[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 - 22:38
      +1

      There isn't necessarily an "optimal" level but a spectrum of risk. Its best to talk to your GP because the interpretation of the cholesterol levels and breakdown can be somewhat difficult to explain without actual assessment.

  • [Deactivated] on 09/03/2018 - 22:04

    Hi OP,

    My wife is an RMO and looking to go down the GP route. She can't wait to be in 'GPland' having regular hours.

    Do you mind telling me how much you earn as a GP reg and young GP specialist? I know it depends on % of billings and number of patience but how much did you earn?

    She's on about 95k with overtime at the moment so hopefully it's an increase on that.

    I find it strange how the system rewards those (financially) who burn through patience but those who spend me time and offer a better service get paid less. That's fine if you are private but my wife doesn't believe in private billing and will only bulk bill. Reason being she think good GP's should be available to everyone not just those that can afford.

      • [Deactivated] on 09/03/2018 - 22:23

        Online research would dictate $200,000 - $300,000 somewhere in the ballpark (for an experienced GP)

    • freemoneyhunter on 09/03/2018 - 22:19

      There are terrible GPs out there, my father was having a heart attack for 1 month, the GP kept telling him he had acid reflex, he got a referral for an xray and even the receptionist there thought he was having a heart attack. Eventually one night he was in so much pain he called an ambulance and confirmed he was having a heart attack, unfortunately his heart was quite damaged from the weeks of misdiagnosis. You can't trust doctors, many are incompetent, you must take your health into your own hands by practicing preventive medicine through a healthy lifestyle, mainly whole food and low fat diet.

      • [Deactivated] on 09/03/2018 - 22:22

        Don't let one bad experience but you off getting medical advice when required. There's some bad GP's out there but plenty of good. Like my wife and OP they both graduated with honours (top 10%) but made the choice to be GP's instead of seeking out fame and a higher salary.

        • freemoneyhunter on 09/03/2018 - 22:38
          +1

          Nah you can't say 1 bad experience, when he got out of hospital they sent him back to the doctor all he said was I heard you had quite an adventure and took no responsibility. From my observation, unless it is a broken bone or you need stitches, they are good with that, anything else like a chronic illness there isn't much they can do other than treat the symptoms without fixing the underlying problem which will get worse overtime.

        • AusGP on 09/03/2018 - 22:52
          +1

          @freemoneyhunter:

          I'm so sorry about your dad's experience. That's one of those common traps that can be misdiagnosed and sorry to hear it wasn't caught in good time :(

          The thing with chronic diseases is you want to prevent it and that's what a good GP should do. Work on the preventative care stuff. It's probably why I keep running late with my patients. But noone will see this as critical life saving work or "curing" anything because by definition there's nothing to fix if you did a good job in preventing the disease in the first place.

        • dmcneice on 09/03/2018 - 22:52

          @freemoneyhunter: sorry to hear that your dad had a heart attack. From the other side of the coin, we are often presented with undifferentiated illness all the time, with often very limited time to think. The problem with HA in general is they can present like many other illnesses, and can even have many negative tests and only show up on more invasive tests. People underestimate time as the best diagnostic tool we have. If your dad presented multiple times to the same GP for the same problem, then that's bad. But often I see patients go away and not come back for a month, while it's getting worse, expecting the gp to magically know their initial management was wrong.

        • freemoneyhunter on 09/03/2018 - 22:58

          @RJW: Yes I agree with you, if you make your patient healthy by giving good advise on how to look after themselves and prevent a disease from occurring, there isn't much in it for a practice, good to know you are one of the good ones. I understand the problem.

          My father received acid reflux medication and it did nothing for the problem, so he was then given a stronger a drug, did nothing so was referred for xrays. Before the xray results came back he was already in hospital.

        • [Deactivated] on 11/03/2018 - 11:54

          @freemoneyhunter: I am sorry about your dad and I don't want to sound like a dick but many chronic illnesses are lifestyle driven. GPs should be encouraging healthy lifestyle but I've done so many times and patients do not take it seriously and still end up in the same position because motivation to change is internal and we as GPs can't be there 24/7 to guide them to change.

        • freemoneyhunter on 11/03/2018 - 17:59

          @r3d3mption: Yes he smoked and he has quit after his heart attack, boggles the mind the doctor still thought it was acid reflux and he knew he was a 1 & 1/2 packet a day smoker at 67 (since 14). My father is to blame for his bad habit, but to let his heart attack to go on for 1 month and he is driving around to specialists for his acid reflux and he had to drive with the seat reclined and pushed all the way back and the only person who could diagnose correctly is a receptionist and I even said it sounds like heart disease but told me was it was dismissed by the doctors. There is too much gross incompetence in the profession that anything they say can not be trusted, like used car sales men.

        • [Deactivated] on 11/03/2018 - 21:12

          @freemoneyhunter: Sometimes even the best doctors miss serious diagnoses and I am not trying to defend your GP but I don't know the whole story so I don't want to judge on that regard. Sometimes it is worthwhile to get a second opinion if you are worried and I often encourage patients to do so because a new set of eyes on the scenario sometimes can shed new light on the situation. I've diagnosed a skin cancer on a patient who was seen by a very senior GP who didn't pick up the diagnoses so it does happen.
          I think to generalise is wrong and if you have that attitude you will unfortunately be worse off in the future. Doctors all have gaps in their knowledge and I've personally witnessed specialists fall into that trap too. However, there are good doctors out there and it is important to find those ones. It's akin to saying all lawyers are bad because they defend bad guys but I know lawyers who work solely for not for profit organisations.

