Win, lose, or draw in 2020, you would have had to have been living under a rock to not be aware of the virus. It has coloured every aspect of life. People have died, people have lived, elections have been influenced, Presidents have fallen. How are we going to move past this? Let’s have a look at Bayesian thinking. Bayesian decision making involves basing decisions on the probability of a successful outcome, where this probability is informed by both prior information and new evidence the decision maker obtains. The statistical analysis that underlies the calculation of these probabilities is Bayesian analysis.
Bayesian thinking is probabilistic thinking – rather than this will or won’t happen, we consider what is more or less likely to happen. This applies to risk. As Jim O’Shaughnessy has said, ‘we are deterministic creatures living in a probabilistic world’. We want certainty. We get probabilities. Vaccines are not 100% effective or 100% safe (NOTHING IS). Neither are masks, nor social distancing, nor even simple hand sanitiser. Yet all of these, little by little, piece by piece, will lower our risk so we can get back to the new normal of life. Better probabilities, not 100% certainty. More poetically:
PartridgeGP works with you to help you make your best health decisions. We will take you through the risks as we see them – online, through our social media, our email newsletters, and in our consultations with you. We pride ourselves on great communication and we’re ready to share our professional skills and knowledge with you. This is only MORE important now, in the time of a global pandemic with new vaccines on the horizon. The way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200.
Want more?
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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.
Yesterday we talked about risk. Risk is mitigated by knowledge and experience. I don’t know who said this, but I’m going to take a wild and crazy guess and say it wasn’t from Terry Pratchett’s wonderful Discworld series. This gives us another way to mitigate risk. Insurance.
Risks come at us everyday in our personal and professional lives. We accept that life involves risk. Risk happens.
‘Life is a risky business, no-one gets out alive’
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Health concerns us all, especially now, and we try to improve our health or at least to manage it. Some risks are foreseeable but some are not. These drive our uptake of health insurance. Health insurance is therefore a bit of a ‘grudge purchase’ – we don’t really want to buy it but we don’t want to do without it. Is it worth the money we pay for it? Some high profile voices say no. A past president of the AMA agrees:
if you increase the number of GPs by 1 per 10,000 people the death rate goes down 9%
Dr Bastian Seidel; Past President, RACGP
Your health is your wealth, as the saying goes, and you build wealth by spending wisely.
Some tests, treatments and procedures provide little benefit. And in some cases, they may even cause harm. Use the 5 questions to make sure you end up with the right amount of care — not too much and not too little.
Do I really need this test, treatment or procedure?
Tests may help you and your doctor or other health care provider determine the problem. Treatments, such as medicines, and procedures may help to treat it.
What are the risks?
Will there be side effects to the test or treatment? What are the chances of getting results that aren’t accurate? Could that lead to more testing, additional treatments or another procedure?
Are there simpler, safer options?
Are there alternative options to treatment that could work. Lifestyle changes, such as eating healthier foods or exercising more, can be safe and effective options.
What happens if I don’t do anything?
Ask if your condition might get worse — or better — if you don’t have the test, treatment or procedure right away.
What are the costs?
Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?
Your GP can be a great ally in navigating through the health system, a great support for you in times of need, and a great investment in your health.
“Patients whose care is well managed and coordinated by their usual GP are less likely to cost the health system more in the long run because their GP-coordinated care will keep them out of hospital.
“Supporting general practice to continue managing these patients – who are growing in number each year – is an investment in health care that can help make the health system more sustainable.”
Past AMA President, A/Prof Brian Owler
PartridgeGP works with you to help you make your best health decisions. We pride ourselves on great communication and we’re ready to share our professional skills and knowledge with you. This is only MORE important now, in the time of a global pandemic with a new vaccine on the horizon. The way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200.
Better, for you.
Want more?
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Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
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!
Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
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.
