A Rural GP Weighs In On #justagp
In 2016, Dr Paddy Mosse organised a Twitter storm using the hashtag #justagp in an effort to highlight the essential and all too often undervalued role of GPs in our healthcare system. It sparked lively discussions that reverberated across blogs, Twitter and Facebook, and with the ascendancy of COVID-19 in 2020, the hashtag and its attendant discussions have returned.
We’d like to welcome back Dr Jonathan Ramachenderan this week. While he supports the #justagp ethos, he has an issue with subconscious effects of the phrase itself. This is an edited version of his article Why I stopped using the word “just” and why the #justaGP narrative has to stop, published here with his permission.
Jonathan is a palliative care doctor and GP anaesthetist based in Albany, WA.
There are a few words and phrases that I do not use. The large majority of them include offensive slang, derogatory names, words and phrases that simply bring down the conversation that I am having to the lowest levels of respectability.
But there is one word that is innocuous and hides in plain sight which dismisses, diminishes and reduces whatever it is connected to.
And that word is “just”.
A couple of years ago I stopped using the word “just”.
Perhaps it had something to do with my work with a vulnerable population of patients who needed me to use clear language and speak with absolute truth, but more than that I became aware of the true meaning of using the word “just”.
I became precise in how I talked because I became aware of how my words framed my thinking and thus action.
When I became aware of the limiting beliefs in my life and the false stories that I was telling myself, I started to observe the language that I was using and the effect and results that they were having on my life.
Here are a few familiar examples that we may be aware of:
“That always happens to me”
“Things are never going to change”
“I don’t like exercising,”
“I’m really bad at dermatology and diagnosing skin diseases” (General Practice example)
One thing that you may not know is how much influence your subconscious thinking has in ruling and running your life. It is the operating system that keeps you from harm and allows you to live to the level of your self-belief and self-doubt.
So how does this relate to using the word “just”, the #justagp narrative and to wider General Practice?
The #justagp narrative started because of a familiar conversation that GPs, students and junior doctors encounter which is “are you going to become a specialist or just a GP?” or “are you a specialist or just a GP” and the various other permutations of this conversation.
“Just” in this context is being used by unskilled and unqualified people to label General Practice as being diminutive and less than the comparison, and as GPs we know this to be untrue.
The term “just a GP” and its associated narrative is offensive.
This is because it is not who we are as a speciality and if we continue to use it to describe our work, or when things do not go our way or when we are disrespected, what we are doing is reinforcing in our subconscious minds that “yes, we are not good enough”, we are feeding an inferiority complex.
More than that and the biggest reason why I stopped using the word “just” and the term “just a GP” was because it gave my power away to unskilled, uncaring and unqualified people.
It is saying “yes you are right, I am just a GP. What do I know?”
Even though we may NOT think that our language is utterly imprecise and unhelpful if we are ever going show up to the medical world secure and self-referenced.
No significant and enduring contribution to medicine can EVER be made from a place of insecurity and inferiority.
As a GP, I know that I am valuable. My generalist skills, my diagnostic ability in the face of uncertainty, my communication expertise (never to use the phrase “poor historian”) and my procedural abilities are excellent. I will never diminish General Practice as I strongly believe that it is the absolute wisdom of medicine.
But if we continue to be “just GPs” we will become the most insecure speciality in Medicine.
In the original and seemingly innocent conversation, members of the public and juniors doctors did not have a clear picture of what a General Practitioner looked like.
In their mind there existed a hierarchy of medicine of which GPs sat down at the bottom and therefore, could be diminished and dismissed by using the word “just”. As a rural GP, I know this not to be true. Of course, it isn’t!
This is because I know that I am more than enough to sit at the value table alongside my medical and surgical specialist colleagues in a horizontal medical playing field. See, the one thing I know about working in Regional and Rural Medicine is that I am absolutely respected for my specialised and generalist skills as a GP in Palliative Care, Pain Medicine and Anaesthesia.
