[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

    • AusGP on 09/03/2018 - 11:09
      +2

      Neither - Honda :D

      • Kapinny on 10/03/2018 - 00:49

        u must defs be asian :)

  • [Deactivated] on 09/03/2018 - 10:26

    just a number to be disposed of as quickly as possible, that has been every experience with different GP's throughout the years

    • AusGP on 09/03/2018 - 11:10
      +1

      I highly encourage you to try a private billing clinic - should be chalk and cheese

      • [Deactivated] on 09/03/2018 - 12:13
        +1

        Thanks, on the lookout for one and trying to control my anxiety about it

  • jeeg on 09/03/2018 - 10:27
    +2

    What is the average salary of a young GP?

    How much do you earn?

    • AusGP on 09/03/2018 - 11:14
      +9

      Can vary wildly. Also most GPs are not salaried but simply get a proportion of patient billings.
      Taking into account that I haven't had any annual leave yet for the recent past, I would say it would be around $240k before tax or super or sick leave etc etc.
      But I've been offered at corporate bulk billing clinics up to $350k a year but I turned it down as obviously I had to churn through patients and not provide the ideal care I want to provide in those circumstances.

      • jeeg on 09/03/2018 - 14:19
        +4

        Let me pick up my jaws from the floor.

        • AusGP on 09/03/2018 - 14:31
          +6

          Yeah it is quite a bit. Similar to executive level salary - but I'm 6-7 years down the track from graduating from a 6 year degree. Not to mention the countless hours in hospitals and stress and a lifelong of preparing to be smart enough to be a doctor….(tutoring, Saturday/Sunday schools etc. No TV or video games most of the time etc. etc.)

          But it's good reward for the years and years I've put into this.

          For comparison, when I was an intern, I was earning $30 per hour when a plasterer from Ireland comes in and goes - They're ripping me off for $50 an hour! Same age as me, but had already been working for years. -_-'

          Some of my friends in Banking jobs had a couple of properties and managed to get in early in the property boom.

          So not complaining but also there's a lot of work that went into earning what I do now :)

          EDIT: Not to mention some very dark days in my life on my journey to becoming a doctor….

        • whoopi on 10/03/2018 - 20:23
          +1

          @RJW:
          Excuse me I earn about half that amount and I’m a GP similar number of years out as you but in a bulk billing clinic! Goes to show how much of a difference mixed billing can make. I need to aim higher

        • AusGP on 10/03/2018 - 21:11
          +2

          @whoopi:

          Hey whoopi what percentage are they paying you and are you working full time??? If you're saying that you're only getting 120k full time then something is wrong! I was earning more than that as a GPT 3/4 registrar in a bulk billing clinic and was doing good medicine too.

        • whoopi on 11/03/2018 - 18:47

          @RJW:
          60% including super. True I'm working part time, but full time would be about $150K. Fully booked, 15 min appointments. Are you working 5 days x 10 hrs a week?

        • AusGP on 11/03/2018 - 21:32

          @whoopi:
          4 days x 10 hours when factoring in follow-up.
          But as other commenters have noted, even I'm not doing very well because apparently most bulk billing GPs are billing 2-3k per day!!! (I normally average 1.8-2k billings per day at a private billing practice!) - I guess I'm not aggressive on the care plans :D

          But really I was getting offered 70% billings all over Melbourne for bulk billing clinics. Even 5% extra during after hours periods for one of the ones I was there as a registrar (standard offer there)

      • TimApple on 13/03/2018 - 17:16

        I feel like this number should be advertised more widely. A lot of people don't realise this, and I'm sure a lot of people got into software engineering just because the jobs pays $100k+. If only they knew how much doctors earn, they might have studied differently. I'm sure not all software engineers can be doctors, but when smart people put effort into their education, they could be more than they thought they could.

        • AusGP on 13/03/2018 - 17:30

          Actually I thought doctor pay was advertised really widely!

          But it's delayed gratification basically. My friends whom were bankers got paid reasonably well and did 3 years less study and bought houses and now it will take me probably 5-8 years to catch up the gap.

          (180k-200k in pre-tax income difference works out to be more than 3 years of me earning 180-200k difference due to the way tax rates work) plus the appreciation of property over that time.

