The GP Landscape – Dr Tony Rombola

CMDFA NSW Conference on Moral Injury


from Luke’s Journal 2021 | Fire in the Belly 2021 | Vol.26 No.1

General Practice is challenging and complex. Its very nature is unpredictable, with a broad cross-section of medical, surgical, social, psychological, and other issues likely on any given day. 

The environment is often chaotic, with frequent distractions and interruptions. There are pressures of varying degrees of urgency from patients, hospitals, colleagues, aged care facilities, and others. The business side of general practice requires attention to government regulations, administration, Medicare compliance, accreditation, accounting, payroll and human resources. Increasing reliance on computer technology demands ongoing maintenance, with the unpredictability of potential outages. Then there are the practitioner’s own considerations – issues at home related to their own health, their partner, their family, and other personal agendas. Yet, the pressure to see patients is constant, due to both the patient’s clinical needs and the financial pressure to keep the practice running.

Our medical system has squeezed practice income through restricted Medicare funding while demanding ever more in bureaucracy and administration. The rest of the medical landscape is also overloaded, with delayed or blocked access from long waiting times, increased financial constraints, and high out-of-pocket expenses. There is a higher burden of chronic diseases, an increasingly ageing population, and a rise in psychological issues such as anxiety and depression. It is not surprising that patients rely more and more on their GPs to manage their complex needs. With that greater complexity, more time, resources, and expertise are required at the primary care level.

“Patients rely more and more on their GPs to manage their complex needs. With that greater complexity, more time, resources, and expertise are required at the primary care level.”

Moreover, the current COVID-19 pandemic has significantly impacted General Practice, adding further demands on already-limited resources. The immensity and uncertainty of the problem is resulting in rapidly escalating mental health symptoms, both in the community and among health professionals. 

Such an overview could make general practice appear quite unappealing, with good reason for many sleepless nights. Despite this, with 30 years of general practice behind me, I still find the opportunities to treat, minister, and interact with patients immensely rewarding and challenging.

As I ponder the things that have disrupted my sleep over the years, I realise that they fall into three broad categories: People, God, and Self.

Patient/clinical issues (People)  

The sheer volume and breadth of work in general practice can be daunting. The GP always has a background fear of missing something, misdiagnosing or delaying diagnosis, and potentially harming a patient by omission or by treatment. There are complex and difficult patient presentations or complaints and sometimes unexpected outcomes. Dealing with death and dying seems to get harder, especially with long-term patients. There is a pressure to deal with issues within set timeframes, sometimes dictated by external factors beyond the practitioner’s control.

Christian issues (God)

It is a constant challenge to follow a Christ-centred approach and to maintain a faithful witness. The pressures are amplified by the multiple interactions each day with patients, staff, colleagues, and others. As Christians, we aspire to treat patients as Christ would treat them, which can translate into setting ourselves higher standards of care than might ordinarily be expected. Being human, we cannot possibly achieve this consistently and so we may experience internal conflict. Long work hours and other commitments also affect the time available for prayer, reflection, interacting with other Christians, and attending church.

Personal issues (Self)

Urgent problems may also arise at home. Unpredictable illnesses may affect the practitioner and their family. Raising children brings numerous demands and commitments. Houses need maintenance and cars need servicing or repairs. Work pressures impact social activities. It is sometimes a struggle to get away on a holiday and to relax. Balancing home life with work commitments is a never-ending challenge and can cause or perpetuate tensions.

“As Christians, we aspire to treat patients as Christ would treat them, which can translate into setting ourselves higher standards of care than might ordinarily be expected.”

My Response

My response to these issues can be distilled into five core areas:

  1. Psychological well-being: It is so important to be intentional about your mindset, and to challenge your thinking. It is easy to fall for the “imposter syndrome” and feel inadequate, leading to a lack of confidence in your judgement. Of equal importance is to be aware of the opposing trap of being overconfident. God wants us to appraise ourselves fairly and appropriately. 

    “Be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is … Do not think of yourself more highly than you ought, but rather think of yourself with sober judgment.” Romans 12:2-3

    Keep a lookout for harmful habits. Regularly monitor and review your behaviours and intervene early. Keep stock of your mental health.

  2. Physical well-being: Take breaks at work, make time for lunch and to connect with others, regardless of your workload. Schedule regular leave. Recognise your particular personal signs which suggest you need time off. Be intentional about eating a balanced diet, sleeping adequately, and exercising. Practice strategies to wind down after a day’s work, especially if there have been unresolved or difficult issues.

  3. Spiritual well-being: Pursue and maintain a spiritual perspective. Pray, read scripture, and listen to worship music. Bring your day to God and lay your worries on Him.

    “Come to me, all you who are weary and burdened, and I will give you rest.” Luke 11:28-29

    Recognise and acknowledge that God is in control. Intentionally seek fellowship, stay planted in one church, and attend regularly. Seek encouragement from other Christians.

    “Let us consider how we may spur one another on.” Hebrews 10:24

  4. Community connection: Daily clinical work can be very isolating, even in group practices. Therefore, be intentional in building your key relationships: with your partner, your family, and your friends. We all need a few trusted people in our support network, so foster and strengthen your inner circle. Connecting in meaningful ways can ease stress, lessen the weight of your burdens, widen your interests, and provide accountability.

  5. Connect with a GP: It’s important to see a regular GP and be a patient. Schedule regular check-ups. Review your mental and physical well-being and do not delay seeking help.

    If you feel isolated, overwhelmed, depressed, or anxious, talk to your GP, a counsellor, or a psychologist. This must be done in a professional setting during a scheduled appointment, and not ‘on the fly’ in a corridor consultation or a social setting.

In summary, take care of yourself psychologically, physically, and spiritually. Stay connected to God and his people. Have your own doctor and seek professional help if needed. Be deliberate in setting up the best environment for you to thrive – both professionally and personally.

A video of this talk is available to members of CMDFA. If you are not a member and would like more information please call the CMDFA Office on 02 9680 1233.

Dr Tony Rombola    
 Dr Antonio Rombola (MBBS, DipRACOG, FAICD) is a general practitioner working in Windsor NSW. He has been practicing as a GP for over 30 years. Tony is also an adjunct Senior Clinical Lecturer with the University of Notre Dame, Sydney Medical School and a GP supervisor in the GP Registrar training programme.

Would you like to contribute content to Luke’s Journal?  Find out more…