The side effect is a demoralised profession .

infrastructure for his practice .

As we know , diabetes is a condition where it is easy to measure outcomes .

Weight , HbA1c , eGFR , visual acuity

, medication doses , triglycerides ,

distance walked in a day — the list

is long .

This of course is all necessitated

by the smoothed rationality of basic

science .

In early phase diabetes trials , the

rats will be ‘ Normed ’, because in

basic science , the standard rat is a

Dr Louise Stone GP and clinical associate professor at ANU Medical School , Canberra .

white , male rat . In the later clinical trials , the human participants will be Normed .

And this is because the easi-

est way to attract big-dollar grant funding is to perform randomised controlled trials ( the ‘ best ’ form of evidence ) capable of generating

Anne Tonkin , about the mass dis-

uncomplicated , non-confounded

quiet among doctors with the new

outcomes to justify the interventions

mandatory CPD regime .

being assessed .

Dr Tonkin justified the board ’ s

These uncomplicated outcomes

approach on a series of different lev-

can then be used to inform the

els , stressing its primary purpose was

uncomplicated guidelines followed

to keep everybody practising safely .

by people like Dr Tom for patients

But she laid particular empha-

like Norm .

sis on what she considered to be the benefits of doctors reviewing their performance and monitoring their

Dr Tom ’ s evidence

Dr Tom has a multidisciplinary

outcomes .

team funded by one of the Federal

After all , this was the key change

Government ’ s schemes .

— at least for GPs — from the previous

This team is excellent at pro-

CPD system with its focus on educa-

viding integrated care for Norm by

tional activities .

working at the top of their scope ,

Looking at the data and measuring what happens in your practice is a really good way to ensure your per-

Audits drive change by encouraging practitioners to modify their

Let me describe the individual circumstances of two patients , ‘ Norm ’

Understanding Norm

Norm is the sort of patient that

delivering care that meets those gold standard guidelines designed for Norm .

formance is up to scratch , she said .

practice so that individual care bet-

and ‘ Maria ’, because I think it ’ ll show

everyone thinks of when designing

The local hospital is happy to

She clearly believes , like many

ter approximates ‘ best practice ’.

the difficulties of audit and perfor-

GP interventions .

oversee Norm ’ s secondary and ter-

doctors who are not GPs , that audits

It allows us to see the extent to

mance measurement many GPs face .

He is in his 50s and has some car-

tiary care , and if he is sick , there is

are the tool best used to do this .

To me , this exposes a profound ignorance of what general practice actually is as a medical specialty .

Up to scratch ?

The RACGP defines an audit as

We are the home of the outliers , those patients other services do not want , cannot help or refuse to see .

diovascular risk factors . He drinks too much , exercises too little , is overweight and has type 2 diabetes .

He is literate , speaks English , has one chronic illness and has a high-stress job in a busy city .

His GP , Dr Tom , sees a lot of peo-

no question of him not securing it , because he has valid and objective proof that he is ill , and importantly , that it is the sort of illness that has a treatment .

He has the necessary objective metrics and not just symptoms .

“ a systematic review of aspects of

which we have adhered to ‘ stand-

We are the home of the outliers ,

ple like Norm .

Dr Tom can also track Norm ’ s

clinical performance against explicit

ards ’ of care so that , in Dr Tonkin ’ s

those patients other services do not

Dr Tom works in a large , multi-

metrics in his IT system .

predetermined criteria , and the

words , our “ performance is up to

want , cannot help or refuse to see .

disciplinary clinic in a suburb of

The IT system has also been built

implementation of change when

scratch ”.

To put it more eloquently , they

Melbourne .

by people like Norm , largely because

the results indicate standards aren ’ t

This is appropriate for certain

are “ the last , the least , the lonely and

His average consultation length is

of the lucrative gains that can be

being met ”.

patients and certain circumstances ,

the lost ”.

15 minutes , and he brings in $ 571,000

secured by the new breed of health-

So , in other words , an audit

but it is far from universal .

Looking after these patients has

in Medicare rebates to the practice

care data entrepreneurs .

compares individual and / or prac-

This is because ‘ best practice ’ is

been described as “ sweeping up after

every year , working full-time .

They are wired to drive audits

tice-based outcomes against a

usually defined as the best outcome

the parade ”, caring for the patients

He invests some of this

using their data systems , with the

standard .

for the average patient .

left behind by other services .

money into contemporary data

lofty goal of improving

PAGE 16

Australian Doctor team Editor : Paul Smith ( 02 ) 8484 0795 Medical editor : Dr Kate Kelso BMed FRACGP ( 02 ) 8484 0713 How to Treat editor : Dr Claire Berman MBBCh ( 02 ) 8484 0749 Chief of staff : Rachel Carter ( 02 ) 8484 0631

6minutes news editor : Carmel Sparke ( 02 ) 8484 0979 Political news editor : Antony Scholefield ( 02 ) 8484 0616 Clinical news editor : Kemal Atlay ( 02 ) 8484 0648 Chief reporter : Heather Saxena 0425 271 128 Senior reporter : Sarah Simpkins ( 02 ) 8484 0688

Junior reporter : Rachel Fieldhouse 0420 834 340 Production editor : Sophie Attwood ( 02 ) 8484 0786 Senior content producers : David Dombrovskis ( 02 ) 8484 0765 Robert Santos ( 02 ) 8484 0674 Senior website manager : Stacey Shipton ( 02 ) 8484 0799 Senior graphic designer : Edison Bartolome ( 02 ) 8484 0872

Managing director : Bryn McGeever ( 02 ) 8484 0650 Sales and marketing enquiries : 1300 360 126 Classified pages bookings : ( 02 ) 8484 0666 gpclassifieds @ adg . com . au Production manager – client services : Eve Allen ( 02 ) 8484 0764 EMAIL US @: To email staff , use the following format :

first name . surname @ adg . com . au The views expressed in this publication are not necessarily those of Australian Doctor Group . Australian Doctor is an independent publication serving the needs of Australia ’ s GPs . It has no affiliation with any medical organisation or association , and our editorial content is free of influence from advertisers .

Australian Doctor is sent free to full-time GPs in private practice and certain prescribing and staff specialists . It is available to other readers on subscription for $ 390.00 pa including GST . Overseas rates apply . Phone 1300 360 126 . Average Net Distribution Period ending March 2023 15,918 Australian Doctor is published 12 times a year by Australian Doctor Group ,

Level 12 , 117 York Street , Sydney , NSW , 2000 Ph : ( 02 ) 8484 0666 Fax : ( 02 ) 8484 0633 Email : customer . service @ adg . com . au www . ausdoc . com . au ( Inc in NSW ) ACN 132 719 861 ABN 94 615 959 914 ISSN 1039-7116 © Copyright 2023 www . adg . com . au