Why are you here and not somewhere else?

This is a piece of installation art by Jeppe Heine, which lives in the Booth School of Business at the University of Chicago. To me it asks the question of what is important and why does it matter. It is just the right question to bring together what I’ve been thinking about over the last week at Tharawal:

• Why am I here?
• Now that I’m here what am I trying to achieve?
• Why do patients come here?

In this post I’ll deal with the first question and then move on to the others I love going to work – wherever that work might be. Tharawal like some, but not all, of the places I have worked has a great vibe – that quality that is difficult to quantify, takes many forms but you know it when you see it. At Tharawal it stems from individual and community ownership of the work – this is the reason for Aboriginal Community Controlled Health Organisations.

And that ownership means services exist that actually benefit our patients. Trying to find useful services (outside of your own area of practice expertise) is often one of the banes of trying to deliver good healthcare. Tharawal is a magnet for great clinicians and members of the community. That, in turn, engenders a degree of drive amongst the whole team to deliver better care.  The practice escapes from the notion of individuality and that each person is trying to achieve something on their own. 

And I’m now a part of that team.

The best experiences of my training have been where this kind of team exists.  You can’t quite know this is going to be the case when you pick a practice.  But sometimes there are inklings. Now that I’m here the concept of ‘fit’ comes into play.  I’m still new to the place but the first steps have been promising. There are projects with Tim, ideas for improving current programs, outlets for my own teaching interests and a challenging clinical environment.

So I’ve lucked into a great job and now is the chance for me (and Tim) to make something of it. This week has involved the first draft of a conference abstract to both talk about the conception of supertwision and also to give us an idea of where we are going. Doing that is giving me a better understanding of what I am trying to achieve while at Tharawal – the subject of the next post.

The start of something...

When Tim Senior and I started together, it was with a degree of excitement that has continued to mark our relationship in the practice. It was a Tuesday afternoon, my first in the practice, and Tim was letting me in on his plans for #supertwision. In the intervening weeks the plans have grown and become better informed as we both come up with ideas about how to engage with social media with general practice in the context of indigenous health.

 

Across the first weeks in the practice (as I slowly put together this post) I reflected on what my perspectives are about the delivery of healthcare. The basic determinants of health have been a sideline in the previous parts of my career looking after people in a tertiary teaching hospital. The ideas of wellbeing including personal freedoms, good social relations AND physical health are the cornerstone of indigenous health. Wellbeing considers a more holistic view of health which is in keeping with the concept that:

 

“There is no word in Aboriginal languages for health.”

Prof Judy Atkinson

 

It is becoming clearer, from the first few weeks and Tim’s pearls, that a ‘traditional’ view of the general practice consults won’t reach through to encompass true wellbeing. Trying to find a consult style that works will be a big part of what I blog about over the next 6 months.

 

This is my first exposure to general practice in an Aboriginal Medical Service and also my GPT1 term (my first term as a trainee on the Australian General Practice Training Program). So even understanding general practice in the healthcare system is a little alien to me. The practice room is now starting to feel like my own and a place for expression for the people who come in.

 

My postgraduate career has been a bit of a mixed bag; working for the military, having clinical interests in maternal & child health and mental health, working my way through a Masters in Public Health and taking a stint away from clinical practice to be an advocate for the health profession. But maybe it’s the kind of mixed bag that will make for a successful and enjoyable journey in indigenous health, you can watch my progress and tell us what you think.

 

Follow our journey here at the blog, with the #supertwision hashtag and with each of our accounts (@timsenior and @michaelbonning) where we both post on things in healthcare and beyond that interest us.

 

What should new GPs read?

There are many doctors around Australia who have just started their higher professional training to become a GP, the most effective of medical specialists. The learning curve from hospital to primary care is often steep. People can present with anything, everything and nothing, the medical is intertwined with the social, cultural, economic and political, and working out what to do can be quite unclear. All of this happens in a room with a closed door and no one else around, unlike in the hospital wards, which are far from private. It's testament to the quality of doctors choosing to do GP training and the quality of GPs doing the training that so many do so well.

So, with this in mind, and now a couple of weeks in, it's worth thinking about what would be ideal introductory reading for a new GP?

I received a few very interesting suggestions on Twitter.

@timsenior diving bell and the butterfly
— madhu singh MD (@thinkalot) January 30, 2013

@timsenior The Other Side by @grangerkate so that they realise how small actions can have a big impact
— Elin Roddy (@elinlowri) January 30, 2013

@grangerkate @timsenior Yep! It's not a rant - it's a really good book! I also love Intelligent Kindness by Ballard and Campling.
— Elin Roddy (@elinlowri) January 30, 2013

@timsenior @atul_gawande 's Better. Improving health care from both patient and systems perspectives.
— Melanie Thompson (@dr_mel_thompson) January 30, 2013

@timsenior Advice on learning how to access and use social media eg mashable.com/social-media/ Why-this is the future wrt information streaming.
— Deborah Verran (@VerranDeborah) January 30, 2013

 It's interesting that when people want to recommend reading to produce good GPs, they don't go for writing about diseases, they go for writing about understanding humans in difficult circumstances, often serious illness.

(The obvious exception is Deborah Verran's suggestion. Will the use of social media be so crucial that we all need to know it? Is it comparable with, say, skills like minor surgery, breaking bad news or clinical audit - whether we like it or not we are just going to have to do it? I'd love to hear your thoughts on this - comment below or tweet on the #supertwision hashtag)

What would I suggest? Here would be my top 3 suggested readings. Of course, I might change my mind, but these are today's thoughts. And, somewhat to my suprise, this is all core general practice literature. But all three have changed my practice for the better.

3. General Practice by Prof John Murtagh
What Australian GP could go without Murtagh? Just about every GP I know has one close at hand. Though the clinical chapters are excellent, the safe diagnostic strategy outlined in the early part of the book is gold for any GP at any stage in their career.

2. The Doctor, his patient and the illness by Michael Balint
Excuse the inappropriate gender specific pronoun here. This book was published in 1957, and is arguably the best book on general practice ever written. This was the book that moved general practice away from a purely biomedical paradigm and made the profession take an interest in the dynamics of what was happening when a doctor and a patient meet in a room. There's been a lot of other work done on this since then, but Balint is still a cracking read, full of mind-expanding insight. You can get a taste of the ideas here. ("the most frequently used drug in general practice was the doctor himself”). Don't rely just on this summary - do read the book. And don't worry if you're not sure about the group methodology - the insights are still valuable.

1. The Mystery of General Practice by Iona Heath
This is the best, and most beautifully written, description of general practice I have come across. It's a must-read for anyone interested in what your family doctor does. It's short (easily the shortest of these threee recommendations) and you can download it for free at the link above. You might start reading and worry about the relevance of commentary on 18 year old health reforms in another country. But don't worry. It's highly relevant still, and the description of the role of a GP in a community and in reducing health inequalities will make you proud of your chosen profession.

Those are my top 3 picks. I'd love to hear your suggestions, either tweeted on the #supertwision hashtag, or posted as comments here. And if you don't post your suggestions, Michael Bonning will have to read what I suggest. Is that really fair?