Mandatory reporting of health professionals: has COAG delivered on its promise?

On the one hand patients must be certain that health practitioners are fit to practice in a competent and ethical manner, but on the other hand practitioners should be able to seek treatment without fear of being reported, penalised or losing their jobs. Has the Council of Australian Governments (COAG) found the right balance?

The National Law contains mandatory reporting obligations for registered health practitioners, employers and education providers to protect patients. However, if you’re for example a midwife, psychologist, pharmacist, doctor or student with a mental health condition, it can be a challenging decision to seek help. Many don’t out of fear that the treating practitioner may believe they have to notify authorities.

Concerns have been raised that practitioners and students don’t seek or delay treatment – and when they seek care, there may be a reluctance to be open and honest with the treating practitioner, leading to suboptimal treatment eventually putting the health and safety of the practitioner and the public at risk.

For years the AMA, RACGP and other professional bodies have argued that the regulation needs to change to ensure health practitioners can, just like others, seek help.

In October 2018 an Amendment Bill was introduced to the Queensland Parliament, which if passed will automatically be applicable to most other States and Territories. The Bill introduces a higher threshold for mandatory reporting in an attempt to give registered health practitioners greater confidence to seek treatment for health issues.

Western Australia exempts treating practitioners from mandatory reporting for all forms of notifiable conduct if their patient is a registered health practitioner. The WA model or similar has always been the preferred option of health providers. There is no evidence to suggest patient safety in WA is worse.

In addition to mandatory reporting requirements, practitioners have ethical and professional obligations to report other practitioners who may pose a risk to the public.

Brief history

On 13 April 2018, after the COAG Health Council meeting in Sydney, the federal, state and territory Health Ministers, issued a press release stating that the law regarding mandatory reporting of health professionals would be strengthened ‘to remove barriers for registered health professionals to seek appropriate treatment for impairments including mental health.’

The ministers further agreed to a nationally consistent approach to mandatory reporting which would propose exemptions from the reporting of notifiable conduct by treating practitioners, noting Western Australia’s current arrangements would be retained.

Explicitly mentioned in the COAG press release was the fact that in WA health practitioners in a treating relationship based on the reasonable belief can make a voluntary notification as part of their ethical obligations in relation to any type of misconduct.

Health Ministers agreed that the reforms should ensure that registered health practitioners can seek help when needed, but must also protect the public from harm. On 12 October 2018, COAG Health Council approved the reforms to mandatory reporting by treating practitioners in the Amendment Bill. The WA model was not adopted.

The Council concluded that the amendments would achieve the right balance between encouraging practitioners with an impairment to feel confident that they can seek treatment, while protecting the public from harm by requiring treating practitioners to make mandatory reports about other registered health practitioners that pose a substantial risk of harm to the public or are engaging in sexual misconduct in connection with the practice of their profession.

What’s good?

A treating practitioner will only be required to make a mandatory report if their practitioner-patient’s conduct involving impairment, intoxication or departure from professional standards meets a higher threshold of risk of placing the public at substantial risk of harm (this threshold does not apply to mandatory reporting of sexual misconduct).

Only serious impairments that are not being appropriately managed through treatment or mitigation strategies need to be reported if the safety of patients would be at risk.

The amendments also include guidance factors; in considering whether the public is at substantial risk of harm, a treating practitioner may consider the following matters relating to an impairment of the health practitioner or student:

  • the nature, extent and severity of the impairment;
  • the extent to which the health practitioner or student is taking, or is willing to take, steps to manage the impairment;
  • the extent to which the impairment can be managed with appropriate treatment;
  • any other matter the treating practitioner considers is relevant to the risk of harm the impairment poses to the public.

According to the explanatory note a treating practitioner may make an overall assessment about a practitioner-patient’s conduct relating to impairment, intoxication or departure from professional standards in deciding whether a mandatory report should be made. All three types of conduct are measured against the same threshold for reporting.

If an impairment issue is connected to, or a significant cause of, intoxication or departure from professional standards, a treating practitioner is able to take into account the effectiveness of treatment or engagement in treatment of an impairment by the practitioner-patient in deciding whether there is likely to be an ongoing risk of harm to the public.

“Also, in cases where an impairment may be impacting on, or causing, instances of intoxication at work or departure from professional standards, a treating practitioner may consider the guidance factors related to the impairment first, such as the extent to which treatment is likely to be successful and the practitioner-patient’s engagement with treatment. If the treating practitioner is satisfied the impairment issue is being managed appropriately and does not reach the threshold of ‘substantial risk of harm’, the treating practitioner would not be required to make a mandatory report for the impairment.

“The treating practitioner could then consider, in light of the impairment issue being managed, whether future instances of intoxication at work or departure from professional standards are likely to recur. If, given appropriate management of the impairment, they are not likely to recur, the mandatory reporting threshold of ‘substantial risk of harm’ would not be met. In this way, the current provisions provide adequate flexibility for a holistic assessment of risk.

“It would be possible for a practitioner to have a substance abuse or dependence disorder, but it may be something that only affects their personal life or only occurs while they are away from their workplace. This type of conduct should be considered as an ‘impairment’ for which it is appropriate to apply the guidance factors. However, the risks associated with a practitioner being intoxicated at work are considered significant, so that if a treating practitioner becomes aware that a person is practising while intoxicated, they should be subject to mandatory reporting if their conduct reaches the threshold.

Source: Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 — Explanatory Note.

The explanatory note further states that the guidance factors included in the legislation send a clear signal to practitioners and students that, provided they are engaged in treatment and willing to take steps to address their impairment, a treating practitioner is not required to make a mandatory report, unless the safety of patients would be at risk.

Seeking treatment may indeed become easier as the explanatory note of bill explicitly states that the test of ‘substantial risk of harm’ is not intended to require reporting of low-level or trivial types of harm or mere inconvenience. Only serious impairments which are not being appropriately treated are intended to require reporting. This means that harm would need to be ‘material’ to reach the threshold of ‘substantial risk of harm’.

What’s not so good?

Some have argued that although the wording ‘substantial risk of harm’ may have increased the risk threshold, the harm threshold is low, and it appears that all levels of harm, including trivial harm and inconvenience, need to be reported even though the explanatory note states the opposite.

The explanation may be reassuring but the bill itself raises questions. The wording has the potential to create confusion around the interpretation of the legislation and, worse, may prevent health practitioners from seeking help or being open and honest with their treating practitioner.

Doctors and other health workers have the highest suicide rate in Australia’s white-collar workforce. Legislation is of course not the cause of mental illness and suicide and we need to continue to look at other factors, including our professional cultures and how we communicate and treat each other. This is a shared responsibility of the profession and policy makers.

It remains vital that health practitioners can seek help without fear of repercussion no matter where they live and work. The Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 is a welcome step in the right direction, but there is room for improvement if the COAG Health Council wants to deliver on its promise to remove barriers for registered health professionals to seek appropriate treatment for impairments including mental health.

Tribes, tribulation and the elephant in the room

If we want to change bullying and abuse within the profession we have to move our tribal cultures to the next level.

The medical profession has come a long way in the past 25 years, but sadly seems to have difficulties eradicating issues of humiliation and abuse of colleagues and medical students.

One option to fix the problem is to make junior doctors and students more resilient, which seems like a good principle that is currently being applied by other organisations in other areas. Fore example, Beyond Blue has released a practice guide for professionals to help children deal with the adversities they experience early on to prevent mental health conditions later in life.

But teaching resilience alone is not enough.

Another option is to increase awareness and understanding among senior doctors and educate them about bullying, discrimination and sexual harassment. A good example is the mandatory education module, ‘operating with respect’, from the Royal Australian College of Surgeons (RACS).

Elephant in the room

The elephant in the room, however, is our culture – or at least certain aspects of it.

David Logan, a professor at the University of Southern California, said it a few years ago in his New York Times bestseller ‘Tribal leadership’: on the tribal culture scale of 1-5, most professionals around the world score a meagre three. This includes lawyers, doctors and professors.

According to Professor Logan and fellow authors John King and Halee Fischer-Wright, a stage-three culture or tribe is built around knowledge, personal accomplishments and individual expertise. The emphasis is often on winning. Although there may be talk of teamwork, the group interactions usually resemble those of a master-servant relationship.

The mantra of a stage-three culture is, ‘I’m great’. The language used is often along the lines of, “I’m good at my job,” “I try harder than most,” “Most people can’t match my work ethic,” and key pronouns used are ‘I,’ ‘me,’ and ‘my’.

This creates several problems. Professionals operating in this type of culture often feel unsupported, undervalued and frustrated, and those around them feel like a support cast.

Stage-three cultures cannot be fixed, but they can be abandoned. The answer is to upgrade the culture and move away from the ‘I’m great’ mantra to ‘We’re great.’

The next level

Instead of relying on personal achievements and expertise, at stage-four it becomes all about the accomplishments of the group. Partnerships, communication and transparency are recognised as essential ingredients for success. This is a healthier environment, in which people feel more valued and supported.

Professor Logan’s top level is stage-five. Highly functioning teams focus on maximising achievement – not in competition with other groups or tribes but with what’s possible. Stage-five teams can work with anyone.

Australian research has shown that hierarchical and stereotype behaviours largely dissolve when health professionals are working in a more collaborative, multidisciplinary environment.

Resilience training and anti-bullying education are essential, but if we really want to make a difference we have to move our tribal cultures to the next level.

This article was originally published in newsGP.

Here’s a challenge for the Pharmacy Guild

One of the big questions in primary care is: will the community pharmacy sector and general practice be able to work together without fragmenting care or duplicating services? If we don’t solve the issues and start to work as team, patient care will suffer.

For that reason, I’d like to take the Pharmacy Guild up on their suggestion to collaborate.

