Your best Health Insurance is Your GP v2.0

Yesterday we talked about risk. Risk is mitigated by knowledge and experience. I don’t know who said this, but I’m going to take a wild and crazy guess and say it wasn’t from Terry Pratchett’s wonderful Discworld series. This gives us another way to mitigate risk. Insurance.

Risks come at us everyday in our personal and professional lives. We accept that life involves risk. Risk happens.

‘Life is a risky business, no-one gets out alive’

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Health concerns us all, especially now, and we try to improve our health or at least to manage it. Some risks are foreseeable but some are not. These drive our uptake of health insurance. Health insurance is therefore a bit of a ‘grudge purchase’ – we don’t really want to buy it but we don’t want to do without it. Is it worth the money we pay for it? Some high profile voices say no. A past president of the AMA agrees:

A past president of the RACGP concurred:

if you increase the number of GPs by 1 per 10,000 people the death rate goes down 9%

Dr Bastian Seidel; Past President, RACGP

Your health is your wealth, as the saying goes, and you build wealth by spending wisely.

Some tests, treatments and procedures provide little benefit. And in some cases, they may even cause harm.
Use the 5 questions to make sure you end up with the right amount of care — not too much and not too little.

Do I really need this test, treatment or procedure?

Tests may help you and your doctor or other health care provider determine the problem. Treatments, such as medicines, and procedures may help to treat it.

What are the risks?

Will there be side effects to the test or treatment? What are the chances of getting results that aren’t accurate? Could that lead to more testing, additional treatments or another procedure?

Are there simpler, safer options?

Are there alternative options to treatment that could work. Lifestyle changes, such as eating healthier foods or exercising more, can be safe and effective options.

What happens if I don’t do anything?

Ask if your condition might get worse — or better — if you don’t have the test, treatment or procedure right away.

What are the costs?

Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?

Your GP can be a great ally in navigating through the health system, a great support for you in times of need, and a great investment in your health. 

“Patients whose care is well managed and coordinated by their usual GP are less likely to cost the health system more in the long run because their GP-coordinated care will keep them out of hospital.

“Supporting general practice to continue managing these patients – who are growing in number each year – is an investment in health care that can help make the health system more sustainable.”

Past AMA President, A/Prof Brian Owler

PartridgeGP works with you to help you make your best health decisions. We pride ourselves on great communication and we’re ready to share our professional skills and knowledge with you. This is only MORE important now, in the time of a global pandemic with a new vaccine on the horizon. The way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200.

Better, for you.

Want more?

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

For everyone, we believe that having a usual GP or General Practice is central to each person’s care and recommend that people with any health issues that come to the attention of other health professionals should be advised to attend their usual GP or General Practice rather than a specialised service (ie a place not providing the holistic care a specialist GP would).   If  they say that they don’t have a usual GP or general practice, they should be helped to find one and to actually attend it. Call PartridgeGP on 82953200 or make an appointment online here.

(Hat tip: Dr Oliver Frank)

(TL;DR – Get a regular GP or General Practice and use them!)

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you’re employed, get a side hustle and get into business. If you’ve already got a business, get a network. Want to get started? Find your tribe here!

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you are a great GP or a great Allied Health Professional, and you want to serve your clients or patients to the best of your ability, without worrying about all the non clinical things that get in your way, lets talk. Call Mrs Hayley Roberts on 8295 3200 and have a coffee and chat with us as to how PartridgeGP can help you to help others.

Risk

In 1990 I watched Graham Gooch of England make 333 and 123 in a Test Match against India at Lord’s. It was a different time and a different country. Gooch looked decidedly unathletic (although apparently a fitness fanatic) and I certainly don’t remember the Indian pace attack as anything like the current potent crew. As Gooch approached his three hundredth run, the BBC cut to a horse race showing the usual tin ear of public broadcasters. It was compelling but hadn’t quite reached exciting. For those of you not baptised into the religion of Test Cricket, simply put, one fellow throws a small hard leather ball in a special way (bowling) at some wooden poles (the wickets) from a distance of 22 yards (the pitch) while another fellow (the batsman) uses a wooden club (bat) to prevent this. Other fellows stand around to catch or intercept the ball, and also provide commentary on the batsman’s skill, character, and parentage.

