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

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!

closed Comments

    • Hi Yaren24 - this probably needs to be explored more with your doctor as needs a proper assessment before suggestions can be made (I.e. is it really IBS needs to be established) Also as a public forum I will refrain from too specific medical advice about certain conditions.

  • Hi RJW thanks for doing this. I had a few questions about training/work.

    How difficult is it to get accepted into gp training straight after the intern year?
    - For example, is research required?
    - I would imagine getting good references is crucial, any tips on this besides just being a good intern?

    How stressful is working as a gp? and compared to med school/internship/residency? As a gp you have all the responsibility now, but I thought, maybe once you get past the initial hurdles and have a knowledge base to work off maybe it's not as hectic.

    Thanks!

    • +1

      Another GP here who will hop on and help with the answers.

      You can apply for the GP training program in your intern year but still need to complete your RMO year before you can start your GP Training. If you are unsuccessful in your Intern year application you can reapply in your RMO year and technically it wouldnt delay how long it takes to start working as GP if you get in during RMO year.
      - Research isnt required and wont help you get onto GP training, you do need to do a minimum requirement of rotations as a Intern/RMO. These are General Medicine, Surgery, ED and Paeds. Where I live it is difficult and competitive to get Paeds terms in your 1st RMO year (PGY2) so instead you can do 2 terms in a outer metro ED that has paeds patients and they will consider that your paeds experience.

      They have a entry exam for GP training that is more aptitude testing rather than knowledge based, practice questions should be available on GPRA or AGPT website.

      GP can be stressful but if you can find a good practice it makes a world of difference. The hours improve significantly from prior medical training/time so work/life balance is a big win. But it can be a steep learning curve. One of the hardest aspects is learning to get ontop of the paperwork in GP, but a simple trick would be block off your last 2 appointments every day and allow time for phone calls/paperwork to catch up.

    • Hey Coolhand-Mikey - basically Azrael169 has covered it all!

      I would just add being a GP can get stressful as you're responsible for all aspects of their care. Inevitably, you are seeing undifferentiated patients and this can mean anxiety about missing a diagnosis. I have had a patient end up in ICU barely days after seeing me as a registrar - but luckily I had called my supervisor in at that time (whom has 30 years of experience). In talking through the experience and after hospital discharge (with no apparent specific infectious cause found for the problem - sorry I'm being vague due to confidentiality requirements), we both agreed that we wouldn't do anything different even if we saw the same symptoms again (vague flu like symptoms).

      However depending on your personality this can cause a huge stress or you might be ok and learn to deal with this uncertainty.

  • Do you think that we will end up with male doctors needing a witness in the room any time a female patient needs to undress?

    • It will depend - I think I'm still happy to examine without a chaperone but I always offer patients a chaperone from our nurse (if they're there).

  • I think I am a lucky one, have been visiting bb gp only and had treated me very well, never paid anything out of my pocket. Which makes me wonder what warrants other GPs to charge more than Medicare covers?

    Th bb clinic I go do bookings. I get good 10-15min consultation with my dr every visit. Occasionally my dr just gives me samples like puffers, sprays, etc., saving me from buying. I mean what more do you get from non-bb GPs by paying more?

    And I don't agree GPs don't get enough so they need to charge more. The $37 sf splits $15 and $22 between the clinic owner and my GP, so even with bb, a GP gets $88~$132 hourly rate! That's at least $174k annual income to you!

    • Perhaps you need to consider:

      • the additional 1-2hour/day that GP needs to look over blood test result, specialist letter, and notifying pt of urgent results

      • the professional indemnity insurance which is in thousands a year

      • registration to profession body i.e RACGP and the requirement for ongoing professional development to meet registration requirement

      • debt accumulated over the years of university study

    • At the rate I practice it will be more close to $88 per hour as I see 4 per hour and find myself pressured if faster (as mentioned by another commenter - not including any super, sick leave, annual leave, insurance, follow-up time).

      Hence most BB GPs get patients to come back for the simplest things. I have been told gently previously during training maybe I shouldn't give patients the full script for the pill so that they can come back (I smiled but just did the same I always do and give repeats as appropriate for the patient).

      It really depends on the area as well as expenses for clinics are higher at certain locations (due to rent).

      As I mentioned in another comment, doctors have made some life sacrifices so whilst I'm not complaining, I don't feel embarrassed with what we earn. In comparison with some of my friends I'm just starting the journey of catching up to the several years head start they've had on me!

      • So you are saying in your case, even the clinic charges more, your getting the same $22 per consultation as BB GPs, only your clinic gets a bigger bite? Hence at the end of the day, we do not pay more to GP, just more to landlords?

        • I don't currently work at a bulk billing clinic but I did previously whilst training. I still bulk bill around 25% of my patients.

          What I was saying is if I worked at my current level if service I would be earning $88 as per your calculations. (I strictly do 15 min appts but still end up running late 30 min at times).