The relationship between doctors and community pharmacists is an interesting one: the two professions rely heavily on each other. For example, I find the advice and support from pharmacists invaluable when trying to solve difficult medication problems with my patients. Pharmacists also act as a ‘second pair of eyes’ checking my prescriptions.

Both doctors and pharmacists are highly valued by consumers and are, with nurses, in the top three most trusted professions.

On another level doctors and community pharmacists are often at loggerheads. Issues that come up time and time again are differences of opinion about the commercial aspects of healthcare, conflicts of interest with regards to prescribing and dispensing, and who does what.

In the eyes of many doctors, community pharmacy has gone off track with little connection at policy level with other primary care providers. Pharmacist will tell a different story. For example, some pharmacists – not all – seem to think that the main agenda of doctors is to protect their ‘turf’ – but there’s much more to it as I’ll explain below.

Unintended consequences 

A while back I published an article on behalf of RACGP Queensland, drafted with input from a diverse group of academic and non-academic GPs. I outlined various issues with the Queensland immunisation trials, which have led to a change in Queensland’s legislation allowing community pharmacists to administer certain private vaccinations to adults.

The idea behind pharmacy vaccinations is to improve vaccination rates in people who don’t receive care through GP services. This sounds appealing from a public health point of view, but the impact on existing services has not been reviewed or taken into account during the trials.

Unfortunately the change impacts on the care delivered by family doctors and their teams. For example, my patients now regularly tell me that they’ve been vaccinated at a community pharmacy but have forgotten where, when and what exactly – and communication from the pharmacy is usually missing.

One of my frail elderly patients who came to see me for something else declined a government-funded influenza vaccination by our practice nurse because she was booked in to have a private vaccination at the pharmacy the following week, and felt she couldn’t cancel that appointment.

This goes against the argument that pharmacy vaccinations are only targeting people who don’t have a GP or people who fall outside the national immunisation program.

Moving services away from general practice also has an impact on opportunistic screening and prevention of health conditions by GP teams. So far this season I have been able to pick up several health problems in people who came in for vaccinations, including an aortic stenosis, pneumonia and two melanomas.

We are all connected

The Pharmacy Guild’s Strategic Direction for Community Pharmacy. Source: Pharmacy Guild
The Pharmacy Guild’s strategic direction for community pharmacy. Source: Pharmacy Guild

The main message here is that a change in one part of the health sector always affects the other parts. We’re all connected – this has nothing to do with money or turf but is all about providing high value, coordinated care.

It would have been nice if RACGP Queensland had been involved in the recent Queensland immunisation trials; we could have flagged and perhaps solved some of the many issues at an earlier stage.

Will the My Health Record fix these problems? Not entirely, because uploading data to an electronic health record on its own will not replace the need for good communication and collaboration.

In the article we also warned against introducing further changes to care delivery in community pharmacies (see image) that may result in poorly coordinated, duplicated or fragmented health services.

How to move forward?

After voicing our concerns in the article various debates occurred on this blog and in the pharmacy press, for example here and here.

The response from the Pharmacy Guild in Cirrus Media’s Pharmacy News however contained incorrect information:

Response from the Pharmacy Guild

This statement is wrong for several reasons: part of my work as a family doctor involves giving advice to travellers but I am not a proprietor of a travel clinic and I don’t profit from the sale of vaccines or other products.

So how to move forward from here? I thought this response from Tim Logan was more encouraging:

“(…) it profits society more for GPs to work with pharmacists, citing a presentation at the Australian Pharmacy Professional conference earlier this year by US expert Dr Paul Grundy, who demonstrated the benefits provided by a model which encouraged GPs to do so.”

I’d like to take Tim up on his suggestion to work more closely together and invite the Pharmacy Guild to meet with RACGP Queensland. I acknowledge that there are always two sides to every story. Let’s see if there is common ground and room for agreement on how our professions can work better together at policy level, without duplicating services or creating more fragmentation of care.

As said before, the RACGP remains committed to working collaboratively with other primary care providers and government to develop innovative and effective models of care such as the patient-centered medical home, and we strongly advocate for solutions that support genuine integration of care, not more fragmentation.

At the time of writing Dr Edwin Kruys was Chair of RACGP Queensland.

We told you so: Ignoring primary care is never a good idea

Last night’s undecided election results raise many questions – and doctors will say: we told you so.

Family doctors have made it very clear during the lead-up to the federal election that it’s crucial for governments to invest in primary care to keep Australians well and out of hospital.

But not only that, during the longest election campaign in Australia’s history, GPs around the country have had discussions with millions of patients about the future of their healthcare.

Looking at the outcome of the election night, it seems that voters have taken the message to the polling booths.

Wealth should not affect our health

The day after the federal election date was announced, the Royal Australian College of General Practitioners (RACGP) launched the You’ve been targeted campaign, warning people about the looming higher out-of-pocket costs, which have already become a reality.

The aim of the campaign was not to increase health corporate profits or fill doctors’ pockets, it wasn’t even a political campaign – it was all about the message that the Australian people must be able to visit their doctor when they need to.

Doctors called on a newly elected government to invest in quality and sustainable general practice to strengthen patient services.

“Our first and foremost responsibility is to our patients,” said RACGP President Dr Frank Jones, “and this is really the message from the College in the campaign, because this is about the fact that we cannot sustain quality general practice under the present Medicare freeze.”

Posters went up in GP surgeries, messages were printed at the bottom of prescriptions, TV ads were aired and there were 2340 syndicated media stories featuring the RACGP on national TV, print and radio, and in medical and consumer media outlets across all formats.

The Australian Medical Association (AMA) followed suit and threw its weight behind the issue, and shortly after many political parties made health a key focus during the election campaign. The policy shift by Labor to lift the Medicare freeze and fund chronic disease management by general practice teams was welcomed by many.

What should happen next?

Whatever the outcome of the election will be, the new government would do well to sit down with GP leaders and develop a long-term plan to strengthen primary care. The message is simple and supported by abundant evidence: strong primary care keeps people well and out of expensive hospitals. Investing in general practice patient care pays off!

Dr Frank Jones: “The RACGP is seeking progressive health reform and a genuine commitment to the future of our healthcare system from our political leaders and we are committed to discussing funding models for a sustainable and effective primary health care system.”

As GPs around the country are moving away from bulk billing, health minister Susan Ley has already indicated she is prepared to look at a medical home model. The proposed appointment of a National Rural Health Commissioner and commitment of the Coalition to pursue a National Rural Generalist Training Pathway is another positive sign.

However, the medical home is more than a hospital avoidance project. “In a patient-centred medical home, patients have a stable and ongoing relationship with a general practice that provides continuous and comprehensive care throughout all life stages,” said Dr Jones. “This model is the most cost-effective way to address the needs of patients, healthcare providers and funders.”

There are many versions of the medical home or healthcare home. The ‘gold standard’ version is outlined in the RACGP’s Vision for General Practice and a sustainable healthcare system.

Part of the future plan should be the continuation of high quality primary care research and the introduction of non-face-to-face patient services such as video consultations to improve access to family doctors and to transform Australian primary healthcare to the digital age.

The problem with ‘record-high’ bulk billing rates

According to government data, bulk billing rates are at an all-time high: around 85% of GP services are bulk billed. This figure is often used to justify the lack of investment in general practice, including the freeze on Medicare rebates patients get back after a visit to their family doctor.

Why is this figure so high? Not surprisingly, the issue is more complex than politicians want us to believe.

According to the government it is a matter of supply and demand. In other words, they claim that GPs will not be able to introduce a fee because their patients would go to a bulk billing practice down the road.

This argument, as well as the government’s focus on record-high bulk billing figures, is misleading and doesn’t tell the whole story.

The truth about BB rates

The reality is that we don’t exactly know why bulk billing levels are high. There are several possible explanations, such as:

  • GPs have been billing compassionately to provide access to all their patients
  • GPs have been absorbing the costs of the government’s freeze on patient Medicare rebates
  • Doctors have increased their services to compensate for the low Medicare rebates
  • As a result of the ageing population more people are bulk billed.

The explanation given by the government that market forces are the reason GPs bulk bill does not do justice to the work of GPs around the country. Besides, as a result of government policies, out-of-pocket expenses for patients have been rising over the years.

Why out-of-pocket costs go up

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Image: As a result of the Medicare freeze on patient rebates, GP practices across Australia are getting ready to introduce fees. Source: Twitter

GPs are genuinely concerned about their patients first and foremost and, no matter what politicians say, GPs have been bulk billing a large proportion of their services because they know that many patients would not seek medical care if they had to pay a fee of $15-$20 per visit.

Unfortunately the government has indicated it will not further index Medicare patient rebates, and as result of the government’s long-term Medicare freeze, practices across Australia will be forced to introduce fees.

This was the whole idea behind the government’s original co-payment plan and the reason the Medicare freeze has been dubbed a ‘co-payment by stealth‘.

The short-term ‘savings’ created by the Medicare freeze will likely result in more health problems due to delayed GP visits, and drive up costs in the longer term. A typical case of a penny wise and pound foolish approach.

Downward spiral

What if practices don’t introduce a fee? A bare-bone, high-turnover model is one way bulk billing practices can sustain themselves: doctors may decide to see 7-8 patients per hour instead of 4-5. The question is of course: how safe is this and how long can they keep doing this?

High bulk billing rates, yes – but is this the health care system we want for Australia?

Out-of-pocket costs comparison
The focus on high bulk billing rates is misleading as it only tells part of the story. At the same time Australians pay more out-of-pocket for medical care than many other countries, which creates barriers to visiting a family doctor. Source: RACGP

The bulk billing statistics tell us what percentage of services is bulk billed, not patients. We also know that Australians already pay more out-of-pocket for their care than many other countries, which creates barriers to visiting a family doctor. These figures are rising, so clearly the bulk billing statistics only tell part of the story.

