Proposed changes to mandatory reporting laws for impaired practitioners

One of the perceived barriers to health care by impaired health practitioners (outside Western Australia) is the fear of being reported to AHPRA.  This particularly affects practitioners with a mental health condition. Mandatory reporting of AHPRA registered practitioners by AHPRA registered practitioners was introduced into National Law in 2010 and there is still widespread confusion as to what the requirements are.

The threshold for reporting to AHPRA is high and its purpose is to keep the public safe, not to punish or discriminate against doctors who are struggling. If a practitioner has an impairment (e.g. a psychiatric illness) but works appropriately, safely, and is managing the condition appropriately, they do not need to be reported under current legislation. The trouble is that this is not well understood by practitioners who are patients or by practitioners who are treating other practitioners.

I facilitate workshops for doctors and other health professionals on mental health and wellbeing on a regular basis. The topic of mandatory reporting comes up nearly every time, even in groups of highly experienced practitioners.  It is seen by many as a barrier to seeking help and to providing health (to other practitioners).

In WA, practitioners are not required to make a mandatory notification when their reasonable belief about misconduct or impairment is formed in the course of providing health services to a health practitioner or student. However, there is still an ethical obligation to protect the public and voluntary notifications can be made. This would generally only happen if the risk to patients is high and the health professional is unwilling to self-report.

The mandatory reporting requirements of treating health practitioners is currently under review and the Australian Health Ministers’ Advisory Council has recommended a nationally consistent approach to mandatory reporting, in line with West Australian legislation.

Ministers at the COAG Health Council meeting on 13 April 2018 unanimously agreed to take steps to remove barriers for health practitioners to seek treatment for an impairment, including mental health conditions. Ministers agreed to the drafting of a nationally consistent approach to mandatory reporting.

Watch this space!

In the meantime, PLEASE never make a report to AHPRA without discussing it with your medical indemnity organisation first. They are exempt from mandatory reporting requirements and you can discuss your situation in complete confidence.  They will advise you whether your situation meets the threshold and if so, how best to report it.

 

References:

COAG Health Council Communique 13 April 2018

https://www.coaghealthcouncil.gov.au/Portals/0/CHC%20Communique%20130418.pdf

Australian Health Practitioner Regulation Agency (accessed 31 Dec 2017) Guidelines for mandatory notifications. Available at: http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Guidelines-for-mandatory-notifications.aspx

Bird, S. (2016) Mandatory Reporting of Health Practitioners, MDA National Defence Update, Winter 2016. Available at: https://www.mdanational.com.au/~/media/Files/MDAN-Corp/Publications/Defence-Update-Winter-2016.pdf?la=en

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Why I may sign your fitness to drive form

A great blog post on Assessing Fitness to Drive by Dr Mark Raines

rain0021

“Well, Mr Terry I have some bad news. The results of your tests shows me that it is no longer safe for you to drive.”

“But why, young whipper snipper, you don’t understand, I’ve been driving since before you were born……”

One of the harder things I have do as a GP is to tells someone that they should no longer drive and they need to hand in their license. I have lost a few patients along the way because we have disagreed on their ability or competency.  Generally during a consultation, I consider the patient before me, and sometimes their family. But in this situation, I have a responsibility to consider the wide community. In fact, you also have this responsibility as the F3172 form you gave me to sign for your drive medical stipulates.

“If you hold a Queensland driver licence, or are applying for a Queensland driver licence, you…

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“I’m more like herpes than Ebola” – spreading the message about driving fitness

Assessing to Drive teaching Sydney June 2017

Since my partner was hit and killed in 2015 by an unfit elderly driver, I’ve been on a mission to increase awareness of the importance of fitness to drive assessments by health professionals.

My YouTube video on assessing fitness to drive has not exactly gone viral but it does have almost 6000 views, steadily building over time, being passed from one person to another.  Actually, it has gone “viral” in that respect , but more like herpes than Ebola! And like herpes, I hope the message sticks with those who watch it, quietly sitting in the background and then making its presence known now and then, such as when they have to do a driving assessment on an elderly driver.   I’m not sure that the phrase “I’d rather be herpes than Ebola” will ever take off, but it works for me.

