[AMA] I'm a Young GP. Ask Me Anything and Provide Feedback

LAusGP on 09/03/2018 - 00:15
Last edited 09/03/2018 - 13:45 by 2 other users

So I recently went to an Innovation in Healthcare conference and feel inspired to change General Practice. Also with the long weekend thought I would offer a limited time AMA.

So ask me anything (within reason) you like as long as it isn't direct medical advice.

Also I'm looking to see what people would love from their GP. Put some outlandish ideas out there as well as some practical ideas.

Edit: Would love to hear what people ideally want from their GP. I'm hearing you would love to have a good GP in the first place but if you had a clinically competent GP who does listen to You- is there anything else you would want?

For context I work at a mixed billing clinic where I probably bulk bill around 25% of my patients. I've been a qualified GP for 1 year and been working in general practice in training for the 2 years prior to that. Our clinic already offers a high touch service where I spend probably 1-2 hours a day following up results and ringing patients. We also run a results line where patients can ring in to find out from the nurse at a basic level what their results are like.

Ask away!

Introduce Yourself

closed Comments

      • [Deactivated] on 10/06/2018 - 12:56

        Yeah, this is really wierd by GPs. Also happened to me. They look up meds on google! FTW? Why go to med school then?

  • Ti-au on 09/03/2018 - 00:29

    some outlandish ideas

    more jellybeans. Except for fatties.

    How hard was practical after medical sch00l?

    Is obesity becoming a major focus of your practice? (what % is it).

    What do you think of vapes? how long before legalised?
    What do you think of medical cannabis? Why is the jury still out?

    • AusGP on 09/03/2018 - 01:27
      +6

      We give lollies to kids sometimes after immunizations:D - although with all sorts of allergies and parents not so keen on lollies I usually just use stickers!

      Internship and residency was hard. Long hours, shift work, barely spent any public holidays with family. Having said that it was reasonably well supported so the weight of making decisions about life and death didn't quite eat at you as it can do now.

      Obesity - absolutely an increasing problem. Even in a higher socioeconomic area where I work currently it's a big issue. Problem is most people know what they're doing is bad, they just don't go and do it - so it's a negotiation of sorts and sometimes I'm just a coach trying to coax the best I can from my players.

      Vaping- not too much idea about it. As per comment above - medicine has been burnt by new things before so just overall very cautious in case in 20 years time you discover actually it gives you respiratory failure or something similar.

      Medical cannabis - I think the jury is out because it hasn't had overwhelming evidence its benefits outweigh the risks.

  • FireRunner on 09/03/2018 - 00:31
    +18

    How many hours a day before it becomes unhealthy to browse ozbargain?

    • AusGP on 09/03/2018 - 01:21
      +17

      Haha depends on your credit card bills? ;)

  • DarthAntz on 09/03/2018 - 00:31
    +2

    what is your cut when you prescribe people painkillers or antibiotics? whats the best prescription with the best incentive for the prescriber?

    • AusGP on 09/03/2018 - 01:21
      +8

      None. There is no incentive at all. They've even banned specific drug branded gifts (e.g. pens) from being given out these days.

      I work at a clinic where we strictly do not see drug reps.

    • Tech5 on 09/03/2018 - 11:02
      +2

      It is unethical to take incentives in any medical profession like Doctor or Dentist. If found out, you will get sanctioned by AHPRA, or deregistered by the medical/dental board. The most I have seen is us getting free sample packs of mouthwash etc.

    • AusGP on 09/03/2018 - 01:29
      +13

      The reason I said no medical advice is the dangers of giving specific medical advice without assessing properly. If a mechanic gives the wrong advice because they didn't do a full assessment - your car breaks down. If I give the wrong advice - someone can die…

      • manshrew on 09/03/2018 - 08:37
        +14

        In fairness, if a mechanic gives you the wrong advice someone can die as well.

        • AusGP on 09/03/2018 - 09:53

          True!

        • MessyG on 09/03/2018 - 19:00
          +2

          But way less likely to get sued and medical insurance probably doesn't cover advice given on bargain forums.

        • [Deactivated] on 10/03/2018 - 10:45
          +1

          If a mechanic gives you bad advice, one can (not always) follow the steps in reverse to undo the procedure. In the worst case scenario, get a new car and pursue legal action. May end up in a better car

          If a doctor gives you bad advice, procedures are much harder and not always reversible, and will leave scarring. Many medications have side effects or long half lives. One cannot get a new body part or new body. Will never end up in a better scenario.

          Of course, a bad car can cause lives but these are the exceptions that do not make the rule. A bad microwave can fail to cook food and cause death too.

          The primary difference between a technician (ie. Mechanic) and a physician is the level of liability and the training to control the situation should said situation deteriorate.

