As per the title - I'll try and give my personal and professional experience, without providing any specific medical advice (which is fraught with risk over the internet, without being familiar with your medical history).
I have been working as a specialist General Practitioner for the last 5 years, and am currently working in a COVID screening clinic in Melbourne seeing all the lovely coughs and colds.
I think you're right about the informative and entertaining part. Every time I hear any word with the suffix -emia, I his his voice in my head saying "-emia, meaning presence in blood". However, if I was a patient at a hospital and he was my doctor, I would be absolutely terrified.
I'll check out ZDoggMD, thanks!
Any thoughts on online medical certificate issuers (such as Qoctor)?
Yeah I think they can be pretty useful if that's all you need - you can save lots of time and it's very convenient.
However there is the risk that it could fragment care further because even for short consultations, they're often used as opportunities to practice preventative health (e.g. "while you're here Mr. Smith, I noticed you're overdue for that stool screening test"). You do get to build up a picture of the patient over time and you get a feel for when patients aren't feeling their usual selves which gets missed with brief one-issue consultations.
How common are HPV's, how can we avoid getting one (although I guess the answer to this is obvious) and what can we do if we contract one? I am scared to death of cervical/ovarian cancers
+1 to this question. I understand viral warts eg. on face or legs, are also caused by certain HPV strains? Can these lead to cervical/ovarian cancers?
Get the vaccination. After that it's unlikely unless you've already had exposure. You can't do anything about it, most people clear all HPV types normally with no intervention. And yes, warts of all sorts are often HPV. Cannot lead to cancers unless they are found where the cancer is- they don't migrate. And certain types are much less lkely to be cancer causing than other. 16 and 18 are strongly associated with cerivcal, for example.
Thank god for the vaccine! I have history of cervical cancer in my family and I have to go in for screening and I'm just anxious even though I think it's unlikely but I guess you never know.
Very common - did you know common warts are caused by a strain of the HPV? There are a few 'oncogenic' strains of the HPV which are responsible for the majority of cervical cancers, however with the Gardasil vaccine (which protects against these oncogenic strains) we're now seeing a huge decline in cervical cancers in a single generation. If you contract one of these oncogenic strains there's not much you can do, and you don't necessarily even have to had been sexually active as it can be passed on during delivery from your mother. Sometimes (usually?) they stick around in the body and don't progress to cancer, but I couldn't quote the literature on the likelihood of this happening - i.e. just because you contract the oncogenic strain, it doesn't necessarily guarantee you'll go on to develop cervical cancer.
That's the reason we recommend early immunisation, as well as regular CST (cervical screening tests - which replace the old PAP smears) in women every 5 years from the age of 25 years, so we can identify and closely monitor any pre-cancerous changes.
I'm not aware of any association between HPV and ovarian cancer (the main ones being age and genetic disposition)?
re: common warts and finding out the type of HPV strain, how does one go about finding out? can a GP take a skin sample and get it tested from a lab?
I'm sure the technology exists for this, however what would be the point of doing this, as it doesn't change your prognosis or treatment? If you're female and worried you could have an oncogenic strain "down there" - the way to find out is through regular CSTs
Have you ever filled out sick certificates for patients suffering from work related stress? Cause I need one.
I sure have (refer to my reply on the first page). I recommend seeing your local GP if this is starting to adversely affect your work performance or attendance.
What do you think about some doctors that say depression is just 'all in the mind'? Do you think this is professional?
Do doctors really say this?
Unfortunately, yes - but just a small minority. My guess is that it could be a cultural thing or something they’ve internalised from med school.
I'm not sure of any doctors that would say this because 1) it's incredibly insensitive, 2) it's not even correct, in that there might be other factors we can work together to address. I would always take someone's experience at face value and work from there.
However, I do wonder about the increasing trend in people self-diagnosing mental illnesses (for some reason, this happens alot in young women in particular) because there are long-term medico-legal consequences, it diminishes the experiences of people with genuine mental illness and traps these "diagnosed" individuals in a victimhood mentality. To clarify my position (in case this sounds insensitive) - say an individual is "depressed" because she's just broken up with her ex-boyfriend for the umpteenth time…of course we'll work together to get her feeling better so she can get back with rebuilding her life…but technically she doesn't have depression, but rather what we would term an adjustment disorder. To give the diagnosis of depression is a very serious affair which has treatment implications as well as ability to claim admissions on certain private health, obtain certain forms of life insurance or be employed in certain capacities in the future. Not only that, but it also runs the risk of 'medicalising' what is probably fundamentally an issue with relationship dynamics (e.g. underlying codependence), and prevents people from addressing the underlying causes of the depressed mood, and I'll be damned if I chalk it down to 'imbalances in neurotransmitters' in the brain while convincing her that the medications will help her situation,
I think that just as often pain is the body's mechanism to alert us that there's something wrong with our physical state, and we need to address the underlying cause, likewise mental anguish is a flag to alert us of underlying issues in the psyche that need to be addressed urgently. In modern society we've lost the ability to sit with and derive meaning from unpleasant sensations and experiences, which is why I believe we have an epidemic of substance addiction, volatile relationships and "depression".