  • Scrooge McDuck on 09/03/2018 - 10:35

    How can one find a GP who will prescribe Testosterone Enanthate?

    • Banana on 09/03/2018 - 10:49

      Where are you located?

    • AusGP on 09/03/2018 - 11:14
      +1

      I hope you have a good use for it - but I'm pretty sure it now needs an endocrinologist approval first

  • yoonibear on 09/03/2018 - 10:36
    +6

    Not so much a question but a comment.
    There was a young GP that worked (I think he was on rotations) at a medical centre near me. I had basically given up on my eczema (atopic dermatitis) and figured I'll just use moisturisers from there on. Not only did the GP sat there and listed to me explain my symptoms and my eczema, but he also "Googled" other things and consulted w/ another senior GP that had eczema. Without him being thorough and being really helpful I would've never found that my eczema was related to my immune system. Because of his recommendations, I was able to partake in a trial for a drug that actually "cured" my eczema.

    He basically did in 2 weeks what other GP's and dermatologists couldn't do for about 25 years! I don't know where your rotations are now Dr Braithwaite, but from the bottom of my heart, thank you.

    So if I had to give feedback - please don't lose that mentality of wanting to help people out.

    • AusGP on 11/03/2018 - 14:30
      +1

      Thanks yoonibear for sharing that story! Reminds me to look further for any trial treatments for refractory cases!

  • Godric on 09/03/2018 - 10:56

    How to get prescribed free massages?

    • AusGP on 09/03/2018 - 11:14
      +1

      ?

  • [Deactivated] on 09/03/2018 - 11:14

    What medical illnesses can you cure?

    • AusGP on 09/03/2018 - 11:15

      Lots but was there anything specific you were hoping to find out about?

      • [Deactivated] on 09/03/2018 - 11:25
        -1

        Just name one.

        • AusGP on 09/03/2018 - 11:30

          Skin infections, pneumonia, sinus infections, urinary tract infections
          Eczema (not technically cure but control)
          Constipation
          Preventative healthcare - stopping smoking, weight reduction

        • whytd on 09/03/2018 - 13:54
          +2

          @Warier:
          What are you trying to get at….?

        • [Deactivated] on 09/03/2018 - 18:23
          +1

          @whytd:
          Probably preparing to enter the discussion with snake oil - the magic cure to every ailment.

          Doctors are bloody useless anyway. They have to ask so many questions, do so many tests just to come up with a few possibilities and come up with a plan. Even after all that, they are not sure of how much medicine to give and have to get you back few times to titrate (balance) your dosage.

          Now, in my practice, I can tell you what ails you by just sensing your energy. I will then mix you the finest concoction of the rarest herbs. Not only is it going to cure you, make you know more about "wellness" than your friends, it will also make you see the conspiracy of the medical charlatans.

        • AusGP on 11/03/2018 - 14:31

          @tshow:

          I had a good laugh reading this!

        • [Deactivated] on 12/03/2018 - 14:35

          @RJW: What's the best way to quit smoking. I've tried countless times, I guess I have no self control.

        • [Deactivated] on 12/03/2018 - 17:58

          @voolish:

          GP's don't have a solution for the problem of habitual smoking. They only solve problems related to bacterial infections with their antibiotics. If your problem is not bacterial related then best not to ask a GP but it will be interesting to see what solution RJW will reply with :)

        • R-Man on 13/03/2018 - 20:51

          @Warier: what illnesses do you think your General Practitioner should cure? Just name one.

  • idonotknowwhy on 09/03/2018 - 11:16
    +1

    Hi, thanks for the AMA, I have a couple of questions:

    1. What are your thoughts about this diet: https://www.reddit.com/r/keto/ ?
    2. Do you ever lie to patients (or withhold information) for their own good?

    Feedback:

    Some GPs are hopeless. One GP misdiagnosed me 3 times for a simple joint problem.
    What I've found is you're better off paying for a private billing GP, otherwise it's just a quick in-and-out, here's a script, here's a medical certificate, (profanity) off.

    • AusGP on 09/03/2018 - 11:21
      +2
      1. Ketogenic diets can be useful - the theory being when you burn fat/ketones, it makes your body think its in starvation mode which suppresses your appetite. Provided you don't have any major medical conditions I don't see any issue.