          Also a bulk billing clinic in inner city with higher rent would either have to pay GPS less, or get them to see more patients per hour - putting downward pressure on quality either way

        • +1

          GP Registrar here. In rebuttal to your $174k income per year:
          -take close to 17k off that for superannuation
          -take 4 weeks annual leave, there's another 13k gone
          -take 10 days sick leave in a year, theres another 6k gone
          -take out indemnity insurance, CPD, registration etc - another 10k+ gone
          -reminder that your not always "fully booked", which means you dont earn anything
          -Take all that stuff off, if you bulk billed 4 patients an hour, youd get a bit over $130k

          -130k sounds amazing for 8+ years of university training, whilst everyone else has had a house for a few years, no HECS debt. It really isnt that much

        • @dmcneice:

          Don't know about you, but before I fellowed I raked in 190k. Super was on top and I took my 4 weeks leave. I was on 130k on my 2nd year as reg.

        • @majuks: Teach me how.

        • @dmcneice:

          Then factor in other expenses. I'm not a GP reg but I spent about $15k in the last 12 months on education, and am sitting shout $5k of exams this year.

          I earn more on paper than my wife who is a pharmacist but her actual usable income is more due to my greater debts and expenses.

    • My Bulk billing colleagues bill medicare about 2500-3000 per day on a good day. Oh, and I won't work for less than 70%.

      • Surely they don't see 4 patients an hour though?

      • How do they manage to bill 2500-3000? - I don't even hit those numbers at a mixed billing clinic!

        Is it through chronic disease management plans? That gravy train is likely to end soon…

        • My old bulk billed GP asked my wife when pregnant to come visit him once a fortnight to check up, this was after we got a referral to the hospital and seeing midwives there. After a couple of consultantions where he just had a casual chat to my wife about “hows it going” and taking her blood pressure we stopped seeing him.

          It’s jsut obvious govt coffers were supporting his Mercedes (parked infringement of clinic every time).

          Can the government tell if GP’s Rip off the system?

      • I take it that you won’t work for less than circa 1500 per day, but why not?

        • After clinic takes cut I reckon around 1200-1300 is my income (pre tax and have to pay own sick leave, annual leave and super) - not complaining though.

        • @RJW:

          We’re talking per day right?

          aftrr taking into account all those perks, I’d guesstimate you’re on the equivalent of around $900 per day, or 4500 per week pre tax. Not bad.

        • @cloudy:

          I actually only work 4 days (about 40 hours as each day averages 10 hours) but I guess that's about right?

        • @RJW:

          Yea, most people work a minimum of 40 hrs, 45 -50 is pretty normal. But that’s for a 1000-1500 salary, per week.

          Most people I know on 3000+ per week would work around 55-60 hrs

        • @cloudy:

          Yeah I am aware and know I'm pretty lucky. My family survived on Centrelink as my parents studied (after dad finished up his struggling business) so I am absolutely aware of the privilege I have and how fortunate I am.

          Having said that I am also aware lots of people see doctors as earning more than they deserve. I can only speak from personal experience but I sacrificed a significant proportion of my childhood and adolescence to gain the smarts to get into med school, then slogged through med school and internship and residency to get to where I am today

        • @RJW:

          Oh yea, please don’t feel the need to justify your earnings. Good doctors can and should earn top dollar.

          What I am disappointed in is seeing doctors game the system. When the patient pays nothing they just listen to the advice as it’s important for their health, where as GPs are happy to bill the paying 3rd party to have a casual chat about someone’s health to fill in empty gaps in their time slots.

          Worse still my old family GP missed my grandpas cancer for 6 months, he has no care for his patients. And would easily be one of those GPs who got 3000 per day. I’ve had an appointment with him that lasted 2 mins lol. He averages 5 min appointments per patient.

    • -1

      If you want an influx of average IQ people becoming doctors this is the way to proceed. Income is an attractant for those intelligent as well so if there is no incentive in that regard people would end up doing something else. I am sorry but this is the reality of it. Many people don't just choose medicine to help people because there are plenty of other jobs that help people. They choose it for the challenge, to help others etc. and to earn a good income. Do you really want to put your health in someone of average intelligence? I probably wouldn't considering I have seem such dumb things done by even smart people.

  • Where do you practise? I and my partner have had horrible luck finding a decent GP, as have many others here. You sound awesome, id be stoked to have a doctor like you!

    I think the main points have been made many times and it sounds like you have them covered. The biggest gripe I have, and I push for it as much as possible, is that I hate being treated like a puppet. I like to understand what is happening. If they prescribe something then why, what does the drug do and how does it relate to my symptoms and help me. If they order a blood test, what are they looking for? I crave detail. It doesn't have to be a lecture, but I come from an academic family and background, and it should at least be an option if you recognise someone is interested to know what you are doing. If you a feeling for something in their body what are you looking for? Why?

    A typical experience for me happened recently:

    I recently had a sports injury and couldn't move my wrist properly, and I would have intense pain occurring seemingly randomly. I went to a (private, paid) clinic the day after, I had been icing it and it hadn't subsided at all.

    When I walked into the doctors rooms they didn't even look at me or ask what happened. They asked what I wanted. I explained how I got my injury and described the pain and issues I was having, and still without even looking away from the computer, they asked what what I wanted them to do.

