[AMA] I'm a General Practitioner - Ask Me Anything

As per the title - I'll try and give my personal and professional experience, without providing any specific medical advice (which is fraught with risk over the internet, without being familiar with your medical history).

I have been working as a specialist General Practitioner for the last 5 years, and am currently working in a COVID screening clinic in Melbourne seeing all the lovely coughs and colds.

closed Comments

    • +23 votes

      Nothing that's too important, you know, minor little things like empathy, picking up on nuances…

      I think most people would like to receive advice that is relevant to the personal circumstances and that takes into account their experiences, education, personal preferences, life goals, values and risk aversion. I see the role of a good GP as helping a patient navigate between these confusing and oftentimes competing interests, in arriving at a decision that is appropriate to their circumstances - something that AI will never be able to replicate.

      • -24 votes

        AI can do all that. Can you elaborate on why your thought process can't be replicated by a probability based weighted system? Do you have the time to go through all those factors in a 10min consult + making the actual medical diagnosis on top? Personally I've never sought empathy from medical professionals- I am only interested in their assessment. If we take out the emotional aspects then can the assessment be done through AI only?

        • +7 votes

          People have no idea what AI is about to do to/for the world. They think its still chess. Its everything.

          • +15 votes

            @jacross: This^^. I fell in love with an algorithm, and our kids are algorithms and we love them to bits.

          • +1 vote

            @jacross: AI is awesome, it needs to replace things like checking scans for cancer immediately (people make way more mistakes). But it’s going to be a long while before it’s capable and cost effective to totally replace rather than augment things that require human to human physical contact and empathy.

            People both underestimate and overestimate AI. It’s coming for a lot of jobs sooner than people think, but by the time it completely replaces rather than augments others humans as a species will basically be useless.

            •  

              @jkart: There's an app called SkinVision I use to check my skin for cancer. It spins up an AWS instance and uses some machine learning / AI to give it a rating. Last I checked it had a similar success rate as a trained human.

              https://www.skinvision.com/au/

        • +1 vote

          next time you become unwell, type your symptoms into google and you'll have your answer (Google may say you've got cancer or some very rare autoimmune condition that most GPs will never see in their career). Diagnosis is much more complex than symptoms x + y + z = diagnosis. Sifting through which of the symptoms are related and which aren't can be tricky for an AI, as most AIs will assume all symptoms are equally relevant. Which specific questions to ask and when to askthese questions to illicit important information. Having a discussion about pros and cons of certain investigations and treatment.

          When medicine becomes as simple as symptom A should have test B should get treatment C (and test B is 100% accurate and treatment C is 100% side effect free and 100% effective), AIs might be able to replace doctors, but we're very far away from that. So far it looks more like, Symptoms A, B, C, X, Z, 2 (C, and X may or may not be relevant however) might benefit from clinical exam F and D, and blood tests 4 and H, but depending on exam F and blood test H, imaging s or V might be give us more certainty of diagnosis T, but we still can't rule out diganosis F. Maybe we should try treatment 4 in the meantime, as it may take a week to sort out those investigations and get results and treatment is a relatively low risk test of treatment. If treatment 4 doesn't work however, and imaging V comes back negative, we should reassess our options…

          •  

            @uedamasaki: oh, and by the way, I should also check your blood pressure and add in basic screening tests to that blood test to explore your cardiovascular risk. And if we have time, take the opportunity ask about that smoking again to encourage you and hopefully assist you in quitting. Maybe even check that suspicious looking mole on your back that you never knew about as well when I listen to your lungs.

          • +2 votes

            @uedamasaki: Again, AI tech exists that does all that already much more efficiently and quickly. The theory for probability weighted analysis and/or data mining for regression curve fitting is far from new. If quantitative knowledge and experience are the requisite skills, AI will beat a human every single time.

            • +2 votes

              @star-ggg: Sure it's possible, but it's more about complexity, how/where you extract that data to make that analysis, and how you actually implemment that. There's more data that comes from people speaking about their symptoms than what a computer can harvest from someone clicking a series of yes/no tick box questions. Let alone clinical exam which is far from being redundant. Do you sit someone infront of their computer for an hour answering 100s of questions, take their own temperature, take a picture of their throat, use a remote auscultation device to record their breath sounds, ulstrasound and measure the side of their lymph nodes, and have an AI analyze all that to make a diagnosis of common viral respiratory infection? or does everyone get blood tests and radiological imaging for every common cold? or does everyone get antibiotics just incase it's bacterial?

