twrama 1841_august_2.. - AMA WA

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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
OPINION to assess and coordinate complex childhood issues? As usual the answer lies in training programs and adult learning principles. As a core requirement of Australian vocational training, general practice registrars are required to complete a hospital paediatric rotation or an emergency department rotation with a significant paediatric caseload. In addition, community-based paediatric exposure and experience is required. There is an expectation that registrars will gain experience in the management of acute and chronic childhood illness. The 2011 RACGP Curriculum for General Practice has specific statement chapters on children and young people’s health, as well as other chapters describing acute serious illnesses and the management of chronic disease illness applicable to both the child and the adult. The Red Book provides age-specific guidelines for preventative activities in general practice and the Colle ge recently released a Children and Young People’s Health position statement (well worth a read). At the end of the day, a learning experience for a doctor reflects the clinical situation, the learner, and the supervisor/ mentor/teacher/vocational educational program. Although I am not a huge fan of a log book, perhaps we need to revisit the concept. In summary, general practice can support optimal healthcare and development of children and young adults through: • Provision of a “medical home” • Ensuring we practice evidence-based preventive health activities • Ensuring access to appropriate medical attention for acute healthcare • Delivering systems of care (developmental surveillance and screening) to optimise and support bio-psycho-social development of children; and • Co-ordinating the health, social and education sectors with the united purpose to improve health and early childhood development. References: www.racgp.org.au/curriculum Position paper “The role of general practice in the provision of healthcare to children and young adults” available at www.racgp.org.au/policy/clinical. FREEAMA (WA) Seminar for GPs The next GP Breakfast Seminar, hosted by the clarification on how GPs could confidently provide Australian Medical Association (WA), will be PCEHR under the current Medicare arrangements. held on Wednesday 26 September. Attendees will also be given updates on item Naturally, the Personally Controlled Electronic number compliance, and AMA GP advocacy Health Record (PCEHR) will be top of the list of and policy. discussion points. The AMA will discuss why the Date: Wednesday 26 September 2012 biggest element of health reform now confronting Time: 7am–8.30am GPs – the PCEHR – is being undermined by potential Venue: To be advised legal hazards and financial disincentives, its impact on RSVP: Wednesday 19 September 2012 GPs and patients and what you can do about it. To register, contact Skye Connor. E-mail The seminar will update you on the skye.connor@amawa.com.au; phone 9273 3028; implementation pitfalls, their legal and financial fax 9273 3073. implications, including the Federal Minister’s recent August MEDICUS 33
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