I’m very grateful for the opportunities afforded to me to speak in person at educational sessions, especially sessions run by GP regional training organisations including GP Synergy, EV GP Training, Murray City Country Coast GP Training and Generalist Medical Training.

I was particularly delighted to be a recent guest on the wonderful GP Show podcast with Sam Manger, on which I shared practical tips for GPs on how to approach driving fitness. I hope you will check it out….

http://thegpshow.libsyn.com/assessing-fitness-to-drive-with-dr-genevieve-yates-gp

Nothing can bring the love of my life back. But if sharing our story indirectly results in one fewer person being injured by an unfit driver, at least some good has come out of this senseless tragedy.

Dr Viktor  Frankl an Austrian neurologist and psychiatrist who survived the Holocaust, expoused the importance of finding meaning in terrible circumstances. He said “In some way, suffering ceases to be suffering at the moment it finds a meaning.”

Much as putting our story out there has been hard, knowing that it could possibly save someone else’s loved one has made it worthwhile.  And I’m so grateful to the many doctors who have told me that it has changed the way they approach fitness to drive assessments.

Remember, driving is a privilege, not a right.

Drug seeker basted me like a turkey

A brilliantly witty piece from Justin Coleman about being duped. I can certainly relate. I once had a regular patient with whom I spent 45 minutes talking about how she would tell her 10 year old daughter that she was dying of metastatic ovarian cancer. She was in tears, I was in tears. Understandably, she was on high doses of opioids for her cancer pain. It was only later I discovered her impressive medical documentation was fake and that she had neither cancer nor a daughter. It was all an elaborate hoax to get prescriptions.

drjustincoleman

Turkey, by Ben Sanders Illustration: Ben Sandars

This month I got done over by a drug seeker. Tattoo Man basted me like a Christmas turkey, peppered me with garnished praise and slow baked his way through my seasoned outer crust. Bugger.

Usually, when it comes to slamming the script pad shut, I’m all Fort Knox.

Reception deliberately sends all hopeful newcomers down dead-end street to my brick wall. Five minutes later they exit, loudly proclaiming to the waiting room that, in effect, my clinical decisions are being influenced by the rather unlikely combination of both my genitalia and distal GI tract.

Funnily enough, those occasions are relatively easy. My patients in the waiting room know me well enough to guess what might have happened. And everyone knows their role: the receptionists blame me, as instructed, and I blame our Practice Policy—the only thing I’ve ever written which remains unsigned.

“Sorry madam, I’d love to…

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48-second GP consultations

If I could change one thing about working clinically as a GP, it would be time pressure. I find seeing patients every 15 minutes a struggle, especially when instead of “catch up” slots there are “fit in” slots. I cannot imagine being able to feel good about my job if I only had a couple of minutes, or less, with patients. I know the environments and expectations are very different, but I’m not the high throughput type. I like taking my time… https://www.youtube.com/watch?v=zF5gcEQVxL4

drjustincoleman

Less is less

A recent BMJ study highlighted the remarkable degree of international variation in how much time GPs spend with their patients.

In Pakistan, a patient with a laceration would barely have time to explain how it occurred, let alone have it sewn up.

Whereas in Scandinavia, by the time the consultation ends, the wound has already healed by secondary intention.

Of the 67 countries studied, Australia ranks pretty much where you would want it – our 15 minute slots put us in the top quarter. Generous enough for a country that can afford it, without being inefficient.

Half of the world’s population—predictably, the poorer half—spend less than five minutes with their primary care doctor.

A couple of minutes is all you get in Nepal or China, regardless of how long it took you to travel to the surgery in the first place. I suspect there’s not much chit chat about the…

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GP Sceptics podcast 12: Doctors’ resilience

It was a thrill and an honour to be interviewed on my favourite podcast, by two of my favourite people, on one of my favourite topics. I hope you enjoy it at least a tiny bit as much as I did.