              Who takes responsibility for missed and incorrect diagnoses? Is it the developer that designed the AI, or the company that delivers the service? I'm sure some parts of medicine are going to be replaced by AI, but I doubt any significant part will be placed anytime soon.

              And how about mental health consultations? determining severe mental health illness where the patient may not have enough insight to anwer tick box questions accurately. How does an AI perform a mental state examination (reading body languate, reading affect, determining appropriateness of attire, behaviour, cooperativeness, etc).

              • -3 votes

                @uedamasaki: What makes a human better than a computer at processing volumes of complex data? That's literally what computers are good at. For a common cold, is your GP doing all those things you mentioned in the 10min consult? I agree you will still need a human operator to collect the input data but you could pay 10 nurses to do that for the cost of 1 GP.

                Your description of mental state examination sounds very subjective which means the assessment will vary a lot between GPs. If that was the case then I'll argue it's not a very effective form of diagnosis.

                • +1 vote

                  @star-ggg: true about the subjectivity of mental health consultations. The idea of the mental state examinations is to try and objectify a lot of what might appear subjective (a large part of it does still end up being subjective). If you can sit someone infront of 5 psychiatrists, you'll usually get 5 different treatment plans. But progress is usually made with follow up, fine tuning/changing therapy and developing rapport over time, rather than spot diagnosis and treatment.

                  Your GP should be doing most of those things in a 10 min consult. Even if a lot of the clinical decision making process is done subconsciously. A lot of the data gathering comes in more subtle cues and nuances that I think a programmer would struggle quanitfying in measurable data. The human brain is incredibly complex and incredibly diverse and inconsistent amongst individuals. I think the main advantage a computer AI would have over a human brain is consistency and accuracy; however the inconsistent nature of humans is what's most challenging.

                  Let's take dizziness for example. What does it mean when a patient is dizzy? are they light headed? are they unsteady? do they have vertigo? are they "giddy?" is it a sinus thing? is it a vision thing?. How does a patient describe that to an AI when it ultimately comes down to a dynamic converstation about the different types of dizziness. There are plenty of symptoms that mean one thing for someone and an entirely different thing for someone else. How does an AI differentiate?

                  But to summarise I think the things AI will struggle with includes:
                  1) accurate, consistent, measurable data collection (if a human operator is collecting data, you're already introducing potential inconsistencies).
                  2) logistics of collection and implementation of this data
                  3) overinvestigation (bloods, scans) to compensate for inability to physically examine someone and to offset medicolegal risk.
                  3a) consequent rabbit hole of investigating incidental findings on above investigations and managment of risk/harm associated with investigations
                  4) medicolegal implications of AI driven diagnoses and treatment
                  5) challenges with with mental health consultations, procedures (biopsies, excisions, etc)

                  But to be realistic a GP does not get paid the same as 10 nurses. maybe 2-3 nurses?

                  Again, possible, but not practical in the near future. My opinion is that only when we get close to making an AI with as much processing power as the human brain, will we be close to replacing doctors.

                  *great conversation btw!

                  •  

                    @uedamasaki:

                    A lot of the data gathering comes in more subtle cues and nuances that I think a programmer would struggle quanitfying in measurable data.

                    That's more how a programmer currently works and has been working for many decades. No AI about that.

                    Look, I'm not an expert on the topic, but from what I understand… It's… much more brute force method than you'd think. It's not exactly this way, but a way to explain it would be along the lines of the AI would be given a bunch of data points for one specific decision through examples of positive and negative results and then the AI algorithm analyses the data and spits out an algorithm that would fit that piece of the puzzle. The more data, the better the end result.

                    Given enough pieces of the puzzle, it'd be able to take over some duties of a doctor over time. First I'd expect to see some sort of assistant and then move up from there.

                    My opinion is that only when we get close to making an AI with as much processing power as the human brain, will we be close to replacing doctors.

                    I'm guessing by this comment, you're talking about the singularity (think Terminator movie) and not the machine learning kind of AI. The later is more likely to replace some doctor functions than the former. Much like the systems that are already in place replacing the work paralegals typically do in the legal profession.

                    It really is an interesting topic.

                    • +1 vote

                      @TheBird: AI needs data, lots and lots of data, accurate, standardized and unbiased data. It’s extremely good at finding patterns that people are not, but it needs lots of training and it’s susceptible to mistakes based on mistakes in the training.

