I don’t want to be left to ‘only manage the more complex stuff’. I need that light and shade in my day.
I know it shouldn’t annoy me as much as it does – but I can’t help it. It is in my face every time I go to work. The banner outside the next-door pharmacy. In essence it says: “Got symptoms of a UTI? Come talk to us!”
Really??!!
I love the pharmacists next door – they are truly lovely people and very competent pharmacists. It’s not them – it is just indicative of the general job creep that is being pushed by, not only pharmacists but also allied health, nurse practitioners and seemingly anyone else who the government might think will save them a Medicare dollar or two under the guise of promoting access to healthcare.
This is not a new issue and I have long railed against the idea that there is a lot that we do in general practice that is so easy and straightforward it should be given to other people so we can be left to only manage the more complex stuff … like mental health.
So many of the arguments against this stupid idea focus – quite rightly – on the fact that, what some bureaucrat might consider easy and straightforward might involve complexities that, if not recognised, could jeopardise a patient’s health. In addition are the risks of fractured patient care, conflict of interest between the “diagnose” and the “dispenser”, and the lack of ongoing accountability and monitoring.
All sound arguments to be sure.
But if I’m entirely honest, my greatest peeve about this whole situation is the fact that I don’t want to “be left to only manage the more complex stuff … like mental health”.
I need that light and shade in my day.
I need that patient with nitrates and leucocytes in their sample. I need to pierce that little herpetic blister, send off the swab and simultaneously get the patient started on antivirals. I need to discuss all the nuances around taking the OCP.
That’s what I do, and I know I’m good at it.
If they really want to improve access to GPs and share the burden of patient demand – take some of my other patients – some of the ones where their healthcare needs, I feel, are way out of my jurisdiction or expertise but they’re there because I’m their most affordable option.
Take Tess*, my 13-year-old patient who was brought in by her mother last week. I have treated the mother in the past but had never before met Tess.
Just a 15-minute appointment booked, of course.
In a nutshell Tess had been in a (very) physical fight with her older sister two days earlier – so physical the mother called the police to break it up (yes – you read that right) and the mother just wanted Tess’s shoulder checked because it had been sore the day after. Apparently, Tess and her older sister are best friends again.
Tess obviously didn’t want to be there. She never met my eye and gave me monosyllabic answers. Her mother drip-fed me the information. There were so many layers to this story including school refusal, insomnia, bullying, school psychologists, menarche, iron deficiency … and anger – lots of anger.
With each new revelation, Tess would yell at the poor mother who remained sanguine about the whole situation and never actually asked for help beyond asking me to check for post-fight injuries.
It was a truly bizarre 30 minutes! Felt more like a confessional than a consultation. Certainly not a classic clinical case written up in John Murtagh’s General Practice bible.
So what did I do? How did I sort out this more “complex GP scenario” that the government is so keen that only I can manage?
Well – I can tell you it wasn’t any brilliant therapeutic tool or highly specialised insight.
Basically, I just stated the bleeding obvious. After making some suggestions about sleep and iron supplementation, I said she (as in Tess) obviously had a lot of anger and was clearly unhappy. Maybe I could help – maybe I couldn’t but I could not force help on her. If she wanted to talk more (with or without her mother) she was welcome to come back.
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I have no idea whether that made one iota of difference, but it was all I could think of. She’s seeing the school counsellor regularly. To my mind – anyone could have done what I did! It was advice based on age and experience – nothing to do with my degree.
How would the Pharmacy Guild feel about taking on Tess presentations? That would certainly help access to this GP.
Can’t see it happening anytime soon though, can you? For one thing there aren’t any medications involved, except perhaps some iron and I doubt the mark-up on that would justify the 30 minutes.
Still, I can dream. Maybe one day I’ll come to work and the banner next door will read “Are you a sullen, angry, passive-aggressive 13-year-old? Come and talk to us”.
I’m not holding my breath.
