Pharmacists and doctors: Let’s change the script

This week saw another low point in the communication and relationships between health groups in Australia. We must find a better way.

It began after the release of a report from the Queensland parliamentary inquiry into pharmacy, which recommends that pharmacists should be able to prescribe and dispense ‘low-risk emergency and repeat prescriptions’ and ‘low risk vaccinations’, subject to consultation with a ‘13HEALTH GP’ or checking ‘the patient’s medical record’ through MyHealthRecord.

Medical groups including the AMA and RACGP indicated they will not support the recommendations. This is hardly surprising as the results of the deliberations by the parliamentary committee led by Chair Aaron Harper MP are not based on mutually agreed principles or a collaborative care model.

Although the report repeatedly mentions a shared prescribing model, the recommendations, if implemented, will not result in effective collaboration. For example, checking the MyHealthRecord (which is not always available or complete) or calling a health-line can hardly be seen as supporting team care and collaboration with treating doctors. Cooperation between pharmacists and medical teams should be more than a box ticking exercise.

I believe we can do better than this.

Community pharmacists feel that their scope of practice is restricted and that they can contribute in a more meaningful way to patient care. Medical groups are concerned that more prescribers can lead to fragmentation of care and poor health outcomes, especially in the absence of meaningful collaboration.

Both arguments are valid and should be explored further. There is always a better way but this requires a willingness to work together and find mutually agreed solutions. Indeed, not an easy task, but we can’t leave this to a group of parliamentarians.

I’d also like to think we are able to move beyond strongly worded media releases, open letters, lobbying and political donations.

On a positive note, it was good to see that the Pharmaceutical Society of Australia (PSA) recently organised a low-key summit between medical and pharmacy groups to discuss patient safety. PSA president Shane Jackson said that the summit will seek to develop a set of principles to support respectful and collaborative practice between pharmacists and doctors.

Reaffirming these principles is a useful exercise and a good place to start. My colleague Dr Ashlea Broomfield and I spoke with Shane Jackson about collaborative models of care (listen to the BridgeBuilders podcast here). Although doctors and pharmacists may never agree on everything, which is absolutely fine, we must find a better way forward in the interest of our patients.

The daunting revalidation dilemma

The Medical Board of Australia is well aware of the daunting revalidation dilemma: how to identify underperforming doctors without subjecting the rest to time-consuming and needless procedures?

The percentage of underperforming doctors is low. Nevertheless, in the UK all doctors undergo regular appraisals and are ‘revalidated’ every five years if they are deemed up to date and fit to practice.

The UK revalidation system has received its fair share of criticism. A common complaint is that the collegiate appraisal process has been ‘dumbed down’ as it changed from a formative to a summative process.

Other criticism includes the heavy time burden and paperwork, the negative impact on doctors’ wellbeing (while the profession already works in a highly stressful environment), the creation of a tick-box mentality, and a situation where some doctors are avoiding complicated situations and high-risk patients that could get them into trouble.

The good news is that the Australian Medical Board does not seem to want to copy the UK model and instead appears to be looking at countries like Canada or New Zealand, where the focus lies more on self-regulation as opposed to external regulation.

Expect the introduction of some sort of revalidation model in the next two to five years. The question is of course: are we heading in the right direction?

The purpose

Interestingly, there is still discussion about the purpose of revalidation of doctors (see picture). The overarching principle seems to be improving patient care, but whether it’s about ensuring public safety, ‘catching dodgy doctors’ or making good doctors better, is not always clear.

Some say it’s a bit of everything, which may be true but the problem is: how are we going to develop a revalidation system that does ‘a bit of everything’?

Differing message about the purpose of revalidation
Differing messages about the purpose of revalidation in the UK. Source: The Kings Fund

According to the Medical Board of Australia the fundamental purpose of revalidation is to ensure public safety. The Board has proposed a two-pronged approach to achieve this, namely improving continuous professional development (CPD) and identifying at risk doctors:

  1. To maintain and enhance the performance of doctors practising in Australia through efficient, effective, contemporary, evidence- based CPD relevant to their scope of practice.
  2. To proactively identify doctors who are either performing poorly or are at risk of performing poorly, assess their performance and when appropriate support their remediation of their practice.

