New SA Health boss favours home care to reduce hospital pressure

General Practice and Partridge Street General Practice can do better than this! Get away from five, six, or ten minute medicine and enjoy better care. Primary Care is the most efficient and cost effective part of the health system and its time for patient rebates to align with this.

“If you’re too ill for your GP to (be treated) in a normal, you know, 10-minute business model of general practice you’ll end up in our public hospital system, and that’s just crazy,” McGowan told ABC Radio Adelaide this morning...

https://indaily.com.au/news/2018/07/24/new-sa-health-boss-favours-home-care-to-reduce-hospital-pressure/

Better.

With Partridge Street General Practice.

GPs want clinical handovers, not discharge summaries

Partridge Street General Practice is all about professional, comprehensive, and empowering General Practice care by our GPs. When we refer our valued patients for treatment elsewhere we promote the same high standards, values, and communication  that we provide. A letter, referral, or phone call is just part of the standard Partridge Street General Practice service – it’s good clinical handover. Dr Nick Tellis recently collaborated with some excellent GPs in writing an article for the Medical Journal of Australia’s online Insight Blog on ways to improve communication during these times and stressing the importance of better clinical handover. It’s another one of the ways Partridge Street General Practice provides Better Healthcare for our valued patients. Read on.

 

This is the third article in a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group that is based on GP-led learning, peer support and GP advocacy and was originally published at the Medical Journal of Australia (MJA) Insight Blog here

 

“PASSING the baton” describes what health care professionals try to achieve as care of patients is transferred between providers in our complex health care systems. The topic of safe and effective clinical handover comes up repeatedly in discussions on GPDU.

 

It is apparent that the impacts from delayed or poor clinical handover on patient care across the country are significant, under-reported, and have a profoundly negative effect on the care patients receive.

 

Dropping the baton

 

First-hand accounts of treatment delays, duplication of testing, medication errors, and unplanned readmissions are frequently discussed by GPs. Recent clinical case discussions have included a patient in palliative care being transferred to a hospice on a Friday afternoon with no clinical handover, and a 3-month delay in the completion of a discharge summary for a truck driver who was admitted with a myocardial function.

 

The safety concerns related to poor clinical handover are not new: it’s a problem the health care industry and doctors as a profession have been grappling with for decades. Poor clinical handovers are wasteful of limited resources. How can we improve patient outcomes and “drop the baton” less often?

 

Rules of the game

 

The National Safety and Quality Health Service Standards (NSQHS) and the Australian Commission on Safety and Quality in Health Care (ACSQHC) define clinical handover as; “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group”. Appropriate clinical handover is a requirement of the NSQHS. The ACSQHC notes the importance of “transition of care” that “ends only when the patient is received into the next clinical setting”. The Australian Council on Healthcare Standards EQuIP National Standard 12, in particular, specifies the planned provision of transfer information, including results of investigations.

 

Breakdown in the transfer of clinical information has been identified as one of the most important contributing factors in serious adverse events, and is a major preventable cause of patient harm.

 

Why is clinical handover from hospitals to GPs done so inconsistently for patients transitioning from our major private and public institutions? The benefits of passing the baton smoothly are clear. It’s time to coach the team to get it right.

 

Timing is everything

 

Health services continue to debate the appropriate timeframe for communicating with the GP who is continuing the patient’s care. Timeliness of clinical handover is a topic that comes up frequently. Hospital targets for transfer of care communications vary widely. A recent discussion on GPDU identified several targets within one small geographical area, ranging from “at the point of discharge”, “48 hours after discharge” and “5 days after discharge”.

 

GPDU dragon head-3

 

The reality is that few patients leave hospital with an effective clinical handover. Some will be received within the hospital’s current targets; however, many clinical handovers are not received for weeks, months or, as one post highlighted, years after the patient care is transferred. Some never occur.

 

Many GPs are asking whether these targets are consistent, appropriate, acceptable or safe. A robust discussion took place after GPs were approached to complete a survey that included a question asking what conditions should warrant a discharge summary on discharge, and what the acceptable timeframe for receiving a discharge summary should be.

 

The overwhelming consensus was that the gold standard should be clinical handover on discharge for all patients. Many were frustrated that this question even needed to be asked. Some GPDU members wondered whether this was a trick question aimed at moving the goalposts further away from quality patient care.

 

Services promoting clinical handover to GPs on discharge were highlighted. The Sunshine Coast Hospital and Health Service was identified as a provider that was actively trying to effect positive change. They received plaudits from the wider GP community simply by having a discharge summary management policy specifying complete discharge summaries available at the time of patient discharge.

