GPs outraged at suggestion of inadequate expertise

Doug Hendrie

28/10/2019 9:22:31 AM

GPs have expressed anger and disbelief at ‘offensive’ claims they are not sufficiently skilled to provide end-of-life care.

Dr Harry Nespolon
RACGP President Dr Harry Nespolon called Martin Pritchard’s comments ‘offensive’.

WA Labor member Martin Pritchard last week questioned whether GPs are up to the task in a debate over his State Government’s plans to introduce voluntary assisted dying legislation.
‘I cannot believe that it could be appropriate for a person to say, “I’m going to die in six months. I should take advantage of voluntary assisted dying”, based on the advice of a general practitioner,’ he said in Parliament.
‘With all the respect in the world for general practitioners, there are some who specialise, but the vast majority are the doctors down the corner that people go to for some cough medicine.
‘The vast majority are generalists … I am not sure that a general practitioner in the backlots of the regions would have the ability to provide the closest prognosis possible when it comes to things outside their area of speciality.’
Mr Pritchard also said he does not think he would accept a GP’s assessment that he had four months to live due to cancer.
Mr Pritchard did go on to say he had no concerns about the coordinating doctor in an assisted dying case being a GP, and said he would prefer a GP who had a relationship with the patient to play that role.
But the comments sparked a strong response from RACGP President Dr Harry Nespolon.
‘These offensive comments show how out of touch Mr Pritchard is with modern general practice,’ he told newsGP.
‘The experience in Victoria has been that GPs are the backbone of putting into action the legislation.
‘Mr Pritchard fails to understand how many hours are required with patients and their families in this situation – even the patient and families who are just considering accessing voluntary assisted dying.
‘He is mistaken. GPs are specialists and the specialty of general practice is about the whole person, not just an ailment or particular body. They are not there to simply dispense cough medicine.
‘GPs working in the CBD of Perth, Albany, the Pilbara or – as Mr Pritchard himself describes – the “backlots of the regions”, provide complex, holistic and patient-centred care.
‘GPs apply their sophisticated skills in diagnosis and prognosis and an intimate understanding of a patient’s medical history and life circumstances to determine the best care and treatment. This includes coordinating care with other doctors, such as palliative care specialists.
‘I recommend Mr Pritchard visits his local GP and talks to them about the myriad complex clinical presentations that they manage every day before commenting on the role of general practice any further.’
RACGP WA Chair Dr Sean Stevens has also called on policymakers to remember that GPs are ‘recognised specialists in whole-person, patient-centred’ care.
‘GPs provide a range of specialist medical services for patients at all stages of life, and are well equipped for end-of-life care. Recognising and supporting the role of GPs is central to meeting society’s growing need for high-quality end-of-life care,’ he told newsGP.
‘GPs are experts in not only diagnosis and treatment, but also prognosis. Assessment of life expectancy for the purposes of voluntary assisted dying could be appropriately done by two GPs, with reference to a medical practitioner sub-specialising in the disease if deemed necessary.
‘It is also important to remember that arrangements for end-of-life care need to work for all people across Australia, not just those in metro areas.
‘GPs are the backbone of the healthcare system, including end-of-life care, and are often the only medical specialist in rural and remote communities.’
The controversy comes as WA debates the role of doctors in its proposed assisted dying legislation.
The legislation this week overcame another crucial hurdle, passing a preliminary vote in the state’s upper house. The laws passed the lower house in September.
Under the proposed laws, terminally ill patients over the age of 18 in pain with less than six months to live – or one year for those with neurodegenerative conditions – will be able to apply to access to a substance to end their lives.

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Anonymous GP   29/10/2019 6:57:58 AM

More communication is needed. As the specialist training and college has evolved, there is distinct and concerning lack of health literacy and awareness of the scope of GPs in our communities spanning all levels of society and despite whatever efforts to roll out GP awareness and public campaigns, this article is a gross exemplification of otherwise highly educated individuals in the community in highly respected positions of authority having seriously erroneous awareness in this regard, and further disseminating such in potentially damaging comments, which when one considers the broad scope of quality healthcare initiatives, and well-founded valid goals, represents significantly counterproductive uninformed statements at odds and as the author points out simply grossly disconnected and out of touch with up to date professional college, governance and guidelines publications that extensive backing work has gone into that defines the roles of general practice in the nation.

A.Prof Christopher David Hogan   29/10/2019 8:11:17 AM

OK Game On ! A message for anyone who underestimates GPs.
An essential skill of the GP is the ability to communicate with & understand people. To achieve this, their patients must be relaxed & able to speak freely.
* Do not confuse GPs’ modesty with their ability
* Do not confuse their achievements with their lack of arrogance
* Do not confuse the fluency with which they undertake their job with the difficulty of the task.
- An expert makes a difficult task look easy and General Practice is anything but easy.
-It takes at least 10 years to train a GP.
-They are all in the top tiers of academic results.
* Do not confuse GPs’ approachability with their skills as interrogators, analysts, diagnosticians, communicators , coordinators and therapists.
* Do not confuse their relatively low remuneration with their value to the community
* Do not forget that their knowledge & practical wisdom cannot be equalled by the modern access to information
All this is proveable

Dr Lisa   29/10/2019 8:19:33 AM

“Go to for some cough medicine”. It’s hard for the public to see us as qualified specialists when this is what our government representatives think of us. As a rural GP trainee I am absolutely offended by the statement. I can anaesthetise provide retrieval services, palliative care and much more in my community. A frustrating and demeaning comment.