To be fair, I agree our CPD model could be a lot better, focusing more on where we need to improve instead of what we want to improve.

At the same time there are concerns about the Medical Board proposal, especially with regards to the method of finding the underperformers. The Medical Board has recognised many of the issues and is currently consulting with the profession.

Strengthened CPD as proposed by the Australian Medical Board. Source: Medical Board
Strengthened CPD as proposed by the Australian Medical Board. Source: Medical Board of Australia

Two issues

The overarching problem is that there is little evidence to show that revalidation improves patient outcomes. I can see at least two other major issues:

  1. Externally enforced actions have less impact than internally-driven change in a collegiate, supportive environment. The colleges, rather than the Medical Board, AHPRA, employers or other parties, should be supported with data and resources to provide skilled remediation.
  2. The proposed profiling of doctors (e.g. over the of 35, male, trained overseas, previous complaints) appears to be a blunt approach. The tools should be sharpened, focusing more on behaviour and performance. To identify underperforming doctors we need a good screening tool. As Wilson and Jungner outlined fifty years ago, there are several criteria to be met first, to make sure we’re not doing more harm than good, especially as the percentage of underperforming doctors is low and at this stage we’re not 100 percent sure what kind of doctors we are looking for. We should also be careful not to confuse screening and assessment tools.

The way forward

The starting point should be a supportive, non punitive solution. Only when the desired outcomes through collegiate processes are not achieved, should regulators become involved. Any model must be fair, evidence-based and not create large amounts of paperwork.

Here are seven principles I believe are important when moving forward:

  1. The focus of revalidation should be heavily weighted towards self-regulation and strengthening collegiate education and remediation processes;
  2. Self-initiated gap and learning needs analysis are effective tools to direct life-long learning, supported by evidence;
  3. Peer review, performance review and outcome measurement could be used to strengthen QI&CPD but will require further evaluation;
  4. Data exchange between agencies and organisations, keeping in mind confidentiality and privacy, could identify underperformers earlier;
  5. Under performing doctors must be supported, not only via remediation but also looking after the wellbeing of the doctor involved;
  6. There needs to be clarity and transparency about potential medicolegal use of data collected during the revalidation process;
  7. The costs involved should not be carried by the profession alone.

And lastly, we really need a less punitive term instead of revalidation.

Lab report and cat scan

This joke was posted by a colleague. He pointed out that the scenario is very applicable to general practice. Indeed, it nicely illustrates the cost benefits of a good doctor who can often make a diagnosis without many expensive tests…

A woman brought a very limp duck into a veterinary surgeon. As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird’s chest.

After a moment or two, the vet shook his head and sadly said: “I’m sorry, your duck, Cuddles, has passed away.”

The distressed woman wailed: “Are you sure?”

“Yes, I am sure. Your duck is dead,” replied the vet.

“How can you be so sure?” she protested. “I mean you haven’t done any testing on him or anything. He might just be in a coma or something.”

The vet rolled his eyes, turned around and left the room. He returned a few minutes later with a black Labrador Retriever. As the duck’s owner looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom.

He then looked up at the vet with sad eyes and shook his head. The vet patted the dog on the head and took it out of the room.

A few minutes later he returned with a cat. The cat jumped on the table and also delicately sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.

The vet looked at the woman and said: “I’m sorry, but as I said, this is most definitely, 100% certifiably, a dead duck.”

The vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to the woman.

The duck’s owner, still in shock, took the bill. “$150!” she cried, “$150 just to tell me my duck is dead!”

The vet shrugged. “I’m sorry. If you had just taken my word for it, the bill would have been $20, but with the Lab Report and the Cat Scan, it’s now $150.”

Warning: digital challenges ahead

Warning: digital challenges ahead

There were a few interesting tech news facts this week. I thought this one was interesting: a Dutch campaign group used a drone to deliver abortion pills to Polish women, in an attempt to highlight Poland’s restrictive laws against pregnancy terminations.

