GP in same situation as me

[The_Possum]

Hi there

I just found out a few of weeks ago that my GP is in the same situation as myself ie we both have close family with terminal cancer.

At first I thought this would be good. But every consult seems to be highly emotive, sometimes I almost reduce my GP to tears. Other times she is trying to help me but becomes rather irritated and the advice ends up becoming more about her than me.

The last time we spoke ended with her telling me that I needed to grow up because we can't keep our loved ones here forever and we can't save everyone.

I walked out feeling very shocked particularly as she knows I'm bipolar ii and struggling with depression at present.

I had my phone off to calls for a week to have a break from people calling and yesterday found three voicemails, Two from staff and One the practice manager saying to call and make an appointment with the GP. The practice manager asked me to get in contact with her

I called yesterday and got the run around. So just sent the practice manager an email apologising that I didn't have my phone on and asking if I still needed to make an appointment. I've heard nothing.

I was in the practice a few days ago for an emergency consult due to a medication rash and saw a different GP and he said nothing. So if something was on my file ie a recall request I'd assume it would be on there.

Anyway guess I'm just feeling confused and wondering if she should be my GP if it's too emotive like this. I'd be devastated to lose her as she has been my GP for years & really helped me, but maybe it's not healthy. I don't know.

[Peppermintbach]

Hi Possum,

My condolescences for your loss. Losing a loved one can feel as though your heart has been ripped out. It's absolutely devastating and it can make some people feel as their life ,as they knew it, has been uprooted by the loss.

Your GP sounds absolutely shattered by her own loss. While in some instances, medical and allied health professionals can use their personal experiences to help their patients and clients in terms of empathising- I don't mean necessarily sharing one's own experience- it does seem as though she is struggling to emotionally separate her own loss from yours. I feel as though she is projecting her own feelings onto you.

For example, her irritation could be more about her own conflicted feelings rather than about you. Also, her comment about "growing up" was harsh and uncalled for. Not that it's an excuse, but again, I suspect she was possibly projecting her own feelings regarding her own coping onto you.

I suppose it's a tricky situation because you have developed rapport and have a good, professional relationship with her. At the end of the day, it's your decision to make (I obviously can't and shouldn't be telling you what to do). But maybe I can make some suggestions if you don't mind.

If you want to continue seeing the same GP, I would suggest that now is the time for an honest conversation. This would be difficult but if you can get an appointment with her, maybe be upfront about how you feel about her comments and how she makes things about her (instead of you). Her response might be an indication of whether it's worthwhile seeing her again or finding a new GP.

Alternatively, if you're leaning more towards a new GP altogether without seeing her again, that is also understandable.

Whatever your decision...at the end of the day, the important part is that you feel supported and receive the help that you need. GPs are human but they are also professionals who need to maintain healthy boundaries with their patients in order to help them. You deserve the best help you can find.

All the best,

Pepper

[Dr_Kim]

This is a really great post as I think it highlights so many things. You are clearly very insightful and also very compassionate as you are willing to try and stay calm and wonder about what is going on for her and give her a bit of leeway because of her circumstances. 
 
However, lets be clear. She is not your friend. She is your health professional . This relationship is not like a friendship as you are not meant to be there for one another. It is supposed to be one sided. She is meant to care for you. You have no duty to offer her support or care . She should be getting her emotional needs met  from others support in her personal or professional life. 
 
Now , of course health professionals are not robots and have emotions. They also are subject to mental health problems themselves and actually have high rates of depression and anxiety. However, it is their job to manage them effectively so they can treat patients responsibly . I would guess that what is happening in your consultations isn’t feeling like effective management .
 
So … what to do from here. I would think about what you want to do with respect to staying with her or leaving and going to a new GP.
 
If you want to stay then I would write an email to her and cc it to the practice manager stating your concerns clearly and concisely. Something around 
1. concerns around your quality of care is maybe slipping citing the example of the miscommunication with the clinic leaving you in the dark as to what the 3 missed calls were about.
2, concerns about your GP and HER mental health . Maybe state that you are worried about her as she has seemed tearful, and unable to give advise that feels helpful or kind at the moment. Express that you trust that it is not because she is a bad person , but that you are concerned that there is something wrong and you care that she gets support so you can continue to receive the excellent help that have in the past.
3. state that you would like to continue to be her patient but feel that she might need to understand your vulnerabilities a little better and be a little more cautious in some of her statements 
4. Give her an option that if she doesn’t think she can mange to give you quality health care you wish her all the best  but you would appreciate a full hand over to a recommended GP. 
 
How does that sound ? I think something along these lines allows you to frankly and openly state your issues and needs without being punishing to her. I hope this helps. 

[The_Possum]

Thanks Pepper, I appreciate your reply. They haven't passed away, but are terminal ie undergoing treatment for incurable cancer. So it's more anticipatory grief as well as anxiety. I do agree that a conversation might be in order to clear things up.

Thanks Dr Kim I appreciate your input here. I understand the boundaries in the therapeutic relationship & it's not my responsibility to care for her. I guess as much as I am aware of that I do care about her though & I find it concerning that she is clearly upset.

My whole family see her, my husband, kids, my parents, my sister and her family, my grandparents and my aunty and uncles and their kids. So effectively she treats 23 family relatives. She has also been there through thick and thin, my little ones serious illness in particular. I've cried with her. Laughed with her. I find it hard to feel absolutely nothing for her and not care to some extent.

Having said that, she has only acted this way to me and none of my other family members. We do and always have seemed to have a greater therapeutic relationship though. For example she has reviewed my resume on occasion during a consultation & given other advices over the years. I haven't really thought anything of it though.