Terry (aka Mr Perfect) wrote a lovely blog post on the episode with his take home messages here:  https://www.linkedin.com/pulse/doctors-resilience-gp-sceptics-podcast-terry-cornick/

drjustincoleman

Kat_Ritchie_pod12_small By Kat Ritchie

soundcloud

What keeps a doctor resilient, when dealing with a high-pressure job helping patients who are distressed and traumatised?

How can doctors balance empathy with self-care? Does easing a patient’s burden imply carrying it for them?

Dr Genevieve Yates teaches the art of resilience to doctors around the nation, and here we distil one podcast-worth of her wisdom.

Listen to it after a long day at work, or when you’re feeling vulnerable.

Even better, listen in bed, where Justin’s soporific opinions will guide you towards a replenishing sleep. Look after yourself, folks.

In Liz’s Special Source, Liz takes a look at the funding and influences behind ‘Therapeutic Guidelines’ — hint: it comes out clean.

Liz reveals her pin-up nerdy-researcher boy (Justin’s is Ben Goldacre), and we invite Dr Google into the GP surgery.

All this and more, in our final podcast for this ‘RACGP Year’ (October to October).

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Weathering the anniversary storm

I had a sudden urge to slap a patient yesterday afternoon.  I didn’t act on the urge and was in no danger of doing so, but it rattled me all the same.  I’ve never before felt like I wanted to hit anyone (with the possible exception of my brother when we were kids, at times of peak annoyance).

For confidentiality reasons, I cannot reveal the content of the consultation which triggered such an out-of-character emotional response in me.  In general terms, the patient has an unhealthy dose of the “poor me” mentality, a stark lack of insight into, or compassion towards, others, and is causing her loved ones distress and harm.  We not uncommonly see patients like this and she was not an exceptional example.  I normally handle such patients perfectly calmly. She just happened to inadvertently say exactly the wrong things at exactly the wrong time…. wrong for me that is.

My response was not about a heartsink patient, it was about a heartbroken doctor.

I have become really good at separating my “stuff” from my patients’ “stuff”.  Caring about, but not self-identifying with, patients’ problems.  Not contrasting or comparing.  Being very mindful (ie present, aware and non-judgmental) during consults.  Providing genuine empathy without taking others’ emotional burdens.  It has taken time and a heap of deliberate practice to do this well but the rewards have been oh so sweet.  Career saving.  I’ve got back my clinical work mojo. I once again love seeing patients.

But not yesterday.

Yesterday,  communicating with patients and staff felt forced. Conveying empathy felt fake. Working like that is draining; utterly exhausting.

Why were things suddenly so difficult?  Why was I feeling so vulnerable?

You are probably familiar with the acronym H.A.L.T. which, in a medical practitioner’s work context, stands for Hungry, Angry, Late and Tired. Being hungry, angry, late or tired not only affects our sense of work satisfaction but increases our propensity to make cognitive biases in our clinical decision making, and for medical errors to occur.  The idea behind H.A.L.T. as a self-monitoring tool is to:

  • encourage us avoid these states as much as we can (eg by prioritising sleep and nutrition),
  • recognise when we are affected by one (or more) of them, “halt” what we are doing, ask ourselves what influence being hungry, angry, late or tired is having on our performance, and then try to minimise its impact.

In contexts such as addiction recovery, “Lonely” is substituted for “Late”.  Same principles: halt, reflect, rectify (when possible), avoid negative impacts.

I was not working while hungry, angry, late or tired yesterday, but the principles of H.A.L.T. did apply.

Yesterday was my partner’s birthday.  And today is the anniversary of his death; two years since he was mowed down on his morning jog by an impaired driver. Two years ago today, I got the phone call we all dread. The phone call that informs you there’s been an accident involving one of your immediate family. The phone call that tells you that the person you love most in this world has been killed, changing your life forever.

I always find anniversaries hard, and with two dead partners and two dead daughters, I have had plenty of experience with them.

Should I have gone to work yesterday? The practice I work for is brilliant about such things – everyone there would have been utterly supportive of my taking the day off despite us being understaffed at the moment. Why then it is so hard for me to admit that, despite how far I’ve come and how well I’m doing overall, I’m not always OK? And that is OK to not always be OK?