There was scary news too: a private health insurer encouraged its members to use a Facebook-owned exercise app to qualify for free cinema tickets. Not surprisingly, Facebook was entitled to disclose all information shared via the app, including personal identity information, to its affiliates.

But there was also this: Telstra has launched its ReadyCare telehealth service. For those willing to pay $76, a doctor on the other end of the phone or video link is ready to care for you. No need to visit a GP or emergency department.

The telecom provider will offer the service to other parties like aged-care facilities and health insurance funds. Telstra is aiming for a $1 billion annual revenue.

Digital revolution

Digital developments increasingly create new opportunities, challenges and risks, but we have yet to find ways to incorporate the new technologies in our existing healthcare system.

In an interview in the Weekend Australian Magazine Google Australia boss Maile Carnegie warned that the digital revolution has only just started and that Australia is not ready for the digital challenges ahead.

Carnegie said that 99% of the internet’s uses have yet to be discovered and although Australia is the 12th largest economy in the world, it ranks only 17th on the Global Innovation Index.

She said that Australia has become a world expert at risk-minimisation and rule-making. Unfortunately this seems to slow down innovation.

“We are either going to put in place the incentives and the enablers to create the next version of Australia as a best-in-class innovation country or we’re not,” she said. “And I think it’s going to be a very stark choice that we have to make as a community.”

Who’s taking the lead?

In the last ten years we have seen major progress in for example mobile technology, but my day-to-day work hasn’t changed much. Healthcare has difficulty harnessing the benefits of the digital revolution.

Is the industry leading the way and letting governments, software developers and other parties know what is required? Do we have industry-wide think tanks to prepare for the near future? Have we listened to what our patients need and expect from us in the 21st century? And will Medicare eventually reimburse services delivered via modern technologies, such as pioneered by Telstra?

Lots of questions. Who has the answers?

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

Your GP and Dr Google: a good team

Your GP and Dr Google: a good team Many of us use Google to look up health information. Even doctors google. I often use the search engine to show my patients for example images of anatomy or skin problems. As more people become tech-savvy and websites get better, I expect that Dr Google will be even more popular in the near future.

A study published in the Australian Family Physician in 2014 found that 63 percent of patients accessed the internet in the previous month; 28 percent had sought health information online; and 17 percent had obtained information related to problems addressed during a GP visit.

The challenge is of course to find reliable information. To help you pick the right sources here’s a list of trustworthy websites containing useful general information about common health problems. These sites often show up in search results.

It is recommended to check with your GP or specialist that the information is applicable to you. Your doctor may be able to recommend some good resources too.

General health problems

Diabetes

Cancer

Heart problems & cardiovascular risk

Asthma

Mental health

Alcohol & drugs

Sexual transmitted diseases

Sexual transmitted diseases at www.sti.health.gov.au

Dementia

Incontinence

Of course this is only a basic list of Australian websites. There are many other Australian and international sites with disease specific information. If you know of a particular good source, please feel free to mention it in the comments section below.

One word of warning: Information on the web is sometimes outdated or incomplete. But occasionally it is deliberately incorrect or manipulated, for example to make you buy something. To help you differentiate the good from the bad, have a look at this post: 6 warning signs that online health information may be unreliable.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.
Sources:

6 key conditions that must be met before private health funds can engage with general practice

6 key conditions that must be met before private health funds can engage with general practice
Six key conditions that must be met before private health insurers can enter the general practice market. Image: Pixabay.com

Private health insurers are gearing up to enter the general practice market. But it appears their plan is a copy of the dreaded US-style ‘managed care’ approach.

It’s best to keep health funds at arm’s length or else they will decide what care can, and can’t be given – instead of the patient and the healthcare provider. Therefore, I suggest that six conditions must be met before private health insurers can engage with general practice:

#1: Universal access

Every Australian should have equal access to a GP, independent of insurance status.

#2: Freedom of choice

People should have the option to choose their GP and private specialists; this cannot be dictated by health funds. Patients together with their doctors are best at deciding which tests and treatments are appropriate, not third parties like insurance companies.