Having said that, there are plenty of individuals without any underlying psychosocial stressors to account for why they feel terrible (the so-called 'biological depression'), or alternatively there are others with terrible, tragic life circumstances and traumas way beyond their control which any attempt at cognitive reframing is likely to be a lifelong process, and to casually quip that their suffering is all in the mind would be incredibly insensitive, so as in all things, discretion applies.
This is a nice idea; thanks for doing it!
This is a general question and not COVID-related, but it could well apply to COVID situations too.
What's your advice for someone who'd like to convince a friend or relative that a few bad experiences with a GP or GPs does not mean they should stop listening to medical professionals altogether? To be clear, I think a certain level of critical thinking or skepticism is useful in almost all contexts, but I'm talking way beyond that.
Note that what I've tried so far is simply noting that there's no doctor that knows everything, and even the most assiduous doctors cannot possibly keep on top of everything. Moreover, you're also human and humans make mistakes and have failings. (There are also some kind of structural aspects relating to socio-economic issues and the like that are probably worth pointing out, but for now I've just started with the stuff that seems most obvious.)
How can I convince somebody that the above paragraph can be true, but that in general it's still good to take the advice of medical practitioners? In discussions, the person I'm thinking most about it is typically receptive to these points, but their subjective experiences with their GP do not seem to change.
What techniques could be useful here? And apologies for a kind of complex question with possibly no good answer!
You've raised a couple of great points there already about the reasons as to why your friend/relative didn't have the experience they were expecting. I guess I would advise that like with all relationships, there's the good and the bad - who hasn't in their life come across both? Kind of like how some men or women in failed relationships end up misogynists or radical feminists (and I make no apology for using that analogy here). Most people realise that they just weren't a good match and move on to find someone they're more compatible with.
I guess what I would advise (in a long-winded kind of way) is to encourage your friend/relative to give it a try and see for themselves that not all doctors think/practice in the same way.
Thank you! I like the compatibility angle and it's not one I've tried before so I'll give it a shot.
(Also for what it's worth I probably fit the radical feminist mould, though not due to any failed relationships that I can identify, but I won't take offence!)
I have another shorter question too.
What are the best ways to increase one's medical or scientific literacy generally? (Basically just as a lay person wanting to understand things a little more deeply.)
Books by Ben Goldacre- Bad science and bad medicine are a start.
Cheers.
What's your thoughts on bulk billing. Why do some do it, while others not?
And for specialists, why are the Medicare listed rates usually 1/4 to 1/5 what specialists actually charge?
This might help- https://feeslist.ama.com.au/file/download/fees-gaps-poster-2…
Most GPs charge 2-3 times the rebate too.
My thoughts on bulk-billing have been covered in previous responses. Whether doctors privately or bulk bill ultimately comes down to personal preference and style of practice, as there are pros and cons to both models (also covered in previous responses).
Most GPs actually bulk bill, so I'd be interested to know where you got that figure of GPs charging 2-3x Medicare rebate @cynicor
Sorry, most GPs that private bill. As previously mentioned, I don't think UBB are worth discussing.
How much do GPs simliar to yourself get for the base salary and how much more can you earn if you max out overtime? I had no idea that GPs could get overtime on top of their base salary until I saw it on a website. This is why I chose a different career path, it's too late for me now but I'd like to know the answer.
Most GPs work as independent contractors (not as employees) and the income varies according to many different variables. In an earlier reply I gave a few figures as to how much can be expected for a basic consultation, so if you extrapolate those figures you can probably work out how much extra a GP could expect to earn if they're willing to work the extra hours.
To be specific, there is no base salary and no overtime. Most GPs working an FTE (normally about 4 days a week) would be on 200-250k. this is as their entire remuneration, so take super out of that, and no paid LSL, leave, sick leave etc. And that would be after tax.
