[AMA] I'm a Young GP. Ask Me Anything and Provide Feedback

LAusGP on 09/03/2018 - 00:15
Last edited 09/03/2018 - 13:45 by 2 other users

So I recently went to an Innovation in Healthcare conference and feel inspired to change General Practice. Also with the long weekend thought I would offer a limited time AMA.

So ask me anything (within reason) you like as long as it isn't direct medical advice.

Also I'm looking to see what people would love from their GP. Put some outlandish ideas out there as well as some practical ideas.

Edit: Would love to hear what people ideally want from their GP. I'm hearing you would love to have a good GP in the first place but if you had a clinically competent GP who does listen to You- is there anything else you would want?

For context I work at a mixed billing clinic where I probably bulk bill around 25% of my patients. I've been a qualified GP for 1 year and been working in general practice in training for the 2 years prior to that. Our clinic already offers a high touch service where I spend probably 1-2 hours a day following up results and ringing patients. We also run a results line where patients can ring in to find out from the nurse at a basic level what their results are like.

Ask away!

Introduce Yourself

closed Comments

    • AusGP on 09/03/2018 - 16:24

      I don't think I will ever go into Concierge medicine myself (you do mean those services where patients pay through the roof but their doctor is available 24/7 right?). I like my current balance of those whom are well off and those whom need my care and don't have money (mostly elderly).
      Yep I have started recommending aspirin again - luckily this was brought up at our weekly clinical meetings (A unique aspect I believe amongst general practices - several heads better than one!)

      I would not recommend routine screening with MRIs (unless in the future we become more confident with incidental findings)!!! So many incidental findings and sometimes when you do one scan it suggests needing another and then another and it goes on and on and is just not good medicine sometimes.

      • [Deactivated] on 09/03/2018 - 16:28

        Many different levels of concierge medicine but the main difference is the time you spend with individual patients and having the time to look up the issue if it is perplexing which is almost impossible in a normal setting unless you take it out of your own personal time. I also think people don't realise how much personal time doctors sacrifices in order to progress their training or to become better as a doctor. Most people can knock back after their job ends but nope not us.

        • AusGP on 09/03/2018 - 16:35

          Well I already do spend time after work looking things up. Probably around 7-8 hours consulting mixed with 1-2 hours daily of follow-up. I'm currently logged into work remotely doing a medical report on my day off. :D

        • [Deactivated] on 09/03/2018 - 16:36
          +6

          @RJW: What frustrates me is that most people pay $20-25 dollars for their hair dresser on a monthly basis. Yet they are not willing to pay that amount to see a doctor. The concept of bulk billing really has changed the dynamic between GPs and patients. People don't want to pay but expect a 5 star service which is not congruent. People don't realise a ~15min consultation is $37 from medicare and the medical centre takes 30% of it. Or people who say they have no money despite having the latest iphone or those that continue to spend money on cigarettes.
          Rant over.

        • AusGP on 09/03/2018 - 16:38
          +1

          @r3d3mption:
          Correct I have seen those cases where people do rock up with fancy newer phones than mine complain about the cost of medicines. I have also done home visits to commission housing where they had more electronic devices than my whole family put together.

        • parisienne on 09/03/2018 - 19:31
          +1

          @r3d3mption: You,Sir or Madame , deserve a million up votes for that.We (several of my colleagues and i ) say that about a lot of things that we see. It really seems people don't understand that tax dollars are not infinite,and that the medicare levy barely touches the surface when compared to the cost of healthcare as a whole.Also,to think that the system we have now is sustainable is naive…ageing population,more disease by preventable causes and the declining birth rate (future taxpayers) means that a modified version of the US model of healthcare is inevitable at some point.

        • dmcneice on 09/03/2018 - 20:35
          +4

          @r3d3mption: also a first year GP registrar. Saw an 19 year old guy with his mum this morning who were from Melbourne (I'm in QLD). Diagnosed and treated him for otitis externa, examined and ordered imaging for a knee injury and wrote him a letter for his airline. Took 18 minutes of my time because the mum wanted everything explained in detail. We are a mixed billing practice. Charged him the $67 ($30 gap). Mother absolutely lost it refusing to pay saying it should be bulk billed. Had to cave because don't want bad google reviews

        • [Deactivated] on 10/03/2018 - 02:55
          +1

          @parisienne: Thank you for agreeing. I totally agree with the fact that it is unsustainable and it will definitely get worse in the future. I don't like talking negatively about my colleagues but whenever I see a patient that has had a misdiagnosis or makes a comment about an "uncaring" doctor I often wonder how much this is related to the fact that bulk billing doctors are time poor. I think most doctors are quite knowledgeable but in order to make a decent living on bulk billing you would have to churn through patients as RJW mentioned in earlier comments.