I moved to Australia and one of the instant upgrades was supporting the Australian cricket team. Staying up in 1995 to listen to Steve Waugh wearing bouncer after bouncer after bouncer as Australia finally rolled the West Indies in their own backyard was incredibly exciting. Part of that excitement was risk. The players had arm/chest guards, gloves, pads, boxes, helmets, and increasingly large bats but the spectacle and danger of confronting 140-150 kilometre missiles was enthralling.

It had a lot of value for the players involved and for the audiences in the West Indies, Australia, and around the world. The West Indies are a collection of independent island countries who only come together as the West Indies for cricket. Much the same could be said about Australia and it’s Federation of States (especially in light of recent border shenanigans). Australia had been planning this assault for years. The West Indies were coming off a long period of world domination and were raging against the dying of the light as their great players aged.

Fast forwarding again, I went back to England in 2013 to watch the Australian team play England at Lord’s. One of the Australian players to watch was a star of the future – Phillip Hughes. He didn’t have the most auspicious day at Lord’s but certainly looked a player of the future. It was to be his final Test Match. Hughes was a short man, like many of the great batsmen, and so had become accustomed to bowlers aiming at his chest and head. He was an accomplished player of this style of (short pitched) bowling. Sadly, in 2014, Hughes was batting in a State game and despite all of his protective apparel, was hit in the neck by a short pitched ball. He was incredibly unlucky to be hit in the neck in precisely the wrong spot. Wikipedia recounts:

causing a vertebral artery dissection that led to a subarachnoid haemorrhage. The Australian team doctor, Peter Brukner, noted that only 100 such cases had ever been reported, with “only one case reported as a result of a cricket ball”

The risk that made the matches in the West Indies so enthralling and the risk that added value to that spectacle was the same risk that ended with Phil Hughes’ death. Certainly players, spectators, and officials thought long and hard about this risk afterwards. As a result of this we now have something called a stem guard which is a little bit of plastic that protects that very vulnerable area of the neck. Hopefully this particular type of injury will never happen again with these consequences. The amount of short pitched bowling decreased, for a while, but then returned to previous levels (perhaps regressed to the mean). Then, something else happened. 

Today we can see players like Neil Wagner eulogised for bowling into the batsman’s armpit, shoulder, and head. This line of attack into the batsman’s blind spot can hit them, hurt them, or just put them off their game. Wagner recently won a Test Match for his country like this (with two broken toes).

“Neil Wagner was outstanding,” Stead said. “I’m not sure there are too many individuals that could do what he did in that Test match.

Further statistics during the current Australia vs India test series show a clear advantage gained by short pitched bowling. Furthermore, almost uniquely in top level sport, this involves the some of one team doing what they do best against some of the other team doing what they do worst (bowlers bowling at bowlers batting).  Is this too much risk and who makes this decision and on what basis?

This conundrum – the risk of injury and death versus the benefits of economic value resulting from the spectacle – mirrors some situations we face in medicine and life:

Lockdowns vs Targeted Protection

New Vaccines vs New Viruses

Medication vs Lifestyle

I don’t have a universal answer for this, in cricket, life, or in medicine. I firmly believe that we should have these conversations and come to answers that are transparent and workable. From the macro level in Australia and the world to the micro level in the consult room, I think this is the way we should manage risk. We should be mindful of risk in all of our consultations and all of our dealings with patients. If you would like to be part of a team that can afford and prioritise the time taken to consider risk in each and every consultation and dealing then the way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200 or…

here are the steps!

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

For everyone, we believe that having a usual GP or General Practice is central to each person’s care and recommend that people with any health issues that come to the attention of other health professionals should be advised to attend their usual GP or General Practice rather than a specialised service (ie a place not providing the holistic care a specialist GP would).   If  they say that they don’t have a usual GP or general practice, they should be helped to find one and to actually attend it. Call PartridgeGP on 82953200 or make an appointment online here.

(Hat tip: Dr Oliver Frank)

(TL;DR – Get a regular GP or General Practice and use them!)

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you’re employed, get a side hustle and get into business. If you’ve already got a business, get a network. Want to get started? Find your tribe here!

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

If you are a great GP or a great Allied Health Professional, and you want to serve your clients or patients to the best of your ability, without worrying about all the non clinical things that get in your way, lets talk. Call Mrs Hayley Roberts on 8295 3200 and have a coffee and chat with us as to how PartridgeGP can help you to help others.

