Lonely Planet: General Practice
Welcome aboard the MJA's 2003 General Practice issue. This year we will take you on a journey of discovery, including some time travel, if you're up for it! For a brief itinerary, consult Van Der Weyden in Australian general practice: time for renewed purpose.
As an academic discipline, General Practice in Australia began its journey fairly recently, with the first nine professors of "Community Practice" appointed between 1974 and 1976. One of these pioneers, Kamien has surveyed the original cohort to gain their perspective on the first 20-odd years "on the road" (A patience of professors). Mudge, a current Professor of General Practice, agrees that the discipline has come a long way, and issues a challenge to keep up the momentum (Australian academic general practice: looking back, looking forward).
Don't look now, but according to Del Mar et al, Australian general practice has lost its way. Reluctantly recruited, GPs are undervalued, poorly remunerated, looked down upon and (not surprisingly) their morale is low ("Only a GP?": is the solution to the general practice crisis intellectual?). Will intellectual enrichment of the discipline provide a way forward? ask these GP academics.
Take the train(ing)
Like any journey, general practice requires planning and preparation. Vickery and Tarala are involved in pre-vocational general practice training of junior doctors in rural Western Australia. The road has not been smooth, but the benefits are such that they are keen to see the program expanded (Barriers to prevocational placement programs in rural general practice).
Australia's General Practice Training Program has just undergone a major upheaval and is now being driven by a federal government-funded company. In Is general practice vocational training at risk?, Kidd asks how the new training scheme can meet both government and professional goals while maintaining the current high standards.
Another government initiative involves postgraduate mental healthcare training for interested GPs, and new Medicare rebates for those delivering certain psychological treatments. What does this initiative involve and will it work? Blashki et al give their opinion (Providing psychological treatments in general practice: how will it work?).
Lost in space?
While it's interesting to examine where general practice has been and where it might be going, we've made sure that, in this issue, we hear from those who are currently on the journey. Ahearn and Kerr asked individual GPs about their experiences with the decision-support aspects of their prescribing software (General practitioners' perceptions of the pharmaceutical decision-support tools in their prescribing software). Meanwhile, Oldroyd et al convened focus groups to discuss how GPs meet the needs of patients with chronic illnesses within the current structure of general practice (Providing healthcare for people with chronic illness: the views of Australian GPs).
General practice patients can make excellent clinical research subjects. Pirotta et al put their female patients' waiting-room time to good use by asking them about their experiences of thrush, especially after taking antibiotics ("Not thrush again!" Women's experience of post-antibiotic vulvovaginitis).
GPs have been treating people for heroin addiction for years. However, buprenorphine is relatively new and has usually been used in dedicated drug-treatment clinics. Gibson et al have conducted a randomised trial, comparing outcomes of patients treated in these clinics with those of patients receiving the drug in general practice (A comparison of buprenorphine treatment in clinic and primary care settings: a randomised trial).
Starship MJA and the next (GP) generation
Boldly going where no issue has gone before, Starship MJA embarks on a voyage through general practice scenarios set in the year 2020. On a mission to mould our destiny, we lift off with Dr Zen, FRACGP and minion of the soulless Corporation Enterprise (The destiny of general practice: blind fate or 20/20 vision?). Dr Zen metamorphoses as we travel through uncharted territories that explore and offer brighter futures, with alternative workforce, training, practice management, consultation, societal and research scenarios.
No medical travel guide would be complete without some discussion of life's final journey and every doctor's desire for her patients to have a smooth passage. A recent article by Somerville has reignited the euthanasia debate in the pages of the Journal (Matters Arising).
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