twrama 1841_august_2.. - AMA WA

OPINION
Kids’ stuff
by Associate Professor Frank R Jones
Chair, RACGP WA Faculty and AMA (WA) Councillor
It is true as one grows older as a GP, one’s patient following
also seem to inextricably age. These days I see older patients
with complex co-morbidities, polypharmacy issues and an
increased expectation of survival associated with a good
quality of life.
Most of us struggle with the ageing process and the
prospect of loss of independence, and statistics bear this out.
As the demographics of the Australian population age, so does
the average age of the patient encountered in general practice.
The population of adults and seniors is rising at a faster rate
than the population of children.
What a medical pleasure it is then when I get to see a toddler
with a “simple” upper respiratory tract infection (URTI) or
cough. Or is it so simple?
Is this child really ill? How do I know? How do I teach
my registrar when it is okay to practice “watchful waiting”?
Does my registrar think “why here, why now”? In fact, is my
registrar seeing enough paediatric cases to be confident and be
deemed competent? Am I seeing enough cases to be as assured
as I was after my Diploma in Child Health training?
What about more “complex” paediatrics – developmental
issues and behavioural problems? What about an
understanding of the close interaction between the child’s
social environment and illness?
Our younger Aboriginal and Torres Strait Islander
populations have really complex unmet needs – morbidity
statistics speak for themselves. And then, how do we access
appropriate services for
these very vulnerable
A recent paper...suggested
patients? We all
that exposure of general
know how difficult practice registrars to
co-ordination
chronic illness in children,
of care is for the
and to a range of other
parents of a child
more acute diagnostic
with mixed physical
conditions, may be
and intellectual issues.
General practitioners increasingly limited
have a critical role in
advocacy here – know
your local referral pathways and
be a champion for your young patient.
A recent paper in the Australian Family Physician caught
my eye (Vol. 41, No. 7, July 2012). In essence, the paper
suggested that exposure of general practice registrars to
chronic illness in children, and to a range of other more acute
diagnostic conditions, may be increasingly limited. Somewhat
surprisingly, registrars spent most of their time in consultations
with patients aged 65 plus years and the least time with children
aged 5–14 years. Only one in 10 consults were with children less
than four years of age. Long consultations were virtually absent.
These figures are of concern.
How can we ensure our young doctors have adequate
exposure and experience on the one hand to recognise and
manage the acute sick child, and on the other, have the ability
32 MEDICUS August