Yesterday You Said Tomorrow

Half way through the week…did you know what some GPs are thinking?

You’re a Great GP

You’ve studied and trained

You’re here to help!

But who is here to help you?

Those things you didn’t train for

When your computer doesn’t work

When your receptionist books appointments through your lunch break

Who will look after patients when you’re on holiday?

Who will keep you working safely during COVID?

PartridgeGP is here to answer all of these questions for you!

Don’t put your safety, income, and professionalism second

Put yourself first – call PartridgeGP on 8295 3200

#gp #glenelg #privatepractice #team #job #career #awesome #bettercareer #beachside #dreamjob #dreamposition

Here We Are: 5 Stories That Got Us To Now

We live in strange days. Humans have always made sense of their lived experience through stories. Here are some, courtesy of the excellent Morgan Housel (yes, this guy).

Three days after Ronald Reagan was inaugurated in 1981, New York City Council President Carol Bellamy joined a group of speakers at a luncheon to discuss the country’s future.

The group tried to make sense of a world that was hardly recognizable from a generation before.

Familiar? Read on!

Things that make you go hmmm

When it all turns to custard, as they say in New Zealand, one of the safest places on Earth (as I type), your GP is there for you. Your GP is, really, your best insurance.

If you’re a patient, looking for a great GP, PartridgeGP is here to help you, safely and well. You can book a face to face or telehealth consult right here.

If you’re a great GP/Allied Health Professional wanting PartridgeGP to provide you awesome services, facilities, and team so you can serve patients to the best of your ability, contact us here, here, or call Mrs Hayley Roberts on 08 8295 3200.

Stay safe. Use your GP!

Here We Are: 5 Stories That Got Us To Now

We live in strange days. Humans have always made sense of their lived experience through stories. Here are some, courtesy of the excellent Morgan Housel (yes, this guy).

Three days after Ronald Reagan was inaugurated in 1981, New York City Council President Carol Bellamy joined a group of speakers at a luncheon to discuss the country’s future.

The group tried to make sense of a world that was hardly recognizable from a generation before.

Familiar? Read on!

Things that make you go hmmm

When it all turns to custard, as they say in New Zealand, one of the safest places on Earth (as I type), your GP is there for you. Your GP is, really, your best insurance.

If you’re a patient, looking for a great GP, PartridgeGP is here to help you, safely and well. You can book a face to face or telehealth consult right here.

If you’re a great GP/Allied Health Professional wanting PartridgeGP to provide you awesome services, facilities, and team so you can serve patients to the best of your ability, contact us here, here, or call Mrs Hayley Roberts on 08 8295 3200.

Stay safe. Use your GP!

COVID clearance certificates and PartridgeGP

Did you know medical certificates expire? They have an end date! So when an employer or other entity asks for a clearance certificate, this is what we are going to write:

Dear Employer,

The whole point of a medical certificate is to certify someone unwell or unfit. This is why there is a beginning date AND an end date. At the end date, the patient is no longer certified unwell/unfit. I have enclosed the negative COVID results and you will note your employees certificate has reached its end date. I further enclose professional advice from our professional organisation in regard to this. It follows that the certificate of ‘clearance’ you are suggesting is unprofessional and those who would provide one are acting similarly.

I hope this information finds you well.

Regards

Doctor Nick
Specialist GP

Hope this helps! If you are still unwell or need any further information, say hi to your PartridgeGP and book in here for a phone or face to face consult!

PartridgeGP | Telehealth | COVID19 | Physical Examination

We all want to provide great general practice care. Most of this comes from time, curiosity, and interest in our patients. When we turn our attention and medical skills to their problems and issues we do better work.

Physical examination has been around since antiquity and is a useful adjunct to taking a great history. Much like over investigating, physical examination is not always needed.

General practice is so much more than compliance and paperwork.

So much can be pared away to reveal the essence of what we do.

In the time of #COVID19, perhaps we can chip away to reveal our statues of David rather than be inflexible blocks of government marble.

More ideas here!

Another set of thoughts, better expressed…

It’s time for emergency physicians to put away our stethoscopes

By Jeremy Samuel Faust

Since 1986, federal law has mandated that any patient requesting emergency medical care must be evaluated by a physician to assess for any threatening conditions. The law, often referred to as the “anti-dumping law,” requires that physicians perform a medical screening evaluation, including a physical examination.