In 1990 I watched Graham Gooch of England make 333 and 123 in a Test Match against India at Lord’s. It was a different time and a different country. Gooch looked decidedly unathletic (although apparently a fitness fanatic) and I certainly don’t remember the Indian pace attack as anything like the current potent crew. As Gooch approached his three hundredth run, the BBC cut to a horse race showing the usual tin ear of public broadcasters. It was compelling but hadn’t quite reached exciting. For those of you not baptised into the religion of Test Cricket, simply put, one fellow throws a small hard leather ball in a special way (bowling) at some wooden poles (the wickets) from a distance of 22 yards (the pitch) while another fellow (the batsman) uses a wooden club (bat) to prevent this. Other fellows stand around to catch or intercept the ball, and also provide commentary on the batsman’s skill, character, and parentage.
I moved to Australia and one of the instant upgrades was supporting the Australian cricket team. Staying up in 1995 to listen to Steve Waugh wearing bouncer after bouncer after bouncer as Australia finally rolled the West Indies in their own backyard was incredibly exciting. Part of that excitement was risk. The players had arm/chest guards, gloves, pads, boxes, helmets, and increasingly large bats but the spectacle and danger of confronting 140-150 kilometre missiles was enthralling.
It had a lot of value for the players involved and for the audiences in the West Indies, Australia, and around the world. The West Indies are a collection of independent island countries who only come together as the West Indies for cricket. Much the same could be said about Australia and it’s Federation of States (especially in light of recent border shenanigans). Australia had been planning this assault for years. The West Indies were coming off a long period of world domination and were raging against the dying of the light as their great players aged.
Fast forwarding again, I went back to England in 2013 to watch the Australian team play England at Lord’s. One of the Australian players to watch was a star of the future – Phillip Hughes. He didn’t have the most auspicious day at Lord’s but certainly looked a player of the future. It was to be his final Test Match. Hughes was a short man, like many of the great batsmen, and so had become accustomed to bowlers aiming at his chest and head. He was an accomplished player of this style of (short pitched) bowling. Sadly, in 2014, Hughes was batting in a State game and despite all of his protective apparel, was hit in the neck by a short pitched ball. He was incredibly unlucky to be hit in the neck in precisely the wrong spot. Wikipedia recounts:
causing a vertebral artery dissection that led to a subarachnoid haemorrhage. The Australian team doctor, Peter Brukner, noted that only 100 such cases had ever been reported, with “only one case reported as a result of a cricket ball”
The risk that made the matches in the West Indies so enthralling and the risk that added value to that spectacle was the same risk that ended with Phil Hughes’ death. Certainly players, spectators, and officials thought long and hard about this risk afterwards. As a result of this we now have something called a stem guard which is a little bit of plastic that protects that very vulnerable area of the neck. Hopefully this particular type of injury will never happen again with these consequences. The amount of short pitched bowling decreased, for a while, but then returned to previous levels (perhaps regressed to the mean). Then, something else happened.
Today we can see players like Neil Wagner eulogised for bowling into the batsman’s armpit, shoulder, and head. This line of attack into the batsman’s blind spot can hit them, hurt them, or just put them off their game. Wagner recently won a Test Match for his country like this (with two broken toes).
Further statistics during the current Australia vs India test series show a clear advantage gained by short pitched bowling. Furthermore, almost uniquely in top level sport, this involves the some of one team doing what they do best against some of the other team doing what they do worst (bowlers bowling at bowlers batting). Is this too much risk and who makes this decision and on what basis?
This conundrum – the risk of injury and death versus the benefits of economic value resulting from the spectacle – mirrors some situations we face in medicine and life:
Lockdowns vs Targeted Protection
New Vaccines vs New Viruses
Medication vs Lifestyle
I don’t have a universal answer for this, in cricket, life, or in medicine. I firmly believe that we should have these conversations and come to answers that are transparent and workable. From the macro level in Australia and the world to the micro level in the consult room, I think this is the way we should manage risk. We should be mindful of risk in all of our consultations and all of our dealings with patients. If you would like to be part of a team that can afford and prioritise the time taken to consider risk in each and every consultation and dealing then the way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200 or…
here are the steps!
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Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
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!
Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
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.
