many illnesses, particularly when we

are talking about subtle changes in,

and the adverse effects of, the latest

gizmo drugs.

How then can we help?

We can retrieve the most recent

Dr Craig Lilienthal GP and medicolegal adviser in Sydney, NSW.

report from the specialist to see what meds they last prescribed, but between the patient’ s prearranged appointments, there is little advice

It often leaves GPs to pick up the mess.

about what to do when things go wrong.

Even when we contact said specialist’ s rooms for acute advice, we are often given the bum’ s rush:

“ Doctor is not available. Would you

A lot has changed since then, but it hasn’ t always been in patients’ best interests— nor ours.

When I was a young rural GP, there was one physician, one dermatologist and a couple of orthopods down the road at the base hospital, 150km away. To be clear, gastroenterologists didn’ t exist then, and the only thing we had for assessing rectal bleeding was the“ Silver Stallion”.

We would send our patients to these colleagues, who were all called consultants, for direction on how to manage their problems.

Then, as medicine became more complicated— and we learnt more and more about every disease and witnessed the management options for each mushroom— some of these

became more complex and, in turn, were taken over by new specialists. They no longer gave us advice about caring for our patients but took over their day-to-day management.

Having established themselves as the custodians of elevated knowledge, they downgraded the GP’ s position in the hierarchy of medical care and took over responsibility for managing our patients— at least within the limits of their special interests.

So not the whole patient, just the bit they were interested in. And therein lies the problem.

When they get into trouble, the patients end up calling us GPs for help.

There are other differences. We good GPs make ourselves available to meet our patients’ acute needs, whereas non-GP specialists like to see our‘ shared’ patients on more

sedate cycles, such as at three-, six-

time to see our shared patients for acute issues stemming from their own management decisions.

They certainly don’ t want to become involved in extraneous matters.

“ See your GP for that” is what

Specialists have retreated back into their silos and are pretending to be consultants again.

PICTURE CREDIT

patients are likely to get, or maybe just

care to leave a message?” You leave a message, which is never to be returned. It is like waiting for Godot.

Or try making a referral for a new patient whose life has suddenly got clinically complicated, say, to a haematologist.

The receptionist invariably tells us( or the patient) to send in the referral letter and copies of all test results that might support the referral.

They will get back to say whether they have decided to see the patient, and if so, by whom and when it will occur.

The irony behind the rise of specialism is that it began as a willingness to take on the management of patients, but the complexity became so great, specialists have retreated back into their silos and are pretending to be consultants

consultants started taking over the

This specialist takeover has led

or 12-monthly intervals.

a recorded message suggesting they

again.

ongoing care of our patients.

to a growing problem with patient

I know some reading this article

can call 000 or visit their nearest ED.

There is a universal truth in med-

This was particularly relevant with

management.

may find what I’ m saying harsh. But

Even worse:“ If you have symp-

icine— things can go wrong. And

endocrinologists and the management

Patients are not made up of

what specialists don’ t like is to be

toms such as a cough or cold, don’ t

things can and do go wrong between

of patients with diabetes.

jigsaw pieces. But some of our

interrupted by our patients between

come near us.”

non-GP specialist consultations.

In seriatim, the management of

patients end up surrounded by a

these preordained appointments.

Given the sophistication of cur-

If, as GPs, our specialism is in

cardiovascular disorders, mental

plethora of specialists but with

They don’ t like direct requests for

rent specialist care, we GPs are out of

mopping up the aftermath, then we

health issues and cancers similarly

no-one co-ordinating their care.

prescriptions, nor can they find the

our depth with the management of

need the proper support to do that.