Integrating opportunity Goodfellow Symposium 2012 Dr Liza Lack National Clinical Leader GPEP2

Liza

Integration 1. To make into a whole by bringing all parts together; unify. 2. a. To join with something else; unite. b. To make part of a larger unit: integrated the new procedures into the work routine. 3. a. To open to people of all races or ethnic groups without restriction; desegregate. b. To admit (a racial or ethnic group) to equal membership in an institution or society

General Practice in New Zealand How many general practice visits do you think happen each year in New Zealand ? What percentage of the population do you think this represents? How many clinical decisions are made in those visits? If they visit once what is the average number of times that they visit? On average how many clinical problems are dealt with per consult ?

General Practice in New Zealand 11.3 million visits (ref3) 80% of the population (ref1) 19 million clinical decisions (ref3) 4 visits (ref1) 1.68 problems per consult (ref2)

The references Reference 1 –A Portrait of Health: Key Results of the2002/03 New Zealand Health Survey. Public Health Occasional Bulletin No.21.Wellington: Ministry of Health; 2004 Reference 2 –Raymont A, Lay-Yee R, Davis P, Scott A. Family Doctors: Methodology and description of the activity of private GPs. The National Primary Medical Care Survey (NatMedCa):2001/02.Wellington:Ministry of Health;2004 Reference 3 –GENX course book University of Otago. Mod 1 pg 1

Opportunity opportunity n pl -ties 1. a favourable, appropriate, or advantageous combination of circumstances 2. a chance or prospect

Integrating Opportunities

Finding the balance

Communication The opportunity to build a therapeutic relationship with a mother and her child A mother comes in with her child asking you to check his ear as she is worried that she may have an infection. In the pram asleep is her new baby. The consultation is over quickly as the child’s ear is fine What is the opportunity? How you might address it?

Things to think about! How is mum coping? How was the birth? Does she have any specific concerns about hearing ? How do you engage with the child? How does mum feel about immunisation - does she know how the clinic runs regarding immunisation? What do you know about the effects of a new sibling upon any existing children? Where is Dad?

Clinical Expertise The opportunity to learn a new skill in house You have a patient present to you with what looks like a sebaceous cyst. They advise you that one of the doctors who is not there that day treated the last one by trephining it and it was successful. You have never done that before. What is the opportunity? How you might address it?

Things to think about! How are you going to proceed today when the other partner is not there? How will you communicate with the patient about what is happening? How will you develop your skills in that area? What important things does the patient need to know before leaving? What do you need to set up to make things go smoothly?

Professionalism The opportunity for education rather than anger You are new to this practice and one of the receptionists is very patient centred, or at least she thinks that she is. She has been there for years. She keeps fitting extras into your surgery and also when you finish there is a long list of telephone calls for you to make. What is the opportunity? How you might address it?

Things to think about! How are you going to deal with the receptionist? Will you involve any of the other members of the team? What outcome do you want to have?

Scholarship The opportunity to revise your knowledge of a disease but also to understand from the patients perspective what it is like to have this illness You have a new patient enrol who comes to see you. They have a diagnosis of Marfans syndrome. You did not know this before they arrive. What is the opportunity? How you might address it?

Things to think about! How were they diagnosed? What do they understand about their condition? How does their condition affect their daily life? Have they read any articles about it which they think would be useful to share with you? How can you find out more about it before next time? How are you going to let the other people in your practice team know about this?

Context of General Practice The opportunity to work with the extended practice team You are new to New Zealand and have been working at the practice for a while. One of your patients becomes terminally ill. You want to provide the care but you are unsure about how to go about it. What is the opportunity? How you might address it?

Things to think about! Who will you talk to? What do you need to know? Who are you going to be working with throughout this episode of care?

Creating opportunities!

Carpe Diem – Seize the Day!

Looking ahead!