  • Geekomatic on 09/03/2018 - 00:39
    +2

    Hi RJW

    I was in a MVA in Aug 2011.

    The emergency room said no broken bones and to see them or a doctor if I needed to afterwards. I went to a local clinic, as I now had no car (totalled) & no job (closed 5 days before).

    I had a very sore knee (steering wheel had been crushed down to the point they had to cut away my slacks to get me out) & a limp.

    This Dr. said that "MVA's can take time to recover from". He wrote, at the end of the diagnosis paper, "give time". That, was his diagnosis! Give time. No tests. No nothing.

    Two years after, I find I had income protection insurance. I ring to see if I can claim, & I can. I cannot find his paperwork, so I call. They say I need to make an appt….which is already ridiculous because there are SICK PEOPLE who need to see this quack. Anyway, I go in, state what I want, and watch him bring up MY form on his screen——-> then, HE STARTS TYPING!

    He changed, "give time", to "return in 30 days"!

    I didn't read it until I was home. In the days after, I found the original.

    My question to you— I realize that this is reprehensible. I want to sue this doctor. His blase actions caused me to not seek any treatment for my injuries. By the time I saw another doctor, in that December, I was placed in a queue of a year to see someone.

    IN the interim, I've finally had a proper examination. Despite the insurer's doctor (end of 2014) stating, "I was fine", I have current MRI showing crushed/impinged discs as well as bulging. I also have another stating I have no reflex response in my ankles (I had complained I couldn't feel my feet at times).

    I am STILL in it trying to convince the insurer that everything I said at the start is still present.

    Your thoughts?

    You asked. ;)

    • Ti-au on 09/03/2018 - 00:55
      +1

      If he added it to the software, there may be a log of it.

      Depending on how important it is (does the case rest solely on the doctor changing his advice?) I would seek advice from Solicitor.
      This may cost money, as this is OzB you probably don't want this option.

      If it doesn't - you can always make a complaint to medical board - you just got to realise it may have a bias to protect Doctors.

      • Geekomatic on 09/03/2018 - 01:04
        +1

        I'm going to use a FOI form to request the altered document. Then, I'll ring around.

        I'm assuming it's a criminal violation to alter a patients records to cover your *rse.

    • AusGP on 09/03/2018 - 01:37
      +3

      It's always hard in these scenarios that I see on OzBargain to give a definitive opinion.

      I would seek a solicitors advice first.

      All medical software has an audit trail. Some though are more rigorous than others.

      As I don't know the exact details of this case I can't comment for sure, but in general discs can bulge from a variety of things (sometimes they're there without causing any problems). Given the length of time between accident and now, it can be difficult to prove. (Partly why I normally have a lower threshold for scanning patients in accidents in case of legal issues for the patient later - provided the symptoms warrant a scan that is)

      In any case if you can show two documents that are distinctly different and has been altered by the doctor without changing the date or annotating it's a modified copy then you most likely should see a solicitor for advice.

    • kipps on 09/03/2018 - 08:22

      You need to get proper legal advice ASAP as there can be strict time limits to pursue claims.

    • mkerr on 09/03/2018 - 20:12
      +8

      you had a sore knee after an MVA.
      there was no fracture or evident injury on what scans you had at the time
      you don't describe an injury / symptoms consistent with radiculopathy nor a bulging disc

      YEARS later you get an MRI. this shows bulging discs, as it OFTEN does.
      it's one of the reasons that imaging is often NOT recommended in investigation of back pain.

      disc prolapse is not a common consequence of MVA / acceleration deceleration injury.

      so what's happened, is you've had an ouchie knee. you had scans on your ouchie knee. there was no bone injury to your ouchie knee. the treatment for an ouchie knee is, to wait and let it heal. later, you've had an MRI that shows something. you've misattributed this something to be related to the MVA.

      you now want to sue said GP.

      i'd suggest you strongly consider the fact that these things are unrelated.

      however, i could be wrong. you could have other symptoms etc that suggest a more temporal relationship.

      • gleason50 on 11/03/2018 - 15:18

        disc prolapse is not a common consequence of MVA / acceleration deceleration injury.

        100% this

  • John Kimble on 09/03/2018 - 06:59

    My wife said I should probably start getting my prostate checked regularly soon (probably read something on FB), but I'm not even 40! Is she taking the piss?

    Who would be more gentle in your opinion, a male or female doctor? What is involved? How long does it take? Do I get a lollipop/cigarette after?

    How many have you done, any stories worth sharing?

    • kathartic on 09/03/2018 - 08:50
      +6

      Hey not OP but am med student! It is currently NOT recommmended to undergo prostate screening (involving physical check up and blood tests) when you have no symptoms at any age. Even for men with increased risk due to family history.

