Perhaps the author is finding that GP's are taking business from him, and doing it a lot cheaper and more effectively.

We don't hear GP's complaining about the symptoms or types of illness their patients present with. The first port of call for anyone from what Dr. Ahmed calls the 'worried well' is their family GP. If he cannot handle the problem, the patient is referred to a MUCH MORE EXPENSIVE psychiatrist.

Fortuately, the modern GP is better educated than he or she used to be and actually knows his or her patient; and more often than not, can alleviate the need for the patient to get tangled up in drawn out sessions with a psychiatrist at huge expense to the health system.

We need more, accessable GPs who actually know their local community and their patients. Money should go to them so that people can afford to consult them and take the load of public hospitals.

It will be interesting to see what some GP's say about this article.

Dr Ahmed fails to take into account why many people see their General Practitioner. Their Boss. As an example, I have a bad cold. Couldn't be bothered going to work - feeling too sick. I know I need bed rest, fluids, staying warm, the odd cold/flu tablet. I also know that there is absolutely nothing the doctor can do for me.

So why do I see the doctor? - the certificate that my boss wants to confirm I am sick, and the only place I can get this is my doctor - who has to see me on the day that I am sick in order to issue the certificate.

I would say that the inherent distrust of employees by employers is more to blame for GP overuse by the community.

I believe that what Dr Ahmed is saying is a good opening to support the introduction of more practise nurses, cousellors and social workers attached to the clinic in which the Dr works or if he works independently from a clinic then there should be provision for the Dr to refer his patients on to the appropriate person, ie. cousellor, social worker or practise nurse. The patient would then be managed at this level at a lower cost than that of psychiatrist or psychologist. Of course the concept would have to be endorsed by Medicare in order for the other practitioners to have a provider number and be able to bulk bill the disadvantaged groups.
Rosemary (retired through my own ill health, Registered Nurse).

When Health Maintenance Organizations (HMOs) were introduced in the US the proposition to the general public was similar to the Aus health system. The public pays a set monthly fee (either individually or through employer benefit programs) and the HMO will take care of whatever happens to you. In the case of Aus we pay a tax - in the US HMO membership is similar to medical insurance.

Early on the HMOs determined that when a "free" service is being offered people will flock in with minor sniffles and non-specific aches and pains. The solution was to put a minimal fee on every office visit (in the cases I am familiar with it was around $5). This substantially reduced the non essential visits and cleared the waiting rooms for the people that had a problem that required medical services.

The US HMO industry has many similarities to the way medical services are delivered in Aus. Since many of the HMOs are for-profit enterprises they have incentives to deliver the best possible care to their customers for the lowest possible costs. I would suspect that there are many service delivery and management techniques that have been developed in the US that would pertain to our system and improve our services without necessarily increasing costs.

"The largest-ever health financing survey by the American think tank, the RAND Corporation, put thousands of patients on different co-payment and compared their usage of health services with their health outcomes over a number of years. It showed that when patients have to pay a reasonable slice of the health care cost, they buy fewer services."
Brilliant !! A stunning result from the most expensive health financing study ever.. What in hell did they expect?.

Snooty_56's idea is far better. Rather than forcing the general populace to fork out bigger bucks, screen the malingerers with qualified nurses, to hand out the sickies to Narcissist and the like, and let the Docs get on with those who need them.

Maybe Dr Ahmed , it would be cheaper to euthanise all those pesky little old ladies.
Twenty dollars to see a GP is fine if you are on a larger income than some pensioners. It is not so long ago that all GP's bulkbilled and medicine was free , then came multiculture and up went all the costs as the population swelled.
I know of nobody who ,these days, visits a doctor unnecessarily, most cannot afford it.
Cheaper to put people down.

Charging patients makes them wait longer until they are really sure they need a doctor, by which stage a small problem, may now be a big problem.

Secondly, a patient is not always the best person to judge if a symptom is minor or important.

It is better for a diabetic to come in complaining of an infected toe, than to whack some salve on it and come in a cold sweat two weeks later because "My freaking toes gone black!" and getting an amputation.

