RACGP – Do they teach perfume dispensing in pharmacy school?

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My first encounter with the Pharmacy Guild was over 20 years ago, when I was working for the AMA.

‘Hello, I’m from the Guild.’ It was a well-known media representative on the phone.

‘Harry, we need to have lunch.’

‘Why?’

‘I need to tell you a few things.’

 

Read on…

 

https://www1.racgp.org.au/newsgp/gp-opinion/do-they-teach-perfume-dispensing-in-pharmacy-schoo

 

 

SafeScripts

We’ve written before about how PartridgeGP prefers safer and better options to opioid and benzodiazepine prescribing. These medications do serve a purpose at some times in some patients and so we must be safe.

Victoria has an amazing system – SafeScripts. Let’s get it here in South Australia!

1 December 2018

Hon Stephen Wade MLC
Minister for Health and Wellbeing
Email: Ministerforhealth@sa.gov.au
Street address: Level 9, 11 Hindmarsh Square, Adelaide South Australia
Telephone: (08) 8463 6270
Fax: (08) 8463 6277

Dear Mr Wade MLC,
I understand you are currently learning from other jurisdictions, including Victoria, in regard to better ways to manage the prescribing of high -risk medications. I refer to the SafeScripts information below:

SafeScript is computer software that allows prescription records for certain high-risk medicines to be transmitted in real-time to a centralised database which can then be accessed by doctors (or nurse practitioners) and pharmacists during a consultation with a patient.

The records will be obtained automatically via an electronic transfer of prescriptions through a Prescription Exchange Service (PES) when a prescription is issued or dispensed at a medical clinic or pharmacy. No data entry will be required.

SafeScript will enable doctors and pharmacists to make safer clinical decisions and identify circumstances where patients may be receiving high-risk medicines beyond medical need.

While taking prescription medicines can be beneficial for managing medical conditions, some medicines are harmful if taken in high doses or in combination with other medicines. It is easy to develop a dependence on a high-risk medicine even when the medicine is only being taken for a short period of time to address issues such as pain or anxiety.

The number of overdose deaths in Victoria involving pharmaceutical medicines is higher than the number of overdose deaths involving illicit drugs and, since 2012, has exceeded the road toll. The latest available data, from 2016, shows that 372 Victorians died from overdoses involving prescription medicines, 257 died from overdose deaths involving illicit drugs and 291 died in road accidents.

As a practicing GP, practice owner, resident of South Australia, taxpayer, and voter, this issue is important to me in many ways.

Minister Wade, every day patients are at risk from this information not being available to doctors, hospitals, and pharmacists in South Australia. I ask you to expedite the introduction and adoption of SafeScripts as a matter of public health urgency.

I look forward to your reply and action on this issue and thank you for the time you have taken in reading this letter.

Kind Regards,

Dr Nick Tellis

GP and Owner, PartridgeGP
Chairman, Southern Regional GP Council
Member, Southern Adelaide Local Regional Network Clinical Council
Adjunct Senior Lecturer, College of Medicine and Public Health, Flinders University
Co Administrator on GPs Down Under – Facebook Networking Group for GPs

Discharge summary versus clinical handover: language matters

PartridgeGP 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 PartridgeGP 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 PartridgeGP provides Better Healthcare for our valued patients. Read on.

 

This article is part of a monthly series from members of the GPs Down Under (GPDU) Facebook group, a not-for-profit GP community-led group with over 6000 members, 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

 

IN our earlier article we described the concept of “passing the baton” when talking about transfers of patient care. All patients come from their communities and to their communities they shall return. In this transition from tertiary hospital to primary care, they benefit from timely, safe, effective clinical handover as defined in the National Safety and Quality Health Service Standards.

 

In primary care, communication matters, perhaps more so than in tertiary care. Words matter. The language we use matters. It informs thought at conscious and subconscious levels and influences behaviour.

 

The words “discharge summary” evoke feelings of an administrative process at best, and various unsavoury processes at worst. The accidental discharge, the dishonourable discharge, and the smelly discharge all come to mind. The words “clinical handover” instantly sound more professional. They reflect the sort of interaction between clinicians of which we want to be part. Clinical handover is a term familiar to both clinicians and administrators. It is taught in medical schools around the country and practised between junior and senior doctors within our hospitals.

 

Transition of care is well known to be a time of maximum risk: “Adverse events are seen to increase particularly during a transition of care, when a patient is transferred between units, physicians and teams.