Instead of looking at bulk billing rates as a measure of success, we should be carefully monitoring the out-of-pocket health expenses in Australia.

GP Leaders have warned that we’re facing a downward spiral – which is a risk for the nation’s health and leads to higher overall costs. Even if the freeze on Medicare patient rebates is reversed – which is an absolute must – we’re not out of the woods.

We need well-resourced, sustainable primary care funding models that support high quality care for our patients and are easy to implement at grassroots level.

Why doctors will stop bulk billing

Patriotism is supporting your country all the time, and your government when it deserves it ~ Mark Twain.

Although federal health bureaucrats seem to think bulk billing rates will increase, about 30% of GPs say they will stop all bulk billing soon. In a previous post I explained why. As a result of government policy to freeze patient Medicare rebates, doctors are faced with three options. They can:

  1. take an estimated $50,000 pay-cut;
  2. see more patients more often;
  3. charge more.

Some will choose option 1, because they don’t want to or cannot charge their patients more, and are also unable to work more. The reality is however that most GPs will not be able to afford this option.

Others will go for option 2: they may, for example, see 7-8 patients per hour instead of 4-5. They may decide to work more days and longer hours. The question is of course: how safe is this?

Can doctors continue to offer good care when they are churning through high patient numbers? It will certainly feed the epidemic of burnout, depression and suicide among doctors and medical students.

What the Medicare rebate freeze is all about
Medicare is shaping up to be a major election topic. Still, the freeze on the patient Medicare rebate is a complex topic for many. It was a lot easier to understand when Medicare was called the Health Insurance Commission, but the principle is still the same: Medicare pays a contribution towards the doctor’s fee on behalf of the patient. Many GPs have accepted this contribution as a full payment, which is called bulk billing.
The ‘indexation freeze’ everybody is talking about means that this Medicare contribution will not be increased annually, in line with the increasing cost of living. The shortfall will have to be made up by patients which means that the out-of-pocket expenses will go up as doctors stop bulk billing. The freeze on the patient Medicare rebate was introduced by the Labour government in 2013, and will continue under a Coalition government until 2020 and possible longer. The rebate has not kept up with costs and inflation for a much longer period.

3-tier system

Then there is option 3: doctors will charge more, which will increase out-of-pocket costs for patients. As RACGP president Dr Frank Jones mentioned in this interview, we may see a 3-tier system in Australia soon:

“Dr Jones warned poorest patients would feel the impact of the freeze hardest, while there was a risk doctors would churn through appointments more quickly.

He predicted it would lead to a three-tier billing system: doctors would bulk bill their most disadvantaged patients, charge other health care cardholders a concessional rate, and private patients would be charged the Australian Medical Association’s recommended fee.”

In 2015 the RACGP surveyed GPs on how they planned to manage the patient rebate freeze. Of the 566 members who responded, the majority (57%) said they would have to increase out-of-pocket costs for patients.

GPs said they would have to do this either because the practice would stop bulk billing and begin charging a gap or co-payment (30%), or the practice would increase out-of-pocket costs for non-concessional cardholders (27%). Only 8% indicated that they would not increase out-of- pocket costs for their patients.

How fees will go up

It is to be expected that many practices will start cost-cutting: staff levels may be minimised and investments in new equipment, training & education, IT or buildings may become a lower priority. This is a risk for the quality of care.

Practices will determine a fair and equitable fee based on their increasing practice costs, professional time and services. The RACGP and AMA support GPs to set fees that accurately reflect the value of the services they offer, such as the recommended fees in the Australian Medical Association’s List of Medical Services and Fees.

Practices will review their patient demographics and billing profile and optimise the utilisation of MBS items. Pensioners and/or health care card holders may be charged an extra fee which will be much higher than the bulk billing incentive of $9.25.

Practices may decide that certain services will attract fees, for example dressings and other consumables, treating doctor’s reports, off-work/off-school certificates, phone/video consultations, data entry or certain surgical procedures.

Updating practice management software to streamline Medicare claims and EFTPOS payments may be required in some cases. Expect notices to go up in surgeries across the country to tell patients about the changes in billing policies. Unfortunately there will also be some practices that will have to close their doors.

Warning: Dear patients, you’ve been targeted!

The co-payment is coming back. Australians will have to pay more for a visit to the GP or specialist. The freeze on your Medicare rebate means you will get less back from Medicare. It is expected that many practices will stop bulk billing. Join the ‘You’ve been targeted’ campaign and let your local member know that you oppose the freeze on your Medicare rebates.

The Federal Government is reducing its investment in your healthcare by freezing your Medicare rebates. This means your Medicare rebates will remain the same until 1 July 2020, despite the cost of delivering healthcare services increasing (see graph below).

The freeze is a co-payment by stealth and the Government has implemented this measure to reduce the amount it spends on all Medicare subsidised services, including general practice services.

Your health is important. Please do not let the freeze on your Medicare rebates stop you from seeking the healthcare you need.

Out-of-pocket costs comparison

What can you do?

Join the ‘You’ve been targeted’ campaign which aims to lift the freeze on your Medicare rebates. Go to the website of the Royal Australian College of General Practitioners (RACGP): yourgp.racgp.org.au/targeted to access campaign materials including a template letter you can send to your local political candidates demanding the freeze be lifted.

Indexation of MBS patient rebates should keep pace with the costs associated with providing quality health services and employing highly trained and skilled staff, while supporting patient access to services. This illogical decision further demonstrates the government’s continuous disinvestment in general practice.

How will the freeze affect you & your GP practice?

  • The MBS rebate freeze will affect all practices, GPs and patients
  • The cost of providing services will continue to increase while MBS rebates remain frozen
  • Practices where most services are privately billed will need to meet those costs through increasing out-of-pocket payments
  • Practices where a large proportion or all services are bulk billed will be significantly affected. The rebate freeze will have a detrimental impact on the viability of the practice. These practices may need to consider introducing or increasing out-of-pocket expenses to ensure the sustainability of the practice
  • The impacts will be magnified for GPs and practices providing patient services in lower socio-economic areas, where a majority of patients are from vulnerable groups (such as pensioners, Aboriginal and Torres Strait Islander peoples and people on very low incomes). Many people in these areas cannot afford to meet out-of-pocket costs for care
  • Unable to absorb the reduced rebate over time, some general practices will have no option other than to close, leaving the most vulnerable groups unable to access care.

The next government

Doctors call on the newly elected government to invest in quality and sustainable general practice and strengthen patient services by:

  1. Immediately reinstating annual indexation of Medicare Benefits Schedule (MBS) patient rebates
  2. Introducing MBS patient rebates for non face-to-face services (for example, video consultations)
  3. Committing to properly fund quality and comprehensive general practice through implementation of the patient centred medical home.
Increasing out-of-pocket costs
Graph: Your rebate has not kept pace with the increasing cost of living. This will become worse over the next few years. The freeze on Medicare rebates will negatively impact you and the sustainability of many general practices. The example above is for the most common service provided by GPs, a consultation lasting less than 20 minutes (Level B or Medicare item 23). Source: RACGP

Overcoming tribalism in healthcare

When I was preparing this session I thought I’d start by telling a joke:

Five doctors went duck hunting one day. Included in the group were a general practitioner, a pediatrician, a psychiatrist, a surgeon and a pathologist.

After a while, a bird came winging overhead. The first to react was the GP who raised his shotgun, but then hesitated. “I’m not quite sure it’s a duck,” he said, “I think that I will have to get a second opinion.” And of course by that time, the bird was long gone.

Then another bird appeared in the sky. This time, the paediatrician drew a bead on it. He too, however, was unsure if it was really a duck in his sights and besides, it might have babies. “I’ll have to do some more investigations,” he muttered, as the creature made good its escape.

Next to spy a bird was the sharp-eyed psychiatrist. Shotgun shouldered, he was more certain of his intended prey’s identity. “Now, I know it’s a duck, but does it know it’s a duck?” The fortunate bird disappeared while the fellow wrestled with this dilemma.

Finally, a fourth fowl sped past and this time the surgeon’s weapon pointed skywards. BOOM!!

The surgeon lowered his smoking gun and turned to the pathologist beside him and said: “Go see if that was a duck, will you?”

The tribal jungle

Two years ago our keynote speaker was the amazing Dr Victoria Brazil, emergency physician and medical educator from the Gold Coast. She spoke about tribalism in our profession and said:

“I think we actually work in a tribal jungle in healthcare.”

She was right. We make jokes about the characteristics of the other tribes, like I just did, but tribalism is still one of our biggest challenges today. We are concerned about fragmentation in healthcare – but what about the divisions within our own ranks?

Part of what makes general practice attractive is its diversity, but it is also a weakness. Think, for example, of the stereotypical dichotomies: generalists vs partialists, private practice versus corporates, rural versus metropolitan etc.

I’m not saying we should be one big happy family, but why not focus more on what we have in common?

There is hope: participants of groups like United General Practice Australia and, here in Queensland, the GP Alliance, have shown a desire to put aside tribal differences and work towards common goals. This is a start, and initiatives like these must further strengthen the voice of general practice in the near future.

Investing in general practice

With the Federal Budget due to be handed down this coming Tuesday, this weekend also serves as a timely reminder of the RACGP’s advocacy campaign to reverse the freeze on Medicare rebates. As part of our pre-budget submission to the Federal Government, we outlined 4 key strategies that will improve quality-led patient care.

In order to provide quality healthcare services, MBS rebates must be in line with the cost of doing so. More than 80% of the Australian population is seen by GP’s each year but only 8% of Government healthcare spending is allocated to general practice.