 

It is well known in GP circles that starting late ensures that you will run late all day. Timely discharge summaries aren’t late. Timing is everything when you want to be a frontrunner.

 

Don’t fumble the handover

 

The consensus among GPs is that well timed, efficient, effective and safe clinical handover, at or before the point of transition of care is essential. Alternative strategies risk adverse outcomes. Clinical handover must be a standardised process between clinicians.

 

Returning to the athletics track, we can see a clear difference between a handover, a throw, and a drop. Highly trained athletes accept nothing less than a smooth handover – nor should highly trained clinicians. Delegating the handover to non-clinicians, including nurses and medical students, is not good enough. Supervision and ongoing coaching of clinicians is vital.

 

The baton is passed between people not machines

 

Imagine the difference electronic systems could make to this smooth handover. Sadly, this smooth electronic handover exists only in the imagination.

 

In the real world, GPs are grappling with being thrown links to hospital electronic records through systems such as “The Viewer”. Investigations are likely to be uploaded (after a delay) to MyHealthRecord. These are raw data, unfiltered and disorganised, and more of a throw than a handover. Being thrown raw data and being expected to catch them in this way is akin to a hospital doctor being given the login to the GP clinic’s patient management system and being expected to extrapolate a referral.

 

Personal bests are set; medals are won

 

The late Sir Roger Bannister ran the 4-minute mile and reset the expectations for all that followed him. GPs and their discussions can highlight outstanding clinical handovers and applaud initiatives and hospitals that are doing it right. Feedback and constructive criticism can be passed back to hospitals that are raising the bar. Medal-winning performances show the possible and provide a model for future improvement. GPs are uniquely placed to spot the talent and report the score widely and rapidly.

 

Eyes on the prize: what’s the next goal?

 

If we can normalise the clinical handover to young GPs who are the future of general practice, it will encourage them to demand it of their hospitals.

 

Hospitals are incredible places, but the aim is for patients to return home to their communities and trusted GPs. They come home. Their GPs are waiting, willing and able. We can do better, and we will. We extend an open hand to our amazing hospitals. Pass us the baton – we won’t drop it.

 

clinical handover

 

Dr Katrina McLean is a Gold Coast-based GP, Assistant Professor in the School of Medicine and Health Sciences at Bond University, and a GPDU administrator.

 

Dr Michael Rice is past-president of the Rural Doctors Association of Queensland, an educator of students and registrars, a long term resident and rural GP in Beaudesert. He’s a keen user of social media.

 

Dr Nick Tellis is passionate about great general practice. He’s a proud GP, beachside Adelaide practice owner, and a happy new father. He blogs at www.partridgegp.com when not administrating on GPDU.

Contact Dr Nick Tellis at drnt@partridgegp.com.au or 0882953200 if You are a Great GP and want a Better Place to practice great medicine!

 

join the team

 

Skin Cancer Medicine and Surgery with Dr Nick Mouktaroudis at Partridge Street General Practice

Dr Nick Mouktaroudis is a GP and co-owner at Partridge Street General Practice. He’s  passionate about health education, has a special interest in Skin, and a lot of expertise to share when it comes to helping people cope with and improve Skin Conditions. We recently had occasion to have a think about how we started Skin Cancer Surgery and Medicine at Partridge Street General Practice and we have a little story below.

 

Imagine a perfect day in a perfect General Practice. Focus on a busy yet unrushed GP, consulting with another valued patient. The flow of the consult is perfect, the communication great, everything is as it should be. 
 
We have to imagine days like this because they very rarely occur. Flow is fleeting and perfection is often aimed for and seldom reached. 
 
Going back to that consult, we can see that the GP is busy – but is definitely not unrushed. You can feel the pressure in the room as the patient seeks answers and closure and the GP senses the minutes ticking by. The consult comes to a close and both stand, the patient heading towards the door, the GP wishing them well, the patient’s hand is on the door and then. It happens. 
 
‘By the way Doc, what do you think of this?’
 
The GP turns away from the flashing screen and sees, across the room, a spot on the patients leg. 
 
Should we get the patient back at a later date? Offer reassurance we don’t feel confident giving?
 
Or, as the GP in this story does, do you reach for the dermatoscope, call the patient back, and look. There’s no such thing as a quick look and so the light comes out, the gel is applied, and a good thorough look is had. 
 
It’s an ugly duckling, a chaotic little mishmash of colours and globules. 
 
It would turn out to be a nasty – a nasty better appreciated in the pathologist’s dish than in the patients bloodstream.
 
A good result.
 
At the end of the day, the GP sat and wondered how this could be avoided in the future – how could we improve and be better. These challenges see us but we do not always see them.
 
