Divided, the Empire must unite…

Romance of the Three Kingdoms is
one of China’s four Great Classical Novels. The title of this blog post is more fully:

The empire, long divided, must unite; long united, must divide. Thus it has ever been.

PartridgeGP is based on a triple promise that we will be great for our patients and our community, GPs and our staff, and for the owners and the practice. Further, we will provide a comprehensive, professional, empowering, and sustainable service at all times.

Our friendly neighbourhood pharmacist sent this to me (see below). He was a little worried about the threat to his full service pharmacy and also to great General Practice.

Hmmmm

Now different companies will have different service offerings at different levels of the market. Think Porsche and Hyundai. Both very acceptable to different groups. Maybe even acceptable to the same group at different times. I’m not sure they are competitors.

I put my thoughts down here:

Upon reflection…

So keep playing to your strengths, keep doing your best, and unite not divide.

If you want to join a team that’s here to guide and help our valued patients, give Dr Nick Tellis or Dr Nick Mouktaroudis a call at PartridgeGP on 8295 3200!

Coronavirus 101 | PartridgeGP

The pandemic is here. This is what we can all do:

Watch a short video!

Wash your hands! Soap and water and 20 seconds if you can, alcohol hand sanitiser is second best.

Don’t touch your face! Dr George Forgan-Smith demonstrates in the short video at the link…and goes further with…

Social distancing. Try and stay 1-1.5m away from people. Don’t hug, kiss, shake hands…and DON’T do group meetings / big gatherings. These will soon be cancelled (Monday, if over 500 people) but really, it starts with you!

Dr George demonstrating cough etiquette and social distancing!

Cough into your elbow and clean your phone! Both of these will limit spread of those little virus particles!

Now that you’ve cleaned your phone, and are practicing your social distancing, USE the phone. Telehealth is here via your phone, no special equipment needed.

STAY AT HOME, USE THE PHONE

Great advice if you’re unwell, good advice just for day to day. Call PartridgeGP on 08 82953200 for a phone appointment!

So remember

Wash Your Hands

Wash. Your. Hands.

Don’t Touch Your Face

Social Distancing

Social distancing works

Clean Your Phone

Use Your Phone

Stay Safe and Good Luck!

Some more videos and links below:

What is Your GP trying to do about this?

What about kids and schools?

What about the elderly?

What about my specialist appointment?

Thanks to:

Dr George Forgan-Smith

Dr Todd Cameron

Dr Chien-Wen Liew

Dr Sachin Patel

And please share this to all your friends and family

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!

 

 

 

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Drive through COVID in Victoria!

Oh…you thought I meant testing!

I meant THIS

 

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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!

Resourcing, not medication restrictions, needed in aged care

Thanks to Dr Michael Clements and NewsGP from the RACGP for highlighting the needs for aged care 👍🏼

Dr Michael Clements


9/12/2019 3:14:11 PM

The Government’s recent funding injection has to be specifically targeted to address the problems GPs, staff and patients face within residential aged care facilities, Dr Michael Clements writes.

Aged care
Dr Michael Clements believes that while aged care requires a significant funding boost, it will only be helpful if it is specifically targeted to the sector’s needs.

‘Mrs X was found wandering at night in the carpark, can you please prescribe medication?’
 
This was how one recent residential aged care facility (RACF) interaction began for me.
 
After meeting with the staff and ruling out delirium or biochemical causes, and noting a worsening in the behavioural aspects of dementia, I suggested the patient move to the restricted ward or have extra supervision.
 
But my request was declined due to lack of beds and I was specifically asked, once again, to commence a medication to prevent the patient from wandering.
 
The situation was clear: under-staffing in this facility led to pressure to prescribe sedative medications that would keep the patient compliant and allow staff to attend to other residents.
 
Provision of care within RACFs has become more complex and time-consuming as the population ages and rates of dementia rise. Unfortunately, funding models have not kept pace, even as clinical governance requirements in RACFs have increased and nurse autonomy reduced.
 
This has led to a situation for many GPs who work within RACFs in which countless night-time phone calls, form-signing, box-ticking and compliance measures now form the largest part of their care. It has also led to an overreliance on anti-psychotic medications for the behavioural aspects of dementia, as understaffed facilities come under pressure to medicate their problems away.
 
GPs have been looking forward to the Royal Commission into Aged Care, Quality and Safety because they, along with RACF staff, have seen cost-cutting measures applied in facilities, with reductions in numbers of trained staff, greater reliance on lower-skilled assistants, and decreased activities and programs.
 
Staff across the aged care sector want to see better diversionary activities and care services, nursing numbers, and funding to allow GPs to spend more time with patients and their families. This is felt most acutely in rural and regional areas, which are already experiencing aged care staff and GP workforce shortages.
 
The Federal Government has suggested high prescriptions of anti-psychotic medications in RACFs is a source of the problem, rather than an indicator of a system that is under-resourced to deal with the complex issues of dementia care.
 
