The Golden Month v2.0

January 21, 2021 by Dr Nick Tellis, posted in #justagp, Comprehensive, Empowering, General Practice, Glenelg, GP, health, How to, Information, Medical, Men, Men's health, New doctor, News, Occupational medicine, Partridge Street General Practice, Professional, Return to work, Self help, Workcover

A guest post by the excellent Dr Kar Loong Ng of Next Generation Occupational Medicine – NGOM.

Time. Timing. Such a critical aspect of Medicine. When a patient is in VF (Ventricular Fibrillation) the medical team has seconds, tens of seconds to act before the probability of successful resuscitation decreases exponentially. Act too fast (not yelling ‘CLEAR’) whilst activating the defibrillator and they risk hurting a team member and losing further precious seconds whilst the machine recharges. Act too slow and the patient is lost forever.

The same principles apply for non-emergency musculoskeletal workplace injuries. More often than not, I encounter patients, employers and insurers who request for MRIs at early stages of injury when there is no medical indication. The fact of the matter is, there is very little correlation between most MRI findings and the patient’s current injury or problem. Kind of like seeing all the imperfections on footy player’s faces on a 4K TV during a game. Additionally there are quite a large number of studies that show that early spinal MRIs that are not medically indicated often result in poorer outcomes and disability. I once saw a worker who was in such severe pain due to his belief that his ‘discs are squashed, bulged and spinal cord and nerves crushed’. When viewed I his MRI scans and told him that there is mild bulging of his lower 2 lumbar discs , his immediate response was “That’s where my pain is !! Between my shoulder blades……..”

Another example is that of shoulder impingement syndrome. A subacromial injection early on the injury is not going to be of benefit if the patient is not aware of how to perform rotator cuff exercises. An injection too late will also have less chance of success.

It is all about timing. Right, Roger Federer?

I previously wrote about Specialised Early Intervention and Second Opinion Medicine. With both services, we have been able to successfully rehabilitate a good proportion of complex worker injuries to normal work, alternative work, new employment or community restoration. Unfortunately some patients do not do so well. Being a sub-specialist practice, all our patients are referred from GPs. Despite extensive communication to the GP community, employers, insurers and rehabilitation providers emphasising the importance of early referrals, our earliest referral over the past few years has been 7 weeks post injury. This was an outlier, with the average referral being 6 to 9 months old. Well…….it beats my record a few years back when I saw a 50 year old man (with a six-pack) who had been on benefits since 19 and could not remember which leg his sciatica was on………..

Successful Early Intervention requires implementation at 2 to 3 weeks post injury. Some people refer to it as ‘The Golden Month’. For complex worker injuries, there is now good evidence that screening and intervention at day 1 of injury result in a significant reduction in disability and cost.

We are now in the process of implementing this with the introduction of services to GPs. The aim is to provide patients, workers and employers with a personally tailored comprehensive suite of medical and allied health care, as well as quick but well-timed access to medical sub-specialists.

I feel like I have been playing the game of RISK over the past few years. Disability is the enemy. I hope this strategy contains it.

Thanks Kar – it’s inspiring to see the passion you have for returning injured workers to work! Getting you better is what we’re about at PartridgeGP and so we’ll be working together with NGOM whenever we see injured workers.

Here to Help

Our Doctors at PartridgeGP are Here to Help Injured Workers – you can meet them here.

Want more?

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

(Hat tip: Dr Oliver Frank)

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

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

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

Warning: This website and the information it contains is not intended as a substitute for professional consultation with a qualified practitioner.

June 16, 2019 by Dr Nick Tellis, posted in Partridge Street General Practice

More gold here from Dr Raines!

Feel free to bring any information from these links to your consult with Your GP at PartridgeGP 👍🏼

Book in right here: http://bit.ly/2XmM0n5

Mark Raines

It may not come as a surprise but as a doctors I use Google quite a bit. There are of course other alternative search engines; “Just Google it” has been adopted into our lexicon, whilst “DuckDuckGo it” or “Dogpile it” doesn’t have the same ring, although some would argue they are better. But getting back to the topic.

During a consultation, I may turn to my computer and search Google for a picture to illustrate a point, for example, I think you have measles – see here is a picture of the rash in question. My consulting room is set up so we can both see the computer screen. That makes it hard to surreptitiously do a quick search as you talk. Don’t ask what happens when the computer isn’t working! My doodles are not art, but I do have books!

When it comes to making a diagnosis, I…

View original post 797 more words

Men’s Health Week 2019 at PartridgeGP

June 13, 2019June 13, 2019 by Dr Nick Tellis, posted in #justagp, Anxiety, Comprehensive, Depression, Diet, Empowering, Exercise, General Practice, Glenelg, GP, Grass fed, health, How to, Influence, Information, LCHF, lowcarb, Medical, Men, Men's health, Men's Health Week, Mental health, Natural, News, Occupational medicine, Partridge Street General Practice, Physiotherapy, Professional, Psychology, Return to work, Self help

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!