Why is FTE 4 days?
Realistically, how many patients can you see in an hour? I've noticed things like HealthEngine etc can book appointments in 10 minutes increments.
What happens when there's more patients waiting even though it's past your off work time?
Depends on the doctor. Some book in 5-10 min increments! Some book in 15 and 20.
You book patients, so I guess there are two option to your question.
1. If you are running behind scheduled patients, you just keep working
2. If patients are there in the hope of being seen, then the clinic needs to sort it out- they should have asked if they can overbook, or booked the patients for another time.
If you ever move to Sydney hit me up. Ill be your first customer!
What did you do before joining the GP training program?
What kind of clinic set up did you work in pre-COVID?
I've always thought that GP can be a bit isolating compared to the inpatient when you're always working within a team of other doctors - do you find this to be the case, or do you find the half hour you take for lunch to be adequate socialisation?
I've heard that the training program/exams are not as difficult as say internal medicine or critical care, but the actual day to day work of being a GP is very mentally and emotionally challenging as you need to keep a broad working knowledge of basically all of medicine and there's no immediate pathology/imaging/specialty consult to back you up. Would you agree?
I'll let the OP speak about themselves, but yes, GP can be isolating. If you are the sort who likes various team interactions then you need to find the right clinic setup, right work type (say an AMS or prison or other) or just not do GP. It's often not about socialising but having the debrief, the corridor consults, someone to ask without feeling stupid and people to keep your practice inline with sanity. The kookiest doctors are single practitioners, in any speciality.
And on the training program, sadly yes, I think the exams are far too easy still and the program too short. But the actual work is very challenging to do well, and easy to do poorly.
I was working in the hospital system for a few years as a resident - mainly in internal medicine, paediatrics, obstetrics, psychiatry and emergency.
Since then I've worked in a variety of settings including private, bulk-billing and mixed-billing. The last practice I was in was mixed-billing, but in reality most patients were bulk billed because they had the relevant concessions (e.g. HCC, pensioners, children under 16).
It can be isolating, but there are always plenty of opportunities for informal catchups e.g. at lunch time, in the corridor or the reception. Some clinics have drug rep lunches or journal club. We're quite a collegial bunch and are always bouncing ideas off each other, so all in all I've personally never felt isolated.
I agree about it being potentially being mentally (and emotionally) exhausting having to keep on top of everything, but I think at the end of the day you just have to accept that it's impossible to know everything there is to know about all conditions, and to to try and keep up with most of the important advances in medicine. The mark of a good doctor is someone who will go away and read up on the conditions/symptoms they're not sure about, they will be honest and transparent to you about their limitations, and/or refer you on to the appropriate non-GP specialist.
This has been great to read, thank you!
How could I increase referral from local GP's to our gym / clinic to see our allied health team (exercise physiology, physiotherapy, dietitian)?
We are a private clinic and not sure of the best way to increase referrals from GP's for TCA or CDM referrals. Should we offer bulk billed services?
What can we offer GP's to help them with their patients?
My 2c
1 - make sure the GPS know you exist! But also what you do, costs, areas of interest. Maybe a lunch meet and greet, or better yet an education session on something topical or that your practitioners have a special interest in.
2 - definitely likely to get more referrals if you BB, but is that really the path you want to go down? Also timely letters back to gp as well as helping us with Medicare compliance - participate in the TCAs, letter back after first and last visits as is required by Medicare.
3 - your work should speak for itself. If you help our patients we'll be happy. But also above, education if it's done well is usually well received.
Time and publicity. But mostly, patients need to see value in it and that is the biggest stumbling block. Esp the ex phys and dietitians, where patients feel some PT with a few months of TAFE is equivalent and in diet where they aren't going to listen anyway.
TBH, considering you don't need referrals, you're best off advertising direct to public (which I assume is legal for you, unlike GPs in many ways).
The clients you want as a private billing service are often ones who don't really qualify for CDM or who are going to use more than 5 visits in a year anyway. Don't race your fees to the floor.
Let’s be honest here, after patient No. 34 who is arrogant and ignorant do you still have empathy for people?
What is your view of the security of Personally identifiable information (PII) with GPs and clinics? How are you protecting the personal information? My GP leaves her computer monitor open with other people’s info and leaves to reception, never locks her screen and also prints the date of birth and medicare number with name and address in all certificates and bills. Perfect recipe for identity theft!
Have you come across patients who persistently (years) have swollen glands under the jaws and elevated Immunoglobulin levels and white Lymphocytes counts from blood tests but biopsies do not suggest leukemia?
