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

 

 

join the team

GPs want clinical handovers, not discharge summaries

Partridge Street General Practice 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 Partridge Street General Practice 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 Partridge Street General Practice 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!

 

join the team

 

Partridge Street General Practice is Proud to be a Teaching Practice

Quality accredited by AGPAL

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx and our local Medical School at Flinders University.

 

 


 

 

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.

 

 

Teaching Practice of the Year

 

 

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.

 

 

Professional. Comprehensive. Empowering.

 

See just how we do it here.

 

Good luck to all the fantastic GP trainees out there!

 

 

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!

 

Why is Partridge Street General Practice a Teaching Practice?

The word “doctor” is derived from the Latin, docco, which means “to teach.”

 

Partridge Street General Practice is an accredited General Practice and is further accredited by our Regional General Practice Training Provider GPEx and our local Medical School at Flinders University. Teaching is in the DNA of our GPs and so it is in the DNA of Partridge Street General Practice!

 


 

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.

 

Teaching Practice of the Year

 

IMG_20180618_135950_756
Ms Shantay Budz – First Year Medical Student at James Cook University

 

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.

 

 

Professional. Comprehensive. Empowering.

Want to be part of this great team? Email Dr Nick Tellis at drnt@partridgegp.com.au or call on 0882953200

 

 

 

join the team

Be Super Kind

Doctors are people too. Is this a controversial statement? I’m going to go further and say doctors are people first. I bring this up because some doctors are amazing but they are still only human. There’s a special respect from me for our rural doctors including rural generalist GPs. To me, they are Superhuman! I look at what I do now, and what I used to do as a rural doctor (within 30km of a major Australian city), and, to quote a popular film it’s not the same game. It may not even be the same sport.

 

 

 

I’ll move to some other popular culture. A guilty secret of mine is that I like comics. One series I really liked (and beware this is a NSFW comic and not for children) is Irredeemable. It’s the story of an alien superman (The Plutonian) who becomes a superhero on Earth. He’s super resilent, can fly, has superhuman endurance…you know, those usual rural generalist abilities. The series opens with a family running for their lives. Heat beams target them. Their house is reduced to rubble. Spoiler Alert – they die. Hovering in midair over their bodies is The Plutonian. What happened?

 

 

Screenshot_20180304-173758.png

 

 

Prior to the above events, the Plutonian was doing his thing, saving people. It’s what he did. Day in, day out, with never a day of rest. He stops a nuclear bomb going off in a packed sports stadium. The crowd goes wild. He stands there, letting his adrenaline drop down. One voice comes to his ears amongst the adulation of the crowd.

 

 

‘What a poser’, or words to that effect. Only a few words, only one person, and buried in a sea of praise. But they were enough. They were too much. Superhumans are human too. Perhaps they are human first too? He snaps and flies off.

 

Irredeemable-7-6.jpg

 

I think 14 doctors committed suicide in the last 12 months. I could be wrong about this number. I’m not wrong when I suspect the number that had contemplated suicide was probably much higher. I don’t know the answer but being kind is a good start. Please, be kind. That is all.

 

#bekind

I would love to hear other views on this. We are all professionals or patients or both and we can always improve. Let me know here on the blog (or on our website) – or, if you’re a GP, on the fantastic GPDU FB Group – where GPs are invited to a festival of education and collegiality (#FOAMed – #GPDU18) May 30 – June 1!

 

Get a Great GP!

(Here’s some we made earlier)

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

Dr Gareth Boucher

Dr Gareth’s Cycle of Care

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Katherine Astill

Dr Katherine Astill 1

We look forward to seeing you soon!

Qi at Partridge Street General Practice

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.

 

 

But!

 

 

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:

Asthma Incentive

Quality Prescribing Incentive

Cervical Screening Incentive

Diabetes Incentive

General Practitioner Aged Care Access Incentive

 

The six PIP Incentives that continue to remain unchanged are:

eHealth Incentive

After Hours Incentive

Rural Loading Incentive

Teaching Payment

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:

 

 

Quality – Time and Presence with Our Valued Patients

 

Service – Charging a private fee to those who can pay, allowing us to be charitable to those who cannot

 

Finance – Running Practices efficiently and well, with clinicians as owners steering the course of patient centred practices.