 

Clinical handover is a recognised, evidence-based, structured and essential safety mechanism for minimising this risk. Remember, all patients come from their communities and to their communities they shall return. Their community doctor, their primary care physician, is their GP. Patients deserve the best clinical handover we can provide, whether transitioning into or out of our hospitals.

 

Junior doctors in hospitals presently perform the clear majority of clinical handovers to primary care, labelled as “discharge summaries”. According to the Discharge Summary – Literature Review, published by Queensland Health in May 2017 (not available online):

 

 

“Junior doctors perform the clear majority of discharge summaries:

  • Many interns have a flippant attitude to the completion of discharge summaries and have a low perception on the importance of a safe handover of care;

  • Most medical education programs provide minimal education on the completion of discharge summaries;

  • Most interns learn from each other with little input or guidance from registrars and consultants;

  • Interns tend to ‘lump’ discharge summaries together, often completing the summaries on patients they have never met.”

 

 

This frequently happens after the transition has occurred. To borrow from our legal friends, you cannot sell what you do not own. How then can you transfer the care of a patient you have never cared for?

 

 

Junior doctors report that they have limited supervision and lack templates or guides to help them produce a comprehensive and useful handover for community-based care whereas they receive a considerable amount of training for internal clinical handover.

 

 

Medical practitioners frequently use ISBAR (introduction, situation, background, assessment, recommendation) to guide clinical handover. A recent GPDU discussion highlighted that the Gold Coast University Hospital was moving to an ISBAR format for clinical handover to primary care. This was seen by many in GPDU to be a significant step in the right direction. ISBAR for the clinical handover to primary care aligns with hospital handovers and can only improve the transfer of care. Brewster and Waxman recently proposed amending ISBAR slightly to K-ISBAR by adding some kindness into the equation. Taking the opportunity to actively incorporate empathy and understanding into the primary care handover would be a great place to enhance collegiality across community and hospital teams.

 

 

When deciding who is tasked with a clinical handover within the hospital, it is unlikely that this would be handed to the most junior member of the team, and exceedingly unlikely that it would be delegated to someone who had never treated or met the patient. Within hospitals, it is expected that a clinical handover occurs at or before the time a patient’s care transitions to another team or provider. Why should this be any different for the clinical handover back to the GP?

 

 

In our first InSight+ article, we used the analogy of passing the baton. But what happens when the baton is dropped?

 

 

Dr Mandie Villis recently wrote a heartfelt plea for hospital doctors to inform GPs when patients passed away on their watch. Discussions around primary care clinical handover are now occurring around the country and pockets of significant improvement are being made. Momentum is building in regard to formally recognising and changing the language used from “discharge summary” to “clinical handover”. Several hospital and health services have, or are in, the process of implementing “same day” or “24-hour” clinical handover policies, and ultimately the best practice standard will be that this clinical handover occurs at the time of transition of care.

 

 

My Health Record (MHR) has been touted as a partial solution to the problems that have traditionally plagued clinical handover. It is important, however, to remember what MHR is and what it was created for. It is a repository of information for patients – a “shoebox” of documents akin to the jumble of receipts we burden accountants with at tax time. It is not, nor was it designed to be, a communication tool for clinicians. The baton transfer cannot occur within the MHR shoebox. It was not designed to replace current clinical record systems or current communication channels between clinicians. These limitations and precautions are outlined in the RACGP My Health Record guide for GPs:

 

 

“My Health Record is not designed as a substitute for direct communication between healthcare providers about a patient’s care, and should not be used in this manner. Healthcare providers must continue to communicate directly with other healthcare providers involved in the care of a patient through the usual channels, preferably through secure electronic communication.”

 

 

The  Australian Digital Health Agency states:

 

 

“The My Health Record system supports the collection of Discharge Summary documents. When a healthcare provider creates a Discharge Summary document, it will be sent directly to the nominated primary healthcare provider, as per current practices. A copy may also be sent to the individual’s digital health record.”

 

 

Mission creep of MHR is real, with multiple reports on GPDU of GPs stumbling across clinically relevant information in MHR rather than receiving a timely clinical handover. Important clinical information is “pushed” into MHR and the receiving clinician is not “pulled” to it by any sort of notification. There is no handover without closing the communication loop. Health professionals and organisations must ensure that clinical handover occurs with the intended recipient at the time of care transition. A copy uploaded to MHR for the patient to access, as an archive, may serve as a safety net if all else fails, but should not be relied on as the only source of communication.

