GPs forced to defend commitment to Hippocratic Oath

Matt Woodley

20/05/2022 5:49:17 PM

Another high-ranking state politician has accused GPs of putting undue pressure on hospitals, prompting a strong rebuke from RACGP leadership.

WA Premier Mark McGowan
West Australian Premier Mark McGowan has blamed GPs for hospital overcrowding. (Image: AAP)

West Australian Premier Mark McGowan has sparked outrage, after he attempted to quote the Hippocratic Oath to GPs and accused them of ‘driving’ people into the state’s already overcrowded hospital system.
Premier McGowan made the comments after being questioned about his government’s handling of a resurgent COVID-19 outbreak – the worst in WA to date – that has broken daily case records and left more than 200 people dead since the beginning of the year.
Overall, there are nearly 90,000 active COVID cases in Western Australia, while Premier McGowan said ‘way more’ than 3000 public health staff are currently furloughed due to COVID – including 40% of ambulance staff.
However, despite the transmission risks associated with in-person consultations – and the potential for the health worker absentee issue to spread into primary care – Premier McGowan has asked GPs to scrap triaging safeguards designed to protect staff and vulnerable patients by accepting all people with respiratory illness, even if the practice is not equipped to deal with them.
‘You can go to a GP surgery … and there’s a sign on the door, “if you have a respiratory illness don’t come in”,’ he told reporters.
‘That’s driving more people into our hospitals … [so] I would request that GPs don’t do that.’
The claims mirror similar statements made by Queensland Deputy Premier Steven Miles, who earlier in the week blamed GPs for ambulance ramping in his state. However, Premier McGowan appeared to take the rhetoric one step further by questioning GPs’ commitment to their patients.
‘Isn’t the Hippocratic Oath that you’re supposed to allow anyone to come in and receive medical attention?’ he said.
‘If people are unwell, please deal with them.
‘Referring them to our emergency departments just puts additional pressure onto our hospitals.
‘Wear the appropriate PPE, wear the appropriate masks. If you want to wear a face shield wear that. But please, see anyone who comes into a GP practice.’
RACGP President Adjunct Professor Karen Price responded by labelling the comments as ‘completely unfair and unacceptable’, adding that general practice teams deserve better.
‘I encourage Premier McGowan to reflect on the fact that GPs and general practice teams truly are the foundation of the nation’s health system and that we are doing our absolute best,’ she said.
‘In fact, it is our preventive care, early intervention, and sub-acute care that results in reduced numbers of people presenting to emergency departments. We are desperately needed by our communities and are working extremely hard.
‘I remind the Premier that without us, the healthcare system would collapse.’
Although Premier McGowan sought to shift blame for problems with the state’s healthcare system onto GPs, overcrowded hospitals and ambulance ramping have been longstanding issues in Western Australia.
In August last year, elective surgeries were placed on a month-long freeze due to overcrowding and staff shortages – the third time such steps had been taken during the pandemic, despite WA being essentially COVID-free until opening borders at the beginning of 2022.
Meanwhile, St John Ambulance figures indicate a 10-fold increase in ambulance ramping time since the McGowan Government was elected in 2017.
Instead of pointing the finger at GPs for the state’s woes, Professor Price said the Premier should offer support to general practice – including by helping to supply life-saving PPE that up until now has mostly had to be sourced privately.
‘I note that he has encouraged us to wear the appropriate personal protective equipment and “appropriate masks”,’ she said.
‘That is all well and good … but throughout the pandemic many practices have reported significant shortages with no support from the state.
‘So, instead of criticising us, why not get behind general practice and assist with PPE and help us with the many challenges GPs and general practice teams are facing on the frontline every day?
‘GPs and practice staff are also off sick, having come down with COVID or another virus. They’re stretched and they’re at breaking point.
‘The timing of today’s comments could not be worse; this really looks like a case of kicking GPs and general practice teams when they are down.’
RACGP WA Chair Dr Ramya Raman was also critical of the Premier, saying ‘no GP’ would direct patients to emergency departments unless it was ‘absolutely necessary’.
‘GPs don’t need to be reminded about the Hippocratic Oath; we are fully aware of our responsibilities as health practitioners,’ she said.
‘What the Premier clearly isn’t considering is that each individual practice has to make extremely careful decisions about managing patients in a pandemic.
‘Some practices in Western Australia will have the capacity to see patients with respiratory symptoms; however, others sometimes will not … we can’t just discard all the systems we have implemented during the pandemic.
‘We still have to triage symptomatic patients and implement infection control precautions such as the use of personal protective equipment and this takes time and resources.
‘If practices don’t have the space to manage this task, they will have processes in place to refer patients appropriately, be that to a nearby practice or a local GP led respiratory clinic.’
Dr Raman also asked Premier McGowan to consider what would happen if general practices stopped taking precautions.
‘If COVID-19 spreads throughout a practice and GPs and staff are forced to isolate this will have a huge impact on patients in that community,’ she said.
‘We are not “driving more people into hospitals”, we are doing all we can to limit COVID-19 transmission in our practices.
‘Anything less would be irresponsible.’
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Dr Sean Colin Chesson Stevens   21/05/2022 12:26:45 AM