This was our practice and so we had to change. 
 
Plan
Do 
Study
Act
 
Patient safety is paramount. We decided to solve for quality improvement and patient safety at the same time and made the decision to upskill one of our GPs, Dr Nick Mouktaroudis. He undertook multiple courses and extensive study in Primary Care Skin Cancer Medicine, Surgery, Therapeutics, and Dermatology. Following this we spent time and money upgrading our procedure facilities, equipment, and systems to support Dr Nick. We then allocated time for dedicated skin checks and adjusted our online booking and reception protocols. 
 
These were the first steps and in conjunction with our most recent AGPAL accreditation we have repeatedly run through this cycle, improving every time. We now have dedicated times for skin checks and skin cancer surgery, as well as protocols, systems, and education supporting Dr Nick and the other GPs in the practice. Patients enjoy seeing a GP they know and trust who can deliver appropriate care at a Primary Care level and price point. We receive great feedback from patients and local sub-specialists. It’s a clear win for patients, GPs, and our practice – and the mindset of continual quality improvement that we share with AGPAL was the way to get there. 
img_1955

 

 

 

img_2998

 

 

 

What is a Skin Check?

 

 

A Skin Check is a Comprehensive Skin History and Examination which is done at Partridge Street General Practice.

 

Your GP will ask you questions to assess the extent of Your risk/exposure to UV radiation and Your risk of solar related cancers.

 

They will examine you head to toe, examining the skin surface, focusing on any areas of concern (including the eyes, mouth, and anywhere else you may have noticed any spots, lumps, or bumps).

 

 

 

Are there any tools used for the Skin Check?

 

 

A proper examination needs proper equipment and we use handheld LED illumination with magnification as well as polarised light and clinical photography.

 

skin check dr nick mouktaroudis light

A dermatoscope is used to examine specific skin lesions. This is a particular type of handheld magnifying device designed to allow the experienced examiner to further assess skin lesions and determine whether they are suspicious or not.

 

 

 

Who should have a Skin Check?

 

We encourage all Australians over the age of 40 to have a Skin Check annually. Australians have one of the highest rates of skin cancers in the world.

 

Australians who have above average risks should be having Skin Checks before the age of 40 and sometimes more than annually.

 

You should have a Skin Check at any age if You are concerned about Your skin or particular skin lesions/areas.

 

img_2746-1

 

 

We ask You to identify any lesions of concern prior to the Skin Check wherever possible.

 

These may include new lesions that You have noticed or longstanding lesions that may be changing in some way or that You are concerned about. If You are worried – Ask!

 

Skin cancer check risk dr Nick Mouktaroudis

Risk factors for skin cancer

 

 

 

People at higher risk of skin cancer are those who:

 

have previously had a skin cancer and/or have a family history of skin cancer

have a large number of moles on their skin

have a skin type that is sensitive to ultraviolet (UV) radiation and burns easily

have a history of severe/blistering sunburns

spend lots of time outdoors, unprotected, during their lifetime

actively tan or use solariums or sunlamps

work outdoors

 

 

 

 

Does My GP take photos of My Skin?

 

 

 

During a skin check at Partridge Street General Practice Your GP will ask Your Specific Consent to take photos if they are concerned or want to make note of a particular skin lesion.

Photographs are useful as an adjunct to description of the lesion and act as a reference to position and comparison if required.

The photos will be uploaded onto Your Private Medical Record at Partridge Street General Practice.

 

 

 

What if My GP finds something?

 

 

 

This will depend on what Your GP has found.

 

If they are concerned about a particular skin lesion they may suggest a biopsy to clarify the diagnosis.

 

A biopsy is a surgical procedure during which they take an appropriate sample of tissue from the lesion of concern and send it to a pathologist for review.

 

Generally pigmented lesions (coloured spots), will be biopsied in their entirety whereas non pigmented skin lesions may be sampled partially if the lesion is too large to sample in its entirety.

 

The results of the pathology report will guide further treatment.

 

Your GP may elect to treat without a biopsy if they are confident of the diagnosis.

 

This may include freezing/cauterising a lesion, cutting it out (excising), or offering topical treatments such as creams.

 

Biopsies are scheduled in the Partridge Street General Practice theatre and our Practice Nurse will assist Your GP.

 

 

img_2745

 

 

 

What do I wear for a Skin Check?

 

 

 

Comfortable clothing.

 

Your GP will ask to examine you down to your underwear.

 

A sheet or towel will be provided for you to preserve your comfort and dignity.

 

A chaperone (Our Practice Nurse) is always offered.

 

Please avoid makeup or nail polish as the Skin Check involves the face and skin under the nails.