      The gist of it is that 1. prostate cancer is extremely common but in most cases will not kill you because it grows so slowly and 2. these tests are very nonspecific and not sensitive ie. you will get a lot of false positives and false negatives. Treatment for prostate cancer is also wrought with significant side effects.

      As a result the potential benefit of finding out you have prostate cancer at this stage is heavily outweighed by the potential harm you would go through if the tests came back positive.

      • Amazible on 09/03/2018 - 09:38

        My ‘new’ GP did a PSA test as part of a thorough check up and found slightly elevated PSA levels. As a precaution, he sent me to a urologist who ordered scans and subsequently a biopsy of my prostate. The biopsy revealed my prostate was riddled with cancer and that it had to be removed. My former doctor never did any of these tests based on the premise stated above that “it is currently NOT recommended…”. All I can say is thank God for the rare minority of doctors who don’t listen to silly rules and take precautionary action to test. My recommendation: If you’re 40+ make sure you ask your doctor for a PSA blood test and if the levels are slightly raised, get a referral to a urologist and get the scans necessary to check it out.

        • AusGP on 09/03/2018 - 10:09

          I'm glad you've got a good GP there and lived to tell the tale!

          It is a difficult area as the test has shown to be beneficial in a certain age range, but the biopsy itself has risks so can cause harm to the patients whom don't have cancer.

          I had a long chat to my mentor about this and despite the guidelines, he too has caught some prostate cancer through his 30 years which strictly speaking may have been difficult to make a case for screening.

          The reason we have these debates is because investigations can still cause harm as no test is perfect and can set in motion a chain of events where you can get harmed from the procedures that try and sort things out.

        • kathartic on 09/03/2018 - 10:53
          +6

          With all respect, the reason there are guidelines is to provide the most potential benefit to patients. I am certainly glad that you had an aggressive cancer picked up, but if you were to test everyone that walked in off the street with our current screening tests it would be akin to sentencing several men to years if not a life time of incontinence, sexual dysfunction and psychological stress unnecessarily just to be able to treat one man's cancer. If you understand the risks and still want to be screened that is absolutely your decision, but the healthcare profession has a duty to provide recommendations that firstly do no harm and it would be unacceptable to harm a great many for the benefit of few.

        • mkerr on 09/03/2018 - 20:18

          @kathartic:
          and with respect, and not in disagreement: this is why the medical profession is special. we're allowed to know the guidelines and data around them, interpret them as we will, and decide on what's best of the patient.

          strict adherence to guidelines (remember they're only guidelines) is what nurses think is best practice. doctors will not infrequently deviate. this decision is one of privilege out of expertise.

      • AusGP on 09/03/2018 - 10:12

        Whilst I agree the general gist is PSA screening is fraught with risks, and is not routinely recommended thesr days, there are certainly individual cases that have benefited.

        Doctors will form their own opinions but I currently feel screening from 50-69 can be warranted provided I consent the patient to the risks of screening.

        Check out Health Pathways Melbourne. If you're medical you should be able to rustle up the username and password ;)

        • kathartic on 09/03/2018 - 10:26

          Will do! Yes in my GP rotation I did see a lot of screening being performed for concerned patients and I definitely understand the rationale behind both the patient and the GP's decision making. I was mainly concerned that the first poster was not aware of the background of evidence and was at risk of making an uninformed choice! Thanks for your feedback :)

    • AusGP on 09/03/2018 - 10:03

      Depending on your family history prostate screening can start either at 40 or at 50.

      The current best test to screen for prostate cancer is a blood test that's not terribly accurate unfortunately but has a small proven benefit between 50-65 but with problems of false positives which can still lead to harm if too aggressively investigated.

      The finger up the bottom isn't really routinely recommended these days as it's felt in the hands of a GP (pardon the pun) it's not accurate and gives false information

      I've never felt a prostate cancer- but have felt a rectal cancer though when I went looking for it…:\

      • Scrooge McDuck on 09/03/2018 - 10:09

        What can we do to prevent prostate cancer?

        Other than the thing everyone does…

    • Scrooge McDuck on 09/03/2018 - 10:07
      +1

      Who would be more gentle in your opinion, a male or female doctor?

      Females typically have narrower fingers.

      • John Kimble on 09/03/2018 - 10:22

        So girth does matter!

        • Scrooge McDuck on 09/03/2018 - 10:25
          +2

          Whoever told you otherwise, was just being polite.

  • tighttighttight1 on 09/03/2018 - 07:01

    Hi OP,
    1) How is your work life balance? - Do you have set work hours?
    2) I live in a particular region of Sydney considered low SES. There seems to be an exorbitant number of GPs in the area. I have visited many never really satisfied about the visit. A lot of the GPs seem really dodgy and unaware of what they are doing.
    eg. last time I had my blood test, the GP did not put gloves on (basic hygiene) OR another time I went in to ask about an illness. The GP simply said it was due to an allergy that occurs all year round and left it at that. No real solution provided.
    My question is, do GPs have to undertake some kind of refresher course? or is there some sort of system in place to ensure GPs are performing their duties properly?