As a front line GP who has just spent an 8hr day seeing patients face to face and keeping them out of ED and then a 4hr shift in the GP Led Respiratory clinic seeing and treating people with COVID, I find it incredibly galling to find my Premier reminding me of my obligations under the Hippocratic Oath. When the RACGP WA was asking the state government for PPE they were very quick to shift the responsibility to the Commonwealth, now they are asking why GPs don't have the PPE to keep patients out of their EDs. You can't have your cake and eat it too.

Dr Sally Francis Partington   21/05/2022 4:53:30 PM

Fully support what Dr.Sean Stevens commented re Mark McGowan

Dr Yee-Shing Cathy Kan   22/05/2022 7:27:09 PM

I will suggest the premier to set up a directory for all the GP clinic ( just like the directory for COVID vaccine GP clinic in the state) that will see patient with respiratory symptoms so patient and be directed to. I m sure he will be surprised how many practices do see patient with respiratory symptoms in every suburb ( including Rockingham where he lives) - opposite to what his impression is . And I am sure those clinic don’t’ see patient with respiratory symptoms face to face do offer Telehealth consult to patient and manage them appropriately without sending them to queue up in ED. So, his statement about GP not seeing respiratory is completely wrong and causing hospital congestion and ramping is totally rubbish - a cheap political game! And we should remind him that his successful COVID vaccination rate are mainly due the large involvement of GP clinic that go above and beyond what we signed up or pay for.

Dr Cindy Sze Yoong Ng   23/05/2022 1:19:44 AM

It is an easy deflection to point the finger at GPs when we know a large part of the problem are lack of staff for hospitals, hence bed shortages and ambulance ramping. As I GP I really try everything I can to manage my patients in the community , before I even contemplate sending patients to ED.

Dr Henry Arthur Berenson   24/05/2022 9:42:52 AM

Pot calling the kettle black. A risk averse premier closed the borders but wants GPs to expose themselves and their practice.

Dr Kosala Abeysundera   24/05/2022 12:02:48 PM

Another idiotic politician trying to cover up their incompetence. He should remind himself he’s under an oath to serve the country but he has failed contained covid in his state and provide adequate care by providing funds and staff to hospitals
Stop blaming and pull up your socks

Dr Shuaib NASSIR Ellahi   24/05/2022 2:44:28 PM

How dare he?! I would urge some action to be taken on this by the RACGP other than just having a rebuttal that will fall on deaf ears.
I work in community as well as emergency departments, i am well aware that his comments are then held as views by the general public as well as hospital staff, because i experience them on a working daily basis.

How much effort has he made to have focus groups to discuss the issue? How well does he even understand how poorly funded the primary care sector is?
The gall of this incompetent premier whom has done nothing but surround himself with yes men when it comes to health.

Beyond infuriating and no doubt the RACGPs rebuttal will fall on deaf ears as there is no mainstream media reporting on the Karen Prices' comments.

Dr Edward William Brentnall, MBE,OAM   27/05/2022 5:20:00 PM

I was a GP in the UK for seven years, and in Melbourne for a further ten years.
Then I became an Emergency Physician for the following twenty or so years, so I have seen both sides. There is a limit to the ability of GPs to provide proper modern care.
GPs are experts in knowing what they can safely do and when referral to hospital is the wise and proper course of action. Politicians always think that they know best! And they merely expose their ignorance.