Life of a GP ‘a great privilege’

The relationship between a patient and their GP is one that can last a lifetime, and recently-retired GP Dr Mark McCormick has described it as privilege to know people for that length of time.

"It's a great privilege, the duration, the length of time of the relationship. I have known people since they were born and since their children have arrived and seen another generation. The trans-generational contact is really unusual and very rewarding and gratifying. It's a pleasure and a privilege to know people on that type of longevity," he said.

"You don't get that rapport in hospital medicine. In some medical disciplines you can build a relationship with patients, but nothing is quite like family medicine and general practice in terms of that relationship."

Dr McCormick retired from general practice at the end of April, having served patients in the Athlone area for almost 40 years. The Wicklow native graduated from Trinity College in 1980 and became a GP in 1986, serving a year in Arklow, before moving to Athlone in 1987 where he joined the practice of Dr Norman Furlong.

"Norman was intending to retire in 1990 so we overlapped for three years. I was in partnership with Dr Graham Kearon," he explained, adding that Dr Patricia Campbell also worked at the practice on a part-time basis.

Dr McCormick explained that the practice grew gradually over the years, and in 2013 it moved from its Garden Vale premises to the primary healthcare centre, where it now has five doctors.

Speaking about the changes he has seen while practicing medicine in Athlone for the past 38 years, he said: "There was more genuine poverty in some areas, there was typically larger families and things were financially difficult for a lot of families. A lot of families wouldn't have had access to transport and we did a lot more house calls then because of the practical difficulties patients had in actually getting to the surgery. It was clearly a long time before bus services and widespread car ownership didn't really exist then. A lot of the rural areas we served have changed very dramatically."

Another big change for doctors locally, he explained, is the out of hours co-operative service, which means there is little, or no, out of hours required.

"The HSE looks after that now. When I started in the 1980s that was a big part of the practice. We were always lucky in the Athlone area in that there was always a good working relationship with other practices in the town and we had a good co-operative on-call rota," said Dr McCormick.

The administrative side of a GP's practice has increased dramatically during his time in practice, he said, something he described as quite burdensome. Although, he added that it is certainly a career he would recommend to anyone interested in pursuing this route.

"Nowadays it's quite possible for a young doctor to have a good work/life balance. Certainly, it is possible to make a difference as a young doctor in people's lives, their contentment and so on," he said.

Dr McCormick added that while studies show that morale is perhaps not as good in general practice as it once was and that stress levels are increasing, it is still a very rewarding career.

"We've also been a training practice for the last 25 years and that's been rewarding as well. We take in young GP registrars and spend a year with the practice. They're quite experienced by the time they come to us, they'll have done a lot of hospital medicine. Some of them, in particular, will have done a lot of hospital medicine because they might have been embarking on a career in surgery or obstetrics and then decide to switch to general practice. So some of them are very experienced and they can teach us quite a bit as well," he explained.

Dr McCormick's own history prior to becoming a GP was quite varied, with a one-year stint working in medicine in Dr Steven's Hospital, six months working in psychiatry in St Patrick's Hospital, six months in paediatrics in what was then the National Children's Hospital in Harcourt Street, six months in Wexford General Hospital and one year working in Zambia, Africa, with Voluntary Service Overseas (VSO) in 1985.

While in Zambia, he worked as a paediatrician in a district hospital, where he was also the TB specialist, medical specialist and worked in obstetrics.

"I did everything really. It was very basic. It was a hospital but the diagnostic facilities were limited, we had x-ray, we had laboratory back-up for blood counts and kidney and liver function and malaria diagnosis. But we had no CT scanning, for example, surgery facilities were fairly basic but we did a lot of surgery," he said, explaining how there was a huge difference in medicine in Central Africa compared to Ireland, even then.

He said lack of access to drugs and sterile equipment was a big issue.

"We brought a lot of things over with us, like sterile needles, for one. That has all improved quite a bit in Africa in the last 40 years, but it's still considerably behind Western world countries.

"We were there for the emergence of the AIDS epidemic. We did see a lot of cases of HIV/immuno-deficiency, but at that time we didn't recognise it as AIDS, that came subsequently," he added.

Dr McCormick said that often by the time patients came to the hospital, they had already been to local spiritual or witch doctors.

"The giveaway sign was scarification, which are little nicks and cuts on the skins. What a lot of the local healers did with painful conditions was to scarify the skin and rub herbs and sometimes soil into it. I'm sure it was effective in relieving pain but it clearly wasn't effective in getting to the root of the problems, so that was a giveaway. In general, they would have tried all the traditional and local remedies first, so things tended to present very late.

"Quite often by the time we saw them, they were very grateful for any help we could give, but quite often with a cancer diagnosis it was too late. Cervical cancer was very, very common there, breast cancer not so much, whereas it's the other way round here," he said. "Tuberculosis was rife and where we had tuberculosis in AIDS patients, they didn't respond to the usual treatment."

He said measles was also an issue, explaining: "The year before I was there we had over 30 deaths from measles and the year I was there we had eight deaths from measles. We were attributing the reduction in deaths from measles to a vaccination campaign that was instituted a couple of years earlier, so it's a very important vaccine. People forget how dangerous a lot of these conditions are.