      However so many diets out there and so many that can work for people, my head is usually spinning with what patients come in - this month is 5-2, then something new called 16-8 or something or other XD. Best to see a dietitian!

      1. No I don't lie to patients. Before a diagnosis is certain I may not provide them with my fears for them (e.g. cancer) - but I always am completely honest when I have all the information available to me.
  • Tech5 on 09/03/2018 - 11:35

    Do you find a lot of the older doctors and mentors you have had, see us Dentists as your mentally stunted, midget distant cousins who are basically glorified carpenters?

    • AusGP on 09/03/2018 - 11:37

      Haha - no not that I have known! Having said that I do work at a great clinic where everyone is respectful to anyone in our practice no matter their position so maybe others might have a different perception.

      I have several friends whom are dentists :)

    • [Deactivated] on 09/03/2018 - 18:40

      Stethoscope or no hope.

  • reflexline on 09/03/2018 - 11:46

    Are you prescriptions of certain medications, such as Benzodiazepines reviewed? I find I have to argue for my prescription every time I go to get a refill, despite the small amount of diazepman (100mg/4 months) and the success and long and responsible history I have had with the drug (11 years).

    • AusGP on 09/03/2018 - 14:37
      +1

      They are potentially a very addictive class of medications. I think in Victoria they're a controlled medication (I think schedule 5 or something) which means the Police are very interested.

      Also according to a drug addiction talk I received a while back, more people die from benzodiazepine related deaths than from road accidents. (usually overdosed in combination with something else). Benzos are rife on the streets and some of my patients openly to admit buying them off acquaintances etc. :\

      There's better medication for long term control of symptoms but certainly they can have an appropriate place in treatment. Just make sure you go back to the same GP for prescriptions and generally as they get to know you they will trust that you are not "diverting" it to someone else.

  • luvv on 09/03/2018 - 11:48

    I'm a psychiatrist. How can I do better in the eyes of a young GP? :)

    • AusGP on 09/03/2018 - 14:39

      Hey thanks for replying!!
      Tips:
      1. Make sure you write to us promptly when you see a patient - it sometimes gets difficult to know exactly what a patients progress is when they show up and say bla bla has prescribed me this.
      2. Accessibility - I have found it really hard to find a private psychiatrist promptly for when I need my patients seen acutely! It was quicker to send them via local area mental health for an acute assessment.
      3. Be caring and listening to your patients - number one complaint I hear from my patients is it feels like the psychiatrist is only interested in prescribing medications - I'm sure you won't fall in that category given you've replied! :D

      • tj9630 on 11/03/2018 - 21:38

        I’m a Gp too… correspondence!!!! Hardly any psychiatrists I refer to correspond back…. I need to know what’s the plan what drugs you have started… if you corrrespond I am more likely to refer more to you in future

  • [Deactivated] on 09/03/2018 - 11:48

    Is it true that there is a cure for cancer but its suppressed by big pharma cos its a billion dollar industry?

    • Tech5 on 09/03/2018 - 13:14

      Not that we know of

    • AusGP on 09/03/2018 - 15:00

      We wish. But not that we know of!

    • kingmw on 10/03/2018 - 23:20

      There isn't just one type of cancer so there is no one cure either.

      However a number of innovations have occurred in the fight against specific cancer including HPV vaccination against cervical cancers/head and neck/anal cancers, H Pylori eradication to reduce stomach cancer and elimination of certain types of Hep C virus that will likely reduce liver cancer.

      Also there are many preventative measures which we know that will reduce your risk of cancer but not everyone abides to them e.g. No smoking, moderate alcohol consumption, healthy weight range, exercise etc. These are probably going to be more effective to reduce your overall risk of cancer than any miracle cures.

    • [Deactivated] on 12/03/2018 - 02:19
      +1

      Dont think so Billionaires die all the time. Forbes magazines has a annual "Billionaires in Memoriam"

  • max2million on 09/03/2018 - 11:50
    +2

    In my families experience, we have found GPs (and doctors in general) fall into two camps.

    Either they are aware of their limitations or are absolute in their belief in knowing it all. I've never met anyone in the middle! A good example is acknowledging the limited training in nutrition in med school.

    Have you noticed something like this?

