Dr Rob Park

FEW weeks ago I became a dad. Obviously many things have changed, but the resounding difference is that I now survive on less sleep than is required for daily functioning.

In addition, my appreciation for the emotional complications of the surprisingly complex task of breastfeeding, the constant oppressive internal question‘ am I doing the right thing?’ and the nagging idea that‘ I should have appreciated my previous freedoms’, has exponentially increased.

Most importantly, I believe it will change the way I practice medicine as it’ s made me realise how important personal experiences are to the care we offer patients and to the doctorpatient relationship.

I’ m book-smart and I know what’ s advised to manage parental and newborn medical challenges. But the textbooks do not describe the feeling of sheer exhaustion at 2am when this crying, beautiful baby, despite all your protestations, begging, pleading, and appalling singing, just won’ t go to sleep.

My new perspective has given colour and emotion to the blackand-white clinical skills I previously used to manage these patients. I have a deeper understanding of the emotional complexities surrounding breastfeeding.

I can appreciate the tired mother who has not slept for a few days, and needs reassurance and validation,

not medication and a psychologist. I understand the parental frustrations that go with purple crying / colic and can provide reassurance that this can be normal, and that, like a category five cyclone, it will pass.

This newfound insight makes me cringe when I remember a conversation I had with two nurses years ago.

I was listening to them discuss their difficulties with menopausal symptoms and one suggested that the other should:“ Go and see the new young male GP in town as a patient,”

glancing cheekily in my direction.

The other nurse laughed and said:“ What would a young man know about menopause? He has never gone through it.”

I thought for a moment and wittily replied:“ No that is true, but I have also never experienced a heart attack. And the gentleman I just treated for cardiac arrest seemed pretty happy with my emergency care.”

I’ ll be honest, I felt pretty smug at my clever response. But reflecting upon that conversation, perhaps there was more to what the nurse said than I appreciated.

We are taught at medical school to

acknowledge transference from our patients and to not allow it to influence our medical care. However, it is naïve to believe that simply noting these feelings makes us immune to their influence.

For example, if a patient comes to you, describing how they have been getting drunk and angry at their family, and your father was an alcoholic who was aggressive to you as a child, then let’ s be honest, this will affect your ability to offer impartial care.

Conversely, a patient who presents

MY NEW PERSPECTIVE HAS GIVEN COLOUR AND EMOTION TO THE BLACK-AND-WHITE CLINICAL SKILLS I PREVIOUSLY UTILISED.

with pain in their cheek, similar to the pain you experienced prior to a diagnosis of parotid cancer, is likely to lead you to order a rapid and possibly unnecessary ultrasound.

Both these responses are human— neither is right or wrong. Our actions are based on our previous learning and experience, and as doctors, we should embrace the positive affects of that and ensure the negative effects aren’ t detrimental to our patients’ care.

There’ s one patient, I often reflect upon now— a young mother with a beautiful new baby. That baby was very unsettled, screaming from dawn

until dusk with that‘ in pain’ cry that to a mother sounds like glass scratching deep into a chalkboard.

We sent bub to appointments with paediatricians, specialist paediatric gastroenterologists and sleep clinics— which led to a myriad of diagnoses and a menagerie of explanations for the crying.

The mother— confused, exhausted, and feeling inadequate in her ability to provide for her child— I diagnosed with postnatal depression and referred her for help.

She continued to struggle for many months and when I reflect upon their care, I don’ t feel that they ever received a satisfactory or comforting response.

The experience was medicalised, confused with multiple inputs, and led to significant anguish for the family and baby.

Do I think that anything I did was medically incorrect? No. Do I think I would have treated her differently now with some of our shared experience? Absolutely.

I may have been able to build better rapport, gain her trust, and perhaps say the things she needed to hear at the right times.

In medicine, nothing is certain, the retrospectoscope can be cruel.

I will continue to treat patients in the best way I know how, based upon my medical knowledge and skills, and also my personal experiences. Dr Park is a GP on the Sunshine Coast, Qld.