Empower our GPs

April 10, 2010 at 12:52 am (Uncategorized) (, )

The Sydney Morning Herald  April 10-11, 2010

GP is in house

A thing that I find amazing in the whole health debate about costs and lack of professionals in the system, is that no one seems to mention the under-utilisation of general practitioners.

It’s not so long ago that 90 per cent of surgical and obstetrics procedures were carried out by GPs. Until the 1960s it was common to see, both in the country and in the city, GPs with hospital appointments. Surely our GPs, after eight or nine years of training, would be better employed practising medicine and surgery than merely writing out prescriptions and referring patients to specialists.

I can’t see why specialists are deemed to be the only ones medically capable to carry out procedures and, incidentally, charge what they like.

David Wall Newtown

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The Sydney Morning Herald  April 12, 2010

 

Leave surgery to the experts

David Wall (Letters, April 10-11) wonders why GPs no longer perform surgery as they did in the good old days. One reason can be found in Beyond the Hill Lies China, the fictionalised story of Herbert Moran, surgeon, bon vivant and one-time captain of the Wallabies.

Moran’s hero establishes a general practice in Glebe in the 1920s and is given an appointment in surgery (at which he thinks he is a ”dab hand”) at Glebe Hospital. For an outrageously high price he operates on a young man with abdominal pain. Alas, the patient deteriorates and a consultant is eventually called in. After confirming that the patient is doomed, the consultant asks our hero why he performed an appendectomy when the patient obviously had a ruptured stomach ulcer. The GP replies that he knew how to do an appendectomy but didn’t know that much about stomach ulcers.

Today, GPs and surgeons undergo intensive, high quality training in their respective fields of practice and the amount of surgery to which a trainee GP is exposed is much less than it was 40 years ago. Surgeons are not trained to have the appropriate skills to be GPs and GPs are not trained to have the skills of surgeons.

Dr Greg Watters Port Macquarie

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Stories by David Wall  April 13, 2010

Dr Watters’ recourse to fiction to prove a point I found rather cute (Letters, April 12). Malpractice has actually occurred in all branches of the medical profession, but so has good practice. My father, Jim Wall, a GP with over forty years experience told me he had had four patients with burst abscesses on their brains. Three he referred to Melbourne and Sydney, and on one, he performed the surgery himself. The one he did himself made a perfect recovery and the three he referred to specialists all died. Of course, this might be a one-off case.

 I fully agree with Dr Watters that all medical practitioners undergo ‘high quality training’, but this is exactly my point. All graduates are bachelors of medicine and surgery but if GPs’ practice is largely confined to writing scripts and referrals, how does this give them the opportunity to practise what they have learnt? GPs can and should be able to carry out most minor surgery and attend to patients in our hospitals because we need to access their skills, and they need to actually practise medicine.

 A thing I find ironic is that in my many years as a plantation manager and field officer with the health department in PNG , I saw more medicine practised by paraprofessionals than I see done by professionally trained GPs in Australia today. So put the scalpels back in the hands of our GPs, allow them to treat patients in hospitals, and fully utilize their training.

David Wall

 

 

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6 Comments

  1. John Christie said,

    Interesting comment.
    Fact is that in most country areas GPs still have hospital appointments and carry out a wide range of procedural interventions – particularly anaesthetics and obstetrics. Main issue is that GPs in the country are not under utilised but are under increasing stress with patient demands/expectations and administration. Fewer graduates see this form of career as sustainable either professionally or for their family.

  2. David Wall said,

    John
    A very good point, but of course, this is not the situation in the cities. I did have this at
    the back of my mind when I wrote the above piece and I should have mentioned it.
    Dave

  3. Noomps said,

    Thank you so much for your information.

  4. Old post, perhaps worth another look at! | Stories by David Wall said,

  5. Anonymous said,

    With advances in medical care and sub specialisation there is less chance for GPs to perform procedural work however if they get a diploma then they also sub specialise or they can go to an area of need where they can get more hands on experience……it really depends on what the GP wants …….some like a life of of writing scripts, others want more hands on experience so get extra training or work in places more demanding
    Meena Chandra
    Prince of Wales hospital

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