Q1: You’ve been writing a column for many years in NZDoctor magazine, but extending out into a book was of quite another order. Which is harder — working as a GP or writing a book?
Writing a book and being a GP are both hard, and both rewarding in different ways. Both are crafts that take a long time to learn. I didn’t start out to write a book, so it has been probably a 10-year project. Being a GP is hard these days and when we are under pressure it’s easy to take the easy way out, write a prescription, send a referral knowing the person will not be seen. But we all want to do work that is meaningful, so I think we have to stick to our kaupapa: What story are we in, what is important, what are our human values? It’s certainly true that my work as a GP informs the writing but also the writing helps me understand my work as a GP. I started by doing reflective writing as a way of making sense of the complex and distressing stories I had been given by patients. Then I realised what incredible stories they were and often stories that are not heard.
Q2: Many doctors have written books over the years. Which were the exemplars you were drawn to?
There are so many books that have profoundly influenced me. I just hope the next generation keep reading books because when we read something that long, we are subsumed and that allows something important to wash into us. As a medical student I picked up on sale, at UBS, The Healers Art by American oncologist Eric Cassell. It was gripping, because someone was speaking about things that were sadly absent in my training. Early in my GP training I read Proferssor Ian McWhinney’s A Textbook of Family Medicine. Considered the grandfather of general practice, he had that ability to communicate complex ideas with clarity, covering the philosophical basis of general practice, illness, healing and communication. Of course, Glenn Colquhoun’s work especially his poetry collection Playing God: Poems about medicine and his small book Late Love: Sometimes doctors need saving as much as their patients. He has had a profound effect on generations of doctors in New Zealand. More recently I loved Collaborative and Indigenous Mental Health Therapy: Tātaihono — stories of Māori healing and psychiatry by Wiremu NiaNia, Allister Bush and David Epston. And also Ora: Healing ourselves — Indigenous knowledge, healing and wellbeing edited by Leonie Pihama and Linda Tuhiwai Smith.
Q3: What is it that fascinates lay people about what doctors do, do you think?
I think people are most often fascinated by the gory bits and the emergencies, when the stakes are high. General practice is much more about the human stories, which can also be gory with high stakes. People tend to think that other patients are just like them. They don’t realise the range of humanity that walks through the door — everyone from gang members to bankers. They have more in common than you think!
Q4: In this book’s pages we see you wrestle with what it is to be a good doctor — in the sense of a doctor who is effective and kind and who listens and who is also humble. How tough is that wrestle?
More and more I think we need very clear values about how we want to treat people. For example, the idea of not judging, seeing the mana in a person regardless of what they are doing, or have done — these are challenging positions to hold but so powerful that they can be the treatment. Listening is often the treatment. I also understand now that how we are is almost more important than what we say; patients sense us and what we think. They know if we are judging, or not safe, or not hopeful for them. And sometimes hope is hard to muster but we must find it. Hope involves trusting the person has it in them; I can’t carry it for them, but I know they can. I’m really a minor part of what happens in their week!
Q5: Lay people can also put doctors on pedestals. Should they?
I think people want to trust their doctor. But different people trust different things. For some people a doctor who puts themselves on a pedestal, wearing a suit, is just the right thing. For other people, a middle class Pākehā person like me might not be instantly trustworthy. The suited professional is not always the right thing.
Q6: This book is also a memoir, not of your whole life but certainly of big crunchy parts of it: your brother’s death, the end of your marriage, falling in love with your best friend, your son’s epilepsy and your own burnout. How hard was it to be open about all these things?
My family of origin was very open about things, so it doesn’t feel hard. But in medicine we are professionalised to keep our personal self hidden, even to our colleagues. When I got burnt out I realised that if I didn’t speak about it, I would always hold a sense of shame and failure. I didn’t want to read another burnout book about ‘other people’ who had it. I wanted to hear lived experience. I’ve learnt that the more open I am about my story, the more open others will be about theirs. I do a lot of teaching of GP trainees and I always implore them to be themselves. They are scared that is unprofessional. I watch about 150 consultations a year, mainly with GP registrars. It’s truly magical to see what happens when the doctor is being who they are. So yes, that is part of my reason for being me in the book.
Q7: After leaving your GP practice in Wānaka, you have worked mostly in community health services settings, with people who haven’t always been dealt the best hands in life. Why are you drawn to those work environments?
I like to be put on my own edge, to go to the limit of what I thought I could do, then peer over the abyss and see what’s there. I call it human mountaineering. It’s edgy. Most often I am seeing people who don’t really trust doctors or the biomedical model. They have had bad experiences in the health service and they have a different view of what is important; sometimes the wellness of their body is just not top of the list. I get so upset about the judgements people in positions of power and privilege make. I work with the people they are talking about; they are beautiful people, often very warm and caring themselves. Just about
everyone is doing their best.
Q8: You have also done a huge amount of work to turn yourself into a doctor who is more useful to her Māori patients. How difficult has that been?
I was bought up in the deep south, so things Māori were in books and on TV. And my early life was a different part of history, so in many ways my struggles with being Pākehā have travelled alongside the incredible resurgence of te reo Māori and matauranga Māori over the last 30 years. I feel lucky to have been part of that. It is so incredible to live in a country where we need to consider another way of seeing, which makes us super aware of our own culture and assumptions about the world. There is a real opportunity in that to make Aotearoa a pretty special place.
Q9: And how rewarding?
I think the Pākehā doctor-Māori patient scenario is both tricky and simple. Tricky because it is a politicised relationship; colonisation is in the room with us. Tricky also because the answers and outcomes we want are not always easy to achieve. But in some ways simple because in the end it is about whakawhanaungatanga. You can’t do anything without relationship.
Q10: Proud of the book?
I guess I have written the book I wanted to read as a medical student or young doctor. Although recently I have read some of the stories to very experienced GPs and their response is a sense of being seen and acknowledged for what they do all day; those things that aren’t counted in quality measures and performance scores. It’s moving to see how moved they are by being seen. I think it’s unusual for a doctor’s book because it’s so personal. I am honest and open about myself and about how it is to sit in the room with all that distress and suffering, but also honest about the culture of medicine. These are things doctors don’t often talk about in the first person. I wanted to write a book about how it is to be the doctor, rather than a book that just peers into patients’ lives as if they are interesting cases. It’s a tricky balance because to describe being the doctor, you have to have a character called patient. I think I have tried to uphold the mana of all.
