Dr Rachel Glasson GP in Sydney, NSW.

These demands come from other doctors.

It is probably no accident that many of us, having pursued a career based on helping others, tend to want to save people, sometimes from themselves.

We are ideally placed to know a lot about our patients, especially those for whom we care over many years, but at the same time, there is obviously a limit to what we can ultimately do for them.

I had a patient many years ago who was desperately ill with meningococcal sepsis.

I was a junior hospital registrar at the time and took care of this very complex patient for almost six months as she recovered from kidney failure, massive skin grafts and amputations affecting all four limbs. My strong suit is attention to detail, and there was plenty of it to keep me busy on a day-to-day basis with this patient.

Her situation was awful, but she bore it with incredible composure and grace.

Over so many months, it was impossible not to get attached, and despite the usual advice, I pretty much became part of the patient’ s family and remained in touch with them for many years.

Her mother was an amazingly strong woman who, for the best part of a year, spent almost every single day at the hospital. And so my role was to be all over the medical problems, not to act as a surrogate parent.

Medicine has long been criticised for being too paternalistic.

Some patients do not like the idea

of the traditional male doctor doling out instructions and telling them what to do.

It is strange, then, that maternalistic behaviour seems to be far more accepted— and even expected.

As a female GP, especially as I have become older, I have found

myself increasingly playing mum to my patients.

Mostly, this takes the harmless form of providing a sympathetic listening ear, supportive noises, a bit of practical advice and the occasional,“ No, don’ t do that; stop it.”

But sometimes, it is much more complicated.

Some years ago, I had a patient whose self-harming habits resulted in several referrals to a specialist burns unit— at least one of which ended with a skin graft.

I subsequently received a phone call from a hospital registrar who was very upset about it all and told

‘ I am not their mum. What do you expect me to do, move in with them?’

me:“ You have to stop them from doing this!”

I was a bit puzzled as to how I was supposed to achieve this outcome, desirable though it would have been. I ended up saying, quite literally:“ I am not their mum. What do you expect me to do, move in with them?”

PICTURE CREDIT

Maternalistic behaviour is expected.

He then hung up on me.

Every other day I get a discharge summary where some intern or JMO basically implores me to be the patient’ s mum:

“ GP to kindly review details of this admission and monitor for resolution of symptoms and general wellbeing.”

“ GP to kindly provide ongoing scripts for new medication.”

“ GP to kindly chase and follow up on formal report of X-ray.”

“ GP to please refer for further imaging if symptoms do not improve.”

Once, I received a discharge summary about a patient who was notoriously non-compliant, instructing:“ GP to please ensure patient is fully compliant with all medications as listed above.”

After I stopped laughing, I felt

quite pleased that the JMO believed I had such magical powers.

Now, it seems even the RACGP has jumped on the‘ be my mum’ bandwagon.

In an act that literally throws the lot of us under the bus, the college has recently issued guidelines suggesting GPs should be monitoring all investigations ordered by anyone and everyone for our patients— which will now be mandatorily uploaded to their My Health Record— and acting upon any abnormal results.

The guideline states:“ Where there is any doubt, it is good practice for GPs to take a cautious approach and check with the person who initiated the test and / or the patient as to whether further follow-up is recommended.”

There are so many things wrong with this concept that I almost do not know where to start, but in the spirit of being a responsible mum, I will give it a go.

We have no way of knowing when an abnormal result is uploaded to a patient’ s My Health Record. It is like trying to monitor your kids’ Snapchat history— except they have lost their phone and you do not know the PIN anyway.

We have no way of knowing why the test was ordered or what the clinical indication was, if any. It is like a conversation with a teenager: minimal information to work with and lots of silent eye-rolling.

None of the time spent on this cautious approach is going to be remunerated. Exactly who is going to pay for our time to phone the person who ordered the investigation, if we even manage to get hold of them? It is like the bank of mum and dad: lots of withdrawals but no deposits, ever.

The bottom line is that pretty much everyone expects us GPs to go above and beyond, to the point that we turn into a surrogate parent for our lucky patients, for whom we will inevitably end up doing lots of extra work without remuneration, recognition or even thanks.

Sounds exactly like … motherhood.