I agree with Snooty, one of the big problems of medicare is it's assumptions that "Health = Doctors." It's time we opened up medicare to legitimate and evidenced based allied health and nursing.

It would probably save money in the long run too.

Just my 2c.
Husmusen.

When my son was so ill that he didn't leave his bedroom for a year except to see a doctor as he suffered from excruciating pain throughout his body and a severe migraine that never ended they told him that it was all psychosomatic and sent him to a psychiatrist. When I insisted that he was really ill I was told to see a psychiatrist too. The psychiatrist thought my son was ill because of a bad childhood.

It took seven years before he had a diagnosis of CRI-chronic rickettsial infection, but in the meantime it was alternative therapies that brought him some relief. It was chiropractors, osteopaths and naturopaths that got him off constant painkillers, out of his bedroom and into a place where the pain reduced and he had some painfree days.

Psychosomatic? Bull.

My father was told that he was a hypochondriac because he thought he had a heart condition. The tests they did on him four month before he died of a heart attack showed he was fine--so they told him to stop worrying. The autopsy showed he had severe atherosclerosis.

Psychosomatic? Bull.

My mother was continually told she did not have cancer and that she was fine as the cancer ate her away--they finally told her she did have cancer a few weeks before she died but not before she had wasted away to skin and bones and was so weak she could barely raise a hand let alone stand up.

Psychosomatic? Bull.

I was told by a GP I was a hypochondriac and I had to accept getting older when I had hip pain so bad that I could not sleep at night. One session with a chiropractor and years of pain were completely over--One session.

Psychosomatic? Bull.

Psychosomatic is what doctor's say when they can't work out the problem.

And I agree with Narcissist. The person in my family who uses the doctor the most these days is my super healthy other son who regularly goes to the gym and eats a great diet and is really fit but if he gets the flu he has to get a doctor's certificate. It's a joke.

The health system should focuss more on prevention and early intervention anyway. If doctors and the health system wasn't so focussed on the absolutely extreme cases they might catch a few more before they become extreme cases.

The only reason I go to conventional medicine these days for my family is to get a bone set, a cut stitched or a burn dressed--which I think conventional medicine is brilliant at. Otherwise they either give you a pill with side effects without addressing the real illness or the lifestyle issues that might be making you ill or they tell you that you are crazy.

A suitably provocative article.
A couple of very good suggestions in the comments thus far:

1. Registered nurses, with a most basic training, to check for flem in the nostrils and on the hanky - and to hand out the sicky certificates.
2. Some more people employed as social workers to help the lonely, worried and disenfranchised.
3. Registered nurses - (they usually have few practical clues), to make recommendations to the seemingly psychosomatic, as to what to try next. Include the chiro's and naturopaths as the second port of call.

And what about allowing some more Australians, who are not necessarily 'top of the class', but are in the 89% range, and who have a promising 'bedside manner' to become GP's.

Perhaps we could 'follow' poor, but practical China, and get the relatives (who are willing) to provide the meals in hospitals, and be a general help aroung the place. All that saved cash could be spent employing more orthopedic surgeons, and the like, to get the massive waiting list shortened. (I know some people will be miffed at this last suggestion - but it has merit - sometimes the relatives are in to visit, just about every meal-time).

Perhaps you could select the cheaper option hospital cover - choose it, with or without the meals!!

People sometimes visit medical practitioners for reasons requiring only modest skill to address. Some are even trivial.

I visited our family doctor twice in the last year. The first time I was seriously ill with symptoms that could have indicated a stroke. Physical examination and CT scan eliminated that. Blood tests eliminated other possibilities and in the end, the conclusion was viral meningitis, for which, like most viral diseases, best treatment is to just wait and see whether you live or die. (I lived.)

I was certainly grateful for finding myself in very skilled and experienced hands.

The second time was for a certificate for my superannuation fund to attest that I am still alive. Blind Freddy could have attested to that if the fund was prepared to trust him.