          @dmcneice: Totally frustrating luckily I haven't had such an issue yet but I am sure I will encounter one eventually. My young patients actually makes the comment that they like someone who can relate to them and they are willing to pay a gap because I took the time to really explain things and to try suggest a solution that would fit their lifestyle. Also I really do appreciate patients who say thanks or who really understand and appreciate my efforts, it does mean a lot to me personally and definitely motivates me to do better.

        • parisienne on 10/03/2018 - 09:49
          +1

          @dmcneice: Oh dmcneice ,whilst there is a time and place to do things like that for extenuating circumstances,i have to say that maybe this was NOT one of those times.
          By doing that,just to avoid a neg Google review,you have set a precedent,and may well have to do such a thing again when some ranting,verbally abusive a$$ comes in and demands that that they should not have to pay,or else they leave a bad review.Do you think that BS is stood for if you try that on a plane ? NO,you'll get kicked off.Try that in a store,you'll be banned,try that in a restaurant,cops will be called….see what i am getting at ? As health care professionals,we are subject to verbal and physical abuse on a daily basis,and by doing what is being demanded just to " make the problem go away " is what is allowing this to happen , and it is saying that this behaviour is OK.And if that "women" who did that has friends in the area that your practice is in,don't think that she may not tell those people that you are OK with wiping the payment….just act like a beatch and get what you want.
          Lastly,anyone with any functioning neurons can tell a review written by someone who is just doing a " revenge review " or a "didn't get what i want,so now i'm going to go to some public soapbox to see if i can get some sympathy" or a review that actually IS warranted.Besides,THAT type of person isn't the type you want at your practice….let them go elsewhere.

        • dmcneice on 10/03/2018 - 10:20

          @parisienne:
          Problems with small businesses man in an area with lots of GP's. Also not my decision, practice manager overrided my billing to avoid the negative review

        • kingmw on 10/03/2018 - 23:50

          @parisienne: Completely agree with this.

        • parisienne on 11/03/2018 - 10:58

          @dmcneice:I understand,and i don't blame you for the actions of your manager,but the fact remains that this is a huge problem that we all need to work together to address if this is to stop.Perhaps at the next team meeting,ask that the manager be there (and prior to this,ask your colleagues how they feel about such behaviour…they would no doubt be on the same page,and be prepared to back you in any conversation)and explain the situation as it was…reminding him or her that such behaviour should never be tolerated.Also,it is OH&S guidelines that a workplace be free from harassment,verbal and physical abuse and be safe for staff and patients alike….i think that prior incident may have either swayed dangerously close,if not crossed a couple of those,so if no resolution is forthcoming,perhaps a little reminder of that.
          The GP practice i go to is a small business as well (several MOs in there),in a place that has,quite literally,around a dozen or more within a few km radius.They have a sign that states that verbal and physical abuse will not be tolerated,and that you will be banned if you demonstrate such behaviour…maybe suggest a similar sign.That practice has neg reviews on it….about waiting and the reception staff mainly,BUT it is easy to see when reading those who is writing them out of spite (99.9%) and who genuinely has a reason to be upset.My point is that this practice is still bursting at the seams everyday,despite those reviews,and has always been so.If you lose 20 patients due to just one review,there will be many,many more who will come (and see the reality,not some attention seeking idiot's perception),after all,it is a GP clinic,not a restaurant or motel we are talking about here….people need you,not the other way around.
          I am simply saying these things as a fellow healthcare colleague who feels that we deserve better than this.

        • parisienne on 11/03/2018 - 11:10

          @kingmw: THANK YOU.I am passionate about this issue,as i have been on the receiving end of this type of behaviour (and a lot worse),as have my colleagues (some of which have had A LOT worse….think stuff that has wound up on the news type of worse).If we don't act,it is saying that this is all OK….there are staff out there who will never work again due to injuries sustained from aggression,and families who won't see there mother / father / son/ daughter etc again who would argue otherwise that point to the death.It is only a few small steps from what was mentioned by dmcneice to the types of incidents that i have seen,and i wouldn't want that for anyone.

        • [Deactivated] on 11/03/2018 - 11:34

          @dmcneice: If you were a fully qualified GP the practice manager wouldn't do that. Unfortunately, it is bullshit but doctors like to avoid drama and most will just take the path of least resistance although it perpetuates the behaviour.

    • kingmw on 10/03/2018 - 23:47
      +1

      This is why attending large conferences (every 2-3 years) are very helpful to keep medical professional updated about changing practices. However despite this, most doctors like to stick to the tried-and-true rather than try or recommend something new.

  • Imightnotbearobot on 09/03/2018 - 16:22

    Whats the pay like as a Gp?

    • AusGP on 09/03/2018 - 16:25

      See above!