    • dmcneice on 09/03/2018 - 22:29

      I'm a GP registrar. Like a fellowed GP, we get percentage of billings. I reckon if I keep going the way I am at the moment, about 110k to 130k per year.

      • [Deactivated] on 09/03/2018 - 22:32

        Would that be at the top of your game? or what you're earning as a registrar? (PGY 3-4 right?) I take it that your vocationally trained too?

        • dmcneice on 09/03/2018 - 22:37
          +1

          I'm pgy3 (gp registrar 1). You get 44% of billings. You start at 2 patients an hour which if you spend all 30 mins with them and bulk bill them, is about 71 per consult, or 142 per hour. Works out about 62/hour but theres still a lot of hours you do where your not billing. My pre tax is around 2000 per week, but it varies greatly.

        • eldudebrothers on 10/03/2018 - 20:57

          @dmcneice: once u hit GPT3+, u can get 2-3K in billings per day seeing 3 an hour. Try and find a practice that gives you 65% of billings and that lets u see just 3 an hour, do that and your set.

        • dmcneice on 10/03/2018 - 22:04

          @eldudebrothers:

          I don't know anyone up here that gives registrars that percentage of billings.

        • AusGP on 11/03/2018 - 14:43

          @eldudebrothers:
          How do you get 2-3k billings every day seeing 3 an hour?!
          I don't get that consistently currently… -_-

        • AusGP on 11/03/2018 - 14:44

          @dmcneice:
          You can negotiate - I was on 60% GPT 3 and 65% GPT4 but I stayed for the year (allowed to for GPT 4 as its counted as an extended term)

        • eldudebrothers on 11/03/2018 - 19:09

          @RJW: work in a mixed billing clinic, charge appropriately for procedures, care plans, health assessments etc… Also many GP's dont bill appropriately and don't use item numbers which they are entitled to or use combinations such as 23+2713, 721,723,2700,11700 etc

        • AusGP on 11/03/2018 - 21:34

          @eldudebrothers:
          We certainly aren't very aggressive with our care plans. But I do plenty of 2715 although technically speaking 23+2713 would take a long time?

        • eldudebrothers on 11/03/2018 - 21:53

          @RJW: yeah it does but on average, I spend over 20mins per patient and they occasionally have mental health issues (one of aspects I focus on). I rarely do care plans because they take too much time but they are very helpful for certain patients. Most of my patients are 36's which when combined with a private fee (never more then $40 and a significant number of bulk billed), procedures (skin, cryo, sutures, plastering etc) and mental health, 2K billings are within easy reach. Patients get much better care this way because you can spend lots of time with them and really tend to their issues. Its also less stressful for me as im generally on time, made sure my patients are safe and thoroughly reviewed.

        • AusGP on 11/03/2018 - 22:25

          @eldudebrothers:

          Does Cryo and Plastering attract Medicare items?

        • eldudebrothers on 11/03/2018 - 22:51

          @RJW: several practices I worked for charged privately for this as it costs them to perform and you have the responsibility that comes with the procedure. Like medicals, you should charge a good amount because of storm of excrement that can happen if anything goes wrong. If you are very good at what you do, people are more then happy to pay due to superior service, better outcomes, short waiting times and generally cheaper then allied health/alternative medicine.

        • AusGP on 11/03/2018 - 23:04

          @eldudebrothers:

          Thanks that's awesome!

    • AusGP on 09/03/2018 - 22:45
      +1

      As a trainee the minimum I earned was around 85k 1st year and more towards 120-130k during 2nd year training.

      I used to be like your wife! But then I experienced my current clinic. I bulk bill those who can't afford it, and I charge those whom have way more money than required. I have treated CEOs and senior executives whom can definitely afford the fee I charge, which frees me to treat my bulk billing patients with the same care as everyone else - which is a lot better than what I could achieve at a bulk billing alone clinic.

      • [Deactivated] on 09/03/2018 - 22:58

        Did you find your income went down from your residency to your 1st year GP registry? The style that you work with mixed billing is what I'm encouraging her to do. Seems to be the best of both worlds. She's also on a bonded medical scheme which is going to be so much fun! moving our kids from the Northern Beaches of Sydney to a regional town…. I'll have to find another job (I'm a Digital Marketing Manager) I think i'll be apply at the local McDonalds lol. Package deal, didn't find out she was a bonded medical student until after we were married.

        • AusGP on 09/03/2018 - 23:07

          Haha surely Digital Marketing Manager can be done remotely? My wife tells me how one of her team (non medical) is a contractor based in Noosa!

          My income didn't go down I don't think.

        • Save Medicare on 10/03/2018 - 13:58

          Buy out the bond or see if the ama wants to sue the department of health

    • [Deactivated] on 11/03/2018 - 11:52

      First 6 months of GP training 74k. Second 6 months 89k. Third 6 months 95k. Or 45% of your billings whichever is higher. By the third 6 months you should be earning more than 95k with your billings.
      There is nothing wrong with bulk billing and you can certainly earn more than 100k a year just by bulk billing and still give your patients attention. The issue is that no clinic will want to retain you (unless they are desperate) because your billings are too low or unless you wish to start your own clinic. Clinics usually take 30% cut once you're a fellow and they get more if you bill more. Hope that helps.