    • AusGP on 09/03/2018 - 14:42
      +1

      I think overall there is a spectrum but yes you are right that mostly there would be two peaks in terms of confidence vs knowing limitations.

      The more and more you know about something, the less and less you become certain, until you become an absolute expert on the matter. But this never happens in General Practice because there's no way we can be across everything in medicine! (Otherwise we'd be House MD!)

      The ones whom have absolute belief in knowing it all can be dangerous - medicine changes all the time. Also somtimes the ones who "know it all" are actually just bluffing. I have heard of one story like this when training - I thought the doctor seemed very confident and competent - turns out he wasn't….lucky he didn't kill someone….(but sanctioned and reported to AHRPA so processes are in place)

  • [Deactivated] on 09/03/2018 - 11:53
    +1

    I've had a few run-ins with different docs at clinics.
    one was a male Doc told me to loose weight, what are you for real you are two times bigger than me and you are giving me advice - stick your practice so he kicked me out and escorted me to the entrance past the counter and out the door. Then he is yelling to come back and pay the bill, so I says go jump you kicked me out of your practice should have thought of that before, never did get a bill from him and he is no longer there.
    So I finds another practice with a very good female Doc who was very pleasant and knew her work, and became my Doc.
    In the mean time she asked me to get my files from the other practice so that she could read my condition, well what a hassle, they wanted $60 to send my files to the new practice so I smartly told them to burn them I'll start again and that I did, with the new Doc I was sent to specialists who took me off most of my tablets stating why the hell was I taking them in first place. I have been seeing this Doc for quite a while now and was having 6 monthly check ups but she is now in so high demand it has been hard to see her and was seeing duty Docs for my prescriptions and has turned me off going to this practice. So I have now started to attend a newer practice that has setup shop and will sus out all the docs there and work out which one to be my Doc. They also call you and the last call was to make an appointment with a Doc as I have recently had a blood test, so so far they seem very organised.

    • AusGP on 09/03/2018 - 14:44

      Sounds promising as a practice!

  • ihbh on 09/03/2018 - 12:02

    Were you taught much about diet/nutrition in your studies? If not, how much have you investigated on your own?

    • AusGP on 09/03/2018 - 12:05

      We were taught some but not much. I haven't really investigated fully beyond what I've been exposed to I must say - Having said that I did go through the Austin Hospital as a medical student and observed a professor there renowned for his ideas about weight loss etc.

  • d-hunterz on 09/03/2018 - 12:07

    Hi RJW,

    Hope you remember me https://www.ozbargain.com.au/node/364395#comment-5702679. I got the MRI done, doctoro advised me there is nothing significant in the reports. Hoiwever as I am still having a little issues with my back and taht has restricted me do few things at my part time workplace hence covinced doctor to do TAC certificate for me.

    Do you think TAC would pay me MRI cost back if the claim is approved?
    Also I wish to attend Physio would it be covered by TAC? As the GP has advised me TAC will only start covering once the expenses has exceeded $600.

    • AusGP on 09/03/2018 - 12:09

      I think they will reimburse you. Having said that I'm not sure about the $600 limit. Whatever you do just put in the paperwork and then see if they'll reimburse you.

      Physio should be covered by TAC but again I'm not sure about the $600 threshold.

  • cypher67 on 09/03/2018 - 12:44
    -4

    Ever done a physical examination that you enjoyed so much little RJW was awaken?

    • AusGP on 09/03/2018 - 12:46

      No absolutely not! - And I have done plenty of intimate examinations as part of my previous 6 months at Royal Women's

  • Well Wasted on 09/03/2018 - 13:16

    are you an australian citizen?

    • AusGP on 09/03/2018 - 13:17
      +1

      Yep. Have been since 9yo :)

  • Well Wasted on 09/03/2018 - 13:20
    +1

    in the chase of the almighty dollar… do you think doctors overlook the fact that they have sworn a hippocratic oath to base all decisions in the best interests of the patient?

    • AusGP on 09/03/2018 - 13:29
      +1

      In general absolutely not. All the doctors I associate with will not make decisions based on the dollar and is always acting in the interests of the patient.

      Having said that there are always bad apples and slightly going off ones in any profession - so we have to be careful and watch out for those.

