Issue 3 / 2 February 2015

FOR many Sydney-siders the details revealed last week at the inquest into the deaths of two hostages in the siege in a Sydney café, were probably too much, too soon.

The siege in December last year visited its horror on the city in a way that felt unprecedented, leaving many — even those with tenuous connections — feeling frightened and traumatised. These feelings are likely to re-emerge as the inquest continues and previously unknown details become public.

The timing of an article in this week’s issue of the MJA is thus serendipitous.

In it, Australian trauma and grief experts Beverley Raphael and Penelope Burns write of the things that threaten and sustain us in such crises, and of the importance of community connectedness and support in transitioning to recovery. Inevitably the authors go on to explore the vital role that GPs play in recognising those whose distress requires further assessment and treatment.

Reading the article, it reminded me of the breadth of the term “general” in general practice. What GPs do in their limited time with patients has been partially quantified by research projects such as the BEACH study, but there are elements that cannot be captured by the descriptors. With all the possible things to consider during the idiosyncratic interaction of a consultation, being a GP can feel like the job that keeps on giving.

Viewed together, two of our news stories in this issue of MJA InSight exemplify how the layers of care might interact. One story highlights the need for GPs to be aware of the cumulative anticholinergic effects of common medications, particularly on cognition, when prescribing and reviewing pharmacotherapy for older people.

The other story explores GPs’ responsibility to assess patients’ capacity to make financial decisions, and ways of working with elderly, impaired patients and their families to prevent financial damage and abuse.

These issues could arise in the same patient at the same consultation, most likely as a side issue to the presenting complaint. The longitudinal nature of general practice means that it should be possible to cover all angles, but the piece of string that constitutes good general practice care is certainly difficult to measure.

Our other news story this week highlights that the way GPs bill their patients is correspondingly complex.

Research published in the MJA has examined the factors associated with the decision to bulk bill by surveying more than 2000 Australians about their recent experiences. Overall, 71% said they were bulk-billed at their last GP visit, with both patient and practitioner factors influencing the decision.

Consultation length was not a driver, probably because the simple measure of time conceals myriad individual considerations in practices where a mixed billing system is in operation.

GPs could be forgiven for feeling overwhelmed at the breadth of their professional responsibilities but, of course, most enjoy similar or better levels of job satisfaction to that of their peers in other specialties.

Perhaps they have long ago taken up the excellent mantra put forward for this year’s World Cancer Day on Wednesday, 4 February.

The “Not beyond us” campaign proposes that solutions to the “continuum of cancer” — health promotion, early detection, access to treatment and a focus on quality of life — are well within reach, providing optimism in the ongoing fight against cancer.

These also happen to be four of the pillars of good primary care.

Perhaps it’s the need to consider the multiple layers that influence health that make general practice so satisfying.

If you’re a GP, the challenge is to discover at every consultation what you can do for each patient, right now, to provide the best of care — and that is definitely not beyond you.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight

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