I’ve told at least four stressed patients this week that it is OK to take sick leave for mental health reasons. I’ve counselled. I’ve written medical certificates. I’ve told them to put themselves first etc etc.  With the greatest sincerity and not a hint of irony.

I teach about doctors’ health and wellbeing all around Australia, and beyond. I’ve written a play about it (“Physician Heal Thyself”).  I’m extremely passionate about doctors’ self care, almost one of those annoying crusader types. And yet I find it so hard to practice what I preach.

Today, I have halted. I’m having a quiet day and I’m feeling much more settled.  Tomorrow I will start marking 1400 odd GP exam papers (the FRACGP written exams are being sat today around Australia). And on Monday I will walk back into the surgery, hopefully with my ability to empathise intact and my mojo restored.

The waves of grief come far less often and with less intensity as time goes on. The short storms that hit around anniversaries are precious reminders of what I’ve lost and how far I’ve come, and as such, should be treasured.

I’m positive that this one, like the last, will clear soon…. revealing clear skies and calm seas.  For underneath the currently choppy surface, I am at peace.  I’m happy, I’m fulfilled and I’m loved.  Truly loved.

Most of all, I’m grateful.  I’m grateful for many things, including the silver linings of the storm clouds – the wisdom, strength, opportunities and sense of purpose which have been given to me by that which has been taken away.

Plan A didn’t work out for me. Neither did Plan B or C.  But Plan D is working pretty well, and I’m buoyed by the knowledge that there are 22 more letters in the alphabet if I need them.

(15th July, 2017)

 

After the storm… with Amalie’s tree in foreground

All that “GP stuff” in the Emergency Department

Nomadic GP

“We are just FULL of GP stuff today. We’re pretty much just running a GP clinic” you say, with a big sigh and roll of the eyes.

You’re an emergency nurse or maybe a doctor. You’re frustrated because you are working your butt off, haven’t had a lunch break or time for a wee and still people are waiting for hours and hours to be seen. The ambulances keep arriving and you’re irritated by the patients who are adding to your workload that don’t need to be here at all.

I know the stuff you’re talking about. It’s all those simple problems, the non-urgent problems, the tedious and uninteresting problems. You’re talking about the triage category 4s and 5s that don’t have a life threatening illness and can wait while you and I attend to all the exciting, high acuity, real emergency stuff. You’re talking about the sniffles and rashes, the UTIs and…

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Making Valentine’s Day matter, without spending a cent

For many years, I rallied against Valentine’s Day.  I saw it as crass commercialism of love.

If I’m honest, I think that underlying my objection were memories of teenage angst.   Unlike all of the “popular” girls at school, I didn’t receive a single Valentine’s Day card or gift.    In the typical heightened emotional mindset of an adolescent, I saw Valentine’s Day as an annual reminder of how unloved and unlovable I was.

I learned the truth at seventeenJe ne regrette rien
That love was meant for beauty queens
And high school girls with clear skinned smiles
Who married young and then retired
The valentines I never knew
The Friday night charades of youth
Were spent on one more beautiful
At seventeen I learned the truth

Janis Ian “At Seventeen”

Fast forward a couple of decades and I found myself with a man who loved Valentine’s Day.  Growing up in America, for him it was a much hyped event.  According to Wikipedia, “in the United States, about 190 million Valentine’s Day cards are sent each year, not including the hundreds of millions of cards school children exchange”,  and “the average Valentine’s spending has increased every year, from $108 a person in 2010 to $131 in 2013”.

For my partner and his family however, Valentine’s Day was not about sending cards or gifts, it was about showing friends and family how much you appreciated them.

In some Latin American countries, Valentine’s Day is known as “Día del Amor y la Amistad” (Day of Love and Friendship). Part of this is about performing “acts of appreciation” for friends and colleagues: acts like a kind word, helping someone out with a chore, expressing gratitude, and telling colleagues, friends and family how much they mean to you.

You could argue that we should be doing this every day of the year, and you would be absolutely right, but it can help to have a day to remind us to focus our efforts on nurturing our various relationships, personal and professional.

Extending this further, it may be a timely reminder to check in on the most important person in our lives: ourselves.  How are you travelling? Are you nurturing your body and mind? Showing yourself a little self love? As we are all aware, we need to look after ourselves properly in order to help others.

