How to Get The Most Out of Your GP- a Doctor’s Point of View

GPs are seldom asked what they want from their patients – in fact nobody has ever asked me. I’m going to tell you anyway! You can choose to ignore this advice and your GP probably won’t mind at all. Part of the beauty of general practice is the unforeseen variety of every working day and that includes the mundane and sometimes pointless cases as well as the mysterious and sometimes serious cases.

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The perfect patient arrives a few minutes before their appointment is due and is (hopefully) seen on time. The perfect patient understands that if the GP is running late it’s usually because somebody seriously depressed or clutching their chest in pain has required a bit more attention earlier in the clinic. Indeed, the perfect patient knows that they themselves may be that unwell patient one day.

The perfect patient should certainly expect an apology from the GP if the clinic is running late.

Facts you may not have realised, number 1: Most conventional GP surgeries run on an average appointment duration of 10 minutes. This means that, after the pleasantries you have about 8 minutes. Yep, it’s crazy. You may now understand why, once a clinic is running late, it’s almost impossible to catch up. The perfect patient is aware of this and books a double or even a triple appointment if they know that they have complex needs or lots of problems to discuss.

Facts you may not have realised, number 2: If you have an uncommon illness, you may know more of the finer details about it than your GP can remember from medical school. A good GP, however, is not embarrassed by this fact. A good GP will have resources for very quickly researching your condition and their role is to use a wider understanding of medicine to help you.

Facts you may not have realised, number 3: Many GP consultations are totally unnecessary. There are vast numbers of appointments being used (at enormous cost to Medicare) by patients who don’t need to be seen in clinic. What’s even more shocking is that these patients don’t even want to go to the clinic… And the doctors don’t want them to come to the clinic!

Clinics the length and breadth of Australia are full to bursting. From Darwin to Hobart, Brisbane to Perth, patients are struggling to see their regular GP. Patients aren’t getting what they want and many are denied access to what they need. Thus the rise of the online medical certificate. There’s a start-up company called DrSicknote which has been saving Medicare money and freeing up GP appointments for over a year now- by providing medical certificates for minor illnesses, via consultation with an online doctor.

If you don’t feel you should be at work because of a minor illness like a cold or gastro- you need a medical certificate, but you feel it doesn’t warrant attending a GP surgery (perhaps you’re even starting to feel better already) – this GP thinks you should get in touch with drsicknote.com.au and keep the clinics free for people who need to be there. It costs $20 and you speak with a real online doctor who provides you with a real online medical certificate! All without leaving the comfort of your home!

Role of Online Doctor appointment

What is a doctor? If you visualize a GP, what do you see in your mind’s eye?

For many of us, the stereotypes learned in childhood never really fade. I am a thirty-something female GP myself, but I admit that my mental image of a doctor consists of a solemn, grey-haired, bespectacled man in a tweed suit. Unsurprisingly, my own childhood GP actually looked very much like that. He always seemed ancient to me, though when I do the math, he was probably only in his 40s at the time.

I remember being truly terrified by the life-sized skeleton looming in the corner of his surgery, the eeriness of which was partially offset by a giant Mickey Mouse soft toy that sat on his desk. I also distinctly recall the dread of having “ that stick thing” poked down my throat. (These days, when I examine a clamp-jawed kid with my tongue depressor, I can quickly find my empathy when I remind myself of my own childhood terror).

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I remember watching the urine dipstick standing in a pot of wee, turning all the colors of the rainbow, and marveling at how this clever man could figure out all these tricky things and make me well again. And he always seemed to be close at hand whenever anyone in my family was unwell- rain, hail or shine, he’d arrive at our house in his beat up old car, often at an ungodly hour and when his work was done he’d head off into the night, undoubtedly to visit some other sick person in the village. No wonder he looked ancient!

Then there were the venerable family physicians in various Jane Austen period dramas. The heroine usually had a broken heart which rapidly ( and inexplicably)  progressed to a life-threatening illness. The doctor would arrive in his barouche, and dutifully bleed his patient to rid her of disease. The feverish girl would just about pull through, and invariably bag her Mr Bingham or Colonel Brandon shortly afterwards.

Whilst these various doctors of my childhood  both real and fictional are seemingly quite different from each other, they do share certain traits. One such trait is the prominent place of the house call in their work.  The virtual house call to an online doctor was a traditional aspect of medicine for hundreds of years but it has largely died out in modern general practice. Aside from palliative, frail or bedbound patients, people are expected to make the journey to see the doctor and not the other way around.