 

 

I would love to hear other views on this. We are all professionals or patients or both and we can always improve. Let me know here on the blog (or on our website) – or, if you’re a GP, on the fantastic GPDU FB Group – where GPs are invited to a festival of education and collegiality (#FOAMed – #GPDU18) May 30 – June 1! My last quality ltip – for personally better Qi – is below!

 

Get a Great GP!

(Here’s some we made earlier)

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

Dr Gareth Boucher

Dr Gareth’s Cycle of Care

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Katherine Astill

Dr Katherine Astill 1

We look forward to seeing you soon!

3 Free 2018 Fitness Tips from Partridge Street General Practice!

It’s 2018 and many of you will have made your New Year’s resolutions. Many of these resolutions will have been broken by January 15th! We’re past that date, so for those of you who are left, here are some free Fitness Tips to help you carry on and improve your health in 2018.

 

 

Number 3 Fitness Tip from Dr Nick Tellis and Partridge Street General Practice

Get to the Gym…or the Run…or the Swim

 

 

We’ve all had those days where we don’t really want to exercise. Abs may be made in the kitchen but they’re certainly not made in bed. Remove the obstacles. Have your gear out the night before – clothes, trainers, swimmers, headphones – whatever you need to Get It Done. Leap out of bed as the morning alarm sings, get your gear, and Get Out.

 

 

Once you’re at the gym or pool or about to start your run – Start! If you’re not feeling it after 5-10 minutes, stop and head home. That’s cool, it’s not your day. I can assure you following this tip will hugely increase the amount of exercise you do.

 

 

Get a great gym with Anytime Fitness Glenelg, just off Jetty Road, Glenelg!

 

 

dr nick lifting with chris (1)
Younger Fitter Training Partners – the Famous Chris Hooper

Number 2 Fitness Tip from Dr Nick Tellis and Partridge Street General Practice

Don’t be the fittest person

 

 

Here’s the easiest tip here – especially for those of you just starting out. It’s often said that if you’re the smartest person in the room, you need to find a new room. Training with people fitter than you will bring you up with them. Generally people fitter than you have been doing it longer than you have and have built up some great habits and great tips of their own. Let them lift you up!

 

 

My personal take on this is that I train with people younger and fitter than me. I take the opportunity to train with great female athletes – even though I’m nearly double their weight, I can almost keep up! 😎

 

 

Get some great training partners!

 

 

Run with Good Physio or Aspire Pilates and Physiotherapy!

 

 

Lift in the gym and Smash it in business with Sammie Johannes here, here, and here!

 

 

dr nick lifting with sammie
Ms Sammie Johannes – Business Development And Powerlifter

Ms Sammie Johannes – Business Development And Powerlifter

 

 

Number 1 Fitness Tip from Dr Nick Tellis and Partridge Street General Practice

Rack Your &%*%ing Weights!

 

 

You’ve got to the place of exercise and you’ve lifted/run/swam. It’s time. Time to put the little metaphorical cherry on that big beautiful exercise cake. Time for a little ‘accessory exercise’.

 

 

 

 

Rack your &%*%ing weights! Seriously! This is free exercise! You’ll feel better, your training buddies will love you, and your friendly gym owner will sing your praises (and maybe even put your picture up in the gym!). Routine will give you strength and is that extra 1% for you when motivation fails. Routine gets you to the gym. Routine gets your training partners to the gym. And the Routine of racking your weights is worth it’s weight in gold.

 

 

 

 

 

If you’re running or swimming instead of lifting – that’s cool too. Walk more. Walk to and from your run or swim. That incidental movement – briskly, to be truthful – adds up. It adds up to fitness. It adds up to cardiovascular health. It adds up to a little less weight around the middle. It Adds Up!

