WA News Doctor Polls
Poll Results
Medical Volunteers Abroad - December 2013

There were 233 responses from GPs (41%), non-GP Specialists (37%), DITs (14%) and ‘Other’ doctors (8%). Questions around this topic produced some interesting craft group differences but the 77% agreement with question 3 is of particular note, and probably a reflection of changing community attitudes where helping people to help themselves is seen as producing more lasting benefits.

Overseas medical relief programs that WA doctors volunteer for – how much do these statements reflect your views?

Strongly Agree  Agree Neutral  Disagree   Strongly Disagree
One big attraction of these overseas programs is that more can be achieved for every health dollar used, compared to WA. 17% 42% 30% 8% 3%
Proceduralists involved are motivated partly by access to more interesting operative cases. 9% 49% 27% 12% 3%
I judge the value of any program by how much it trains local people to do the health work. 29% 48% 18% 4% 1%
I could give my time and lost income if an overseas medical relief program could use my unique skills 15% 51% 20% 12% 2%

 ED. Craft Group Differences

Giving time. 70% of non-GP Specialists agreed or strongly agreed they “could give my time and lost income if an overseas medical relief program could use my unique skills”, whereas 55% of GPs and 81% of DITs felt the same way. The next question is what defines “could” in each group. Certainly, over half of WA doctors seem willing to embark on overseas volunteer work at their expense.

Motivation. Around 50% of non-GP Specialists (and DITs) agreed or strongly agreed that “proceduralists involved [in volunteer overseas work] are motivated partly by access to more interesting operative cases” whereas a larger 65% of GPs pointed to this as a motivating factor.

 
GPs and Specialists, Partners in What? - December 2013

This e-Poll has some fascinating results, including comparisons between GPs and Specialists. Many of the questions were sparked by issues raised at the latest Doctors Drum breakfast. There were 233 responses from GPs (41%), non-GP Specialists (37%), DITs (14%) and ‘Other’ doctors (8%).

Communication between doctors over patient management - what are your views?

Strongly Agree Agree Neutral Disagree Strongly Disagree 
A big contributor to difficulties in patient management is difficulties in communication between doctors. 16% 48% 12% 22% 0%
Any poor communication is a product of our times and cannot be easily remedied 2% 8% 9% 63% 18%
Public hospitals fragment care through poor communication with community doctors. 20% 51% 15% 13% 1%
Both GPs and Specialists are pretty well ‘on the same page’ when it comes to patient care. 5% 39% 29% 24% 4%
Establishing a network of doctors you know early in your career is important. 19% 58% 16% 8% 0%

 

ED: A resounding two thirds of GPs and Specialists say there is a problem of communication between GPs and Specialists adversely affecting patient management. Interestingly, in the next question, 81% say the problem is fixable.

Craft Group Differences: Awareness of the ‘public hospital fragmentation’ issue is strong across all groups, with GPs more strongly agreeing with this idea (73%) vs Specialists (64%). DITs were most in agreement (78%).

Doctors In Training (DITs) did not agree so much (25%) with the perception that GPs and Specialists and specialists held (~44% each), that they were on the same page when it comes to patient care. Across the board, similar proportions held undecided views, but DITs indicated the strongest disbelief in this concept (53%) versus the other craft groups (~24%). Do DITs know something the other groups don’t?

Question 5 results as slightly skewed by DITs more strongly believing in early establishment of a network (87% strongly agree or agree) compared to the other craft groups (~72%). In both cases, the early personal network is given strong importance, which is something that those attending the Doctors Drum intimated may be under threat with the influx of OTDs and interstate graduates in our public hospitals.

Is one big barrier to meeting health demands the burnout of compassionate doctors?

Yes                                                                  63%

No                                                                   19%

Uncertain                                                         18%

ED: Interestingly, burnout of compassionate doctors was seen more often as a barrier to meeting health demands by both GPs (67%) and DITs (72%) than by Specialists (54%). Uncertainty over this issue was 10%, 6% and 30%, respectively. Some might interpret this as Specialists not working under as much pressure as the other two craft groups.

The role of health consumers (patients) – do these statements reflect your point of view?

Statement... Strongly Agree Agree Neutral Disagree Strongly Disagree
GPs rely on patient feedback in judging specialists they have referred to. 16% 61% 17% 6% 0%
The profession is less focused on the needs of the 'whole person' in dealing with patients. 11% 43% 17% 26% 3%
Today, the patient is less responsible for their own health than in past years. 12% 33% 16% 36% 3%
In most cases, specialists who write back to referring doctors should send a copy of that letter to the patient. 10% 22% 22% 37% 9%
Health professionals have taken too much control off patients who are coping with chronic disease. 6% 22% 27% 40% 5%

 

 

 

 

 

 

 

 

 

 

 

ED. A resounding majority of both Specialists (74%) and GPs (83%) recognise that patient feedback is critical to any referring GP in judging the performance of a specialist. While doctors are equally divided on whether patients take more or less responsibility for their health these days, the majority (54% vs 29%) agree doctors are less involved in holistic care than they used to be. The minority (28% vs 45%) said doctors take too much control off patients with chronic disease.