New data presented in the flagship report from the National Health Performance Authority released this week, shows that people who do not see a GP have a 30% higher chance of visiting an emergency department.

Investment in primary care will result in long-term health savings and reversing the freeze on MBS indexation is a must. The College will continue to represent our members and lobby the government on this very important issue.

A challenge 

The theme of this RACGP Queensland Conference is ‘the future’. So here’s a challenge for you:

You don’t have to go duck hunting with your colleagues, but what can you do to reduce tribalism?

If you decide to take up this challenge, do one thing, one little thing, and start this weekend while you are amongst your peers.

If we want the future to be different, if we want to see different results, we should do things differently.

Opening speech given at RACGP Queensland’s 59th Clinical Update Weekend: iGP, General Practice into the future. Source joke: Nursing Fun

The family doctor – old-fashioned or the key to a healthy future? (Part 1)

The Family Doctor
The Family Doctor in 1948. Source: Nedhardy.com

A few years ago, when I was boarding a plane I picked up The Times newspaper and noticed a big headline stating: ‘The family doctor is going out of fashion’. In the article journalist Matthew Parris explained why young people prefer to go to the emergency department. I kept the article as I thought it would be a great blog topic, but for some reason I forgot about it – until something jolted my memory.

Last month I had the pleasure of meeting with the Board of Health Consumers Queensland. I enjoy conversations with consumer representatives as I always learn something, even though these exchanges are usually slightly confronting. One of the topics we touched on was continuity of care, or better, the perceived lack thereof in general practice by consumers. During the drive back home to the Sunshine Coast I suddenly remembered the article in The Times.

In 2013 Parris wrote: “Very gradually the era of the personal physician is drawing to a close.” He said he noticed a trend in the UK where younger, busier people were going directly to specialist accident & emergency departments and argued that they don’t want a local GP because working men and women in a hurry will be attracted to a place where they can walk from one room to another and access the specialism they need.

So, I wondered, is the family doctor who provides ongoing care a thing of the past? Am I really a dying breed – the last of the Mohicans?

What exactly is continuity of care?

In primary care literature continuity is often described as the relationship between a single practitioner and a patient that extends beyond specific episodes of illness or disease. To confuse the situation other terms are used synonymously, such as ‘care coordination’, ‘integration’, ‘care planning’, ‘case management’ and ‘discharge planning’. On top of that the experience of continuity may be different for the patient and the health practitioner, adding to even more misunderstandings.

Continuity is how individual patients experience integration and coordination of care.

The authors of an article in the BMJ titled ‘Continuity of care: a multidisciplinary review’ said that continuity is not an attribute of practitioners or organisations. They defined continuity as the way in which individual patients experience integration of services and coordination. And also: “In family medicine, continuity is different from coordination of care, although better coordination follows from continuity. By contrast, a trade-off is required between accessibility of healthcare providers and continuity.”

There are three types of continuity of care:

  1. Informational continuity: The use of information on past events and personal circumstances to make current care appropriate for each individual
  2. Management continuity: A consistent and coherent approach to the management of a health condition that is responsive to a patient’s changing needs
  3. Relational continuity: An ongoing therapeutic relationship between a patient and one or more providers.

Continuity is more than just sending a message to another health practitioner, or uploading a piece of information to an e-health database. Understanding of individual patients’ preferences, values, background and circumstances cannot always be captured in health records; health providers who have a longstanding relationship with their patients often have this information in their heads.

“Poor continuity gives rise to high risk medicine

In 2010 Dr Frank Jones wrote in Medicus: “Poor continuity gives rise to high risk medicine. Ideally continuity should be personal and longitudinal – the essence of the traditional general practitioner. However the very concept of continuity gets more complicated nowadays. How does it apply to single-handed GPs or to group practices?”

Indeed, continuity of care exceeds disciplinary and organisational boundaries. The Royal Australian College of General Practitioners describes continuity of care as “the situation where patients experience an episode of care as complete, or consistent, or seamless even if it is provided in a number of different consultations by different providers.”

The benefits of continuity

There is abundant evidence that continuity in primary care results in improved patient health outcomes and satisfaction. Evidence also indicates that primary care (in contrast to specialty care) is associated with a more equitable distribution of health.

GPs often manage up to 4 problems per visit, which is of course more efficient than walking ‘from one room to another’ in an emergency department or hospital outpatient department. Overall, primary care is associated with lower total costs of health services.

Looking at the primary care reform processes that are under way in Australia, it is not unlikely that the multidisciplinary general practice team will be the key component in the care for people with chronic and complex health conditions.

In part 2 I will discuss the six methods GPs use to improve our health, according to world-renowned primary care researcher Professor Barbara Starfield, and why primary care plays an important role in a sustainable health system.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.
Is family medicine going out of fashion?
Is the family doctor going out of fashion? Not really. Source: The Times

Do we trust our doctors? Why UK-style revalidation in Australia would be a big mistake

Australian doctors are kept on a short leash. I recently renewed my registration with the Australian Health Practitioner Regulation Agency (AHPRA). This annual ritual is always interesting.

Like thousands of other doctors, I first had to fill out an online questionnaire. As usual, AHPRA wanted to know if I had a physical or mental impairment, disability, condition or disorder – including substance abuse or dependence – that would detrimentally affect my capacity to work as a doctor. They reminded me I’m required by law to declare any impairments.

I had to answer questions about my criminal record, compliance with the law, continuous professional development, indemnity insurance, work history and even immigration status. If I did not give the required information, I could lose my registration.

Finally, I had to make a declaration that I spoke nothing but the truth, and I dutifully transferred the required $724 into AHPRA’s bank account.

High professional standards

The yearly AHPRA registration procedure symbolises the way doctors are controlled in Australia. Contrary to common belief, we’re allowed little freedom.

Before we can prescribe medications, we have to ring up Medicare to get approval. Our prescribing habits are being watched. We are audited randomly to make sure our billing practices are not out of line with our peers. We may be prosecuted by the PSR if we deviate from the average. In most states, doctors have to report colleagues who underperform.

At the same time, professional medical standards in Australia are high. Take the accreditation standards of the Royal Australian College of General Practitioners, or the CPD requirements. Both quality assurance programs have become more robust over the years and are continuously being reviewed and improved by the College.

The RACGP ‘Standards for General Practice’ ensure safe and high quality care, and are used by over 80 per cent of Australian general practices for accreditation. The QI&CPD Program recognises ongoing education to improve the quality of everyday clinical practice by promoting the development and maintenance of General Practice skills and lifelong learning.

Is there a problem?

So why is there still talk about revalidation of doctors? Is the public concerned about the quality of Australian doctors? It appears that the opposite is the case.

The national AMA patient survey indicated that GPs are considered by the public to be trustworthy, knowledgeable and experienced. A large patient satisfaction survey endorsed by the RACGP found there was a very high level of satisfaction with General Practice in Australia.

Another study published in the MJA also showed that patients reported high levels of satisfaction with GP care, and for many years Australian doctors have been in the top three most trusted professions in the annual Roy Morgan research.

Based on numbers from Canada, AHPRA estimates that 1.5 per cent of Australian medical practitioners are performing ‘unsatisfactorily’. I’m not sure Canadian figures can be applied to Australia, but 1.5 per cent of unsatisfactory performers in any group is low. It appears that any potential problem lies with a significantly small minority of doctors.

Carpet-bombing the profession

There are many revalidation models – from strengthening CPD to targeting those at high risk of complaints, to the full- bore version rolled out in the UK. But if the AHPRA tries to identify substandard doctors, carpet-bombing the whole profession is problematic.

Dr Steve Wilson, Chair of the AMA (WA) Council of General Practice, questioned in the Medicus magazine whether revalidation would address those who failed to practise to agreed levels. And if it did, he asked, would that be a sign of impairment or does it reflect personal style, or lack of time, training, experience or adequate remuneration? Excellent questions indeed.

Competency checks of doctors may sound appealing to the public. I’m sure some politicians will love the rhetoric. But simply copying the UK’s revalidation system would be a big mistake.

About 5,000 doctors a year are considering leaving the UK, and many come to Australia. Bureaucracy is one reason they emigrate. The last thing we need in Australia is more regulation, red tape and stressed-out doctors.

Existing quality systems

In recent years, our healthcare system has seen enough unsuccessful concepts not supported by evidence. Think for example about the super clinics program and the accompanying cost blowouts, delays and disappointing results. It will be easier and cheaper to build on existing quality assurance systems.

This article has previously been published in Medicus, the AMA(WA) magazine.

An easy introduction to Twitter

An easy guide to Twitter

“It’s like being delivered a newspaper whose headlines you’ll always find interesting.” ~ Twitter

Yesterday I was at a conference in Brisbane, organised by the Australasian Medical Writers Association. I met some interesting people and learned a lot about writing from speakers like Dr Justin Coleman and Ben Harris-Roxas.

Interestingly, many speakers mentioned Twitter. Social media are essential if you want to bring a health message across. Twitter is also a great tool to connect and collaborate with others and learn new things. It’s my favourite social media platform.

Twitter seems a bit daunting in the beginning, but it’s really easy to use. After reading this post, which should take you no more than five minutes, you will be ready to take the plunge.

Getting started

Because of the limited character count of 140, Twitter is called a microblogging platform. The social media giant describes itself as an information network made up of 140-character messages called tweets. A tweet is the expression of a thought or idea. It can contain text, links, photos and videos. Millions of tweets are shared in real-time, every day, all over the world.

Twitter egg head
Make sure you upload a profile picture, or Twitter will give you the default egg-head. You will get more followers if you use a good picture of yourself (and preferably not the dog or the cat).
You can read the tweets of people or organisations you follow in your timeline, and your followers can read your tweets, click on any links or hashtags you have included in your messages, or they can retweet your tweets, which means that they share your messages with their followers. I’ll explain it in more detail below.