    I said I wasn't sure since I wasn't a doctor, suggested maybe they could take a look or feel the joint or something, use their professional expertise to see if they think it might have some serious damage, maybe they they can judge if I hurt anything in there and need to do sending to help recover properly.

    Still not looking at me, they asked me if I wanted an xray. I said yeah maybe that would help it might be featured or something. They printed out an xray order and showed me the door.

    Not once did they make eye contact, or look at my wrist or really say much to me at all. Not even basic politeness like hello and goodbye.

    • +1

      Hi Sammus, sorry I don't feel quite comfortable disclosing where I practice specifically - I am practising in Melbourne though!

      That sounds concerning particularly for a paid private clinic! Interpersonal skills and listening properly is so important particularly in general practice - where patients often feel a little worried to mention their deepest concerns.

      However I would say don't give up! If you hear of a good GP from your friends that would be a good place to start!

      • Of course you shouldn't disclose, I was asking semi tongue-in-cheek :) thanks for your reply.

  • Is there any particular medication for hair loss ?

    • There is but best to see your GP +/- referral to dermatologist if you want the latest advice!

  • Do u reckon MINOXIDIL works for hair loss ?

    • Don't you mean Dimoxinil?

      http://simpsons.wikia.com/wiki/Dimoxinil

      • Lol! Didn't realise Simpsons did a take on this - but I'm sure it's a take on minoxidil. Brucet - sorry can't give you any specific medical advice on an online forum!

    • Depends on the type of hair loss. If its the typical male-pattern baldness(adrogenetic alopecia) then Minoxidil does have some efficacy but the response to treatment is quite variable.

  • Hi Doc, Is there a way to test if a swollen lymph node on a neck is caused by cancer? I.e blood or sample test?

    Thanks for your consideration.

    • It's possible to have a biopsy taken which involves sampling it and sending it off for testing.

    • Yes as synergy already responded. However should discuss this with a doctor as there's always risks with procedures and wouldn't want to do anything unnecessary

  • +1

    I find GP's these days just want to pump us with pills and send us off, they aren't interested in investigating the cause of the problem any more.

    • I think some GPs do that and unfortunately spread a bad name for other GPs:\

    • It really depends on the presenting complaint. There is many conditions where investigations aren't warranted and it is a "clinical" diagnosis i.e by history and examination. Investigations are also not risk free and there is also a cost to the taxpayers. The issue is that many doctors feel time pressured and agree with patients when they ask for antibiotics because it is easier to write a prescription than to properly explain their condition won't need antibiotics. I've seen a a child with herpes given antibiotics and then develop diarrhoea and the parents complained the child was not getting better. I've seen oral candidiasis for a child with herpangina (which is a viral infection) and he didn't eat anything for 2 days, all which could have been avoided if the doctor properly examined and talked to the parents instead of giving amoxicillin straight away.

      • Wholeheartedly agree with r3d3emption's response!

  • Thanks for the AMA - I always wondered about a few things so here we go: I have this great practice nearby (Sydney) with good doctors but they also charge a lot for 10 mins consultations. I’m OK with that as I don’t have the time to spend 1h or longer at the local medical centre who bulk bill. What I don’t get though is how if I got to the medical centre, they can do photos and scans as well which don’t cost me anything but through the other practice I have to book an appointment somewhere and pay lots of money. Similarly, when doing blood tests and other health checks, why does it sometimes cost money? What choices do I have when my blood etc gets tested? And why does it sometimes take a day and other times 3 days for results to come back?

    • Some blood tests do not have a medicare rebate,hence the extra charge. Increasingly, some labs are now charging money and only bulk bill concession/pensioners. Sometimes if your pathology form wasn't ticked direct bill and you have not signed the form, you will get a bill.

      You can ask your doctor to make sure the bulk bill box is ticket.

      Blood Test results - some test will take 5 days + days to come back too, part of it is limitation of technology, part of it is because certain tests are only run on certain days so they won't lose too much money to bulk bill you tests. A good example would be Hepatitis C PCR test.

      Remember, Medicare is purely insurance. all GPs that is not attached in a hospital are all private, not part of the government, even the Aborignal Medical Centres. GPs aren't obliged to bulk bill ANYONE.Not even pensioners or concession card holders.

      Why do tests cost money ? Well, its the same thing like why do Haircuts costs money? Why isn't KFC free? Why isn't my back massage bulk billed by the remedial massage therapist? A service is a service and just because no money is exchanged doesn't mean someone else is paying for it.

    • +1

      Hi Bozbargain - part of the reason from a process point of view is that any pathology and radiology company are free to charge whatever they want, just like GPs. The reason the majority of GPs are still bulk billing despite the pressures of the Medicare freeze is everyone is afraid to stop bulk billing as they will lose customers (essentially they're worried whoever blinks first stands to lose). Same applies to some pathology and radiology companies.

      At your private practice that charges, they're just renting out the space to a radiology company - so if that company decides its better for business to bulk bill then they will.