 

 

Hospital systems must support and value the safety delivered by effective clinical handover to primary care. This will reduce the readmission rates to hospital care and improve the care patients receive. Patient care and practitioner wellbeing should not continue to be compromised due to the hospital culture of a discharge summary being an administrative task undertaken by the most junior team member. The challenges of high administrative burdens, inadequate staffing and unpaid overtime all need addressing. Junior doctors should not be left alone grappling with piles of outstanding discharge summaries to complete on patients they have never met.

 

 

The patient journey can be tracked, important milestones bookmarked, and plans documented as they are formed so that when it’s time for a transition, the “baton” is ready. The need for handover cannot come as a surprise when the patient’s trajectory was plotted from the day they were admitted. Adequate clinical staffing levels with protected time for clinicians to prepare clinical handovers should be a key performance indicator in hospital care. Proactive strategies must be put in place to identify and document who will be receiving the clinical handover. The culture that prevails within many of our hospitals needs to change.

 

 

Safety and quality bodies, such as the Australian Commission on Safety and Quality in Health Care through its National Safety and Quality Health Service Standards, and the Australian Council on Healthcare Standards through its accreditation regime, can provide effective oversight. All clinicians must lead in continuous improvement in “best practice” for quality and safety in transition of care both into and out of our hospitals.

 

 

Let us recognise and applaud our hospitals and health services leading the way in acknowledging discharge summaries as the clinical handovers that they are. May 2019 bring us all closer to high quality, timely, safe and patient-centred clinical handovers.

 

 

GPDU dragon head-3

 

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!

 

 

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What the FACRRM with Dr David Hooper at Partridge Street General Practice

 

David completed his nursing and medical degrees at Flinders in 2010. He subsequently spent 4 years in Darwin, Hervey Bay, and Port Lincoln completing his fellowship in rural and remote general practice. He spends 1 week each month as an emergency physician in Broken Hill. He’s married to Kerri and has 2 boys, Aiden aged 9 and Mason aged 11. In his spare time he enjoys marathon running (very slowly) and silver smithing.

 

Dr David is a Fellow of the Australian College of Rural and Remote Medicine, which is the other qualification that fully qualified General Practitioners in Australia can have. ACRRM defines a General Practitioner as the doctor with core responsibility for providing comprehensive and continuing medical care to individuals, families and the broader community. Competent to provide the greater part of medical care, the general practitioner can deliver services in the ambulatory care setting, the home, hospital, long-term residential care facilities or by electronic means – wherever and however services are needed by the patient.

 

We’re very happy to have Dr David with us as part of the PartridgeGP team and you can book in to see him right here.

 

Our team – here for You!

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Dr David Hooper

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Our GPs at Partridge Street General Practice

Our team – here for You!

20180920_082754_0001
Dr David Hooper

 

 

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Why do we charge a gap?

 

There has been a change in Canberra. Is an election coming?

If you suffer from premature election, you may feel the need for better healthcare. Primary care consistently delivers better bang for your buck – whether via the tax system or from your own pocket. Sometimes there is a gap – read on and watch the video.

 

 

Bulk Billing.

 

 

Medicare.

 

 

It’s important to us at Partridge Street General Practice that our valued patients know why we charge a gap fee.

 

 

Here’s a video by the excellent Dr Edwin Kruys that sums it up.

 

 

 

If you still have questions, come and say hi!

 

 

Our team – here for You!

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

dr gareth boucher

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Abby Mudford

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

dr chrissy psevdos at Partridge Street General Practice

Dr Katherine Astill

(on Maternity Leave from August 2018)

Dr Katherine Astill 1

join the team

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Are Medically Prescribed Opioids Killing Australians?

In 1996 Oxycontin a drug more powerful than Heroin hit the medical marketplace. It was touted as the cure for any pain, without addiction and without risk. Drug Companies have made many millions from this drug, at the cost of many deaths.
In 2018 we face an evolving crisis following America down a slippery slope, that will cost us our relatives, parents, sons, and daughters if we don’t change.
Partridge Street General Practice is proud to be a low prescriber of opioids, narcotics, and other medications that have NOT been shown to be effective and safe. We will be happy to discuss better options with you right here.

 

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Do You Even Aged Care?

Last night on the 730 Report we saw several GPs make the point that fewer GPs are providing care to elderly Australians in Nursing Homes and other Aged Care facilities.

See Here

 

TRACY BOWDEN: Dr Joseph is a strong believer in continuity of care.

DR PETER JOSEPH: For patients, they come in and they don’t have to explain things to you, that happened years ago, because you know it.
You learn what’s going on in the family and how that affects their health.
You can also pick subtle changes.

 

What are the solutions?

Dr Stephen Dick suggests the following:

 

The service is not viable financially and is attached with a burden of being on call 24/7, and having to deal with untrained staff triaging patients who are
quite sick with chronic diseases.

