Doing the hard yards

Dr Steve Hambleton, AMA Vice President

Australian Medicine

2 November 2009

At the time of penning this column, the Minister for Health has been in the media proclaiming that doctors charge too much.

Sorry, Minister, but once again, as with successive governments, the Medicare rebate has not kept pace with practice expenses.

Let’s do the sums. If we follow the new AMA rate for our patients for a standard visit and compare that with the miserable increase from the Government, our patients will be out of pocket just over an extra dollar.

On top of this, just as the Government lifts the MBS fee for a Level B GP consultation by a whopping 75 cents to $34.30, we are told that, as part of the award simplification process, we will need to be paying our staff in accordance with a new award - and the only possible movement will be upwards.

Thankfully, the AMA has been able to negotiate transition arrangements to ease in the changing business requirements over the next five years [please refer to your State or Territory AMA for details].

We have also been told that general practice will be subject to increased scrutiny and audit, and we know that some of those audits are going to cost time and, therefore, money.

We know that we are serving an ageing population and that the complexity of the work we are doing is increasing, which increases the amount of time we need to spend with each patient.

We are also told that it is not just ill health that we should be treating but that we should also be ramping up our preventive health and health promotion measures.

We are also told that the Government will be looking to GPs to increase their training commitment for not just their own registrars, but also to pre-vocational trainees, and even interns.

We are told that it is our patients who are clogging up emergency departments and that if we were more available after hours then the problems would be lessened.

We are told that there are not enough GPs prepared to visit residential aged care facilities, despite the fact that the rebates are woefully inadequate for the complexity of the work that is often required in a setting with often poor support and infrastructure.

We are told that we need to be team players and utilise other members of the primary health care team despite the fact that our own practice nurses’ ability to provide meaningful input is severely constrained by the current Medicare rules.

We GPs know how much non-face-to-face time that we spend keeping our patients healthy.

We know that the fee for the visit has to pay for checking and following up pathology results. It has to pay for the time we spend dealing with correspondence from our colleagues in other specialties and in hospital.

It has to pay for the phone calls to patients and to carers. It has to pay for updating medical records with new information, and it has to pay for our ongoing self-education. It has to pay for the red tape. Every hour is another four patients not seen.

If you happen to be a rural GP and you are reading this, you may in addition to the above be on call 24 hours per day. If you send a patient to the hospital for further treatment, that doctor may be yourself. You may be the anaesthetist or the surgeon or the obstetrician as well.

I think we are worth that extra dollar.

I have the privilege of having a student with me in my practice at present. Alyssa is in her third year. After her first day, she told me she was amazed at the wide variety of complicated medical problems that I had to deal with. As each day has progressed, the range of medical problems we have seen has just widened. We have hardly seen any coughs and colds.

Just in the last few weeks, I have seen Barry with vague lower back pain and a mild temperature. He was fit and well and has hardly needed to see a doctor. For some reason, I requested a CT scan (despite the radiation risk), which revealed the fishbone perforating the third part of the duodenum as it was heading for the renal artery.

We saw Peter, a new patient who presented urgently after a wasp bite who proceeded to suffer cardiovascular collapse from anaphylaxis.

Today, Rita was slurring her words. She is an Aboriginal lady on oxycontin for chronic pain, who had accidentally taken both last night’s tablets and this morning’s tablets from her Webster pack.

Christine - a lady who has beaten her melanoma, survived her bicuspid aortic valve and aortic root replacement, and who has recently developed multiple myeloma and has just started taking thalidomide - presented for advice.

I saw Nick, who is 97 years of age with bilateral recurrent otitis externa. (I am not sure he really did not mind not being able to hear his wife.)

There was the three year old boy who lay as still as a gladiator as his chin was sutured after his latest battle with a doorway. The list goes on …

I asked Alyssa to check with the other students at her next gathering to see what the experiences of her colleagues were in other general practices. Not surprisingly, their experiences were all similar - full of admiration for their GP preceptors who have given freely of their time to enthuse and inspire their students.

We are the last true generalists. We love our job and we are going to continue to do our best for our patients and guarantee the quality of our health system.

Minister, we are doing more with less – we need support, not criticism or political point scoring. The Prime Minister is on the record as saying ‘…we need more GPs, we’ve got to train more GPs …’

The Government must turn these words into action, and soon. But until those new GPs get into the system, more has to be done to look after and appreciate those of us who are doing the hard yards in general practice because we genuinely care for our patients.

I salute my colleagues for their dedication to their patients, their profession and to our future colleagues - our registrars and students.

I am sure we are all worth that extra dollar.