But I do feel that the emotions are intense and I can't honestly deal with her emotions on top of my own, especially as I am struggling myself. I almost feel like I need to hug her and say 'it's ok everything will be ok'.. But it's not really my job to do that.

My husband thinks she just needs space, so I cancelled an appointment this week and went and saw one of the other doctors so I didn't need to deal with it.

But I have booked in to see her in a fortnight for a medication review & bloodwork to get my liver checked and I'm thinking I'm just going to ask her straight out, if she finds it too difficult to treat me. Because maybe over the years we have crossed the boundaries without realising it & now it is becoming evident given the situation.

I'd hope the therapeutic relationship can be salvaged due to the history and I'm just plain comfortable to go in and talk of any issues or health concerns. But at the same time I don't want to put her under any stress if I am triggering something for her.

So rather than email I'm just going to go in and talk. As for the phone calls, I have no idea what this is about & that's something I'll ask about too. My husband thinks maybe she wanted me to go in to apologise for the last consult.

[Peppermintbach]

Hi Possum,

I'm so sorry, my bad, I didn't read your post properly. Thanks for clarifying.

I'm glad Dr Kim responded with some sage advice, and I'm happy that you now have a plan in place.

All the best with the conversation 🙂

Kind thoughts,

Pepper

[The_Possum]

Just to update.. I had my appointment scheduled today and I realised about four hours before it that I really couldn't do this.

So I chickened out and cancelled!

I blame it on not feeling 100% so in a vulnerable position whereas normally I'd be a bit stronger.

But yeah couldn't do it!

I'll try again in a week or two I guess.

Either than or I default to email as suggested, which was a really good idea, but I really think this deserves a more personal face to face discussion. If I can.

Anyway there's my update x

[Peppermintbach]

Hi Possum,

Thanks for the update. It's okay, you gave it your best shot and maybe that moment just wasn't the right "time" for you.

Be kind to yourself, have a think over which mode of communication will work best for you and just take it step by step. You'll get there.

Warm thoughts,

Pepper

[The_Possum]

An update! I cancelled my appt with the GP, as I couldn't handle to it.

In the meantime my mum went & GP downloaded all this personal stuff to her and started crying on my mum's shoulder. My mum has terminal cancer. Personally don't feel that was appropriate.

She proceeded to tell mum that her 'mind isn't with it' and consulting is difficult. But she is going mad at home around her partner with cancer & hence feels working is good to get her out of the house.

It's OK for a patient to walk in with 'their mind not with it' that's why we are going in. But I don't think a GP should be practising if they feel that way. I don't think working with vulnerable patients should be her 'outlet' from her situation. She can go see a movie/play golf, there's other things she can do than go to work, putting patients at harms way.

In between all of that I had a great cancer researcher in the city who was happy to review mums case. Mum isn't fit to travel so he said if I gather her records, get a referral, as long as mum agrees, he will review it for me.

So I called the practice to find out if I could make an appt & what I was going in for, & to ask if I needed mum to sign an authority to let me access the records or if she needed to come in (mums pretty weak from chemo & we didn't want her to go if she didn't need to). The receptionist said she wasn't sure of the protocol, would ask the doctor, call me back.

No response. This we believe is off the back of my chat with her, where she told me that my research is a waste of time as mum will die anyway, I need to grow up, just accept that I can't save her.

I find this unacceptable. We believe she is trying to keep me from doing this as she doesn't agree. Or she is projecting on me.

She also made a comment that she sees our relationship as 'maternalistic'. Well she isn't my mum & I'm disturbed by this, as although I admire, look up to her & trust her. I do care about her. Thats the extent of it.

We do get along & if she weren't my GP we would possibly be friends, but that's irrelevant

I sent an email listing out all the things I don't like.

Im leaving the practice, seeing a new GP. I have my file as I always get copies.

This is so disappointing, Feel like I'm mourning the loss of someone. I trusted her. I always thought one day when she retires we could be friends. But this is beyond! I was going to book an apt to say goodbye but I'm not going to.

Mum feels she is trying to take her place in my life..

[Peppermintbach]

Hi Possum,

Thanks for sharing with us and letting us know how things are going. The way she has acted is very disappointing, and I would say, unprofessional.

I personally think she has crossed professional boundaries here and seems to have blurred her own personal life with your life. I think you did the right thing- even if it was very painful for you to do- because, at the end of the day, doctors have a duty of care to their patients. And judging from her actions and words, she seems unable to follow through with her duty of care or or at least not with you anyway.

Hey, I'm sorry that this has happened to you. It's awful. I hope you're able to find a new doctor that you can build a new, professional rapport with...

Kind thoughts,

Pepper

[The_Possum]

Thanks Pepper

Yes I agree totally. She does have a duty of care to the patient.

The thing that disappointed me the most was her non support for me in seeking to gather records for a researcher to review mums case.

Even if she feels research is a waste of time, it's not her decision to make. Or to tell me she is going to die anyway.

It's like a patient coming in and say they want an abortion. Well the doctor may not personally agree with that, but they can't project out their personally views on it and persuade the patient otherwise. Their role is to objectively ensure the patient understands the pros and cons so they can make an informed consent. They then have to support the patient.

So really it's inappropriate for her not to support me on the issue.

Furthermore just because a patient has terminal cancer, does not mean they can't be treated. Medical science can influence when the patients 'end point' may be. Ie the treatment options can prolong lives. I did end up seeing this specialist and there are two drugs she can trial that can manage the spread of cancer. These are drugs we wouldn't even know of or how to access overseas if I hadn't done research and then saw this guy!

So no, regardless of my 'care' for her and the fact I really like her as a doctor for many years. Not wanting to help me with my mum's cancer.. Is a deal breaker lol My husband laughs every time I say that. But it really is!

Thanks Pepper, I'll get over it in a week or two x