                      It’s going to be great to augment decision making, but for a lot of extremely rare things it may be generations before there’s enough data to build a decent AI. At the end of all that AI produces probabilities of results which can often benefit from human interpretation.

                      •  

                        @jkart:

                        It’s extremely good at finding patterns that people are not

                        True that. It can also interpret data wrong. Take for instance the case study where it was trying to distinguish between a domestic husky and a wolf. With the dataset it was given, it came to the mistaken conclusion that if the background had snow in it, the dog was a wolf and a hudsy if it didn't.

                        for a lot of extremely rare things it may be generations before there’s enough data to build a decent AI

                        True. It might never get to a point where there's enough data for AI to handle every circumstance.

                        If you follow AI in the legal realm, you can see exactly what you're talking about. The general stuff that happens every day, the AI is getting good data sets so it'll be able to (as you said) do the repetitive tasks, in which humans aren't as equipped to do long term, leaving humans to do the outlier stuff. The stuff that requires a more creative or radicial approach.

                        It's an interesting field. I can't wait to learn more.

                  •  

                    @uedamasaki: I agree the uniqueness of very individual makes a universal program more difficult to implement, but again data mining has techniques to overcome these individual variabilities. Firstly, it is well known humans are consistent in relatives not absolutes. If I take a 50C bath of water and ask a bunch of ppl to guess the temperature. Ppl who have just been in a cold environment will guess hotter than ppl in from a hot environment.
                    You use dizziness as an example- you could potentially design an objective physical test like "spin around 10 times and tell me on a scale of 1-10 how dizzy you feel". That becomes a reference point for future data inputs. Secondly, what is "intuition" but a collection of of historical experiences and knowledge? A decision that is made subconsciously means mental shortcuts were taken- how is this less risky than an AI system which you can practically trace the logical process from A to B?

        •  

          You would need a medical education to
          1. Realize there was an issue
          2. Answer the questions in the right way

          The patient is the limiting factor.

        • +1 vote

          AI is not going to replace doctors in our lifetimes, it will just be another tool doctors can use to be more effective and efficient.

    •  

      Several things.

      Firstly, AI doesn't actually exist as yet whereas doctors do, so there's that.

      A computer can be better at diagnosing things and recommending safe treatments than a human is when operating under a very limited scope.

      The problem is getting the information into the computer in the first place. Patients don't have the knowledge themselves to enter their details into a computer, plus they lie. A human is required to interpret the knowledge transfer going both ways.

      Whatever results that a computer does spit out still needs to be reviewed by a human for sanity, computers often come up with some crap. It may be a result of garbage in garbage out, but it still needs to be checked.

      •  

        I agree you still need medical professionals to understand the system and know what inputs it requires and to interpret the outputs.

    • +1 vote

      You would need an AI of sufficient power to communicate flawlessly with a broad range of people of differing cultures/ intelligence/ temperament noting every nuance of the consultation, synthesise an enormous amount of information and not just brainlessly remember facts but understand their actual meaning, draw on thousands of prior experiences, have mechanical abilities to examine and listen to the body, integrate with multiple other systems such as radiology and pathology machines, all within a strict legal framework where 1% failure rate is considered excessive. Although possible in the far future you might find its cheaper and easier to use a real doctor for the time being. When this becomes possible we will be living in a utopia where machines perform every known task and humans rest in absolute luxury, or perhaps we become slaves to the very machines we created. Who knows?

  •  

    Do you ever get grossed out by anything or are you de-sensitized to the some of the nastiness the human body can dish out?

    • +17 votes

      Even after all these years I can't do smells - the worst ones are impacted foreign bodies like tampons, upper GI bleeds with old digested blood and necrotic wounds like in diabetic foot ulcers!

      Once I had an old bloke in emergency with a massive BCC (a type of skin cancer) covering half his scalp. Let's just say I smelt it before I saw it..

      •  

        I can smell the nastiness just from your words!

        Someone's got to do the job though, so good on you : )

        • +2 votes

          I forgot to add, that the wound was flyblown and also crawling in maggots!

          Heavens knows how he managed to walk around that long without getting it looked at…

          • +14 votes

            @inasero: MS Paint illustration pwease!

          •  

            @inasero: I don't know what it is with the stubbornness of some older men with getting aliments like those checked out, I just seem to hear about these kinds of situations all the time.

            Is it a common theme with older citizens not getting stuff like this checked out before something simple manifests into something quite serious?