  • lbsyc on 09/03/2018 - 13:30

    Would you advise people to do regular full body check ups every few years?

    • AusGP on 09/03/2018 - 13:32

      Depends on age but overall yes - mainly simple things like blood pressure, height and weight, check blood sugar and cholesterol if at an appropriate age, run through anything preventative that needs to be done and look at what screening activities need to be completed.

      I generally ask anyone over 50 to do a checkup every year.

  • Deridas on 09/03/2018 - 13:56
    +1

    RJW, I've noticed there are a significant proportion of comments that show animosity towards the medical profession. Did you expect this prior to starting your AMA? Do you feel this is a reflection on the Australian population in general?

    As part of your AMA you mentioned you were inspired to change General Practice (I presume you mean change the perception of General Practice), how has this AMA so far contributed to this goal?

    • AusGP on 09/03/2018 - 14:25
      +2

      I wasn't surprised to be honest. I have talked to my friends even and their perception isn't that great even though they know me! It is a sad state of affairs that Australians don't appreciate their healthcare system - but I am willing to put up my hand and say there's lots that can be better.

      I'm not inspired to change the perception as much as I want to change general practice to be better. There are a few political impediments to changing things which I'm not intending on tackling until I have enough experience and clout that people will listen to me. I want though to change things up to make general practice as good as it can be.

      E.g. email communications with your doctor, using AI to help, using more data and trying to dig through your data to identify which patients you can help the most etc etc.
      But sometimes innovative ideas come from patients and consumers so really keen to hear if anyone got some bright outlandish ideas that sound crazy initially but might actually work.

      General practice is changing and there may be a new funding model coming out soon - so now is the time to try and disrupt things!

      • Deridas on 09/03/2018 - 14:25

        Thanks for your reply.

    • kingmw on 10/03/2018 - 23:29
      +2

      We have an excellent healthcare system in Australia and our international comparisons show it. I know I rather be sick in Australia rather than most other countries, even more so if you don't have money.

  • Trinion1 on 09/03/2018 - 14:08

    Hi RJW, thanks for doing the AMA.
    I am 2 months into my intern year and am considering going down the GP training pathway. When and why did you decide you wanted to be a GP and what's the general process of applying to be on the pathway? I had a flick through of the AGPT handbook but my understanding still limited. Thanks again :D

    • AusGP on 09/03/2018 - 14:52
      +2

      Well I didn't always want to be a GP. I initially wanted to be a surgeon (then found I was way too clumsy and uncoordinated to do that too well), then wanted to be an anaesthetist / intensivist. But after I did intensive care as a resident I found actually maybe I didn't enjoy not talking to patients. I rotated through cardiology in the rotation after and didn't recognise someone whom I had seen in ICU - made me feel wow - I was involved in the care of this man and we saved his life yet I don't even recognise him!

      What sealed the deal was when I did Rural ED and found I loved being able to take charge of the care of a patient - and that's what you do in General Practice - they're your patient to take care of and if you don't agree or are worried about an opinion / investigation - you chase it down further. I was persistent and picked up a lymphoma this way. There's nothing more special than to have a grateful patient come back to you and say thanks (or better yet a 7yo drawing of how the doctor fixed her wound! - it was mainly the nurses work haha - but the nurse got a drawing too).

      As far as I understand it, you need 1 year internship, 1 year residency (ensuring you get paediatric experience), 2 year GP registrar training - that's the minimal pathway under the RACGP. I did 2 years residency and felt I was better for it, as I picked up a 6 month O+G rotation (most stressful 6 months of my hospital life) which really stood me in good stead for general practice.

    • AusGP on 09/03/2018 - 14:54
      +1

      The process itself - I think you can apply in intern year to AGPT. Select your pathway. There's usually an entrance test. Then after that you have an interview. It's actually surprising in some ways but only 1 in 2 applicants get accepted into the training program from last that I heard.

  • diceman99 on 09/03/2018 - 14:11

    Why didnt u become a gynacologist

    • AusGP on 09/03/2018 - 14:54

      Not that interested in gynaecology and also super stressful training in O+G

  • Blue Cat on 09/03/2018 - 14:30
    +1

    I fart a lot but my farts barely smell, sometimes they are odourless.
    Before this happened I would fart very rarely but my farts would smell.

