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Attention doctorportal newsletter subscribers,

After December 2018, we will be moving elements from the doctorportal newsletter to MJA InSight newsletter and rebranding it to Insight+. If you’d like to continue to receive a newsletter covering the latest on research and perspectives in the medical industry, please subscribe to the Insight+ newsletter here.

As of January 2019, we will no longer be sending out the doctorportal email newsletter. The final issue of this newsletter will be distributed on 13 December 2018. Articles from this issue will be available to view online until 31 December 2018.

The bush GP: what it’s really like working in a remote location

 

Being a GP in a remote outback location is rewarding work – but it’s not necessarily for the fainthearted. You’re likely to be the only doctor there, and if things go wrong, help may be some time coming.

“You’re by yourself, you’re thrown in the deep end and you’ve got to manage that,” says Dr Chris Clohesy (pictured), who has spent the last five years working as a GP in remote communities in Northern Territory, after a 20-year career in the city. “There’s the constant threat that something will come up that takes you to the limit and there’s no one holding your hand. You’re asking yourself: am I up to it?”

Dr Clohesy recounts a time when he had to manage a child who had drunk petrol and was fitting.

“I was in a remote community and there was only me and a couple of nurses. We didn’t have much equipment and we were talking to Darwin by phone, with a plane a good couple of hours away. This one had a good outcome, but you remember these things. They’re frightening and challenging situations.”

And then there are the more quirky episodes that a doctor is never going to experience in a suburban Sydney clinic – such as the occasional veterinary intervention, for example.

“Late one day a chap brought in his dog, which had been run over and had a massive abdominal wound, extending from the groin to the belly. Can you do anything, the owner asked. So we sewed the dog up and gave it some antibiotics and incredibly, the dog survived. I couldn’t believe it! So you do have to think out of the square and handle some weird cases.”

The key to working remote, Dr Clohesy says, is to keep your skills and knowledge up to scratch.

“It’s a difficult process finding the educational resources to be able to upskill. I spend a lot of time hunting down courses and clinical attachments to keep me up to date. And it’s a lot of time and money. Rural and remote doctors have the same educational requirements as everyone else, but it’s a lot harder to get them. And for junior registrars studying for exams it’s really hard, particularly if you have a dodgy internet connection!”

Online learning definitely has a big role to play for rural and remote doctors, Dr Clohesy says.

“But it’s got to be good. You can’t just put something up on the internet and say, there you go. There’s still got to be some sort of human contact with that online course where you can actually talk to someone, and an expert you can contact really enhances the course.”

Dr Clohesy recently flew to Melbourne to do an Advanced Life Support course. He says he paid his own airfare, plus the $700 for the course, with the whole trip taking three days.

“That’s so I’m up to speed on the cardiac stuff I need to deal with out here. It’s not about sitting about under a palm tree on the beach; it’s a serious challenge.”

And it’s also important to keep your outside interests and lifestyle ticking over, Dr Clohesy says, whether it’s sport, exercise, fishing or reading.

“At the moment I’m getting my bikes and gym equipment shipped to me by barge from Darwin. Luckily, where I am has a swimming pool, so I can do my laps which is important to me.”

Keeping in the medical loop and maintaining your networks is also important when you’re working in remote locations.

“I belong to the AMA, I join as many committees as possible, and all that improves my interactions with other doctors.”

The job definitely has its own rewards, Dr Clohesy says.

“Most doctors are out here because they want to help, and they want to look after these impoverished people, and that gives them a huge amount of satisfaction.”

Junior doctors may think if they go rural they’ll miss out on positions in metropolitan hospitals, but that’s not at all the case, Dr Clohesy says.

“These days, as a junior doctor, it’s really positive to have a CV with some rural work on it. It shows you can work independently.”

And there are various incentives, such as the General Practice Rural Incentives Program, which pays doctors an annual amount for working in rural and remote areas, with the amount rising with each extra year of service.

“We have a public health role. I think it would be great if all doctors did a six-month stint in a rural or remote community. We’d overcome a lot of deficiencies if that happened.”

  • Are you working in a remote or rural community? Doctorportal Learning has a number of online learning modules that may suit your certification needs.
  • Our Cranaplus Advanced Life Support Certification can be completed entirely remotely, with an online theory component and a clinical assessment using Skype. This module is the only accredited ALS in Australia that enables you to undertake the clinical assessment via a virtual platform.

 

Is breaking bad news to patients an art you can learn?

 

Being the bearer of bad news is often the unhappy duty of doctors, and can be incredibly challenging. Getting it right is not only hugely important for patients and their families, it’s also critical to the well-being of the doctors themselves.

Some doctors are better at it than others, but the good news is that even for those who don’t feel they manage it well, this is certainly a skill that can be honed.

“One of the lessons of the workshop is that communication skills can be learned and developed,” says Dr Ruvishani Samarasekera, a paediatric registrar at Sydney Children’s Hospital. “There are doctors who are not naturally empathetic or lack an emotional IQ, but they were still able to improve their communications skills to manage these situations better.”

Dr Samarasekera attended the Complex Communication in Health Care workshop under the guidance of Professor Stewart Dunn, a medical psychologist specialised in the psychological care of cancer patients and their families. The workshop uses actors playing patients in realistic scenarios where workshop attendees have to break bad news, often in difficult, complicated scenarios.

“There is not a lot of formal training  in breaking bad news in medical school,” Dr Samarasekera says. “Then, when you are a junior doctor the task is usually done by the most senior doctor. As you progress throughout your career, there is an expectation that you will then learn from what you have witnessed. But that’s not always the case.”

