Volume 195 - Issue 4
Keeping the connection
Author: James A Best
Med J Aust 2011; 195 (4): 214. || doi: 10.5694/j.1326-5377.2011.tb03284.x
Published online: 15 August 2011
Published online: 15 August 2011
Team care is replacing individual GP care, but is this good for patients and for general practice?
Dr James Best is a GP from Sydney who won the Royal Australian College of General Practitioners General Practice Supervisor of the Year Award 2010.
As a young fella, graduating from medicine and then going through general practitioner training, I was drip-fed a culture of fierce independence.
This independence extended to the notion that a “good GP” was one who was intricately connected with his or her patients, and barriers to this connection, including computer screen distraction, outsourcing of patient contact to others, or anything that stopped you looking your patients in the eye and spending time with them, were to be avoided.
My colleagues and I learnt — and believed — that if we were spending one-on-one time with our patients, observing their body language, picking up social cues, and finding out about how they were connected with their families and communities, these would all enhance our ability to develop rapport and maximise clinical success. We wanted to know — really know — our patients, and didn’t really want anyone else in the room with us.
We are now in a period of flux regarding the best way to manage patients in Australian primary care.
Other factors besides the “connection” to our patients have entered the equation. The looming wave of chronic disease management — the one we are looking anxiously over our shoulders at as it heads our way — is one of them. A gradual but steady increase in the understanding and (at times) acceptance of the value of team care is another.
We are slowly coming around to the idea of letting other professionals help us in our connection and, conversely, helping other professionals connect with our patients and each other.
Yet, 20 000 professionals do not represent a homogeneous group. An individual GP in Australia may have been trained any time in the past 50 years, may be rural or urban, young or old, motivated or disenchanted, innovative or conservative.
Governments and their advisers chip away at GP independence with both carrot and stick. They want change and they want team care management, but, as many of us know, not always for the right reasons.
So, do we dare disturb the GP universe? Yes and no. We need to take the best of the old and the best of the new.
We should never lose sight of the fact that connecting with our patients, establishing rapport over time and developing a relationship between patient and doctor founded on trust is clinically invaluable. This will require one-on-one time, and quite a lot of it, and will still be built on all the same time-honoured principles of communication.
There are some things that patients will only reveal to someone they know and trust, and there are some things that will only be picked up by a doctor who knows an individual patient and his or her particular idiosyncrasies well.
However, a changing world requires nimble thinking. We and our governments and funders cannot ignore what is happening to the population we seek to serve and the increasingly rationed resources — financial, workforce and otherwise — available to do so.
We should also be cognisant of the benefits of letting others into our party. Other professionals such as practice nurses, allied health workers and specialists connect with our patients in their own ways, and differing viewpoints can provide a clearer picture of the problems at hand.
It should not be about replacement, but enhancement. If we can incorporate the differing viewpoints of all professionals, outcomes for patients are only likely to improve, just so long as that cornerstone — the family doctor knowing and connecting with his or her patients — is never allowed to be trumped by competing interests.
Provenance: Commissioned; not externally peer reviewed.