Guest Editor's Note:
The author of this piece prefers to remain anonymous. As a rule of thumb, we avoid publishing "anonymous" articles. I had asked my friend to pen a piece regarding being a GP here as I thought she/he would be able to enlighten readers with a unique perspective, since she/he had undergone several specialist training tracks before deciding to take up heartland medicine. She/he agreed to do so on the condition that her/his name is not published so that she/he would be able to write candidly about her/his take on "GP-Land". Regardless of whether the readers agree with the author's opinions in the article, the SMA News editorial board believes that it makes for a thought-provoking read and has thus decided to publish this article as written.
A good friend of mine – one of the very few friends I have in the medical fraternity anyway – texted me out of the blue one day and asked if I could write "a short succinct piece on being a GP in Singapore – the ups and downs."
"WOE?" I replied with a capital E (Guest Editor's note: the original acronym has been replaced with the edited acronym for "what on earth" in case children might be reading this). "I'm the last person you want writing for any sort of establishment."
"Just an opinion piece. Free reign."
Like any true blue Singaporean, the word "free" reeled me in. It reeled me in hard and fast like a fish that is no longer free, just like any Singaporean. (Has this piece really gotten past the editorial?) Yet, somehow, the idea of putting down on paper the words I had never thought to broach upon myself was strangely appealing in itself. And before I knew it, there I was, tapping upon the rapping keys beneath my fingertips.
Before I continue, allow me to ascertain my position on the matter. I am an outsider, in the truest sense of the word. I was the one with no friends in school, the one who skipped all the orientation activities, lessons and tutorials as much as possible.
The number of friends I have can be counted with the single hand of a Yakuza – not just any Yakuza but one who has been extremely stupid or incorrigibly disobedient.
Why am I so messed up? I don't know either. Well, maybe I do, somewhat, but this piece of writing isn't THAT kind of confession. Basically, – I just prefer being alone, and I'm certain there are others who feel the same way as I do, but maybe as an ailment less chronic and malevolent than mine.
Now, what does this have to do with general practice? Well... which spaces of the medical world do you think a messed up person could survive in?
Note that I am not disparaging general practice, if that is what you are thinking. I am, in fact, giving credit and thanks to the field. (No wonder I have so few friends.) For if it were not for GP-Land (our very1 affectionate term for the field), I might very likely be splashing the blood of poor innocent dead animals upon the doorsteps of not-so-innocent HDB dwellers' apartments to eke out a living.
Thing is, in life, there are often "inside" spaces and "outside" spaces. In the medical field, inside spaces would probably refer to specialties such as ophthalmology, cardiology, anaesthesia, orthopaedic surgery, etc. And like everything else in life, the outside spaces are very much larger than inside spaces. To further stratify the matter, there is another category: outsiders who do not want to be outsiders, which also includes outsiders who are living or practising in the inside spaces. Even those on the "inside" tend to feel themselves being on the "outside" at times, I would imagine; "outside" being not just a spatial concept but also a temporal and emotive one.
Don't get me wrong. It is not that I did not try. In fact, I felt like I tried every specialty available, from surgical to medical to psychiatry to public health and, gasp, forensic pathology. I'm not so messed up that I was kicked out of every one. Truth is, I'm thankful for having been able to forge closer relationships with a few senior colleagues out there across these varied fields. But something inside me just didn't allow me to settle down in those places and I continued on the vicious cycle of department hopping, deriving some twisted satisfaction from being accepted and then rejecting offers. (I am proud to announce that this pathological drive does not extend to my personal relationships, thankfully.)
The last straw that simultaneously broke and liberated me came when a certain professor in forensic pathology called me, and I quote, a "walking time bomb" and accused me of some nebulous nefarious event I would cause in the distant future if I stayed on and ascended the ranks of the fraternity.
Boy, was I pissed! But in retrospect, he did have a point and that was what propelled me to take action. I ended up leaving for GP-Land, the "outside" space – a vast landscape that is capable of assimilating any kind of personality. It is a safe haven and back-up plan for those who did not manage to "fit in". You can choose to be a locum or employee; just sit back, work your number of hours and collect a pay check.
But GP-Land is also unique, for it is so vast a space that it is also capable of accommodating inside spaces if you look carefully enough. To paraphrase: it is vast, it contains multitudes.
But not all is golden on the inside. These inside spaces in GP-Land manifest a little more differently, with their focus being on capital gains and expansion. To be perfectly honest, this concept also rests more than a little uncomfortably in the seat of my being – for the purist in me still believes in the sanctity of skills, knowledge and sustainable community. (Disclaimer: I anticipate some degree of confusion regarding the constitution of the inside spaces of GP-Land. To be more precise, I refer to it being a partner or shareholder in a larger private group in this particular context.)
But our landscape is evolving rapidly. Financialisation is rapidly pervading all our systems and along with its tide comes the ever so subtle displacement of hierarchies. More and more professionals are being relegated to labour at the behest of capital and with it, the loss of our autonomy and time.
In short, capital is winning the war. And as professionals, we are essentially "labour". This predicament is not limited to private GPs (although the relative scalability of the sector renders it the first point of contact), neither is it confined to the private sector since the public sector is technically managed relatively like a private entity too.
For this reason I am worried. I am worried for my current and future colleagues, and for the future generations of society. I am worried about shrinking safe havens and opportunities especially for those like myself who dwell in the margins. Yet, at the same time I am deeply thankful for the current opportunities and leverage that GP-Land has provided for me over the past three years.
As I stop to reflect at yet another crossroad in life, another conflicting waypoint where the bitter past begins to taste a little sweet, but where the distant shores of the future seem to be wrecked by waves of increasing volatility, I find myself overwhelmed with gratitude for these safe spaces.
Not just for GP-Land, but even more importantly, for the presence and support of those who have been steadfast friends through all these tumultuous years; and for my mother, my wife and a small handful of good friends.
I hope that everyone else will manage to create and find their own safe spaces. Thank you, GP-Land, for being mine.