls in to bed and crashes for the night, ready for his 4am start the next day. She knows he’s stretched thin too – dairy farming is exhausting, especially a one-man outfit like theirs – and she feels like she’s letting their team down if she can’t even keep control of the household.

She hasn’t told him she’s struggling. If he tries to help, to take over some duties, she sees it as a criticism of her abilities. She feels ashamed. Why is it so much harder this time? This baby wakes constantly through the night. She’s so sleep-deprived; she can’t even be bothered to get out of her pyjamas most days. The house is a pigsty. The kids are being sent to school with coins for lunch. She hasn’t been to the hairdressers since halfway through the pregnancy. She hasn’t shaved her legs in a month. She feels fat, unsexy, useless and worthless as a woman and a mother. She wouldn’t be surprised if he doesn’t love her anymore, who would?

I prod a little deeper. I’ve noticed that through this entire consult, she hasn’t made eye contact with her baby. When he whimpers, she rocks the handle of the carrier. When he squawks, she picks him up roughly and pats him over her shoulder, until he stops and she puts him back down. I can see he’s mouthing and chewing his fists; he’s clearly hungry. She doesn’t seem to notice.

“When the baby’s driving you mad and you’re at the end of your tether, you can feel really angry. Does it get like that sometimes?” She hurriedly nods, relieved I’ve put it out there. “Some women even think about hurting their baby – slapping it, or shaking it. It doesn’t mean you’d do it, but has the thought occurred to you?”

This is what she’s been waiting for, to tell someone this dreadful, shameful secret that’s eating her up from inside. Her voice drops into a whisper, tears spill down her cheeks and she admits that sometimes, she wishes he’d never been born. Sometimes she has to stop herself from slapping his chubby little thigh when he’s screeching uncontrollably. Sometimes when he won’t stop screaming, she won’t pick him up, because she’s worried she’ll shake him like a rag-doll if she does.

Two nights ago, in the dead of night, she thought about ending her own life. She was up yet again with the baby, her husband was asleep. She’d take the baby with her. Something gentle, like car exhaust, where they could both slip away into sleep. Her other kids would probably be better off without her since clearly she’s not fit to be a mother.

We’ve reached the crux of the consult. She looks fearfully at me. She’s exposed her soul, put it out there for judgment, and she’s instantly regretful – yet at the same time, she’s desperate for someone else to take the burden from her. Shame and guilt radiate off her in waves. “I think you’re having a really, really hard time of it. I think you have postnatal depression. And I’m worried for you. I think we need to help you, fast. What would you say to a short stay in hospital, a bit of R&R?”

I’m lucky, you see. I have admitting rights to my local hospital. And what I think this woman needs first and foremost is sleep, as well as recognition of her predicament and pretty urgent help. My practice nurse and I arrange the details – call her husband to explain, ask him drop off clothes and take the kids home, while I run her case past some experts over the phone.

This is how we’ve come to be sitting on the concrete outside, later today. I find her here, freezing in the cold, after discovering her bed empty on my evening rounds. I pat her on the back as the deep sobs choke their way out of her. I sense a catharsis, a release, in their violence. She’s been trying to keep it all under wraps, under control, not letting anyone know for so long. And now, of course, everyone will know. She’s not sure how she feels about that yet. I help her up; we wander back to her room and talk.

We talk about how these things she’s feeling – guilt, shame, worthlessness – are all part of postnatal depression. I explain that many women in her place have similar thoughts of hurting their baby, or hurting themselves – it doesn’t mean she’s a bad mother, it means she’s very, very unhappy. I tell her we can help her, and we’ll make plans in the morning once she’s rested. But for now, we’re going to send her off in a chemically-assisted snooze until morning.

A last shuddering sigh escapes her as she climbs under the covers.  She looks down at her hands. “Thanks for listening… I must look like the worst mother in the world right now.”

“Not from where I stand.”


I’m taking a guilty break from my GP exam study, so it’s a brief blog from me this time.  How do you recognise a Gen-Y doctor? Let me tell you, as I sip my fair-trade chai latte and touch-type on my MacBook Air:

1.  You’ve actually used the word ‘chillax’ in a consultation.

2.  You’d like to save the world – but only if you can do it part-time. How else will you manage your eco-solar-chookshed and your sustainable-organic-vegetable patch?

3.  You play Words With Friends, not Sudoku, while you’re anaesthetising patients.

4.  The administration staff are amazed you can plug in a LAN cable. Or fix the printer. Or touch-type. Or, heaven forbid, SEND A FAX YOURSELF!

5.  You’re planning a Locum Odyssey that entails surfing/working around the country for a few years. YOLO!  (Also, you know what YOLO means.)

6.  You’re not going to hang your diploma on your clinic wall. You’re going to hang photos you took on your DSLR of your hot-air-ballooning adventure over Myanmar, or your trek through the remote Nicaraguan jungle, or your windsurfing tour of the Maldives…

7.  You consult the Twittersphere, not the library, to find out about the most up-to-date medical research.

8.  You’re considering early retirement after 3 years of full-time employment.

9.  You’ve never seen a case of Smallpox. Or Polio. Or TB, Measles, Diptheria, Tetanus… or pretty much any vaccine-preventable disease. (Unless you live in Northern NSW, that is.)

10.  If the Internet shut down, you might not remember how to be a doctor.  See, you haven’t bought textbooks, because they go out of date before they hit the shelves these days. (Scary thought, that one…)

That’s all for now. Back to the books… Or should I say, back to my online subscriptions, FOAMed and RACGP website tutorials?