But this respect begins with how I talk to myself and about myself. Also, respect flows two ways, it is reflected first in my humility and understanding where my limits lie but most importantly deeply embedded in what I CAN do to help my patients. Secondly, respect flows from my wise medical and surgical specialists colleagues, who understand what practising community medicine entails and where THEIR expertise finish and where MINE begin.
So, to use the word “just” to describe and act as an associated totem for what I do, is a value judgement on my abilities and a conscious message that I am sending to my subconscious — that I am NOT good enough to sit at the horizontal value table of medicine. This leads to an inferiority complex, silo’s within medicine and to constant bickering and in-fighting and the Medical blame game — sound familiar?
Why I stopped saying and using the word “just”
While I once proudly placed this hashtag on my tweets and social media posts, I started to question it when I began to really appreciate my value and contribution as a Rural GP to my profession, my speciality and to my community.
But more than that in the last many years, I stopped using the word “just” because of its ability to minimise and diminish whatever I was saying and whatever I linked to it. When I examined my language, it was chilling and dripping with insecurity.
“I’m just emailing to ask…”
“I’m just wondering if I could..”
“I’m just ringing to ask..”
The word “just” is the epitome of selling myself short, diminishing my contribution and value and the wonderful experience and wisdom that GP’s bring to their communities.
But more than that, I found the word “just” to be passive, slightly apprehensive, imprecise and aggressive.
When I stopped using the word “just”, I became precise in what I said and clear about what I wanted.
This is because people who know what they want in life have a confidence in themselves and their value to the world — this is the type of person who I wanted to be.
With great respect to my General Practice colleagues, I would strongly suggest that you would please stop using the “justagp” hashtag and narrative — it reinforces a sense of inferiority and diminishes your great contribution which you and I know, is significant.
Determining our value as GPs
It may have taken a pandemic to really hit it home for me, but 2020 taught me that I was very valuable and absolutely enough as I turned 40 years old.
What this means for my clinical practice is that I am confident in myself as a GP as I have nothing to prove to anyone and nothing that anyone can take away from me. When I introduce myself as a General Practitioner it is not up to a patient, specialist colleague, nor the public to provide me with value, but completely up to me to know who I am and what I can offer. It is also up to me to know that I am enough and a good enough doctor.
If a colleague looks down on me or a patient values the opinion of another “more qualified” doctor over mine, it is not my problem, it is not personal and not even about me. I determine my value and I determine who I give my power away to. If I lose it each time something does not go my way or throw my hands up in disgust when I am under-appreciated or talked down to or a political agenda does not fall in my favour, I lose all my power.
I am not a reckless doctor but rather a diligent, creative, honest, passionate and intelligent person who seeks to make a difference — no one can take away your value unless you allow them to. Power is given away rather than taken.
We don’t need another doctor, patient or family member to validate us, this comes from within, our story, our spiritual connection and the agreements we have made about ourselves.
Perhaps we need to spend a little more time developing a rapport with ourselves, our spirit and what is sacred and significant to us. And also explore those ideas and stories which are holding us back from being fully secure in ourselves, our speciality and what we can offer.
My friend, speaker and life coach Jaemin Frazer says “those who are doing well in life are simply telling a different story”. What story are you telling?
Because to say that I am #justagp is to diminish myself, to enter the world from a place of neediness and to be unsure of my worth and value and worse still, ascribe this for others to determine.
We determined our value as GPs.
So with great respect please stop using the #justagp phrase and hashtag and understand that you are not “just” a GP or “just a _____” insert term here.
Be precise in your language for it is the fuel and frame for your thoughts and actions. You are absolutely enough. Thank you.
Dr Jonathan Ramachenderan
Thank you to our guest writer Dr. Jonathan Ramachenderan. This is an excerpt from Why I stopped using the word “just” and why the #justaGP narrative has to stop published on The Healthy GP. You can follow Jonathan on Twitter @thehealthyGP.
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