  • llwl on 09/03/2018 - 16:23

    Thanks for being a GP who is committed and inspired to change general practice. I’m PGY5, left the hospital for 4 months to do GP reg training last year. It turned out it wasn’t for me, but it made me appreciate how hard it is to be a good gp. Now that I have returned to the hospital to do physician training, I tell my colleagues that being a good gp is difficult with the resources available, and I’m very grateful to the good gps in the community. I also tell my patients to look for a good gp because they could literally save their life.

    After reading comments here and what I have experienced myself, work needs to be done to change perceptions about gps. Not all are equal, and it’s unfortunate some bad gps have tainted people’s perception. Don’t know how that could best be done. I think your AMA is a good start though!

    • AusGP on 09/03/2018 - 16:27

      Thanks llwl. Good luck with physician training - that is also a very tough road (not helped by IT failures lol)! One thing I will say is we do need more general physicians whom I can send my patients whom I'm left scratching my head to!

  • ChurchMouth on 09/03/2018 - 16:24
    +1

    What do you think about GPs prescribing things such as bcp's and statins which are supported by studies to achieve a certain reduction in a lab value or reduction in a symptom, yet the effects on overall wellbeing are quite controversial and not well understood yet?

    For instance on birth control pills (summary - http://www.newsweek.com/breast-cancer-birth-control-may-incr…), a small increase in breast cancer risk and 300% increase in risk of suicide (maybe this correlates with depression).

    Consider how many girls are on it to just control unpleasant period and skin issues, how does a GP feel about recommending these sort of fixes that alchange the hormone profile in the body?

    Similarly with statins there seems to be a lot of controversy around whether lowering the cholesterol will reduce mortality (I grabbed one study - https://www.ncbi.nlm.nih.gov/pubmed/25655639)

    I geuss I am wondering how you prescribe these things to uneducated people, when science is still lacking a lot on many chronic diseases that seem to be plaguing us.

    Also how much does industry around these drugs (ie bcp's and statins) influence GPs? Do you apply any skepticalism to the arsenal of new drugs approved for use?

    • AusGP on 09/03/2018 - 16:34

      1) Statins - they can be quite useful and have a proven role in reducing mortality beyond its effects on cholesterol. However they do have side effects so these need to be discussed and basically with all medications and treatments - its weighing up the risks of doing something vs the risk of not doing anything.
      http://www.cochrane.org/CD004816/VASC_statins-primary-preven…

      So if a patient isn't at high risk then I wouldn't recommend it

      2) Oral contraceptive pill - this is certainly a personal decision. There is definitely noted mood side effects and we usually counsel people about the side effects before starting. Again its a benefit vs risk equation. If you drive every day you will be at risk of being killed/maimed on the roads (1:20000-40000 I believe) yet lots of people will say that's worth the risk. At the end of the day it's something offered and we go through the risks.

      3) There is definitely influence from drug companies so we must work to remain impartial as much as we can.

      4) Prescribing to lay people - requires clear, easy to understand explanations about the risks vs benefits. At the end of the day a bit of maths and probability knowledge will help the patient understand but I guess if people haven't got a concept of that, I normally couch in in terms of car accident rates, or risk of dying from smoking etc.)

  • leiiv on 09/03/2018 - 16:55

    If you are sick, do you need to go to another GP, or can you just write yourself a referral to any specialist you want?
    Does a doctor need to see a GP to be referred to a specialist? (example, neurosurgeon having a heart problem)

    Do most doctors take private insurance themselves? Do they give significant discounts to other doctors (as a patient)?
    If using the public system, are you, as a patient, prioritised more than other non-doctor patients? Eg less wait time, assigned better surgeon, etc.

    • AusGP on 09/03/2018 - 17:15

      Best practice is to have your own GP and I certainly do.
      You can actually refer yourself (any doctor can for that matter but timeframes for validity will vary) and one of my doctor patients does but then I'm not kept in the loop and have no idea what's been happening to them.

      I have private health insurance. No significant discounts although I haven't looked at joining Doctors Health Fund so far.

      Public hospitals should not prioritise doctors or any staff for that matter but we all know that it will happen (mostly other staff as doctors tend to opt for the private route as its faster and more convenient to book a time suitable for their busy schedule)

  • HarleyRider on 09/03/2018 - 17:05

    Hi OP,

    I am planning to change my GP, which is near to my house.
    Is there any way or procedure to transfer my past data/reports from current GP to new GP?

    • AusGP on 09/03/2018 - 17:12

      Hi HarleyRider - yes you go to your new GP and sign a transfer of medical records form. This is then faxed to your old GP.

      There may be a fee associated with transferring your file to cover the costs of administration (from your old GP that is). This depends though as my practice has taken a stance not to charge for this (even though it does take the GP up to 10-15 minutes to sort out your file for transfer - and also reception/admin time after that).