Patients should always be given the option to choose and change health funds and insurance products.

#3: Transparency 

Health funds must provide a straightforward package covering GP and/or basic private hospital care – as well as more comprehensive packages. Exclusions should be kept to a minimum. Health funds should make patients aware of exclusions and any other limitations before they buy a product.

To assist consumers choosing the best health insurance that suits their circumstances, an independent Government website should monitor, compare and publicise all available insurance packages.

#4: Professional autonomy

GPs and practice staff need support to be able to provide good care; this also means they should not be overloaded with red-tape, reporting requirements and KPIs. For the same reason health funds should not cause delays in treatment. GPs have the right to set fees to ensure practice viability.

#5: Evidence-based care

Only proven, appropriate, and cost-effective care should be covered.

#6: Stakeholder involvement

Health consumer organisations and the medical profession need to be engaged, as this will likely lead to better outcomes.

Finally, new regulation should be put in place to safeguard compliance by all parties.

5 little-known reasons why pharmacies should not become GP surgeries

5 little-known reasons why pharmacists should not be playing doctor
Image: Pixabay.com

So there is a budget crisis. There’s also a new federal Health Minister. And, here it comes, community pharmacies are negotiating over a billion-dollar deal with the Government: The Community Pharmacy Agreement sets out the Government funding pharmacists receive for dispensing PBS medicines.

 

If it’s up to the Pharmacy Guild, pharmacists will be:

  • Filling repeat prescriptions to ‘free up doctors time’
  • Treating ‘easy’ minor ailments
  • Giving more vaccinations (e.g. a flu-shot for $25 with no Medicare rebate)
  • Doing ‘easy’ health checks, screening and preventive health services
  • Giving mental health support.

Sounds great doesn’t it? At first glance this improves access to health services and saves tax payers bucket loads of health dollars. This can’t go wrong!

Maybe not. Here are 5 reasons why role and task substitution by pharmacists will fail:

#1: Avoiding the doctor is probably not going to help

A repeat prescription or a vaccination is a valuable opportunity for a family doctor to screen for, and treat health issues before they escalate. This is one of the strengths of general practice. If people don’t come in because they get their cholesterol or blood pressure scripts from the pharmacist every 6 months, this system will fail.

It will worsen health outcomes at drive up costs. Is that really what we want?

#2: We are treating people (not ailments)

People are more than the sum of their ailments. Over the years there have been many attempts to replace the doctor with algorithms, machines and computers, and they have all failed.

The human body and mind are complicated. Take the nurse-practitioner clinics trial in the ACT. They created duplication and resulted in more emergency department presentations. The clinics were also more expensive than a GP service.

If you think a professional is expensive, wait until you hire an amateur.

#3: Don’t put the cart before the horse

If it’s improved access or multi-disciplinary care we’re after, then strengthen general practice. Unfortunately the opposite is happening: Practice nurse support has been cancelled, and I won’t mention the Medicare rebate cuts and freeze.

One GP said about role substitution by pharmacists:

“If this was a good way to practice a profession, we could all just buy a book on law and represent ourselves in court, organise our own house sales and never need a tradie either. But we all know that there is more to a ‘job’ than it appears.

#4: Disruption is not innovation

A common mistake is to assume that disruption is the same as innovation. Disruptive services – like those suggested by community pharmacists – may be simple or convenient, but the quality will be poorer.

A recent study showed that only 3 out of 32 fish oil supplements contain what the label says; I believe pharmacies should focus on evidence-based medication advice and quality control of over-the-counter drugs.

#5: Conflicts of interest

A question we should ask is: Can the person who is selling the drugs give independent health advice?

Pharmacies face reduced profits because the Government has set lower prices for generic medications under the price disclosure arrangements.

Although it is understandable pharmacies are looking for other income streams, it is unlikely that the proposal by the Pharmacist Guild is a win-win solution.

Playing doctor may be good for the pharmacist and possibly for the health budget in the short-term, but not for the health of Australians. It will hinder GPs in the effective delivery of care and will eventually increase costs.

There is value in team work, but only if we work together.

