In our recent discussion on Labor’s proposed GP Super Clinic for Canberra “JumpingTurkey” made a lengthy post worthy of its own thread.
So here’s a GP on GP services in Canberra:
#18 JumpingTurkey
(Newbie)
11:51, 13 Aug 10As an existing GP I have a few comments.
1. Building a huge builing to the tune of several million dollars is going to do absolutely nothing to address the GP shortage in Canberra. GPs are not going to be suddenly lured to Canberra to work in these new super clinics.
2. Issue of how to get GPs to work in Canberra is complex. I think it has to do with the fact that GPs generally don’t stick around in cities and places that they did not train in or grew up in. Until very recently, Canberra did not have their own medical school, except for students who rotated from Sydney Uni. Hopefully when ANU starts pumping out graduates, (and they are now) then this will address some of these issues.
3. You say that there are incentives for GPs to work in Canberra. I’ve never heard any details of these incentives. And I read through most medical newspapers / journals regularly. If it does exist then the government is not doing a good job of promoting this, are they?
4. You’ve got to stop blaming GPs for not bulk billing, but blame the government for not increasing medicare rebates. If you are an intern or a resident in the hospital contemplating your next career move – whether to specialise or enter GP training, and if you know that the government pays specialists double or more compared to GPs, and if you know that the training time for most specialties is only 2-3 years more compared to General Practice (and of course you earn an income as a trainee too, so its not as if you are paid nothing), then why would you enter general practice?
If you feel that your GP bills too much, then do you feel that your accountant who spent 3 years at Uni, followed by 2 years doing his CPA (compared to your GP who spends 10-12 years studying and training), charges you too much? What about your lawyer who charges you $50 for a couple of phone calls?
As a GP I’ve never dreamt of charging people for phone calls that I make to them, or bill them for the time it takes me to check their blood results or pathology results as they come through, or to call and talk to specialists or hospitals to discuss a patient’s case.The money that you pay GPs need to pay for the surgery expenses, including rent, including electricity, phone bills, staff wages, and all sorts of expenses needed to keep the equipment sterilised, and also for medical indemnity insurance that protects you as a patient in case anything goes wrong (its not that we try to practice dodgily, but we are humans too and you’ve gotta be deluded to think that we never make mistakes).
The fact is that what medicare covers seems to rise in the order of 1% of less per year. Compare this to your electricity charges, or even the inflation that goes up at 3-4% per year. Or even your own salaries and wages that goes up by at least that amount per year.
5. Many GPs that I know will bulk bill patients who are in genuine financial difficulties. For instance, I bulk bill some of my patients – e.g. those with mental health issues, because I need to follow them up closely, and I don’t want money to be a barrier in them coming to see me frequently. Also we bulk bill those folks in nursing homes who are extremely fragile and often in the last few months to years of their lives.
6. I think having nurses working with GPs is a great idea. However you’ve gotta be kidding me if you think that nurses can replace GPs or do 80-90% of their work. What even makes you think / or what qualifies you to think that this is the case? As a GP, I can confidently tell you that 20-30% of my work is routine – i.e. coughs and colds, and issuing scripts and so forth. Around 40% are intermediate – they are things like people presenting for scripts but they actually need to be properly reviewed to make sure everything is okay – e.g. people who ‘thinks’ that they can come in asking for more scripts for diabetes tablets, without realising that they did not have a blood test for that in 12 months, or had their blood pressure checked, or does not realise that the sensation in their foot is slowly dying off due to diabetes, or their vision is silently going etc. That’s when I have to actually tell them that its not a simple matter of giving them scripts, but I have a responsibility to make sure that they are properly assessed again.
The other 30% of my work are diagnostic dilemmas. e.g. funny skin rash, or abdominal pains, headaches that persist, or dizziness etc etc. These are not ’simple’ things and they need extensive history taking, examination and investigations to get to the bottom of things.
Now, I think a well trained nurse would be able to do the routine things. They might be able to do parts of the intermediate things, but they will always need a doctor to check to ensure that nothing was missed. Often during the course of routine BP check, I often discover things like a mole, or funny irregular heart beats. And this kind of stuff only comes with years of medical training, not years of nursing training.
There is no way that nurses can deal with diagnostic dilemmas or the harder cases.The fact of the matter is that nurses are NOT trained to be diagnosticians. Diagnosis is the most difficult part of health care. The rest – how to get you better – is easy – you just look up a book. For instance, if you KNOW that what you have is a skin cancer – treatment is easy – cut it out or burn it out (depending on the type). But getting to that point is difficult and requires specific training.
Nurses are good at ‘nursing’ people to health. Once they have a diagnosis, they are very good at taking good care of them, and monitoring their recovery to ensure that they are back to their health. With further training they become good at technical tasks – e.g. as scrub nurses who assist surgeons, or ICU nurses who are very good at looking after patients in critical conditions and become good at protocol-driven management of people’s airway, breathing and circulation issues.
However nurses are not trained to be diagnosticians and will never become good at this because they lack the broad medical training.
Remember 20 years experience as a nurse is not the same as even 2 years experience as a doctor, given that what you are doing is so different. this is same as thinking that a dental assistant working for 20 years will be able to do the job of a dentist – although they spend a lot of time looking after patients, they are simply not involved in making diagnosis or taking on the heavy responsibility of patient’s care – so how do you expect them to be the same???
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