      •  

        Wait, skin cancer has a smell humans can detect? What does it smell like?

        • +2 votes

          Death

        • +1 vote

          i believe its not the cancer itself more like the bacteria colonising the fungating wound, i forget which type causes it to smell

  • +1 vote

    You must get a lot of patients coming in with colds and cases of flu etc. How often do you get sick and why don't GP's wear masks to help prevent catching colds?

    • +9 votes

      In winter time the majority of consults are for this very reason. Medical staff do in fact get sick from seeing these all the time, but you do tend to develop an immunity over time. Maybe those working in childcare could also attest to this? Interestingly, mask wearing is now compulsory when seeing anyone with suspected COVID (which is pretty much anyone with a mild cold or flu symptom) or in high community transmission areas here in Victoria, but historically that hasn't always been the case.

      I think there used to be a kind of culture/mentality where if you get sick you still show up to work - there used to be an expectation that you show up to work unless you're sicker than your patients, so to speak. However with the recent pandemic there's certainly been alot more interest and awareness around the transmissibility of contagious diseases, and we may indeed see mask-wearing become commonplace in our society in the future.

      Anecdotally, in Asia where they've had to deal with the Swine Flu and SARS epidemics there's not so much of the stigma around wearing masks in the public, where it's seen as the responsible thing to do.

      • +1 vote

        just like with teachers, i remember junior teachers getting so sick they ended up in ED in the first weeks of their job

  •  

    Can you let me know the A.M.A. recommended fee for Medicare items 46375 and 46384. My specialist claims to charge the recommended fee but will not tell me what it is. He hit me with out of pocket cost of $1,510 for the op.

    • +1 vote
      • +2 votes

        The link is to the Medicare rebate, which is what the Aust Gov provides in the form of rebates for certain procedures/consultations. However most doctors set their private fees over and above the recommended rebate, which means that the patient ends up with an out of pocket expense. It's nigh on impossible to find a surgeon who won't charge any out of pocket expense, but if these costs are prohibitive then going through the public system might be an option for you? Or getting a quote from another surgeon for the same procedure.

        • +1 vote

          I have already checked on the Medicare recommended fee but what I am trying to find out is the AMA recommended fee. Did give them a call but they run a closed shop on would not tell me.

          • +10 votes

            @Ocker: It's not information which is freely available at this stage (at least without paying AMA a subscription fee), which I feel is wrong and which I am aware there are a few doctors trying to make this information publically available. I think this sort of information should be made available to patients upfront in the interests of transparency and as part of the process of financial consent

          •  

            @Ocker: Probably about 3x the MBS fee

    •  

      sounds like you were scammed

    • +2 votes

      The AMA recommended fee is often significantly more than the Medicare rebate. The main reason for this is, as mentioned elsewhere in this thread, Medicare rebates have lagged behind the CPI increases for a long time. That's why surgeons (and physicians) fees are so much higher than what people get back from Medicare. In your case, the surgeon has been honest with you (I have access to the recommended fee list, but am unable to share it).

    • +3 votes

      46375: $1665
      46384: $975

  •  

    I was always curious on the amount of details you learn about mental health, since I had both fantastic and slightly questionable GPs when it came to my mental health issues.

    So what kind of stuff do you learn about mental health and are there changes to what you've learnt over the years on mental health issues?

    • +2 votes

      When I went through medical school over a decade ago there were certainly lectures and tutorials on mental health, and I suspect the content would have increased by now with the increased awareness and support for mental health issues. In fact one of our mandatory clinical rotations as part of our training involved spending time in various community and inpatient psychiatric settings (alongside obstetrics, paediatrics and general practice)

  • +5 votes

    What do you think about GPs who aren't pictures of health themselves?

    • +18 votes

      Not sure what it is about this particular condition, but I confess I used to be quite judgmental of other health professionals (and patients) who themselves were morbidly obese, although there weren't too many around as we tend to have greater health literacy than the general public. In retrospect I don't think it was exactly the healthiest mindset as it prevented me from seeing past their physical characteristics and reduced them to a figure or a measurement.

      Now that I'm a bit wiser (?) I try not to let that influence the way I see people and understand them as a whole. If I'm honest with myself, I'm not exactly the paragon of virtue and glowing health I encourage my patients to be - I could drink more water, go to bed earlier and exercise more each day. And yes, as I've aged I've found it's harder to shed the kilos, but that doesn't stop me enjoying treats if I want them (on occasion)!