An earlier post suggested that nurse practitioners and other health professionals, who cost less and and take less time to train than doctors, could handle much of the work that doctors do - especially counselling of the "worried well".

It is more economically efficient for a registered nurse to change a pensioner's light bulb than for a GP.

The government has made moves in this direction. However the Australian Medical Association is firmly opposed to inroads into its monopoly.

QUOTE
Following debate at its Federal Council meeting [in August 2005], the AMA has released a Position Statement on Independent Nurse Practitioners, which states categorically that nurses are no substitute for doctors.

AMA President, Dr Mukesh Haikerwal, said today that at a time when Australians expect and deserve higher quality health care it would be irresponsible for governments to pursue medical workforce solutions that offer patients less than the best possible care.
END QUOTE,
from http://www.ama.com.au/web.nsf/doc/WEEN-6FK2UA

Is having less than "the best possible care" preferable to having no care at all - because there is no doctor in your vicinity, because you can't get an appointment for a fortnight or because you just can't afford it?

Perhaps if Dr Ahmed wants to see the situation improved, he might have a chat with his professional colleagues.

Such a view could only come from a person who knows nothing about scraping to survive.

My household is a family of 6 people. So let's just say we pay $50 per patient when a sickness runs throughout the household, as it often does. That would equal $300 upfront for the doctor followed by medicine. This is before you get any money back.

There has been a number of times where we have opted not to take a sick child to a doctor simply because we can not afford it. Should the child become so sick as to really need the doctor, then up to the emergency department we go.

Then we have another problem. Because we don't take the child to the doctor on getting sick due to finances(rent and food must come first), ideological Social Workers jump at the chance to scoop yet another bunch kids off their parents. Each netting of kids is a badge of honour to them as they break up the children who tend to get abused in 'Foster Care'.

Sure, there are people who abuse the system. That's for sure. Your view of making Doctor's even more expensive is just going to force many families into a worse scenario. Are YOU going to take the blame for the kids not seeing a doctor when Social Workers steal the kiddies? No, ofcourse not. You'll be sitting in your soft armchair sipping fine wine calling the now criminal parents, negligent.

Some hospitals are having trouble with so called Superbugs and the problem appears to be deepening.
Many years ago when hospitals were run by Matrons, cleanliness beat Godliness by a mile. These tough old birds had their finger into everything and every window sill.
Last few times I have been in hospital, the bed and curtain linen has never been changed daily as it used to be, the ward floor was carpeted therefore unwashable and had a vac cleaner run over quickly twice in a week and the whole place had no sparkle and did not even smell clean.
Things have changed and not for the better, no wonder bugs thrive.

I take issue with the term "worried well" if you are worried you are not well.

Remember that 77% of health costs are for pharmaceuticals, the humble GP is not costing us anywhere near what Tanveer suggests.

Steve Madden,

77% of health costs are for pharmaceuticals? Absolutely not.

According to the Commonwealth Department of Health, government expenditure on pharmaceutical benefit scheme prescriptions for the year ending 30 June 2005 Australia-wide totalled $5,305 million, http://www.health.gov.au/internet/wcms/publishing.nsf/Content/F046EA251DBC1AC0CA2570A500086F14/$File/summary.pdf

According to the NSW Health Department, state government expenditure on health services (mainly public hospitals) in NSW alone was budgeted at $9,970 million for the 2004-05 year, http://www.hnehealth.nsw.gov.au/news/releases/2004/June/budget_icu&nicu_22.htm

The only enterprises that might find pharmaceuticals are 77% of their costs are bikie gangs buying pseudoephedrine cough medicines to make speed.

Surely you must have meant something else?

Mike

Google OECD health costs. I do know what I mean I just cost the taxpayer $25,000 for rituxan, 6 weeks worth.

Worried and unwell.

Look what I found:

"Early medical detection and treatment is available, but the effectiveness of this in actually preventing heart attacks is questionable according to a study that was published in the journal Circulation.