You can use twitter from your phone, computer or tablet.

To get started, first sign up at twitter.com or directly from the app on your phone or tablet, and choose a public Twitter username (also called a Twitter ‘handle’). The user name is always preceded by the @ symbol. I recommend to use your own name or business/practice name, but any available name is fine.

I picked @EdwinKruys, and Twitter has assigned this Twitter URL (or web address) to me: https://twitter.com/EdwinKruys. Twitter users will see your preferred name next to your Twitter username. This is how my names appear: ‘Dr Edwin Kruys (@EdwinKruys)’. It doesn’t matter if you use capitals or not.

You may want to register a few variants of your name or business name. I have also registered @DrKruys and @DrEdwinKruys.

Here are a few examples of Twitter user names:

Next, you will have to set up your profile. Make sure you add a profile photo or Twitter will give you an egg-head. For professional accounts I recommend a 400×400 pixels close-up photo of your face – not the dog, cat, flowers or a stethoscope. Fill out a short description of yourself and a link to your website or blog.

If you like you can add a background header photo (recommended dimensions are 1500×500 pixels). Once you’ve done all this, start following people. See who others follow and follow the interesting people, organisations and businesses.

Click here for my list of Australian GPs on Twitter.

Twitter lingo

There is a bit of Twitter lingo you need to learn, but it’s easy. Let’s start with hashtags. A hashtag is any word or phrase preceded by the # symbol. Conferences and television shows often use a hashtag, e.g. #GP15Melb. Hashtags are also used for advocacy campaigns, like #AHPRAaction, #ScrapTheCap and #CopayNoWay.

A hashtag is like a label added to your tweets to better file and retrieve messages with a certain topic or theme. It doesn’t matter where you place it. And you can add a few hashtags if you like, although two is probably ideal. When you click on a hashtag in someone’s tweet, you will see all other tweets containing the same word or topic.

Here are some other Twitter buzzwords:

  • Tweet: A Twitter message
  • Tweeting: the act of sending tweets
  • Tweeps: Twitter users
  • Favouriting a tweet: this indicates that you liked a specific tweet
  • A follow: someone following your Twitter account. You can see how many follows (or followers) you have from your Twitter profile
  • Home: your real-time stream of tweets from those you follow, also called a timeline.
Social meidia in general practice
Tip: Have a look at the new Social Media Guidelines from the RACGP. It’s a good summary of the pros and cons of social media, including the AHPRA advertising and social media policies.

Your first tweet

When you compose your first tweet, you could write something like:

“Hi there, I’m new on Twitter. Still figuring out how this works.”

But if you haven’t got many followers, few people will read it. So you could tell someone that you have joined Twitter by adding their username to your tweet. I’ll use my username as an example, but of course anyone’s username can be inserted instead:

“Hi there, I’m new on Twitter. Still figuring out how this works. @edwinkruys

Now I will receive a notification that you have mentioned me, and I may respond, retweet your message or suggest a few people to follow.

If you would put my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:

@edwinkruys. Hi there, I’m new on Twitter. Still figuring out how this works.”

If you put something in front of my name, all your followers will see your message (instead of only those who follow you and me):

“Hi @edwinkruys, I’m new on Twitter. Still figuring out how this works.”

Try adding a hashtag and a link:

“Hi @edwinkruys, I’m new on Twitter. Still figuring out how this works. #newontwitter. Read my profile here http://www.mywebsite.com”

You can link to websites, pdf-files, videos etc. The hashtag increases the chance that others with similar interests will read your tweet.

Retweets and replies

A great way to get started is to retweet someone’s message. Ask questions or make some friendly comments to get a conversation going.

A tweet from someone else, forwarded by you to your followers, is known as a retweet or RT. Often used to pass along interesting messages on Twitter, retweets always retain original attribution. Respect the original message and make sure you don’t change the original tweet when you retweet. If you do change it, for example when you delete a few words to save characters, it will become a modified tweet or MT instead of a retweet.

Here is one example of a retweet. Imagine I have just tweeted this message:

“Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

You could retweet this – assuming you wanted to share it with your followers:

“RT: @edwinkruys: Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

You could also add a brief comment to tell your followers what you think of it or to start a conversation:

“Excellent resource, thanks for sharing! RT: @edwinkruys: Have a look at this great resource to get started on #Twitter: http://www.linktoresource.com”

There are other ways to retweet, for example by retweeting the complete original message without adding your own text, or by retweeting the original message in a box and adding your own 140 character message. Press the retweet button under a message (the two arrows going up and down) to discover the various options.

You can send the same message by replying. Note that, by putting my username at the beginning of your tweet, your message is still public but only those who follow you and me will see the message:

@edwinkruys Excellent resource, thanks for sharing!”

Again, if you want others to see your reply so they can follow our conversation, you need to add something in front of my name, even a full stop will do:

“.@edwinkruys Excellent resource, thanks for sharing!”

Or:

“Excellent resource @edwinkruys, thanks for sharing!”

When you share a resource you have found via someone else, it’s always nice to mention that person:

“Here’s and excellent resource to get started on Twitter: http://www.linktoresource.com – via @edwinkruys

Direct messages, lists and login verification

Use Twitter direct messages to start a private or group conversation with your followers. It is possible to enable a setting to receive direct messages from anyone, not just followers, which may be useful for businesses. Direct messages have no character-limit so you can type as much as you want.

You can add images to your Tweets and even a link plus an image. Although you’re limited to 140 characters, it is easy to get around this by taking a screenshot from a large amount of text and attaching it as an image to your tweet.

Twitter lists are often used to create a group of other Twitter users by topic or interest. Lists contain a timeline of tweets from the users that were added, offering a way to follow individual accounts as a group on Twitter.

There are many third-party apps available to manage your Twitter account(s). I often use buffer to schedule tweets. To avoid getting hacked I recommend using two-step login verification – see the video below. Have fun!

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

Competency checks on doctors could become a costly mistake

Competency checks could become a costly mistake
The last thing we need in Australia is more regulation, red tape and stressed-out doctors. Image: Pixabay.com

The Medical Board of Australia could be about to make a costly mistake. Regular testing of competency being introduced is not a matter of if, but when, said the new boss of the NSW Medical Council, Dr Greg Kesby, in an interview with Australian Doctor magazine.

Dr Kesby also said there needed to be a process to instil confidence within the community that all doctors’ knowledge was up-to-date.

On the face of it, competency checks of doctors sounds appealing. I’m sure some politicians will love the rhetoric. But at the same time, alarm bells were going off when I read the interview.

Many unanswered questions

Does Dr Kesby imply that the Australian public has lost confidence in its health practitioners? Are there concerns about the quality of Australian healthcare? There are many other unanswered questions too.

Is there any evidence that the current quality assurance systems, such as accreditation and CPD, are insufficient? Is recertification or revalidation — such as has been implemented in the UK — an efficient way to improve the quality of healthcare? Is it possible to design a system that reliably differentiates between good and bad practitioners? And how do we define competency?

Based on numbers from Canada, AHPRA estimates that 1.5% of Australian medical practitioners are performing ‘unsatisfactorily’. I’m not sure Canadian figures can be applied to Australia, but 1.5% of unsatisfactory performers in any group is low. There are numerous models: from strengthening CPD to targeting those at high risk of complaints, to the full-bore version rolled out in the UK. But if the board tries to identify these substandard doctors, carpet-bombing the whole profession is problematic.

An expensive solution

One thing is for sure: UK-style revalidation is expensive. The process takes 1-2 working days per practitioner. Imagine thousands of Australian doctors having to take a couple of days off work to fulfil revalidation requirements.

Imagine the enormous effort it will take to manage this process. Think about the additional cost of the training, time and wages of the appraisers — who, I assume, will be doctors too — and the admin staff, extra regulation, log books, documents, IT etc.

According to the UK’s Pulse magazine, the revalidation of doctors has become a colossal enterprise, costing taxpayers £97 million (about $207 million) a year. This figure does not include revalidation of other health practitioners. Critics of the UK system have said it will not detect poor doctors, as its main purpose is to gain patients’ trust. Others feel it mainly serves to demonstrate what good practice looks like.

Policing the profession

A former UK GP-appraiser, now working in Australia, mentioned on the GPs Down Under Facebook group that appraisals used to be fun, interesting and mainly pastoral. Under revalidation, they became a form of policing the profession, he said.

Professor Kerry Breen, adjunct professor in the department of forensic medicine at Monash University, wrote in the Medical Journal of Australia last year that there was little evidence to support the idea of transposing the UK system to Australia.

He said that despite some local failures of medical regulation and hospital governance, the community had not lost faith either in its doctors or regulatory system. Indeed, it appears the public is largely content with its healthcare practitioners: Australian doctors, nurses and pharmacists have been in the top three most trusted professions for many years in the annual Roy Morgan research.

More recently, Dr Steve Wilson, an AMA WA representative, questioned in the AMA’s magazine whether revalidation would be able to address those who failed to practise to agreed levels. And if it did, he asked, would that be a sign of impairment or does it reflect personal style, or a lack of time, training, experience or adequate remuneration?

Don’t follow the UK

About 5000 doctors a year are considering leaving the UK, and many come to Australia. Bureaucracy is one reason they emigrate. Simply copying the UK’s revalidation system would be a big mistake. The last thing we need in Australia is more regulation, red tape and stressed-out doctors.

In recent years, our healthcare system has seen enough unsuccessful concepts not supported by evidence. Think about the super clinics program or the PCEHR, and the accompanying cost blowouts, delays and disappointing results.

It will be easier and cheaper to build on existing quality assurance systems.

