[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

      • that, or void your life and income protection insurance.

    • Hey wjb,
      Very interesting question! I had my friend asked me this recently at a 30th: "what health check should I get - I got fobbed off by a GP whom said I didn't need it".
      In actual fact if you're entirely asymptomatic and there's no risk factors (family history, previous illnesses / related illnesses etc.) there is no need for any checkups. As some of my colleagues have alluded to it can affect insurance if you find anything. However having said that if something is worrying you or if there's a vague symptom, I would still talk to your GP about it. Sometimes you may not know what's important so it's important to check!

  • How do you handle patients who insist they know what cause their illness? e.g. Grandma said she has cancer cause she's sinner and being punished. Would you do a referral to psych but mask it as something else?

    • +1

      I had a patient who told me that Australia gave her Diabetes and now Australia should fix it for free.

      I gave her a dietitian ref. SMH response as anyone can guess.

    • maybe ask her the question why she think she's a sinner. I wouldn't jump to psych first.

      • The concept of sin is on religious/superstitious grounds. It is an extension of conscience but one that is built on religious construct and dictated by third parties that do not (or definitely not) relatable to the "sinner".

        I think a psych ref is due.

    • Hi anastasiastarz, I would ask the patient what makes them think that?

      If there is clearly a psychiatric cause and I feel needs assessment, I will seek psychiatric input. Normally that can happen directly via phone and the psychiatric service will contact the patient directly (or assess over the phone in my room - although this is often impractical).

      I wouldn't ever lie to patients but I've worked in psychiatry before and sometimes I found you have to redirect patients. My consultant would be very direct and tell the patient they have psychosis, the thoughts aren't real (by challenging their thoughts slowly) - but I found that this sometimes seems to make them more guarded - so I am a bit more circumspect (still never lie) - and say, we have to focus on making you less anxious and paranoid about those people coming after you etc etc.

      • She says she was a bad person in a past life. But how does she know that? She avoids the question and compares it to science where a mango seed grows mangoes, and chili seeds grows chili. One of science and proven whereas the other isn't…

        It's quite funny because she was a health lecturer back in the day before she went rouge and started saying whatever she thought in her classes.

        • I would get a GP assessment as a start - it sounds like it could be a few things

        • @RJW: Until they hull her off she won't go and believe 'young people' are the problem. She's also a hoarder, level 5 out of 6 according to the fire department. How do you help someone if they won't admit they have an issue? Unlike being an alcoholic/drug addict at some point it doesn't appear that there can be an intervention?

        • +1

          @anastasiastarz:

          Maybe you can start by referring her (need her to agree) for an aged care assessment. You can do this through the My Aged Care website.

          You can always say this might give her extra services to help her?

          Sounds like a tough situation

  • +1

    My wish is that GPs learn more about links between nutrition and chronic disease. See for example "How Not To Die" by Dr Michael Greger.
    https://www.bookdepository.com/How-Not-Die-Michael-Greger/97…
    Otherwise I have been happy with my GP across a range of issues.

    • Thanks temperature. I will certainly pay more attention to journal articles about nutrition from now (well this AMA) on!

  • I've gained some weight in the last 2 years and I just wanted to know how you felt about the health outcomes for fat people. I'm probably 105-110 and 175cm, 28yr male. I was previously 80kg when I reached 175cm in high school. Also I'm a smoker who sleeps ~4hours a night.
    What would be best for my health if I had to pick one thing to change weight/smoking/sleep? and would doing one these actions make the next couple easier?

    i.e. if I'm not smoking I won't have nicotine in my blood so can easier sleep although if I sleep more I would have less serotonin and would make better smoking/eating choices.

    • Smoking if probably one of the worst things for your health but ideally you should be doing all three.

      The BMI scale is a rough indicator of how much weight you should be however, I also take onboard a patient's frame. I saw a guy who was 177 which was my height but weighed 105kg. He was much bigger in frame previously was in the army and if he went down to my weight (74kg) I would think he would be too skinny therefore I advised him to aim for ~85kg instead.

    • Hey Voolish,

      I agree that ideally all 3 should be tackled simultaneously. You should do this in conjunction with your GP (who is hopefully caring and will listen) who will assess whether there's anything specific you need.

      Smoking would be pretty important I would say. I also don't tend to focus on weight as much as waistline although weight is still a good and easy number to track.

      General advice would be to start doing a graduated exercise program (supervised if necessary), look at Quit.org.au and speak to your GP about ways we can help, and talk to a dietitian.

  • I'd like to know why drugs are so expensive in Australia I'd swear it's a scam the government is running.
    If I bought any of these it would cost $39.50 under the PBS yet I can buy the same overseas For $1 to $2.50 USD a pack.
    amoxicillin 500mg
    Diclofenac 100mg VOLTAREN copy
    Celebrex 200mg
    Panadeine forte 30mg
    Contraceptive pill
    Sildenafil 100mg or 20 x 50mg for $5.50
    Cialis
    Diazepam 10mg

    • Why do you think affluent tourists stock up on our "ridiculously expensive" meds to take home, where they are far cheaper?

