Case Study: Lyn

Lyn, a 47-year old GP, was married to a medical professional (not a doctor); they have two daughters. She had been a suburban practice owner for 11 years, and for the first three years worked solo, and then employed another female GP. Although Lyn did not enjoy the business aspects of owning a practice, she highly valued the autonomy and flexibility that being a practice owner provided. Lyn considered that the autonomy gave her the decision latitude to take control of her work hours, workload, and how she conducted her business. In particular, she valued being able to adjust her work hours so that she could be at home with her daughters after school.

Lyn was committed to her patients and knew them all by name. She felt honoured to share in her patients’ lives, and provide them with care over many years. She contrasted her capacity to know her patients with the larger clinics where people may not have a regular GP. She preferred a smaller practice because this allowed her to practise in a way that was congruent with how she perceived the role of GP. She was concerned the

continuous changes and increasing pressures in general practice caused different working patterns resulting in a loss of continuity of care. She saw the outcome of these changes as a decrease in ownership of the responsibility that co exists with being a person’s GP, and fragmentation of care. She considered the continuity of care particularly important for managing complexity, co-morbidity, and multiple pathologies in patients.

Lyn liked most of her patients, but believed a few patients did not value the level of care she provided, and the effort this entailed. She decided she was not going to spend her

time with patients who did not respect the service she gave, and dealt with these patients by writing to them suggesting they seek another GP to provide for their health care. This strategy had the added benefit of reducing the number of patients and, therefore, her workload.

Lyn intended to work until her daughters were finished their education. She was the only participant who stated she no longer gained satisfaction from her work. Even though she felt highly skilled and highly qualified in a job with social status, she had begun to question whether her job gave her a happy life. She often thought that, in hindsight, she should have been a teacher so she could spend school holidays with her daughters. She also wondered if, in fact, her daughters would have been happier if she had been a teacher rather than a GP, because being a teacher was, in her opinion, less demanding than being a GP. Lyn believed she was ‘too old’ (at 47 years) to leave medicine and pursue a

teaching career. She was not prepared to forfeit the financial and emotional investment she had in her medical career, or to devote effort to obtaining teaching qualifications.

Lyn perceived the high demands of general practice were insufficiently financially remunerated. She addressed this imbalance by moving from bulk billing her patients to a co-payment system, which gave her higher financial remuneration. This allowed her to feel more adequately rewarded for her efforts. However, she had not been able to address the lack of intrinsic rewards that had diminished during the years she had been in practice; this contributed to her dissatisfaction with her work. She explained:

The buzz has gone. I had a lady in the other day with an infarct; got an ambulance, gave her aspirin and knew she got in and was stented, and she’s alive. 5-10 years ago I’d say ‘oh yes! yes! I saved a life’, now I think my God, will the ambulance just come. I’ve got to go home and cook tea, and then I’ve got to go to a school meeting.

Prior to becoming a parent, work had been Lyn’s primary life interest. She struggled with the transition to parenthood at a time when she had just begun in her own business; trying to meet the demands of these two domains had been challenging. She said:

The most demanding part of the job for me was to find a way to be a mother and to do the job - that was incredibly difficult. I went back to work when my second child was 3 weeks old, and because I had a practice that was close to home, Mum would look after her and I would go home and breastfeed her. If you’ve actually got autonomy over your own hours you can do it. I’ve been able to be there for my kids as well as work. But it’s taken a lot out of me.

Lyn had chosen to work and live in the same geographical area. She was well known in the community as the local GP. Although this had benefits, such as a short commute time, and being able to conduct home visits on the way to the surgery, it did not help her to place boundaries and separate her work and non-work/family domains. She accepted phone calls from patients during non-work hours, and had difficulty leaving thoughts about her patients at work.

In order to alleviate frustrations associated with the changes to medicine and the healthcare system, Lyn acknowledged that it was important to identify the things that you can and cannot control. She put strategies in place that helped her adapt to change and took regular breaks to detach from work and replenish her resources.

This case study has illustrated the importance of time in general practice and the strategies adopted to deal with organisation and management of time. Several issues were identified and included: the relevance of time to the business of general practice, the significance of time to health and disease, especially the continuum of care that has been traditionally associated with general practice. Also demonstrated has been the importance of the meaning of time and money to GP participants, and how this is linked to effort and reward at work. The ability of participants to obtain a balance between effort and reward,

as well as their perception of achieving balance between work and life domains influenced their satisfaction with their work.