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Why GPs don’t need to have all the answers
Dr Tim Jones writes about how an empowering exchange with one of his patient’s teachers helped spread the load and deliver outstanding results.
Parents often just want to know how they can best support their child.
‘Thank you so much for your email. I really appreciate you getting in touch … Let me know if I can provide further information to assist you.’
I’d been seeing Sam* and his family for three months. He’s a sparky child attending early education with caring parents and two younger siblings who he feels are ‘okay but noisy’.
His personality is phenomenally nurturing, and he’s got high levels of commitment to learning and attention to detail. But he’s also experiencing significant challenges and his approach to disputes can be perceived as impulsive and physical, both with siblings and fellow students.
The family are reasonably concerned that his strengths are being overridden in the school environment and their desire was to support him in showing his best sides. They’d met with Sam’s teacher a few times but could see the workload she was under and knew he was one of several students in the classroom that seemed to be clashing regularly.
I’d spent some time supporting the family in enriching positive communication and debriefing of emotion between themselves and Sam. We felt that involving the teacher in a consistent response to outbursts would be helpful, so I obtained the email address for Sam’s teacher and introduced myself and the work we had been doing.
It’s hard to overstate how professionally positive and heartening it was to receive the above reply.
As a GP with an interest in child and family support, the last few years have shown a strong consistency in the challenges children are facing.
I have a number of families where a child has spent their pre-school period in a COVID-induced lockdown of isolated development and whether due to this or not, they are now in early school life and undergoing a period of intense social and emotional adaptation. There are meltdowns, there is impulsivity/distractibility, there are screen use challenges, and sometimes there is outright school refusal.
Where I live in Tasmania, we have no ready access to paediatric psychiatry – there’s a 2–3 year wait for paediatric developmental/behavioural assessments and close to a two year wait for child/family psychology involvement. As a result, it’s been easy for my professional overwhelm to match or exceed that of the personal overwhelm my patients are encountering.
Something that consistently comes up in my consults, though, is that families just love their children and want to see them thrive. Once we have a therapeutic relationship, most confide that they just want to know ‘how to support their kid’ far more than pursue any particular diagnostic label.
In particular, they want to see their child thrive in the school environment.
I have significant empathy for our teachers. There appear to be many parallels between health and education systems in the challenges we’re encountering:
- Chronic underfunding
- A broad remit of service to deliver
- Pressure from multiple sectors
- Limited availability of allied supports
It’s easy to be overwhelmed. It’s also easy to see the disbelief in parents’ faces when they ask for referrals and you discuss expected wait times, and tempting to put it all in the ‘too hard’ basket and do a high-quality referral letter to paediatrics and move on.
What I want to share is that this big overwhelming family/child/school scenario is made up of countless small opportunities for positive change and that I believe connecting with the education system as a GP goes a long way to achieving the best results.
As GPs we have such strength in knowing the families we engage with and utilising this to deliver personalised care. There is substance to be found in focusing on ‘micro’ changes. For Sam’s family, we had initially turned to making sure he had a moment of positive connection with his family each morning and each afternoon after school.
Sam found it easier to open up about his feelings in those moments and his parents found that he seemed less frustrated by conflict. By sending a brief email to his teacher about what we were noticing, they elected to make a focused effort to welcome Sam to the classroom each morning and connect with his interests.
At each subsequent consultation I’ve delighted in hearing Sam’s confidence in discussing conflict and his skills in emotional awareness blossom. I’ve been able to see the relief in his parents as they now believe that he is going to thrive.
Most of all, I’ve felt joy to hear from his teacher that Sam is now taking some other vulnerable students ‘under his wing’ and normalising their tough experiences. Any initial requests for paediatric or psychological involvement have been collaboratively paused.
My reflection as a practitioner is that it was the unity between child, parent, practitioner and teacher that achieved positive outcomes for Sam. By having a consistency of focus and approach Sam drew security and a feeling that he mattered.
I’m very careful not to demand special focus from teachers when every child in their class is deserving of their best work. I do, however, think the teacher in this case felt empowered that ‘the system’ was doing what it could and that she wasn’t alone in her mammoth responsibility.
More than anything else, I think collaboration at a ‘grass roots’ level:
- taught me something about the world of education
- taught education something about what a GP can offer
- taught a family that their needs are heard
- taught a child that they are loved and valued by all.
Best of all, it’s allowed me to feel that I don’t have to have all the answers or take responsibility for a very crumbly system – I can just be the ally and advocate, through which positive change can flow.
*name edited for privacy
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