Increasingly complex presentations pile pressure on GPs

Increasingly complex presentations were the greatest source of pressure in 2022 for nearly one in four respondents to a newsGP poll, an end of year survey has found.
 
The poll, which attracted more than 1200 votes, also revealed that excessive paperwork/red tape was the chief issue for more than one in five respondents (21%), while business sustainability (17%) rounded out the top three issues over the past 12 months.
 
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, noted that the poll did not provide enough detail to determine what constituted a ‘complex presentation’, but said the results support the push for general practice reform.
 
‘My involvement in the review of the Red Book and many other clinical practice guidelines has made it very clear to me that the practice of medicine only gets more complicated,’ he told newsGP.
 
‘That is why we desperately need patient rebates to increase, particularly for longer consultations.’
 
He also suggests that the ongoing impacts of the COVID-19 pandemic – now into its third year – and increasing frequency of mental health consultations may be contributing factors.
 
‘There is evidence that COVID interrupted some prevention and monitoring of chronic disease,’ he said.
 
‘In my practice, many consults to manage acute presentations end up being an opportunity to catch up on the management of risk and existing conditions.
 
‘The Health of the Nation report also showed the increasing impact of mental health, which is always complex.’
 
Meanwhile, recent research into the long-term sequelae stemming from COVID-19 may provide other hints as to the cause of these increasingly complex presentations, with studies pointing to physical and potentially neurocognitive impairment following COVID infection for some patients.
 
GP Dr Bernard Shiu, who has helped to establish long COVID clinics in Geelong and Torquay, believes the condition’s prevalence is contributing to the rise in complex presentations.
 
‘Long COVID is a highly complex condition as many of the patients have multiple comorbidities before contracted the virus,’ he told newsGP.
 
‘It takes real GP skills and understanding of the patients’ background to tease out what the actual consequences of the COVID virus are, what are [related] exacerbations, and what are completely not related to COVID – for example, pulmonary embolism, multiple sclerosis, postural orthostatic tachycardia syndrome, etc.’
 
Dr Shiu said the problem is further complicated by the fact that long COVID can affect patients’ mental and social wellbeing.
 
‘Many of our patients have not been able to return to work and addressing issues that come along with that can be a real challenge,’ he said.
 
‘At the end of the day, we are dealing with a lot of uncertainties regarding a disease we only have limited knowledge about, and of course the ever-changing advice on what to use and what not to use.
 
‘Fortunately, GPs are masters at dealing with uncertainty and guiding patients in a holistic manner. Helping them to find a personalised path to recovery is our bread-and-butter work.’
 
Outside of the top three issues, excessive patient workloads and staff shortages also attracted more than 100 votes, with COVID-19 and medication supply issues the main issue for only 6% and 2% of respondents, respectively.
 
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