Complex GP load often overlooked in health policy: Study

The complex load GPs tackle during a single consultation has been revealed in a new study which found patients raise an average of eight issues across multiple health systems in a single consultation.
 
Published in the Australian Journal of General Practice, the Monash University study explores the ‘hidden complexity of general practice’ using the National Centre for Healthy Ageing’s Digital Library.
 
The library is Australia’s first secure digitised collection of real-world consultations between GPs and their adult patients, including anonymised transcripts, patient survey logs and participant demographic data.
 
Led by GP, Adjunct Professor Liz Sturgiss, the research team examined 54 video-recorded consultations from four different GPs in Melbourne.
 
They discovered, on average, that consultations ran for 19 minutes, five issues were discussed (ranging from one to 14), and a further three were mentioned (ranging from zero to eight).
 
The breadth of the health issues covered included musculoskeletal, cardiovascular, psychological, skin, and digestive complaints. GPs were also called on to provide lifestyle counselling about nutrition and weight management issues in half of all consultations.
 
GPs also discussed medications with almost every patient (98 per 100 encounters) and ‘shoulder a significant administrative burden’ accounting for 83 in every 100 encounters’, the authors explained.
 
Examples of admin work include creating pathology and imaging requests, providing medical certificates, calling the pharmacy to organise an authority script, making follow-up GP and practice nurse appointments, printing off copies of results for the patient to take to other healthcare team members and assisting with social security and insurance paperwork.
 
This was considered separately to referrals to other healthcare providers, which occurred in 40.7 per 100 patient encounters, the authors wrote.
 
Professor Sturgiss said GPs cover a lot of ground within consultations, with multiple issues and inter-related problems to manage.
 
‘When we look at the consultation as a whole, it allows us to see this complexity,’ she told newsGP.
 
‘If we break general practice into small pieces and only focus on the fragments, we lose sight of the whole picture.’
 
Understanding the bigger picture, and the complex workload GPs experience daily, is essential to inform policy and identify ways to support our current and future GP health workforce, the study said.
 
‘Often health problems are seen in isolation – we see programs and policies that focus on one issue, or one body system. But patients don’t present to general practice with one issue or problems with only one body system,’ Professor Sturgiss explained.
 
‘When policy makers look at the cost of care, they often focus on the one issue but don’t see all the complexity.
 
‘For example, the health system cost of managing a UTI might look like a simple problem that could be done more cheaply. But it isn’t just the UTI that is managed within a GP consultation – high quality GP care will also cover preventive care, chronic conditions, mental health, all within the consultation.
 
‘We can’t lose sight of what happens within the consultation as otherwise we miss this complexity.
 
‘If we keep breaking up health problems into small parts, then we lose the effectiveness and efficiencies of whole person care.’
 
Professor Sturgiss added that patients who have a long-term relationship with their GP are more likely to bring up multiple issues, and this was reflected in the study.
 
‘Patients are often presenting with more complex problems – but they often only open up about their issues after they have developed a trusting relationship with the GP,’ she said.
 
‘The GPs in this study were senior, exemplar clinicians and most of the consultations were with patients that they’d known a long time.
 
‘Knowing the patient and having that trusting relationship are essential ingredients for high quality general practice care.’
 
Log in below to join the conversation.

complex presentations GP wellbeing whole-person care