      I'd rather have TGA and pharmacists keeping an eye on Australian medication standards.

      Healthcare card holders get the necessary medications even cheaper.

      • What medications are foreign tourists stocking up on in Australia?

    • +1

      The government makes no profit off of provision of PBS medications. Like anything to do with Australia, multinationals feel as though they can boost up prices and Australian consumers will still gladly pay (which we do). Also, you can opt to import medications legally (i.e. from an indian pharmaceutical company) if you feel domestic prices are too high but you run the risk of poor quality control etc. Case in point, undisclosed hospital I worked at last year imported Indian propafol (IV anaesthetic drug with high fat content) and it was contaminated with bacteria and was recalled. Cheaper sure, but could have really buggered someone up.

    • I'm pretty sure amoxycillin doesn't cost $39.50 - more like $6 given it's a very common and cheap medication.
      Medications here are expensive I think partly due to the approval processes and the strict standards we have. Certainly there may be an element of price gouging but I feel we're pretty good in Australia, because the PBS can throw its weight around and say it won't be covered under PBS if companies charge too much for it.

  • Where are u originally from?

    • China - came when I was 7yo

      • How was the cameing?

  • Who?

    • ?

  • +1

    My local clinic has a mix of good and not-so-good GPs. One thing I'll say about the good ones, even if your appointment has gone over time, and they were already running late, they almost always finish with "is there anything else?". That is, they make it clear they are not ending the appointment, and giving me the opportunity to discuss the issue at hand in more detail or raise a new issue. Often, the thing I wasn't going to bring up in the appointment, because I felt there was not enough time, turns out to be more serious than the thing that I initially presented with.

    • +1

      Oh yes that happened to me a few times. "Anything else? - oh by the way, I've had this chest pain, I think its anxiety….", or "This spot has been growing for a while but I can book in another appointment".

      Still despite putting me behind time I am still glad I asked and my patients told me!

  • What nutritional information did you receive in medical school if any? And how do you feel that Pharmaceutical companies having a stranglehold on the GP's decision on treating patients today?

    • Not much to be honest. If you look into nutrition it isn't actually backed heavily by science. Plenty of people have certainly survived without eating fruit and dairy everyday.

      Pharmaceuticals don't have a stranglehold on GPs decision but there are many reasons why people think so. As mentioned above it is easier to prescribe a medication than go into detail as to how to implement lifestyle changes to treat patient's conditions. Would be nice for you to elaborate on what you mean.

    • Not much nutritional information apart from basics. The most I learnt was observing one of the authorities (a professor that is) on obesity in Victoria consult with obese patients.

      • Joseph?

        • Yep

        • @RJW: ah, you mean Mr. Optifast 😂😂

  • we like our experienced GP who also has PhD. Has worked has head of A and E in major city.
    As we are now on downward glide path we like his practical advice and clear communication skills. Great discusions on balancing medication and risk prevention after 75. Above all he has empathy and sense of humour. Have read several of your responses and you seem to be clear communicator. As an ex teacher my most unusual diagnos2was scabies in middle class city school and insisting disbelieving husband should go to Dr as I was sure he had 2 tiny shingles sores!

    • Wow that's amazing! You're very lucky to have such a GP!!!

  • +1

    Good post and sorry I'm late but this one is a bit pointed and hopefully you can reply.

    How about the perception that GPs are not specialists whilst other fields of doctories are. So somehow GPs are less of a doctor than other fields.

    Ie. Any dr can practice as a GP without further study, I'm guessing like you, but many aren't specialist GPs (FRACGP) - who have to go through 3-4yrs extra study - and are generally pretty damn knowledgeable.

    To add to this… I know of a Dr who works in 2 clinic's 100+ km away from each other and her patients travel that distance still to see her at the other place if she's busy.

    Moral of the story… If you find a good GP then stick with them. Same goes for all professions; law, trade (electrician, plumber, builder etc…), ICT, finance). I'm sure we've all had gripes at all professions - mine personally is accountants.

    Lastly good luck with you career.

    • I think most GPs these days are part of a specialist college (FRACGP or ACRRM) - but I guess some of the perception stemmed from the days when you didn't need to specialise or sit an exam to be a GP. Also some countries simply don't have a GP equivalent!

  • -1

    What is your annual salary as a GP?

    • Hey tradiesunited - please see above replies!

  • Do GPs generally retire early in comparison to other professions?

    • I'm not sure about GP but my wife works for eye surgeons and says most are workaholics who seem to want to work indefinitely, basically until they either die or become senile. According to her this is quite common for doctors, they make all this money but aren't willing to retire early enough to really enjoy it.