    Should I be worried? What is happening?

    • AusGP on 09/03/2018 - 14:55
      +1

      Sounds like that's a good thing? If you're worried see your GP but sounds like your gut microbiome has changed (not necessarily for the worse). But depending on whether you have other symptoms might be worthwhile at least discussing.

    • ToTheMoon on 09/03/2018 - 15:30

      maybe check up lactose intolerance

  • PaperplaneXXX on 09/03/2018 - 14:46
    +1

    Australian health care system is so bad! and all this idea regarding GP practice…you shall go and see GP first.
    I have been struggling with Arthritis for 4 years so far and little help was done by GP.
    They simply don't care! They cant send you to few specialists as its probably not tolerated.
    I had to struggle a lot!.
    Finally got at least an infectious disease doctor.
    Some GPs are using Wikipedia to search the particular illness. so damn bad!

    and also 4 years ago i was improperly diagnosed here as well.
    Only overseas doctors picked up different issues and causes.

    Simply GP system is (profanity)!! you can go and see them and you die and nobody cares!

    • AusGP on 09/03/2018 - 14:58

      Sorry to hear you had a bad experience with GPs here in Aust. It saddens me that you didn't get to meet good GPs who could diagnose you properly (or know when to ask for help from specialists).

      Having said that, I think our GP system here is much better than some countries I know of. If only my grandfather had seen a quality GP equivalent overseas maybe he wouldn't have had such a bad stroke and died (went to see a cardiologist which did the absolute wrong thing during what turned out to be a stroke) - but that's what you get in some overseas systems when you see a specialist directly - if all you have is a hammer, everything is a nail…

    • freemoneyhunter on 10/03/2018 - 18:13

      What type of Arthritis do you have?

    • kingmw on 10/03/2018 - 23:38

      Unfortunately arthritis is a chronic degenerative problem resulting in long term pain and there are no miracle treatments. I don't know what you are wanting your GP to do about it except to manage your pain and maintain your joint function with exercises/physiotherapy?? As a last resort, they will refer you for a joint replacement but that doesn't mean all the pain will magically go away and there always possible side effects/complications as a result of surgery.

    • [Deactivated] on 12/03/2018 - 21:13

      Yes, compounded by lack of physical signs in the early stages.

      In all serious look into the links with diets. GP's while good do not appear to have a clue on the impacts of diet (apart from eat healthy)
      Won't fix the severe cases, but can provide some relief.

      1. Watch your diet to limit Vitamin C. Yes it's essential and required daily (it's added to most food so very easy to exceed the RDI without supplements). Don't cut down on fruit\veg, just any supplements or processed items with Vitamin C added (check labels). Modern medicine has started to link vitamin c (above RDI) to Osteoarthritis, but recommend vitamin c to prevent against Rheumatoid Arhritis, lowing to low\medium levels once symptoms appear. (ie: they are still guessing). If you have Rheumatoid Arthritis, I feel for you and best to see a specialist early as possible and discuss diets and treatments as their are some experimental drugs still being tested (consider going on a trial for one in the later development stages, you need to weigh up the risks). Prevention\slowing down is the best here.

      2. Glucosamine with fish oil tablets do help a lot of people, bit you need to take for 30+ days before they work, and when you stop symptoms can return within days :( Fish Oil tabs have been linked to prostate cancer, make a call based on the pain. Without the fishoil are not as good, unless you eat lots of oily fish. (eg: salmon)

      If you care about your eyes, and can help to restore site take
      Lutein and Zeaxanthin supplements, takes about 60 days to start working, but seriously watch your vision \ eye health improve, even a small improvement while you watch everyone else degrades is amazing to feel.

      Wellbeing
      Avoid large lunches, skip a meal every now and then, but keep up the fluids.

      Alcohol can cause flare-ups but you would know that by now. :)

  • [Deactivated] on 09/03/2018 - 14:58
    -1

    Do you dress up as poor and try to get deals at the op shop?

    • AusGP on 09/03/2018 - 14:59

      Nope

  • AddNinja on 09/03/2018 - 15:10
    +1

    At your clinic, create a system whereby when you start treating a patient, the next in line is sent a text message. I would much rather wait outside or in a cafe than inside your waiting room. Not only would this be convenient, you’d get less frustration from people who’ve been waiting a long time, because their wait would be more pleasant. You could advertise this service to attract customers, I think.