GET A GREAT GP!

(Here’s some we made earlier)

Winter is coming – What does Croup sound like?

June 5, 2019June 5, 2019 by Dr Nick Tellis, posted in General Practice, GP, Information, Partridge Street General Practice

It sounds like this

(click to listen ^)

See PartridgeGP here

(thanks to the Royal Childrens Hospital, Melbourne)

Croup is a condition caused by a viral infection. The virus leads to swelling of the voice box (larynx) and windpipe (trachea). This swelling makes the airway narrower, so it is harder to breathe. Children with croup develop a harsh, barking cough and may make a noisy, high-pitched sound when they breathe in (stridor).

Croup mostly affects children between six months and five years old, but it can affect older children. Some children get croup several times.

Croup can get worse quickly. If your child is having problems breathing, seek urgent medical attention.

Signs and symptoms of croup

Croup usually begins like a normal cold, e.g. fever, runny nose and cough.
Your child’s cough will change to become harsh and barking, and might sound like a seal.
Your child’s voice may be hoarse.
When your child breathes in, they may make a squeaky, high pitched noise, which is called stridor.
In severe cases of croup, the skin between the child’s ribs or under their neck may suck in when they breathe, and they may struggle to breathe.

Croup often begins without warning, in the middle of the night. The symptoms are often worse at night, and are at their worst on the second or third night of the illness. The signs and symptoms of croup may last for three to four days; however, a cough may linger for up to three weeks. The stridor should not persist.

Care at home

A mild attack of croup is when your child has the harsh, barking cough but does not have stridor when they are calm and settled, and they are not struggling to breathe. No medical treatment is necessary for mild croup, or the virus that has caused it. You can usually manage mild croup at home with the following care:

Keep your child calm, as breathing is often more difficult when upset – the more a child is distressed, the worse their symptoms can become. Try sitting quietly, reading a book, or watching TV.
If your child has a fever and is irritable, you may give them paracetamol or ibuprofen. See our fact sheet Pain relief for children.
Croup often becomes worse at night. Many children will be more settled if someone stays with them.

Steam and humidifiers are no longer recommended as treatment. There is no evidence to suggest they are beneficial.

When to see PartridgeGP

You should call an ambulance immediately if:

your child is struggling to breathe
your child looks very sick and becomes pale and drowsy
your child’s lips are blue in colour
your child starts to drool or can’t swallow.

You should see Your GP if:

your child is under six months old and has signs and symptoms of croup
your child’s breastbone or the skin between their ribs sucks when they breathe in
your child has stridor when at rest
your child is very distressed or their symptoms are getting worse
you are worried for any other reason.

If your child has mild croup that lasts for more than four days, or if stridor returns after your child has recovered from croup, take them to see a GP.

IMG_20190601_223800

Your GP may prescribe steroids (e.g. prednisolone or dexamethasone) to be taken by mouth. The steroids help reduce the swelling in the airway, which will make breathing easier. Antibiotics do not work on viruses and are not given to children with croup.

If your child has severe croup, they will need to stay in hospital, where they will be closely watched.

How is croup spread?

Croup is a reaction to a virus, not a virus in itself, so children cannot ‘catch’ or spread croup. However, the virus that has caused the croup can be spread easily from person to person by coughing and sneezing. If your child has croup, you should keep them away from school and child care while they are unwell so that they don’t spread the virus that is causing the croup. Regularly washing hands thoroughly can help prevent the spread of viruses.

Key points to remember

No treatment is necessary for mild croup, or the virus that has caused it.
Croup usually gets better in three to four days.
Try to calm your child, as breathing is often more difficult when your child is upset.
Croup can get worse quickly. If your child is having problems breathing, seek urgent medical assistance.
In a severe attack of croup, your child needs to be watched closely in a hospital.

These are the world’s healthiest nations | World Economic Forum

May 27, 2019 by Dr Nick Tellis, posted in Partridge Street General Practice

Spain number 1! But why?

Its primary care is particularly praised, with specialized family doctors acting as the gatekeepers to the health system.

https://www.weforum.org/agenda/2019/02/these-are-the-world-s-healthiest-nations/

Melanoma May – and Uveal (Ocular) Melanoma at PartridgeGP

May 2, 2019May 2, 2019 by Dr Nick Tellis, posted in #justagp, Care plan, Comprehensive, Empowering, General Practice, Glenelg, GP, health, How to, Influence, Information, Medical, Men's health, News, Partridge Street General Practice, prevention, Professional, Self help, skin, skin cancer

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%.

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

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.

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.

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.

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!

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.

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.