Dr Ben Howell argues that you can't demand GPs do home visits then quibble on the billing
You can’t have it both ways. You can’t demand that GPs provide home visits and then quibble about the billing, writes Dr Ben Howell
As a new GP trying to establish a patient base in a private billing practice, I recently decided to sign up for some after-hours work with a deputising service to supplement my income during the set-up period. After reading the article Is after hours being abused? in The Medical Republic, there is no question that the answer is yes. After hours most definitely is being abused.
However, I don’t think the blame lies at the feet of doctors. On the day I worked, I was in my rooms from 9am until 6pm. There were lots of free appointments for people to see me to have their medical problems attended. I then worked from 6pm until midnight seeing patients who rang the deputising service stating they needed to see a GP urgently.
When a medical professional is confronted by a presenting complaint that requires them to drive to a person’s house to determine whether that patient needs urgent hospitalisation, or can safely stay at home, then the condition of a 597 is met. In my opinion, their presenting complaint required “urgent medical treatment”.
You can’t have it both ways. You can’t demand that GPs provide home visit appointments and then quibble about the items they are billing. The sole reason the government wants urgent, after-hours services is because it’s cheaper to have a GP see people with trivial medical complaints rather than have them present to an emergency department. If you’re not willing to pay GPs for the provision of an urgent, after-hours care then they simply won’t do it. People can take their trivial complaints to the more expensive emergency departments.
So, in my opinion, the misuse of the system isn’t doctors charging a 597 instead of a 5023. The problem is the misuse of the system by the Australian public. I acknowledge there will be some people who have a genuine need for GP attention in the middle of the night, however, on the shift that I worked, every single one of the patients had been unwell for more than 12 hours. All of them could have seen a GP that day if they’d prioritised their medical need over school, work or other commitments. All but one of them could have safely waited for an appointment with their usual GP in the coming days.
So the problem is that people are using these after-hours services for problems that could safely be attended to at a routine appointment with their GP. And nobody is interested in stopping them. Instead, politicians and medical administrators seem fixated on how to best cater to people who want to misuse the healthcare system. How about we stop trying to pander to this misuse of medical resources and start saying no? How about instead of promising the public they won’t wait longer than four hours in an emergency department, we instead promise that people who turn up to emergency with a trivial complaint will be turned away?
Furthermore, if you have a trivial complaint then no doctor can see you immediately. No GP services attached to emergency departments to cater to this demand. No doctors driving to these people’s houses. We just say no. Book an appointment in the coming days with your GP. Nobody else will see you before then if it’s not truly urgent, in the medical sense of the word.
The blame for the misuse of after-hours appointments lies squarely at the feet of politicians, administrators who pander to their ideas, and journalists. Newspapers publish headlines of how long someone had to wait in emergency, the minister enacts some inane changes to appease the outraged public, and heads of departments start raining the chaos onto the rest of us.
All of a sudden every doctor’s priority needs to be reducing waiting times in emergency departments. The solution is to refuse to meet ridiculous demands that are eroding a healthcare budget that could be better spent on people with genuine need.
Dr Ben Howell is a General Practitioner working in Sydney
