On the final day of the GP22 conference, attendees heard what an ‘unchained’ general practice would look like.
GPs may be highly skilled, but numerous barriers hold them back, according to Associate Professor Chris Hogan of Melbourne University’s general practice department.
In his colourful presentation at the GP22 conference in Melbourne, Professor Hogan named them and explained why they need to be torn down.
Fear and excessive risk-aversion
“We live in a risk-averse society, and we have accepted this fear without challenge,” he said.
“However, as I was taught as a child, the person who has never made a mistake has never made anything. Instead of telling our students, our registrars and ourselves, ‘Do not make a mistake’, say, ‘Do your best’.” GPs should avoid being impatient, impetuous or consulting with a patient when ill or exhausted.
Impostor syndrome
“This affects all genders,” Professor Hogan said. “It’s a form of anxiety manifested by an individual’s belief that they are not as competent as other people think they are. It’s an anxiety of self-doubt that results from persistently undervaluing one’s competence; an active role in achieving success; or falsely attributing one’s accomplishments to luck, or other external forces.
“It brings the fear of litigation or censure by AHPRA or other regulators, of being sued, even of adverse social media releases.”
Defensive medicine
“Defensive medicine is the result of all of the above,” Professor Hogan said. “We order needless tests when clinical observation can be enough. We restrict our field of practice so that we are less uncomfortable. We work fewer hours, in areas where there are more resources, such as metro and provincial.
“We do not stretch or expand our skills and we don’t contribute to research. We keep a low profile.”
Excessive litigation
Too much litigation was based on legal precedent, he said, where the decisions of one judge, with minimal resources, can affect a whole health system.
A beneficial reform would see medical regulation set by parliament, where the full resources of parliament and its advisers would be able to examine all the implications of decisions.
An overzealous regulator
AHPRA also needs significant reform, according to Professor Hogan, including improving the waiting times for complaints to be heard and the handling ofinappropriate complaints. AHPRA says nothing to the community about what is reasonable and unreasonable behaviour.
“AHPRA speaks only to the behaviour of individuals,” he said, “not to the systems which often fail to protect or support those individuals.”
Inadequate Medicare rebates
“Because Medicare is now perishing, we charge what we need to charge to make our job viable, and it’s up to no one else but ourselves,” Professor Hogan said.
Medicare was no longer fit for purpose and would not support the unchained general practice of the future, he said.
Referral as default
“We can reinstitute the role of consultants,” Professor Hogan said, “treating our colleagues and other disciplines as consultants to advise us rather than specialists who exclusively manage people with individual chronic conditions. We do not need more and more hyper-specialists. We need unfettered GPs.
“GPs are the experts in the management of complex multiple comorbidities.”
Loss of skills to other disciplines
Doctors need to keep evolving skills in general practice and not let them boil off into other areas, according to Professor Hogan. GPs are very skilled, but when they concentrate on one area, they become specialists in another better remunerated area.
“The reimbursement and remuneration gap between GPs and non-GP specialist is an accident of history. When I started, which was a while ago, the whole lifetime earnings of a non-GP specialist were equivalent to that of a procedural GP,” he said.
Poor community health literacy
“Poor health literacy leads to poor self-management, inability to understand basic health information, and leads to grossly inappropriate expectations of the health system and its practitioners,” he said. “It leads to extremists such as the rabid anti-vaxxers.
“In 2006, only 41% of Australians who spoke English aged between 15 and 74 were assessed as having adequate more than adequate health literacy.”
Inadequate support for IMGs
“Support must continue to expand for international graduates who currently represent 52% of the Australian GP workforce,” Professor Hogan said. “They need adequate information about what to expect when they come to Australia and adequate support to integrate into Australian culture.”
IMGs need support and education to gain registration as well as GP fellowship. The issue is funding. Much of non-GP specialist training is supported by hospitals; GPs must self-fund a lot more of their education, he said.
