No More. It Ends Here.
What to Do Now?
1. Look around our sites and get a feel for what you want to do.
2. Choose Covert / Overt Actions - or Both.
3. Get yourself a ProtonMail encrypted email account. Use this for you correspondence - if you are really going to get involved. It helps keep you organganised and keeps your activities safe and discreet.
4. Send us some information on your email correspondence.
Stories you have heard.
Request for Ideas?
Your details if you are willing to get involved: tell us how involved you want to be.
Send us your email address if you just want to be kept in the loop.
5. Get yourself a group together - if you are keen. Discuss. Do Something.
The CONS10 Approach
AHPRA and the HIC have taken a regulatory approach to imposing demands on GPs. It is essentially impossible for AHPRA to lose any appeal against the imposition of punishment or restrictions. It is an approach that guarantees convictions. It is a game that guarantees the might of the QANGO organisation is always right.
So how do doctors in the real world combat this regulatory imposition?
There is only one solution to the conundrum of –
Limited time
Holistic medical care
Adequate medical records.
The solution is the one issue – 10 minute consultation solution, (for general practice).
(The same scenario applies equally well to specialist consultations – though with different time criteria of course).
So how does this go:
Spend your fragment of time with the patient on one problem (less than 10 minutes).
Deal with this single problem well.
Record this single problem well. (Remember that AHPRA does insist on good recording of consultations on the pain of fine lossless censure and fear of loss of employment).
Now here’s the hard bit.
“Can you count to one, doctor?”
The answer of course is – probably not.
Covert Actions : No One need ever know.
Let’s use some examples:
A patient presents wanting a script and a referral. Note that word “and”. This means that there are two problems presenting. For most doctors such a request seemed reasonable.
But consider what you need to do to do your job well. Can giving a script really be just “one” problem? The answer of course is that you need to do your job properly “for once”. Consider in giving the repeat prescription:
What is the medication?
What are the indicators for its use?
Was a medication successful?
Was medication appropriate?
Was medication safe?
Were there any side-effects associated with the use of medication – have you checked?
Has the patient been taking medication as prescribed?
Are there any regulatory issues with the use of medication? (Especially for example S8 medications like narcotics or other generally accepted drugs of abuse such as benzodiazepines).
Are there any special assessments needing to be done to continue the use of this medication? For example – referral for the review of the use of a narcotic. For example – AAAAA assessment the use of narcotics. For Example, cardiac assessments of BP, ECG, echocardiographic assessments of heart function.
In short, is pretty obvious that if you are doing your job properly – there is only time in the consultation for one item – and doing a script is definitely one item.
Take this attitude to its logical conclusion.
If patients don’t like it – they can go somewhere else, to a helpful medical practitioner who can do twice or three times much work as yourself for the same pay.
If the patient accepts your rules – you get single problem easier and more on-time consultations. You run more on-time for most patients. Patients come back more often and you get paid more for less. It is likely this more than offsets any patients deciding to move on.
Ma'at Egyptian God Justice
Patients moving on, take their excessive demands with them. The patients remaining, become trained as a group to have lower expectations of medical care – and are consequently less likely to complain.
It also means that when someone presents really needing help – you are likely to have more time to see them.
It also means that when problems arise with patients – you are more likely to have time to work through and resolve these issues.
And then you have a choice. See more patients per day. Or you see the same number of patients per day, and go home early.
The 10 minute consultation format gives you a win - win.
You get more time to do the work that needs to be done to a higher quality and/or you get more money.
So by helping yourself, – you help us – and you help everyone else.
The basis of the cons10.com website is to give you new techniques and new phrases to help you change your workflow to a one consultation one problem 10 minute format.
And if you’re still having extreme problems trying to control your consultation times and patient demands, the cons10.com website gives you suggestions to address this issue as well. For example, (in extreme cases), make every patient write their problem on a piece of paper prior to seeing the doctor. (All you need are some writing folders, some paper squares and some small pencils). If it is all in writing, there can be no argument.
Overt Actions: with with a small group to achieve something.
Other Actions to support the proposal to change the medical regulation of doctors:
Overload The System.
Refer things off early, especially
* Non-financially viable work (if it costs too much to do it – than you earn by doing it – don’t do it).
* Medical legally problematic patients (let them be a problem for someone else – and the process of referral gets them to modify their expectations.
* Unpleasant and difficult people
* High expectation people
* Low value stuff – Minor Ops and biopsies
* Unaesthetic stuff – e.g. Plantar Warts, Vaginal Warts
Referring people off for hospital care costs the medical system a fortune. This training system is predicated on GPs earning $35 per patient. But introducing that same patient to the specialist care system can generate thousands of dollars of medical costs.
AHPRA, the HIC and even many specialists have taken the view that many medical activities are now beyond the scope of simple little people such as GPs. Fine! Good luck with that! You can deal with that or more likely not cope with it and see how your costs/funding collapses under the pressure.
To maximise the terror, any patient on many medications can be sent a second opinion on those medications, the continued use of those medications and a review of indications of use of these medications or for a suggestion of alternate medications. The cost amplification factor is x10 to x20. Benefit to the patient – likely very little, adding a lot of inconvenience and delay. But if it is what the “system” wants – so be it.
Benefit to the GP – safer practice as far as AHPRA is concerned, better medical records as far as AHPRA, same income for less work.
Another significant advantage of sending or referring patients with significant problems to hospital – is that the hospital is almost guaranteed to stuff up and have the patient’s bounce back. Then you are capable of doing what you want to do in the first place with the backup that “the hospital could not deal with it”.
Cost The System Money.
* Order extra tests.
* Break tests into batches – don’t do them all at once
Good luck?
Do Something- it will be for your own benefit in the long run.