Over time, the interpretation of this mandate has slowly expanded, not by law so much as by custom. This is why emergency rooms have become our nation’s safety net for care. Despite increasing popularity of urgent-care clinics and telehealth, many patients who could have safely been cared for elsewhere still end up in emergency rooms.

While many of us embrace that mission with pride, it is dangerous and wasteful in the coronavirus pandemic. We need to course-correct to keep everyone safe. Exposing patients to emergency rooms is now far riskier than it was before. In turn, health-care workers must assume that all patients are infected. This forces us to blow through personal protective equipment that we desperately need so that we do not become infected ourselves.

Over the past few decades, we have learned that many, if not most, of our physical examination maneuvers provide little reliable information. In most cases, the information we need can be obtained simply by interviewing patients. But old habits die hard, and patients seem to love our stethoscopes. In our current situation, that simply won’t do.

We need the federal government to allow us to perform medical screening exams via video or through glass doors, even for patients entering emergency rooms. The removal of the requirement that we evaluate every patient by hand will save resources and keep everyone safer.

In recent meetings and phone calls with stakeholders, the Centers for Medicare and Medicaid Services has signaled that it is seriously considering making this change. But it has not materialized, and time is of the essence. The moment to act is now.

Jeremy Samuel Faust is an emergency physician at Brigham and Women’s Hospital in the Division of Health Policy and Public Health, and an instructor at Harvard Medical School.

Telemedicine | RACGP | PartridgeGP

The RACGP SA&NT in conjunction with SA Health and a local panel of presenters, will be presenting a webinar update on Telemedicine, discussing tips and tricks related to undertaking telehealth in your practice.

 

WATCH HERE

 

 

Topics to be covered:

·         Discussing the role of telehealth and the consent process

·         New MBS item numbers

·         Registrars working remotely

·         Undertaking paperwork when working remotely

·         E-prescribing Legislation

·         Combining telehealth with face to face consults

·         Rolling Q&A

Date:  Thursday, 16 April 2020

Time: 6.30-7.30 pm

Cost: FREE

Register in advance for this webinar:

https://racgp.zoom.us/webinar/register/WN_eGyo0yuBR-iLE0Pvh6YehA

Registrations close 5pm Thursday 16 April 2020.

Presenters:

Dr Emily Kirkpatrick – Deputy Chair, RACGP SA&NT & SA Health COVID-19 GP Liaison Team

Dr Daniel Byrne – SA Health COVID-19 GP Liaison Team

Dr Alvin Chua – RACGP SA&NT Council member

Dr Nicholas Tellis – GP, Owner PartridgeGP

Electronic Prescribing at PartridgeGP

You bet!

Those bits of paper your GP gives you to get medications from your Pharmacist are changing. Scripts are now DIGITAL!

GPs can now send prescriptions to pharmacists electronically as an interim solution during the pandemic. 

As part of the COVID-19 National Health Plan telehealth model, the new interim measure allows GPs to send prescriptions electronically to pharmacists without having to mail out a physical copy of the original paper prescription with a GP’s wet-ink signature.

Patients can then have their script filled and medication delivered to their door, helping to minimise the risk of virus transmission in accordance with social-distancing measures.

‘It’s certainly going to make it easier for practices, because they are being inundated with pharmacists asking them to post prescriptions to them,’
 
‘I know at my practices it’s causing substantial concern.
 
‘We’re getting calls every day from pharmacists saying, “I can’t dispense unless you send me the hardcopy paper”, and we’re saying, “We don’t have the resources to keep running out and buying stamps, and it’s just not safe to put staff in that position”.
 
‘So we’ve had a bit of a stalemate for the last few weeks and this is a great outcome in the short term.’

Dr Nathan Pinksier – GP

As outlined in guidelines issued by the Department of Health (DoH), GPs will be required to do as follows:

  1. Create a paper prescription during a telehealth consultation. This will need to be signed as normal or using a valid digital signature
  2. Create a clear copy of the entire prescription (a digital image such as a photo or PDF including the barcode where applicable)
  3. Send via email, fax or text message directly to the patient’s pharmacy of choice

Schedule 8 and 4(D) medicines such as opioids and fentanyl are not part of the interim arrangement.

