Philip Dawson   6/02/2018 9:00:52 AM

The article didn't mention some ED interns are keen to play GP and invite patients back for daily dressings, wound checks, plaster checks removal of sutures etc. Clearly there is a lack of supervision and instruction of the function of EDs.

Mai Maddisson   6/02/2018 10:41:01 AM

I can't speak for all A and E staff but perhaps I do have my finger on the pulse a little given one of my sons is an A and E Physician. The concern of those doctors is to learn to optimise the management of patients who are not adaptable to GP management, to ready them for a return to the GP.
Perhaps looking at it thru a potential patient's eyes
1. No one likes to be shoved in and out of the door in 7-10 minutes, no matter how clever the doctor because apprehensive patients always forget to say something in that time.
2. General practices tend to show up in a harried presentation, and indeed A and Es while overworked often to present with a greater 'ambience' for want of a better word: You know that gentle look from the passing nurse or a doctor etc.
3. The booking system presents badly. The traditional 1/4 hour appointment times generate an allusion of 10-20 minutes allowing for flexibility. The ones ending in x.y0 apart from on the hour and half past generate an allusion of 5-15 minutes. Perhaps marketing needs to be considered.
4. Also under the marketing letter head is the clutter of what seems to be advertising doctors' wares, eg options like vaccinations etc. in the waiting rooms. It generates a sense of pushiness. Something more restful, even simple el cheapo pictures (prints) would present better. And patients would expect a GP to personalise what they offer.
5. The lack of availability of doctors at reasonable hours *. People's jobs have become increasingly insecure and patients can't afford to be perceived to be ill: It could cost them their job. With astute receptionists triaging giving those patients the 6-8 pm appointments would discourage A and E visits. But then doctors need to be prepared to be available as such at least once per week- perhaps with a late start the next day.
6. I have heard, from direct questioning of patients that they see the size of the precinct to be representative of the knowledge of the doctors: Also high drama from screaming ambulances tend to generate a sense of being able to manage more complex pathology.
7. The treatment seems to be for gratis: patients don't realise that they are paying for it out of their wages tax.
8. Society has become very fragmented and patients no longer have objectivity re what is serious, if it is serious or where time and if self TLC will fix the issue: Commonly learned from interacting with people living nearby.
9. There is no continuity in GP care these days: A and E staff are perhaps more 'stationary'.
10. The waiting rooms in the large corporate lounges are like airport terminals: When patients are unwell they like a little space also they like a little 'privacy' not to have the person a few doors away gawking at them. A and E's in that regard tend to generate more anonymity. Rows of chairs don't emulate that-- has anyone ever been to a cosy coffee shop? The chairs the are clustered while not crowded in. Padding for a short time is probably not so salient.
And as doctors we need to do our bit.
1. To be available at a patient's time of need NOT want.*
2. Patients' lack insight: there may be validity in one or two longer consultations explaining what is responsible use of GP time. Diplomatically done I have found this to be very effective.
3. Insisting on triaging appointments so those patients with more flexible times are offered times which others cannot use optimally.
4. Making elective appointments eg repeat medications well in advance to optimise mutual convenience.
5. Suggesting to patients that bringing in kids immediately after school is mutually unbeneficial: the kids are scatty and disrupt waiting rooms where more ill patients are also present-- A and Es tend to segregate! Managing scatty kids is more time consuming for the GP.
6. And some of this begins with reducing expectations from patients. Why have toys scattered around the waiting rooms for the elderly to risk #NOFs etc. Surely the parents can be educated to bring along a kid's favourite book and read it to them (quality parent- child time!!), or some equivalent. It will teach the children some patience for their adult life.

SADLY MEDICINE HAS BECOME 'I WANT INSTANTLY' ON BOTH FRONTS. ALL NEED TO LEARN TO GIVE AND TAKE.

FACEM   6/02/2018 10:24:06 PM

You could see five patients and provide consultation, radiology, pathology, plaster materials and medications all for $250? Are we comparing apples with apples?