  • likang-c on 09/03/2018 - 22:27
    +3

    Why are GP's handwriting so bad?

    • AusGP on 09/03/2018 - 22:46
      +1

      Not mine ;)

  • Maria11 on 09/03/2018 - 22:36

    How would you recommend approaching doctors or a clinic to form a relationship to receive referrals from the local GP's for Chronic Disease Management referrals for Exercise Physiology?

    • dmcneice on 09/03/2018 - 22:38

      Just ask, most gps happy to do if indicated as it has good reimbursement

    • AusGP on 09/03/2018 - 22:53
      +1

      Offer to do a talk at the different clinics about what you do. I often refer to exercise physiologists but not a lot of GPs know what you do! Lots of allied health and specialists send us intro leaflets about themselves but I find this doesn't work very well unless I already know the doctor / allied health professional from a patient's recommendation or through work.

      • Maria11 on 10/03/2018 - 18:02

        Thanks for the reply.

        Should I send a leaflet and then follow-up afterwards?
        1.) What would be something on the leaflet that would make it stand out?

        I understand that each GP / clinic would already be busy but do you think just turning up at the clinic to speak to someone or should I try and make an appointment.

        Marketers would be constantly harassing the clinics and I don't want to be viewed as another marketer trying to sell them something.

        2.) Should I just walk-in or try and make an appointment with someone?

        At clinics am I trying to speak to the Practice Manager / Head Nurse or the individual GP's?
        3.) Who am I best to approach?

        If I were to go into clinics or a GP practice, what time of the day/week/month is usually a time when it is quiter than a busy period?
        4.) When is the busy / quite times for GP's?

        • AusGP on 10/03/2018 - 18:13

          It would usually work best if you arrange with the practice manager ahead of time. I think leaflets for each GP can be helpful but depends on whether the practice is willing to distribute.

          Lunchtimes probably work best but for example my clinic don't accept any private external providers (nor drug reps) giving talks as there's a perception this can unfairly affect referral patterns. We do host external providers (lots of them) once a year but we foot the bill so theres no conflict of interest.

          If anything make sure you write back to anyone that refers to you immediately after you see the patient.

    • colormonochrome on 11/03/2018 - 01:46
      +2

      Are you an exercise physiologist? I'm hoping so, because I have a question….I was referred to one for 5 chronic disease sessions, and the first appointment was promising. However the next two were terrible….he would give me an exercise and then walk away and talk to someone else at the gym, sometimes coming back well after I'd got through it. At first I thought he was being friendly to others he knew, but then I realised he was double/triple/quadruple booking appointments with people. The whole point of an exercise physiologist was to get proper help with fitness without damaging my back…I've had more thorough care from gym staff!

      Is this normal? He claims it is but he didn't warn me he wouldn't be present with me for the whole session beforehand, and I had a look at the medicare website and I'm pretty sure it's meant to be a one-on-one session. I'm going to talk to my GP because I'm kinda angry to have wasted more than half my 5 sessions already, but it would be good to hear from an exercise physiologist.

      Another question…how would you recommend finding one, other than asking a GP? Is there a professional body of some sort?

  • FittyFitty on 09/03/2018 - 22:37

    I've got this pimply thing on my gooch and I was….. Oh, never mind.

  • Eeples on 09/03/2018 - 22:42

    I go to a bulk billed medical centre and specifically ask for a random doctor.

    I randomise to reduce the chance of getting a bad doctor.

    I also randomise so I don’t have a regular doctor who may take my medical details for granted (whereas a new doctor should familiarise themselves with my records; well the good ones anyways).

    The good ones also mention my hypersensitivity to penicillin. Bad ones miss it.

    Nevertheless I always google the prescription.

    Question: Does the benefits of having a regular doctor outweigh the benefit of having fresh eyes on one’s health?

    • AusGP on 09/03/2018 - 22:55

      The best of both worlds is to have a regular doctor that knows you, then once in a while see a registrar who is training (as your fresh pair of eyes and fresh knowledge - and whom are often very keen)

  • Hayo on 09/03/2018 - 22:54

    It is not a question, but a painful experience. My baby has seen 8 GPs including emergency for severe eczema (she also vomit everytime after her bottle, through her nose) before we got referral to the allergist which diagnosis it was cause food allergies, which became anaphalaxis. If you see people with eczema, or babies vomit badly, please do not just give them steroid or tell the parents it is reflux, but check through thoroughly.

    • AusGP on 09/03/2018 - 22:59

      Duly noted! I am aware of the association and for difficult cases definitely send them off to a specialist for opinion and testing.

      • Hayo on 09/03/2018 - 23:19

        I wish we have you to be our GP. We could not find anyone we could trust in our area. Just to clarify that I wasn't trying to abuse the emergency system. I know eczema is not "Emergency" but I did not know what to do because she lose weight so badly after seeing so many doctors. Although the doctor in emergency did sent her to specialist, unfortunately it was the wrong specialist - dermatologist, who only gave us strong steroid with temporary healing, but long term problem. Some parts of her skin is darker than the others. Whereas the allergist taught us to do wet dressing which solved the eczema problem within 24 hours along with dairy elimination. Although it still needs steroid, the Dermaid 1% ointment was sufficient with that method in her case. Then I learned that specialist is not going to help unless it is the right one.