    • AusGP on 09/03/2018 - 10:19
      +2

      As a GP I tend to control my work hours. Work life balance is pretty good now. I normally work 4 days a week around 7-8 hours consulting and 1-2 hours followup. Also do 1 in 6 weekends (Sat and Sun morning). It varies between clinics though.

      There is a CPD (continuing professional development) program in place - however the quality varies in what people do. The good GPS will actually go and learn something useful to fulfill their requirements. The bad ones see it as a tickbox exercise.

      Unfortunately there are bad GPs out there. Furthermore partly the reason is Medicare doesn't fund general practice well enough that the good doctors don't feel time pressure to earn an income. Also there is no quality audit process in place - this can be a tricky one though as if you start an audit process, it will most certainly punish the good doctors with more paperwork than necessary.

  • John Kimble on 09/03/2018 - 07:13

    Thoughts on: https://www.ozbargain.com.au/node/361217

  • ElderyMan on 09/03/2018 - 08:09

    Why the average GP is so unprofessional and it is so hard to find a good one?
    You mentioned a few good pick ups above and that says to me you are caring about your patients. That is not the case for most of other GPs. They DO write scripts and prescribe Panadol in most of cases. I know two cases when people with appendicitis were prescribed panadol and sent home where the condition got worsened and the ambulance was called. I believe if people complained about the strong stomach pain, more analysis should be done as well as the ultrasound too as an absolute minimum.

    • AusGP on 09/03/2018 - 10:31
      +2

      It's interesting conundrum. Partly the problem is there is no disincentive to substandard care at the moment. I feel like the Medicare Co-paymemt would have been a good thing. If you had to decide to pay $5 vs $10 for a better GP, then maybe you might decide to spend more. That means eventually any bad GPS lose all their business. But at the moment there is no incentive for bad GPs to change. The current modus operandi in the big bulk billing clinics is see as many patients as possible as Medicare will pay you anyway (volume of consultations rather than quality).

      • ElderyMan on 09/03/2018 - 10:54

        After some 'shopping' around we found two trusted GPs in our area, both bulk billing. They have been practicing for 20+ years and my family and I never ever had any bullshit treatment from them while the most of others are complete rubbish. All I am asking for is a bit of professional care and not just if a patient said it's cold means it is actually cold and you got antibiotics prescribed (sick!) and released back home.

        Thank you for your time! All the best and wish you only good and reasonable patients :)

        • AusGP on 09/03/2018 - 10:57

          Really glad you managed to find a great GP!

  • barbarella on 09/03/2018 - 08:40
    +1

    Be sure to wash your hands btw patients…and always make sure instruments are cleaned/sterilised between patients too -
    thankyou :)

    • AusGP on 09/03/2018 - 10:26

      I normally use alcohol gel. I trained in the era when this was a major focus at hospitals so don't worry;)

  • peterpeterpumpkin on 09/03/2018 - 08:41

    Is there a secret list of GPs that do regular visits to homes for bed-ridden people? There's a hundred after-hours GP services (being cracked down upon by the government) but finding a permanent GP to visit is a difficult task.

    Speaking of follow-up services, why are there no patient-collaborative follow-up systems in place that I know of?

    Scenario
    Patient leaves office with blood results and a diagnosis.
    Patient's cousin's dog's vet says worth checking for another disease since they had similar symptoms and blood results.
    Patient can lodge a follow-up question on-line or via telephone (for non-internet savvy peeps) for follow-up investigation BEFORE the next appointment. No need to search Google in front of the patient, roll eyes in irritation or let weeks pass with a potentially wrong diagnosis. In fact, all investigations should be triple-checked by other doctors (humans makes mistakes). And every diagnosis should be validated by a specialist in that field.

    This proposal may sound expensive and overkill but I honestly have no faith in people, and doctors are just people. I've corrected doctors in diagnosing my own x-rays and given an alternative (correct) diagnosis in emergency. Everybody makes mistakes so systems should be in place that let doctors collaborate without hurting their egos.

    • AusGP on 09/03/2018 - 10:36

      There's no secret list and the decline of home visits is a problem. The reason is home visits generally aren't economical so to fix this Medicare should take all the money from after hours and increase rebates for regular GP home visits.

      I currently see one home visit patient more out of my moral duty - because on a financial aspect it's pretty poor return for my time. Plus it takes a chunk out of consulting which means other patients of mine that need to see me miss out.

      Most doctors at my clinic also do home visits for their frail patients.