Craft Group Differences:

When it came to one suggested remedy for patient involvement – specialists sending a copy of reply letters to patients – just 32% of specialists and 29% of GPs supported this concept (with Doctors In Training 43%).

 

Will any battle against chronic illness in our community be successful if there are no related public health measures?

Yes             11%

No               73%

Uncertain    16%

ED. There was no significant difference across the craft groups, which should please our public health gurus.

 
Lifestyle, Aged Care, CME, Drug Mishaps, GP Reps - Nov 2013

stethoscope-tug-of-war-lowres70x55

Medical Forum asked GPs about their practice with elderly patients, CME, and keeping it all in balance. Nearly all the 147 responses arrived within the first three days of our broadcast email. Thanks to all those who took part!

Doctors can ‘switch off” from work in a number of different ways – from cooking to walking the dog. How important do you consider regular ‘switching off’ is to being able to perform well as a doctor?

Very important                                                                73%

Important                                                                         20%

No effect                                                                         2%

Unimportant                                                                     1%

Very unimportant                                                             4% 

 

If you had an elderly patient you suspected might be the subject of abuse, do you know who could appropriately look into this for you?

Yes                                                                                                                        37%

No                                                                                                                          18%

Uncertain                                                                                                               42%

Not Applicable                                                                                                         3%

 

In moving someone with Alzheimer’s from low-care independent living to an ageing-in-place Aged Care Facility, where high-care can be made available, what do you regard as the biggest hurdles [up to 3 choices]?

Lack of available places that fit this description.                                                 33%

Inadequate staff training and numbers to provide ongoing care.                        25%

Expense for patient a barrier.                                                                              22%

Lack of RNs to assist in this role.                                                                        13%

Other                                                                                                                   3%

Uncertain                                                                                                             2%

Not applicable                                                                                                      2%

 

Do you think that Advanced Health Directives (AHDs) should be limited mainly to the elderly and chronically sick?

Yes                                                                                                                    20%

No                                                                                                                      70%

Uncertain                                                                                                           10%

Do you think AHDs are important enough to promote more in general practices?

Yes                                                                                                                    65%

No                                                                                                                      21%

Uncertain                                                                                                           14%

Comments on Aged Care

Of the 35 doctors who chose to comment, some thought our most vulnerable citizens were not given the necessary support from government with low-cost accommodation and realistic waiting periods. As for aged care facilities: better training and education of staff were called for; some high-care facilities were dark, depressing and smelt of urine; there were not enough doctors; and there was poor document access, especially finding the I-care software. Mind you, some docs who worked in ACFs said it was thoroughly rewarding.

Advanced Health Directives comments suggested some GPs were unfamiliar with them; what they do and who should get one. “All Docs should have a stack of them and hand them out!” one said but one other thought it macabre for doctors to be promoting them. Rural GPs pleaded for more AHDs in their areas to keep patients near their families. For one doctor the experience of treating the elderly in nursing homes has been too much. “I am afraid to say I never want to go to one. I am hoping an Advanced Health Directive and a belief that death should be of my own choosing will mean I never need to go to a nursing home.” 

As regards CME activities for general practice, how much do you agree/disagree with the following statements?                                                 

The RACGP’s job is to accredit CME providers and it is then up to the providers to meet guidelines.

Strongly Agree                                                                12%

Agree                                                                              52%

Neutral                                                                             20%

Disagree                                                                          12%

Strongly Disagree                                                            4%

Asking the RACGP to screen every CME activity for evidence-based content would be too difficult and expensive.

Strongly Agree                                                                14%

Agree                                                                               50%

Neutral                                                                             21%

Disagree                                                                          12%

Strongly Disagree                                                            3%

GPs will critically appraise the usefulness of any CME activity, and vote with their feet if it is substandard.

Strongly Agree                                                                14%

Agree                                                                               61%

Neutral                                                                             12%

Disagree                                                                          11%

Strongly Disagree                                                            2%

Allowing some CME content that is not evidence-based, and declaring this, would encourage innovation in general practice.

Strongly Agree                                                                  7%

Agree                                                                               44%

Neutral                                                                             27%

Disagree                                                                          18%

Strongly Disagree                                                             4%

CME participants should report to the RACGP any CME content they believe is contrary to evidence, and the RACGP should promptly investigate and act.

Strongly Agree                                                                20%

Agree                                                                              48%

Neutral                                                                             20%

Disagree                                                                          8%

Strongly Disagree                                                            4%

ED. Four times as many GPs thought CME providers should be responsible for meeting RACGP guidelines as did not. A similar proportion thought it too expensive and difficult for the RACGP to screen CME activities to ensure they are evidence based. The vast majority (75%) of GPs said colleagues would simply not attend substandard CME and just over twice as many wanted to retain some non-evidence-based CME, as did not, to encourage innovation. And the RACGP should promptly investigate any complaint from a CME participant that information was contrary to evidence. 

