The Dumbing Down of General Practice

Is GP work being “Dumbed Down”??

In a recent advert by some consultant they are charging a lot per person to say how they should protect themselves from any future litigation arising from a patient contracting some infection from some type of surgical intervention at their practice. This is trading on the concerns / worries guilt that all GP’s have, because no matter how secure their Practice Protocols, how great their case notes—there is still the possibility of being sued for patient outcomes that either did not arise from faulty patient management.

In the example the person providing the session said that in the event of a patient contracting Hep C it could be seen that it could have arisen from recent surgical intervention and that our records / sterilisation may prove unable to defend us.

At first sight it might be simpler to either contract out the sterilisation or simply not to do any work like that. This is in the path of action that might follow if you are challenged for a “missed diagnosis”. So you begin to refer everybody – that cough for one week gets an xray ?? lung cancer etc.

In the end you ability to manage any problem which is even slightly complex becomes eroded. Partly because of a lack of information / partly the lack of numbers seen with that problem. So it means that you long to get out of your practice and become a locum. This partly helps because you are less likely to be blamed if you do not see that patient in a longitudinal management. You also refer more but in the end you become totally “dumbed down” It becomes less satisfying.

So what is the answer??
One way would be to construct protocols / check lists / systems to cope. In this way if the parents of a child with a positive heel stab contact you then I should be able to look up what tests would have been done and what are the management strategies. It would be ongoing and never finished updating this information.

But even as I write this I have the niggling thought “Is it worth it all?” In view of GP’s having to see lots of patients in order to make a living and not to have long consults – are protocols etc the way to go. No!! The government has created this monster and destroyed medicine so just give up. Smile and refer. However I cannot do this. I will keep trying the protocol way.

Getting at the older doctors !!

Are older GP’s cognitively impaired?  In the Australian Doctor http://www.australiandoctor.com.au/articles/B8/0C05C2B8.asp? the question is raised whether or not older GP’s can practice safely.  It is stated that the public now needs to be protected from the older doctors who may be cognitively impaired.

Actually what has been reported is fact (the Victorian Medical Board) but it is disturbing to see the emphasis that is being put now on “lets see how we can start the process / discussion about older doctors so that they will have to leave by the time the new doctors arrive on the scene (2013).  It will take time to get public opinion settled in this way so that older doctors are viewed with suspicion.

No so long ago we were all encouraged to continue to practice and not retire.  Now it seems that Medicare does not want the extra doctors.  Why?  Because it will cost Mediacre more if they do not restrict supply.  It has been done before with bad outcome from the patients viewpoint but a saving in cost for Medicare.  They gambled on the fact that the resticted numbers of doctors will not push up the price.  Well this worked for the consult fee, but locums can demand much higher fees because of a lack of supply. It will not be long before the average metro practice will push up its fees in order to survive and the patients will have to pay.

Training and retaining GP’s

There is a big problem because the costs (inc social costs) of training leave the doctor with a high debt and so not many go on and become GP’s unless they are female with a partner who is the prime bread winner.

The rest become specialists to quickly recover costs.

So the attraction for any new GP’s of no start up costs,no ongoing running costs and a good super all of which happen in a big medical centre.  So with the influx of new graduates these centres will have no problems attracting medical staff.  But the smaller 1-2 GP practices will find it difficult and will not get staff.  Patients will have to adjust and travel long distances to these new / bigger centres.  There is no other solution. 

Rural Practices will not be able to attract anybody and this can be overcome by the Area Health Services setting up 2 year contracts with good wage / super and other good conditions.  You will not be able to rely on GP’s wanting to go to the rural areas without support

Trebor