Chaos alert: GP training in tatters?

Chaos alert: GP training in tatters?

In the ‘Blogging on Demand’ series you get to choose the topic. If you have a great idea you want the world to know about, send an email, contact me via social media or leave a comment below. Karin Calford suggested the topic of this post. She sent an email asking: “With the imminent defunding of GPET*, what happens to GP registrar teaching from this point on? Wondering if you would be willing to blog about this.”

I am so pleased that people ask these questions. Karen wrote that, as a patient, she is concerned about the delivery of effective, patient-centred care in the future. As an example she mentioned the importance of teaching communication skills: “How will this sort of valuable non-clinical registrar training occur in the future?”

The responsibility for the training has been in the hands of GPET since 2001. The organisation was launched as a result of government concerns about the training program from the Royal Australian College of General Practitioners (RACGP). GPET was to give a range of groups a voice in the national GP training program. At the time it made an end to the RACGP’s monopoly as training provider.

From 1 January 2015 GPET is no longer. The Department of Health takes over its responsibilities to achieve administrative efficiencies. Australian Doctor magazine reported: “The Abbott government predicts it will save $115.4 million over four years by a package of cuts that includes abolishing GPET, slashing regional training providers and scrapping the Prevocational General Practice Placements Scheme.”

The current situation can be summarised in one word: Chaos.

The power vacuum

Former chair of GPET Professor Simon Willcock predicted a while back that the axing of the organisation would create a ‘power vacuum at the heart of GP training’. The responsibility for the training program now lies with the Department of Health, but the question remains how well things have been thought through.

It appears GP registrars wanted to get rid of GPET. Shortly after the election of the current government they made suggestions to replace GPET in a ‘draft’ sent to a government policy advisor. Australian Doctor magazine obtained a leaked copy, which “(…) warned of escalating costs facing the government in dealing with the expanding number of options for GP training.”

GP supervisors are now concerned that big corporates will take over the training program, because they “(…) operate with an efficiency that concentrates on urban training to maximise patient throughput, rather than the development of quality general  practitioners.”

What the AMA, RACGP and ACRRM say

AMA president Professor Owler said:

“Abolishing GPET takes away professional control and leadership of GP training. And we believe that the Department of Health does not have the necessary experience to run GP training. The Budget reforms will dismantle the existing GP training infrastructure that has taken many years to put in place.

In the meantime the two GP colleges, RACGP and their rural counterpart ACRRM, have proposed a new framework for the training program. The AMA was not happy about the fact that the colleges kept their plans behind closed doors, but supports a college-led training program as this would be consistent with other medical specialist training programs.

The soap continues: The two colleges were to meet federal health minister Peter Dutton last week, but the get-together was cancelled at the last minute. This promted RACGP president Dr Frank Jones to express his disappointment:

“(The colleges) are extremely disappointed that a meeting scheduled to discuss general practice training with the Federal Minister for Health, The Hon. Peter Dutton MP, was cancelled yesterday. On behalf of the RACGP, I have stressed the critical and urgent need for reassurance regarding the future governance of a general practice training program and will endeavour to reschedule this meeting before Christmas.

It is unknown if Peter had to cancel because of the flu. If that’s the case I hope he has an empathetic doctor – and he’d better ask for a sick note too.

Here’s to hoping that regardless of the government’s administrative ‘efficiencies’, the quality of the Australian GP training will remain world-class.

Thanks to Karin Calford for the topic suggestion.

Amazing Australian GP Bloggers

What is it like to be a General Practitioner in Australia? What are Australian Family Doctors passionate about? What do they struggle with? The Amazing Australian GP Bloggers 2014 give readers a rare look behind the scene.

Bloggers like Justin Coleman, Jacquie Garton-Smith, Genevieve Yates and Penny Wilson are great storytellers with an impressive writing talent. Penny’s post Sorry… But are you really a doctor, reached number 7 in the most popular WordPress blog posts worldwide.

Then there are the GP bloggers who focus on teaching and sharing skills and knowledge, like Michael Tam, Casey Parker, Tim Leeuwenburg, Minh Le Cong and Robin Park. They are responsible for a vast amount of freely accessible medical information. Much of their work can be found via the excellent foam4gp blog.