        • AusGP on 09/03/2018 - 23:28
          +1

          I'm surprised as the dermatologist would have considered allergens as a trigger - normally what happens is I refer to dermatologist who then decides that allergy testing might be required as well and internally refers to the allergy/immunology team.

  • Rohnson on 09/03/2018 - 23:08

    What do you think about Pharmacists?

    • Tech5 on 09/03/2018 - 23:13

      Likely knows more about the drug than the Doctor lol. Probably has saved lots of Doctors asses before

      • AusGP on 09/03/2018 - 23:16

        You'd hope so! (That is their profession after all to know about the medication!)

    • AusGP on 09/03/2018 - 23:14

      They're very helpful! Many lovely pharmacists I know and the good ones pick up our errors as well.

  • peterw1 on 09/03/2018 - 23:33

    The government tells us the rate of bulk billing is increasing. They also tell us obesity rates are increasing. Is this cause or effect? Should the government use the term slim billing instead?

    • AusGP on 09/03/2018 - 23:45
      +2

      They're only referring to the rate of bulk billing based on consultations. So basically what's happening is because the government froze Medicare rebates, a bulk billing practice will simply see 6 per hour instead of 5 per hour whereas the private billing ones keep doing the same. So overall bulk billing rates will "go up". But your consultation quality goes down.

  • MsVnus on 09/03/2018 - 23:38

    Please give me your opinion on my post
    https://www.ozbargain.com.au/node/361217#comment-5639708

    • AusGP on 10/03/2018 - 00:16

      I don't know what to say to be honest! I can see how its very disturbing as a patient to experience so I can only say maybe report for further investigation but at the same time im not sure what AHPRA would do about it in terms of proving any misconduct took place?

  • AustriaBargain on 09/03/2018 - 23:38
    +1

    How scary is the Premier and Health Minister, I mean just the idea of them? If one of them asked you to handle a case a certain way, say the patient was injured by a friend of the Premier and denies it, what would you do? Assuming you’re employed by the state that is.

    • AusGP on 10/03/2018 - 00:11
      +1

      I would stick to my integrity and refuse to fudge anything. We live in Australia so no need to put up with this sort of thing.

  • Tasmaniac on 10/03/2018 - 00:32
    -2

    Will you prescribe all patients my new, fantastic anti-depressant drug if I send you a lifetime supply of pens ?.

    Also what are your thoughts on prescribing testosterone to men for general well being ?.

    • AusGP on 10/03/2018 - 08:52

      No I wouldn't. If it was indeed a great new antidepressant that's been shown to work then I will prescribe it only to those whom have significant depression (or anxiety) that's not managed by psychology or 1st line medication.

      I send men to endocrinologist if it looks like there's real deficiency. Otherwise encourage them to lose weight.

      • Tasmaniac on 10/03/2018 - 12:40
        -2

        It was only a joke and I'm a bit worried now about your level of defensiveness. That to is only a joke.

        With regard to testosterone I'm afraid you didn't really elaborate enough for me to get an understanding of your opinion. I'm wondering how you feel about the studies showing the ability of testosterone to improve quality of life amongst older men.

        • AusGP on 10/03/2018 - 12:53

          Haha the reply wasn't really for you but for the other viewers of posts in case any of them think GPs just prescribe based on incentives to them from Big Pharma.

          I haven't looked into it to be honest. I think until I start seeing specialists in this field start prescribing fdor that problem I won't touch it. There's so much a GP has to know I think I don't have time to look at cutting edge research for a specific problem unless it really interests me :)

  • trevor99 on 10/03/2018 - 01:02
    -4

    Without wishing to be unnecessarily confrontational yet still coming straight to the point,
    which one of the following vaccine ingredients is the healthiest neurotoxin?

    Aluminium, Formaldehyde or Mercury?

    Why do the vaccine inserts (that are thrown in the bin) warn of many contraindications like autism, diabetes and death?

    Thanks.

    • AusGP on 10/03/2018 - 08:45

      Maybe read some of the fact sheets here.

      http://www.ncirs.edu.au/consumer-resources/

    • SydEP on 10/03/2018 - 09:18

      In the hope you are open to learning the facts:

      Firstly, autism and diabetes are not contraindications. Death would also not be listed as it is assumed to be a 'contraindication' to most things, I'm yet to see a doctor advocating for vaccinating someone that is no longer alive.

      Secondly, at the levels of aluminium and formaledhyde included in scheduled vaccines, they can be considered equally 'healthy' since they do not cause neurotoxicity but rather promote stability, maintain sterility and in some cases, such as with aluminimum, seem to facilitate the desired immune response. Mercury (which you may have read as thiomersal in vaccines) was also within certain scheduled vaccines at an extremely low level. It was removed following theoretical concerns of neurotoxicity following mercury exposure at much much higher levels, public concern and a disgraced doctor, Andrew Wakefield, who falsified data demonstrating a non-existent link between mercury (in the MMR vaccine) and autism. Interestingly, since Thiomersal's (mercury) removal from vaccines we have seen rates of autism actually increase - now unlike many of the websites anti-vaccine advocates may be getting their information from, people that understand the scientific method know this does not mean mercury prevents autism but rather we conclude that correlation does not equal causation.

