The thing about General Practice, is that it’s probably the easiest speciality to get away with doing poorly. (Read that twice if you need to). It also happens to be the hardest one to do well. And, to compound this frustrating situation which tarnishes our reputation, GP care is remunerated far better for being fast than it is for being any good. Thus, the clinician who is being thorough and compassionate, teasing out the underlying issue, having tough conversations (eg antibiotics and opioids) and offering evidence-based alternatives instead of simply prescribing inappropriately (definitely a time-saving approach) is punished for their efforts. They will attract increasingly more complex patients, with a diminishing ability to pay a gap fee, while their colleague who is “quick” manages to keep everyone happy! Often, our patients are not actually in a position to accurately evaluate the treatment they receive. Manner and engagement, yes, but when they decide if their doctor is “good” or not based on whether or not they walked out with what they wanted, the measuring stick is wildly inaccurate. I pride myself on providing great care – and my patients would agree. But it is slowly killing me. It’s heartbreaking to know that if I cared less and neglected more, I’d make easily twice as much money and maybe cry less in the car on my way home.

But the thing is, I can’t switch off that part of me that cares. And I don’t actually want to.

What I would like is for it to be recognised, and positively reinforced by the government’s rebates instead of simply being taken advantage of while my patients and I suffer.

Before my day begins, I look through my list of patients. Some mornings, I pause for a moment before I open the door. I take a breath. I reflect on what the day may hold. I prepare myself — mentally and emotionally — for the conversations ahead.

These are the days when my most unwell patients are coming to see me. The ones living with irreversible, life-limiting illness. People navigating grief, fear, uncertainty, and loss. On those days, I know there may be little I can offer to change the course of their illness. My role is simply to be present — to listen, to bear witness, and, for a little while, help carry the burden they have been forced to shoulder. Some days I wonder whether I am enough.

Like so many doctors, there are days when I feel emotionally drained, questioning whether I have enough left to give while carrying the weight of keeping my patients safe, well, and sometimes, alive. It can feel like a heavy load for one person to carry.

Yet somehow, you find the strength. You borrow it from your patients, whose resilience humbles you every day. You draw it from colleagues who quietly understand the weight you carry because they carry it too. You find it in your family and friends, who remind you who you are beyond medicine.

And then there are the moments that restore you. The adolescent you’ve cared for since childhood who overcomes unimaginable challenges and steps confidently into adulthood. The patient who walks into your room beaming because, for the first time in years, they feel well again. The small victories. The quiet triumphs. The reminders that change is possible.

This is the yin and yang of general practice.

Despair and joy.

Loss and new beginnings.

Heartbreak and hope.

It is a profession that asks us to carry both, often within the same morning.

I cannot imagine doing anything else.

That small moment I take before my day begins — that single breath — is more than a pause. It is a reminder of why I do this work. It grounds me before I step in and somehow, it gives me the strength to begin again.

A patient’s grieving daughter once said to me, concerned, “You’re very young to have seen so much death”. Her sympathy was unexpected. Her own mother had just passed. Sometimes it pays to be reminded what an abnormal job we have. Most don’t witness pain and suffering as a normal part of their day. Some days it’s harder to see the light than others.