      However that doesn't stop me from raising the issue with patients if I see patients wilfully engaging in self-destructive behaviours (in fact it would be irresponsible of me not to do so) and I think we should as GPs try and model that behaviour to patients. How are they going to be able to take me seriously if I don't practice what I preach, and don't understand the struggles they go through?

      • +1 vote

        I could always tell when the cardio thoracic guys were operating, the theater change room was full of racing bikes :-)

  • +1 vote

    Whats your annual salary on a 40 hours week like? Assuming you bulk bill, how do you bulk billing GPs even make money given you get paid roughly the same as as TAFE-trained hairdresser per 15 minute appointment?

    • +8 votes

      Bit difficult to give exact figures, as this can be influenced by a whole host of variables.

      Assuming you're a self-employed bulk-billing GP (i.e. don't charge any out of pocket expenses to the patient) and receive the patient's rebate, and assuming you see 4 patients per hour and are consistently booked for the whole day (whereas in reality most GPs aren't fully booked or deliberately leave buffers in their schedule for things like walk-in appointments and emergencies), you would theoretically earn $38.75 (Medicare rebate per patient for a standard consultation) x 4pts/hr x 8hrs/day = $1240/day

      Multiplied by 5 days per week and 47 weeks per year that comes to $291,400 p.a.

      However then you have to factor in practice service fees (30-40%) as an independent contractor (or practice expenses as an owner) and pay tax on the remainder, this leaves not much take-home pay at all.

      The figure also can be influenced by other variables such as whether you perform procedures (e.g. skin cancer removals, botox injections), certain Chronic Disease Management incentives from Medicare (e.g. drawing up a Team Care Arrangement for patients to be able to access up to 5 subsidised allied health consultations per year, or medication reviews for patients). Certain bulk-billing incentives from Medicare provide additional funding in order to bulk-bill children under 16, concession card holders and persons living in certain rural or remote locations.

      • +2 votes

        Screenshoting this to show my newborn when she is older. Love your honesty.

        • +22 votes

          You one of the Asian parents expecting their kids to be doctors from the moment they get out of the womb?

          • +15 votes

            @Hamlet: They should be spending those 9 months inside studying.

          • +2 votes

            @Hamlet: still better than floating around uni not knowing what to do and having a career ressembling a season of quantum leap

      •  

        What about doctors that churn patients every 6 minutes?

        •  

          You can do the math :)

          Edit: that is why I avoided bulk-billed practices when I searched for a regular GP

        • +1 vote

          Those are the ones you don't go to.

      • +4 votes

        Don't forget to pay yourself super, compulsory medical indemnity insurance fees, registration fees and continuing education fees.

        Also consideration should be made for the opportunity cost of doing medicine (5-8 years) and specialty training (another 5-10 years).

      • +2 votes

        Also, no sick leave and also having to work public holidays I'm guessing

        • +3 votes

          As a more accurate answer, most gps wouldn’t do 40 hours a week as it’s crazy hard, but at 4 days a week you would earn between 200-300k pa after clinic fees and before expenses.
          Bulk billing normally earns about the same as non bulk billing as they spend less time and churn through the patients. Not 100% of the time, but definitely most of them.

          •  

            @cynicor:

            most gps wouldn’t do 40 hours a week as it’s crazy hard

            My partner is a doctor (not in Aust) and works 6 or 7 days a week as a GP with a couple arvo shifts in the ED and I'm pretty sure she'd laugh at any doctor thinking 40 hours a week is hard (especially with the lower expected case loads in Aust).

            • +1 vote

              @stewy: Probably the difference is doctors here try to do a good job with patients ;)

  •  

    what do you see as the main blocker to video Telehealth becoming mainstream?

    • +6 votes

      A few issues potentially include lack of security/privacy, lack of computer literacy among the older generations and also some people just prefer the plan ol' face-to-face interaction. However I believe Teleheath is rapidly on track to become (if not already) widespread within our generation as these barriers are addressed. Just look at this massive explosion in Telehealth providers in recent times co-inciding with the Government's announcement of Medicare rebates being available for this model.

      However there will always be things that require F2F consulting, such as medical procedures, mental health, more complex presentations requiring physical examination and/or unwell patients.

      • +15 votes

        Also, you can't smell the patient, as described above, via telehealth.

  •  

    What's a 'specialist' General Practitioner? Isn't that an oxymoron?