    • AusGP on 09/03/2018 - 10:38
      +3

      There's no official collaborative systems but my patients sometimes do email me to ask for a pathology form before they see me for their annual checkup.

      I really do think this is the future and would like to implement more email communications. The key question is how will this be funded - so still a work in progress but I've been stewing over direct patient to doctor communications for a while in my head

      • Keef on 13/03/2018 - 10:05

        Charge per email, like lawyers do

    • [Deactivated] on 09/03/2018 - 14:09
      +2

      Typically there are not online/telephone doctors because they are 100% legally liable for advice they give but get no medicare rebate, so they would have to bill 100% privately, and potentially expose themselves to more risks not having made an assessment in person.

      Basically, good GPs tend to do a ton of follow up work outside of the appointment for free currently because the government doesn't value it. They're reluctant to increase this even further with yet more free work.

      • Keef on 13/03/2018 - 10:06

        Emails from businesses and professionals generally come with disclaimers, no reason why Doctors can't utilise this.

        • [Deactivated] on 13/03/2018 - 14:42

          Being legally able to defend yourself and in the right does not stop you being sued and losing a heap of time in preparing a defense. Again, the issue also is that there isn't a Medicare number for it, so patients would have to pay more than in person anyway.

          People seem to expect lawyers to stiff them on the bill, but doctors they expect (and usually get) compassion from. Because the doctor knows about all their problems and issues and why they may not be able to afford it. The lawyers don't generally care outside of legal aid.

        • Keef on 13/03/2018 - 15:58

          @Bargs: You shouldn't need to defend yourself if it's in writing. I would have thought something in writing would be indefensible, whereas hear/say is not. I don't know, just trying to see how this could work as it would free up a lot of time in my opinion for people who truly need access to a doctor.

          Plus more patients can be assisted in less time.

        • AusGP on 13/03/2018 - 16:37

          @Keef:

          Unfortunately no disclaimer is foolproof in medicine. There is the concept of informed consent where if you explain all the dot points on a consent form but later it can be proven that the patient didn't understand it and you didn't make a sufficient effort to inform them then the patient can still sue you successfully (because of the power differential and what a doctor understands may be different to what a patient understands).

          Also even official written guidelines on antibiotic use have not stopped emergency departments being sued for a bad outcome when the best practice guidelines have been adhered to.

          I guess it is something we must overcome though as I'm sure once upon a time it might be controversial to provide any correspondence to patients (whereas a lot of specialists CC in the patient to their specialist letters now).

        • [Deactivated] on 13/03/2018 - 18:17

          @Keef: Lawyers speculatively sue every doctor involved with a patient quite often, they're just looking for settlements or the one doctor that might actually have been at fault. Actually having done something wrong or being able to defend yourself means nothing. 99.9% of the time the doctor hasn't done anything wrong. 5% of the time they probably settle anyway because their insurance demands it as it's cheaper. And the other 95% they have to put time into going back through notes etc and preparing everything for their legal defense just to have it dropped before it makes it to court. The cost for that time isn't chargeable to anyone.

          Very very rarely does having done everything perfectly actually matter.

          On the times that doctors do make genuine mistakes, they are quite probably with patients too nice to sue.

          Unsurprisingly, legal defense insurance costs are very high.

          *note: I am personally not a medical professional.

        • Keef on 13/03/2018 - 20:31

          @RJW: Why do we see all these doctors replying to posts in places like WEBMD etc are they simply not afraid to be sued?

        • Keef on 13/03/2018 - 20:31

          @Bargs: Cold hard truth right there. What a messed up world!

        • Keef on 13/03/2018 - 20:32

          @RJW: RJW thank you for allowing us to AMA. I have enjoyed reading this and appreciate you making the effort.

        • AusGP on 13/03/2018 - 20:45

          @Keef:

          I suppose there's a different relationship involved where one is an online forum with massive disclaimers (and presumably specialists also sometimes want to get their name out there), whereas if your GP emails you despite disclaimers the relationship could be interpreted differently by the courts if it ever came to a case.

          But just to be clear I'm a massive fan of doctors emailing patients where an established medical relationship already exists and it is safe to do so. But I guess until it becomes widely accepted practice with protections and laws in place it may be difficult from a legalistic and indemnity point of view (even if my indemnity insurance covers me I still wouldn't want to go through that process!)

  • [Deactivated] on 09/03/2018 - 08:54
    -2

    Most people believe doctors are in the upper class (I know it's false but let's entertain this) and by default would hold right wing ideas.

    I noticed in University, especially in the health sciences, faculty practice more left wing ideas, ie. Ethics classes that muddy the lines between actual ethics and charity. I'm not sure if it still happens today but there were compulsory classes about socialist ideas dressed up as aboriginal studies, sociodemographic equity, etc. (The list is long). Did you identify any of those biases when you were studying?

