Little Sick, Big Sick

GPs, Pharmacists, and Nurse Practitioners have roles in primary care – but it’s not either or. It’s both. They shouldn’t be competing against each other. They are not the same.

Professor Claire Jackson has her views and expresses them eloquently below. My views are:

GPs provide excellent care and deliver fantastic value to their patients and to Australia.

Other health practitioners also have the potential to provide excellent care to people at a different level and in different ways. They may very well provide care to many many people that GPs don’t already see. They’re not GPs.

If you want to be a doctor and further go on to specialise in General Practice, becoming the Specialist Urban or Rural Generalist, there is a pathway for this. It’s Medical School, Internship, and Fellowship Training.

Let’s look at some communities and people that aren’t well looked after under the current system like ATSIs, people with an intellectual or physical disability, and the homeless.

These are the groups Nurse Practitioners and Pharmacists should be working with GPs and existing Primary Care networks to get better outcomes happening.

Professor Jackson, Australian Doctor 2009

IT’S as pervasive and globally contagious as swine flu — and potentially as deadly in a susceptible population.

I am talking about the growing conventional wisdom that general practice is a basic combination of lots and lots of ‘little sick’ (so much more easily and less wastefully dealt with by nurses) and the far less frequent ‘BIG SICK’ (which requires the calling forth from the back room of the big gun, highly-trained, clever-dick, scarce-in-supply GP).
Such wisdom has led to the situation in the UK where nurse-led clinics in hypertension, asthma, lipid management, COPD, diabetes, and so on are increasingly the order of the day. In this utopian setting, issues of patient concern are dismembered carefully into presenting ‘body parts’, where nurse-led protocols can be used to define management algorithms. The GPs remain available for those patients who defy the guideline, or where the nurse perceives they require professional referral.

Naturally, there are quite a few problems with this approach, particularly for a country that leads the WHO/OECD league tables for longevity, patient GP satisfaction, and preventable death rates.

 

The first problem is this myth is based on a totally flawed assumption. The ill-defined nature of primary care presentations makes accurate diagnosis and problem definition the most challenging of all medical specialties. GPs and practice nurses are greatly offended by the oft-heard view that general practice is mostly ‘vaccinations, coughs and colds and protocol-driven chronic disease management’. When is ‘diarrhoea’ due to viral infection, and when to coeliac disease, alcoholism or rectal cancer? When is ‘cough’ due to parvovirus rather than oesophageal disease, anxiety, sarcoid or lung cancer? When is ‘nausea’ viral and when secondary to polypharmacy, renal dysfunction, drug abuse, cholecystitis, depression or Barrett’s oesophagitis?

The skill involved in accurately and rapidly diagnosing problems in general practice is profound, requires complex clinical reasoning, and a significant skill base. It is entirely inappropriate to triage most primary care patients into anatomical group assessment clinics based on presenting complaints. To do so is to risk diagnostic delay, confusion and inconvenience for the patient and often significant expense. Patients deserve and expect the best qualified person to work with them in the all-important problem definition and initial management decisions. In our world, that is the GP/practice nurse team in combination.

The second problem with the myth of little sick/big sick is the absence of any pretence at patient-centredness. What patient wants to book appointments at predetermined clinic days/times for between one and four separate comorbidities? How do they fit that easily with competing demands from work, family and carer needs?

Third, the myth ignores the significant and growing prevalence of comorbidity in primary care. Recent data has charted the growing increase in disease co-morbidity in our communities. Such presentations predicate a skilled generalist approach. General practice is trained and skilled for this and is increasing its capacity to deliver.

Fourth, the myth contributes to the decimation of continuity of care.
Stephen Campbell’s paper in the New England Journal of Medicine
in July this year chillingly chronicled the demise of continuity of care in UK general practice since the 2003 reforms. Such data allows Australian communities, governments and health professionals a sneak peek at the consequences if we emulate this model.
The fifth problem in this myth is the complete antithesis of the consultation and reform agenda advanced by the National Health and Hospitals Reform Commission and National Primary Care Strategy. Throughout the reform process, consumer groups overwhelmingly said they wanted comprehensive, co-ordinated, integrated, patient-centred care delivered to themselves and their families — not a fragmented ‘little sick/big sick’ approach.

 

Finally, there is no evidence for enhanced benefit. The Cochrane Collaboration summary on the equivalence of GP-led and nurse-led care has more disclaimers than a set of K-Tel steak knives. Most damning is the statement that these findings “should be viewed with caution given that only one study was powered to assess equivalence of care, and many studies had methodological limitations”.

