‘Corridor consults’ placing unnecessary stress on registrars

Morgan Liotta

15/03/2019 11:43:58 AM

Should general practice registrars be obligated to provide medical care to colleagues and family?

Dr Krystyna de Lange
RACGP Registrar Representative Dr Krystyna de Lange says it is important to maintain professional relationships between general practice registrars and their colleagues.

General Practice Registrars Australia (GPRA) says no, as do a number of registrars.
GPRA recently released a position statement outlining conflicts of interest for medical practitioners treating work colleagues and family, stating that general practice registrars ‘should not provide clinical consultation services or provide medical care to practice staff or others who they work with, or the immediate family of these professional colleagues’.
RACGP Registrar Representative Dr Krystyna de Lange supports this stance.
‘I think this [position statement] was a great initiative of GPRA in advocating for registrars,’ she told newsGP. ‘It empowers registrars to be able to talk to their practice manager or supervisor about this issue.
‘There are some registrars who struggle to raise concerns like this due to a perceived power imbalance with their supervisor, but this gives them something tangible that they can arm themselves with.'

Dr de Lange believes there are many issues that can arise when general practice registrars provide care to family members or those with whom they work, and this can lead to considerable stress.
‘There can be so many issues that arise when we treat other members of staff, from “corridor consults” with inadequate information, to confidentiality issues, to the challenges with remaining objective to the potential for under-investigation or over-investigation,’ she said.
It is risky to underestimate the potential anxiety that treating staff or family members would place on some registrars, according to Dr de Lange.
‘Imagine as a first-term or second-term registrar, looking at your appointment book to see your supervisors’ child or your practice nurse who booked in to see you – it could be quite confronting,’ she said.
‘Sure, it may be something quite benign, but it can be a slippery slope.
‘It is important that practices are looking out for registrars and ensuring there are appropriate boundaries in place and professional relationships are maintained.’

The GPRA’s recommendations include having a written policy in place for all training practices, informed by the Medical Board of Australia’s Good medical practice: A code of conduct for doctors in Australia.
General practice supervisors, the GPRA believes, should also be supportive of registrars who reasonably refuse to see practice staff members or their immediate family members.

‘This [GPRA] position statement provides a great starting point [for practices] to develop their own policy about seeing and treating other staff members,’ Dr de Lange said. 
‘Obviously each practice is going to be different, but education of staff is going to be key.
‘Ensuring that reception staff are aware that the practice policy is not to book staff members in with registrars would be a good starting point. It is important for supervisors and practice managers to support registrars in their decision not to see staff members wherever reasonable.’
Dr de Lange offers her own advice to minimise pressure on general practice registrars.
‘It is my opinion that wherever possible practice staff and their family members should be encouraged to have their own independent, objective GP outside of the workplace,’ she said.
‘Where this may not be possible, it should be a senior GP who is taking on the responsibility – not the registrar.’ 

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Moataz Shaghi   19/03/2019 7:35:18 AM

In some places it is impossible and we need to see every one . I am working in small rural town , the population around 1800 , it’s the only practice in town and me and my colleague in the practice are RVTS registrars now .We are the only doctors in town most of the times for the clinic and hospital . Any idea how we can apply the GPRA recommendation in our case

Dr Nicholas Tellis   19/03/2019 9:31:27 AM

This should be good medical practice for all GPs. I don't have a solution for rural/remote areas and it would be great to hear from some of our experienced rural GP supervisors as how they personally dealt with this issue.

In urban general practice, no GP should be treating their relatives or staff or getting their trainee to do it instead.

Pierre Sands   19/03/2019 10:29:24 AM

As a recently fellowed GP, not so long ago a GP registrar. I found undue stress from seeing patients that presented with more than one complaint. I would often go home upset at nights. I wonder why GPRA have not been campaining against patients that present with more than one issue.

A.Prof Christopher David Hogan   19/03/2019 3:47:31 PM

The answer to every question in Medicine is that "it depends"
I fully accept that it is inappropriate to treat yourself or to treat your family, except in emergency & have stuck to this principle throughout my career.
I also accept that every doctor has the right to not accept a person as a patient- for whatever ethical reason- except in emergency.
However, there is an elephant in the room- not all doctors are the same. Doctors are different with different levels of communication, different personalities & different skills .
When we are patients we expect to be able to choose our GP - if they are available. We are not yet in a capitated system.
One of the reasons we select a doctor is because of trust. We GPs are cautious people & we do not give trust easily. Being asked by a colleague to care for them or their families is a great honour but it requires training for there are traps for new players.

A.Prof Christopher David Hogan   19/03/2019 3:57:39 PM

Corridor consultations are often initiated by an anxious or shy colleague. "do I need to treat this?" is the question they are really asking. If they trusted me enough to ask, I would give them a proper consultation & offer a proper answer. I had a rule of thumb to determine if I was comfortable treating a person. If I could comfortably do an internal exam were it needed, I would see them. If not, I would suggest another doctor.

Dr Peter J Strickland   19/03/2019 5:10:34 PM

I think we have to show a little more confidence in ourselves. Everyone of us has different skills and personalities. In 50 odd years of practice in the services and civilian general practice there was no difficulties with colleagues consulting me about themselves or family. If I didn't know the answer to their enquiries I would advise on how to get the answers they needed ---that is our role in society. I have had colleagues advising me about minor illnesses, on-referring me, or even cutting out a few lumps and bumps. Consultations with colleagues and work staff sharpen the clinical skills, and can be good to mature our professional lives if done properly, ethically and sensibly. We all advise ,and often treat our own families now ---it is part of a loving life.

Assem   19/03/2019 10:07:26 PM

This statement is not going to be valid in remote areas where there no other GPs.. please do not universally talk about this.Be specific and logic as well as real.

Dr Everest Osondu Nkire   20/03/2019 5:23:06 AM

My take on this discussion is to let registrars decide on case by case basis.The General Practice Registrar is a qualified doctor who is capable of seeing or consulting any primary care patient be it his/her colleague, fellow staff members or family to his colleagues. Being a colleague in the same practice does not necessarily mean you are friends. The registrar has the prerogative to consult the supervisor where s/he finds a challenge in the consult and to refer to relevant specialists where the need arises. Registrars also preserve the right to consult or choose not to consult colleagues, families and co workers. Co - workers, colleagues and families who consult the registrar are expressing a level of confidence in the registrar and would not do so if they did not have confidence in the registrar. Encouraging registrars to refuse all consultation with colleagues, families of colleagues and co workers would breed distrust, disharmony and hardship to the registrars themselves