      A word of caution - bulk billing radiology quality can vary. I have a friend who's a sonographer (person who does the ultrasound scans) and has warned me of the very "dodgy" radiology practices out there - and quality does vary wildly. Some even pay the sonographers a cut of the scans above a certain number of scans per day - so then instead of quality there's a natural incentive for speed. Also at bulk billing centres, I'm assuming radiologists (doctors that are specialists in assessing XR and imaging) also have a time pressure at bulk billing radiology services. As such I am very cautious which bulk billing radiology centres I send my patients to. At the same time there are scans that are probably less crucial that I am happy for patients to get bulk billed. Sometimes I get around it by sending patients to a good radiology service that probably hasn't been around for too long and hence to gain business and reputation starts off as bulk billing.

  • What is your take on acne on how should it be dealt with? (asking for a friend in need) :")

    • +1

      Gimli has pointed you to the holy grail of dermatology websites that I always use. But it should be discussed with a GP as there are always treatment side effects, pros and cons etc.

  • How old are you? how much do you make a year pre tax? and after tax ?

    • Hey Bob01, I'm in my early 30s, have already answered in previous questions in detail so might not repeat it again!

  • I just had a couple of questions on your perspective on medical graduates and specialisations.

    1. How do you feel about the issue that stands with certain specialties only accepting a handful of new trainees. (I think derm only took 10 or so last year) This creates an issue with waiting times for patients, as well as certain Doctors spending years and years applying and potentially never getting in. I understand why it happens and the difficulty in changing it, but do you think we might see any changes in the future?

    2. As a current medical student, I often worry about picking a specialty the offers a good balance in work life balance and being in a field that I'm interested in. Specifically the idea that attempting any surgical specialty is signing away your 20's and the better part of your 30's to work/train. I've spoken to quite a few people who were interested, but the idea of missing out on their youth was a strong deterrent.

    3. Finally, as a GP what would your biggest selling points be to entice a student to pursue general practice?

    Thanks for your time!

    • -2
      1. Not going to get better. The Australian Government determines how many new specialists they are going to train per year. Its somewhat linked to population and demographics. It is also complicated by lack of hospital funding, not enough supervisors and most specialty colleges has vested interests. They can't have too many specialists floating around. It is only recently in my local area that cardiologist are willing to bulk bill to drum up business due to more cardiologist around. The major difference between a dermatologist and GP is, the GP cannot really legally just prescribe roaccutane.

      2. Well, Only GP offers some form of work life balance. If you want to go into surgical specialty, you probably need to have the college board members as your best friend in the 3 most major hospitals in your state to have an easier way of getting in.

      3. It can be lucrative. If you are a private GP-Obstetrician in RA 4 area, you can still rake up 800k p.a depends on what you do. Don't be fooled that GP is a poor man's specialty. It hardly is. Plus, you can take as much holiday as you like or work as hard as you want.

        1. Actually limiting factor is colleges. There are various 'non accredited' training positions which unfortunately are not approved by college. Often this are in hospitals with accredited positions where both accredited and unaccredited trainees do similar work.

        2. Medicine is a hard slog. I think you got to enjoy what you do. If you enjoy something eñough to dedicate extra time to it then great if not speciality training may not be for you…

        3. I think as a GP you can choose how you practice and make it is interesting/satisfying or lucrative as you want. Definitely going more remote/regional gives you more flexibility in terms of how you practice!

    • +2
      1. It is a big issue and I think the reality is it's very political. Firstly in the sense that the government has to be willing to provide the funding for training and secondly it's internally political as specialists want to protect their income and turf. I don't see it changing very much. Even despite the smaller numbers trained there's already specialists who can't get hospital positions unless they go far rural (e.g. I have heard of consultant surgeons flying from Melbourne to rural Queensland on a WEEKLY basis - to be a full time consultant in Queensland but their family is in Melbourne)

      2. That is only a decision you can make, taking into account whats important to you. I probably could've gone down many non-surgical specialty routes but in the end chose GP (didn't apply to any other college). I've come across two specialists whom I've worked with before whom seemed disappointed that I had become "just a GP" (by the looks on their faces anyway) but I am proud to say I chose general practice because it fit in with the way I want to practice medicine, but also the way it fit in with those I love around me.

      3. Biggest selling points:

      - Huge variety. We don't see just colds. As you can see in another post - I have picked up some interesting cases and you CAN save lives in general practice even if you don't take into account all the preventative care that saves your patients from heart attacks and strokes and lung cancer etc etc.
      - Personal connection - nothing more rewarding than a grateful patient. Especially lovely when they send you a thank you card or a child sends you a drawing! In the future I'm sure I will also see some of my patients grow up and hopefully go onto big things!
      - You are your own boss - flexible hours, you can choose to work for someone else or you can start your own practice. You can take as much holiday as you want. You can locum easily around the country.
      * I wouldn't say the money should be your biggest aim. 800k per annum as a rural GP-Obs (as detailed by majuks above) seems excessive - but essentially I guess you're practising as a private obstetrician and certainly I know they can hit more than that (although a salaried obstetrician earns much much less)

  • Ok here are some tough questions.

    • What would you do you if you were to realize that a specialist had made a major mistake in diagnosis or treatment? What procedures could you go through to get them re-assessed if it was time critical.