So, Australian policy-makers, reformers and governments beware — 50 years of general practice hard slog has resulted in international benchmarking for key health outcomes, and unsurpassed general practice patient satisfaction. Over the past five years, the GP/practice nurse/allied health practitioner team has progressed a collaborative general practice team that has taken this even further, with the absolute preservation of continuity of care. This is the model Australian consumers have overwhelmingly endorsed.

Unravel this, without clear benefit and evidence, at your peril.

 

This article is based on a speech Professor Jackson made at the RACGP GP09 conference.

Professor Jackson is head of the discipline of general practice at the University of Queensland.

 

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Partridge Street General Practice has better options for your pain – 1

The federal Centers for Disease Control and Prevention recommends that prescribers avoid opioids for most chronic pain.

Read more here:

Partridge Street General Practice is proud to be a low prescriber of opioids, narcotics, and other medications that have NOT been shown to be effective and safe. We will be happy to discuss better options with you right here.

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Dr Gareth Boucher

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Dr Penny Massy-Westropp

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Dr Monika Moy

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Dr Abby Mudford

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Like synchronised swimming, general practice is much harder than it looks

Dr Liz Sturgiss is a GP from our nations capital. Those of you who know me will know that for me to recommend something from Canberra, it’s got to be good. This is. Grab a cup of tea or coffee and settle down for a good read from a great GP on the best job in the world. Here’s an excerpt to whet your appetite and read on at the link.

 

The senior GP in full flight practising quality medicine in a busy clinic looks like they are doing a simple job, but you can only see the surface. They make it look easy.

General practice is a specialty that cannot be done by anyone else “just as well”, even though it’s not very flashy and sometimes seems simple.

Without an underwater camera, much of general practice, like synchronised swimming, remains a mystery.

 

 

Read on here

 

Our team – here for You!

Dr Nick Tellis

 

Your Specialist In Life

Dr Nick Mouktaroudis

 

dr nick mouktaroudis at Partridge Street General Practice

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 Chrissy Psevdos

 

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Dr Katherine Astill

(on Maternity Leave from August 2018)

 

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Our GPs at Partridge Street General Practice

Our team – here for You!

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 Abby Mudford

 

dr abby mudford at Partridge Street General Practice3

Dr Chrissy Psevdos

 

dr chrissy psevdos at Partridge Street General Practice

 

Dr Katherine Astill

(on Maternity Leave from August 2018)

 

Dr Katherine Astill 1

 

 

join the team

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Welcoming Dr Abby Mudford to Partridge Street General Practice

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Partridge Street General Practice 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.

 

 

 

 

 

 

 

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx.

This means that the GPs at Partridge Street General Practice 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 Partridge Street General Practice 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 Partridge Street General Practice 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 Partridge Street General Practice!

 

 

 

 

 

 

 

Professional. Comprehensive. Empowering.

 

 

 

DR NICK TELLIS

 

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DR GARETH BOUCHER

 

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DR PENNY MASSY-WESTROPP

 

 

Dr Penny Massy-Westropp

DR MONIKA MOY

 

 

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DR CHRISSY PSEVDOS

 

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New SA Health boss favours home care to reduce hospital pressure

General Practice and Partridge Street General Practice can do better than this! Get away from five, six, or ten minute medicine and enjoy better care. Primary Care is the most efficient and cost effective part of the health system and its time for patient rebates to align with this.

“If you’re too ill for your GP to (be treated) in a normal, you know, 10-minute business model of general practice you’ll end up in our public hospital system, and that’s just crazy,” McGowan told ABC Radio Adelaide this morning...

https://indaily.com.au/news/2018/07/24/new-sa-health-boss-favours-home-care-to-reduce-hospital-pressure/

Better.

With Partridge Street General Practice.

MyHR…. opt out, opt in or just ignore?

Dr Raines gives another perspective on My Health Record!

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In case you haven’t heard, you will have to decide whether you want to opt-out of the Government My Health Record (MyHR) before the 15 October 2018 or you will be have one created for you.

MyHR is a great idea.

MyHR allows your GP to write a shared health summary and collates data from a disparate number of sources. These will eventually include blood tests, radiology reports, medication and allergy lists and discharge summaries. It is also a spot where track immunisations and keep your achievement diary!

I have one. For those living in North Queensland and the Blue Mountains you probably already have one too. Didn’t you recall getting a note from the Government that you could opt out about 2 years ago. Don’t worry a lot of people didn’t hear you had to either. I use MyHR for my patients several times a week. “I take those little blue…

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