Dr Lamia Nakhal   29/10/2019 10:12:25 AM

I am so offended by those comments. I have always been cynical about “ being valued” and “being important “ and this person just described what people think of us GPS.
I believe our College and our president should call for a public apology.

Dr Horst Paul Herb   29/10/2019 11:19:08 AM

We are used to politicians either lying or being generally clueless, poorly educated, and largely uninformed about the topics when they voice their unqualified and invariably biased opinions. Why then acts everybody so surprised or outraged?

Dr VT   29/10/2019 11:44:24 AM

His comments are reflective of public opinion, and this widespread opinion is one of the reasons for general disillusionment in the GP workforce. As GPs, it is necessary to excel at being a generalist. We do this by choice and it should not be seen as an acceptance of mediocrity. We should be recognised for the effort taken in keeping up to date with the breadth of General Practice, in the same way that our colleagues in other colleges are recognised for keeping up with the depth of their speciality.

Dr Seamus Ryan   29/10/2019 12:06:23 PM

Sadly, Mr Pritchard has put on public display, his own gross ignorance for his constituents to see, the majority of whom will know better. We should not "argue with a fool" - let him wallow in his own cesspit of stupidity....

Dr Fiona   29/10/2019 12:12:28 PM

I read his comments. They are on page 21 of 24 of the Bill. Unfortunately he has had a few negative personal experiences with GPs / doctors (a GP overlooking his early skin cancer, same GP misdiagnosing his wife's MI, another medical team "just upping the morphine" of an elderly frail relative) which has resulted in a general mistrust of doctors. Therefore we are all tarred with the same brush, and the wider debate about VAD becomes more about him (I find it hard to connect how his GP missing a minor early skin cancer on the top of his head informs his opinion on palliative care of the dying). I think he makes some valid comments about diagnosing terminal disease and establishing prognosis (most GP's I expect would like to feel supported in this process) but his passive aggressive cough medicine comment is a major turn off and clearly meant to denigrate and offend.

Prof Max Kamien, AM   30/10/2019 12:09:45 AM

In the WA debate on VAD, GPs have been inaudible and invisible.
One reason is that the RACGP has, because of the different views of its members, correctly chosen to take a position of neutrality in the debate. But that should not mean that it should not be engaged in explaining that GPs do look after our dying patients and that not every dying patient becomes the province of a palliative care specialist. It is not congruent that we spoke up for same sex marriage but are mute on a matter that affects many more of our patients.

Irrespective of where GPs stand in this debate our lack of visibility gives the impression that death and dying are not the province of General practice or General Practitioners.

Similar VAD legislation will soon be debated in SA, NSW and Queensland. The RACGP should not take sides. But for the sake of the status of GPs and the public’s understanding of our work our representative body should be ‘engaged’.

Dr Christine Linnette Troy   30/10/2019 12:17:54 AM

Well said Dr Chris Hogan - worth saying again, in your exact words:
Do not confuse GPs’ modesty with their ability
Do not confuse their achievements with their lack of arrogance
Do not confuse the fluency with which they undertake their job with the difficulty of the task.
Do not confuse their relatively low remuneration with their value to the community

Dr Peter James Strickland   30/10/2019 12:41:51 PM

This statement by Michael Pritchard is typical of the ignorance of some politicians on VAD. He is trying to express the view that an experienced GP anywhere who has dealt with patients dying over sometimes decades is unable to ascertain some reasonable prognosis. A famous author said the following---" politicians and diapers(napkins) need to be changed often, and for the same reason". No-one can accurately predict death months in advance --that is no-one. How often are patients with widespread metastases predicted to live 3-6 months, and go on for 1-2 years --often? VAD should NOT be in any doctor's practice ---it is totally outside our whole philosophy of attempting to heal and relieve, but not kill. VAD is a legal and moral problem, and those who want to introduce VAD have to be prepared to be able to euthanise their parent, child, relative, husband or wife etc --- it happens now, and it is legally murder, and it should never be the role of the doctor except as an adviser.

Dr Paul Vernon Jenkinson   30/10/2019 10:51:27 PM

Can I say that I ,as a GP,worked for a community palliative care network as I had done some post graduate trading in palliative medicine and had a strong interest in it.Unfortunately,it was my experience that very commonly,GPs who looked after their dying patients needed a lot of my support and that a lot of GPs were very grateful for me to take over all the medical care of their patients.
After all,on average ,a full time GP will only be involved with the care of 3-4 dying patients per year ,hardly sufficient to become familiar with the palliative medicine medication regimes and options.
For example ,opiates were consistently under-utilised.
That WA politician is not as far off the mark as we would like to believe.

Dr Anon   31/10/2019 9:44:36 PM

It is not so much about the GP's knowledge or experience in palliative care but in who is best placed to have a discussion with a patient around VAD. When Mr Pritchard mentions things like diagnosis and prognosis I think it is a given we have to be very careful about who may fall into a VAD category. Categorizing a patient as VAD eligible would need multiple opinions from various specialists, including the GP, to properly agree the patient fits the VAD category. From there the next stage of discussing whether they wish to go ahead with it should definitely be more in the hands of the GP. There are GP's who have regular patients they see often throughout their lives and whole family's lives. Patients rely on them. The relationship then means GPs are the best placed doctors to discuss VAD with these particular patients. Patients would feel comfortable with their regular GP as would their families. However no doctor is skilled yet in discussing VAD. It's an uncharted area.

Dr Diana May House   3/11/2019 5:08:34 PM

100% agree with Dr Chris Hogan. Sad so little value or respect for what we do