    Some not so hypothetical examples
    Example A: Arrogant jerk of a specialist who had prescribed Clomipramine for Narcolepsy and petit mal seizures. This had resulted in an increasing frequency of grand mal seizures. When I went to see him with the patient he literally told his secretary this would be a quick consult before even speaking with us. When we described what was happening, he said okay yeah stop the medication. I had to point out that suicide is associated with sudden cessation and the drug is one you need to wean off, and so ask him for a new script. By the way seizures are a contraindication for the drug. Should not have been prescribed in the first place.

    Example B: A loved one use to have a bad shoulder that would dislocate frequently. (By frequently I mean she'd had 170+ documented dislocations). Unfortunately it was a posterior dislocation. So when she would present at hospital they'd do the X-rays for an anterior dislocation. (You have to take an Axillary view for that to show in an X-ray). So with a bone clearly protruding, they would send her home claiming it was swelling, at which point we'd need to go to another hospital. No one was willing to contradict an ortho who'd taken a look at an X-ray and said it isn't dislocated. Yes this happened multiple times. Dealt with this by carrying around this journal article -
    https://www.sciencedirect.com/science/article/pii/S073567570... - but in reality the best way to deal was to present at a different hospital and hope the Ortho on shift was better. To make matters worse she had 2 of the wrong surgeries - for an anterior dislocation - before I found and referred her to a new surgeon who said "they've been doing the wrong surgery all along" and fixed her up on his first attempt (her 3rd surgery, had to beg her to try as she'd given up).

    • How would you suggest a patient deal with a GP that missed something that should be obvious.

    e.g. Spiking blood sugar or insulin levels where instead of telling the patient "hey you're on your way to diabetes, pal. Your call" he instead says not to worry and that the numbers are "just peaking".

    • Medical institutions, authorities and power structures here and around the world are stuck in the dark ages where once a position is attained it can't be challenged easily. As a result people do not report gross negligence and often it is difficult and takes years to get a doctor that's gone a bit loopy out of the picture. There's also systematic stuff - doctors working shifts where any truck driver caught working as long would lose their jobs, medical exams that are run like an ordeal by fire to no positive effect on the new medical practitioner etc. I feel this is the elephant in the room and until we have saner standards and authorities, clear and easy ways to ensure that negligent or malicious doctors are quickly dealt with, any other reforms are going to be slow and hampered by bureaucracy and other interests.

    • Would you favour moving towards a system where there were more doctors with a limit on shift of 8-9hrs/day except in an emergency? Do you believe that the long hours interns suffer are necessary to attain the experience required at the start of their career?

    • *What would you do you if you were to realize that a specialist had made a major mistake in diagnosis or treatment? What procedures could you go through to get them re-assessed if it was time critical.
      -> Contact the specialist directly and say - hey, are you sure this is the right diagnosis/treatment based on XYZ reasoning. If I'm still in doubt I will ring up another specialist and see if can get a second opinion. If I'm still unhappy and time critical send patient to ED (quickest way to get a resolution). The key to all of this is I must write / handover the critical information. Too many GPs send patients to specialists or ED without a detailed letter and no wonder patients get turfed out.

      *How would you suggest a patient deal with a GP that missed something that should be obvious.
      -> Speak with the GP or file a complaint with the practice manager. I don't want to comment specifically on the example you gave without being there and knowing the whole picture, but in general if after that you don't get a satisfactory resolution, you can always escalate to AHPRA or Health commissioner in your state.

      *Medical institutions, authorities and power structures here and around the world are stuck in the dark ages where once a position is attained it can't be challenged easily. As a result people do not report gross negligence and often it is difficult and takes years to get a doctor that's gone a bit loopy out of the picture. There's also systematic stuff - doctors working shifts where any truck driver caught working as long would lose their jobs, medical exams that are run like an ordeal by fire to no positive effect on the new medical practitioner etc. I feel this is the elephant in the room and until we have saner standards and authorities, clear and easy ways to ensure that negligent or malicious doctors are quickly dealt with, any other reforms are going to be slow and hampered by bureaucracy and other interests.
      -> I'm pretty sure doctors are quite happy to report because there is a mandatory reporting system in place where if we think a colleague's "a bit loopy" or unsafe we have to report it legally. This is an issue though with mental health and doctor suicide which may need an exemption (Doctors who are depressed are not willing to seek help because they will technically be mandatorily reported to the regulating bodies - so they suck it up and it gets worse and ultimately sadly a few commit suicide).
      -> There is also the flip coin where AHPRA complaints have been reportedly used as a bullying or intimidation practice against doctors. So we have to be careful either way. Certainly those negligent or malicious doctors whom are dangerous do need to be dealt with quickly. Maybe the Government just needs to resource the regulatory body better so they can action things quickly.

