Romance of the Three Kingdoms is one of China’s four Great Classical Novels. The title of this blog post is more fully:
The empire, long divided, must unite; long united, must divide. Thus it has ever been.
PartridgeGP is based on a triple promise that we will be great for our patients and our community, GPs and our staff, and for the owners and the practice. Further, we will provide a comprehensive, professional, empowering, and sustainable service at all times.
Our friendly neighbourhood pharmacist sent this to me (see below). He was a little worried about the threat to his full service pharmacy and also to great General Practice.
Hmmmm
Now different companies will have different service offerings at different levels of the market. Think Porsche and Hyundai. Both very acceptable to different groups. Maybe even acceptable to the same group at different times. I’m not sure they are competitors.
I put my thoughts down here:
Upon reflection…
So keep playing to your strengths, keep doing your best, and unite not divide.
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.
We find ourselves at the start of a seeming pandemic.
Coronavirus.
In addition to the medical risks to themselves, their friends and families, and their patients, GPs have to consider the risks to their livelihood and practices.
We can’t help our patients if we are ill.
We can’t help our patients if our practices are closed.
We can’t help our patients if we are isolated at home.
So what can you do as a GP to make these things happen?
Stephen Covey talks about a circle of influence and a circle of concern. Your circle of influence should be larger than your circle of concern or you just worry about things you can’t change. Let’s go further and consider a circle of impact.
Where can you apply your time and skills to make a change?
They have about 6000 GP members (my guesstimate). You can join for a monthly fee of somewhere between $15-130 a month as a GP or registrar. You don’t have to join the AMA – it is entirely voluntary. You can leave at any time, and take your money with you.
So join.
On your application, quite clearly state why you are joining and that this is THE thing you would like the AMA to make an impact on. The AMA have access to the politicians. From your membership to their ears.
In addition to the medical risks to themselves, their friends and families, and their patients, GPs have to consider the risks to their livelihood and practices.
We can’t help our patients if we are ill.
We can’t help our patients if our practices are closed.
We can’t help our patients if we are isolated at home.
So what can you do as a GP to make these things happen?
Stephen Covey talks about a circle of influence and a circle of concern. Your circle of influence should be larger than your circle of concern or you just worry about things you can’t change. Let’s go further and consider a circle of impact.
Where can you apply your time and skills to make a change?
They have about 6000 GP members (my guesstimate). You can join for a monthly fee of somewhere between $15-130 a month as a GP or registrar. You don’t have to join the AMA – it is entirely voluntary. You can leave at any time, and take your money with you.
So join.
On your application, quite clearly state why you are joining and that this is THE thing you would like the AMA to make an impact on. The AMA have access to the politicians. From your membership to their ears.
Not long ago I ran into a recently Fellowed GP whom I’d had the pleasure of supervising as a medical student several years ago. She was exceptional – bright, keen and an amazing communicator who just “got it”. During her time with me she joined in with my group registrar teaching and exam prep workshops (AKT/KFP and OSCE). In the mock OSCE she did better than most of the registrars who were about to sit their Fellowship exams. After three weeks in general practice (as a student) and a two hour session on what the AKT and KFP were about, she passed both written practice exams (which were shorter than but of a similar standard to the real thing). Mind you, she wasn’t perfect – there were gaps in her knowledge, and nothing can replace clinical experience, but she was safe. She knew what she didn’t know. She knew how…
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