      • HarleyRider on 09/03/2018 - 18:55

        Thanks mate

      • megasaur on 12/03/2018 - 01:33

        Does this mean medical records can only be transferred between GPs? Ie. If I want a copy of my medical records for my own interest, would the GP provide me with this?
        Also you sound like an amazing doc and I wish I had one like you. Any tips on how to go about finding these elusive 'good' GPs? Trial and error? Non-bulk billing clinics only?

        • AusGP on 12/03/2018 - 13:34

          In general no your GP won't provide you with the entire medical record. The only time this occurs is if you're moving overseas.

          I think word of mouth helps but yeah unfortunately sometimes without trying a GP you won't know. Certainly your chances are higher with a non bulk bill clinic as they can only charge and have a loyal following to sustain them if they are at least decent.

        • megasaur on 13/03/2018 - 18:10

          @RJW: Hi thanks for the response! Curious as to what the reasoning behind not allowing a patient full access to their own medical history would be? Just contrasting this to the veterinary world (in which I work) - if a client wants their animals full history we would generally give it to them with no qualms.

        • AusGP on 13/03/2018 - 20:43

          @megasaur:

          I guess I don't know the legal reasoning but I believe that the medical record when interpreted unfiltered by the lens of the doctor can be misinterpreted (i.e. same reason blood results arent necessarily released so the patient doesnt do Dr Google).

          Also, patients may not like whats written in the record and as the author of the records I suppose specialists / GPs / hospitals have a right not to release at times. Some of the record may contain things that are written in confidence by specialists (e.g. I might write in the notes - such and such specialist / physio rang me and warned me this patient may be drug seeking for example). Also some of the records may impact upon the patients mental state if not interpreted correctly.

          In fact some forms for VicRoads and Centrelink ask whether the records if released may harm the patients (or something to that effect).

        • megasaur on 14/03/2018 - 07:59

          @RJW: interesting, thanks!

  • jaimex2 on 09/03/2018 - 17:13

    Who is your favourite Star Trek doctor?

    • AusGP on 09/03/2018 - 17:15

      Haha I actually don't watch Star Trek…

  • pformag on 09/03/2018 - 17:13

    Can you advise what the difference or benefits of CT Scan vs MRI? Which is better for looking at heart/lungs and for children?

    • AusGP on 09/03/2018 - 17:19

      CT scan is like a 3D X-Ray - good for looking at bones and some organs particularly in conjunction with contrast - however there's radiation involved so not used lightly in children (but sometimes you have to if the benefit of the scan is more than the risks of the scan)

      MRI uses radio waves and magnets and detection of how they change to build up a 3D image of the body - better for soft tissues like muscles and also for the brain and spinal cord. I'm not too sure what the state of cardiac MRIs at the moment. Also for MRI you have to lie still for 30-45 min in most cases so sometimes for kids you have to sedate them which is an extra risk.

  • GourmetFoodie on 09/03/2018 - 17:26

    What makes a good patient? AKA How do I help you help me?

  • AusGP on 09/03/2018 - 17:33
    +2

    1) Clear timeline of presenting problem - some patients have obviously rehearsed what they will say before coming in and it does make it much easier to just let the patient do all the talking and then I can ask certain pertinent questions that are missing from the initial story. Also it makes you feel listened to :)

    2) Booking in enough time if you have multiple problems or a very complex problem - time is an enemy in consultations and not having the doctor rush will help you get a better experience - generally most 15 min appointments no more than 1-2 problems.

    3) Having tests done with sufficient time before an appointment, and always ring up for results as well so that if they're not there, we know you've done them but it hasn't reached us so we can go chasing for it before you come in.

    4) Bringing in a medication list if you're going to a new doctor (or better yet bring all your tablets in a bag in case anything is missing off the list)

    5) Smile/laugh/keep good humour - it helps to have friendly patients particularly if we've had a stressful day and running late and not having had lunch!

    • GourmetFoodie on 10/03/2018 - 18:05

      Thanks so much for your reply! And thanks for running this AMA - have learned a lot and appreciate my local private billing GPs even more now!

      • AusGP on 10/03/2018 - 18:15

        No worries!

  • Diesmile on 09/03/2018 - 17:37

    How did you study for gamsat?

    • AusGP on 09/03/2018 - 17:42

      I had UMAT so was a little bit different. But basically the easiest way is to sign up to a reputable commercial program to prepare.

  • FlatEarth on 09/03/2018 - 17:50

    Hey RJW,
    I just started year 11, and being a GP is one of my top future career aspirations, so would you mind telling me about:
    - What courses for qualifications do you need to become a GP?
    - After finishing your course, do you simply buy/rent a place and start treating people?
    - Thoughts on sharing a clinic with other GPs VS having your own clinic?
    - Good places to start getting medical experience?

