We’ve just celebrated the Chinese New Year – the Year of the Dog. People born in Dog years display loyalty and honesty amongst many other good qualities. However it is said that they can also be critical – maybe overly so. Segueing to another Chinese concept, we meet Qi, the vital life force that flows through the body. Let’s put these together.
A wise man once told me that the three pillars (the vital life force) of general practice are quality, service, and finance. All three of these come together in the form of the Practice Incentive Payments (PIP) scheme. You can read about this here but in summary Accredited General Practices are paid amounts of money for reaching certain quality measures. These include planning the management of a proportion of patients with diabetes and asthma, and ensuring women are screened for cervical cancer. There are also Incentive Payments for managing aged care and quality in prescribing.
These payments were due for a change on May 1st 2018. Were they promoting the vital life force of General Practice, were they tick box exercises for busy GPs, or were they overly critical of General Practice, not focusing on true quality? Enter QI – Quality Improvement. Rather than Qi, QI may be an altogether different beast.
The Department of Health has confirmed that the Practice Incentive Program Quality Improvement Incentive will now occur from 1 May 2019.
From their press release:
The Practice Incentive Program (PIP) has been a key driver in quality care in the general practice sector and the PIP QI Incentive will continue to build on this important work, further strengthening quality improvement in primary health care. The additional 12 months will enable the Department, with the support and advice from PIPAG, to ensure that any implementation issues are identified and addressed and that general practices have adequate opportunity to prepare. It will also allow the Department to continue to consult with stakeholders on refining the design of the PIP QI Incentive.
The changed time frame will mean that the following five incentives which were to cease on 1 May 2018, will now continue through to 30 April 2019.
The five incentives are:
Quality Prescribing Incentive
Cervical Screening Incentive
General Practitioner Aged Care Access Incentive
The six PIP Incentives that continue to remain unchanged are:
After Hours Incentive
Rural Loading Incentive
Indigenous Health Incentive
Procedural General Practitioner Payment
What next? Will the new QI beast be reflective of quality in General Practice? Will the measures align with what we as General Practitioners believe is high quality Great General Practice care? Or will it aptly be launched in the Chinese Year of the Pig in 2019?
For what it’s worth, here are my measurements of quality, service, and finance in General Practice – the Qi of GP:
Mental health and depression are serious issues. GPs see, treat, and support people with these issues everyday but who looks after the GPs? We can see that doctors are only human and suffer the same stresses as everyone else. Sadly, sometimes, it is too much.
I wrote previously about how to detect depression in patients. ‘Listen to the patient’, ‘How do they feel?’, ‘How do they make you feel?’. Experienced GPs can spot depression a mile off…in other people. How many turn that acumen on themselves? How many have their own GP to care for them?
I also wrote ‘American studies show patients are scared of psychiatric referral. Australian GPs are also scared of psychiatric referral’ and ‘Untreated depression is associated with decreased quality of life and increased mortality. Depression can be successfully treated and treatment is effective. The earlier the better!’. This is as true for GPs and doctors as it is for every other person.
So GPs, doctors, and others – Exercise, diet, psychotherapy, GP counselling, reducing drug and alcohol use, getting more and better sleep are all options. These take time and effort so give yourself permission to spend these on You. Your friends, family, and colleagues are here for you. They will #bekind.
Depression is not just a chemical imbalance. No pill can defeat the entirety of the patient’s life and circumstances pushing them in the wrong direction. Consider the your environment and be aware of the particular pressures of medical work and life. GPs have a fantastic and privileged therapeutic relationship with their patients, and they can use this to capitalise on the essential window of time before delivering medical advice. This “privileged moment for change” prepares people to be receptive to a message before they experience it. Robert Cialdini has coined the term ‘pre-suasion’ to describe this. The therapeutic relationship allows pre-suasion, and therapeutic change can then be addressed, with consideration of motivation, opportunity, and ability.
Dr Eric Levi has literally stepped forward online with the #crazysocks4docs / #socks4docs hashtags. It’s a lighthearted way of getting us to acknowledge a serious topic. I’m in!