 

 

 

 

How long is a Skin Check?

 

 

Allow half an hour for Your GP to perform a thorough history and examination.

 

 

 

 

Do I need to see My GP or should I see a dermatologist?

 

 

GPs are Primary Care Physicians on the front line of Skin Cancer detection.

All GPs can check your skin, though not all GPs have formal training or a specific interest in skin cancer medicine and dermatoscopy.

Dr Nick Mouktaroudis has trained extensively in General Practice, Skin Cancer Medicine and Surgery, and has formal qualifications in Skin Cancer Medicine.

Dermatologists are sub-specialists in all skin conditions including Skin Cancer Medicine and Surgery although some will focus on other skin conditions.

 

 

 

 

Can I do more than a Skin Check?

 

 

 

You can Reduce Your risk by:

Avoid unnecessary exposure to the sun

Wearing sunscreen regularly and on all sun exposed areas.

Wear Hats and Sunglasses when appropriate.

Be aware of Your skin – both You and Your partner can check at Home.

 

 

 

525436572488

 

 

 

Book Your Skin Check Right Here.

 

 

 

Need more information? Leave a comment or see us in person. We’re Here to Help!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

The Last Referral

 

rey offers pen for luke to do a referral
Rey offers a pen to Luke to write a Referral

 

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

Dr Mark Raines has written an excellent piece on the role of referrals – I’ve taken some sections and highlighted them below, but you can read the whole piece here.

 

 

In Australia you don’t need a Referral to see a (sub-) Specialist. So, say you wanted to see a Plastic Surgeon about a skin lesion, you can just find a Plastic Surgeon on the internet or ask a friend and make an appointment and off you go. But be prepared for a bill – sometimes a really big bill. This is because, you won’t be able to access a Medicare rebate for the Plastic Surgeon’s fees. To do so you need to first have a valid referral from your GP. But it is not as simple as just calling your GP and asking for a referral.

 

 

 

 

Referrals from a GP are valid for 12 months whereas referrals from one sub-specialist to another are only valid for 3 months (for example when the surgeon that fixes your knee refers to the medical specialist to look after your heart). GPs can also do INDEFINITE referrals – for when you are seeing the same sub-specialist for the same problem for a long period of time (for example when a heart specialist is looking after an ongoing heart problem). Remember though, often your GP can manage your ongoing conditions very well together with your sub-specialist – saving you money and making it more convenient for you!

 

 

 

There are, however, rules!

 

 

 

Backdating Referrals

As a Referral is a legal document, Medicare does not permit backdating a Referral.

A Specialist can see a patient without a valid referral only in an emergency. Apparently, if your dog ate your referral, or another good excuse, there is a exemption available for you to claim your rebate if the Specialist notes that the “Referral is lost”. I am sure that Medicare would get suspicious if this happened a lot. Medicare do audit what GP’s and Specialists get up to make sure the rules are being followed. There are fines for not following the rules!

If you need a Referral make sure you see your GP before seeing the Specialist if you wish to get a Medicare rebate for the service. Asking your GP for a backdated Referral is like asking the Specialist to forward date your consultation so you can get a Referral. Both are not permitted under Medicare.

 

Backdating a referral is stating, in writing, that the doctor saw the patient BEFORE they actually did. Therefore…

 

Seeing a patient on Friday and writing a referral to a sub-specialist dated Monday for a consult that occurred on Tuesday is FRAUD.

 

Seeing a patient on Friday and providing a certificate dated Friday stating that the patient says they were unwell Monday and Tuesday is legally OK.

 

 

Some more rules and regulations.

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

 

 

 

img_8445-2

 

 

 

So when You need a referral – or it’s time to manage Your health more conveniently – You can see any of our Great GPs right here:

 

 

 

Dr Gareth Boucher

 

 

 

Dr Penny Massy-Westropp

 

 

 

Dr Monika Moy

 

 

 

Dr Katherine Astill

 

 

 

Dr Nick Mouktaroudis

 

 

 

Dr Nick Tellis

 

 

Dude, where’s my Outpatients?

Hi from South Australia! Summer has come! Our flagship hospital and one of the most expensive buildings in the Southern Hemisphere, the New Royal Adelaide Hospital (nRAH), came online in September 2017 after a 2 year wait.

 

 

nRAH New Royal Adelaide Hospital

 

 

 

Another big change to the South Australian Hospital System is that the Repatriation General Hospital is gone. Where did the subspeciality clinics go? See below!

 

 

Right Here!

