"Why can't a woman be more like a man?", sang Rex Harrison in My Fair Lady, Lerner and Loewe's 1964 musical adaption of George Bernard Shaw's, Pygmalion.
It would seem poor advice for medical practitioners, however. In this issue of GPSpeak, Dr Jane Barker reports on the significance of the recent JAMA article showing patients of female physicians in American hospitals had a lower mortality rate and were less likely to be readmitted within the month. This finding adds to previous knowledge of differences between female and male medical practitioners.
Female GPs spend longer with their patients and squeeze more into their consultations (1). They are more like to provide counselling and address the social aspects that affect their patient's health. They have longer consultations and refer patients more often while prescribing less medication. They earn 6 per cent less per hour, work fewer hours per week and do more non-billable hours than males.
So what do GPs think about their consultations? Australia's fee for service approach for primary care delivery financially rewards shorter consultations. Previous studies had shown that general practitioners are usually happy with their response to the patient's presenting problems and their management.
However in 2000, GPs were not satisfied with 20 per cent of consultations in the areas of preventative care, lifestyle advice, psychosocial assessment and care co-ordination. The Enhanced Primary Care scheme from 1999 and subsequent Chronic Disease Management program that replaced it in 2005 have gone some way to address these deficits.
Well-respected surgeon and public health researcher, Atul Gawande (3), has recently written in praise of general practice. Clinical Editor, Dr Andrew Binns, recommends Gawande's “Heroism of Incremental Care“ (page five) and reflects on the importance of teaching these values to the next generation of GPs.
Interviewed by Australian Doctor (17 February, 2017) NRGPN Board member, Dr Chris Mitchell has also emphasised the value of having a regular GP. It is the trust relationship, which can take months to years to develop, that underpins the success of the primary care model, he notes. There is also value for the system when the patient has a regular GP. A recent British study (4) showed that older, sicker patients who saw the same GP regularly were 12 per cent less likely to be admitted to hospital that those who did not.
British GPs are struggling, however. Growing patient lists and fewer resources are making it increasingly difficult for patients to see their usual GP. Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, believes the problem is made worse by "super surgeries" of multiple doctors, which are increasingly relied on by patients (5).
Denmark is one country that is said to get general practice right. On page 13 we give an overview of how the Danes have managed practice size, funding and patient access to enhance the GP's role as the coordinating gatekeeper. It seems to be working. Patient satisfaction with the Danish system is over 90 per cent.
All is not doom and gloom in Australia. The Commonwealth Fund's 2015 survey of primary care physicians (6) found Australian GPs were mostly satisfied with their work and income, although they felt somewhat hard done by in relation to their specialist colleagues. Dissatisfaction with one's work correlated strongly with finding the job very or extremely stressful. Pleasingly, Australian GPs ranked near the bottom on these two parameters.
This issue also briefly reports on the improving preoperative management of iron deficient patients in our area (page 9). A normal ferritin but with an elevated CRP still raises the possibility of iron deficiency in patients with renal and inflammatory diseases. In surgical conditions iron replacement can be started by GPs once it is recognised, since early treatment does not interfere with subsequent investigation.
Dr Jackie Andrews (page 30) also gives a few tips on how to optimise patients to get the most from the scarce resources of our Community Paediatric Services.
Commissioning is a new topic for Australian medical practitioners to consider. History may give us some guidance on the principles to be followed (page 16).
Despite the structural impediments to efficient health care in Australia, GPs and their patients are doing pretty well. Having a little more time with your patients and a little more money might improve the well being of both parties.
We can improve by being more in tune with our patients' needs and views. Our female colleagues will show us the way. For, as Charlotte Payne-Townshend, is said to have replied to her husband, George Bernard Shaw, when asked:-
"Isn't it true, dear, that men are smarter than women?"
"Yes dear. That's why I married you and you me."
- Women GPs earn less, more cost-effective, AMA 4 July 2016
- Measures of health and health care delivery in general practice in Australia, Australian Institute of Health and Welfare and University of Sydney, 2000
- Heroism of Incremental Care, New Yorker, January 23, 2017
- Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data, BMJ 2017;356:j84
- Seeing the same family doctor cuts the risk of being rushed to hospital, The Telegraph, Herny Bodkin, 11 Febuary, 2017
- 2015 International Survey of Primary Care Doctors