    Also one last one: Do you ever worry that you may misdiagnose a patient by accident?

    Thanks :)

    • AusGP on 09/03/2018 - 18:10
      +1

      Hey FlatEarth, thanks for your question. Good luck with your High school exams and being a GP (a good one) can be really rewarding.

      1. Courses - you need to do a medical degree. Either straight out of high school via a MBBS degree or you can always do a basic science/biomedical science degree first then do a post-graduate degree in medicine (MD at Melbourne Uni, MBBS elsewhere)
      2. After you finish your university studies, you become an intern for a year, then 1-2 more years of residency, and depending on what sort of GP 2-4 more years of further training (think of it as an apprenticeship). From internship onwards you get paid so you earn and learn at the same time.
      3. After you get your professional qualifications (FRACGP / FACRRM) you can then think about starting your own clinic. However most people just start at an established clinic (like myself) and then think about the business side of things later on down the track.
      4. I love group practices where I have colleagues whom can support me, share ideas with me and we can seek help from each other. A few brains is better than one when it comes to difficult problems

      5. You can do work experience at hospitals (e.g. Royal Melbourne Hospital used to have an official program, or if you know anyone at a private GP clinic)

      6. Yes I worry all the time bout misdiagnosing. Unfortunately if you don't like uncertainty, general practice isn't the career for you. People presenting with vague symptoms often have nothing wrong with them, but just that one in a hundred keeps you on your toes. It worries me a lot but have learnt (at least slightly) to keep a lid on my anxieties around this.

      • Save Medicare on 09/03/2018 - 20:55

        Want to add that since OP has graduated a number of both grad and undergrad med schools have moved to offering the MD. It's clinically equivalent to the MBBS and other degrees. AMSA has a policy on it.

  • lancedefrance on 09/03/2018 - 18:13

    Thanks for doing the AMA, not sure how you even get the time but good on you. I havent read the wall of text but wanted to know how can I tell who is a good GP in my area? Also would bulk bill GPs put them in a lower standard than others that charge a payment?

    • AusGP on 09/03/2018 - 18:39

      I guess if you charge and you're no good then pretty soon you won't have any customers.

      Having said that there are some very good and caring bulk billing GPs

      • lancedefrance on 10/03/2018 - 20:49

        thanks, but would appreciate some insight into my first question, how would I be able to tell who is a good GP in my area. bulk billing aside, what advice do you provide in going about selecting a GP.

        • AusGP on 10/03/2018 - 21:20

          Unfortunately apart from word of mouth or actually trying out a GP there isn't a reliable way. I've looked at Google reviews for practices I've been to and also worked at and not all of them reflect the actual quality of the practice.

          I would suggest when trying out a GP whether they listen and seem to care. Also are they willing to admit their limitations or look things up when they aren't sure? The most dangerous doctor is one whom seems to know what they are doing but actually doesn't!

        • lancedefrance on 11/03/2018 - 05:35

          @RJW:
          Thanks for the response, thats the thing that its really hard to assess if a GP is good or not. I will give you an example, I asked a friend which GP he goes to and swore by this guy that was about 25 mins drive. He was OK, but it turned out later that he was under investigation for prescribing steroids to body builders. My fried was a regular gym guy who was big so I can only assume thats why he recommended this GP.

          As I said it is hard to put some criteria to measure a GP against, for example someone who listens and has a good bed side manner might be worse than someone who is arrogant but gets better diagnosis rate. It would be very hard for a patient to assess. Again thanks for the response.

  • The Wololo Wombat on 09/03/2018 - 18:16

    What do you know about mycoplasma?

    • AusGP on 09/03/2018 - 19:17

      I'm assuming you are referring to Mycoplasma genitalium?

    • gimli on 09/03/2018 - 21:37
      +1

      I'm assuming you are referring to Mycoplasma pneumoniae

      • The Wololo Wombat on 09/03/2018 - 23:43

        Just mycoplasma in general.

        • [Deactivated] on 11/03/2018 - 11:45

          It's pretty much an environmental organism depending on the subtypes.

        • AusGP on 11/03/2018 - 14:39

          @r3d3mption:

          Although can still cause atypical pneumonia or STIs depending on the subtype :)

  • kimmik on 09/03/2018 - 19:29
    +1

    Dr to dr, you can make a real difference by looking into diet and metabolic syndrome, as one previous poster has said.

    Deferring to the dietician is poor practice because i think this is one of the reasons the western society have such an obesity/metabolic epidemic - drs have such poor understanding and interest in managing diet despite it contributing greatly to cancer, vascular disease, mental health and morbidity. Simply suggesting to someone "eat well, exercise, lose weight" you might as well tell people to "just live longer" and not bother diagnosing and treating causes of early mortality.