 

arrow down

 

 

 

RGH Clinics – Quick Reference Guide as at November 2017

 

 

 

SALHN Outpatient Clinics Locations and Details

 

 

 

4th Generation Rehab Clinics

 

 

 

 

Bernie Cummins (see below) previously spoke to the Southern Regional GP Council about Outpatients Services in SA and she generously spoke to us again about how things will proceed over the coming months and years.

 

 

 

Here is some information she prepared.

 

 

 

 

royal adelaide hospital and nRAH and outpatients and health pathways

 

 

 

You can find further information right here.

 

 

gpdu.jpg

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

So, as a public service, we’re Here to Help! Bernie Cummins (Director of Nursing Statewide Outpatient Reform) has provided the following documents to help GPs and patients navigate this system and avoid the ‘named referral bounce’.

 

 

 

 

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

Good luck, and may the odds be ever in your favour!

 

 

 

img_8445-2

 

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Sore Throats at Partridge Street General Practice

Spring is here but it has been a big flu season at Partridge Street General Practice!

 

 

 

What should you do when you have a cough, cold, or sore throat?

 

Flu-Shot-logo
This may have helped before getting ill…

 

 

Here’s some information:

 

 

Do I have the flu?

 

 

 

Should I be on antibiotics?

 

 

 

My ear is sore?

 

 

 

Should I be immunised?

 

 

 

How do I stay healthier?

 

 

Any other ways to stay healthier?

 

 

Got anything else?

 

 

 

And, of course, What should I do instead?

 

 

There’s a new paper, at the link, saying this:

 

 

 

steroids in sore throat at Partridge Street General Practice

 

 

 

Need more information? Leave a comment or see us in person.

 

 

 

We’re Here to Help!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Check Your Skin with Dr Nick Mouktaroudis at Partridge Street General Practice

Dr Nick Mouktaroudis is a GP and co-owner at Partridge Street General Practice. He’s  passionate about health education, has a special interest in Skin, and a lot of expertise to share when it comes to helping people cope with and improve Skin Conditions. Let’s hand over to Dr Nick!

 

img_2998

 

 

 

What is a Skin Check?

 

 

A Skin Check is a Comprehensive Skin History and Examination which is done at Partridge Street General Practice.

 

Your GP will ask you questions to assess the extent of Your risk/exposure to UV radiation and Your risk of solar related cancers.

 

They will examine you head to toe, examining the skin surface, focusing on any areas of concern (including the eyes, mouth, and anywhere else you may have noticed any spots, lumps, or bumps).

 

 

 

Are there any tools used for the Skin Check?

 

 

A proper examination needs proper equipment and we use handheld LED illumination with magnification as well as polarised light and clinical photography.

 

skin check dr nick mouktaroudis light

A dermatoscope is used to examine specific skin lesions. This is a particular type of handheld magnifying device designed to allow the experienced examiner to further assess skin lesions and determine whether they are suspicious or not.

 

 

 

Who should have a Skin Check?

 

We encourage all Australians over the age of 40 to have a Skin Check annually. Australians have one of the highest rates of skin cancers in the world.

 

Australians who have above average risks should be having Skin Checks before the age of 40 and sometimes more than annually.

 

You should have a Skin Check at any age if You are concerned about Your skin or particular skin lesions/areas.

 

img_2746-1

 

 

We ask You to identify any lesions of concern prior to the Skin Check wherever possible.

 

These may include new lesions that You have noticed or longstanding lesions that may be changing in some way or that You are concerned about. If You are worried – Ask!

 

Skin cancer check risk dr Nick Mouktaroudis

Risk factors for skin cancer

 

 

 

People at higher risk of skin cancer are those who:

 

have previously had a skin cancer and/or have a family history of skin cancer

have a large number of moles on their skin

have a skin type that is sensitive to ultraviolet (UV) radiation and burns easily

have a history of severe/blistering sunburns

spend lots of time outdoors, unprotected, during their lifetime

actively tan or use solariums or sunlamps

work outdoors

 

 

 

 

Does My GP take photos of My Skin?

 

 

 

During a skin check at Partridge Street General Practice Your GP will ask Your Specific Consent to take photos if they are concerned or want to make note of a particular skin lesion.

Photographs are useful as an adjunct to description of the lesion and act as a reference to position and comparison if required.

The photos will be uploaded onto Your Private Medical Record at Partridge Street General Practice.

 

 

 

What if My GP finds something?

 

 

 

This will depend on what Your GP has found.

 

If they are concerned about a particular skin lesion they may suggest a biopsy to clarify the diagnosis.

 

A biopsy is a surgical procedure during which they take an appropriate sample of tissue from the lesion of concern and send it to a pathologist for review.

 

Generally pigmented lesions (coloured spots), will be biopsied in their entirety whereas non pigmented skin lesions may be sampled partially if the lesion is too large to sample in its entirety.