My Valentine’s Day-loving partner is no longer with us, may he rest in peace.  However, I would love his non-commercial passion for Valentine’s Day to live on and be shared with others.  So I’m asking you all to consider reaching out to those in your life this Valentine’s Day, and bestowing upon them “acts of appreciation”. And, if you feel so inclined, put aside five minutes to take stock of your own state of happiness and well-being, hopefully showing yourself a little bit of self-compassion and kindness as you do so.

what I do for thirty seven dollars and five cents

that lady doctor

The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, recent cholesterol levels, fasting glucose and urine protein. We discussed screening for bowel cancer with “the poo test” versus colonoscopy, with reference to his family history. We talked in detail about prostate cancer testing and I offered to provide him with written information as we were out of time. As I signed his script for the blood pressure medication he winked at me.

“That was easy money for you, wasn’t it?” he said as he walked out.

Thirty-seven dollars and five cents is the value this government places on up to twenty minutes of my time. This figure, the amount a practice receives from Medicare for a standard consultation, has not changed in four years, and under the current arrangement, will not change for another three. I myself receive sixty five percent of that. But are the pennies…

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Do GPs ever regret referrals?

drjustincoleman

Je ne regrette rien Je ne regrette rien

An Australian study (featured today in Medical Observer) has found prostate cancer patients are more likely to regret surgery than radiotherapy. This had me wondering; if my patient regrets surgery, should I then regret having referred them to a surgeon?

We would like to think our referrals are always based solely on the best outcomes, but can we really claim, as Edith Piaf did, Je ne regrette rien?

Or are we in fact sometimes swayed by factors other than outcomes – things like tradition, familiarity, friendships, or yesterday’s guidelines? It’s hard to identify any one referral as adamantly wrong, particularly if we self-reflect through rose-coloured lenses. But surely not every decision can be all La vie en rose.

If a GP refers to a surgeon in the private sector, the patient usually ends up getting surgery. Something about hammers seeing everything as nails?

So…

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IMReasoning – a brilliant podcast on clinical reasoning and great KFP study resource

imreasoningI don’t often give unsolicited plugs for FOAMed resources but felt I needed to share my delight at having recently discovered the IMReasoning podcast. It is the creation of two internal medicine physicians, Dr. Art Nahill and Dr. Nic Szecket, working in Auckland and is described as “Conversations to inspire critical thinking in clinical medicine and education”.  I have binge listened my way through most of the episodes and thoroughly enjoyed them all.  They have found the sweet spot – demonstrating a near perfect balance between the informative and authoritative, and the entertaining and self-deprecating.

While relevant and helpful to us all, I think it is particularly of value to those intending to sit the FRACGP Key Feature Problems (KFP) exam for the first time, and for those who plan to re-sit.  It is also a “must” for supervisors and medical educators trying to develop clinical reasoning skills in their learners.

The KFP exam is designed specifically to test clinical reasoning.  It tends to have high failure rates and many candidates find it the hardest of the three Fellowship exams to get through.

As an RACGP State Censor, one of my jobs is to give feedback to failed candidates. While exam technique and knowledge gaps are undoubtedly factors for many, time and time again I see doctors with good clinical knowledge but poor clinical reasoning (memorisers, not thinkers).   They tend to find it difficult to assess patients in the context of the scenario given and to identify the key features/critical steps.

I think this podcast might help people better understand what the KFP is about. From here on in I intend to recommend the IMReasoning podcast as a KFP study plan essential.

You can find it at http://imreasoning.com/  and it is also available to download via iTunes.

I recommend starting from the beginning as the episodes build on each other.

In Episode 31: Stump the Chumps International with Genevieve Yates, I present a case for Art and Nic, attempting to “Stump the Chumps” with a very GP-type case. I chose the case because it illustrates some of the clinical reasoning and management challenges when assessing and managing some of the more complex primary care patients. (Spoiler alert – there isn’t a glorious diagnostic prize revealed or a great “ah ha” moment”).