    • +12 votes

      In the good ol' days anyone with a medical degree used to be able to set up shop and call themselves a General Practitioner, hence the 'GP/specialist' dichotomy. However since 1996, there has been a Federally mandated requirement to undergo a period of additional specific training in General Practice (through the RACGP, the college of which I'm a Fellow, and now the ACCRM also) in order for their patients to be able to access the higher Medicare rebates. Along with this comes the requirement for a period of supervised on-the-job training, assessments and ongoing professional development just like any other medical specialty, such that GPs are now considered specialists in their own right.

      Of course there are those without the FRACGP or FACRRM who continue to practice, however these are becoming less common these days as they are 'grandfathered' in to the FRACGP (by virtue of their experience) and the newer generation of GPs replacing them bring their specialist qualifications.

      In addition, there are GPs who choose to sub-specialise in specific areas and attract those patients. Some of the ones I've worked with have had specific interests in mental health, dermatology, skin cancer, weight loss, addiction, occupational health, aviation, paediatrics…the list goes on and on.

    •  

      GP here, we are actually specialists in family medicine and require to do multiple post graduate years to become a GP.

  • +18 votes

    Do you have any tips for finding a good GP? The vast majority I've seen are absolute garbage when it comes to anything more complicated than a sore throat. No offence intended, but as far as my personal experiences go, I've really just come to see GPs as barriers to proper medical care rather than aids.

    • +11 votes

      Yeah - see me! Nah, all jokes aside I'm sorry you've had bad experiences as I know most GPs out there (at least the ones I know) are very thorough and caring in their work, and feel personally responsible if their patients don't get the desired outcome.

      A rubric of sorts I tend to use in relation to doctors (and which probably applies to most professions) is to pick two out of three - accessible, affordable and knowledgeable. The vast majority fit two of these criteria, but to find one that's all three is a rare unicorn indeed (and if you do manage to find one then stick with them!) or they're just starting out in their career.

      Perhaps (and this is just a suggestion) if the doctors you've seen haven't been too knowledgeable, you may need find a privately billing doctor or book in and wait in advance.

      • +1 vote

        As someone who's got pretty minimal health knowledge myself, how do I assess "knowledgeable"? When a GP tells me that the symptoms I'm feeling are probably just something generic like stress or whatever, it sounds both entirely plausible but also a bit difficult to trust.

        • +1 vote

          Perhaps it's a GP that explains their diagnoses in an understandable way, to you? I'd second trying to find a privately billing doctor as they generally 'spend more time' with their patients given the lesser incentive to 'churn' patient appointments for their day's work. A search of the clinic can provide you with some useful information too, finding specialties in services that cater to your needs.

          'Medical School for Everyone - The Great Courses' - Roy Benaroch is a fantastic book I listened to on Audible over the course of a few months that diagnoses several common and not-so-common medical cases with the listener and teaches on the role of a doctor. It's also great at giving tips for non-doctors by giving tips on how you should describe your health ailments, too!

          • +2 votes

            @covid-20: Yeah, I figure that's basically the main criteria I can apply.

            I live in Canberra, where "privately billing doctor" and "doctor" are more or less synonymous…

            I might take a look at that book at some point!

  • +2 votes

    My big little fella has a few blistery/cheesy like bits.

    See it here

    What is your opinion?

    •  

      Wash it before you taste it.

  • +1 vote

    How do you feel about trt ?
    I think if most guys knew what a difference it makes they'd be knocking down your door.

    • +1 vote

      Further, what's your opinion on anti-aging medicine such as TRT and hGH administration?

    • +3 votes

      Useful in certain conditions/situations e.g. Klinefelter's Syndrome. For those in which it is indicated, TRT (testosterone replacement therapy) can absolutely make a difference. However I would say the majority of men come in requesting it as a general tonic for whatever symptom ails them, without a clear understanding of their indications or the potential downstream complications (such as suppression of fertility, or increased risk of liver cancer and heart disease). More often than not low testosterone is a marker of excess body fat and low muscle mass (which is a natural part of ageing) and is far better addressed through non-pharmacological means such as losing weight, moderating alcohol intake and regular resistance training.

      Kind of the same as how Valium (diazepam) helps insomnia, but doesn't address the underlying causes, while causing the risk of sedation or dependence. If you treat the underlying cause, the symptoms will sort themselves out eventually.