Let’s look, for example, at refining CPD and accreditation. As they say, the main difference between a wise man and a fool is that a fool’s mistakes never teach him anything.

Developing an expensive new system with little or no supportive evidence failed in the case of super clinics and e-health, and it will fail with revalidation too.

This article was originally published in Australian Doctor Magazine.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

The joys of pay for performance

The joys of pay for performance
Image: Pixabay.com
“G’day doc. I’m a little embarrassed to bring this up but…”

“No worries, you know you can be honest here. Let’s check your blood pressure first. It was a bit high last time.”

“Oh… ok. Not dangerously high I hope?”

“Well it was just above the benchmark, which is concerning. As you know I don’t get paid if I don’t look after your pressure. Let’s see… 140 over 90. Uh oh. I’m afraid we have to bump up your medications.”

“But doc, could it be stress? I wanted to tell you that…”

“Stress, stress… That’s all well and good but Medicare doesn’t care what the cause is. If it’s too high I miss out. And if I miss out you miss out, you know that don’t you? We also have to talk about your weight target. As I’ve told you before, if you don’t lose those extra pounds our practice cannot afford to look after you any longer.”

“Are you listening to me? John and I broke up last night. I’m a mess!”

“I’m sorry to say that there’s no incentive payment for counselling anymore. Please do me a favour and book in for your pap smear on the way out. Last time you were late and we missed the deadline for our quarterly Medicare bonuses. We don’t want that to happen again do we?”

 Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

Top Australian GP Bloggers

If you enjoy reading health blogs, look no further! This list of Top Australian GP Bloggers in 2015 contains some pretty amazing Family Medicine blogs with many new and upcoming writers.

In previous years I have listed the sites alphabetically, but this year I thought I’d categorise them as follows:

  1. Lifestyle tips
  2. Doctor’s diary & storytelling
  3. Medical education
  4. Patient information
  5. Healthcare, innovation and health politics

Each blog mention contains a brief description and/or quote taken from the ‘about’ section of that blog. Enjoy!


1. Lifestyle tips

‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn
Top blog: ‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn

‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn

Healthy eating, exercise and weight loss ideas, motivation and support. No scams or fads – just a sensible lifestyle approach. A great blog offering healthy tips, news, information and inspiration.

http://lean-green-and-healthy.blogspot.com.au

‘Eat move chill.’ By Dr Kevin Yong

On his blog Dr Yong shares ideas about healthy living: “It’s about getting back to basics and building a strong foundation of health. It’s about turning your good intentions into lasting change. It’s about you taking control and living a better life.” Very inspiring.

http://eatmovechill.com

‘The healthy GP – Live intentionally, love relentlessly and enjoy your health.’ By Dr Jonathan Ramachenderan

Dr Ramachenderan and his family live in the country in Western Australia where he practices as a General Practitioner and anaesthetist. He has some excellent advice for men and dads.

“We are in the busy, child rearing season of life coupled with the beginning of my career and hence achieving a balance is important. I am passionate about men’s health, helping and communicating with other dads, building stronger relationships with our wives and becoming wiser, stronger and more insightful men.”

https://thehealthygp.wordpress.com


2. Doctor’s diary & storytelling

‘Medical history.’ By Dr Gillian
Top blog: ‘Medical history.’ By Dr Gillian

‘Armchair rants from Dr Deloony, musings on Medicine and Life.’ By Dr Claire Noonan

Dr Noonan is a country GP and freelance writer. “My interests, medical and otherwise include but are not limited to: humans, science, general practice, bariatric medicine and surgery, fiction, music, travel, food/nutrition, mental health, philosophy and kittens. I am VERY interested in kittens.” Personal and well-written posts.

https://drdeloony.wordpress.com

‘Medical history.’ By Dr Gillian

Dr. Gillian is a GP Obstetrician, writer, wannabe photographer. For those with an interest in medical history, her blog has a lot to offer:

“In this blog I combine my love of salacious celebrity gossip, medicine and history to give you all the dirt on Henry VIII’s sex life and how it might make his penis fall off.*”

*Not actually true

http://medicalhistory.blogspot.com.au

‘Ailene Chan.’ By Dr Ailene Chan

Dr Chan has worked in many Aboriginal Community Controlled Health Services and Asylum Seeker and Refugee health in Christmas Island and Nauru.

“Being a doctor means being a global citizen. I will share with you my travels, the people I meet and the things I’m learning in medicine and in life.” Beautiful blog!

http://www.ailenechan.com

‘DrJustinColeman – Medical writer, editor, blogger.’ By Dr Justin Coleman

Dr Justin Coleman is a well-known GP-writer who looks sceptically at health interventions where the evidence suggests they might not actually be worthwhile. This is part of his broader interest in the public health concept of equity – fair access to primary health care for everyone.

As he writes on his blog: Despite earnest intentions, he frequently breaks out into lighter reflections on GP practice, with its quirks and oddities – often discovering the oddest person in the room is him!

http://drjustincoleman.com

‘Genevieve’s anthology – Writings to amuse, teach, inspire and entertain.’ By Dr Genevieve Yates

The multi-talented Dr Yates is not only a freelance columnist and novel/play writer, but she also finds the time to play and teach violin and piano, sing, and play in two orchestras.

“This website features a collection of my writings. Here you will find links to and samples of my newspaper columns, novel, short stories, plays and creative medical educational material, plus the odd blog or two.”

http://genevieveyates.com

‘Dr Charles – The blog musings of Dr Charles Alpren.’ By Dr Charles Alpren

Dr Alpren worked at (and blogged about!) the Ebola Treatment Centre in Sierra Leone. He is currently a locum GP who works all over Australia. He has an interest in children’s health, vaccinations and infectious disease, and is also interested in teaching and Public Health.

https://doctorcharles.wordpress.com

‘Jacquie Garton-Smith.’ By Dr Jacquie Garton-Smith

Working as a General Practitioner with a special interest in counselling and family medicine has given Dr Garton-Smith insight into relationships and communication as well as responses to life events:

“My experience is that we can often access our emotions, learn and better understand ourselves through fiction.”

Dr Garton-Smith was the Western Australian Winner of 2009 Medical Observer Short Story Competition for GPs. She is currently working on two novels.

http://jacquiegartonsmith.com

‘KarenPriceBlog – Hippocrates meets Xanthippe.’ By Dr Karen Price

Miscellaneous topics and reblogged posts – often with thought-provoking commentary by Dr Price. Dr Price is Chair of the Women In General Practice Committee of the Victorian RACGP.

“I am active on Twitter and interested in technology as it relates to health. I am prone to an occasional rant so the picture of me with a thistle is probably appropriate. I welcome respectful debate as it contributes to the Science and Art of Medicine.”

http://karenpriceblog.com

‘Peak Health – Challenging the assumption that our health and our longevity will inevitably improve.’ By Dr George Crisp

Our health depends on a healthy environment, says Dr Crisp – who is passionate about our environment.

http://georgecrisp.blogspot.com.au

‘A fig page – Random thoughts from someone who loves Jesus.’ By Dr Joe Romeo

A spiritual blog by Dr Romeo, who is a full-time country GP, aspiring songwriter/ worship songwriter, father of 6 and follower of Jesus Christ.

http://afigpage.blogspot.com.au


 3. Medical education

‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce
Top blog: ‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce

‘FOAM4GP – Free Open Access Meducation 4 General Practice.’ Various authors

Excellent and comprehensive collection of blog posts and podcasts by various rural and city GPs.

“This blog and podcast is for Australian General practitioners, training to be one or already working as one. We cover the whole range of our medical specialty and give you what you need to pass your exams and keep learning in your clinical practice.”

The blog was founded by Dr Rob Park, Dr Minh Le Cong, Dr Casey Parker, Dr Tim Leeuwenburg, Dr Jonathan Ramachenderan, Dr Melanie Considine and Dr Gerry Considine.

http://foam4gp.com/about

‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce

Excellent podcasts including useful links to resources for anyone with an interest in obstetrics and gynaecology – produced by two passionate GPs from Western Australia and Queensland.

http://bitsandbumps.org

‘Michael Tam – Publications archive.’ By Dr Micheal Tam

Michael Tam is a Staff Specialist in General Practice at the Academic General Practice Unit in Fairfield Hospital, in Sydney. His blog is a collection of interesting research articles and interviews.

Dr Tam’s clinical interest is in comorbid substance use disorder and mental health disorders. His research interests are in the detection of at-risk drinking in the primary care setting, and in e-learning in medical education.

http://vitualis.com

‘GreenGP – Reflections of a Rural GP.’ By Dr Melanie Considine

An interesting blog with lots of medical conference reports, tips for students and GP registrars – including how to use social media. Dr Considine is a board member of the SA/NT RACGP Faculty and the RACGP National Rural Faculty.

https://greengp.wordpress.com

‘Broome Docs – Medical education blog for rural GPs.’ By Dr Casey Parker

Top blog intended to provide a single source of up-to-date educational material for country doctors.

“I hope this site can expand this brain pool of rural doctors – please feel free to leave comments on the cases and posts presented – we can all learn from one another – no matter how far we are from the really smart guys in the big centres.”

http://broomedocs.com

‘THE PHARM – Prehospital and retrieval medicine.’ By Dr Minh Le Cong

Dr Le Cong’s comprehensive blog is for the health professionals working in remote locations, outside a hospital, on aircraft, ambulances, in outposts who have to deal with emergencies and the unexpected.