The fix:

1. GPs to operate on a salaried basis to service nursing homes, including a callout fee. The FFS model is broken, utterly, utterly broken, when it comes to aged care.


2. Legislated nurse to patient ratios – both RN to patient and carer to patient ratios.


3. Nursing homes to provide an imprest of basic medications, such as antibiotics and opioids, for after hours issues.


4. Pharmacies to be contracted to provide medications for the residents from a nationally standardised medication chart on a capitated basis – NO MORE OWING SCRIPTS.


5. Get an accreditor with teeth to do spot inspections and severe fines for companies that flout the rules. First offence – $50,000 fine. Second offence – $200,000 fine, resident fees non-payable and the CEO of the responsible corporation placed under house arrest until rectified. Third offence – Home shut down, bonds repaid in full to residents within 30 days, and residents to stay bond-free when and if the facility reopens.I guarantee that if a hospital suddenly had to find 80-odd hospital beds they’d find a solution quick smart.


6. Diets to be individualised and supervised by a dietitian and speech pathologist.


7. Responsibility for the nursing home to provide access to physio, OT, speech, podiatry, optometry in addition to DT.


8. Homes to have a standardised kit out of medical equipment, such as a diagnostic set, ECG machine, local anaesthetic and suture material, biopsy sets, and a room with a printer and wireless access to a network so that we can attend without having to bring every. Little. Piece. of equipment.

 

 

I suggest some simple rules for Aged Care facilities:

 

advice while Dr Nick Tellis is away

 

 

What are your thoughts?

 

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

 

dr gareth boucher

 

Dr Penny Massy-Westropp

 

 

Dr Penny Massy-Westropp

Dr Monika Moy

 

 

Dr Monika Moy

 

Dr Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

image004585

The Psychology of Money (Social Determinants of Health)

When it comes to what makes us sick, approximately 75% of our health issues happen to our patients and us before they or we engage the health care system. The Social Determinants of Health come into play here:

Social and cultural determinants of health

these are defined by the World Health Organization (WHO) as:

The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of people’s lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon. Together, the structural determinants and conditions of daily life constitute the social determinants of health

There is a lot online about combating these – here I’m going to take a different approach. Welcome to Morgan Housel and the Psychology of Money – happy reading!

health and money

Take it away Morgan!

Part 1 (of 20)…

Earned success and deserved failure fallacy: A tendency to underestimate the role of luck and risk, and a failure to recognize that luck and risk are different sides of the same coin.

I like to ask people, “What do you want to know about investing that we can’t know?”

It’s not a practical question. So few people ask it. But it forces anyone you ask to think about what they intuitively think is true but don’t spend much time trying to answer because it’s futile.

Years ago I asked economist Robert Shiller the question. He answered, “The exact role of luck in successful outcomes.”

I love that, because no one thinks luck doesn’t play a role in financial success. But since it’s hard to quantify luck, and rude to suggest people’s success is owed to luck, the default stance is often to implicitly ignore luck as a factor. If I say, “There are a billion investors in the world. By sheer chance, would you expect 100 of them to become billionaires predominately off luck?” You would reply, “Of course.” But then if I ask you to name those investors – to their face – you will back down. That’s the problem.

The same goes for failure. Did failed businesses not try hard enough? Were bad investments not thought through well enough? Are wayward careers the product of laziness?

In some parts, yes. Of course. But how much? It’s so hard to know. And when it’s hard to know we default to the extremes of assuming failures are predominantly caused by mistakes. Which itself is a mistake.

People’s lives are a reflection of the experiences they’ve had and the people they’ve met, a lot of which are driven by luck, accident, and chance. The line between bold and reckless is thinner than people think, and you cannot believe in risk without believing in luck, because they are two sides of the same coin. They are both the simple idea that sometimes things happen that influence outcomes more than effort alone can achieve.

After my son was born I wrote him a letter:

Some people are born into families that encourage education; others are against it. Some are born into flourishing economies encouraging of entrepreneurship; others are born into war and destitution. I want you to be successful, and I want you to earn it. But realize that not all success is due to hard work, and not all poverty is due to laziness. Keep this in mind when judging people, including yourself.

Read on!

Our team – here for You!

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

dr nick mouktaroudis at Partridge Street General Practice

Dr Gareth Boucher

dr gareth boucher

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Abby Mudford

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

dr chrissy psevdos at Partridge Street General Practice

Dr Katherine Astill

(on Maternity Leave from August 2018)

Dr Katherine Astill 1

join the team

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