Australian Doctor Australian Doctor 7th July 2017 | Page 30

Gut Feelings
I
Guest
Editorial
Dr Liz Sturgiss
30
| Australian Doctor | 7 July 2017
General practice is like
synchronised swimming
HAVE always admired the ele-
gance and precision of synchro-
nised swimming, so to better
understand the Olympic sport,
I set out to have a go for myself.
I felt I had all the required creden-
tials — I can swim, tread water, and
wave my arms about. I was also a
talented underwater hand-stander in
my childhood, winning many com-
petitions against my siblings.
I have a swimsuit, I know how to
add sequins, and I feel comfortable
enough to try the nose-plug device.
I was all set. How hard could it be?
So I headed out to the pool with
a few friends fo r a trial run. We
pumped up the music and jumped in.
It didn’t quite go to plan.
I nearly drowned my friend who
was trying to lift me up for a pose,
and my legs muscles have never been
so sore. It seems that synchronised
swimming is harder than it looks.
Had I done my homework prop-
erly, I would have learned that
synchronised swimmers are elite
athletes. They have amazing cardio-
vascular fitness, thanks to training
in the pool, gym and dance studio.
They are master story-tellers through
dance, and can out-swim the average
person by many miles.
They are the generalists of the
Olympic pool.
From the top of the water it looks
like a smooth and simple dance in the
water routine. But what you can’t see
are all the complex manoeuvres that
are going on under the water.
You also can’t see the amount of
preparation, planning and training
that goes into the sport.
Mining magnate Gina Rinehart is
one of the biggest financial support-
ers of the Australian synchronised
swimming team. Millions of dollars
are spent every year on the science of
synchronised swimming — physiolo-
gists, nutritionists, sports scientists,
and technicians all work together
to find the perfect combination for
these elite athletes.
This is why synchronised swim-
ming reminds me a lot of general
of medical research, and general
practice research is even more
undiscovered.
Our colleagues in tertiary care
look at what we do and often
assume we are practicing ‘little hos-
pital’ medicine. The same research
methods, theories, and outcomes
are slapped onto general practice.
The ‘primary care paradox’ finds
that patients who are looked after
by system specialists have better dis-
ease specific outcomes (like HbA 1c
levels in diabetes). 1
WITHOUT AN UNDERWATER CAMERA, MUCH
OF GENERAL PRACTICE, LIKE SYNCHRONISED
SWIMMING, REMAINS A MYSTERY.
practice, although without the mil-
lion-dollar research budget.
The senior GP in full flight practis-
ing quality medicine in a busy clinic
looks like they are doing a simple
job, but you can only see the surface.
They make it look easy.
General practice is a specialty that
cannot be done by anyone else “just
as well”, even though it’s not very
flashy and sometimes seems simple.
Without an underwater camera,
much of general practice, like syn-
chronised swimming, remains a mys-
tery.
Primary care research is in its
infancy compared with other areas
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But patients who are looked after
by GPs have better overall func-
tional outcomes at a lower cost.
Is it really a paradox though,
or are we not measuring the right
things in primary care — the things
that really matter to the health of
our patients?
When you reduce general practice
to bits and parts, you don’t actually
measure what matters.
Pay-for-performance
measures
are an example where if you choose
the ‘wrong measure’, it can detri-
mentally affect the practice of GPs,
or the morale of others.
The ‘Quality Outcomes Frame-
work’ used to manage payments to
GPs in the UK has been reported to
be on the way out.
It has been described as reduc-
ing general practice to a “tick box”
style of practice that has overstayed
its usefulness. 2
What we do know from the work
of the great US paediatrician and
public health physician Professor
Barbara Starfield is that a health sys-
tem with strong primary care works
more efficiently and effectively. 3
From another American, fam-
ily medicine expert Professor Kurt
Stange, we know that healthcare
with less fragmentation and better
continuity gives better patient out-
comes. 4
But we do not have solid ways of
measuring these important things in
general practice.
There is so much we don’t know
about how and why general practice
works, and how we can get the best
out of our daily work.
We are still developing sophis-
ticated research tools to have an
‘underwater camera’ vision of what
is happening in general practice.
Our synchronised swimming
champions have more in common
with us than we realise.
For me, however, I think I’ll stick
to my day job.
Dr Sturgiss is a Canberra GP who
works with an NGO delivering services
to people with drug and alcohol
dependence, or severe and enduring
mental illness.
References on request.