Is there a medical science explanation for the above?
My GP is also a personal friend who once quipped, "do you know what the call a student who finished in the bottom quartile of his/her med. school uni. degree course?"
- a GP
I believe the original joke is " "do you know what they call a student who finished bottom of the class in medical school?“ "a doctor."
GP traditionally has not been the most competitive specialty to go into due to poor pay relative to procedural specialties but there are plenty of doctors who are passionate about primary care as opposed to being forced into it as a last resort, so it would be likely your 'friend' is speaking for herself and not the profession
GP are less bullying types too, no?
Thanks for that insight. I'm not really sure what I'm supposed to take from that…
to the OP
why does it feel like that 9 out of 10 times when I see a GP, I would get send home with "take two panadols and drink plenty of water"? :)
given you are still here i guess that's all you needed :P
Probably because most of the time that's all patients need and most illnesses are self-resolving with time, rest and symptomatic treatment. What was it you were hoping to get from the GP?
thx for the reply, as a layman when it comes to medicine, I guess I was hoping the GP would prescribe me with some magic pill or injection to instantly fix my issue……….. maybe I have been watching too many TV shows :)
at least back in my home country, the running joke was that if you didn't get an injection and a bag full of meds after seeing a doctor, then you probably got ripped off :)
Do you see patients thinking they should be having kids by now and are concerned about the lack of births in Australia?
Are you asking whether I'm concerned or the patients are?
both
I don't care if and when my patients decide to have kids because it's entirely their personal choice, but if they were to ask my opinion I would advise to try for children before the age of 35 just because the increasing risk of birth defects and difficulty falling pregnant naturally. That's not to say that it's impossible, and the fertility industry like to prey on these fears by offering egg freezing services whereas the likelihood of natural conception is still high
@inasero: Purely from a professional standpoint, do you think a male in his 60's and a female her 40's should have a child? Keep in mind the male has had psychiatric/mental health issues and a number of unsuccessful suicide attempts.
@mini2: There's no reason why not, if that's what they want and they feel financially, psychologically and emotionally prepared. However with both parents age being relatively advanced I would counsel there is a much higher chance of birth defects, and whether they would be prepared to deal with the consequences if this occurs.
What are your most frustrating patients, do you wish there was another service for them to avoid clogging up the system (assuming they have a very minor ailment and really just want to chat)
And what is your criteria when you decide to bulk bill or not a patient (assuming you are a practice which does not automatically bulk bill people)
Should nurses be allowed to treat patients for some ailments to help reduce the load on the GP system (similar to the UK)
What is the average age that GPs retire?
It's sad because my parents' GP retired last year. He was really good.
Hi what car do you drive? If it's Mercedes is it because you need look pro?
Haha nah (though I know lots of doc do). I drive the OzBargainer's car of choice - a Toyota Corolla.
I'm not fazed by brand names and value reliability, and servicability over all else.
why do GPs just think everything is covid and not actually diagnose the patient? since there is basically no active cases in australia.
it's not that they think everything is covid - it's that you need to be 100% sure it's NOT covid. when every one walks in going 'oh i got this cough but IT'S NOT COVID' that's when you have a complacent population on the precipice of a third wave. cue SA. no diagnosed cases does not equal no cases, there will always be hidden circulating cases as per sewage analysis
There's plenty of active cases in Australia, and we can't afford an outbreak so currently most GPs are requesting that if patients are experiencing any symptoms consistent with COVID, to ring in advance, to avoid potentially bringing it in to the practice. Also there are temporary telehealth rebates available from Medicare to be able to consult with your GP over the phone, so this might be an option for you (your clinics should have offered you this option already).
Hopefully you can answer this & thank you for doing 5 pages
My Dr has told me he now can't prescribe Tramadol with repeats ,due to medicare or whoever is responsible
I used to take 2 x 100mg per day
he now has given me 1 x 200mg per day & says he can only prescribe for 20 days only , which is about 17 visits a year ! [its like i live there ] compared to the original prescription x 5 repeats
As he bulk bills, I feel partly responsible for the increase to the nation's health bill
do you know if this is right, or a " income increaser "
Thanks
Everyones personal circumstances vary and also the regulations vary according to jurisdiction, but I know here in Victoria the rules around opioid prescribing are very strict with the limit on quantities dispensed, and also being mandatory to check SafeScript each and every time we need to prescribe certain opioid medications (though not currently tramadol).