 

Open letter to OSCE candidates

The below is a copy of an open letter sent to all 2016.2 OSCE candidates today. It was written by the RACGP National Assessment Advisor, Dr Guan Yeo. I’m posting it here as it is one of the best OCSE tip summaries I’ve seen, containing many a gem, and will hopefully be helpful to future OSCE candidates also, when they start to prepare for this last FRACGP exam hurdle.

You can find other OSCE related posts here, here and here. My YouTube channel http://www.youtube.com/user/DrGenevieveYates  has links to various physical examination clips and other videos which might also help in OSCE preparation.

Dear candidate,

How are you progressing in your preparation for the Objective Structured Clinical Exam (OSCE)?

By now I expect you have your regular small-group timed roleplay sessions up and running. Improving your performance in the rating areas that apply across multiple OSCE stations is a good way to maximise your chances of success.

Use this quick list to check your performance, eg.:

Rating areas Some features of good performance
Communication and rapport Patient centred? Empathic? Patient expectations? Simple language explanations?
History General and focussed questions? Orderly? Demonstrates safe diagnostic strategy? (Murtagh)?
Physical exam Hand hygiene? Explains and is considerate of patient comfort? Orderly? Gives positive findings and significant negatives?
Investigations Prioritised? Staged – initial and later Investigations? Differentiates between your differential diagnoses?
Management Prioritised? Considered patient supports? What does the patient think/understand? What are the obstacles (eg. to behaviour change)? Safety-netting?
It is time to critically review your clinical experience and familiarity with conditions represented in the ICPC2 groupings, e.g. women’s health, mental health, musculoskeletal, ENT, etc. Study up now on the common presentations in your areas of weaknesses: How do they present? What history or examination do you target? How do you prioritise investigation? How do you manage – short term and longer term, explanations, drugs and non-drugs, again prioritisation.

Finally, hopefully you have already booked in for a trial exam. This is often useful to ‘polish-up’ your preparation.

To use your time effectively during the exam consider the following:

  • In the three minute reading time, do read the instructions line by line. Some nervous candidates miss entire lines as they read. It can be helpful to put your finger against each line as you read – it is simple, may sound silly, but it works. You don’t have to memorise – there is the same set of instructions on the desk inside the station.
  • When in the station, if you are nervous, it is easy to miss visual cues. So if eye contact is not your strong point, train yourself to look regularly at the ‘patient’.
  • Use the time at rest stations wisely. Besides toilet breaks and drinks of water, regroup your thoughts, use short meditative exercises/mindfulness, focus, and regain your composure in readiness for the next station. Avoid dwelling on previous cases as that won’t improve your scores, but rather prepare yourself mentally for the remaining stations.

I hope that you have found this information useful and I wish you well in the OSCE.

Dr Guan Yeo
National Assessment Advisor OSCE

General Practice – a strong-link or a weak-link profession?

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 to find out.  She was a fantastically self-directed learner.

Fast forward the present day.  I asked her how she found GP training, which she had done with a now-defunct RTP.  She started with some generically nice comments but on my drilling down further she admitted that although it was great socially, the education program didn’t really challenge her and she felt it was, in essence, an exercise in box-ticking.

There are certainly many bright registrars who are extended and challenged during GP registrar training,  but she got me thinking, are we going about this the right way?

The “best and the brightest” are chosen for AGPT training.  Meanwhile, there are large numbers of general practice trainees who are working essentially unsupervised and unsupported.  Some of these have gone down this route by choice; however many are doing so because they are either ineligible for AGPT (usually due to their residency/registration status) or failed to get into the AGPT program.  There are some fabulous GPs amongst them, but there are also many that struggle, both in practice and with their Fellowship exams.  The support for these doctors just isn’t there.

While pondering this inequity, I was reminded of a podcast to which I’d recently listened.  It discussed the difference between weak- and strong-link sports.

soccerIn soccer, research shows that the way to maximize wins is to improve the worst players.  Success typically comes to those teams who have better 9th, 10th, and 11th players rather than those who have the best player.  It is argued that this is due to the nature of the sport, being that one player typically cannot create opportunities alone.  Thus it makes sense to invest in making the least talented players better.  Soccer is a weak-link sport for this reason.

basketballAlternatively, basketball is a strong-link sport.  Typically, the team with the best player wins.  It’s a star-driven sport because one player can have an outsized impact on the game despite also having the worst player on the floor as a teammate.  It is nearly impossible to prevent a great player from getting the ball, and/or helping his/her team score.