    • I think GPs can keep working and working as it's not necessarily a very physically demanding profession and sometimes finishing a career in general practice can feel quite traumatic when you've been caring for a patient directly for 30 years!

      I don't think it's a matter of not retiring because of the money. And as they say if you love your work, you will never work another day again in your life!

      I know of a surgeon that has since retired from practice in Australia but goes overseas to do aid work (properly like a job!). So a lot of the times its for the love of the job.

      Certainly some GPs retire at the standard age and some keep working well into their 70s

      • This is so beautiful and true I love it. The need and want to care and serve and aid others truly does last an eternity. God bless to all the doctors and people who serve and aid humanity.

  • Is it commonly accepted taking 80mg of Asprin a day advisable?

    I ask as an older relative was taking it but somehow it caused internal bleeding and ended up in hospital due to blood loss?

    Is Resveratrol a viable alternative?

    • +1

      Aspirin can be indicated but not knowing the clinical background it's hard. Unfortunately bleeding is certainly an issue so it's a weighing up of the risks and benefits.

      I don't think I know enough about resveratrol to say but as far as I know no overwhelming evidence to recommend it. Certainly it's very different to aspirin and not effective as an anti-platelet medication.

  • -8

    Fellow GP here. Good to see a fellow practitioner who has so much time up their sleeve to spend on online discount bargain forums answering random questions from people looking for material bargains. A most appropriate target audience. I too would post a thread like this on a bargain forum instead of a health or science forum.

    • +3

      Hey Kylarstern, I will keep this civil but your comment really rubs me up the wrong way. Why exactly are you here on this forum if you look down upon the respondents to this AMA?

    • +4

      not sure what you are insinuating but as a fellow doctor i think it's a great idea for public engagement

      • +1

        Agreed. I think RJW is doing a good thing. I don't know what kylar's problem is.

        Edit: Having a look at his post history, kylar must be a really fun person to be around hey

    • -1

      Maybe instead of focussing on replying to a thread on a bargain forum you should be concentrating on buying your designer clothes and cars. Oh wait you probably don't earn that much to afford it either that's why you're on here.

  • Read an article about a young girl looking perfectly normaly, upon doing a pet scan found her whole body is littered with cancer.
    How and should one do a FULL regular check for cancer? (and i mean for ALL sort of cancer as im paranoid)

    not asking for your usual gp textbook answer: check for lumps, bumps on skin etc, drink more water, exercise more, eat more veges.

    • Lol you need to go to America where they scare you into doing full body scans. It'll find numerous lumps and bumps which will then get painful biopsies. If you are unlucky (lucky), you might even get something poked up your bumhole.

    • Since cancer is not one entity, one approach is to work out your risk for each common cancer based on history, examination and selected blood tests.

      Fact of medicine: benefit vs harm is a fine line. Over investigating results in more harm than benefit.

      Do the least harmful and least invasive investigations first, that excludes most radiation based scans and whole body scans especially when you are young.

      This does not address the possibility of mental health issues underlying the paranoid however.

    • In short no you shouldn't get full body scans. There may be rare occasion where it has helped and you hear stories about amazing catches of early cancers. But if you scanned everyone you will find so many little masses that you won't know what to do with. I've seen patients have their spleens removed due to benign tumours.

      Broadly you're likely to cause more harm by looking for it than benefit from finding it. That's why we don't pan scan everyone. We would save one person with an early diagnosis but give 10 others breast cancer from all the radiation.(numbers pulled from my bottom)

      Where there are appropriate ways to screen for cancers we do it. So if you want screening for things we can screen for, see your doctor.

  • What's your take on functional/integrative GPs?

    • +1

      Hey pyjamas, not too sure to be honest. I haven't had much personal experience of them to give an opinion sorry!

  • Just wanna say this is one of the best AMAs I've seen. Thanks for this RJW!

  • How many scholarly journal articles have you read so far in your life and how many do you currently read per year?

    Do you regularly read each edition of journals like NEJM/Lancet/BMJ/MJA etc?

    Do your colleagues read such journals regularly?

    • +1

      I'm less of a fan of reading direct journal articles and more a reader of secondary sources such as Cochrane reviews, therapeutic guidelines, other national guidelines and sometimes NICE guidelines. One of the other docs at my clinic loves his NEJM and other journals so glean a lot from him. We also run journal club once in a while.

      I just find as a GP there is so much stuff to know rather than digging deep for everything I use secondary sources and go searching deeper if need be. I rather use my time to learn new things as I'm a generalist. I know others love their journals and EBM so I just let them distill it for me into national guidelines :D

      • Thanks for your reply.