    Overall, do you believe that medicine as a profession (in it's current form) is more socialist or capitalist?

    • Scrooge McDuck on 09/03/2018 - 10:28
      +2

      Bulk Billing GPs are socialist.

      The rest are capitalist.

      • AusGP on 09/03/2018 - 10:44
        +5

        Actually that might be reversed in some days! I have lots of left leaniing doctors where I work despite not bulk billing. Some bulk billing clinics their whole aim is to rip as much money out of Medicare as possible (patient quantity rather than quality of patient care can do that).

        For comparison when I was looking to establish myself in clinic, a big bulk billing chain offered me a potential earnings that's at least 20-25% higher than what I earn now at a mixed billing clinic. To get those sorts of numbers I would have to practice in a way I am entirely uncomfortable with. But it's know that lots of doctors do work for this chain and do get those numbers.

        • [Deactivated] on 09/03/2018 - 11:19
          +2

          I'm glad you have integrity in your vocation. I think it's important to recognize that remuneration shouldn't necessarily be the deciding factor.

      • [Deactivated] on 09/03/2018 - 18:36

        Respectfully, I disagree. The bulk billing policy is socialist, the GPs that work under the bulk billing system may be as capitalist as any private enterprise.

        Bulk Billing GPs have patients like any other GP but the party responsible for the payments is Medicare, hence the customer is Medicare.

        Bulk Billing GPs are not necessarily altruistic as OP has pointed out, it is a numbers game. I can certainly attest to that from personal experience.

    • AusGP on 09/03/2018 - 10:39
      +2

      I can't speak for everyone but by and large socialist over capitalist. There are many better ways to make money I reckon although I know some disagree.

      • [Deactivated] on 09/03/2018 - 10:56

        Thank you for your opinion.

  • lupiter on 09/03/2018 - 09:07

    How can I get my doctor to stop nagging me? I realise they think it's in my best interest, but it just means I don't want to go to my regular doctor. Even when I saw a different doctor at the same clinic they nagged me about it! I assume my regular GP wrote something in my record. [They want me to have a particular screening, I have weighed up what they said but don't think it is worthwhile]

    Do you prescribe a lot of long-acting contraceptives?

    Do you get a lot of people who store up a laundry list of complaints and then come in?

    • AusGP on 09/03/2018 - 10:59
      +1

      Not knowing what the screening test is, I can't advise but in general if your GP is nagging you its for your own good! Don't look back years later and regret not doing something about it!

      Yes long-acting contraceptives are quite popular

      People store up laundry lists all the time! Sometimes can get hard to manage but we can only do so much in 15 minutes!

      • lupiter on 09/03/2018 - 15:25

        I guess I'm just grumpy because it feels like they're not listening. And if they're not listening on this issue, why should I think they're listening about anything else?

        Are most of your appointments 15 min? My Dr has 15, 30, 45.

        • AusGP on 09/03/2018 - 15:35

          Patients can book longer appointments but then the fee goes up. So sometimes people try and sneak in a laundry list to a single appointment. Most are good though and book a double appointment for their 6 things.

        • [Deactivated] on 09/03/2018 - 20:55

          If they didn't nag you and you ended up having cancer, you would be right back here complaining that they didn't try hard enough to screen you.

          You can't have it both ways.

  • Seraphin7 on 09/03/2018 - 09:08
    -3

    Why does the medical profession involve itself in political matters?

    • AusGP on 09/03/2018 - 11:00
      +4

      I think it's because 1. Smart bunch of people with lots of ideas of how things should be. 2. Idealistic people in general (otherwise why put ourselves through the slog of medicine) 3. The poor quality of current politicians.

      • Seraphin7 on 09/03/2018 - 13:09
        -3

        The medical profession is there to provide medical services to the population, not make pronouncements on political matters. The concept that doctors should be listened to on this matter with any greater weight than any other group in society is breath taking in its arrogance. Unfortunately this appears to be the very feeling I get from my observations on the way many medical professional bodies behave.

        • AusGP on 09/03/2018 - 13:17
          +2

          Just to be clear I'm not advocating people should listen to medical bodies more than any other group. I was merely explaining why it happens.

          Personally I feel we should only involve ourselves in very directly pertinent health matters. But we do need to lobby the government for example if they're cutting health funding or if the system is being rorted (e.g. explosion in after hours doctors companies).

        • Seraphin7 on 09/03/2018 - 13:53
          -1

          @RJW: Fair enough, but it drives me insane listening to medical bodies postulating on matters that have a passing reference to the provision of health services at best, yet always seem to get wrapped up in the banner of "we're looking after people's health". A critical analysis of these statements usually finds a rationale of "this will mean less money going into the hands of doctors" not far below the surface.