    • AusGP on 09/03/2018 - 15:20

      Thanks AddNinja! That is a great idea and one that actually came up 2 weeks ago at our patient feedback/co-design workshop! Sounds like its something we should explore doing (currently we do something similar by delaying patients if we're running late but its manual so if the receptionists are overwhelmed and not paying attention to the patient list the patients don't get a text)

      • decr on 09/03/2018 - 17:37

        Sorry to reply to AddNinja's comment, but it's quite relevant:

        I read through all the way here to make sure no-one had mentioned this before, but I was basically going to say the same thing.

        If you're a patient stuck in a waiting room waiting for your appointment that was due 45 mins ago, with all sorts of other people from the spectrum from screaming kids to who-knows-what, it's not going to be an enjoyable experience for neither. As a GP you are customer facing and the first person the patient is going to take out his/her frustrations on is you. I find this especially frustrating taking kids to see a GP, dentists seem even worse.

        As for running late, It doesn't even have to be overly technical. If the clinic or a specific doctor is running late, it would be awesome if reception would tell you that your appointment has been delayed due to reason x, and your new expected time is in say 30 minutes. That would allow for half the waiting room to go wait outside, have a coffee, walk in a park etc and return at the specified time.

        I try not to see doctors too often, luckily maybe once a year to get a med cert if I'm really ill, but it's different with kids so the above is reflected from those occasions. Last time I had to have a course of antibiotics the ones I was prescribed were way too strong, gave me severe diarrhoea and lost appetite for 2-3 weeks.

        So my question is, if a patient feels that the active ingredient amount is too high, with or without previous experience, would you reconsider the strength of the drug (say antibiotics) you are about to prescribe?

        Your answers have been great throughout the thread, keep it up :)

        • AusGP on 09/03/2018 - 18:03

          Thanks for your input decr!

          We do have a very similar process already in place (we even have a template SMS for this). What happens is if I'm delayed, reception will spot this and start sending out text messages to the subsequent patients for either a 15 min or 30 min delay and most patients use this to go do something else. We also let patients know how many patients are ahead of them so if they arrive and find I'm running late 30-45 min they might go across the road for coffee or nip back home before coming.

          The only problem is this whole process is manual which means it works great when reception are not overloaded but falls over when they're busy.

          Will have to look into whether we can somehow get this functionality from our software providers to automatically send a delayed text message based on anticipated waiting time - or whether we can make it easy when I'm running late to just press a button and it does it for me.

          But yes this seems to be a real bugbear of patients so will look into it deeply!

  • Maccadoodle on 09/03/2018 - 15:22

    Hi RJW & thanks for taking the time to put yourself on the public chopping block.I live in a fair size regional centre and have had trouble finding a doc with that balance of personality,good science knowledge and intuition. My last one was a trainee who was pleasant to talk to but had to leave as he was on rotation. He used to always look at the screen to check on things that an older more experienced GP would or should have known.That was Ok he at least had the keenness to chat and look at things from my point of view. I feel that GP's should try and tune in to patients that take a intelligent interest in their health and are motivated to take steps to do good research. Very very few if any new docs actually say OK then would you like me to be your GP and we can do a complete check on things and keep you up to date. Most just look blandly and ask whats wrong and then just fix the thing I may have come for.I may have a list of things that need checking but I feel I have to do the research and checking and ask for holistic care. I am nearly 62 and so far in good health. I think they see so many people who dont take good care & are on meds for lifestyle diseases that when they see me I just get dismissed. I am one for screening and keeping records to compare. I also like to have time to discuss various issues that may have been in the media like this latest issue with PSA testing.I book a double or a triple appointment as standard now as even if I get charged over a $100 with medicare rebate it is good value and the doc does not have to push me out. I avoid bulk billing practices that have a reputation for high churn.Docs should also be required to put up a good profile of them selves and not just the soft and fuzzy stuff that makes them look so pleasant to deal with. You were at least honest to admit that you made mistakes. That's all that most of the public want some one genuine who has not lost their vocational mojo. Good luck and if you set up practice in Port Macquarie let me know. Oh and I hope you are at least trying to upload records to the cloud. So frustrating as I think medicos are really recalcitrant when it comes to using IT.

