In episode 2 we met with some drug users in the ‘waiting room’ and heard their stories about, not only how drugs are perceived in society - but themselves as well as drug users, as people. In this episode, we visit the most feared step for Jude in the process of visiting her GP – the receptionist!
Kim : You feel a sense of judgement. We touched on that.
Jude : Absolutely, and they're the gatekeeper to the demigod, so you ... If they take a disliking to you, it's hard to get appointments, they're rude to you, they're dismissive of you, they won't make you appointments, they won't fax your script to the doctor, because we're not allowed to take our scripts of methadone to the chemist. They have to send them over by fax, because they don't trust us. They think we'll put 10 mils into 2,000 mils and figure that the pharmacist won't notice, because we are that stupid. There's lots of data around the behaviour of gatekeeper receptionists in doctors' surgeries. Users complain about them regularly in our ... We've got a discrimination survey. This isn't just me and anecdotal. It's been proven time and time again that those nurses ... Those people play a substantial role in the discrimination that drug users feel going to the doctor's.”
Jude’s statement is loaded and we’re actually going to use this episode to unpack several of those themes that she raises from the power given to receptionists – who don’t necessarily have the sensitivity training to handle it, to the faxing of scripts. But first, let’s meet a nice receptionist (or maybe she’s just that good – I just don’t know anymore).
Val : I wouldn't say we're their gatekeepers. I would just say that ... Yeah. That's probably how they feel, but as receptionists, we don't ... Yeah. I don't see myself as a gatekeeper. I just see myself as doing my job.
Val is a mild-mannered receptionist who has been working at her current practise for 10 years. We get the impression that Val might not be the ‘gatekeeper’ that Jude has been referring to, but hoped that maybe, just maybe – knowing that a receptionist like Val exists might help Jude relax in knowing that her community is being looked out for – at least in this practise.
Surely though, this is just something that drug users experience. Kim asks Brian what he thinks (not his real name). Brian is a pharmacist with over 20 years of experience, who deals with drug users – and it seems, receptionists. Brian chuckles at the mention of the term ‘gatekeeper’.
Kim : … is one of the biggest issues for drug users, is they feel like the receptionists are the gatekeepers.
Brian : Yes, yes, yes, they are and they know it, and they take pride in it. The receptionists I think, in general, see it as their responsibility to make sure people can’t see a doctor.
Kim : So you're agreeing with the chats that we've had that show that that's one of their biggest stresses?
Brian : Absolutely. I practise where there's a significant number of doctors who have not specialised but have an interest in this area and do try and help people. I can think of other practises where you can say to someone, a week or two weeks in advance, you need your prescription on such and such a day, and they say, oh I can't get in to the doctor before then, the receptionist can't, won't, doesn't want to make an appointment.
So, who are these receptionists; the all-seeing, all knowing? Jude talks about her experience and how her attempts at ‘passing’ rarely get past a receptionist.
Kim : Judging you accordingly.
Jude : Absolutely, because they've got our records. They know who we are, and they've picked us as soon as we've walked in the door.
Kim : Have you ever literally when you've been waiting there with your Medicare card noticed a shift from the person that they've just ...
Jude : Absolutely. Yes. Their eyes. Sometimes they sort of like quiver. Yes, you do notice, because there's this immediate shutting down.
Kim : How does that make you feel?
Jude : I don't care anymore.
Kim : What if you see it happening to an 18 year old?
Jude : I don't like ... I get angry then. Absolutely. Yeah. You've got to be careful. Because he's got to have a relationship with this woman. You've got to be absolutely better than a general in a battle, strategizing about the best way to play that person so I can get to see my doctor.
Kim brings up the concept of the receptionist as the ‘gatekeeper’ with David, our GP from Darlinghurst to get his perspective.
David : Well, being in Darlinghurst, I mean, we are very used to diversity in our practise, and we only employ staff who respect the diversity of people's sexuality, drug use, and we're used to people presenting, some unusual people. But we hope that everyone gets treated fairly, so this means that everyone, whether they're using drugs or not, will have the same rights to make appointments, to be seen on time, and to be treated properly. Many of our staff have worked around the Darlinghurst area for many years, and they understand anxieties people have, and will make a big effort to try and help people get an emergency appointment for instance, if their prescription is due and things like that.
One of the common stories we heard was around receptionists not being equipped for confrontation with an angry patient. Now in this case I use the term patient rather than drug-user specifically – Jude had shared with us previously that tired housewives with sick children also seemed to fall into the same category – surely this is not the normal day we’ve been seeking?
Kim : Yesterday when we talked also among your community, you talked about the drug users that are angry, and that you have seen users in a doctor's surgery, that have been waiting for an hour and a half, approach the receptionists and they're angry.
Jude : They know it's not right, but that's what they've seen and that's what they do. They talk loud when they want something, and these little receptionists can get intimidated and I don't blame them, but underneath that there's this story about drug users being ... just blowing off for no reason. There's always a reason. The reason mightn't be you then, but that person's had a six hour day of people just being cruel, rude, dismissive, and negating, and then you're the last straw in that day, and that's not good for you, but you're working in a doctor's surgery where you're getting all sorts of people with all sorts of problems. You should know to lower your voice. You don't yell on top of someone who's ... They don't.
The receptionist starts this bloody yelling match, and then it gets put down to the poor bloody drug user for causing a commotion, when really they've been sitting there for an hour and a half. They just want to know something, and you're not telling them anything.
Kim : Do you think the receptionists are unskilled in dealing with some...