Did you know medical certificates expire? They have an end date! So when an employer or other entity asks for a clearance certificate, this is what we are going to write:
Dear Employer,
The whole point of a medical certificate is to certify someone unwell or unfit. This is why there is a beginning date AND an end date. At the end date, the patient is no longer certified unwell/unfit. I have enclosed the negative COVID results and you will note your employees certificate has reached its end date. I further enclose professional advice from our professional organisation in regard to this. It follows that the certificate of ‘clearance’ you are suggesting is unprofessional and those who would provide one are acting similarly.
I hope this information finds you well.
Regards
Doctor Nick Specialist GP
Hope this helps! If you are still unwell or need any further information, say hi to your PartridgeGP and book in here for a phone or face to face consult!
We all want to provide great general practice care. Most of this comes from time, curiosity, and interest in our patients. When we turn our attention and medical skills to their problems and issues we do better work.
Physical examination has been around since antiquity and is a useful adjunct to taking a great history. Much like over investigating, physical examination is not always needed.
General practice is so much more than compliance and paperwork.
So much can be pared away to reveal the essence of what we do.
In the time of #COVID19, perhaps we can chip away to reveal our statues of David rather than be inflexible blocks of government marble.
Since 1986, federal law has mandated that any patient requesting emergency medical care must be evaluated by a physician to assess for any threatening conditions. The law, often referred to as the “anti-dumping law,” requires that physicians perform a medical screening evaluation, including a physical examination.
Over time, the interpretation of this mandate has slowly expanded, not by law so much as by custom. This is why emergency rooms have become our nation’s safety net for care. Despite increasing popularity of urgent-care clinics and telehealth, many patients who could have safely been cared for elsewhere still end up in emergency rooms.
While many of us embrace that mission with pride, it is dangerous and wasteful in the coronavirus pandemic. We need to course-correct to keep everyone safe. Exposing patients to emergency rooms is now far riskier than it was before. In turn, health-care workers must assume that all patients are infected. This forces us to blow through personal protective equipment that we desperately need so that we do not become infected ourselves.
Over the past few decades, we have learned that many, if not most, of our physical examination maneuvers provide little reliable information. In most cases, the information we need can be obtained simply by interviewing patients. But old habits die hard, and patients seem to love our stethoscopes. In our current situation, that simply won’t do.
We need the federal government to allow us to perform medical screening exams via video or through glass doors, even for patients entering emergency rooms. The removal of the requirement that we evaluate every patient by hand will save resources and keep everyone safer.
In recent meetings and phone calls with stakeholders, the Centers for Medicare and Medicaid Services has signaled that it is seriously considering making this change. But it has not materialized, and time is of the essence. The moment to act is now.
Jeremy Samuel Faust is an emergency physician at Brigham and Women’s Hospital in the Division of Health Policy and Public Health, and an instructor at Harvard Medical School.
Dr Zoe completed her undergraduate medical training at the University of Adelaide, and spent her intern and resident years between the Royal Adelaide Hospital and Queen Elizabeth Hospital. She undertook her General Practice training in a number of clinics across southern Adelaide, and is particularly interested in sexual health, women’s health (including Implanon insertion and removal), and preventative medicine. She is also fluent in Mandarin!
She is available to help you with all of your General Practice needs from April 2020 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.
The RACGP SA&NT in conjunction with SA Health and a local panel of presenters, will be presenting a webinar update on Telemedicine, discussing tips and tricks related to undertaking telehealth in your practice.
Dr Nikhil Tamminedi commenced his specialist General Practice training with PartridgeGP in February 2020. He completed his undergraduate medical training at the University of Western Sydney. Prior to commencing General Practice training, Dr Tamminedi worked two Post Graduate years in metropolitan hospitals in New South Wales with a focus on surgical disciplines and emergency medicine. His particular interest include skin, minor surgery, and respiratory medicine. In his free time, he enjoys rock climbing, hiking, and travelling..
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.