    As much as we are taught to think of the big picture, truth is many decisions are made on the basis of short term gains where you can measure or see the difference. You think patients dont listen anyway? Thats because they dont trust you until you demonstrate that you understand their problem, and explain the solution.

    • AusGP on 09/03/2018 - 20:33

      Is there any particular diet / nutrition method you would recommend?

      I mean I give specific advice that I feel has been successful but it's not exactly RCT level advice - but more practical and may work well in reality.

      And of course theres the general advice for what constitutes a healthy diet. If anything though I've found portion control is the main issue.

      • kimmik on 10/03/2018 - 14:17

        My point really is this - metabolic syndrome is going to break the US healthcare. Perhaps we should stop following their dietary guidelines. Fixing coronary arteries, prescribing antihypertensives, medicating t2dm, osa etc are all just treating a core dietary problem with bandaids.

        Time to rethink the role of carb, sugar, fat, protein, fibre, snacking, meals, fasting etc in disease, and its definitely not what medschool taught a while ago.

        Could start with hearing the opinions of Gary Fettke a surgeon from Tas. He raises many of the controversies with the current "general dietary recommendation" which should spark personal research.

        • AusGP on 10/03/2018 - 17:57

          Yep will do. Sounds like I need to do more research!

    • gimli on 11/03/2018 - 14:30

      Do you think the guys who eat KFC and drink litres of soft drink do not realise that it is bad for them?

      • kimmik on 11/03/2018 - 14:39

        its not that simple i'm afraid.

        • gimli on 11/03/2018 - 14:50

          i agree healthy diet goes beyond that but when you talk about obesity and overweight the treatment for most people is going to be reducing excess calories.
          IMO we don't need to complicate dietary advice too much. If you are interested in weight loss there is evidence to show that low GI, low fat, low carb, intermittent fasting, VLED all can achieve weight loss. Weight maintenance is often much harder.

          In terms of general dietary advice. I think this is a public health issue. Highly processes, high calorie, high sugar foods and drinks are just to easily available and people have forgotten about having proper meals from cooking real ingredients.

        • kimmik on 11/03/2018 - 15:00

          @Gimli: While you've touched on some important aspects I wont go into further detail here.

  • [Deactivated] on 09/03/2018 - 19:36

    Have you ever diagnosed a patient with chronic fatigue syndrome? If yes what symptoms did you base you diagnosis on? Thank you for your time in this AMA.

    • AusGP on 09/03/2018 - 20:41

      Not directly as I like to get a second opinion on it. It's basically unexplained fatigue with no cause found. There's a few specific things like unrefreshing sleep or easy fatigue after exertion and no abnormality found on investigations.

  • 4foxache on 09/03/2018 - 19:57

    Why did you just choose to be a GP and not specialise?

    • AusGP on 09/03/2018 - 21:03
      +2

      GP is a specialty just to clarify :)

      1. I like the direct care and responsibility for a patient (they're "my patient" in that Im responsible for keeping people well)

      2. Variety of work

      3. Lifestyle - my wife is non medical and my shift work was really tough on her and I decided she was more important to me than the supposed fame and glory of specialty training.

      A lot of people think GPs aren't specialists but we are! The common misconception amongst some med students is GP is what you do if you can't get into anything else. Well GP was the only specialty I applied to and I graduated with Honours from Uni Melb (top 10% of class)

  • serpserpserp on 09/03/2018 - 20:17

    My goodness there are a lot of angry crackpots in this thread.

  • funkyrx on 09/03/2018 - 20:32

    I work in IT and see the exponential value of internet of things and AI daily. How do you see these technologies disrupting the medical industry?

    • AusGP on 09/03/2018 - 21:20

      AI will be huge. I see it both in assisting a generalist like me to perform more specialised tasks like diagnosing and treating what is done now by specialists, but also in replacing entire specialties (or at least reducing a lot) - e.g. radiologists and pathologists where AI recognition may be able to replace them

      • kimmik on 09/03/2018 - 21:28

        You may be right in 50 years, though till then my question is to you, who gets to control AI radiology and AI pathology? Answer is radiologists and pathologists lol.

        • AusGP on 09/03/2018 - 21:40

          Yep - but you need less of them. There will always be radiologists or pathologists I reckon as humans will always want someone to blame if things go wrong.

        • kimmik on 09/03/2018 - 22:01

          @RJW: Blame is one way to look at it - a GP would rather not be blamed for misdiagnosis while using AI radiology or AI pathology unsupervised. But even if blame is removed, would you as a referrer choose: 1. an AI service overseen by non-medical persons, or 2. overseen by specialist doctors?

