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.

Welcoming Dr Zoe Teh to PartridgeGP

PartridgeGP is proud to welcome Dr Zoe Teh to our team!

 

dr zoe teh

 

Dr Zoe completed her undergraduate medical training at the University of Adelaide, and spent her intern and resident years between the Royal Adelaide Hospital and Queen Elizabeth Hospital. She undertook her General Practice training in a number of clinics across southern Adelaide, and is particularly interested in sexual health, women’s health (including Implanon insertion and removal), and preventative medicine. She is also fluent in Mandarin!

 

 

We welcome Dr Zoe to Our Team here at PartridgeGP to be Your GP!

 

 

She is available to help you with all of your General Practice needs from April 2020 and you can book your appointment with her conveniently online right here – or call our friendly reception team on 0882953200.

 

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All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

 

 

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

IMG_20190321_202633

 

DR PENNY MASSY-WESTROPP

dr penny massy westropp - your gp

DR MONIKA MOY

dr monika moy- your gp

Dr Zoe Teh

dr zoe teh

 

Welcoming Dr Nikhil Tamminedi to PartridgeGP

 

 

 

Dr Nikhil Tamminedi commenced his specialist General Practice training with PartridgeGP in February 2020. He completed his undergraduate medical training at the University of Western Sydney. Prior to commencing General Practice training, Dr Tamminedi worked two Post Graduate years in metropolitan hospitals in New South Wales with a focus on surgical disciplines and emergency medicine. His particular interest include skin, minor surgery, and respiratory medicine. In his free time, he enjoys rock climbing, hiking, and travelling..

Dr Nikhil has quickly settled in and has hit the ground running with the rest of our Great Team here at PartridgeGP!

 

 

 

 

 

 

 

 

 

PartridgeGP is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

 

 

 

This means that the GPs at PartridgeGP are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

 

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Teaching Practice of the Year

 

 

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

 

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

 

Dr Nikhil Tamminedi is a valuable member of our growing Clinical Team!

 

 

 

 

IMG_20190404_191100

 

 

 

 

 

Dr Zoe Teh

 

Dr Gareth Boucher

 

Dr Nici Williams

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

Dr Phillip Maddocks

 

Dr Nikhil Tamminedi

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

Welcoming Dr Phillip Maddocks to PartridgeGP

 

 

 

Dr Phillip Maddocks commenced his specialist General Practice training with PartridgeGP in February 2020. Raised in Adelaide, he studied and practiced in NSW, and then returned to Adelaide earlier this year. Becoming an accomplished GP has always been his career goal and he is eager to commence community-based work. I’m passionate about paediatrics, emergency medicine, sports medicine, and teaching. Prior to my career in medicine I held numerous leadership positions across both business and sport, attaining many skills which are transferable to working in medical teams.

Dr Phil has quickly settled in and has hit the ground running with the rest of our Great Team here at PartridgeGP!

 

screenshot_20200330-194411_wm816164613062801551.png

 

 

 

 

 

 

 

 

PartridgeGP is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

 

 

 

This means that the GPs at PartridgeGP are teaching the Doctors and Medical Students who will be the future of medicine in Australia. It’s a big responsibility and a privilege we take very seriously.

 

 

 

img_1954
Teaching Practice of the Year

 

 

All of our doctors here at PartridgeGP are fully qualified ‘Fellows’ (or are studying towards this) holding a specialist qualification with either the Royal Australian College of General Practitioners (FRACGP) or the Australian College of Rural and Remote Medicine (FACRRM) or both (3-4 years of full time study and 3 exams on top of an undergraduate university medical degree and supervised trainee ‘intern’ year in a hospital). This is our minimum specialist standard and we may have other qualifications and skills.

 

 

 

Our Fellows provide supervision and advice to our Registrars and you may find that they are called in to consult with the Registrar on your case. ‘Registrars’ are qualified doctors who have completed their hospital training and are now embarking on their General Practice training. Some may already have other qualifications in medical or other fields.

 

We also supervise and teach Medical Students from Flinders University. They are still studying to become doctors. All of us – Fellows, Registrars, and Medical Students – make up the Clinical Team here at PartridgeGP with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

 

 

Dr Phillip Maddocks is a valuable member of our growing Clinical Team!

 

 

 

 

IMG_20190404_191100

 

 

 

 

 

Dr Zoe Teh

 

Dr Gareth Boucher

 

Dr Nici Williams

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

Dr Phillip Maddocks

 

Dr Nikhil Tamminedi

 

Dr Nick Mouktaroudis

 

Dr Nick Tellis

 

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

Coronavirus Help Desk – Partridge GP (update with Repat drive through clinic info)

We find ourselves at the start of a seeming pandemic.