It is good to see that some GP bloggers post valuable information for patients, such as Jo Kosterich, Brad McKay and Nick Tellis. Duncan Jefferson is creating a nice podcast collection on his blog.

Examples of posts I enjoyed: How to live to 150 in 10 easy steps, by Brad McKay; The art of uncertainty in general practice, by Marlene Pearce; When Terry Barnes and I bumped into each other on Twitter, by Tim Senior.

The stream of stories, confessions, opinions, experiences, tutorials, interviews and podcasts just goes on. It is impossible to mention everyone here, so I refer to the list below.

I would like to finish with acknowledging the hard work these doctors are putting into their blogs. From experience I know it can be a challenge to keep the momentum of writing going. Even though it is a passion, it is not always easy.

All these creative GP bloggers have inspired me, and I’m sure you will (continue to) enjoy their posts! Click on the WordPress/Blogger logo to go to a blog.


Dr Melanie Clothier

Rural GP | Always learning from my patients | Love music, good company, good food/wine/coffee. Views my own. Rural South Australia. Blogs at: WordPress.

Go to blog


Dr Justin Coleman

President, Australasian Medical Writers Assoc. GP, Inala Indigenous Health. Medical editor. Snr lecturer UQ & GU. Blogger; The Naked Doctor. Blogs at: WordPress.

Go to blog


Dr Gerry Considine

Pilot | Rural GP | = better half | Tweets/thoughts my own. Eyre Peninsula, SA. Blogs at: WordPress.

Go to blog


Dr George Forgan-Smith

Melbourne, Australia. Blogs at: WordPress.

Go to blog


Dr Jacquie Garton-Smith

GP, Clinical Lead, health communications advisor, fiction writer, wife, mum, gardener & doglover, keeps a paper diary & writes lots of lists. Blogs at: WordPress.

Go to blog


Dr Sam Heard

NT Specialist General Practitioner. Making health compute with openEHR, Australia. Blogs at: WordPress.

Go to blog


Dr Duncan Jefferson

Focus on Health. Medical Doctor: Writer: Podcaster. Founder of The Pilgrim Trail and Camino Salvado; can be a tad impish on occasion! Perth, Western Australia. Blogs at: Blogspot.

Go to Blog


Dr Joe Kosterich

An independent doctor actually talking about health. Perth, Australia. Blogs at: WordPress.

Go to blog


Dr Edwin Kruys

Husband, father, GP. I blog about healthcare, social media & eHealth. Sunshine Coast, Queensland. Blogs at: WordPress.

Go to blog


Dr Minh Le Cong

Flying Doctor, rural GP, I work in the sky, live in the tropics, love my family and dream of how to make things better. Supporter of . Cairns, Queensland, Australia. Blogs at: WordPress.

Go to blog


Dr Tim Leeuwenburg

Resuscitate-Differentiate-Prognosticate: Roadkill, Diff Awy & Checklist Fan – ATLS-EMST Director – Quality Care. Out There via & . Kangaroo Island, Australia. Blogs at: WordPress.

Go to blog


Dr Brad Mckay

Doctor & TV Presenter of Embarrassing Bodies Down Under. Skeptically Optimistic. Gadget Geek. Passionate about Health. Blogs at: own website.

Go to Blog


Dr Robin Park

GP on the Sunshine Coast QLD. Doing masters med ed through Flinders. Teaching at Deakin University Medical School. Writer for . Blogs at: WordPress.

Go to blog


Dr Casey Parker

Rural doc, author of the Broome Docs blog. Generalist, supporter and contributor blog. Broome, NW Australia. Blogs at: WordPress.

Go to blog


Dr Marlene Pearce

General Practitioner. Writer, Blogger. Blogs at: WordPress.

Go to blog


Dr Francois Pretorius

Procedural Obstetric GP; Ruralist; Passionate GP educator; Christian; Husband to 1; father to 4; wine lover and chef. Buderim, Qld, Australia. Blogs at: WordPress.