        • BrainSand on 09/03/2018 - 15:43
          +1

          @Seraphin7: You're going to have to use an example of a political matter that the health care professionals have weighed in on if you want people to take your statements seriously.

          what exactly are you talking about? gay rights, abortion, obesity?

        • Seraphin7 on 09/03/2018 - 16:54
          -2

          @BrainSand: Well it would appear our AMA host took it seriously enough to respond and would appear to have had knowledge of the matters I'm alluding to. Thanks for the neg, though.

        • [Deactivated] on 09/03/2018 - 18:13
          +3

          A doctor is certifiably educated.

          Any other group in society involves the ignorant, lazy, criminal… Well pretty much anybody.

          Besides, a doctor can have political ideas. Why shouldn't a doctor have a political alignment? Why should a doctor's opinion be weighed less?

        • BrainSand on 09/03/2018 - 20:10
          -1

          @Seraphin7: hAvE sOmE mOrE

    • [Deactivated] on 12/03/2018 - 14:24

      Honestly I think doctors should have weight in political matters. The only people who should have less weight are politicians.

  • Gandalf the Thrifty on 09/03/2018 - 09:14

    Judging by medical shows on TV, hospital doctors seem to be addicted to drugs (House), daydreamers (Scrubs) or having sex with co-workers somewhere inside the hospital (the rest). Which one were you??

    • AusGP on 09/03/2018 - 11:01

      Haha. I think when I was in hospital - maybe Scrubs?

  • thom on 09/03/2018 - 09:17

    What are your thoughts on alternative medicine practitioners being allowed to use the title 'Dr.'? These alternative medicines (chiropractic, homeopathy, etc.) are not scientifically proven (or operate well beyond the bounds of what has been proven). Are GPs seeing a decrease in patient numbers? Are patients presenting illnesses that would have previously been diagnosed earlier? Do you see any impact on the social status of the 'Dr.' title?

    • AusGP on 09/03/2018 - 11:04

      GPs are still quite critical so no decrease in patient numbers yet. Having said that with the flood of medical graduates who knows. I think though it will be a good thing to have a flood of locally trained medical graduates.

      Personally I don't mind but it might be good to regulate some alternative medicines. There are obvious quacks out there but then there are obviously very good alternative health providers out there too.

      I work in reasonably well off area so I think no delayed presentations from seeking alternative care. However I certainly hear horror stories…

      • [Deactivated] on 10/03/2018 - 10:34

        Follow up question.

        If there are no regulations on "alternative health", how did you define "good alternative health providers"?

        What do you propose is a reasonable regulation on alternative health? As it stands, medicine is defined by being evidence based. If the so called "alternative medicine" has evidence, it ceases to be "alternative medicine" and becomes actual medicine.

        You're a GP and I will safely presume you are absolute in your practice of evidence based medicine. I also presume you see the sound logic above. I'm happy to be proven wrong, however, I would be equally satisfied if I've managed to steer a medical professional back onto the strict academy of evidence.

        • AusGP on 10/03/2018 - 11:13

          There are varying degrees of self-regulation already in place I believe. I'm not really that knowledgeable about the regulatory aspects so probably not the best to suggest something. I would only hope that suitably qualified medicolegal professionals can draft strong enough legislation that punishes dangerous quackery at least - like some of the well publicised issues surrounding cracking an infant spine or the water diet to an infant/ mother that nearly killed them both. There are certain ones like homeopathy that makes no biological / scientific sense that needs to be regulated and debunked.

          Having said that to ignore all providers because of the danger of a few would do injustice to what benefit patients may get. For example Traditional Chinese Medicine (TCM) has some unearthed knowledge I reckon. It actually is accepted medicine in China for obvious reasons with actual hospitals where they integrate Western medicine and TCM (so you can still have Xrays etc). But is it evidence based to the absolute rigors of the scientific method- nope…But amongst all the herbs that are probably useless there will be a few of benefit

        • [Deactivated] on 10/03/2018 - 11:44

          @RJW:
          Your last line is something you'll do well to omit should you be brought to the AMA panel.

          Once again, thank you for your opinion.

          I think it's important to note that OPs views are not necessarily representative of the wider medical community nor the official views of the AMA (Australian Medical Association)

        • AusGP on 10/03/2018 - 12:23

          @tshow:
          I've edited to reflect your advice. By no means do I actively recommend alternative medicine. But if they already started off with it and as long there's no obvious danger I'm accommodating (even if for the benefit of placebo effect).

          Having said that I feel there's a reason why patients sometimes turn to their alternative health providers - I think some doctors are too definite in their explanation without addressing the inherent uncertainty in Medicine. I find most patients if you explain the evidence is heavily against something being effective they will be more accepting than outright rejection and no validation (followed by correction) of their beliefs.