      As some extra info, there are actually different types of mercury. The mercury that was contained in certain scheduled vaccines was ethyl mercury - a form of mercury with a short half-life (i.e. it is cleared quickly from the body). Methyl mercury is another type of mercury with similar identified 'neurotoxic' effects (again, at much much higher levels) but it has a long half life (i.e. cleared from the body much slower). Methyl mercury is found in breast milk. Again, as someone that understands the scientific method, I am not trying to convince you that breast milk is a neurotoxin, however, I wouldn't be surprised if that information is floating around out there by people less open to getting their information from appropriate, scientifically sound sources.

      On the note of good resources, this website is great for answering most of the common vaccine related questions: http://www.immunise.health.gov.au/internet/immunise/publishi…

      • trevor99 on 10/03/2018 - 12:06

        Thanks for the reply. Yes I am open to learning new facts and also sharing some.

        People may like to know that there is a vaccine injury compensation program in the USA where one needs to prove injury caused by vaccine in a court of law - an incredibly difficult thing to to.

        So far there has been cases filed for 1,261 DEATHS and 17917 INJURIES. The compensation payed out so far has been USD $3,855,663,911.58
        Source: https://www.hrsa.gov/vaccine-compensation/data/index.html

        From this evidence alone vaccination is therefore not a one way street.

        Unfortunately saying that aluminium and formaldehyde "can be considered heathy" is an opinion not a fact. There are no safe levels of mercury. It kills brain cells. It accumulates in the body and is not easily expelled. If mercury is spilled in a classroom for example is is considered a TOXIC EMERGENCY.

        Unfortunately pointing to websites from authorities is a pointless and closed loop. It is very difficult for scientific community to speak against the govt line without being under threat of penalty etc. This is not science.

        For people trying to decide for themselves here is a link to package inserts where you can read for yourselves. The shocking evidence is in some of the detail:
        http://www.vaccinesafety.edu/package_inserts.htm

        Statistically there is a very strong correlation between the exponential rise in autism and autoimmune diseases and the increase in the vaccination schedule. The official line is that they DON'T KNOW what's causing it, but they've isolated it to environmental change but it's definitely not vaccinations. That's not science.

        • SydEP on 10/03/2018 - 14:10

          Lol, thanks for the insightful reply. This will be my last reply so that it doesn't detract from the generous time RJW is giving up to answer questions. For others interested in vaccinations and vaccine safety feel free to send me a PM.

          1. Who said vaccines are a one-way street? Vaccinations are a matter of risk-benefit, like all medical interventions and treatments. As you've correctly stated, when harm is proven in a court of law to have been caused by a medicine, such as a vaccine, appropriate compensation should be paid. Like most anti-vaxxers, you are even picking and choosing evidence from your own links - # of cases filed does not equal # of successful claims. 1261 cases of death filed (not all cases successful) with 1 claim per 1 million vaccine doses, we should definitely stick to your opinion and ignore the fact that rubella alone killed more than 2000 people a year in the 60s in the US alone and now infects less than 20 a year.

          2. Using caps lock and words such as TOXIC EMERGENCY do not make your claims more convincing. If you believe any level of a natural occurring element such as mercury is so toxic you'd be very shocked to hear that you'd be hard pressed to find a way of living on this Earth without exposure to such metals, even with avoiding your feared vaccinations ;). Of course we consider a mercury spill in a class room to be dangerous, drinking too much water can also kill you - how does common sense fly out the window with anti-vaxxers, as I mentioned in post 1, it is about the level/dose/quantity.

          I'll stick to my scientific opinion over one that doesn't trust scientists, doctors or government "authorities". Thanks for sharing the package inserts, it is important people educate themselves and feel comfortable enough to ask their doctor questions. All doctors should be comfortable answering questions as part of good quality care and gaining informed consent. Doctors do not, however, have time to continually engaged in a 'pointless and closed loop' trying to convince people like yourself that trusting their handful of hours of research doesn't outweigh the collective tens of years of hard work scientists have put into developing, researching and monitoring vaccines.

        • trevor99 on 10/03/2018 - 15:25

          @SydEP:

          Thanks again for reply. Not so sure about the Lol though, considering the epic misery being caused by new and exponentially increasing cases of autism and autoimmune diseases like type 1 diabetes. Surely tracking down the cause of this should be one of medicine’s top priorities and the system could perhaps be a little less arrogant and a little more thoughtful.

          I didn’t say cases filed = cases won. The figures are there for all to see on the govt website link I provided. I see you didn’t mention the cases that were won and proved, and that already approx AUD $5 BILLION has been paid out to victims and victims families. Of cause the trauma, resistance, burden of proof and financial risk victims have to endure to bring such a case is so difficult that many cases are never even brought.

          Thanks for calling me “Anti-Vaxxer”, nudge, nudge wink, this guy is a loon guys type implication. This is the type of method authorities use to shut down any discussion. This is not science.

          Anyway I’m extremely glad you have agreed that vaccination is not a one way street. Thank you for that. This is usually not the case as the authorities will cleverly imply there is no risk. If others want to take away only one point from this discussion take that.