 

The results of the pathology report will guide further treatment.

 

Your GP may elect to treat without a biopsy if they are confident of the diagnosis.

 

This may include freezing/cauterising a lesion, cutting it out (excising), or offering topical treatments such as creams.

 

Biopsies are scheduled in the Partridge Street General Practice theatre and our Practice Nurse will assist Your GP.

 

 

img_2745

 

 

 

What do I wear for a Skin Check?

 

 

 

Comfortable clothing.

 

Your GP will ask to examine you down to your underwear.

 

A sheet or towel will be provided for you to preserve your comfort and dignity.

 

A chaperone (Our Practice Nurse) is always offered.

 

Please avoid makeup or nail polish as the Skin Check involves the face and skin under the nails.

 

 

 

 

How long is a Skin Check?

 

 

Allow half an hour for Your GP to perform a thorough history and examination.

 

 

 

 

Do I need to see My GP or should I see a dermatologist?

 

 

GPs are Primary Care Physicians on the front line of Skin Cancer detection.

All GPs can check your skin, though not all GPs have formal training or a specific interest in skin cancer medicine and dermatoscopy.

Dr Nick Mouktaroudis has trained extensively in General Practice, Skin Cancer Medicine and Surgery, and has formal qualifications in Skin Cancer Medicine.

Dermatologists are sub-specialists in all skin conditions including Skin Cancer Medicine and Surgery although some will focus on other skin conditions.

 

 

 

 

Can I do more than a Skin Check?

 

 

 

You can Reduce Your risk by:

Avoid unnecessary exposure to the sun

Wearing sunscreen regularly and on all sun exposed areas.

Wear Hats and Sunglasses when appropriate.

Be aware of Your skin – both You and Your partner can check at Home.

 

 

 

525436572488

 

 

 

Book Your Skin Check Right Here.

 

 

 

Need more information? Leave a comment or see us in person. We’re Here to Help!

 

 

 

img_8445-2

 

 

You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Lemons and Lemonade

We live in an age of wonders. Generations past would be amazed by the ease of travel, free information, and the standard of living enjoyed by the majority of the Western world. One of these wonders is Modern Medicine and part of that is medications. We are privileged to live in a time when cancer can be cured, fatal diseases are controlled, and previously life curtailing conditions can be managed.

 

 

‘Nothing is all good and nothing is all bad’ is something I heard from a trusted friend. Does this apply to medications? General Practitioners are Your Specialist Generalists – we do a LOT more than just prescribe medications! Read on.

 

 

Oseltamivir

 

Lemon: This blockbuster drug was supposed to deliver us all from pandemic flu. The Australian government stockpiled it at a cost of many millions. It will expire before we do. It promised the world but perhaps shortened the duration of symptoms by not much.

 

Lemonade: Get a yearly influenza vaccine and if you’re unlucky enough to still get the flu – rest, fluids, paracetamol, and see Your GP if you’re not improving as you think you should.

 

 

Donezepil

 

 

Lemon: Life expectancy increases every year and so do our expectations of our older age. This drug promised an end to Alzheimer’s, later downgraded to ‘it may delay the rate of the decline in your mental abilities’. How would we know if it worked? What would have the rate of decline been without this drug?

 

donepezil lemon

 

Lemonade: Save your money and try some alternatives without side effects. Keep your mind and body as healthy as possible for as long as possible with diet, exercise, rest, and the support of family, friends, and Your GP. Should age related decline set in, there are many supports you can access – check out My Aged Care. Medications can play a role – ask! Also, if you are on this medication, or considering it – have a look here…

 

 

achi yes or no

 

 

Codeine

 

 

Lemon: This drug has been available over the counter at pharmacies for many years. Evidence shows that products with low dose codeine are no more effective than products without for pain relief and so the regulatory authorities have recommended it be rescheduled to prescription only from February 2018. This will be a big change for the community – some of whom will have been taking large amounts of this drug on a regular basis.

 

 

codeine lemon

 

 

Lemonade: Partridge Street General Practice is proud to be a low prescribing practice and especially of this drug. Our advice is to see us for advice on alternatives and non drug alternatives in particular.

 

 

 

Need more information? Have you any other lemonade thoughts? Leave a comment or see us in person. We’re Here to Help!

 

 

 

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You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

The New Royal Adelaide, Ramping Up and Down, and Health Pathways PS: Where did the Repat go?

Hi from South Australia! Winter is here but change is coming. Our flagship hospital and one of the most expensive buildings in the Southern Hemisphere, the New Royal Adelaide Hospital (nRAH), is about to come online in September after a 2 year wait.