        The reason why I suggest reading primary sources is well, secondary sources have their own biases and tend to gloss over methdological failings if it is the norm for that field. Cochrane reviews for example are of mixed quality, despite the status that they like to project.

        I'm not a medical doctor, but my own experience is that you really need to read thousands of studies and examine the methodology and results (not the discussion, which is more or less speculation) to get a good feel for the science.

        You might like these blogs, from an Australian who has worked at Cochrane, NIH and other places looking at the meta aspects of research and research quality. I've found them very enlightening and hit many of the issues that I have the impression that many people seem to gloss over.

        http://blogs.plos.org/absolutely-maybe/
        https://statistically-funny.blogspot.com/
        https://www.medpagetoday.com/Blogs/ThirdOpinion/

  • Have you had any known cases of misdiagnosing someone?

    I'm currently transitioning GP's, my old one had misdiagnosed Anterior Uveitis as conjunctivitis (So painful - I had to wear an eye patch and had two weeks off work. The eye surgeon I saw said that it was the worst case he'd ever seen), along with misdiagnosing anxiety chest pain as an esophagus infection. I paid for 4 weeks of antibiotics before they realised it wasn't actually an infection, as a student at the time, that was rough.

    I've also been getting some mad leg pain lately in my left leg and I'm worried it's a DVT. Thanks anxiety

    • Sorry to hear that Hexo. Anterior Uveitis is one of those nasties but potentially confusing ones to diagnose which we get hammered into us through med school and training ("Beware the painful unilateral red eye"). Hopefully you're ok now and haven't had any long lasting effects. Did you go back several times to your GP?

      What sort of esophagus infection were you diagnosed with??

      I would see a GP (one that is competent) to look at your leg.

      I certainly know of delayed diagnoses or missed diagnoses and these happens even in the best of hospitals too. We have mortality and morbidity (M&M) meetings in hospitals to discuss these events and learn from them. Unfortunately doctors can't get it right 100% of the time. At my clinic we have the equivalent of these meetings weekly - most times it's minor near misses and interesting cases but once in a while we do have missed/delayed diagnoses.

  • Why do GP in medical centres give patients ( 98% of the time ) Antibiotics for viral infections.
    The most common statement I hear is "If it's viral, you can't do anything, and in case it's bacterial, I prescribe you a broad spectrum antibiotic"
    I mean, seriously, you ( a s in general, not you OP ) don't need to have a Doctor degree for that.

    P.S. in 2002 I had pneumonia, and the local GP could not diagnose it, only when after 2 month of coughing I was sent to the specialist, I got the diagnose: "Oh you HAD pneumonia, but now you're OK now". All without Antibiotics, thanks very much !

    • It's not good practice in general to give a script for antibiotics when it's clearly viral. Sometimes when it's not as clear cut or if the patient can't be convinced otherwise a deferred script with detailed explanations may be alternate path.

      Sounds like maybe you had an atypical pneumonia (e.g. Mycoplasma pneumoniae) from that story!

      • I agree with you on the Diagnose.

    • There was a recent study that showed early prescription of antibiotics for pneumonia did not change the number of presentations to hospital or mortality of the individual. So unless doctors has a high index of suspicious for a pneumonia from the history and exam they shouldn't be prescribing antibiotics.

  • What is the typical split of revenue between doctor and the clinic they work in? What has your experience been? Some revenue must go towards building costs, administrative and nursing support, etc.

    • +1

      It depends on the training stage, location of the practice, private vs bulk billing. Also most importantly how much the clinic wants youj. But for full time GPs I know the maximum I've been offered seems 65% to GP for Private / Mixed billing, 70% for bulk billing (+5% bonus for after hours periods).

      I have heard some only getting 55% but at clinics providing more expensive procedures where the total fee is higher so doctors still end up getting paid about the same (but the owners make more of course)

      • My GP told me 50/50. Not only that, they have to pay &000's to buy a place in the practice

  • I love this one… What's your take/opinion on Lyme Disease? I think I have it so what should I do?

    This goes for all the other Australian drs here.

  • I used to go to bulk billing clinics to see whoever is available but recently want to have a regular GP for my whole family and we would like to have a female GP. However, I find that it is actually not very common to have female GP working in bulk billing clinics in my area or it can be difficult to wait for an appointment. Is this true in Melbourne as well?

    I am also curious if GP clinics are usually own by business people or by GPs? I heard that some clinics are own by GPs—what are the benefits to become a owner/partner? or is it just for money making?

    Also.. I wonder if you have any children? would you like your children to study medicine in the future? I heard a lot of doctors would like to kids to become doctors as well…

  • Hi OP, what would 1 if you would joyful experience is can have 46 then prosperous journey found with scorching severity? What would you recommend!

  • Is the AMA bullshitting or is it okay to get a vaccine rn?

  • What is a good food to eat for diabetics type 2 disease.

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