Generally it's more of a hassle to have to jump through these hoops, and also as you say it ties up consultations for those who have more acute medical issues, but all in all the rules are there for a reason (every year deaths from medication misadventure exceed those from the road toll) and they're a necessary hassle in order to avoid these potential complications.
I myself generally have the pharmacist dispense drugs of dependence including tramadol once per week and only give a months worth of medications at a time.
Thanks for the answer,
I don't know what SafeScript is, but i'm guessing a Gov data base of what has been prescribed to that person
I'm from Vic & have been in Qld 3 years & thought/find them much stricter here , but as often the case some mess it up for the responsible users ,
I have had a spinal fusion & you don't undertake these for fun
I guess the idea is small quantities & accounting that the amount checks with what the timeline suggests
,are you allowed to prescribe repeats ?
For someone wanting to become a doctor, what pre-med course would you suggest for a Bachelor's degree that would set you up for success for M.D?
Something you enjoy and wouldn't mind doing if you don't get into Medicine. The traditional undergraduate courses have been science, biomedical science and nursing, however there's plenty of people who enter graduate medicine from non science/healthcare related fields e.g. law, business, teaching etc. so you don't have to do those degrees necessarily.
I'm in med now and did engineering.
Only chose it in case I didn't get through.
It made me school a LOT harder for me than my peers.
At the same time I would never have chosen BioMed as it would just be too risky in case I didnt get in, then finding it hard to get a job, as inasero said.
I would, if I had my time again, probably some nursing, physio or pharmacy.
The other thing is, my 4 years of engineering knowledge adds nothing to my medical career or my life in terms of useable skill set.
I wish I did physio or pharmacy (would be able to work part time or casual shirts during uni easily…
Engieering jobs are mainly only full-time) … And would have useful knowledge to complement what I learnt in med school.
Heck even something like software engineer would have been more useful in life than what I chose (civil engineering).
Username checks out lol
Sorry this is riddled with typos….autocorrect on my phone….
Why do Doctors always vote for the Liberal Party, do you hate Medicare
Why do Doctors always vote for the Liberal Party
They don't…
Why is it that most GPs I've seen in the last decade want me to suffer through a week (often plus change) of sinus pain, coughing, sneezing and not being able to work, rather than give me a prescription for pseudoephedrine so I can actually function and not have to use all my sick days on something that's avoidable?
I haven't read all the comment so excuse me if this came up already.
I'm in 3rd year of med school and went in with the intention of becoming a GP.
However, a number of senior friends who chose GP seem to be miserable here, citing stuff like knowing what the issue is but never being able to treat anything (exaggeration) and referring then on.
How are you finding your choice to become a GP? If you had your time again would you have gone into a different speciality?
Thanks
Despite the issues with the MBS rebate and poor remuneration which I've outlined extensively, personally I would still have chosen General Practice as I find the flexibility and job satisfaction rewarding - being able to know the patient intimately and journey with them in life is a huge responsibility and privilege which I think is difficult to come across in other specialties (potentially psychiatry might tick these boxes).
I would advise those considering GP to avoid it if you're primarily interested in remuneration because you WILL become disillusioned and burn out prematurely, but the opportunities and experiences it provides is unparalleled if that's something that motivates you. In my relatively short career, the relationships and memories formed having worked among patients with addiction issues and in Central Australia are things I will cherish forever, and I'm sure there'll be many more to come.
That's great to know. Thanks for the interesting perspectives.
My friends that became surgeons have the biggest houses. Hope that helps.
I torn my ACL. i need to do surgery. is it ok to wait for a year. Will i have any other further damages if i donot proceed with my surgery asap.?
Sorry to hear about your predicament. Unfortunately I'm not able to give you any specific medical advice, and would advise you book an appointment with your GP
What do you think of fasting?
In what context?
In the context of what it does to the human body.
Can you clarify what kind of fasting you were referring to - water fasting, intermittent fasting or time-restricted fasting?
you fast long enough, you die. hope that helps
How about long enough for the body to benefit from not having to deal with the intake, without dying…?
Do GP's get kickbacks for referring a patient for a cardiac MRI?
It seems that in most cases such referrals from a GP are not covered by Medicare whereas a referral from a specialist may well be paid through Medicare?
Thanks.
HPV is by skin to skin contact… can I refuse to shake hands on this basis?
Yeah I've seen his videos. I think they're quite informative and entertaining, though more geared to the American health system and the topics more relevant to toxicology/emergency
ZDoggMD is pretty good too