      *Would you favour moving towards a system where there were more doctors with a limit on shift of 8-9hrs/day except in an emergency? Do you believe that the long hours interns suffer are necessary to attain the experience required at the start of their career?
      -> In terms of shift length I agree that the culture needs to change. Although handover between doctors is a key risk for mistakes to occur, I have seen some hugely unsafe practices (which were being changed) when I was leaving the hospital system. Heck even if not unsafe, I have worked 12 days straight 8-14 hour shifts, which is super draining - fortunately it was rural hospital and had a half day break in there somewhere so was ok.

  • You have a baby patient who has the cure to cancer and the only way to get the cure and produce in mass production is to kill it and disect it. You will get away with it and no one will know. You will become the richest person in the world and the world will live 100 times longer because of it if you decide to do this. So do you kill the child with no consequences and cure the whole world and Prolong the life every single person on the planet forever minus the child you killed OR let the child love and never ever cure cancer again?

    • +3

      As a doctor my duty is to the patient. First do no harm. Even if there was a cure for cancer my moral duty remains with the patient and I shall let the child live.

  • how many patients have come in because they 'accidently' fell down on something and now it's stuck inside them?

    • I'm sure a few report that in ED but I haven't seen it yet lol

      • One of my best mates had a patient with a vacuum cleaner tip stuck in the rear exit. Apparently he vacuums nude. The nurses said he has had the same problem before.

        I thought it only happened in Scrubs and House.

  • Hi. I have lost a few relatives to pancreatic cancer, including my father. I've asked a few GPs whether there's any specific test I can have done to check for it and they just suggest the regular blood tests.

    Is there anything you could recommend beyond that? I'm 47.

    • +1

      With that family history I would see an upper GI surgeon who deals with pancreatic cancers for advice. Yes there are several rare genes linked to cancers and if you have the funds then consider having these tests despite the overall low yield. This is not a simple question and it may turn out you will be recommended regular screening tests for both causes of, and the cancer itself.

    • +3

      Hi churchado, with such a clear history, I would seek the advice of a Familial Cancer Centre (not sure if these exist inter-state). But there are such services in Victoria, the two I refer to are based at Royal Melbourne Hospital and/or Peter McCallum (Victorian Comprehensive Cancer Centre) - also available at Austin and Monash hospital. You will likely need to see your GP for a referral form.

      If you are in Melbourne Austin seems to have amazing pancreatic / Liver surgeons (state Liver transplant unit)

      • Thanks for that advice. I am in Sydney and googled it, and there is one at Royal North Shore Hospital. I will hitting up my GP very soon for a referral.

  • During my childhooog and early teenage years, my parents would take me to bulk billing doctors. I suffered from many things which are non-life threatening but still impacts my quality of life greatly.

    The doctors always made it seem like there was nothing that could be done and I just had to endure it.

    Then I moved away for uni and was responsible for my own chicet of doctor. I went to non-bulk billing practice and was blwon away by the level of care I received. The GP listened to me and didn't rush. And everything wasn't cured by antibiotics.

    I have an amazing GP now who I recommend to everyone. Even my relatives who were not initially keen on paying gap to see a GP have been converted.

    I'm not saying all bulk-billing GPs are bad or all non-bull billing GPs are good. It's just I found perhaps the good ones can get away with charging higher fees because they are in higher demand.

    This does raise a point about access go quality care though. While I am lucky enough to be a le to afford a good GP, some people might not be so lucky.

    In no particular order, this is what I like about my GP:

    • Does not rush and listens to my concerns
    • Knowledgeable
    • Explains the aetiology of the pathology he has diagnosed, and rationale behind any diagnostic tests or treatment so that I can stay informed about my own health.

    You sound like an amazing GP. I would totally go to you if I ever moved to Melbourne.

    • +1

      Thanks for the vote of confidence Hogg!

  • 1)How do practice nurses get paid? Is there an extra fee you can charge or get from medicare for this or does it just come out of your fees?

    2)Do you get reimbursed for phone consultations?

    3)Are home visits financially viable?

    4)Do you ever refer to specialist because there are certain things which are not manageable in 15min?
    e.g. if some one has diabetes, hypertension, gout, overweight, smokes
    it is impossible to address all these things in a consultation even if you see them 4 times a year as recommended for diabetes and patients may wonder why you are asking for extra appointments if you want to make separate appointments for each problem.

    • +1
      1. Nurses are paid a salary at the clinic. As part of our Private billing policy, nurse only consults are charged $30 private fee. Otherwise I pop in and say hi, normally charge a 3 (short consult) bulk billed (or maybe a standard consult billing if I stayed long enough)

      2. No not yet but with the potential new model of funding coming to general practice, there will likely be internal practice mechanisms. We don't officially do phone consultations per se but sometimes patients will ring in asking for an appointment when there is none available and depending on the severity of symptoms I will ring back and do a phone triage. There are other things like notifying patients of a result and then it inadvertently goes towards a phone consult - try to limit these and redirect patient to come in for a consult.

      3. Home visits are not financially viable. The people whom require home visits are normally elderly, frail, and already part of our bulk billing population. We basically do these out of the goodness of our hearts as it doesn't pay to do home visits.

      4. I think if I can manage it, I would book them in for a double appointment if required. We can also use our nurses for help as well.