The question this threw up for me is whether Australian General Practice is closer to soccer or basketball.  Should we spend more time and resources trying to create a climate that maximizes the number and the relative success of already really successful and talented doctors, or should we do more to help those who are unsuccessful?  Obviously both are important, but which approach best defines and strengthens our profession?

Personally, I think we should take the weak-link approach.

I hasten to add that I’m not advocating a drop in standards, nor a regression to the mean.  We will still have our GP stars, and these inspiring individuals will continue to do our profession proud.  They still need (and deserve) support during training.  My point is that their needs are different, and perhaps the standard AGPT program is somewhat wasted on them, or at the very least would be more useful for others.  I would like to see a more tailored approach.

I’m also not suggesting that any doctor, regardless of suitability, should be working in general practice, and supported to do so.  There should be, in my opinion, baseline competencies, knowledge and experience required – a cut-off point, so to speak, below which a GP provider number cannot be issued.  This would require everyone entering general practice, not just those applying for AGPT, to undergo a rigorous selection process perhaps including an entrance exam.

For those who have reached the required standard of entry, I would like to see the distribution and type of support based on the needs of individuals.  It would be fantastic if extra Commonwealth funding was put towards GP training, but that is unlikely to happen. However, I think we could do so much more with what we’ve got. There are limited resources available, but wouldn’t be wonderful to see quality training opportunities given to those potentially great GPs who have the most need for structured and supported training?

Pie in the sky thinking, but a girl can dream…

 (The views expressed are entirely my own and do not reflect those of my employers.)

 

Sharks and sausages – the risks are small but is it worth it?

One of my favourite quotes from medical school was “There are consistently more people in Queensland killed by choking on sausages than by shark attacks.”  I liked the quote so much it inspired me to write a play called “Death by Sausage”, which toured around South East Queensland in 2010. DEATH_BY_SAUSAGE

It highlighted to me how ridiculous is society’s fear of shark attacks, given how unlikely they are statistically.

I live about 200 metres from Lighthouse Beach in Ballina.   It is once again in the national news following a serious shark attack this morning:  the 4th in under two years, including a fatal one.

http://www.abc.net.au/news/2016-09-26/ballina-shark-attack:-teenage-surfer-bitten-at-lighthouse-beach/7876892

At least 3 of the attacks (I’m not sure about the 4th) have been near “the wall” – where the Richmond River meets the ocean.  With the out-flowing river water there are lots of nutrients, lots of fish and lots of sharks. I’m sure it is more complex than this but the upshot is that this is a very small area where sharks particularly love to hang out.

I love “my” little beach – less than a kilometre long – and visit it daily. I no longer go out past about waist deep water though.  It seems I’ve bought into the shark attack fear I scoffed at for so many years.  My justification is as follows:

Lighthouse beach, Ballina

While acknowledging that the chance of a shark attack is still rather small, this is the very spot where these recent attacks have occurred, while there are many, many kilometres of good surfing beaches in the local area without any reported attacks. Why would anyone choose to swim/ surf near “the wall” at Lighthouse Beach?

I was on Lighthouse beach this morning, about 90 minutes before the attack happened.   I know (by sight only) the local 17-year-old who was attacked and have talked to him and his mates once or twice.  I’m told he was one of the surfers who, earlier this year, protested against the installation of a shark barrier at the very spot he was attacked today, considering it unnecessary.  I believe he is expected to make a full recovery, thank goodness. I wish him all the best.

http://www.abc.net.au/news/2016-03-18/surfer-protest-against-shark-barrier-at-ballina/7259692

I don’t doubt that there are many more serious injuries from sausages than sharks in Queensland, but I’m betting this statistic doesn’t hold true for those who swim/surf near “the wall” at Lighthouse Beach, Ballina.

I’m not taking my chances… with sausages, or with sharks.  😉