"When herd immunity is high and the vaccination uptake is good, conditions such as measles will virtually disappear and most young doctors now won't have seen a case of measles, but we do know the number of cases is starting to rise again," he added.

He said vaccination is important and said the take up of the HPV vaccine, for instance, is good.

"The cause of cervical cancer is the HPV virus, and so it's very effective in giving it to young men and women in reducing the cases of cervical cancer. For men, it's a risk factor for penile cancer.

"If you want to eradicate, you have to vaccinate boys and girls before they are exposed to the virus, which is before they are sexually active," he added.

He said he would like to see a situation where other vaccines are introduced, such as the shingles vaccination, which has been introduced in the UK for over 70s.

Asked whether he believed there is vaccine hesitancy post-Covid, Dr McCormick replied: "Not necessarily since Covid, but there seems to be a fall-off in take-up in vaccines. Covid seems to be considered by everyone as yesterday's problem and no longer relevant but we're still seeing a lot of cases of Covid and we're seeing some post-Covid syndrome and fatigue. I don't think we should be complacent about Covid."

Covid itself had changed practices in medicine, he said, but added that he was very proud of the fact that throughout the pandemic, they had continued to see patients face to face at the practice.

"Unusually, we, probably more than most practices, saw people face to face and we didn't do a large number of phone consultations. Other practices did a lot or remote consultations. We didn't, and we were a little bit unusual in that respect.

"There's no doubt that patients, and the public at large, got more used to dealing with their practice remotely, and I'm not sure that's a good thing because there is no substitute for face to face, particularly with a lot of medical conditions, in terms of examination. For example, dermatology is difficult to practice accurately remotely, and conditions such as rheumatological disorders or potential serious disorders, such as cancers, you really need to see people face to face, or mistakes will be more likely to occur.

"I'm quite proud of what we did. There wasn't a single day that I didn't go into work during that time, and see people. I just felt quite strongly about it and it did work for us," he said.

One of the positives, Dr McCormick believes, is the move to electronic prescribing which came about during the pandemic.

"That was a significant advancement, but ultimately technology and even AI is unlikely to replace the one-to-one relationship a patient has with their primary care doctor. Although, I suspect that eventually AI will introduce further changes into how we work, how general practice moves forward."

Asked whether advances in technology have assisted or hindered GPs, he said: "We've always had good access to laboratory back-up, which is an important requirement for good practice, and access to investigation and x-ray, but there is certainly a higher expectation now with internet and social media and what is appropriate. It can certainly result in pressures on doctors to over-investigate and over-medicalise the trials and tribulations of day to day living."

Dr McCormick added that while some people have always worried about their health, the advent of AI will possibly increase people's health anxieties. He added that anxiety has always been present in people, but people's worries are slightly different now.

"There was genuine poverty when we started in the practice and that was a concern. There's no doubt that social media, in particular, and peer pressure is creating a lot of issues with anxiety for young people now, boys and girls, and the sort of instant gratification and short attention span that tends to result from constant stimulation from social media, TikTok, youtube, Facebook, that sort of interaction can result in other anxieties.

"I think there has always been anxiety but there's no doubt that it's increasing a little bit, particularly among younger people and I don't think it's easy," he said.

Dr McCormick has witnessed many changes in medicine locally since his early days in the practice in Garden Vale, to more recent times at the primary care centre where the growing practice continues to treat the town's increasing population.

Speaking about the move to the primary care centre in 2013, he said: "There is a lot of logic in working out of the same centre. The HSE's underlying policy was to try and develop primary care centres with a lot of ancillary health services, such as physiotherapy, occupational therapy, services such as psychiatric services and obstetric clinics and they really wanted a GP presence in the centre as well.

"It's worked really well having x-ray services there," he added. "We've always had x-ray because before it was in the primary care centre it was in St Vincent's and it's always provided an excellent service to all the doctors in the area. It was just particularly convenient to have it beside us because I could tip over and look at x-rays."

He said the practice was involved in the design of their own part of the building and retained ownership of the practice in the building.

Dr McCormick recalled that the primary care centre was officially opened in 2014 by the late Nicky McFadden and said: "She had worked in the centre before she served in the Dáil and she was wonderful, an extraordinary person, we missed her a lot."

He paid tribute to all the staff who have served in the practice over the years, saying: "We've been very lucky over the years with a very loyal and committed staff and that makes a huge difference."

He said he has mixed feelings about his retirement, but he is confident in the staff and said his own daughter, Kate, is now a doctor there.

"I felt comfortable that the practice is in good hands. I felt the time was right, particularly with the demands of modern general practice, the paperwork and keeping up to date was getting a little more onerous," he said.

Married to Nicky, a retired palliative care nurse, Dr McCormick plans to enjoy activities such as fishing, sailing and woodwork during his retirement. He also has three grandchildren living close by and said they are great fun.

As well as Kate, he as two sons - Neil, who is an architect based in Dublin, and David, who works in biotechnology in Scotland.

Asked how he would describe his career to someone considering a move into general practice, he said it was a "privilege, very rewarding and I would say no regrets. It lived up to my expectations really. I'm happy, at the same time, to draw a line."