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.

Interesting Patients

Patients who have fantasies
Another issue is the high class female patient who has fantasies that they need medical attention and that they are sick. My interaction ius always interesting as they seem to be a lot more up front and direct with the doctor. The examination of these patients is always interesting as well because you do not want to miss anything.
Especially with this sort of patient you should be dressed appropriately as they will also tell you if you are not dressed correctly. Often your hands are tied as regards what you can do but eventually you are able to examine and deal with the situation in a proper manner. Such examination needs to be detailed each time – with nothing missed.
These sorts of patients need to be seen often so that it keeps me up to the mark, then when you have a successful consult it is a good feeling
These patients have a lot of problems and need to be reviewed at least every 2-3 months. Then anxiety levels will not rise.

Nicola Roxon has no new ideas after 12 months in the job

Why blog at all??  I think it is important to record my ideas, thoughts and comments as well my forecasts about General Practice.  In this way I can record where I think things are headed.  More importantly what actions I should take to align myself with what I see as the future.  I have done this all my professional life.  It is not second guessing.

But at the moment all I can discern are changes to registration which involves revalidation and comments on cognition tests for doctors. 

There are no changes to basic consulting patterns – no new ideas!!  So what is this telling us.

I believe that Nicola Roxon is just a public servant with a few new ideas but her kite flying evoked the wrong response.  She realises that if allied health is to do any Medicare paid work then there will be an additional cost.  there will be no cost savings.  Also GP’s will not back or support independant groups.  So they function alone and wear the medico-legal challenge.  It is no use thinking that the existing nurses working in doctors rooms will do any additional work.  Their sessions are always full.  There is no more room for any more nurses.

So what would be the result of any mandated changes..eg paid less for driving licenec medicals.  Doctors would still do them and the gap would be more.  Consult pattern will not change. 

Care plans have not altered patient outcomes.  They are done in addition to the normal consultation patterns.  I have written on this before.  So where does all this leave us.  With all this indecision it means that the AMA has got its act together and has formulated solid proposals and highlighted problems.  Now all Nicola can do is to play catch-up.  If she attempts to go against the AMA proposals then her plans will end up in a mess with patients having to pay more.

The major challenge in GP work is to integrate any followup plan in  a normal 15 min consult.  If you attempt to move to a special number then you are monitored  (see what has happened with level C&D consults)

Another challenge is to ensure that we have concise investigation plans for various diseases easily available so we can initiate investigations before referrals.