 

 

Get to Anytime Fitness Glenelg and hit Ryan up…and maybe rack a few weights 😉

 

 

 

 

walking works for dr nick
One Year of Incidental Movement

PS: Here’s a bonus tip

Get a Great GP!

(Here’s some we made earlier)

Dr Nick Tellis

Your Specialist In Life

Dr Nick Mouktaroudis

Dr Gareth Boucher

Dr Gareth’s Cycle of Care

Dr Penny Massy-Westropp

Dr Penny Massy-Westropp

Dr Monika Moy

Dr Monika Moy

Dr Katherine Astill

Dr Katherine Astill 1

AE5A2E0E-AC9E-436F-B33E-13798EC6AEFE
Weight training – Pumping Iron 😎

We look forward to seeing you soon!

Happy Birthday Partridge Street General Practice!

In 2014, Dr Nick Mouktaroudis and Dr Nick Tellis opened the doors of Partridge Street General Practice at Glenelg!

 

 

 

img_9445

 

 

We’ve gone from strength to strength since then and we’re now well established in our own Health Precinct with Aspire Physiotherapy and Pilates next door.

 

 

 

General Practice and So Much More

 

 

 

The future is bright as we continue to grow! Our Principal GPs :

 

 

Dr Nick Tellis

 

 

 

Your Specialist In Life

 

 

 

Dr Nick Mouktaroudis

 

 

 

 

 

 

Dr Gareth Boucher

 

 

 

Dr Gareth’s Cycle of Care

 

 

 

 

Dr Penny Massy-Westropp

 

 

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

 

 

Dr Monika Moy

 

Dr Katherine Astill

 

 

 

 

Dr Katherine Astill 1

 

 

We’re providing great General Practice care including:

 

Mental Health Care/Plans

 

Skin Checks and Skin Cancer Care

 

Travel Medicine

 

Immunisations

 

Workcover/Compensable Medicine

 

Emergency Care

 

Antenatal Care

 

Men’s Health and Screening

 

Women’s Health and Screening

 

Babies and Children’s Care

 

Nutrition and Weight Management

 

Executive Health Checks

 

Stop Smoking Help

 

Pathology Services

 

 

AE5A2E0E-AC9E-436F-B33E-13798EC6AEFE

 

 

We’re Here to Help You – in 2017 and beyond.

 

 

img_4949

 

 

 

We look forward to seeing you soon!

 

 

 

Join Our Team at Partridge Street General Practice 

 

 

Call

 

 

 

Email

 

 

 

Web

 

 

 

Your future awaits!

Happy Birthday Partridge Street General Practice!

In 2014, Dr Nick Mouktaroudis and Dr Nick Tellis opened the doors of Partridge Street General Practice at Glenelg!

 

 

 

In the Beginning

 

 

 

We’ve gone from strength to strength since then and we’re now well established in our own Health Precinct with Aspire Physiotherapy and Pilates next door.

 

 

 

General Practice and So Much More

 

 

 

The future is bright as we continue to grow! Our Principal GPs :

 

 

Dr Nick Tellis

 

 

 

Your Specialist In Life

 

 

 

Dr Nick Mouktaroudis

 

 

 

 

 

 

Dr Gareth Boucher

 

 

 

Dr Gareth’s Cycle of Care

 

 

 

 

Dr Penny Massy-Westropp

 

 

 

Dr Penny Massy-Westropp

 

Dr Monika Moy

 

 

 

Dr Monika Moy

 

Dr Katherine Astill

 

 

 

 

Dr Katherine Astill 1

 

 

We’re providing great General Practice care including:

 

Mental Health Care/Plans

 

Skin Checks and Skin Cancer Care

 

Travel Medicine

 

Immunisations

 

Workcover/Compensable Medicine

 

Emergency Care

 

Antenatal Care

 

Men’s Health and Screening

 

Women’s Health and Screening

 

Babies and Children’s Care

 

Nutrition and Weight Management

 

Executive Health Checks

 

Stop Smoking Help

 

Pathology Services

 

 

Here to Help!

 

 

We’re Here to Help You – in 2017 and beyond.

 

 

 

 

 

We look forward to seeing you soon!