          Also I’m not surprised you don’t want to continue this discussion. I’m not blaming you, any graduate would say the same. Rope learning, reaction, prescription just as the system demands. Ask yourself, has the system and consensus always been accurate? Ask yourself, how long did it take to declare smoking bad for your health. Ask yourself, why thousands of doctors said smoking did you no harm and many argued which brands actually gave you more health benefits. Ask yourself, what are the financial incentives provided by big pharma and the govt these days to make vaccination targets. Ask yourself, why big pharma in the USA has been exempted from being sued from vaccine injury. Ask yourself, is Aluminium really not poisonous, does that really ring true? Ask yourself, what incentive do parents have to try to speak out? Only for the common good.

          It’s not until doctors have many years of experience of cases that they sometimes question vaccines, but even of those who have these thoughts, most would not dare speak as it’s quite clear what happens to them if they raise questions. Public humiliation and loss of licence. This is not science.

          The best vaccine ever invented was plumbing. Hygiene.
          This, not vaccines is the single greatest cause of disease rate reduction.
          Think.

        • geoffs87 on 11/03/2018 - 22:39

          @trevor99: mate, everything has risks. You say 1200 cases of death in USA, a country with 325million people. Lets assume each person had 1 vaccination in the timeframe you have referenced, (which is a stupidly low assumption given most people have multiple vaccinations). Thats a 0.0003% chance of death, for having a vaccination. I think most vaccinations are there to:

          A) provide you a much greater chance than 0.0003% chance of surviving the thing you're being vaccinated against
          B) trying to eradicate a disease from a population altogether

          Sure, it doesnt always work, but flushing the toilet doesnt always remove the waste from the bowl either

        • trevor99 on 11/03/2018 - 23:17

          @geoffs87: Hi Geoff, thanks for the reply. I can see you are being thoughtful and trying to be helpful.

          However consider for a moment Autism. They have no explanation as to the cause of it's exponential rise. They're finally giving up on their attempt to explain the increase in autism by "genetics" which was always a ridiculous argument as we had the same genetics 100 years ago. So it's a mystery but it's been isolated to some change in the environment.

          Unfortunately it's rise is closely statistically correlated to the rise in the vaccination schedule. By the way the govt knows who isn't vaccinated - approx 5% or so of kids but won't release the stats of disease rates in this population. Wouldn't that be a simple way of proving their case? I can tell you from the examples I know, quite a large sample, the unvaccinated kids are healthier.

          In the 1950s it was estimated that 1 in 25,000 children was diagnosed with Autism.
In 1970s and 1980s, about one in 2,500 children was diagnosed with ASD.
In 2000, the US Centre for Disease Control (CDC) reported that the prevalence of ASD had reached 1 in 150 children.
In 2004 this figure had reached 1 in 125 children
In 2006 The figure was one in 110 children
In 2008 this figure reached 1 in 88, based on the CDC’s ADDM network of 14 monitoring areas across the US. These ranged from 1 in 208 in under-populated states to one in 47 in populated eastern states.
In March 2013, the US National Health Statistics Report indicated that 1 in 50 children across the US were diagnosed with ASD. In populated US cities this is already 1 in 27 children.

          If one extrapolates the trend from these figures as shown in the following graph, we could easily be looking at a 5% incidence in Autism by 2020. That is one child in every 20 children across the US having a diagnosis of ASD by 2020.

          "The exact causes of Autism in general, and for each individual child with Autism remain elusive."
          The number of children diagnosed with ASD has and is still growing at an alarming exponential rate.

          Of course it makes perfect sense that neurotoxins found in vaccinations can cause brain damage, in effect what autism is.

    • Save Medicare on 10/03/2018 - 14:01

      Lol

  • geoffs87 on 10/03/2018 - 07:56

    curious to how mixed billing works? My doctor also does mixed billing, and i am bulk billed. When i started going to him i certainly needed the help with bulk billing, but since then my personal income has increased, and certainly could afford to pay full fare (but the bargainer in me is obviously happy i am still bulk billed).

    Thanks!

    • AusGP on 10/03/2018 - 08:49

      It depends on the clinic - different clinics have different policies. Our clinic has a policy of no bulk billing on first visit but I have certainly put that policy aside for the patients that needed my help.

      It's up to you but I would personally let them know I can afford to pay. I actually forced my own GP to start charging me as he kept bulk billing me and I really don't need the discount and someone else can benefit more from him bulk billing them.

    • [Deactivated] on 11/03/2018 - 11:37

      Mix billing works by you paying a "gap" on top of what medicare pays the doctor for the time of consultation. As RJW mentioned it is at the discretion of the GP and although my clinic is mixed billing for certain age groups I still bulk bill some patients for example if they say they are struggling financially or if they are a student without a job (It is discretionary though).

      • geoffs87 on 11/03/2018 - 22:23

        You'll have to excuse my ignorance, but why aren't all patients not bulk billed then? Is it because only a certain number of patients are covered by government payments, or, due to the lower amount covered by medicare, practitioners therefore need to charge a higher rate to others to support their costs (and ultimately salaries).

        FWIW, I did 2yrs of a medical degree before deciding it wasnt for me, before moving into finance - so the business side of medicine actually interests me more than the healthcare side of it (how terrible is that! people generally become doctors to help people, somewhere along the line i lost that ideology :( )

        • [Deactivated] on 11/03/2018 - 22:51
          +1

          To each of their own my friend. I think many doctors lie to themselves and think they are "altruistic" when they aren't. They say they feel sorry for others who are poor when they themselves earn $200k+ and do nothing about it.