          Medicine is not static, AI is not set and forget, and specialists are the peak bodies of their fields that make the final decisions.

          Just banting…

        • AusGP on 09/03/2018 - 23:02

          @kimmik:

          Oh I'm not disagreeing! I think there will always need to be specialists to be able to supervise the AI - just like modern day pilots of planes that mostly fly themselves - but things can go very wrong if on fully auto (as has been shown on multiple episodes of Air Crash Investigations lol)

  • Flamo on 09/03/2018 - 20:40

    I'm a 32 year old male with an osteophyte complex in my cervical spine. I haven't injured my neck or played contact sports.

    Can bad posture cause something like this to happen? I have a mild scoliosis as well as kyphosis. Shit's all over the place.

    • gimli on 09/03/2018 - 21:36

      Cervical osteoarthritis has strong genetic element to it…

  • Save Medicare on 09/03/2018 - 20:53

    I need to do a mantoux for work. It's really hard to book into the staff clinic at a time that suits because work is really busy.

    1. What's the process to get a mantoux in the community?

    2. What do you think about capitation vs activity based funding in GP land?

    3. Do you think that healthcare is an inalienable right, and do you think that from a moral/ethical standpoint all patients should have access to a quality GP without having to pay a gap? Or do you think that patients who can afford to pay $40 gaps for a GP consultation should receive better care?

    4. How did you know you wanted to do GP? When did you know?

    5. What do you think about our reliance on IMGs and do you think we should be investing more into specialty training programs for local doctors?

    • AusGP on 09/03/2018 - 22:08

      1. I'm not aware of any way to get a mantoux in the community - maybe some infectious diseases / travel clinics privately?

      2. I'm actually involved in preparatory work for the local primary health network in preparation for the likely introduction of capitated funding under the new Health Care Homes model - I think its a great idea and will reward GPs to provide better care in any way they see fit (with nursing staff support more than direct GP input, telehealth etc). Having said that - there's some unanswered questions about the effectiveness in an Australian context even though it has been shown to be helpful overseas.

      3. I think everyone should receive quality care. However I don't think we can expect there to be no gap payment for everyone. The government mis-sold the Medicare co-payment campaign previously. But now that I've worked in the profession for a while - its obvious a copayment is required to act as a very important price signal - the main benefit is if you are paying $5 for a GP, why not pay $15 for a better one? This will mean a natural incentive for better medical care - as it stands GPs who are "bad" can provide care without value but not worry about not having enough patients coming in the door.

      4. I knee when I was PGY 2 (post-graduate year 2). Already documented previous posts :)

      5. I think there will be more locally trained doctors soon!

    • therooftop on 10/03/2018 - 13:39
      +1

      You can ring your local chest clinic to make an appointment for a mantoux test. Just google (Suburb) chest clinic not familiar with Melbourne sorrt.

  • surm on 09/03/2018 - 21:05

    Why do GP practices not give out copies of pathology results to patients before having them "reviewed" with a GP?

    When I am told that my pathology results have arrived and the Dr wants me to make a booking to review them, I want to prepare myself for that reviewing appointment. I want to search online and find out the possible scenarios (to what is found in pathology tests) and possible treatment options, their side effects etc, so that I can discuss this with the doctor. However, the GP practices DO NOT give out pathology results to patients before the "review" appointment! This makes me go "blind" to the initial review appointment and then make another appointment after I do my research and want to discuss my concerns.

    Does your practice do this as well? If it does, what is the reason?

    • gimli on 09/03/2018 - 21:41

      to save you from doing "blind" dr googling.

  • hellothankyou on 09/03/2018 - 21:11

    Qn on your insurance…

    Assume you have medical indemnity. If you stop practicing, presumbly you would stop paying your premiums. Would you still be covered for past medical work?

    • AusGP on 09/03/2018 - 22:11

      There is a drop off scheme provided by the government for situations where people retire / leave the profession / have babies etc. I'm not too sure about the exact details but have filled in some form for one of my GP patients.

  • simgue on 09/03/2018 - 21:21

    What technology do you currently use or plan on using? Do you or are you ever requested to use the national e health records for your patients? Why do you think there's been such a poor uptake of use for what could have a huge benefit to society with the data it creates?

    As you're at the beginning of a 30-40 year career you'll most likely see monumental change in your role as a GP. The rise of machine learning and image recognition among a multitude of other technologies promises to revolutionise how you as a GP work with patients. Will be very interesting!

    • AusGP on 09/03/2018 - 22:24

      Yes I get requests from patients to upload their records. At the moment the main issue with the system is its slow and clunky so its a huge disincentive. In the days of instant Gmail / cloud access to files, it sometimes takes a minute or so for the whole upload process - so uptake is a bit slow. I'm hoping it'll speed up and I will certainly look at doing something about it at my practice.