However, the latest promise of extra funding from the Federal Government does nothing to address the reasons behind the increased use of anti-psychotic medications for the behavioural aspects of dementia; it is simply ‘shooting the canary’ and will have no impact on the gas leak in the coalmine the canary has been screaming about for the last five years.
 
What RACFs need instead is funding targeted towards sufficient numbers of appropriately trained nursing staff, for GPs to provide comprehensive team-based care, and for tertiary services to get out of hospital grounds and into RACFs to work with GPs.
 
Novel solutions are required to the problems faced in residential aged care, and each facility will need to find one that reflects their community workforce and need.
 
But some general steps that will be helpful across the board include:

  • additional money injected into the system from federal and state health budgets
  • patients getting used to private fees for GP services
  • nurses and nurse practitioners being allowed to practice at their full scope
  • GP-led rather than GP-delivered care being utilised where possible.

The message should be clear: fund RACFs and GPs in order to enable them to provide the care that is so desperately needed.

Do not shoot the canary.

© 2018 The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807

PartridgeGP and Dr Nick Tellis are doing our best for better aged care in many of our local aged care facilities. We will do more in 2020! Watch this space 👍🏼

Men’s Health Week 2019 at PartridgeGP 

June is Men’s Health Month and June 10-16, 2019 is Men’s Health Week at PartridgeGP. Men are important and Health is important so let’s look at some issues in Men’s Health.

 

 

 

Do you look after yourself like you do your car?

 

 

From the Men’s Health Week website:

 

A boy born in Australia in 2010 has a life expectancy of 78.0 years while a baby girl born at the same time could expect to live to 82.3 years old. Right from the start, boys suffer more illness, more accidents and die earlier than their female counterparts.
Men take their own lives at four times the rate of women (that’s five men a day, on average). Accidents, cancer and heart disease all account for the majority of male deaths.
Seven leading causes are common to both males and females, although only Ischaemic heart disease shares the same ranking in both sexes (1st). Malignant neoplasms of prostate (6th), Malignant neoplasms of lymphoid, haematopoietic and related tissue (7th) and Intentional self-harm (10th) are only represented within the male top 10 causes.

 

 

Smoking, Skin Cancer, Suicide, and So Much Alcohol

 

 

The above figures are taken from the Australian Bureau of Statistics. Furthermore, there are specific populations of marginalised men with far worse health statistics. These marginalised groups include Aboriginal and Torres Strait Islander men, refugees, men in prison or newly released from prison and men of low socioeconomic standing.

 

Men’s Health Week has a direct focus on the health impacts of men’s and boys’ environments. It serves to ask two questions:

 

What factors in men’s and boy’s environments contribute to the status of male health as indicated in the table above?

How can we turn that around and create positive environments in men’s and boy’s lives?

 

 

We’re going to ask and answer those questions this week. Stay with us online and in person – we’ve got your back!

 

 

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GET A GREAT GP!

(Here’s some we made earlier)

 

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Melanoma May – and Uveal (Ocular) Melanoma at PartridgeGP

Marissa Wreford writes (thank you!), and Dr Ian Kamerman from Northwest Health passes on:

 

May is Uveal Melanoma month.

 

Each year approximately 7 out of one million individuals are diagnosed with some form of Uveal (Ocular) Melanoma. Around half of those people will develop metastatic disease (Stage IV). Whilst average survival time has increased from 6 months to three years since my diagnosis in 2017, metastatic uveal melanoma still has a 5 year survival rate of just 15%.

 

 

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The best chance of survival is early detection. This May do something for your health, and the health of your eyes – a very underrated, yet essential, sensory organ.

 

 

So remember to go and get a dilated eye exam. A standard eye checkup with your optometrist may not show small changes, which when found early can make a big difference. Don’t take your eyes for granted. Don’t think that wearing sunglasses or eating “organic foods” and general healthy choices will spare you or someone you love from this disease. Research regarding lifestyle risks are still to this day inconclusive. Your best chance is, and likely always will be, early detection.

 

So this May ask specifically for a DILATED eye exam. Then continue to do this every May.

 

Use Ocular Melanoma Month as a reminder to give your eyes some love.

 

And for the rest of your skin:

 

Dr Nick Mouktaroudis is a GP and co-owner at PartridgeGP. 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. With our recent move we thought back to how we started Skin Cancer Surgery and Medicine at PartridgeGP and the story is 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. 
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What is a Skin Check?

 

 

A Skin Check is a Comprehensive Skin History and Examination which is done at PartridgeGP.

 

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.

 

 

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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 PartridgeGP 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 PartridgeGP.

 

 

 

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 PartridgeGP theatre and our Practice Nurse will assist Your GP.

 

 

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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 non-GP 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.

Having a yearly DILATED eye exam with Your Optometrist (anywhere that sells glasses!)

 

 

 

 

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Book Your Skin Check Right Here.

 

 

 

Need more information? 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 David Hooper

Dr Clare MacKillop

Dr Jen Becker

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Abby Mudford

Dr Katherine Astill

Dr Nick Mouktaroudis

Dr Nick Tellis