The equally dapper Terry Cornick has been kind enough to contribute his story to my blog – and I hope it gives some of you hope, a good read, and another option for you and your patients.
Terry is a Healthcare Consultant, Mental Health Advocate and Freelance Writer.
His professional background includes Consulting in Healthcare and he loves creating, research, technology, and communications. Daily he deals and develops relationships with Doctors so knows a little about them too and the unique stresses they are placed under.
Initially as a hobby, Terry created a grassroots men’s mental health support network named “Mr. Perfect” that is growing by the minute. Although it does not pay a cent, it pays handsomely in purpose. You can check it out at www.mrperfect.org.au
Known sarcastically by his wife as “Dr Terry” he lives on the North Shore of Sydney with his young family and is currently contemplating his next move professionally, navigating the ever challenging and life-threatening dilemma for men of “providing” yet being “Mr. Perfect” personally too.
Trying to summarise and reduce my story to a blog is a challenge to say the least. Although a relatively spritely 33 years old, the increasing grey hairs and wrinkles around my eyes and my “old soul” remind me daily this life is a battle. And the battle is ultimately with yourself (hands up I have paraphrased this from a song I once heard, I just cannot remember which).
I love to compartmentalise and segment so my mind can attempt to process things, ideas, events, thoughts, feelings. Broadly speaking I did this with my life; pre-25 years old, 25 to 30 years old and 30 years old and beyond.
The first stage can sometimes appear as a blur. But perhaps an easier way of me dealing with it. It was a painful period for the majority of it. A challenging upbringing, tragic events, abuse and trauma pushed me so far into a shell that I never thought I would emerge from it.
During the okay times, this was okay with me. My introverted character and lack of self-esteem meant hiding was easier and far less painful. Until the occasional explosions. But life then returned to the blur.
A couple of moments in my early Twenties truly made me question my sanity. So at 21 years old I googled “Depression”. I matched 6 out of 8 symptoms. So clearly I was fine. I closed the laptop and the cycle of darkness continued as did the periodical suicidal meltdowns (behind closed doors of course).
Then the “Great Escape” took me to the other side of the world travelling. Less than two years later I was back in Australia for good, despite this being the deepest, darkest scene of my life. After a night out on the Gold Coast I stood on a balcony peering and leaning over contemplating that this was a good time to jump and end the pain. I felt so weak and thankfully, eventually, stepped back.
Somehow, after a few more substantial blips and obstacles, my life starting to become what others saw as “success”. More money that I knew what to do with, travel, a waterside apartment and a beautiful partner. One of my best mates teased me at work and called me “Mr. Perfect” regularly, not knowing 1% of my history or what was going on in my complex mind.
Behind the acting and those curtains and backstage was a chaotic scene. Anxiety, PTSD and Depression drove me to the edge. But approaching my 30th year on this earth I made some changes. As I was about to get married, my absent dad passed away in the UK. I was sick of my job and when we started to talk about having a family, I could imagine putting my child through a similar existence.
So I visited my in-law’s family GP. He looked me in the eye and asked “How long have you felt like this?” I paused. “For as long as I can remember.” His usually relaxed face turned serious. “I know a great Psychiatrist I would like you to see”. It took every ounce of energy to do so but once that train was in motion I was getting professional help (lucky enough to have the resources to do this privately) and within six months I felt positive.
I started writing a book and then a blog (I did not show my wife) and Mr. Perfect was born. A chat in the pub with mates, a cursory read of a report about men’s “connectedness” and healthcare professionals I know telling me there was little grassroots support for their male patients, and the Mr. Perfect movement gained momentum.
There have been many blips, I am not “Perfect” after all. From stopping my medication without advice, from stopping my Doctor appointments to then leading back to professional help when the cloudy spells turned into storms and into hurricanes. These weather systems are here for life, and that’s okay, but with the right strategies I can turn this into something impactful for others.