 

Coronavirus – latest government info – CLICK HERE

 

If unwell with cough/cold symptoms, stay home and use the phone

 

CALL coronavirus hotline 1800 020 080

free advice, home testing after doctor advice

CALL healthdirect 1800 022 222

free advice

 

If further advice needed

 

CALL PartridgeGP 0882953200

phone consult, private fee, no Medicare rebate

CALL/ATTEND

nRAH

Flinders Medical Centre

Lyell McEwin Hospital

coronavirus clinics

free, can see and/or swab

 

updated re the Repat drive through clinic

 

Accessing the Repat Collection Centre:

Patients must be booked into this service to ensure a controlled flow

Bookings are to be made by the practice by ringing 8222 3000

The practice is to advise patient of date and time of booking

Fax the request form to SA Pathology on 7117 5085

The service is available between 8.00 am and 4.30 pm Monday to Friday

Access is via Gate 4, 216 Daws Road, then follow the signs

Please ask patients to remain in their car and the SA Pathology staff will come to them

Instruct the patient to remain in isolation until the results have been communicated to them by you (their GP)

 

The Royal Adelaide Hospital

7 days a week 0900-2000 – walk in, just follow the signs!

Royal Adelaide Clinic Location HERE

NEW Southern Suburbs Coronavirus Priority Care Clinic

 453 Morphett Rd, Oaklands Park 7 days a week, walk in 1000-2000

 

How Do I Self-Isolate- click HERE!

AND HERE

OR HERE!

 

 

 

coronaadvice

 

img_20200127_145549_wm7637784655035031070.png

Drive through COVID in Victoria!

Oh…you thought I meant testing!

I meant THIS

 

1552719486937

 

In other news

We find ourselves at the start of a seeming pandemic.

Coronavirus.

In addition to the medical risks to themselves, their friends and families, and their patients, GPs have to consider the risks to their livelihood and practices.

We can’t help our patients if we are ill.

We can’t help our patients if our practices are closed.

We can’t help our patients if we are isolated at home.

There may be solutions. One, from Dr Todd Cameron and Dr Sachin B Patel, is outlined in the following videos.

 

1. GPs to instigate protocols in the way they see patients

2. GPs to alter the things they need to see patients face to face for

3. GP Practices to support the GPs who pay them to do so

4. Use telehealth and have MBS item numbers 23/36 cover this in this time of need

The videos are here

 

And here

 

So what can you do as a GP to make these things happen?

Stephen Covey talks about a circle of influence and a circle of concern. Your circle of influence should be larger than your circle of concern or you just worry about things you can’t change. Let’s go further and consider a circle of impact.

Where can you apply your time and skills to make a change?

Here it is.

Join the AMA.

They have about 6000 GP members (my guesstimate). You can join for a monthly fee of somewhere between $15-130 a month as a GP or registrar. You don’t have to join the AMA – it is entirely voluntary. You can leave at any time, and take your money with you.

So join.

On your application, quite clearly state why you are joining and that this is THE thing you would like the AMA to make an impact on. The AMA have access to the politicians. From your membership to their ears.

Watch the videos.

Make your decision.

Join.

Take action.

Make a difference.

Good luck!

 

 

Coronavirus Help Desk – Partridge GP

We find ourselves at the start of a seeming pandemic.

Coronavirus – latest government info – CLICK HERE

 

If unwell with cough/cold symptoms, stay home and use the phone

 

CALL coronavirus hotline 1800 020 080

free advice, home testing after doctor advice

CALL healthdirect 1800 022 222

free advice

 

If further advice needed

 

CALL PartridgeGP 0882953200

phone consult, private fee, no Medicare rebate

CALL/ATTEND

nRAH

Flinders Medical Centre

Lyell McEwin Hospital

coronavirus clinics

free, can see and/or swab

The Royal Adelaide Hospital

7 days a week 0900-2000 – walk in, just follow the signs!

Royal Adelaide Clinic Location HERE

NEW Southern Suburbs Coronavirus Priority Care Clinic

 453 Morphett Rd, Oaklands Park 7 days a week, walk in 1000-2000

 

How Do I Self-Isolate- click HERE!

AND HERE

OR HERE!

 

 

coronaadvice

 

img_20200127_145549_wm7637784655035031070.png

GPs. Protect yourself. Join the AMA. Good reading for politicians!

We find ourselves at the start of a pandemic.

Coronavirus.

In addition to the medical risks to themselves, their friends and families, and their patients, GPs have to consider the risks to their livelihood and practices.

We can’t help our patients if we are ill.

We can’t help our patients if our practices are closed.

We can’t help our patients if we are isolated at home.

There may be solutions. One, from Dr Todd Cameron and Dr Sachin B Patel, is outlined in the following videos.

1. GPs to instigate protocols in the way they see patients – pivot to PHONE

2. GPs to alter the things they need to see patients face to face for – PHONE!

3. GP Practices to support the GPs who pay them to do so – BE SAFE!

4. Use telehealth and have MBS item numbers 23/36 cover this in this time of need

The videos are here

And here

So what can you do as a GP to make these things happen?

Stephen Covey talks about a circle of influence and a circle of concern. Your circle of influence should be larger than your circle of concern or you just worry about things you can’t change. Let’s go further and consider a circle of impact.

Where can you apply your time and skills to make a change?

Here it is.

Join the AMA.

They have about 6000 GP members (my guesstimate). You can join for a monthly fee of somewhere between $15-130 a month as a GP or registrar. You don’t have to join the AMA – it is entirely voluntary. You can leave at any time, and take your money with you.

So join.

On your application, quite clearly state why you are joining and that this is THE thing you would like the AMA to make an impact on. The AMA have access to the politicians. From your membership to their ears.

Watch the videos.

Make your decision.

Join.

Take action.

Make a difference.

Good luck!