 

 

 

Another big change to the South Australian Hospital System is that the Repatriation General Hospital is gone. Where did the subspeciality clinics go? See below!

 

 

Right Here!

 

arrow down

 

RGH Clinics – Quick Reference Guide as at November 2017

 

 

 

Bernie Cummins (see below) previously spoke to the Southern Regional GP Council about Outpatients Services in SA and she generously spoke to us again about how things will proceed over the coming months and years.

 

 

 

Here is some information she prepared.

 

 

 

royal adelaide hospital and nRAH and outpatients and health pathways

 

 

 

You can find further information right here.

 

 

 

 

 

The good GP has a stewardship role in the Australian medical system and part of this is referring to subspecialist and hospital care. This is an important role and we don’t take it lightly. We want to do our best for our patients and help them get the care they deserve. One of the challenges is referring to public hospitals, where our referrals sometimes get ‘bounced’ back to us. In private practice, for the patient to receive a (Federal) Medicare Benefit (like when you see Your GP), the GP referral must be to a named provider (Dr Smith, Dr Jones, for example). When referring to a public hospital, there has historically been no Medicare rebate for the patient – public hospitals are funded by the State Governments and Medicare is funded by the Federal Government, and care is free at the point of service. This is changed recently, and public hospitals are now using Medicare funds to run their services. Therefore they now seek named referrals. But to who? It’s very hard to find out exactly which doctor will be seeing you, and so it’s hard to do a named referral, which may delay you being seen.

 

 

 

So, as a public service, we’re Here to Help! Bernie Cummins (Director of Nursing Statewide Outpatient Reform) has provided the following documents to help GPs and patients navigate this system and avoid the ‘named referral bounce’.

 

 

 

 

 

 

 

directive+medicare+billing+outpatients

 

 

 

medicare+directive+and+outpatient+private+practice

 

 

 

 

Good luck, and may the odds be ever in your favour!

 

 

 

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You can see any of our Great GPs right here:

 

 

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Mr Perfect and #socks4docs

Mental health and depression are serious issues. GPs see, treat, and support people with these issues everyday but who looks after the GPs? We can see that doctors are only human and suffer the same stresses as everyone else. Sadly, sometimes, it is too much.

 

 

 

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I wrote previously about how to detect depression in patients. ‘Listen to the patient’, ‘How do they feel?’, ‘How do they make you feel?’. Experienced GPs can spot depression a mile off…in other people. How many turn that acumen on themselves? How many have their own GP to care for them?

 

 

I also wrote ‘American studies show patients are scared of psychiatric referral. Australian GPs are also scared of psychiatric referral’ and ‘Untreated depression is associated with decreased quality of life and increased mortality. Depression can be successfully treated and treatment is effective. The earlier the better!’. This is as true for GPs and doctors as it is for every other person.

So GPs, doctors, and others – Exercise, diet, psychotherapy, GP counselling, reducing drug and alcohol use, getting more and better sleep are all options. These take time and effort so give yourself permission to spend these on You. Your friends, family, and colleagues are here for you. They will #bekind.

 

 

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Depression is not just a chemical imbalance. No pill can defeat the entirety of the patient’s life and circumstances pushing them in the wrong direction. Consider the your environment and be aware of the particular pressures of medical work and life. GPs have a fantastic and privileged therapeutic relationship with their patients, and they can use this to capitalise on the essential window of time before delivering medical advice. This “privileged moment for change” prepares people to be receptive to a message before they experience it. Robert Cialdini has coined the term ‘pre-suasion’ to describe this. The therapeutic relationship allows pre-suasion, and therapeutic change can then be addressed, with consideration of motivation, opportunity, and ability.

 

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Dr Eric Levi has literally stepped forward online with the #crazysocks4docs / #socks4docs hashtags. It’s a lighthearted way of getting us to acknowledge a serious topic. I’m in!

 

 

 

#socks4docs (holiday edition)

 

 

 

 

 

The equally dapper Terry Cornick has been kind enough to contribute his story to my blog – and I hope it gives some of you hope, a good read, and another option for you and your patients.

 

 

 

Terry is a Healthcare Consultant, Mental Health Advocate and Freelance Writer.

His professional background includes Consulting in Healthcare and he loves creating, research, technology, and communications. Daily he deals and develops relationships with Doctors so knows a little about them too and the unique stresses they are placed under.


Initially as a hobby, Terry created a grassroots men’s mental health support network named “Mr. Perfect” that is growing by the minute. Although it does not pay a cent, it pays handsomely in purpose. You can check it out at
www.mrperfect.org.au


Known sarcastically by his wife as “Dr Terry” he lives on the North Shore of Sydney with his young family and is currently contemplating his next move professionally, navigating the ever challenging and life-threatening dilemma for men of “providing” yet being “Mr. Perfect” personally too.