While not legally required, the DoH encourages practices that are able to continue sending the original script to pharmacies to do so as soon as possible. All other practices must retain the paper prescription for a period of up to two years for audit and compliance purposes.

Yes!

This is a great step forwards!

Electronic Prescriptions

Changes have been made to Commonwealth legislation to recognise an electronic prescription as a legal form to allow medicine supply. This provides prescribers and patients with an alternative to paper prescriptions. Paper prescriptions will still be available.

Electronic prescribing will not fundamentally change existing prescribing and dispensing processes. It provides patients with greater choice and patients can still choose which pharmacy they attend to fill their prescription.

Under the Australian Government’s National Health Plan for COVID-19, electronic prescriptions are now being fast-tracked to support telehealth and allow patients to receive vital healthcare services while maintaining physical distancing and, where necessary, isolation.

A significant amount of work has already been done to ensure that necessary upgrades to both pharmacy and prescriber software can be done quickly and electronic prescriptions are expected to be available from the end of May.

Electronic prescriptions are an alternative to paper prescriptions which will allow people convenient access to their medicines and will lessen the risk of infection being spread in general practice waiting rooms and at community pharmacies.

Quick links

Information for prescribers 

Information for dispensers

Tokens

The solution being fast-tracked will see a unique QR barcode known as a “token” sent via an app (if you have one), SMS or email. The token will be sent to you from your doctor, which is then presented or sent to a pharmacy, to supply your medication.

The token will be scanned by your pharmacist as a key to unlock the electronic prescription from an encrypted and secure electronic prescription delivery service.

If you have any repeats of a prescription, a new token will be sent to you when the prescription is dispensed. You will need to keep the token to send to your pharmacy when you need to get the repeat filled.

Active Script List

By the end of this year, more functionality will be available and in addition to the token, there will also be an option for your pharmacy to have a list of your active prescriptions in their software, so you don’t have to forward it on.

To get your medicines you will need to prove your identity to the pharmacist and provide consent for the pharmacist to view your prescriptions.

Steps to take in preparation for using an electronic prescription

  • Ensure your address, email address and mobile number are up to date with your doctor and pharmacy.
  • Check that your pharmacy can take an electronic prescription and are delivering medicines.

Your GP at PartridgeGP

Your Pharmacist at Bayside Village Pharmacy

Typhoid Mary and COVID Colin

Those who don’t know history are doomed to repeat it.

Typhoid Mary was a cook who moved from one rich employer to another in New York and Long Island, infecting seven households with typhoid between 1900 and 1907 before doctors traced her as the common cause of the infections. The key point is that she was in good health herself throughout. When confronted, she indignantly refused to submit stool samples for analysis, until eventually imprisoned for this refusal.

After three years she was released while promising not to work as a cook. Unhappy with the low wages of a laundress, she changed her name, resumed cooking and resumed causing typhoid. After a 1915 outbreak in a hospital for women in which 25 people fell ill and two died, Mary Mallon/Brown was again arrested and kept in quarantine for the rest of her life, refusing to have her gall bladder removed. When she died in 1938, an autopsy revealed a thriving colony of typhoid bacteria in her gall bladder. For some genetic reason they had not caused any symptoms in her.

Clear!

What is the current understanding of the ability to return to work and risk of reinfection/further complications for clinicians who have recovered from COVID-19?
The department will determine when a confirmed case no longer requires to be isolated in hospital or in their own home, in consultation with the treating clinician. This will be actively considered when all of the following criteria are met:
• The patient has been afebrile for the previous 72 hours, and
• At least ten days have elapsed after the onset of the acute illness, and
• There has been a noted improvement in symptoms, and
• A risk assessment has been conducted by the department and deemed no further criteria are needed.
Apparent re-infection has been reported in a small number of cases. However, most of these reports describe patients having tested positive within 7-14 days after apparent recovery. Immunological studies indicate that patients recovering from COVID-19 mount a strong antibody response. It is likely that positive tests soon after recovery represent persisting excretion of viral RNA, and it should be noted that PCR tests cannot distinguish between “live” virus and noninfective RNA.
For further information, go to the department’s website and see Advice for clinicians / epidemiology!

Stay home | Save lives

Now, if you really really must leave home…

Flu Vaccine