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

 

 

 

Welcoming Dr Jen Becker to PartridgeGP

PartridgeGP is proud to welcome Dr Jen Becker to our team!

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Dr Jen completed her medical degree at Flinders University in 2012 and since then has worked in hospitals across Adelaide and beyond. She most recently completed a 6 month term in public health in Darwin.

Her medical interests include sexual health, women’s health, and adolescent health. Outside medicine, her energies go into cooking, travel, and spending time with family.

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

She is available to help you with all of your General Practice needs from mid April 2019 and you can book your appointment with her conveniently online right here – or call our friendly reception team on 0882953200.

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.

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DR NICK TELLIS

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Your Specialist In Life

DR NICK MOUKTAROUDIS

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DR GARETH BOUCHER

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DR PENNY MASSY-WESTROPP

dr penny massy westropp - your gp

DR MONIKA MOY

dr monika moy- your gp

DR ABBY MUDFORD

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DR JEN BECKER

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DR DAVID HOOPER

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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.

 

 

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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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Dr Abby Mudford at PartridgeGP

 

 

 

PartridgeGP is proud to welcome Dr Abby Mudford to our team! She’s a graduate of the University of Auckland and commenced her specialist General Practice training in February 2018 after three years of post-graduate hospital work at Flinders Medical Centre. Dr Abby has special interests in surgery, skin medicine, and gastrointestinal diseases.

 

 

 

 

 

 

 

 

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 Abby Mudford is a valuable member of our growing Clinical Team and she’s keen to hit the ground running here at PartridgeGP!

 

 

 

 

 

 

 

 

 

 

DR NICK TELLIS

 

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Your Specialist In Life

DR NICK MOUKTAROUDIS

 

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DR GARETH BOUCHER

 

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DR PENNY MASSY-WESTROPP

 

 

Dr Penny Massy-Westropp

DR MONIKA MOY

 

 

Dr Monika Moy

 

DR ABBY MUDFORD

 

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DR JEN BECKER

 

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DR DAVID HOOPER

 

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Welcoming Dr Chrissy Psevdos to Partridge Street General Practice

dr chrissy psevdos at Partridge Street General Practice

Partridge Street General Practice welcomes Dr Chrissy Psevdos who has kindly agreed to locum with us while Dr Nick Tellis is on Paternity Leave. She is a quality GP with a Fellowship of the RACGP and many years of experience. She has a passion for people and can assist you with all of your health needs.

Her first day with us is Tuesday 24th July and you can book an appointment with her right here.

 

All of our doctors here at Partridge Street General Practice are fully qualified ‘Fellows’ 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 Partridge Street General Practice with our excellent Practice Nurses. We all uphold the highest standards of privacy, confidentiality, professionalism, and clinical practice.

 

She is keen to hit the ground running with the rest of our Great Team here at Partridge Street General Practice! We look forward to having Dr Chrissy Psevdos as part of our growing Clinical Team and sharing her experience with us and our valued patients.

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

 

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 CHRISSY PSEVDOS

 

dr chrissy psevdos at Partridge Street General Practice

My Health Record: Former digital transformation head raises concerns about security of online system – Politics – ABC News (Australian Broadcasting Corporation)

The man appointed by Malcolm Turnbull to transform the Commonwealth’s digital public services has said if he was Australian he would probably opt out of the Government’s controversial online health database.

http://mobile.abc.net.au/news/2018-07-18/my-health-record-former-digital-transformation-boss-has-concerns/10006788?pfmredir=sm

Learn more here!

Alternative…Patients – #kickback edition

Thanks George Forgan-Smith 😉

 

 

It’s the week after the RACGP AKT and KFP exams for some and before a busy week for others. You may be a little flat and the world may seem a bit chaotic at the moment so I thought I’d take a minute to remind us all of how good we have it in Australian General Practice.

 

What are some of the little things your patients have done for you? (#kickbacks 8-)) These are three that come to mind for me:

 

 

 

Sugar free, too 👍👍👍

 

 

 

When the person I squeezed in for an appointment because they were ‘really ill’ stopped the consult to give me a (sugar free 👍) lolly when I was coughing at the end of a long day with lots of sniffling kiddies.

 

 

 

A Series of Unfortunate Events

 

 

 

A lovely painting I got for ‘mates rates’ after helping someone through a ‘series of unfortunate events’ (see the main picture!)

 

 

 

Needs banana for scale 🍌

 

 

 

3. A fantastic steak dinner cooked for me when I was spotted sneaking out of the practice clutching a bag of chips on a big on call night.

 

 

 

 

 

What little things have your patients done for you? 

 

 

Sunset at Glenelg

 

 

Take a moment to have a think and feel grateful – we really do have the best job in the world!  👍

 

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 would like to be:

part of a great team where everything is set up to help you help others

helping great patients

near the beach

working fewer hours and earning more with private billing

 

 

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GPs want clinical handovers, not discharge summaries

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

 

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

 

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

 

Dropping the baton

 

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

 

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

 

Rules of the game

 

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

 

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

 

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

 

Timing is everything

 

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

 

GPDU dragon head-3

 

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

 

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

 

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

 

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

 

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

 

Don’t fumble the handover

 

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

 

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

 

The baton is passed between people not machines

 

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

 

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

 

Personal bests are set; medals are won

 

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

 

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

 

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

 

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

 

clinical handover

 

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

 

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

 

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

 

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

 

 

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