She recalls a very difficult case with a 21 year old patient in ICU who had complications related to morbid obesity early in her career.

“I witnessed the consultant telling the patient’s parents that he had passed away as a result of these complications. I remember how the consultant tactfully brought them into a private room and the non-verbal cues in the consult. I remember thinking how I wanted to communicate with such empathy and learn to use my own style as well.”

She says that learning and trialling diverse techniques in a workshop with actors is a very different experience to interacting and debriefing with colleagues. It is an immersive and safe experience that covers everything from the way doctors should be positioned in the consult to the words they should use, directly approaching the bad news or leading the patient towards it.

“Some scenarios we did were around breaking bad news with oncology patients, others were interactions with family members and telling them the news. And then there were other scenarios around daily communication skills with your colleagues.”

The course gave her more confidence that she could perform these difficult tasks, she says.

“I had a 10-year-old patient who’d been in and out of the ED over the course of two months with vomiting and clinically she had some concerning signs of unsteady gait. This was a red flag and so there was a looming question of whether this could be a brain tumour. Due to my earlier experiences observing my seniors in oncology combined with the practical skills gained in the workshop, I felt better equipped dealing with this emotionally challenging situation. From guiding the parents, preparing them for the likelihood of what the imaging would show and then discussing the results after.”

She says the situation was complicated by the fact that the parents had been in some denial about the symptoms and their child’s unsteadiness and had also at times received reassurance about them.

“You have to deal with this level of complexity; you have to be empathetic but honest, so that they are on your side as they go through the journey of diagnosis and treatment.”

Breaking bad news is one of the most difficult communications challenges in medicine, but not the only one. Dealing with colleagues, particularly at opposite ends of the hierarchy, can be challenging.

“One of the workshop scenarios that really struck a chord with me was one about being a junior doctor and dealing with the consultants,” she says.

The particular scenario involved a registrar being asked to be on call, despite a long-planned commitment towards a birthday party for her own child.

“The consultant very subtly manipulated her and made her feel like she couldn’t say no without losing something in her career. That kind of pressure is a huge part of medicine. The actors played out this scenario and the attendees had to decide whether they would intervene in the scenario they had witnessed. Talk to the consultant, perhaps, or try to empower the junior doctor. Some even thought the situation was not concerning, or that the junior doctor just needed to be more resilient. It was interesting to see how people responded.”

Professor Dunn will be moderating two workshops in Sydney on complex communication in health care this year. The workshops will cover breaking bad news, open disclosure, end-of-life conversations and dealing with conflict in the workplace. Read more about the workshops and sign up here.

What do you want from your CPD?

 

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible.  An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

The fine art of communication in general practice

 

Read about our new workshop exploring complex communication in primary care – breaking bad news, end of life conversation and more…

Communication skills are uniquely relevant in the general practice setting, because no other medical practitioner offers the continuity of care that GPs afford their patients. This workshop, conducted by the multiple award-winning Pam McLean Centre, will address some of the most challenging communications in the context of the long-term doctor-patient relationship – breaking bad news, open disclosure following an adverse event, and initiating discussions about treatment options at the end of life. The common theme is talking about things our patients really don’t want to talk about.

Models abound – SPIKES, ABCDE, BREAKS, ISBAR etc. And models have their place. But putting the models into practice can sometimes be surprisingly hard. This workshop allows us to put theory into practice through trial-and-error, working with a highly trained professional actor to negotiate step-by-step through the maze of emotionally-charged communication. Just like learning to intubate on mannequins, working with actors allows us to try various approaches to communication safe in the knowledge that no-one gets hurt. The workshop is based on rigorous research, including one of Prof Dunn’s PhD student’s projects, which measured heart rate and skin conductance in doctors whilst they told a woman that her husband had just died. The results will surprise you.

In this workshop, you will meet two patients (played by two of our most experienced actors) who present all these challenges in a panorama of multiple presentations. There are options to practise the delivery of bad news in different emotional contexts, and to explore appropriate responses to an angry relative when there has been a serious adverse event. Finally we will investigate ways of initiating and supporting discussions around disease progression. You will have the opportunity to stop the consultation at any time and seek feedback from the patient and from other workshop participants. And Prof Dunn will provide insights from the relevant literature to help us along the path.

Sign up to our Complex Communication in Health Care learning module here.

CPD audits: what you need to know

 

Although it’s been three years since AHPRA started randomly checking medical professionals’ declarations about their CPD activities, many doctors are still unaware that they can be audited.

Particularly vulnerable to being caught out are IMGs, doctors in training and non-vocationally registered doctors, who are not affiliated with a college and so don’t get the same prompts that other doctors get from their college to do their required CPD.

Here’s some key information about the auditing process:

  • Doctors under audit are sent an audit notice, and have 28 days to demonstrate that they’ve met the Medical Board of Australia’s registration requirements.
  • This includes not only CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If found to be in breach in any of these areas, doctors can be reported to the Board.
  • Doctors who belong to a college need to meet the CPD standards set by their college. But those who are not on the specialist register – whether they are in training or are simply non-VR doctors – must also demonstrate that they have fulfilled CPD requirements.
  • For non-VR doctors, this involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.
  • Trainees will need a signed letter or report from their supervising hospital to confirm your participation in training and education programs in the year being audited.

See here for more information on CPD requirements for junior medical officers, IMGs and non-VR doctors.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your MBA CPD reporting obligations.