But there is hope. Friends, family and colleagues have all benefited and most importantly my son will arguably be the most loved and supported kid when it comes to talking about his mental health.
Thanks Terry! You can see the themes above of time and a relationship as potent therapy for the management of major depressive disorder in general practice. The initial clinical gestalt and the ongoing therapeutic relationship can be powerful tools for change. Depression is subjective and has been part of the human condition throughout history. This gives us all we need to move forward.
It therefore seems fitting to end with the words of a doctor from another time:
“The three grand essentials of happiness are: Something to do, someone to love, and something to hope for.”
Alexander Chalmers (29 March 1759 – 29 December 1834)
If you are worried about depression, anxiety, or have any other mental health concerns, reach out:
ACIS 131465 (South Australia – Acute Crisis Intervention Service)
The Australian Privacy Principles, and the recently passed (by the Australian Parliament) Mandatory Breach Notification bills provide various guidelines, which should be adhered to by anyone who handles any electronic medical data. Basically, the principles stipulate that all medical practices must ensure that all necessary measures are in place while saving, accessing and sharing any electronic medical data to keep patient data secure. Lack of compliance to the security standards could lead to large fines for both companies and individuals. Several steps can be followed by medical practices to ensure compliance to privacy standards. These steps include:
Run a complete risk assessment of the practice
Many medical practices adopted electronic health recording systems before there were clear guidelines on what these systems should contain. This means that a practice could be using electronic systems which are not compliant with current standards. To ensure compliance, a risk assessment should be done on the current systems to highlight areas in which compliance is not enforced, and to expose areas in which changes are needed. Ensure the latest version is being used, including any security patches from the vendor.
Prepare for disaster before it occurs
All data handled by a medical practice should be safe both from loss and corruption. One of the main ways of ensuring that data is not lost in case of any mishaps is backing up of medical data daily. Data should be backed up in an offsite location to ensure that in case of incidents such as natural, or man-made, disasters the data backup is not destroyed, as well. Antivirus programs should also be installed on all computers to ensure that data is not corrupted or destroyed by computer viruses, or held to ransom by cyber criminals.
Implement an ongoing employee training programme
Any system is only as strong as its weakest link, and in some cases poorly trained employees, or temporary staff, are the entry point for hackers into medical practices. It is also these staff who are more likely to have an “oops” moment and accidentally release confidential information. A medical practice could have excellent processes and systems, but if the employees don’t use their passwords to securely access records and files the system security is rendered useless, and anyone can gain access to these records. Medical practices should continually train their staff on how to follow the right security protocols, to ensure data integrity and security.
Purchase medical products with security compliance, and compatibility in mind
New equipment bought for a medical practice should be compatible with existing systems and should offer enough security features. With the advent of connected devices, the Internet of Things, it is critical that devices are secure, and kept up to date. Before making any major purchases enough review of the product should be done to ensure both security and compatibility.
Collaborate with affected parties
Changes which need to be made to bring about cyber security and privacy compliance affect many people in the practice. Affected groups should be offered training and management must ensure that staff understand the importance of compliance to everyone involved in the practice. Also, ensure that key staff are trained on what to do in the event of a breach. A comprehensive disaster plan is essential, and must be practiced regularly.
Karen Dearne, freelance journalist and former e-health writer for The Australian, has produced a review of the PCEHR, on behalf of the Consumers e-Health Alliance.
The conclusion is disappointing: It appears that the government has been successful in uploading non-clinical documents about users, but otherwise our expensive national e-health record system seems to be in a pilot stage.
The full document can be downloaded here. Below are a few quotes from the report.
The numbers are telling
“After two years and more than $1 billion in costs, only 26,332 shared health summaries have been uploaded by doctors to the troubled Personally Controlled e-Health Record system.
While the Department of Health and the National e-Health Transition Authority trumpet their ‘success’ in signing up 1.7 million Australians to date, the truth is that the system holds a mere 288,368 clinically useful documents.
Obviously, if every person who had registered had just one