      • Sorry more questions

        1. Is there something you used to refer to specialists but now manage yourself due to reading/attending course or more experience?

        2. Is procedural work still viable? My understanding is dermatologist get paid 5x more to remove the same skin lesion.

        3. If pt needs a script do they need to make an appointment. (Existing patient who forgot to get say script for there anti hypertensive when they saw you 1 month ago)?

        4. What do you do for patients who are booked for say a review where blood tests are required in advance but forget to do blood tests. (e.g. someone recently started on thyroxine)? Do you call them with results from bloods done when they see you or make them book another appointment?

        5. How do you choose which private specialist to refer someone too? My GP always gives me a name I never question them.

        • Hey no worries Gimli…are you working in medical field or other health profession? Please do give any suggestions or feedback you would like to see in general practice!

          1. I guess skin excisions I'm increasingly more comfortable as I do them more and more even though I work at a pretty non-procedural clinic. But training was all through previous registrar training. I have been trained in Implanon insertion as well although I think that is certainly in the domain of GPs. I have done an online Diploma in Child Health which means I am more comfortable in managing paediatric patients but still not entirely replacing specialist care.

          2. We are a private billing clinic so I guess so! - but it does break up my day to have some small procedural work.

          3. I think if it was 1 month ago I'm usually pretty ok to not charge for it and issue the script. Otherwise patients can ring in and pay a script fee and provided I have seen them within the past 12 months and on reviewing the file I feel the medication is still appropriate, I issue the script.

          4. Yes normally in that scenario I will call the patients / or text them with results / or ask the patients to ring in and speak to the nurse.

          5. Sometimes its experience in referring other patients. Other times its talking to the other GPS in my clinic and see whom they recommend. Other times its relying on me having worked with them in hospitals and knowing their work directly (particularly useful for surgeons), or their reputation.

        • @RJW: thanks for the replies. You do sound like very good and thorough GP esp based on some of your replies above. Am completing sub-spec phys training. So doing a lot of clinics and liaising with various GP's. So interested to see how different practices work.

        • @Gimli:

          Let me know if there's anything else you would like to know! I certainly would like to know how we can better integrate GP and specialist care (problem is both systems are funded by different

          I was previous in Hospital Improvement for 3 months as part of my residency so am well versed in some hospital processes and have sat on some pretty senior committee meetings so also let me know if there's anything else from that point of view!

  • Why do GPs prescribe antibiotics for viral infection?. For flu and the like wouldn't antibiotics cause more harm than good?.

    • This one is really tough. In an ideal world you wouldn't prescribe them antibiotics, and your explanation to them as to why would suffice.

      However a large chunk of the population thinks otherwise.

      When people come to the doctor they want to walk away with something. Patients feel ripped off when you tell them it's a viral infection, and they think your a great gp when you give them antibiotics and it went away.

      The GP's giving loads of antibiotics out make it harder for the ones who use them sparingly. I know almost all the gps in my practice give them out like lollies, then when I see them, they expect it and are left angry despite 15 minutes of explanation as to why it's not needed. It's easy to just give them, the doctor saves time and patients are actually happier

      • A lot of GPs I know survive by giving out referrals, prescribing antibiotics and steroids. Very hard to find a half decent GP.

        Another aspects that I find very annoying is the need to get prescription for diarrhoea/gastro sort of stuff . Do I stop the damn thing or queue up at the doctor's with people who have every other random disease!.

        • Try to find a GP registrar. They may not be as knowledgeable as the Good GP's, but you will get listened to and should definitely get a proper history and examination taken. At the start of their first term, they have 30 minute consults by default, so they don't have to rush.

          Your also more likely to find a half decent GP in private billing than bulk billing, because:
          1) They usually only see 4 patients per hour
          2) If they suck compared to the bulk billing alternatives, people will just choose someone else

    • +1

      Its because they want to make the patient happy and not after their patients best interests. I have lost many patients because I have refused to prescribe antibiotics but thats something I would never change in the way I practice. This is after explaining that 1. it will make a viral illness last long, 2. if it was a bacterial infection, antibiotics are not that helpful in a signficant number of cases, 3. you get resistant bacteria that can last for years, 4. they have a huge number of side effects and some of them are fatal 5.there is increasing antibiotic resistance in the community which is scaring the hell out of many infectious disease specialists 6. cost and effort to obtain them can be hard for some people…The list goes on and it blows my mind that some doctors treat these serious medications like paracetamol.

    • Hi Negger, I think some of my colleagues have given some great answers already!

  • I'm under 18 and found that the right side of my neck has a little bump, went for an ultrasound but doctors said they could'nt find anything, what are the chances of lymphoma at my young age? I also have a swollen right back with minor back aches which the doctor has examined and I went for an xray. I know you can't give any specific medical advice but can you point me to some possible things I might be dealing with?

    • It really depends on how long the lump has been there for. Usually it's caused by a virus and can persist for a few weeks-months. If it has lasted months it may be worthwhile to investigate it further with an ultrasound which you had done. Surprised they didn't find anything but usually they would comment on the size of the lymph node if it was enlarged. It might even be structures around it. It's really hard to say without a proper history and examination so pursue it with your GP.