 

Personally, whilst house calls were very time-consuming and often took up an entire lunch break when I worked as a GP back in Ireland, I was always interested in meeting a person on their own turf- it often revealed the true context of a person’s life- and sometimes revealed stories that were harder to uncover in the setting of a busy clinic. (I’ll never forget the lady with a long term unexplained chronic cough- after months of puzzlement on my part, a house call for an entirely unrelated issue allowed me to discover that she shared a very dusty bedroom with a flock of guinea pigs and rabbits!)

However, in a slightly different format, the house call may be set to make something of a comeback. The concept of an “online doctor” has been emerging over recent years, and with ongoing advances in IT, it is now often possible for a doctor to assess a patient and conduct a thorough history online. Examination may not be possible as yet (though with advances in technology, it is probably only a matter of time before there will be a way to examine a patient remotely). And most GPs will attest that many common conditions seen on a daily basis are treatable on the basis of a conversation, without a need for examination.

Dr Sicknote is a new online doctor service of this nature, which offers an array of medical services on line –including re-referral letters to specialists and medical certificates for certain illnesses. Over the coming months Dr Sicknote will also offer treatment for a variety of medical conditions and where appropriate, it will be possible to obtain repeat prescriptions, such as the contraceptive pill.

The advent of the “online doctor prescription” may in some ways bring us full circle: once again, a doctor will visit patients in the comfort of their own home- offering that personal connection, on their own turf and at their own convenience – though maybe this time without the tweed suit and spectacles!

Online Medical Certificates- a Solution for Busy Patients and Busy Doctors!

I am a GP.  It’s a great job, with a variety of work.  With such a diverse workload comes a busy day; we see lots and lots of people, with a multitude of conditions. After you’ve been established as a GP for a while, the job gets even busier. That is where managing the appointment book is crucial being able to continue providing an excellent service.

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As the appointment book fills up and waiting times increase, it becomes increasingly helpful to manage patient demand.  This is when it is important to consider whether patients actually need to attend when they book an appointment.

It was at this point in my career that I started to analyse why patients were attending. I started to see patterns emerge. Patients would attend for a medical certificate online, a carer’s medical certificate or  a renewal of referral amongst other minor paperwork type issues.

All that I want to do is really help people when they need it most.  That means giving them an appointment when they really need one. With a full book it often means we are turning away people when they are sick. At the same time we see people who require a medical certificate because the employer demands a medical certificate even for short-term illness. Often these individuals did not feel they needed any treatment from me, they just came to keep the employer satisfied.

As a GP my job has always been to solve problems; and it seems to me that the most natural solution to this problem is to be able to provide a medical certificate online where a patient does not feel they need to see a doctor.  Provided this is done in a safe and ethical manner, this is an excellent set of solutions to multiple problems: reduced taxpayer funds used in funding GP appointments, saved patient time to focus on recovery, reduced transmission of infective illness in the GP surgery and better satisfaction for doctors in being able to provide access to those patients who need it most.

So by providing an online medical certificate I feel I am doing my best to help all the patients who need to see me in the most efficient possible manner. 

By Dr Sachin Patel

The Online Doctor – What Would Sir Osler Think?

Often referred to as the “Father of Modern Medicine”, Sir William Osler ( 1849-1919) was a Canadian physician and one of the four founding fathers of the world-renowned Johns Hopkins Hospital. His influence on medical education was profound- it was he who pioneered what is now the standard practice of teaching medical students at the patient’s bedside. Prior to this most learning had been done in the “ivory towers” of lecture theatres, libraries and laboratories. And it was also he who conceptualised the “medical team” as we know it in today’s hospital environment, with its pyramid structure of consultant (resident), and underling doctors-in-training of various grades.

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He was an eloquent writer and public speaker- and many of his quotes have become standard gems of medical wisdom- the kind that medical students hear trotted out time and again during their training, perhaps not realising that so many are attributable to one man:

“He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all”

 “Listen to your patient, he is telling you the diagnosis” and

“The good physician treats the disease; the great physician treats the patient who has the disease”

These erudite gems of medical wisdom are as relevant now as they were back in the 1800s, largely because they relate to the timeless art of listening to the patient.

However, the day to day nature of being a doctor has changed quite a bit since Osler’s time. One of the most significant developments is the manner in which information technology is transforming how we assess and treat patients. I am a GP, and lately have started to do some work as an online doctor. Online medicine has grown exponentially in the past decade- apparently health advice is now the second-most popular topic that people search for on the internet, second only to pornography! Recent studies in many countries confirm high numbers of people are accessing prescriptions online, and are consulting with online doctors and other health professionals on a regular basis.