          A standard <20min consultation is only $37 under medicare. So the doctor gets 70% of $37. If you think about it and calculate it we get $26x3 (per hour)x40 (hours per week) x 48 (weeks) as our yearly pay which is $149k. We don't get bonuses, we don't get paid lunches, we pay for our own study material and courses, insurance, college fees so at the end of the day most doctors don't feel they are being paid what they are worth. Also clinics don't like doctors who bill less because it cuts directly into their profits. If they could hire a doctor to bill $300k a year vs $200k a year of course they would pick the one that earns more.

        • geoffs87 on 12/03/2018 - 09:58

          @r3d3mption: Thanks for your comprehensive reply. That makes complete sense, and i never actually did the math (or understood the medicare contribution).

          My GP is the best i have used, generous, friendly, works tirelessly to get to the bottom of the issues, and books in 30min sessions… so he's likely getting less than what you've suggested above. Maybe it is time to start being charged when seeing him.

          Yeah, i understand what you are saying about the clinics, they are after all a business.

          Glad this AMA came up - i learnt a few things this week. so thank you @RJW and @r3d3mption

  • Clear on 10/03/2018 - 08:44

    Hey RJW thanks for taking the time to do this AMA!

    I currently work in the medical industry managing IT and medical equipment infrastructure from the tiny 1 man GP practice to the massive hospital with an emergency department. My questions are more technical.

    • What software package are you using? Medical Director? Best Practice? … Genie?
    • Any preference if you used more than one?
    • Anything you find particularly frustrating working with the software?
    • Do you think printers are cancer?
    • Do you believe everyone's medical records should be accessible in the cloud? A system perhaps similar to MyGov?
    • Any thoughts on software going cloud based? E.g. MD Helix
    • Do you think access to records should be better regulated? Are you aware of the many third parties that access records?
    • AusGP on 10/03/2018 - 09:06

      Hey Clear thanks for the question!
      1. We use none of the mentioned packages. I don't want to be too specific in case it identifies my specific practice as I know very few practices use our software.

      2.In an ideal world I prefer my current software melded with MD or Best Practice

      3.It keeps crashing intermittently. I can't send and receive plain emails from the software itself (so that it is logged) - there is a function to send word doc attachments

      4.Printers are still very useful. Wish didn't have to print so much off to fax etc.

      5.If the PCEHR actually works that would be magical and a huge benefit to medical care. What would be even better was if it was live automatic upload and download like a cloud based platform. There are so many issues with interoperability between software though. (In commercial interests of software providers for this to continue unfortunately)

      1. MD Helix sounds good but I'm told it's not quite ready yet and there are issues?

      2. Not aware of any 3rd party use in general. There are functions within local primary health networks where he identified data is extracted to see for example how practices are doing as a whole managing diabetes etc.

      • Clear on 10/03/2018 - 12:39
        1. We use none of the mentioned packages. I don't want to be too specific in case it identifies my specific practice as I know very few practices use our software.

        Unlucky! I hope it's not some of the nasties like Zedmed or Medtech. Perhaps Telstra's Communicare? Those are all horrible from my experience.

        2.In an ideal world I prefer my current software melded with MD or Best Practice

        That's what everyone says! Everyone loves the simplicity of BP but miss some of the advanced feature of MD.

        4.Printers are still very useful. Wish didn't have to print so much off to fax etc.

        What I meant was do you have a love-hate relationship? I can't go a single day without half a dozen doctors complaining that their printer isn't working among other issues. Normally they've turned it off. Sometimes I wish fax would just hurry up and die. They're bit a funny as they consider emailing to be insecure while fax to email is acceptable.

        5.If the PCEHR actually works that would be magical and a huge benefit to medical care. What would be even better was if it was live automatic upload and download like a cloud based platform. There are so many issues with interoperability between software though. (In commercial interests of software providers for this to continue unfortunately)

        Not sure how your software package uses it, but the general feedback I get from people using it with MD has been really good. Not that I've ever properly used it though.

        MD Helix sounds good but I'm told it's not quite ready yet and there are issues?

        Horrible. Absolutely horrible. Considering how many times HCN has changed ownership over the years it's not a surprise that Helix is broken. Heaps of my clients talk about it, but our main concern is who owns the data? It all gets hosted offsite and you have no way of knowing who could access it.

        Not aware of any 3rd party use in general. There are functions within local primary health networks where he identified data is extracted to see for example how practices are doing as a whole managing diabetes etc.

        I should have been more clear. There are many different people from different organisations accessing medical information on a system. I often come across a Doctor who hasn't received results for a patient like pathology. They get their reception staff to check who can't find it, so pathology check and say they've sent in. Then the IT department/contractor get involved and look at the patient file to ensure that it's not there aaaand finally the software vendor who provides the link has a look and manages to find the results stuck in the software. At the end of all of that you could have had 10 people from 3 organisations look at the patient's file.

        • AusGP on 10/03/2018 - 12:50

          Hmm yes that's indeed a big concern if multiple people have looked at it. In general we're pretty good and I don't think there's been that level of issue with our data requiring lots of people to look into it. But at the same time I'm not working at the back end of things.