 

Trying to summarise and reduce my story to a blog is a challenge to say the least. Although a relatively spritely 33 years old, the increasing grey hairs and wrinkles around my eyes and my “old soul” remind me daily this life is a battle. And the battle is ultimately with yourself (hands up I have paraphrased this from a song I once heard, I just cannot remember which).

I love to compartmentalise and segment so my mind can attempt to process things, ideas, events, thoughts, feelings. Broadly speaking I did this with my life; pre-25 years old, 25 to 30 years old and 30 years old and beyond.

The first stage can sometimes appear as a blur. But perhaps an easier way of me dealing with it. It was a painful period for the majority of it. A challenging upbringing, tragic events, abuse and trauma pushed me so far into a shell that I never thought I would emerge from it.

 

 

During the okay times, this was okay with me. My introverted character and lack of self-esteem meant hiding was easier and far less painful. Until the occasional explosions. But life then returned to the blur.

A couple of moments in my early Twenties truly made me question my sanity. So at 21 years old I googled “Depression”. I matched 6 out of 8 symptoms. So clearly I was fine. I closed the laptop and the cycle of darkness continued as did the periodical suicidal meltdowns (behind closed doors of course).

Then the “Great Escape” took me to the other side of the world travelling. Less than two years later I was back in Australia for good, despite this being the deepest, darkest scene of my life. After a night out on the Gold Coast I stood on a balcony peering and leaning over contemplating that this was a good time to jump and end the pain. I felt so weak and thankfully, eventually, stepped back.

Somehow, after a few more substantial blips and obstacles, my life starting to become what others saw as “success”. More money that I knew what to do with, travel, a waterside apartment and a beautiful partner. One of my best mates teased me at work and called me “Mr. Perfect” regularly, not knowing 1% of my history or what was going on in my complex mind.

 

 

Look familiar?

 

 

Behind the acting and those curtains and backstage was a chaotic scene. Anxiety, PTSD and Depression drove me to the edge. But approaching my 30th year on this earth I made some changes. As I was about to get married, my absent dad passed away in the UK. I was sick of my job and when we started to talk about having a family, I could imagine putting my child through a similar existence.

So I visited my in-law’s family GP. He looked me in the eye and asked “How long have you felt like this?” I paused. “For as long as I can remember.” His usually relaxed face turned serious. “I know a great Psychiatrist I would like you to see”. It took every ounce of energy to do so but once that train was in motion I was getting professional help (lucky enough to have the resources to do this privately) and within six months I felt positive.

I started writing a book and then a blog (I did not show my wife) and Mr. Perfect was born. A chat in the pub with mates, a cursory read of a report about men’s “connectedness” and healthcare professionals I know telling me there was little grassroots support for their male patients, and the Mr. Perfect movement gained momentum.

 

 

There have been many blips, I am not “Perfect” after all. From stopping my medication without advice, from stopping my Doctor appointments to then leading back to professional help when the cloudy spells turned into storms and into hurricanes. These weather systems are here for life, and that’s okay, but with the right strategies I can turn this into something impactful for others.

But there is hope. Friends, family and colleagues have all benefited and most importantly my son will arguably be the most loved and supported kid when it comes to talking about his mental health.

 

 

Thanks Terry! You can see the themes above of time and a relationship as potent therapy for the management of major depressive disorder in general practice. The initial clinical gestalt and the ongoing therapeutic relationship can be powerful tools for change. Depression is subjective and has been part of the human condition throughout history. This gives us all we need to move forward.

 

 

 

 It therefore seems fitting to end with the words of a doctor from another time:

“The three grand essentials of happiness are: Something to do, someone to love, and something to hope for.”

Alexander Chalmers (29 March 1759 – 29 December 1834)

 

 

 

If you are worried about depression, anxiety, or have any other mental health concerns, reach out:

ACIS 131465 (South Australia – Acute Crisis Intervention Service)

 

 

 

Partridge Street Doctors

 

 

Your GP at Partridge Street General Practice

Dr Gareth Boucher

 

 

Dr Penny Massy-Westropp

 

 

Dr Monika Moy

 

 

Dr Katherine Astill

 

 

Dr Nick Mouktaroudis

 

 

Dr Nick Tellis

 

 

Beyond Blue & Beyond Blue New Access (free mental health coaching)

 

 

Mr Perfect

 

 

Doctor’s Health SA

 

 

GPs Down Under

 

 

GPDU