0830: Hospital ward round, visiting and reviewing the care of my patients. There is now appropriate recompense for GPs’ hospital visits under the ‘Continuity of Care’ program that was established under the new Medicare agreement – and the improved patient outcomes and avoidance of duplication has saved millions. Hospital care now reflects the same partnerships (between GPs, specialists and other health providers) that had long characterised a patient’s normal (outpatient) care.
0930: Arrive in surgery for morning session
• a 65 year old man, recently admitted with LVF, now undergoing rehabilitation through the Priority Health Care Program under my supervision. I review his community based program, increase his target walking distance, and indicate on his (computer based) care-plan that he would benefit from a dietician’s review. (My practice nurse will review all modified care-plans and arranges the recommendations.) Care plans are no longer seen as an administrative ‘hoop’, and have become a most useful tool in the daily management of each patient.
• a 21 year old woman with probable PID. The clinical software recommends an empiric treatment and dose based on the patient’s age, weight, history and on local sensitivities, using inbuilt therapeutic guidelines. The guidelines are automatically updated.
• a 10 year old boy, whose mother gives a history of recent onset asthma, acute last night. My practice nurse performs respiratory function tests that confirm the diagnosis. We arrange appropriate management, and he will be reviewed by me over the phone tomorrow and in the surgery in two weeks, having seen my nurse for an asthma education review in the interim. He will be further reviewed in two months, completing the asthma 3+ program.
I share lunch in the tea room with my partners, who are also running on time. One of them has that morning convened a conference in the local nursing home in which management plans were reviewed for all our residents. The nursing manager, physio, speech pathologist and occupational therapist attended. He was (almost) finding interest in his nursing home rounds now.
1300: Our division rep attends for our monthly meeting. She lets us know about a new specific incentive payment. She and the division IT officer have already met with the practice manager and nurse, and the systems are in place for us to comply with the reporting requirements, if we choose to take up the offer.
The division’s quality practice educator accompanies her on this visit, to let us know about the latest evidence concerning medication use in depression. He also tells us about any recent POEMS that have been published (POEMS being Patient-Orientated Evidence that Matters – outcome based evidence that changes the way we manage a common condition). He also reminds us that POEMS about less commonly encountered conditions are available on the MedAu web site, so that they will be available in a timely manner if we should need them.
1330: Phone calls
At this time each day I take my phone calls. Today, a case teleconference has been arranged with the drug and alcohol counsellor and a child psychologist, who had both reviewed a troubled adolescent I had referred the previous week.
One of my other calls is from the boy’s mother, so it was good that I was up to date with his progress, rather than somewhat in the dark, as used to happen.
1400: Afternoon session
• a 4 year old for his pre-school check up. The division has established a GP managed ‘Family Care Centre’ that provides resources and education in parenting issues as well as a day hospital for management of postnatal problems. Therefore I have resource material to assist the parents with their child’s sleep problem, and I confirm that they are attending the parent effectiveness training evenings that the local GPs and the centre conduct at the schools.
Parents now accept these workshops for ‘normal’ families at various stages of their child’s development, just as they do prenatal classes. (The division supports other centres of GP expertise in drug and alcohol, palliative care and mental health.)
• a 78 year old man for his health assessment. He has seen my practice nurse the previous week and the summary is available to me on the computer. I perform a general physical examination and arrange carotid studies for his loud bruit. I note that he is up to date with his recommended screening activities and immunisations.
1645: Meeting with practice nurse.
My partners and I meet with our practice nurse frequently. Today she has figures on the effectiveness of a recent program we instituted for our diabetic patients, and the progress of a study we are conducting into the value of FHH screening. She also presents us with population health statistics, as accurate epidemiological data is collated by the division on behalf of the local GPs.
My correspondence arrives by encrypted email and is viewed and managed on the computer.
I have received two proposed discharge plans from the hospital, which I modify and return by email.
I check the pathology, Xray and specialist reports, and each patient is emailed their results, information and follow-up appointments, appropriately encrypted. The software will chase up those who do not acknowledge receipt.
1730: The computers are all backed up automatically – I don’t need to know how, it is taken care of by the division support staff.
There will a division board meeting tomorrow night – which is conducted efficiently over the internet.
Once a week, I am part of a small learning group that shares information, also over the net.
And some nights I am on emergency call for the practice.
But tonight I can drive home to my family, up-to-date, on time, in my new car, which is all paid off.