“My focus is rural Australia but my journey will be international, hearing from folks in other countries and how they deal with out-of-hospital emergencies. Of course I am a flying doctor so there will be a healthy dose of aeromedicine.”

http://prehospitalmed.com

‘KI Doc – Kangaroo Island doctor blogging about Rural Medicine in Australia.’ By Dr Tim Leeuwenburg

Encouraged by emergency medicine and retrieval medicine blogs such as EmCrit, Resus.me, BroomeDocs and Prehospitalmed, Dr Leeuwenburg has embraced the #FOAMed paradigm: “Whilst the lifeinthefastlane emergency physicians have lead this in Australasia, I reckon #FOAMed has a lot to offer rural doctors.” Excellent blog.

http://kidocs.org

‘Rural GP Education – Thoughts and experiences on the journey to enlightenment.’ By Dr Ewen McPhee

Dr McPhee is an experienced rural GP and educator in Central Queensland. On his blog he shares his thoughts and other interesting posts about healthcare and medical eduction.

https://ewenmcphee.wordpress.com


4. Patient information

‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis
Top blog: ‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis

‘Dr Ginni Mansberg.’ By Dr Ginni Mansberg

Ginni Mansberg is a well-known, celebrity doctor in Australia. She is a Sydney GP sidelining for Sunrise & Morning Show, various magazines, and is a self-proclaimed wannabe Masterchef and caffeine addict.

http://www.drginni.com.au/blog.html

‘Do It Yourself Health DIY Health), Healthy Living and Health Information from Dr Joe.’ By Dr Joe Kosterich

Dr Kosterich is a well-known GP, author, and keynote speaker. “Your well-being is the most important thing you have.  My passion is empowering you to take charge of your own health through easy to understand steps enabling you to live well for longer.”

http://www.drjoe.net.au

‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis

This is a great example of a practice website with health tips and interesting newspaper articles and reblogged posts including comments by Dr Tellis. Dr Tellis is passionate about great quality General Practice and is enjoying beach-side practice after seven years in rural South Australia.

http://partridgegp.com

‘The Healthy Bear.’ By Dr George Forgan-Smith

Dr George Forgan-Smith is a GP and passionate gay doctor in Melbourne Australia: “I have a strong interest in male health, mental health and health promotion. I enjoy writing and teaching and I hope that this website may help to inspire other men to move towards health in all aspects of their life.”

http://thehealthybear.com


5. Healthcare, innovation & health politics

‘Lean Medicine.’ By Dr Moyez Jiwa
Top blog: ‘Lean Medicine.’ By Dr Moyez Jiwa

‘The Influence of the Tricorder.’ By Dr Tim Senior

Dr Senior has an interest in Aboriginal health & medical education. Other themes he often writes about are environments that keep us well and social justice.

His blog is an amazing collection of various articles he has published over the years. “I write stuff. It ends up in various places on the web. This site keeps track by linking to it all from one place.”

http://iofthet.blogspot.com.au

‘Lean Medicine.’ By Dr Moyez Jiwa

A well-written and beautiful blog about solving healthcare problems with creativity, intuition and insight with lean and inexpensive innovations. Dr Jiwa is Professor of Health Innovation at Curtin University and a GP practicing in Western Australia. He is also the Editor in Chief of The Australasian Medical Journal.

http://leanmedicine.co

‘Dr Thinus’ musings – This is Canberra calling.’ By Dr Thinus van Rensburg

“Canberra – we love it and, despite what the rest of Australia might think, it is not just about pollies and Public Servants. It has it’s ups and downs but this is our hometown and I hope readers enjoy my occasional posts.” Honest commentary on a variety of articles and reblogged posts by Dr Van Rensburg.

https://tvren.wordpress.com

‘Doctor’s bag.’ By Dr Edwin Kruys

Health politics and e-health. I’m living in the Sunshine Coast, Queensland, where I work as a GP. When I’m not working I spend time with my family or blog about healthcare, social media and e-health.

http://doctorsbag.net


 Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

A painful topic: what doctors need to know (according to patients)

Ok, so I was wrong. I really liked the RACGP good GP television commercial. It had some flaws but I thought they were small in the grand scheme of things (see my last post). But many patient advocates did not agree and were unhappy about the lack of communication portrayed in the video.

Blogger Michelle Roger commented: “My current GP asks me what I want to do, what I think is most important and together we sort through the problem at hand and potential solutions. I feel valued and heard and trust her more knowing that she listens and knows me and my family.”

“That for me was missing in the video. It was one-sided and the patients appeared little more than props to be talked at. In fact the patients had no voice at all. A problem that still permeates a lot of medicine.”

Crockey health blog posted an article titled ‘The Good GP never stops learning: the RACGP video that made doctors cry – and patient advocates wince’. In a response to this article Irish blogger Marie Ennis-O’connor wrote on her blog: “We can’t just talk about a commitment to patient centred care – we have to live it. It is only by bridging the divide which places patient and doctor expertise on opposite sides that we can achieve more personalized and meaningful care of the patient.”

Patient blogs

I wondered why the patient opinion was so different to mine. On Twitter it was suggested to me that more doctors should read patient blogs to understand their view better. I thought that was a good idea so I asked for some recommendations and started reading.

I can tell you, it didn’t cheer me up but it was enlightening. It felt a bit like a refresher course “do’s and dont’s for doctors”. What I read was that, in the eyes of patients:

  • Doctors often don’t know how to deal with disabilities
  • Doctors sometimes blame patients for treatment failures
  • Some doctors find it hard to accept patients as experts
  • Doctors don’t always communicate well.

Now that I’ve read the blog posts I feel that I can better appreciate the patient response to the RACGP video – and I learnt a lot more along the way.

I have been given permission to share parts of these blogs and I recommend anyone who works in healthcare to read on. It may help to bridge the divide. Doctors beware: don’t expect flattery.

Empathy towards disability

Carly Findly
Carly Findlay: “Doctors need to move past the textbook and immerse themselves in the disability community to truly learn and empathise with our experiences.” Source: Carly Findly

In one of her posts writer and speaker Carly Findlay tells the story of how doctors gave up on her and told her parents to prepare for her death, and how she later met one of these doctors.

(…) “Over the Christmas holidays, I introduced myself as an adult to the dermatologist who gave me a pretty dismal prognosis as a baby. He pretended not to remember me until he told me I always had blocked ears. I think he was surprised to see me. I told him some of my achievements including how I am now educating dermatologists about my condition (something he needed when he treated me).”

(…) “Other people with Ichthyosis tell me that doctors didn’t give them a chance either. My friends have said that their parents were told they wouldn’t make it into mainstream school, that they wouldn’t have relationships or children, and that they would be social outcasts.”

(…) “The political models of disability can determine a person’s compassion and empathy towards disability. And so a doctor’s low expectations for a baby born with a disability can set the scene for their attitude through the lifespan of that patient.” (…) Doctors need to move past the textbook and immerse themselves in the disability community to truly learn and empathise with our experiences.”

Read the complete post here. Follow Carly on Twitter

Blaming patients

Caf
Caf: “I’m not sure that I truly trust any doctors, despite having a lovely GP.” Source: Rellacafa

Blogger Caf explains how doctors told her to see a psychiatrist when their attempts to treat her chronic pain failed.

“I had arrived at the appointment of the reveal, hobbling with a pair of forearm crutches. I could hardly bear any weight on the offending ankle. It didn’t take long for him to deliver his message, laced with condescension and arrogance. ‘There’s nothing wrong with your ankle. Why are you on crutches?’”

(…) “Chronic pain has been misunderstood and stigmatised for so long that many people probably don’t know what to believe. Even patients themselves often wonder if they’ve just gone crazy because their symptoms are so utterly illogical.”

Caf says that her experiences have affected her trust: “I’m not sure that I truly trust any doctors, despite having a lovely GP.”

Read the complete post here. Follow Caf on Twitter

Michelle also writes about pain in this post: “And there is a pervasive idea of the drug-seeker, seen in every patient who has chronic pain. That those who simply don’t get over pain and require ongoing pharmaceutical management are weak.”

“Friends who have used pain clinics tell stories of dismissal and blame. That they are not trying hard enough when they don’t recover, when I know the lengths they have gone to to try and alleviate their pain. And compassionate pain doctors who become the exception not the rule.”

The patient as expert

In another post she writes: “As a patient with an unusual, complex, and poorly understood disorder, 9 times out of 10 when I see a new doctor I am the expert in the room.”

(…) “I spend my spare time researching my disorders on Medline. I flip through Cochrane Reviews, and review consensus statements regularly. I read up on the drugs I’m taking and keep abreast of current research trials. On forums, I can ask questions of other patients.

“The constant fight to be heard is exhausting

Arm rash Michelle Rogers
Michelle Rogers: “I awoke to welts and rashes across my body. My pre-op information met with eye rolls, a sense that I was over-anxious, and thus completely ignored.” Source: Living with Bob (dysautonomia)

(…) “Some doctors are quite happy to acknowledge that I may know more about my disorder than they do. For example, my GP is happy for me to take the lead on my treatment needs. Even my cardiologist is happy to discuss my disorder in more of a collegiate manner, than the traditional doctor-patient relationship.”

(…) “Yet there are many others who are nothing short of dismissive. Should I dare to suggest a potential treatment or line of investigation the appointment can become adversarial. At times what I say is outright ignored.”

“Case in point my recent hospital admission. Despite having a red allergy band on my arm, sharing the information from my Allergist, and speaking to both my neurosurgeon, anaesthetist and senior nurse about my allergy to adhesives, I awoke to welts and rashes across my body. My pre-op information met with eye rolls, a sense that I was over-anxious, and thus completely ignored.”

(…) “The constant fight to be heard is exhausting. We are told that we must be our own advocates. That the future is patient-centred medicine. That rapport and making a patient feel part of the decision-making model leads to more compliance and more successful outcomes.”