Can you recall any instance involving your patients where use of generic pharmaceuticals has created confusion that resulted in a medication mishap?

Yes                                                                                  66%

No                                                                                    25%

Uncertain                                                                         5%

Doesn’t apply                                                                   4%

Given current circumstances with brand substitution, about how often to you believe such medication mishaps occur amongst doctors within your practice, on average?

More than once a week                                                    12%

About once a week                                                          11%

About once a month                                                          17%

Less than once a month                                                    31%

Never                                                                                  7%

Undecided/Doesn’t apply                                                  22%

ED. These two questions were prompted by a letter to the editor, suggesting that the proliferation of similar sounding names amongst generics, were leading to medication mishaps, such as patients wrongly doubling up on or avoiding medications. Amongst our respondents, two thirds recall an episode where generic pharmaceuticals caused confusion and a medication mishap, and about half said brand substitution was leading to medication mishaps at least once-a-month in around half of general practices. These are big numbers. 

Within the Western Australian setting, who best represents your interests as a general practitioner?

Myself                                                                             28%

RACGP WA                                                                    25%

AMA WA                                                                        21%

Uncertain                                                                       18%

Medicare Locals/Divisions                                              4%

Other                                                                              4%

Comments on GP representation

The fact that nearly a third (28%) of GPs thought they did a better job of representing themselves, speaks for itself. Of the 29 who chose to comment, fragmentation of representation, and representative groups showing competing interests were strong themes. Influences from rural-urban and GP-specialist differences, along with government bureaucracy and conflicts over funding sources were all sources of discontent. Medicare Locals were not painted as having a clear role in representing GPs. This comment sort of sums it up: “I wish there were not so many organisations all claiming to represent my views when in reality none do!” Mind you, one GP suggested that without apparent fragmentation “we would be a force to be reckoned with”.

 

 
Child Health, Urban Design, Disadvantage - July 2013

Doctor-with-boy70x55

Specialists were polled this month about a number of important issues, with 72 responses across a variety of disciplines

Where possible, should asylum seekers who are children be allowed to live in the community with their families and have access to health and education services?

Yes                                                   46%                 

Yes, with restrictions                       39%                 

No                                                     11%                 

Uncertain                                           4%

 

The percentage of children with ongoing pain is said to be slightly less than the adult population. Do you think a dedicated Paediatric Pain Clinic, run on similar lines to the three adult pain clinics, is needed in the public health sector in WA?

Yes                                                   60%                 

No                                                    15%                 

Undecided                                        25%                 

Would you have any misgivings about establishing such a Childhood Pain Clinic?

Yes                                                  19%                 

No                                                     56%                 

Uncertain                                          25%

Comments

ED: Views ranged from an “essential service” to suspecting “someone is looking for a cause” from the 22 respondents who chose to comment. Among those who thought there was a need for a paediatric pain clinic, the emphasis was on a multidisciplinary psychosocial approach. For one the issue is close to home: “I work at PMH and it is astounding that we cannot offer the same level of care that adults get.”.

A number of experts, writing in Medical Forum, have scored Perth comparatively highly as a ‘liveable city’. Given the known link between urban design and psychosocial health of inhabitants, how would you rate Perth?

Highly favourable, a great place to live                                            30%              

Moderately favourable, could do better                                           56%              

Pretty average, there are better places to live                                11%              

Poor, people would be better off leaving                                          3%                

Uncertain                                                                                          0%

Comments

ED: Better public transport, including the development of light rail, dominated the responses from the 36 doctors who chose to comment, with more car-free bike paths a close second. Some called for higher density living within 10km of the CBD to stop the urban sprawl.

WACOSS says the health of the socially disadvantaged is adversely affected by the relatively high cost of housing/rental. Do you have experience of someone from this disadvantaged group seeking help for a health problem made worse by financial stress?                                                           

Yes                                                         54%              

No                                                          18%              

Uncertain                                                8%                

Doesn't apply                                         20%

Comments   

ED: There were strong views on Perth’s cost of living with a number of the 36 specialists (out of 72) who chose to comment citing the affordability of housing as a serious impediment to good health. “For people who are not affiliated with the mining boom, Perth has become very unaffordable for housing, groceries and fuel. Public housing and better transport (more rail services & wider spread) would make Perth more accessible."

‘Herd immunity’ is said to decrease the circulation of some preventable viral infections in our community. All considered, should this be promoted by the profession as a reason for parents to vaccinate their child/children?

Yes                                                  89%                 

No                                                    5.5%                

Uncertain                                         5.5%

The August 2012 E-poll respondents said speech pathologists were the most difficult allied health practitioners to get appointments for children (43% pointed to a clinically undesirable wait time). In the last year, based on your experience, how do you think this situation has moved?

Improved                                           1%                   

Worsened                                         8%                   

Not changed                                    10%                 

Uncertain, N/A                                 81%                 

ED: Results could have been affected by the fact that GPs would mostly handle referrals to speech pathologists.

 

 
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