      • -2 votes

        I think they are all valid points at a superphisialogical level. I'm talking about returning men to a level they were at in their twenties. It really is a game changer that improves quality of life a lot. In most cases I think declining testosterone levels start a spiral towards bad health that would best be treated by improving testosterone levels artificially. Even if it's just for a bit. I actually think the science is wrong with this one. Just my opinion of course.

        • +7 votes

          I think we're actually in agreement about the benefits of increasing testosterone levels, that I don't dispute. My only qualm is using pharmacological means to do so when there are far safer and proven methods to do so, which is certainly what I would be recommending in the first instance, in the absence of specific medical conditions causing the low T

  • +1 vote

    I've found that in the instances I've had to go to bulk billed GPs, the more senior GPs seem to be less organised and more robotic with just getting the patient in and out.
    - doctor being consistently late but also rushing through the appointment
    - doctor not filling in forms/forgetting to fax forms so I'd have to rebook
    - never asking more exploratory questions

    What might cause this systemic burnout/lack of effort?

    I'm assuming they get paid decently well enough, have good security but are just too comfortable? Did they perhaps lose the whole helping others thing?
    I'd be happy to have a job where I actually can help others versus being part of the corporate machine

    •  

      Many of them just don’t realise how poor a job they are doing. They have rusted on old patients that are mostly treated ok, and they have lost the ability to do acute medicine and take proper histories and examinations.
      Bulk billing also disincentivises this- the pay is so much lower than what you might earn- say a private patient at $90 per consult vs a bb at $37.

  • +7 votes

    I hereby apologise to you and your colleagues for all the patients with no acute medical concerns me and my colleagues have sent from the ED back to you.

    • +7 votes

      No need to apologise! And thank you for dealing professionally with all the acute sore toes that block up Emergency

  • +25 votes

    I would just like to say thank you! This has been one of the most interesting and well written AMA I've ever lurked on. So much so that I decided to log in for the first time to post this.

    You appear to be genuinely a top person.

    • +12 votes

      Thanks for your kind words! I'm glad you found it of value

  •  

    I noticed that doctors spend more time on their Pc typing than examining patient with stethoscope n blood pressure etc. why is this ?
    How much you charge Medicare per consult?

    •  

      I guess not all consultations require a BP check or a physical examination e.g. if it's for a simple medical certificate, but yeah they should probably check things like BP/height/weight/waist circumference on the odd occasion - we're all trained to do so as part of preventative health.

      Not really sure as to why this is the case, maybe they're just in a rush, or only interested in shorter consultations so they can bill more Medicare consultations per hour? You can always ask for these checks specifically if they miss out on these during a consult, or book in for a preventative health check specifically (which is a good idea anyway from around the age of 40 onwards)

    • +4 votes

      Because you don’t need to spend much time examining. 90% is in history.
      If you want to know how much Medicare cover YOU for your consult (doctors don’t charge Medicare) then you can check the mbs, it’s online. Item 23 is the normal one for most consults.

    •  

      Medical record keeping on computers is pretty standard nowadays (hence the typing) but some old-school doctors might still be keeping written records.

      Also almost everything is generated from medical software e.g. referrals, scripts, med certs, billings, letters, time keeping, appointments etc and therefore the need for typing.

      Lastly, history taking is more important and effective in achieving a diagnosis/recommendation than an examination would.

  •  

    Do you feel Medicare forces you to spend less time than needed with patients. Does Medicare encourage treating the symptoms rather than spending the time needed looking for causes.

    • +7 votes

      Medicare doesn't technically pay doctors - the rebate is for the patient and doctors can charge whatever fee they choose. However this is paid on the basis of complexity of consultation and it just becomes more financially viable for GPs to see 4-6+ 'standard' level B consults per hour, compared to 2-3 'long' level C consults in the same amount of time. Unfortunately the MBS has not risen in line with the CPI for the last few decades, so while practice costs and overheads have risen GPs' incomes have not risen in a commensurate manner, which has led to the current culture of "6-minute medicine" - getting patients in and out of the consult room becomes the main priority, and anything more complicated than the most basic ailment (e.g. colds, repeat scripts) necessitates a repeat appointment.

      Meanwhile on paper, the bulk-billing rates are going up and up and politicians can gloat in their claims of providing universal health care to appease voters, however I digress.

      • +2 votes

        Unfortunately the MBS has not risen in line with the CPI for the last few decades, so while practice costs and overheads have risen GPs' incomes have not risen

        Not saying it’s right, but welcome to our world