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 Phillip Maddocks commenced his specialist General Practice training with PartridgeGP in February 2020. Raised in Adelaide, he studied and practiced in NSW, and then returned to Adelaide earlier this year. Becoming an accomplished GP has always been his career goal and he is eager to commence community-based work. I’m passionate about paediatrics, emergency medicine, sports medicine, and teaching. Prior to my career in medicine I held numerous leadership positions across both business and sport, attaining many skills which are transferable to working in medical teams.
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.
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.
Those bits of paper your GP gives you to get medications from your Pharmacist are changing. Scripts are now DIGITAL!
GPs can now send prescriptions to pharmacists electronically as an interim solution during the pandemic.
As part of the COVID-19 National Health Plan telehealth model, the new interim measure allows GPs to send prescriptions electronically to pharmacists without having to mail out a physical copy of the original paper prescription with a GP’s wet-ink signature.
Patients can then have their script filled and medication delivered to their door, helping to minimise the risk of virus transmission in accordance with social-distancing measures.
‘It’s certainly going to make it easier for practices, because they are being inundated with pharmacists asking them to post prescriptions to them,’
‘I know at my practices it’s causing substantial concern.
‘We’re getting calls every day from pharmacists saying, “I can’t dispense unless you send me the hardcopy paper”, and we’re saying, “We don’t have the resources to keep running out and buying stamps, and it’s just not safe to put staff in that position”.
‘So we’ve had a bit of a stalemate for the last few weeks and this is a great outcome in the short term.’
As outlined in guidelines issued by the Department of Health (DoH), GPs will be required to do as follows:
Create a paper prescription during a telehealth consultation. This will need to be signed as normal or using a valid digital signature
Create a clear copy of the entire prescription (a digital image such as a photo or PDF including the barcode where applicable)
Send via email, fax or text message directly to the patient’s pharmacy of choice
Schedule 8 and 4(D) medicines such as opioids and fentanyl are not part of the interim arrangement.
While not legally required, the DoH encourages practices that are able to continue sending the original script to pharmacies to do so as soon as possible. All other practices must retain the paper prescription for a period of up to two years for audit and compliance purposes.
Yes!
This is a great step forwards!
Electronic Prescriptions
Changes have been made to Commonwealth legislation to recognise an electronic prescription as a legal form to allow medicine supply. This provides prescribers and patients with an alternative to paper prescriptions. Paper prescriptions will still be available.
Electronic prescribing will not fundamentally change existing prescribing and dispensing processes. It provides patients with greater choice and patients can still choose which pharmacy they attend to fill their prescription.
Under the Australian Government’s National Health Plan for COVID-19, electronic prescriptions are now being fast-tracked to support telehealth and allow patients to receive vital healthcare services while maintaining physical distancing and, where necessary, isolation.
A significant amount of work has already been done to ensure that necessary upgrades to both pharmacy and prescriber software can be done quickly and electronic prescriptions are expected to be available from the end of May.
Electronic prescriptions are an alternative to paper prescriptions which will allow people convenient access to their medicines and will lessen the risk of infection being spread in general practice waiting rooms and at community pharmacies.
The solution being fast-tracked will see a unique QR barcode known as a “token” sent via an app (if you have one), SMS or email. The token will be sent to you from your doctor, which is then presented or sent to a pharmacy, to supply your medication.
The token will be scanned by your pharmacist as a key to unlock the electronic prescription from an encrypted and secure electronic prescription delivery service.
If you have any repeats of a prescription, a new token will be sent to you when the prescription is dispensed. You will need to keep the token to send to your pharmacy when you need to get the repeat filled.
Active Script List
By the end of this year, more functionality will be available and in addition to the token, there will also be an option for your pharmacy to have a list of your active prescriptions in their software, so you don’t have to forward it on.
To get your medicines you will need to prove your identity to the pharmacist and provide consent for the pharmacist to view your prescriptions.
Steps to take in preparation for using an electronic prescription
Ensure your address, email address and mobile number are up to date with your doctor and pharmacy.
Check that your pharmacy can take an electronic prescription and are delivering medicines.
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