As a GP I’m your ‘specialist in life’. Yet life, as we know, is a tumultuous, unpredictable creature.
What I actually specialise in is managing chaos.
It’s no exaggeration to boast that, after 25 years of constant practice, I have mastered the art of uncertainty.
Mastery is not an end point, of course — the day an expert stops learning is the day expertise wanes. But I, along with thousands of my GP colleagues, am about as good as it gets.
Collectively, we experienced GPs constitute the A-team of sorting out the whims and vagaries of all of life’s assaults upon health.
Give me a thousand people with a fever (or just hang around my office for a year) and I’ll sift through them more accurately, safely, swiftly and cost effectively than any other health profession in Australia.
It’s what I do.
I’ll do it cheaper than a paediatrician, safer than a nurse practitioner, with fewer tests than an emergency physician, and with better outcomes than a whole host of alternative therapists.
Ditto for a thousand folk with tiredness, pain, worry, dizziness or nausea. Or indeed, a thousand well people who want to stay well.
All these grand claims are based upon one underlying precondition: uncertainty.
Without that, I’d gladly step aside for plenty of other experts.
If, instead of ‘worry’, it emerged that the person had acute psychosis or PTSD, then psychiatrists or psychologists could rightly refute my ‘master’ status. Or, if the worry turned out to be ‘fleeting disquiet’, I could probably tag in their best friend and a cup of Earl Grey.
And let’s define ‘tiredness’. If it’s due to Cushing’s syndrome, I tip my hat to the endocrinologist; if its due to heart valve sepsis, get me three specialists and a machine that goes bing — pronto!
But heaven forbid if a thousand people who are tired but don’t know why, walk (slowly) into any other health provider but their GP. When uncertainty is at its peak, I’m at mine. No one does it better. Not even a naturopath.
Despite my training in a thousand possible medical interventions, intrinsic to my mastery is knowing when not to intervene. This is the edge I have over those trained in hospitals, where uncertainty is, understandably, an enemy to be defeated as soon as possible.
As a horse master embraces the wild brumby, I embrace uncertainty. I treat it with respect, often merely enveloping it with protection until it calms of its own accord.
Yes, I am the guru. The master of inactivity, the lion who watches.
My registrars emerge from their decade of hospital-based training brimming with enthusiasm and knowledge, eager to trounce any hint of uncertainty with tests, referrals and blind treatment, early and often.
Before their conversion, poor innocents, they believe that mastery means elimination at any cost.
I have taught these disciples to embrace careful observation over time, striking only when necessary.
They, too, become uncertainty whisperers. My work here is done.
Dr Justin Coleman co-authored the recently published GPSA guide to Managing Uncertainty in General Practice
Reblogged this on Dr Thinus’ musings and commented:
This is how we roll in GPland – brilliant post Justin
Reblogged this on Rural General Practice.
Great Read Justin.
Maybe the RACGP should change their slogan to “Not Just A GP – I’m your specialist in uncertainty, in translating medical jargon and in navigating the health system”. Not a catchy though…
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We’ll work on it, Ivan, and bring that thorny word count down.
Maybe “…in uncertain translational navigation”?
Nope, I have it! “…in life”.
Hope they didn’t copyright.
It’s a poorly understood fact that GPs are experts in uncertainty and it is a highly undervalued skill. Generalists manage uncertainty specialists/partialists (not a derogatory term just meant non generalist specialists) aim to provide certainty (often with more tests/costs). Systems with more generalists perform better for cheaper …. Keep spreading the word Justin
Wonderful! I just translated your text to Swedish to make more people able to understand it fully. Thank you!
Thanks so much, Margareta – my first translated piece, as far as I know! That’s a lot of hard work.
“safer than a nurse practitioner”
How – can you give us specific examples?
Because as far as I am concerned, any health professional is prone to mistakes. This is the very reason why a number of hospitals have implemented check lists, like they do in aviation, to avoid hierarchy getting in the way of patient safety. Everyone is accountable for safety in care delivery.
This sentence was really patronising. Maybe you need to reword it.
In awe ! Hope I get there one day too !
Thoroughly enjoyed this. Thanks, Justin.
Love this. I remember doing a placement at the clinic you worked at in Inala with Geoff when I was a med student and being impressed with how calm and collected with basically everything you seemed at the that time.
I was discussing today the issue of uncertainty in GPland with a patient. Don’t feel like I’m quite a master yet but I’m hopefully on my way.