New technology

Michelle: “Patients no longer live in a bubble where they are reliant upon their doctors as the only source of information. With the advent of social media and the ease of access to medical journals, patients can be as up to date, and at times, in front of their doctors, with regard to advances within their various disorders. We come empowered and informed to our appointments and have an expectation that our doctors will be equally informed or at the least, willing to listen and work with us.”

“We have an expectation that our doctors will be equally informed or at the least, willing to listen and work with us

“The medical community needs to be aware of the new ways information is being shared, especially the speed at which information can now travel. Instead of criticising patients for researching their ailments, they should instead be working with them, especially to direct them to more appropriate medically sound sources of information.”

“Patients are already distrustful of big pharma and the way research is funded. If their physicians also refuse to help them navigate these areas or are dismissive of their efforts, such distrust will also pass to them, to the detriment of both practitioner and patient.”

Read the complete post here. Follow Michelle on Twitter

Doctors who listen

Carly: “I went to hospital earlier this year. I was so sore, and a bit miserable. I saw a junior doctor, one I had not seen before. I spent an hour in the consult room, talking to her about Ichthyosis, but also my job, blogging, wedding plans, travel and the Australian Ichthyosis meet.”

“Their compassion means I am a human being first

“She said I was the first patient she’d met with Ichthyosis and she wanted to learn more than what she’d seen in the textbook. Her supervisor came in to provide further input into my treatment. Again, we talked about life, not just Ichthyosis.”

“And she told this junior doctor how lucky they are to have me as their educator. What a compliment. I am so lucky to feel empowered as a patient at my hospital. These doctors listen to me. They treat me as a person not a diagnosis. They see my potential and are proud of my achievements. Their compassion means I am a human being first.”

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

Why doctors should work closer with patient organisations

Why we should work closer with patient organisations

Historically, campaigns against bad government health policies have been predominantly doctor-centric. And the usual government response is to divide doctors and patient organisations.

Many politicians have mastered playing the ‘greedy doctor’ card, which is an effective way of making doctors’ objections seem less trustworthy.

A while back, I interviewed the influential patient advocate Jen Morris for my blog. Ms Morris is a researcher in healthcare quality and safety at the University of Melbourne.

Patient–doctor alliance

We spoke about the untapped power of the patient–doctor alliance. She strongly feels that we can achieve so much more in Canberra if patients and doctors joined forces more often.

“At a strategic level, it’s a numbers game,” she said. “There are approximately 26,000 GPs in Australia, and about 82,000 registered medical practitioners. But there are over 23 million patients. That is an enormous bloc of voters and lobbyists to leave untapped.”

The RACGP’s ‘You’ve been targeted’ campaign earlier this year against the co-pay plan was an example of what happens if patients stand united with GPs to protect primary care. The Consumers Health Forum of Australia (CHF) issued a joint press release with the RACGP and the Australasian College for Emergency Medicine to reject the co-payment scheme. The RACGP’s change.org online petition had obtained 44,800 signatures within a week.

Other organisations including the AMA followed suit. The broad approach seemed to have an impact, first in the media and eventually in the corridors of power, and GP co-payment and extended level A consultations were dropped.

More recently, the RACGP, the Royal Australasian College of Physicians, and the CHF partnered in a joint submission to the Federal Health Minister regarding the deregulation of pharmacy locations and ownership.

Concerns

Although these are great developments, there are also concerns. What if our goals are in opposition?

Take for example the PCEHR. Patient organisations want full control of the data, which makes it less useful as a clinical tool for doctors.

Understandably, there is scepticism from both sides. Patient organisations may be wary of working with powerful medical organisations setting the agenda. Patients may feel that doctors are not genuinely interested in their opinions. Doctors on the other hand may be concerned about increasing demands and consumerism.

Morris: “It is important to remember that disagreement doesn’t only pose an obstacle in ‘patients and providers’ scenarios. Neither patients nor providers are homogeneous groups, and we do well to remember that. It is worth asking how providers approach the problem when they disagree on an issue or project, and source lessons from that.”

So, the answer lies in building trusting relationships. GPs are good at this on an individual level. It is one of the strengths of general practice. We should be doing the same at an organisational level. Working closely with patient organisations will improve the mutual understanding of our values and beliefs.

According to Ms Morris, we should be looking for common ground. More often than we acknowledge, patients and doctors are really advocating for the same outcomes. But too often, she added, we don’t take the time to really analyse where the crux of disagreement actually lies. Morris: “(…) if we find that the aims of doctors and patient organisations are so distinct as to be deemed incompatible, we should be re-evaluating those aims urgently.”

‘Them and us’

Of course, the ‘them and us’ thinking also occurs between providers. This can be confusing for patients and third parties including government organisations. For that reason, I’m a great believer in the power of United General Practice Australia. It is made up of the main GP groups, including the colleges, the rural groups, the AMA, registrars and supervisors and the divisions network. These organisations have shown a desire to collaborate and put aside their differences.

A similar structural working relationship should be developed between doctors and patient organisations. This alliance should exist not just to respond to new developments, but also to proactively set out a future course and lobby governments accordingly. It would make primary care less vulnerable to the rapidly changing preferences and priorities of the government of the day.

It is good to see the willingness from both sides to work together, and I hope it is the beginning of a fruitful collaboration in years to come. We must harness the potential power of the patient–doctor alliance to protect what’s good and, where needed, improve the care for our patients.

This article was originally published in Australian Doctor Magazine.

Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

5 questions to ask your doctor (before you get any test or treatment)

5 Questions to ask your doctor

The National Prescribing Service (NPS) has made an interesting list of 5 questions patients should ask their doctors. The aim is to be well informed about the benefits and potential harm before you undergo medical tests, treatments, and procedures.

I think the list is useful and I’d encourage people to ask these questions. At the same time I suspect I will not be able to answer all the questions. For example, I don’t know the costs of all available tests, and the exact risks of certain interventions is something I may have to look up.

I have been told NPS is planning to develop resources for doctors so they can better help their patients with these queries. This would indeed be helpful. But in the meantime, feel free to ask! I hope it will lead to less unnecessary interventions.

Choosing wisely

So here they are, the 5 questions to ask your doctor before you get any test, treatment, or procedure:

5 questions NPS

Source: Choosing Wisely Australia

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Should health professionals discuss patients online? (poll)

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It’s time we cut all this red tape ourselves

It's time we cut all this red tape
Image: Pixabay.com

It had taken a year to organise the required paperwork to make the move from the Netherlands, and finally I was here, about to start my job in a remote hospital.

However, the manager on the other side of the desk had other ideas. She looked at me over her glasses and shook her head. I wasn’t allowed to work, she said, because my Medicare provider number would take another month to come through.

Of course, this was just the beginning. After a few years working in the bush, I was thrilled to qualify for a permanent Australian residence visa. But first I had to pass the international English language test — again.

“G’day mate, do you really need me to come to the big smoke?” I asked a clerk at some department over the phone. “I’m flat out looking after this mob in the back of Bourke. I passed that exam ages ago, before I came to the Lucky Country. Surely me Strine hasn’t got worse since I’ve been here. Crikey, the rellies back home reckon I have a dinky-di Aussie accent.”

Needless to say, I had to sit the English test again.

Red tape bugbears

This was a decade ago, but things haven’t got any better. The GPs Down Under (GPDU) Facebook group, a new, quickly growing online community of Australian GPs and registrars, listed their ‘red tape bugbears‘ earlier this month.

The amount of time and energy GPs waste filling out forms and jumping through bureaucratic hoops is gobsmacking.

One GP recently posted on the GPDU Facebook page: “For practices employing a new rural doctor, there are at least 14 different forms across Commonwealth and State jurisdictions. Some have to be completed online, some need to be scanned, some mailed — yes, with a stamp. And some faxed.”

Hospital bureaucracy is also a big bugbear for many GPs. For example, in Queensland the public hospitals have an extensive referral ‘criteria’ for each department. GP referrals that don’t tick their boxes – often checked by non-medical staff – are simply refused.

One orthopaedic outpatient department doesn’t accept a referral until GPs have faxed a completed three-page ‘hip and knee questionnaire’.

Other health professionals can also add to the GPs’ burden when they selectively take over parts of our job under the notion of helping to reduce our workload.

But it doesn’t always work out that way as one GP on the GPDU site recently highlighted when she told of how her local pharmacy happily manages her patients’ warfarin doses, but only as long as the INR is within a safe range.

“Apparently this service is more ‘convenient’ as well as lucrative for the pharmacist. Until the INR level is more than 2.5. Then, late Friday afternoon, the pharmacy demands I manage the warfarin dose. So then it’s suddenly my problem,” she posted.

Knee-jerk reaction

Red tape is often a knee-jerk reaction to a problem and not usually the best solution.

An estimated 25,000 patient consultations are lost every month while doctors are waiting for PBS Authority call centre operators to answer the phone. Meanwhile, our Medicare-funded sick certificate ceremony is estimated to cost the Australian economy $3 billion a year.

It’s time we did something about it.

Collaboration with other professions and organisations is more important than ever. If we help hospitals solve some of their outpatient department problems, our workflow will improve too. GPs need to negotiate innovative solutions that are mutually beneficial and acceptable. Building relationships, communicating and networking are the key to success.

We are in an ideal position to show leadership. This means we have to organise ourselves better, learn to be good followers, and support those who are trying to build bridges, including our peak organisations. No doubt we will occasionally have to compromise and, in some instances, lift our game.

I realise this is not easy in the current climate of cuts and freezes, but if we fail to do this, others will continue to take control of primary care. I love Australian general practice – it’s a great profession and the reason why I came to Australia. But we must protect what’s good and make it future-proof.

My call to action to colleagues, the colleges and the AMA is simple: please use your extensive experience and influence to make things easier for all parties involved.

This article was originally published in Australian Doctor Magazine.

Follow me on Twitter: @EdwinKruys.
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