          Yes I heard MD has a really simple interface with PCEHR. Unfortunately we're using one of the ones you mentioned and although initially I thought it had some good functions, the main problem is it's not a market leader so all sorts of problems with 3rd party software that doesn't work well (including PCEHR uploads needing some manual input)

          Printers break often. But our practice manager is so organised we got backup brand new printers (they're no longer being sold)

        • Clear on 10/03/2018 - 13:43

          @RJW: Let's hope your package gets better with time because converting databases from one package to another is a nightmare when you're not using the leaders. Hundreds of hours of my life have been taken away from those not going smoothly.

          I'm glad you've got a competent practice manager. The worst practices always have the worst managers.

        • Save Medicare on 10/03/2018 - 14:03

          @Clear: hundreds of hours of your life that you got paid for though. If I were you I wouldn't mind too much. More work = more money

        • Clear on 10/03/2018 - 14:04

          @Save Medicare: Significantly harder and more draining work for the same level of pay as any other day. 10+ hours a day of SQL is very tiresome.

        • AusGP on 10/03/2018 - 17:54

          @Clear:
          Do you think there's room for a new software package to thrive?

        • Clear on 10/03/2018 - 20:34

          @RJW: If they're able to offer the same features as the competitors for a reasonable price they could succeed. The difficulty is getting their software to implement well with all the other applications that are used in a practice to download results, send analytics away etc. The best way is to get a larger group that manage several practices to switch over.

          In the pharmacy space some companies are pushing out the cloud applications to their flagship stores to gain confidence.

        • AusGP on 10/03/2018 - 21:22

          @Clear:
          That sounds pretty tough then! (Needing to try and get a large group to switch over)

  • gumcheap on 10/03/2018 - 09:00

    I have a tiny penis, what can you give me?

    Also I have angry issues very snappy at idiot and rude workmates, long queues at shopping, traffic jams, etc

    • AusGP on 10/03/2018 - 09:40

      Have you talked to your GP about your anger issues? A good GP may be able to help and assess and send you in the right direction for help :)

    • IWoNdEr on 11/03/2018 - 11:13

      If you suddenly become very angry and quite consistently - I would suggest a scan of your head.

  • mangochicken on 10/03/2018 - 09:20

    I'd like to see some type of of online portal where I can view my results, my doctors attendance and future appointments. Does this already exist? And this maybe integrate into MyHealthRecord?

    And why do you think there is such a variation in care in general practice? I feel like alot of GP's I've seen are duds, I've been moving around just to find the right one. And alot of the good ones will be private billed.

    Love your idea of using this platform to engage with consumers (I also work in health and was at the BCV event and also look for an occasion bargain on here). Awesome work we need more GP's like you.

    • AusGP on 10/03/2018 - 09:38

      I think our software package has this kind of "portal" functionality but as far as I know not necessarily the easiest to use. Apart from appointment times, I can actually load patient results manually to myHealthRecord so that is probably the way to go forwards.

      If they can expand MyHealthRecord to include a timeline of patients specialist and GP appointments that would be amazing!!! I was talking to someone at the BCV where their hospital appointment letter arrived AFTER their actual appointment date - luckily he was being managed the BCV backed Virtual Fracture Clinic and was notified!

  • GOCAT9 on 10/03/2018 - 09:32

    RJW: is there such a thing as an “off the record” conversation with a doctor. In other words you don’t want the topic or conversation to appear on your medical record. I’m not talking about topics with involve unlawful behaviour for example or topics about which may place other people at risk etc.

    Are doctors obliged or is it normal for them to make a record of all conversations on your medical report?

    • AusGP on 10/03/2018 - 09:41

      There's a functionality where the record for that interaction can be made confidential and only accessible to that particular doctor you spoke to :)

      • GOCAT9 on 10/03/2018 - 09:56

        Ok, but in that case that would mean it is still technically “on your medical record” albeit with more limited access!

        So, it would seem it is not possible to have a totally, in all senses of the word, “off the record conversation” where the doctor enters NOTHING on a computer or paper record??

        • AusGP on 10/03/2018 - 10:16

          It will depends on your doctor whether they agree. It comes with legal risk but if they're comfortable with it then they might be willing to not note anything down.

  • pyramid on 10/03/2018 - 10:36

    Why does GP prescribe medicine with steroid for sore throat

    • AusGP on 10/03/2018 - 11:00

      It can be useful in severe tonsilliti, glandular fever for example. Sometimes the body's own immune response and inflammation to infection is so severe that we need steroids to suppress it.

      However not routinely used for standard sore throats.

  • Amour on 10/03/2018 - 12:02
    +1

    I suffered through many years with an under active thyroid due to several GP’s and two endocrinologists treating TSH as the panacea of thyroid function. If I could make one improvement in the GP’s I see, always check free T3 and free T4 levels, as T3 results can be in complete contrast to TSH (as it always is with me). OP - don’t underestimate the difference you can make to someone’s life if you pick up thyroid issues on a person who has been previously undiagnosed by Dr’s who are blind-slaves to TSH.

    • AusGP on 10/03/2018 - 12:27

      Thanks lms1306, hope you are feeling better now. Sounds like you might be one of the unlucky few who have that rare combination of blood test results (that we are aware of but due to rarity the teaching is to treat TSH) - but I will definitely keep your story in mind!

    • gimli on 10/03/2018 - 22:48

      What do you take for your thyroid now?

  • Yaren24 on 10/03/2018 - 12:42

    Hi OP, thanks for posting this thread, do you have any advice for IBS? I have been doing everything I can to improve the symptoms?

    And how do you help with your patient to gain more sleep?

    Thank you

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