"Dear doctor... please help me!"
I continued to examine every single word that followed that plea. Even though it was written on simple paper, I could clearly feel the weight of that letter.
As I gazed into his eyes, I felt as though I was staring into a different world. This man had been through so much and had spent most of his life in prison for violent crimes; yet it was not I who was afraid of him. He was in fact afraid that I was going to reject him as a patient. He appeared anxious and fidgety, stammering along in his speech, as he tried to present himself. Given his social phobia, he knew that he would have trouble expressing himself in my busy clinic and had prepared the letter in advance.
This story sounds all too familiar to me by now.
It was a story of drug addiction – GHB, amphetamines, marijuana and alcohol. It was a cry for help. Having been rejected by other doctors with the label of being a drug addict or drug seeker, this man was simply asking to be normal again.
It was a story of chronic depression, which stems from childhood abuse and domestic violence. I began to contemplate the combination of venlafaxine, quetiapine, lithium, valproate and clozapine that he is going to need. These medications have been prescribed with a frequency close to that of metformin or atorvastatin. Just like many others, I was most certain that he would eventually require such a cocktail of medications. Even so, I know that these medications cannot heal a broken heart.
As he shared the story of his childhood, I was reminded of the many other children I have seen with similar experiences of family violence. Witnessing violence, drugs and sex from a very young age, many of them have been removed from their families by child protection services. Even in their very tender age, their wounded emotions with behavioral manifestations can be clearly seen. I truly hope to see a different future in their lives.
I recall reading the statistics – one in four Australian women has experienced physical or sexual violence by an intimate partner. Now, that certainly feels like a gross underestimate given the many broken lives and families that I have been seeing around me.
Then there are the refugees and asylum seekers, presenting with symptoms of post-traumatic stress disorder. They have witnessed horrors of war and violence which have left wounds too deep to be reopened.
These are the very people that I have always wanted to serve. As it was written by Robert Pierce, founder of World Vision and Samaritan's Purse, "Let my heart be broken with the things that break the heart of God".
I have always sought to stay true to the words spoken during my medical school interview. I recall my life calling to serve the needy through medicine to the best of my ability. However, after medical school and a couple of humanitarian mission trips, I learnt that the goal of "healing the world" will take much more than passion. It requires a lifelong commitment with careful planning. There is so much to be learnt about life and medicine before I can become a truly effective instrument – a family physician who offers quality holistic long-term care that will make a difference.
I therefore set out towards obtaining the Fellowship of the Royal Australian College of General Practitioners. In Australia, having fellowship status is the minimum standard required for working independently and unsupervised as a GP.
It was indeed by providence and not mere coincidence that I ended up working in Broadmeadows, Victoria. In the most recent census, Broadmeadows was listed as the most disadvantaged suburb of Melbourne. This was a suburb in northwestern Melbourne that I had not considered in my initial applications. All foreign-trained doctors who commence work in Australia must work in a "District of Workforce Shortage", and that usually meant rural areas.
Considering that I had been used to seeing eight to ten patients an hour working in the polyclinics, I was glad that there is an appointment system in our clinic. A standard booking is 15 minutes long, which is supposed to be the average duration of primary care consultations in Australia. Often though, I would get my patients to book double appointments – that is 30 minutes or even more. However, that amount of time, luxurious as it sounds, is still never enough to offer my listening ear to the lives and stories that my patients have for me.
Thanks to Medicare, the universal healthcare system of Australia, these patients are able to see me with practically zero out-of-pocket cost. Medications are highly subsidised as well and can be obtained with a script from the GPs rather than being sold in the clinics. While I believe in a free market, there is still a place for social welfare and universal healthcare for the many who cannot afford.
I am heavily indebted to SingHealth Family Medicine Residency and the faculties who have mentored me in the practice of family medicine. Even though it may seem trendier these days in Australia with the title of "GP" instead, I still believe in the family as the foundation of primary care medicine.
And I envision a future whereby children may grow up with love and truth, in marriages bounded by covenantal faithfulness.
Although this article is based on a real-life scenario, some details have been changed to protect patient privacy.