As the concept of seeing an online doctor has become more widespread, there have, understandably been critics, who argue that it may threaten the traditional doctor-patient dynamic. It may be quick, convenient and more economical, but with the doctor and patient separated by a screen, and perhaps lacking a long term relationship, can it really work? What would Sir Osler make of it? Would he be thoroughly unimpressed by the “hands-offness” of it all?

I think the answer to this hypothetical question depends upon how an online doctor service is provided- by whom and to whom. Modern medical training promotes the art of communication- of listening and understanding people. As a medical student and junior doctor, I was educated in this patient-focused way, just as promoted by Osler- and many years working in General Practice have helped me to hone these skills further. I think it would be impossible to be a competent online doctor without having this solid foundation in traditional medicine. A well-trained doctor, will quickly recognise patients or conditions unsuitable for online management- and they can be referred back to a regular clinic. But in many situations, where the illness is mild or well-controlled, and the patient’s need is relatively simple (e.g. a repeat prescription, a medical certificate or a routine blood test), the patient, as Osler might have put it, is “telling you the diagnosis”. It seems reasonable, in an era of ever-increasing healthcare costs, to combine the common sense of patients with the clinical knowledge of an online doctor- and solve as many problems as possible in this economical way.

Osler once said that “the value of experience is not in seeing much, but in seeing wisely”. I think an experienced doctor can be a great online resource for patients, and can help them safely and wisely navigate this brave new world of online healthcare.

The Ever-Changing Role of the Family Doctor- From House-Calls to the Virtual Visit.

When I was a child, I remember staring at my family doctor, with his grey hair, tweed suit and battered leather bag, wondering how anyone could be so wise. To me, he was a god- all-seeing, all-knowing. The mysteries of the human body were not mysteries to him!

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My parents were solid and sensible- I believed they could handle almost anything. So it was naturally alarming to me if they ever seemed out of their depth or worried. This rarely happened, but if it did, it usually related to the health of a family member and Dr Walsh was the man called upon in such a situation. Maybe that’s why I saw him as superhuman- he was summoned when my ever-so-capable parents ran out of ideas. And he’d arrive at our house in his old car, usually in the middle of the night, to see the feverish baby or the vomiting sister and all would be well again.

The years rolled past-  I grew up and went to medical school myself.  I’ve now been a doctor for over a decade- and a GP for the past 6 years. I sometimes try to imagine what the 6-year-old version of myself would say if they could see me now as a 36-year-old doctor. I certainly don’t feel superhuman or god-like! When I compare myself to my old family doctor, I can see that the role has, in some ways, not changed much, and in other ways, changed quite dramatically.

At the centre of it all, you still have that special relationship between patient and doctor- that space, where any issue can be discussed- ranging from physical, to psychological, to sexual, to all manner of life’s challenges. I’m still regularly amazed by the fact that a person will walk in off the street to meet me for the very first time, and within seconds we may be discussing matters so personal and delicate that even their nearest and dearest are entirely unaware.  Obviously, as doctors, our ability to investigate and treat disease has advanced hugely in the past 20 years, as has our knowledge and understanding of illness. And one of the most recent changes in medicine is the rise of telemedicine and the “online doctor”.

Whilst I see patients in my clinics, I also work as an online doctor. Becoming an online doctor has been one of the most interesting developments in my career to date.  What has surprised me most about it, is the fact that the human connection is actually surprisingly strong. I’ll admit that when I started, I worried that it would lack the personal touch. But I have found that a conversation via a webcam is basically not very different to a face-to-face encounter. As more and more of our day-to-day lives move online, seeing an online doctor will become quite a routine occurrence. The middle-of-the-night house-call by the physician with his battered bag and tweed suit may well be replaced, at least some of the time, by a doctor on a smartphone screen! Having spent the last year consulting as an online doctor myself, I find this virtual connection can be just as warm, personable and effective. Over the coming years, I think people will learn to view the “virtual house-call” as a very convenient and helpful element of healthcare for their families.

Getting a Medical Certificate From an Online Doctor- Another Little Bit of Life Goes Virtual!

