GPs are well and truly irritated ‘ Well placed ’ is the new
MO phrase for ‘ GPs should ’ — and we need to stop using it
Well said , Dr Ashlea Broomfield . I ’ ve glared at it too .
Being a skilled generalist , the GP sees all walks of life and points the way forward in each case .
We have this in common with primary school teachers .
But saving the whole world ’ s social and health problems needs a well-funded system , not just doing more in the same amount of time .
Dr Megan Elliott-Rudder GP , Wagga Wagga , NSW
The junior medical officer compiling the discharge summary likely doesn ’ t realise that ‘ kindly reviewing ’ results pending requires more time and effort than is generally available in the average day of a GP .
In NSW , if the GP is copied in to receive the results by being named , with the relevant provider number on the request form , we do ( sometimes ) receive said results electronically . What a treat that is ! I understand that NSW Health is ( still ) working on systemic adjustments in order for this to occur more frequently . How are other states faring ? Shouldn ’ t we have a national standard ?
Dr Gull Herzberg GP , Coffs Harbour , NSW
I once got copied in for pathology results from a patient who spent four weeks in ICU .
I think they sent me close to 200 results , and I had to review them and tick them to clear out my inbox .
Dr Peter Morrison GP , Logan , Qld
As a frequent reviewer of medical articles for a medical journal often written by non-GP specialists , I am always correcting ‘ GPs should ’ and ‘ GPs are well placed ’. It irritates me too .
I ’ m hoping the editors are getting the message as well .
Dr Kerry Hancock GP , Adelaide , SA
Light a candle , don ’ t curse the darkness |
‘ In non-doctor speak ,
Dr the patient is f *** ed ’: a GP ’ s story
I know what this feels like — to be alone , to be truly alone , with
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one or more sick patients and with help so far away that it is irrelevant . It is just you . Take the memories of the advice your teachers gave you , such as :
• You did not cause this ; you responded to it .
• If you were not there , the patient would have no chance . With you there , they have a chance .
So follow the protocols . If there is no protocol , go back to first principles .
It is lonely , but it is always better to light a candle than curse the darkness .
And yes , I pray regularly .
Associate Professor Chris Hogan GP , Melbourne , Vic
Self-reflection ? More like self-doubt I learnt to wipe my bum
MO years ago — there ’ s no need to send me to the ‘ CPD trade school ’
Dr Pam , I love the way you slice through this nonsense .
The RACGP seems to have become an enthusiastic partner with any organisation that seeks to de-professionalise our discipline .
This ‘ reflection ’ is no more than a pandering to society ’ s current normalisation of the perverse wish for self-flagellation .
It engenders self-doubt , insecurity and fealty to faceless and unaccountable authority .
To paraphrase Orwell , we acquiesce despite the evidence of our own ears and eyes that we are being manipulated and deceived .
Dr Michael Akram GP , Mackay , Qld
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Personally , I don ’ t have much of an issue with the CPD changes .
It is easy to sling mud at superficially ridiculous requirements .
They are presumably to ensure the whole population of doctors performs at an acceptable level .
I can ’ t say I have huge insight in the best processes to improve doctors ’ standards .
As with most things , they are targeted at the lowest common denominator .
But bureaucrats , for the most part , are good people working within the constraints of a complex system .
And CPD requirements are aimed at keeping the public safe : a somewhat useful endeavour , I would think .
A colleague recently told me that , in the US , family physicians have to sit exams every seven years to maintain currency .
In that context , our requirements don ’ t seem that bad .
Dr Colin O ’ Shea GP , Innisfail , Qld
Stuck between a referral and a hard place GPs vs specialists and
Dr the ( alleged ) initial consult Medicare rort
I am a consultant physician and frequently receive comments from GP friends and referring doctors who share Dr Craig Lilienthal ’ s views .
What is missing in his commentary is that , if a patient is reviewed on an indefinite referral that is more than 12 months old , the longest item a physician can charge is a 116 , which carries a six-minute minimum .
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We have no access to extended time-based items except by billing an initial consultation .
I doubt Dr Lilienthal would like his highly complex medical patients shown the specialist ’ s door after just a few minutes . But under current Medicare arrangements , it is either that or the patient pays a large out-of-pocket gap for a long appointment . Also , we are not price gouging . If I see a complex patient as an initial consultation , I must spend a full 45 minutes , which is absolutely required for the highly complex patients I see .
As in general practice , it is far more lucrative to churn through multiple short visits than one long one , but it does our patients a great disservice .
Dr Richard O ’ Brien Endocrinologist , Melbourne , Vic
I think Dr Lilienthal ’ s rage is truly misdirected .
Referrals serve two purposes . First , it is a form of communication . The referrer believes someone else has specialised skills to help with the patient .
For the specialist , it should ( but often does not ) contain useful updated background information to help decision-making .
It also allows direction of reports since the referrer is often the primary holistic practitioner and should be the repository of all health information .
The second aim ( and a minor component ) is that the referral allows a Medicare rebate .
I am quite happy to see a patient without a rebate , but ...
• No referral equals no rebate .
• New referral equals higher rebate ( by some $ 35 ).
• Existing referral equals lower rebate ( less than item 23 for a GP visit ).
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Often , patients present with emergencies unrelated to the initial referral , and I will see them .
If they go to the GP and obtain a new referral , they will get more rebate in their pocket , but I do not make them do so as it is just too hard to get a GP appointment to make the extra $ 35 worthwhile .
As for specialist fees , we live in a capitalist economy ; price is determined by supply and demand .
If you debase yourself by charging $ 100 an hour before practice-running expenses , as suggested by the MBS , then that is your choice in a free country .
Good luck keeping the door open for your patients .
Dr Joe Li Ophthalmologist , Mackay , Qld
Recently , I was dictating a letter on a new patient .
I try to do this in front of the patient . I began , “ Dear Dr Bloggs , Many thanks for ...”
The patient stopped me and said , “ Why are you writing to that doctor ?”
“ The letter goes back to your referring doctor ,” I replied .
The patient explained , “ Oh , that is not my doctor . I just go there to get referrals as they do not charge me .”
It was not the first time . I wonder how common this is .
We also increasingly see patients who don ’ t get referrals at all . They argue it is too much trouble .
At the other extreme , when I first started , there was a doctor who used to send in referrals that were valid for one appointment only .
That made for some interesting patient conversations !
On one memorable occasion , this doctor accused a colleague of overservicing as they treated skin cancers other than the lesion they were referred for .
Tricky , the whole business .
Professor James Muir Dermatologist , Brisbane , Qld
Private screens flying under the radar Bowel cancer screening
Dr rate drops for first time in 10 years
If you would add the private screens , you might find different data .
At least 10 % of my patients elect to use the more user-friendly private screens and will pay to do this .
But I am not able to add their results to the national register .
Dr Linda Mann GP , Sydney , NSW
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