    • AusGP on 09/03/2018 - 15:34

      Thanks Maccadoodle, I shall try and keep my vocational mojo for the next 30 years! (as my "mentor" has done before me)

      1. Preventative care actually should be top of the list for any GP. I normally do try and run through any screening activities with my patients. I definitely do discuss the controversies surrounding PSA testing before I order it (given basically it's not a harmless blood test). If anything I keep running late because I try to fit these extras in! But yes I think we should always strive to provide holistic care and take any opportunity (whether script / cold / work certificate) to review a patient's file and see what other general health checkups should be done. I applaud you for booking double appointments so GPs don't have to feel rushed!

      2. PCEHR (E-Health record) is a bit clunky at the moment. It takes about a minute of back and forth for the computers to register the e-Health summaries I send and sometimes it keeps failing for very simple reasons like one tickbox wasn't ticked. It is something my practice will begin to focus on as we are involved in a leadership / pilot group with the local primary health network. But thanks for the reminder! I shall strive to upload more!

      • Maccadoodle on 09/03/2018 - 15:48

        Thanks keep up the IT push. Not having digital integration between auxiliary services, specialists pharmacists GP's and hospitals is appalling. Wasting dollars inconvenient and dangerous. My wife a senior RN works for part of the week at the local Base hosp pre admissions dept and she is always on the phone looking for patent records. No one dept or practice is able to communicate with another. Some even require a phone call and a fax!!

        Another big issue that will become more important in your career is the need to include genetic screening in with other checks. This I hope will soon become standard and the results will be used for research. Dont be one of these wimpy doctors who get nervous and say oh if this indicated that you are at higher risk we dont know how to treat that yet. I dont want you to fret unnecessarily. So important to build up big data and associations with disease then can be focused on.

        Last is dont be soft on those folk who really are not good at looking after themselves. Be kind but very firm. We are all paying the huge tax bill for so many of their health problems.

        • AusGP on 09/03/2018 - 15:56

          Yes frustrating indeed! It is all due to the lack of interoperability of systems so hopefully with E-Health records (if they can streamline it to work flawlessly) it will become much easier! Faxes frustrates me no end - we really should be on email now!

        • [Deactivated] on 09/03/2018 - 16:33
          +1

          @RJW: I think even email is an old age concept now. It's all about the cloud and having information on one easily accessible platform instead of segregated and scattered which makes patient care extremely difficult.
          I remember in hospital training I was speaking to one of the JMO representatives on changing Powerchart (this is what we use in hospitals) to allow it to be user friendly especially since they were introducing E-prescribing. He asked if they could create a new program and he was given the answer that it was going to be too expensive to develop. So it appears we will have to deal with it.

        • AusGP on 09/03/2018 - 16:36

          @r3d3mption:
          Yes but so difficult with IT systems. I was at the BCV Innovation in Action conference recently where one slide showed 90% of IT projects essentially fail to do what they set out to do….

        • Maccadoodle on 09/03/2018 - 22:38

          @r3d3mption: This country so desperately needs just ONE health authority not 9. So many self serving jurisdictions and vested interests.Just a dislocated mess.

  • skywards on 09/03/2018 - 15:55

    Can you please shed on some light as to why Porsche is the car of choice among doctors?

    • AusGP on 09/03/2018 - 15:57
      +1

      Haha not amongst me and my friends - I drive a Honda :)

    • dcep on 09/03/2018 - 16:04

      doctor likes german engineering

    • kimmik on 10/03/2018 - 13:57

      attention to detail.

  • [Deactivated] on 09/03/2018 - 16:15

    I am a GP registrar just started. Ever thought of concierge medicine or because of medicare and the number of potential clients it isn't financially viable in Australia? Definitely something I considered or to go into cosmetic medicine.
    I feel the same way I've picked up multiple preventative measures in patients and with changing guidelines it's always hard to get things right (i.e . now the recommendation for aspirin for prevention of colorectal cancer because I bothered to check the cancer council clinical guidelines). I have also heard of specialised private clinics in the UK where they offer screening MRIs for people who will pay for it (but there lies in the risk of incidental findings which might be benign and as a result be over investigated).

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