    • Hi Blasterbot, as per redemptions reply below - I agree with his reply!

  • I'm absolutely fascinated by the general treatment style within the medical profession to effectively accept the development of metabolic, degenerative and inflammatory diseases (type 2 diabetes, Alzheimer's, rheumatoid arthritis etc) as either unavoidable or incurable once developed, considering the prevalence of these conditions are unquestionably on the rise as a percentage of the population, and yet are also statistically very region/culture/diet specific.

    What are your thoughts on diet in relation to being the major contributor towards developing these conditions, or do you think diet has less or no impact?

    Considering it's being classed as an epidemic, what are your thoughts on existing 'preferred' treatments of type 2 diabetes, and is it a condition that you believe is at best, 'controlled' or would you prefer to work towards reversing it?

    what are your thoughts on the current methodology of prescribing a 'lower calorie higher activity' lifestyle with regards to weight loss and pre-diabetics? (regarding success rates most specifically)

    Genuinely keen to hear your thoughts, you seem like a smart egg.

    • +1

      Great questions maybe I can answer a few. There is lots of research now into how gut microbiom may contribute to chronic diseases such as the one you mentioned above. Although I don't think there is any definitive answers yet. To be honest I don't know how reversible degenerative and inflammatory diseases will be in the future but right now I think the consensus is if you are diagnosed you have it for life.
      I personally think diet has one of the biggest impacts on health and unfortunately I feel the food industry is driven by money rather than by health benefits. Personally I don't believe in diary because you can get enough calcium if you eat the right foods. Why we are drinking milk that is meant for a calf? I still eat dairy products for the sole reason that they are delicious and not for the nutrients.
      The best treatment of T2DM is diet and exercise. It is essentially caused by insulin resistance and if you have T2DM for too long your pancreatic isletsecreting cells also die off and you will end up requiring insulin and then it would be irreversible.
      The way I think of weight loss is simplistic. If you eat more than you burn then you will gain weight. Our bodies try to maintain a set weight and this set weight can increase dependent on our behaviours that is why losing weight is so difficult. I believe you have to feel hungry in order to lose weight because it's readjusting your body's self regulatory system to get used to eating less. When I hear patients talking about their inability to lose weight it is because they are still consuming too much food despite what they say.
      I am not saying I am correct but this is what I believe anyway.

      • This simplistic view of eat less move more is why so many people fail to lose weight despite trying. People have used this dogma for 40 years and it hasnt worked, time to look at the evidence.

        A calorie is not a calorie.

        • Eat even less? If you don't eat you will lose weight. I think a majority of people don't count their calories properly.

        • @r3d3mption: ok, so being fat is the person’s fault for not eating less, got it.

        • @kimmik: In my opinion yes that is true. There is no easy way out from obesity and if you try to find an easy way out sorry it is unlikely to work long term. Feel free to prove me wrong I would love to see an obese person eat the same amount as me and gain weight.

        • @r3d3mption: being normal weight and healthy too, your description is how i used to think.

          Look up the lectures of endocrinologist robert lustig - what he talks about is tip of the iceberg, there is a lot more if you keep looking.

        • @kimmik: Will do. I am open to change if I see the validity of it. I am sure there are plenty more science to be discovered.

        • @kimmik: Hey mate. I looked into it further it seems you are correct. Will be changing the way I educate patients thank you appreciate it. I will also look into my own diet XD

  • Hi Op,Can you advise how to become a GP.I mean the requirements to fulfill.

    • Hey Javin sorry it's taken a while to get to this reply, can you tell me whether you're asking as a high school student, Uni student not in med, medical student, or simply from another field looking to change?

      • Yes from another field looking to change.

        • Hey Javin,

          So you need to do a postgraduate medical degree (minimum 4 years with the right pre-requisites). Then you do 1 year of internship (paid), 1 year of residency in the right pre-requisite rotations (paediatrics mainly, but depending whether you completed the basics of general medicine, general surgery and emergency medicine in internship), and then 2 years of registrar training. This is the minimum pathway to becoming a FRACGP provided you get in first time and pass all exams!

  • -1

    I'm not sure if someone has already asked, but how much do you make? :P

    • Haha yes heaps of the same question so I won't keep repeating :)

  • Partner and I need a general health check and assessment - what should tell our GP?

    The last GP I went to, he sent me to a pathology who took a few bottles of blood (seem excessive).
    I had a follow up session ($90) with the GP for the results. All he said "everything is fine". I was like that's it?
    I asked for a copy of the test results, 1/3 of it about HIV test results??

    PS. we are in our early 30s.

    • +1

      The Government incentives health checks between the ages of 40-49 for preventative health. Generally a health check isn't warranted for someone in their 30's unless they are worried about something in particular. I suggest you go to your GP and tell them what you are worried about and ask them to take a detailed family history of what might come up in the future.
      One thing most people don't realise is that blood tests can affect insurance cover in the future it probably won't affect those in their 30's as insurance companies usually always want a blood test but for those in their 20's it can have a consequence. If anything abnormal is found your premiums would go up for sure.

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