      Absolutely excited about the future of general practice!

  • gimli on 09/03/2018 - 21:35

    Do you recommend vitamin C?

    • sintro on 09/03/2018 - 21:42

      Yes, I do.

      Use sodium ascorbate regularly
      https://au.iherb.com/pr/NutriBiotic-Sodium-Ascorbate-Crystal…

      If you get sick or want to promote skin and muscle repair - use Liposomal Vitamin C.
      https://au.iherb.com/pr/LypriCel-Liposomal-Vitamin-C-30-Pack…

      • gimli on 09/03/2018 - 21:49

        Are you a GP?
        Can you point me to the evidence your recommendations are based on?

      • freemoneyhunter on 09/03/2018 - 22:08

        That's nonsense, everyone gets enough Vit C. Body only requires 5mg daily to prevent scurvy, anymore goes out through the urine. Health guidelines recommend 75mg daily which is way more than you need.

        "stay focused on how excess amounts of fat, protein, sugar and cholesterol causes diseases. He agreed, but could not resist using Linus Pauling’s own study that showed that high levels of vitamin C did not reduce cancer and actually caused health problems in the test animals. Pritikin obtained his outstanding results without using any supplements."

        http://preventivecare.com/pritatkins.html#.WqJqLGpuayo

        • sintro on 09/03/2018 - 22:36

          What is this nonsense you are referring to?
          Taking vitamin C in general or liposomal vitamin C?

          Everybody gets enough vitamin C? 75mg for all?
          We can't produce vitamin c and I'm not going to assume everyone eats well.

          It depends on the oxadative stress on your body such as injuries, surgeries, lifestyle habbits - smoking, eating, drinking, vigorous exercise.

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915787/

        • freemoneyhunter on 09/03/2018 - 22:45

          @sintro: Any form of Vitamin C supplementation. The human body recycles Vitamin C, AA once it is used is becomes DHA and the body recycles it reconverting it back into AA. That is why Humans do not require as much AA as other animals who can make their own by their livers.

        • sintro on 09/03/2018 - 23:09

          @freemoneyhunter:
          Really?
          Even for someone who has chronic infections?

        • freemoneyhunter on 09/03/2018 - 23:53

          @sintro: It won't help unless you have low AA levels. I have heard AA cures everything from Cold to heart disease, I have read plenty of material, I have read the vitamin c foundation material on their website, I have read some of Dr Levy's material, It's quackery. If you are having problems with infections I have some resources to start you off.

          https://www.drmcdougall.com/health/education/podcast/nathan-…

          That is some old tapes which are quite amazing, they are organised by topics so hopefully you can quickly find the part you are most interested in.

          https://www.drmcdougall.com/pdf/nathan-pritikin-review-of-me…

          A REVIEW OF MEDICAL LITERATURE ON RELATIONSHIPS OF VARIOUS DEGENERATIVE DISEASES TO DIET AND ACTIVITY. A lot of useful information there, again check the topics if it is what you are after, I believe that document has information about Vitamin C.

          https://www.drmcdougall.com/health/education/free-mcdougall-…

          That is a quick start program, the diet probably will fix up chronic infections, certainly better than taking large amounts of AA supplements which I believe won't help at all. You can take extra Vitamin C if you feel you need it, I wouldn't take more than 1g a day, that is probably the upper limit that is possible by eating a lot of fruit per day such as 15 bananas, oranges, apples etc together.

    • AusGP on 09/03/2018 - 22:36
      +2

      Has some benefits in shortening duration of colds but needs to be taken regularly.

  • eldudebrothers on 09/03/2018 - 21:54
    +4

    Hey buddy, GP here too. Its great that you are providing a AMA to educate and dispel myths. I just want to add and say that there is a massive spectrum on GP quality and unfortunately, there are many who give us a bad name, especially the burn and churn 8 patients an hour ones who don't care about their patients. Luckily, I absolutely love my job and stick to only 3 patients an hour which gives me the time to really explore issues and practice preventative medicine. I encourage anyone who does not trust their GP to keep trying to find one that they click with because a good GP could literately be the difference of life and death. Also, for the OP, I want to say that you should be extra cautious in giving advice on a public forum because it opens you up for liability and headache :(

    • eldudebrothers on 09/03/2018 - 22:00

      also, judging by your comments, I think we have met, do you practice in melbourne?

      • AusGP on 09/03/2018 - 22:37

        Thanks for the reminder :) I will be careful about giving too much advice! Yes I practice in Melbourne :)

  • freemoneyhunter on 09/03/2018 - 21:59

    RJW, What cholesterol level do you believe is optimal and do you believe low carb high fat diets to be unhealthy.

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