A new Monash study reveals the hidden complexity of general practice where eight health issues, on average, are tackled in just 19 minutes.
Every day GPs are faced with a myriad of complex health concerns raised by their patients. “Holy bananas!” was the reaction of a Monash University research team when they first delved into the complexity of what doctors are trying to manage in general practice.
The research team, led by general practitioner Adjunct Professor Liz Sturgiss from Monash University’s School of Primary and Allied Health Care, and co-authored by Dr Kimberley Norman and Ms Nilakshi Gunatillaka, with Dr Kellie West a practicing rural GP, looked to the National Centre for Healthy Ageing’s new simulation facility, the Digital Library for healthcare interactions, to help solve access problems to doctors’ consultations.
The NCHA’s Digital Library is Australia’s first secure digitised collection of real-world consultations between GPs and their adult patients, plus related data: including anonymised transcripts, patient survey logs and participant demographic data.
The digital research infrastructure aims to support world-class research about healthcare interactions and communication strategies to improve patient safety, health outcomes and consumer satisfaction.
The research team studied 54 video-recorded GP consultations from four different doctors in Melbourne and identified a number of complex health issues raised or discussed by patients.
The team found that eight different health issues, on average, were mentioned or discussed with the GP during a 19-minute consultation. The breadth of the health issues spanned from musculoskeletal, cardiovascular, psychological, skin, and digestive complaints. GPs were also called on for lifestyle counselling about nutrition and weight management issues.
Dr Norman highlighted the importance of accessing NCHA’s advanced simulation facility, the Digital Library, based on Monash University’s Peninsula Campus, to support their research.
“The Digital Library is unique in Australia and brings new possibilities for improving healthcare communication. This world-leading research infrastructure provides a window into real-life consultations and that was crucial for our research objectives,” she said.
NCHA Director, Professor Velandai Srikanth said the research has shown how the NCHA Digital Library can shine a light on the complexity of healthcare interactions.
“Through such research and knowledge translation, it has the potential to enhance interactions in a number of areas relevant to healthy ageing and beyond, from primary care right through to complex specialist care. The ultimate beneficiaries will be both the provider and recipient of healthcare," he said.
The study found that GPs needed a thorough understanding of medications, with almost every patient (98.1 per 100 encounters) raising the issue. They also shoulder a significant administrative burden which included creating pathology and imaging requests, providing medical certificates, calling the pharmacy to organise an authority script, making follow-up GP and practice nurse appointments, printing off copies of test results/imaging for the patient to take to other care team members (specialists, allied health professionals), and assisting with social security and insurance paperwork.
Dr Sturgiss said it was important to demonstrate the complexity of what GPs are managing with each patient.
“Our study showed what is really happening behind the closed GP consultation door. As doctors we recognise the mental load of comprehensive general practice. But there is also joy in providing whole person care,” she said.
The study team concluded: General practice research must include explorations of the consultation process so that we can better communicate to policymakers the complexity of the specialty of general practice. This exploratory study confirms that GP consultations usually include the management of multiple conditions that span multiple health systems.
Read the research paper: Here
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