Go to blog


Dr Karen Price

GP, and Chair of Women in General Practice Committee Vic. RACGP. Interested in Most things. Melbourne. Blogs at: WordPress.

Go to blog


Dr Mark Raines

GP, photographer, kayaker, Dad…. and face painting victim…. Kangaroo Island. Blogs at: WordPress.

Go to blog


Dr Thinus van Rensburg

GP & skin cancer doctor. Fiddles with IT on the side. Canberra. Blogs at: WordPress.

Go to blog


Dr Joe Romeo

Fulltime country GP, aspiring songwriter/ worship songwriter, father of 6, follower of Jesus Christ. Narrandera, Australia. Blogs at: Blogspot.

Go to Blog


Dr Tim Senior

GP in Aboriginal health & medical education. Writer of for a crowd at & other stuff. Tharawal Nation, Australia. Blogs at: Blogspot.

Go to Blog

Also blogs at AMS Doctor


Dr Michael Tam

Michael Tam is a Staff Specialist in General Practice at the GP Unit in Fairfield Hospital, and Conjoint Senior Lecturer at UNSW Medicine. Sydney. Blogs at: WordPress.

Go to blog


Dr Nick Tellis

Passionate about quality in General Practice. Glenelg, SA. Blogs at: WordPress.

Go to blog


Dr Arron Veltre

Palliative care trainee (QLD). Locum GP. Loud shoe wearer. Triathlete wannabe. Scribbler. 80’s skateboard collector. Part time longboard rider. Blogs at: Blogspot.

Go to Blog


Dr Penny Wilson

GP obstetrician, rural locum doctor and blogger. Interested in teaching, leadership, advocacy, quality care. Local, national, global. and . Blogs at: WordPress.

Go to blog


Dr Genevieve Yates

Doctor, medical educator, writer and musician, who believes that you can do it all, just not all at once. Supports , & . Blogs at: WordPress.

Go to blog


Why the doctor doesn’t want to ask about your drinking

Why the doctor doesn’t want to ask about your drinking“It is socially unacceptable to say you’re a heavy drinker, but it is actually socially acceptable to be a heavy drinker.” This interesting quote from a GP came out of a research project by Dr Michael Tam, GP at the School of Public Health and Community Medicine in Sydney. It may explain why GPs feel reluctant to discuss alcohol intake with their patients…

Dr Tam tried to find out why doctors are avoiding the topic. He found the following 3 barriers:

  • Many GPs didn’t want to be seen as moralising or didn’t want to label people with an alcohol problem
  • There was doubt about effective screening tools; what people say may not always reflect their true alcohol intake, so why bother asking
  • GPs were concerned that discussing the topic would affect the relationship with their patients

Dr Tan concluded that routine alcohol screening questionnaires by GPs may not be helpful to detect at-risk drinking.

What do you think needs to happen? Fill out the poll below or leave a comment.

Source: Detection of at-risk drinking – beliefs and attitudes of Australian GPs

2×5 questions you should ask your doctor

2x5 questionsPatients usually visit a doctor to find an answer to two main questions:

1. What’s the cause of my symptoms? (Diagnosis)

2. What can be done about it? (Treatment)

There are a 5 simple questions you can ask your doctor about the diagnosis and 5 questions about the treatment, to be better informed, and get the outcome you prefer.

Diagnosis

  1. How certain or uncertain are you about the diagnosis?
  2. Are further tests required?
  3. If so, how good are the tests? Will they rule out or pick up the problem?
  4. Are there risks attached to the test? Eg bleeding, radiation exposure.
  5. Is the test necessary or are there other options? Eg treat, wait.

Treatment

  1. What treatments are available to manage the problem?
  2. How successful is the treatment?
  3. Are there risks attached to the treatment? Eg adverse reactions, interactions with other medications, antibiotic resistance, bleeding, infection.
  4. Is the treatment necessary or are there other options? Eg wait, try lifestyle changes first, do further tests, see another doctor.
  5. Is there anything else I need to know about the treatment? Eg how to administer, when to come back, how to prevent this from happening again.