Jude : Unskilled and malicious in some, but sometimes unskilled. There's a group in the middle that are just bloody malicious.
Val explains to us that the patients they get in the clinic are diverse, they see a lot of HIV patients – and a lot of families too, they service the whole community. The doctors tend to spend over the allocated appointment time with – well, everybody! Patients can get agitated and shout at the receptionist, the receptionists get nervous and shout back – and well…Kim puts it pretty well.
Kim : So it's a bit like a Mexican stand off. They're on one side of the desk saying, "Hey, I'm anxious and scared," and you're on the other side of the desk saying, "You're anxious and scared." Do you think sometimes drug users don't realise that?
Val : Yes. Yeah, I think they ... because in their mind it's like they're trying to say, "Well, I'm not important enough for this doctor to ..." And this is not like that. It's not just about getting a script. It's about your health, and they have to ask the correct questions.
Jude as always sums up nicely.
Jude : Given the statistics it's highly likely that somebody in your close family is going to be struggling with some issues at some stage around prohibition and the drugs that they choose, so treat us the way you'd treat them, and that doesn't mean you have to take shit for people. If drug users are behaving like arseholes, tell them. They're not special and they shouldn't behave like arseholes, but understand that occasionally their world is really difficult.
Alright, so we’ve gotten an appointment, we know there is going to be a wait – and we’re not going to cause a scene - now let’s delve into the final interaction with the receptionist, getting the script faxed. Earlier we heard Jude’s view of the faxing of scripts, the feeling that there isn’t any trust.
Let’s hear from David again.
David : This is a requirement from the government. I mean, the government actually specifies a lot of very strict rules about pharmacists and doctors, what they have to do, and quite often actually we bend the rules that we are asked to follow to try and make the programme more humane and to fit in more with people's lives. We sometimes we feel we are a bit caught between the government regulations and people's needs.
OK so they have to do it. Here we explore the control or responsibility then that the receptionist holds, whether they know it or not – along with the consequences. Often a patient will want the script faxed while they are there to ensure it happens, only to be told it will happen at the end of the day. Kim picks up on the focus of the receptionist’s responsibility to fax the prescriptions and the anxiety that can cause for drug users.
Jude : It's really important that they do it. It's happened that the scripts have been withheld by receptionists who have a particular vendetta against somebody.
Kim : So, "We'll do that at the end of the day."
Jude : Or not do it. Do it the next morning. Patient turns up, methadone scripts not through. Can't get their methadone, and then they wonder why they get yelled at.
Kim : They also haven't realised that by doing that they've possibly forced somebody onto the street.
Jude : They don't care. This is about the dehumanising of drug users. They don't even care.
Kim : I'm seeing in your eyes you truly believe that.
Jude : Absolutely, because how else could it happen? It's not as though it's not known, it's not talked about, but I don't think people even put it together. You're just that person. I'm doing this, and I don't think they sometimes take it to its conclusion, which could be with that person's death.
Val explains that they have a policy in her practise where they always give a copy to the patient, and try to fax the original as soon as they have a spare moment. For her it’s not about keeping scripts until the end of the day.
Val : We give them a copy. We'll send the scripts and if there's a problem, they're always welcome to call and we always have another copy. We can get another doctor if their doctor's not in to see them or to re-fax the script, so yeah, it's just ... Yeah.
What this all boils down to though is the concept of discrimination discussed in episode 2 – behaviour based on a stereotype. It was troubling to hear in a discussion we had with Dr Lincoln, one of the GPs that we interviewed, that he thought ‘receptionists were a bit dismissive, or short, or sometimes even hostile’. Especially, he said, if they get it into their head that the patient is using the system to obtain what their desire for a drug might be. Dr Lincoln explains how he runs his practice.
Lincoln : Just treat everyone the same. Don't assume that just because someone's a drug user they're there to doctor shop and get other medications. I don't know what they think honestly. People are people to me.
According to the AIVL report into experiences of Stigma and Discrimination, ‘People who inject drugs in particular can be very vulnerable to adopting the negative stereotypes that society inflicts upon them. This can frequently mean that people stop recognising when they are experiencing stigma and discrimination, it becomes ‘normalised’ and almost expected or considered as legitimate or ‘deserved’ behaviour. The first person that a drug-user sees when they step hesitantly into that doctor’s surgery is the receptionist, what’s our GP Dr Lincoln doing about it?
Lincoln : Another part of my role I suppose is to tune my nurses, well not my nurses but the staff of the clinic, and the receptionist, that there needs to be a real welcoming aspect to our patients, and a real bedside manner. It starts not at the side of the bed. It starts at the front desk. That's the kind of message I like to get through to the staff at the clinic, yeah.
In this episode, we got to take a look behind the front desk at the receptionists, are they privy to too much information, or are they just doing their jobs? In some instances, we had great stories filled with empathy, and on the flip side we had cases of too much power and not enough experience or empathy to wield it. One concept that was explored and identified as an area for potential development is that of the receptionist as the first point of contact. A patient’s experience doesn’t start with the GP, it starts at the front desk – this first line, is an opportunity to work towards better understanding and reducing discrimination.
In the next episode we will talk about making it through the waiting room, past the receptionist and into the GPs inner sanctum. A place of confidentiality – free of judgement, well for most of us who have little more than an ingrown toenail to worry about. What’s going through Jude’s head at the moment?
Probably, "Oh, fuck, it's come again." Because they're every three months, and after 25 years methadone is just so much a part of me and who I am that going to see a doctor just seems like an intrusion.