"In this study, Dr. Lewis Kuller (University Professor of Public Health, Department of Epidemiology) reviewed the medical records of 326 individuals who had received medical examinations within the six month period before they died from a sudden heart attack. Eighty-six of the 326 examinations were done within the seven day period prior to death from heart attack. Not a single one of the 326 heart attacks had been predicted by the physicians.."

Not one! So my father wasn't an unusual case. Here we have the number one killer--heart disease and the doctor's can't predict who is even ill--and they trust their tests and not the patient.

The health system needs to emphasise being healthy rather than just fixing extreme bad health. It should start in school.

How ridiculous is it that little kids are made to sit still all day at a desk. Exercise shouldn't be just competitive sport once a week. It should be healthful exercises to increase fitness every day and that corrects bad posture. Aimed towards the unfit and not just for encouraging the kids who are going to 'win' interschool sports.

And what is with school canteens? Why don't they have healthy food? The kids will eat it if they are hungry enough--yay Jamie Oliver's efforts in this area.

Add to that the stress caused by homework--why do kids have to do homework? Why can't they learn everything they need to at school? There was a school that abolished homework and the kids grades improved that was in the paper recently (can't find the article on the net). So if there is no improvement in grades why stress them out and start a whole habit pattern of overwork and stress that they can follow for a lifetime.

In France overtime is illegal--but there productivity is the same as the US even though they do less hours. Go figure.

This article is of course a joke. GP's would all go broke without their neurotics. The fact is there is no such thing as the worried well, this is just psychiatry speak. Pain tells us something is wrong. The wrong can be physical, mental or spitual. In this culture most of our ills are mental/spiritual. Psychiatrists are people who do not generally aknowledge the spiritual part of us. They don't like to admit there are large areas of nature they have no knowledge and control over.
We live in a state so far removed from nature we have lost sight even of the seasons and the sun and moon. We no longer see nature or adhere to its rhythms and as a consequence we feel out of sorts, we have become entangled in our neuroses and fantasies to such an extent we have lost touch as a society of the very essence of our lives. We no longer take time to enjoy nature and as a consequence we live impoverished and diminished lives eeking out an existence in a consumerist hell. Psychiatrists can't fix this. GPs can commiserate though and maybe offer an anxiety agent to quell the angst.

Education must be a key - e.g. Tannahills Health Promoting Schools and a generic framework taught to all, to better lay assess health of self and others. One tool is Hodges' Health Career - Care Domains - Model [h2cm]

http://www.p-jones.demon.co.uk/

- can help identify and map ideas, issues, problems AND solutions. The model takes a situated and multi-contextual view across four knowledge domains:

* Interpersonal;
* Sociological;
* Empirical;
* Political.

Four links pages cover each care (knowledge) domain e.g. Interpersonal:

http://www.p-jones.demon.co.uk/links.htm

- which includes mental health, therapies ...

and crucially a political domain:

http://www.p-jones.demon.co.uk/linksIV.htm

Lancashire
UK
Hodges' Health Career - Care Domains - Model
h2cm: help 2C more - help 2 listen - help 2 care

Dr Tanveer

Thank you for your article.

Have you ever heard of the saying: "Pain is what the patient says hurts"?

"The worried well" is an old cliche which has been used by psychiatrists and psychiatric nurses for yonks - to label people that they mostly do not understand.

A holistic health assessment should include: physical, mental, emotional, social, economic, spiritual, and communication/interpersonal assessments. As a very experienced community psychiatric nurse I have always conducted holistic assessments. I have made provisional diagnoses and then referred clients to psychiatrists, clinical psychologists and other medical personnel, such as GPs. Skilled psych nurses have been doing this for ages.

Cheers
Kay
(retired RPN due to work injury).

Maybe all doctors surgeries need to have a triage nurse. people could phone or drop in and answer some basic questions to establish whether they need to see the doctor or not. Of course, the article is really looking at the wrong end of the problem. If people are seeing a doctor rather than some other professional, the answer is to make alternative support services more accessable, not to make GPs less accessible.