Wondering how to get a medical certificate without seeing a doctor? You’re not alone. Many people suffering from a minor illness find themselves asking this question- and it’s a pretty sensible question to ask! If you’re more or less sure of your diagnosis, and know that a doctor can’t do much for you (think the common cold, viral gastroenteritis, period pain, migraine, sinusitis, viral sore throat, for example), a trip to a busy surgery all for the sake of a piece of paper and a signature can seem rather pointless and annoying. In fact, it may even be harmful, as it encourages spread of infection (one sudden spew in a waiting room can infect numerous people with airborne virus within minutes!). Not to mention the fact that a chunk of precious sick leave gets spent travelling and queueing- instead of resting and recovering.

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Happily, there are now several online doctor services offering medical certificates. This is a massive win for common sense. Yes, there’ll always be a small handful of people who abuse services like this- but those same people can just as easily go to their local doctor and tell a lie to get a day off. The vast majority of people simply need a medical certificate for work, and want to obtain it with minimal fuss, preferably the same day (and, as we all know, it can often be a problem getting to see a GP on the day you’re actually ill). All in all, it’s far more important that the “honest majority” of people can access the benefits of services like this, rather than getting hung up on the tiny percentages of people who will always look for ways to cheat the system.

Most online doctor services are staffed by regular doctors who work in clinics, and who also offer a certain amount of online healthcare. It is not possible for someone to be an online doctor without being a fully registered “regular” doctor too. If in doubt, you can ask for their AHPRA number (Australian Health Practitioners Regulation Agency number) which tells you they are legitimate, and have all the necessary qualifications. A Medicare provider number is also an indicator that the doctor meets all the criteria to practice.

So, next time you feel under the weather, rather than checking in to the local doctor’s surgery, check out the option of an online doctor for your medical certificate. And crawl back under your doona for the day!

An Online Medical Certificate- When is This a Good Option, and When is it Not?

Getting a medical certificate online may be quick and convenient, and for many minor illnesses it makes perfect sense- but it’s not appropriate in every situation. As an online doctor, I cannot physically assess a patient, so I need to be sure that the problem is indeed minor and does not require examination. There are certain minor illnesses that any sensible adult can recognise- and an online medical certificate is a perfect solution in these cases. So what conditions are we talking about?

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The most common one, unsurprisingly, is the common cold. Typically, the patient reports a runny or blocked nose, perhaps some sinus congestion, a mild cough, a sore throat or a low grade fever. Most are not particularly unwell, but they work in jobs where these symptoms are unacceptable- for instance, in food or catering, healthcare, call centres or in the aviation industry. I ensure the patient has no worrying symptoms, such as breathlessness, chest pain or weakness, and then issue the emedical certificat for the necessary period of time.

Another common reason for a person to seek an online medical certificate is migraine. Migraine can come on very rapidly indeed, and if you suffer from migraine, or know somebody who does, you’ll also know that a busy waiting room with bright lights and crying babies is probably the last place on Earth you’d want to be. An online medical certificate can be of massive help to a person in the throes of a bad migraine. Again, there are certain important safety points that an online doctor ought to check- for example, the patient must have a previously confirmed diagnosis of migraine, and the current episode must be the same as their usual migraine pattern. If the headache is new, or quite different to the person’s usual headache, then an online medical certificate is not suitable- and a visit to the doctor in person will be necessary.

Viral gastroenteritis (or “gastro” as it’s commonly known) is another condition I frequently see as an online doctor. Again, most patients recognise the pattern of vomiting, diarrhoea and fever, and are aware that rest, rehydration and quarantining themselves from other people for day or two is the best course of action. An online medical certificate allows the patient stay close to the toilet, whilst also avoiding spread of infection. However, if the person has constant abdominal (tummy) pain, is passing blood in their bowel movements, or is feeling particularly weak or dizzy, they will require assessment by their doctor in person.

Period pain can be very debilitating for women, and an online medical certificate may be appropriate. However, it is vital to take a careful history- particularly to ensure the period has come at the expected time, and to rule out the possibility of pregnancy. Pelvic infection can also present with lower abdominal pain-thus, if there are fevers, or abnormal vaginal discharge, it is safer that a woman sees her doctor in person.

If you are unsure whether your health issue will be suitable for an online medical certificate, certain online services (such as www.drsicknote.com.au) will accept queries, or will even schedule an online consultation and refund you if it turns out not to be appropriate. The vast majority of the diagnosing a doctor does is based on the story the patient tells – but if an online doctor tells you that you should be assessed in person, this means that an examination is needed- your safety and well-being has to be the first priority. If you were hoping to spend your precious sick leave in bed, this may be inconvenient, and it may be disappointing- but better to be safe than sorry!