          After all the advice for aspirin has changed recently (for different indications - but makes me look a bit silly given I only very recently advised someone against it- but I did put a disclaimer that it might change luckily), or for paracetamol recently with an NPS session I just had last week.

          I mean once upon a time, someone had to do a trial to show treating blood pressure was effective in saving lives. The absence of evidence doesn't mean it won't come. Imagine telling a patient there is no evidence blood pressure affects anything before the evidence became definitive!

          I have this conversation a lot with patients. The question is whether that one technique will be the 999 that are shown to be useless (or even harmful) or the 1:1000 (not real stats, just for arguments sake) that might work. I warn patients all the time - including the recent enquiries re stem cell treatment for OA.

        • [Deactivated] on 10/03/2018 - 17:48

          @RJW:
          Kudos on your ability to change your practice based on evidence available.

          There is nothing wrong with recanting your professional advice. It is how the clinician does it and this begins the moment the patient walks through your door for the very first time.

          It is good practice to never comment on another practitioners ability unless you are sure it is relevant to your continuing care (ie. Pharmaceutical interactions). Inform the patient that you are absolute in your practice of evidence based medicine and unfortunately, suggesting alternate medicine is "okayish" is detrimental to your character sooner or later.

          It is perfectly acceptable to tell a patient, "I don't know and I really should find out more before commenting." Or "with the evidence available at this moment, I do not feel comfortable providing a diagnosis". Everything you do from the first impression has to be consistent with an open mind but one that only forms an opinion with information available and that are not above admitting your limitations nor correcting previous erronious conclusion should new evidence surface.

          The decision to exercise the advise you provide will be left entirely to the patient's discretion (as horrific as the outcome may or may not be). It liberates your from the responsibility of the outcome (not the liability should the patient follows your advise) and you are never contradicting your decision as you never made one.

        • AusGP on 10/03/2018 - 18:07

          @tshow:

          Yes I agree with everything you've just said and thanks for putting it so eloquently! Does help crystallize/reinforce in my mind the best approach to these matters so many thanks for the reminder!

  • TransportPosters on 09/03/2018 - 09:24

    I think a good sense of humour goes a long way when it comes to being a GP. That's what I love about mine, he is always fun to see but he doesn't waste time, always straight to the point also.

    My question: How do you deal with people from cultures which prevent you from treating them properly? I've heard stories such as a guy bringing in his wife who has pains in her stomach and the doctor needs to see it but she is prevented from showing it or being touched there due to her cultural beliefs or something.

    • Scrooge McDuck on 09/03/2018 - 10:16
      +3

      I think a good sense of humour goes a long way when it comes to being a GP.

      Laughter is the best medicine.

      Not all heroes wear capes.

      How do you deal with people from cultures which prevent you from treating them properly?

      Natural selection.

    • AusGP on 09/03/2018 - 11:07

      Haha yes laughter is the best medicine - can't say I'm the best at humour but will always have a smile on when people visit :)

      It is difficult - sometimes might have to arrange for another female doctor to see them but it isn't a problem I've run into in GP land (given they can choose who they book in to see). I think maybe once I might've called my female colleague and fitted them in.

      In hospitals though during an emergency post-partum haemorrhage (after delivery of the baby) I remember the head nurse telling off the husband for trying to stop me going into the room (I'm male). At the end of the day we have responsibilities to the patient wellbeing first and foremost - but we will try and accomodate cultural wishes when safe to do so :)

  • cypher67 on 09/03/2018 - 09:27
    +3

    Do you have any colleagues with the last name Nick and if so, does professionalism take a back seat each time you meet them?

    • Scrooge McDuck on 09/03/2018 - 10:17
      +1

      Inflammable means flammable? What a country!

    • AusGP on 09/03/2018 - 11:08

      Haha no unfortunately XD

  • dasher86 on 09/03/2018 - 09:58

    Do you get commissions from drug companies / reps that come to see you to prescribe a certain type of brand for medication - or am i thinking too much like the US market?

    • AusGP on 09/03/2018 - 11:09

      No commissions. However drug companies ply you with free lunches and even free dinners (went to fancy restaurants previously) under the guise of educating GPs about treatment.

      At my clinic we accept no drug reps and we pay for our clinical meeting lunches ;)

    • [Deactivated] on 09/03/2018 - 14:02

      I heard that as of about a decade ago you're no longer allowed to accept so much as a pen from a drug rep in Australia.

      A fair few practices don't see reps anymore as there is nothing in it for them, just a sales pitch that takes up their time for free….

      • AusGP on 11/03/2018 - 14:28

        There's often free lunch provided

  • altomic on 09/03/2018 - 10:01

    McLaren or Ferrari?

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