With around 14 million consultations carried out in New Zealand each year, general practitioners are faced with a vast and unpredictable workload. The nature of the role means it is not often known what patients will require until they are sitting in the consultation room. GPs improve the lives of their patients, but equally, patients can, whether they know it or not, leave a lasting impact on their GPs.
Dr Himali McInnes, a GP with over a decade’s experience working in South Auckland, has recently published her first book The Unexpected Patient - true Kiwi stories of life, death and unforgettable clinical cases. Deeply moved by an unforgettable patient, she was inspired to share her story, and others like it.
Born in Sri Lanka, Dr McInnes moved to New Zealand as a teenager and initially wanted to pursue a career either as a veterinarian or as a nuclear astrophysicist. She worked diligently at school and ended up following her mothers’ footsteps to medical school. It was at med school that she learned the ‘nuts and bolts’ of how the body works, but it was outside of the classroom that she began to unpack the ‘why’ of medicine.
"General practice can often be misunderstood. The reality is that it’s an incredibly complex specialty. You have to adapt and pivot depending on your patient’s needs, and those needs are infinitely vast. Often one patient presents with a series of complex issues going on, and often these issues are not purely medical.
"This is what separates general practice from hospital style medicine, the focus is entirely different. There is a lot of intangible stuff that happens and often that’s more important than the physical stuff," says Dr McInnes.
This intangible ‘stuff’ is what Dr McInnes captures beautifully in her book. The concept came from her own ‘unforgettable patient’; a Māori man who she had been treating in clinic for over a decade. He had an ongoing battle with a chronic lung condition, made worse by smoking, damp living conditions and excessive drinking. He had every intention to make positive change, and would make efforts to improve his situation, but time and time again would slip back into old habits.
It wasn’t until one day when he was in Dr McInnes office for yet another round of antibiotics, he opened about the sexual abuse he had experienced in childhood. It was a conversation that would change his life, and impact Dr McInnes deeply. Together they explored his symptoms beyond just the physical and began to unravel a story of intergenerational trauma.
This patient would fundamentally change the way she approached medicine and forced her to look harder at her own unconscious bias. The experience moved her so much that she was inspired to share it with the world.
Dr McInnes always knew that she wanted to write a book but finding the time and energy while working full time in general practice proved difficult. Moving away from full time general practice in 2019 gave her the time and the right headspace to start crafting her book.
She reached out to her medical colleagues, asking them to open up about their own unforgettable patients and through her writing, she brought those experiences to life. She would interview both the medical professionals and the patient when possible, exploring the themes that emerged, with a focus on the unseen. The beliefs, life experiences, personalities, and desires that shaped the experience.
Everyone she spoke to was offered the chance to read the draft version of her stories and provide feedback. While most were excited to read their stories, there was an unexpected consequence of her work. Some patients, like her own, found reading their lived experience in black and white confronting. It was hard for Dr McInnes to see her patient upset, but he also understood the importance of sharing his story and it was published, with his blessing.
“It was a real privilege to be able to bring these stories together. I have learned a lot about people, through the writing of this book and it inspired and invigorated me. I want people to be aware that there is more to medicine that a patients’ physical symptoms. There is so much to consider that is important. The mental, physical, emotional and spiritual. The effects of the past and intergenerational trauma.”
Dr McInnes book is a delightful balance of meaty medical detail and captivating storytelling. It reads beautifully for both the medically minded and non-medical readers. It is available via Aotearoa Books.