This joke was posted by a colleague. He pointed out that the scenario is very applicable to general practice. Indeed, it nicely illustrates the cost benefits of a good doctor who can often make a diagnosis without many expensive tests…
A woman brought a very limp duck into a veterinary surgeon. As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird’s chest.
After a moment or two, the vet shook his head and sadly said: “I’m sorry, your duck, Cuddles, has passed away.”
The distressed woman wailed: “Are you sure?”
“Yes, I am sure. Your duck is dead,” replied the vet.
“How can you be so sure?” she protested. “I mean you haven’t done any testing on him or anything. He might just be in a coma or something.”
The vet rolled his eyes, turned around and left the room. He returned a few minutes later with a black Labrador Retriever. As the duck’s owner looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom.
He then looked up at the vet with sad eyes and shook his head. The vet patted the dog on the head and took it out of the room.
A few minutes later he returned with a cat. The cat jumped on the table and also delicately sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.
The vet looked at the woman and said: “I’m sorry, but as I said, this is most definitely, 100% certifiably, a dead duck.”
The vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to the woman.
The duck’s owner, still in shock, took the bill. “$150!” she cried, “$150 just to tell me my duck is dead!”
The vet shrugged. “I’m sorry. If you had just taken my word for it, the bill would have been $20, but with the Lab Report and the Cat Scan, it’s now $150.”
The passionate country doctors featuring in these videos with their patients are great examples for rural general practice. Warning: After watching the interviews you may feel the sudden urge to pack your bags and move to the country.
Dr Ken Wanguhu: “Being a GP has taught me that there is a lot more to medicine than disease… It goes beyond the disease to the patient and their family and to the community, and that’s general practice.”
The second video features Dr Mel Considine and her patient Phil from rural South Australia. Phil: “And the first thing I remember was this lovely lady leaning over me, and she said ‘I’m Doctor Mel, the duty doctor today, and I’m here to look after you.'”
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.
‘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.”
‘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.
‘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!
‘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.”
‘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.
‘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.”
‘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.
‘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.
‘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.
‘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.”
‘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.”
‘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.
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.
‘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.”
‘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.
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.”
‘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.”
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.
‘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.
The first video of a national awareness campaign by the Royal Australian College of General Practitioners (RACGP) highlighting the value of general practice, has brought tears to the eyes of many GPs.
The clip starts in the seventies, when home pregnancy tests were not widely available. The young, fresh GP is visibly happy to bring the good news to a couple in his consulting room (“You have a baby on the way”). There is no computer in the room, lots of paperwork on the doctor’s desk, and we see furniture and filing cabinets from times gone by.
As we follow the couple and the doctor over the years, the consulting room changes too. If you look closely (admittedly this may be of interest to medicos only) you will see a beautiful old mercury sphygmomanometer on the trolley. Computers begin to appear on the desk. Time flies in the video; in a matter of seconds the GP and his patients age and new family members enter the consulting room.
The lifelong journey
Towards the end one of the children has become a mother. The GP, now with grey hair, says to her “we have quite the journey ahead of us,” as he gets up from his chair with the visible difficulty of an older man.
Indeed, sharing the journey through life is one of the aspects that sets the GP apart from other disciplines. And just like in the video we’re there for the minor ailments – the nits – as well as the big and often emotional life events, such as a cancer diagnosis or the death of a spouse. I think the video brings this message across very well and that may be why it triggers an emotional response.
But the video also contains another message. Observant viewers will have noticed that the GP has two framed certificates hanging on the wall at the beginning of the clip and, as time moves on, more certificates follow.
The importance of education and learning gained through fellowship of the RACGP is a key message of the campaign. A voiceover at the end tells us: “The good GP is with the Royal Australian College of General Practitioners, because the good GP never stops learning.”
There is of course, as always, criticism. Some have commented that telling patients they have to do something may not be the most effective way to encourage change – like smoking cessation. Good GPs have a conversation with their patients. Others have mentioned the video doesn’t reflect our multicultural society or the gender diversity in medicine.
Fellows of the Australian College of Rural and Remote Medicine (ACRRM) may rightly say that they too are good GPs. And lastly, there seems to be a disconnect between the clip and the message about lifelong-learning at the end. It may be easier to brand general practice than a GP college.
I believe some of the criticism will be addressed in future campaign material – but it is also good not to lose sight of the bigger picture. The campaign aims to improve the recognition of GPs and general practice. If it’s as successful as the RACGP’s You’ve been targeted campaign, the promotion of general practice will benefit all those working in primary care, and more importantly, our patients.
Strong general practice
Personally I hope the campaign opens the eyes of some politicians. Australians rate their doctors in the top-3 of most honest and trusted professions and they visit the GP on average 5-6 times per year. GPs are good value when it comes to spending tax payers money: The average GP consultation costs $50, compared to for example $400-600 per service in a hospital emergency department.
It is a good idea to reduce waste and duplication in healthcare, but poorly targeted cuts and freezes will do more harm than good to the health of Australians. We must also reduce the amount of red tape and stay away from more bureaucracy, like NHS-style revalidation – so doctors can look after their patients instead.
The success of a campaign depends on the people who support it. In a video message directed at doctors RACGP president Dr Frank Jones said: “Talk to your patients and key people in your community about the importance of general practice. Our training and the accreditation standards are why the good GP never stops learning.”
The video touched the hearts of many GPs, but in the end it’s the impact on patients that matters most. I hope its positivity will be contagious.