One challenge we have as specialist general practitioners is that our work is never done. There are thousands of special interest groups who vie for the attention of both general practitioners and our patients. Often the agendas are not transparent: a favourite concern of mine is the push for PSA testing by the Urological Society of Australia despite the lack of evidence of benefit. Faced with patients that seek an intervention they have seen or read about, we are overcome with the need to help and do good. Our education on topics is largely sourced and funded by those with financial interest in our behaviour. We often do not have the tools and information to unravel the evidence and be in a position to provide sound advice to our patients. Very few of our colleagues are equipped or brave enough to challenge these sources: a notable exception has been Prof. Chris del Mar getting the evidence together and going public on PSA testing. Do urologists get lead time bias?
I would like the RACGP to engage in a direct dialogue with the Australian community and investigate the needs felt in primary care and seek innovative and practical solutions that are commercially sustainable. It will be important to include peak bodies in this discourse, while seeking to understand their funding models and motivations. We need to learn how to deal with issues with more trust in our clinical know-how, less medications and fewer tests. Patients prefer such approaches when accompanied with understanding.
Enduring issues that arise in such discussion are the expressed need to have timely access to care when a person is sick and to maximise continuity. These pose difficulties for all of us; hence their appearance in surveys around the world. Meeting these needs can bring more satisfaction than many might think. I work in the large Palmerston GP Super Clinic providing 24/7 general practice and urgent care, covering a population out of hours of 25,000 or so. It amazes me that patients understand the pressures we are under and genuinely value the fact that we deal with emergencies – although it is only 30 minutes to the hospital. Working some shifts is necessary to provide comprehensive primary care just as it is in retail. Continuity means that we need to stay engaged, not referring at the drop of a hat. Generalists need to take responsibility for a broad range of presenting problems and work with patients to come up with solutions. Patient satisfaction is not the sole aim – it does not lead to better health. Getting these things right is a real challenge and requires resources and genuine investigation.
At the heart of our work is care; primary care, health care – what ever you call it. It works better if we care and we can only care together. That’s what our College is for.
Medicine at the Deep End 