Whats Wrong with Medical Preventive Care?

As I sit on the verge of commercialising the DCP I am contemplating and reviewing much of the lessons I have learned in two years dealing with my fellow GPs.
To some extent I have been trying to break down barriers and overcome inertia to change by introducing a ‘Software Tool’ that promotes and rewards implementation of preventive care. The tool has been offered freely.
 Hundreds of GP’s have now been exposed to the DCP concept. Despite obvious benefits for both patients and GP’s, uptake of the DCP is not universal amongst GP’s who could benefit.
There are many and varied reasons for this. I know John Johston the owner of PEN CAT has had similar experiences in trying to promote his
software directly to GP’s and that is why he gave up and instead sells the PEN CAT tool to divisions of medicine, APCC etc. It is a brilliant tool
and a brilliant way to implement change and improve prevention and population monitoring.
Why then weren’t GP’s interested when approached directly??

It may help to understand the situation if I detail the reactions of some GP’s when introduced to the concept of software tools.
Firstly a GP friend of mine working in another surgery, a few suburbs away from mine, where the attitudes and work policies are very different. Together we present opposite ends of the spectrum. They do not use the DCP nor the PEN CAT tool. They do not have a diabetes register or CHD register and do not do not implement preventive care recalls. They don’t monitor weight , height and waist routinely. They don’t utilise EPC items often. In fact, when called upon to create a TCA, by their patients, they had great difficulty in managing to complete the TCA in under 1 hour.

The belief there is “EPC items are overrated and not indicative of practicing good medicine”. GPMP’s and TCA’s in particular are regarded as nothing more than a perverse audit mechanism on providing referrals. TCA’s were treated however with due respect and much time was spent on creating them. It became a real chore. However despite the time spent, content remained lacking, there was no direction and no real preventive plan other than dealing with acute and occasional chronic items in medical history. But the patient did get the referral for getting toenails clipped.
It reached the point two years ago where the TCA’s, AHA’s and GPMP were farmed out — to a stand in doctor. Items and Plans are now generated from information gleaned from histories. At least the plans contained some content for prevention and were based on templates endorsed by the divisions. Boxes ticked, they can get on with practicing real medicine. Software tools like the DCP which helps manage prevention and also to create plans are not required in this environment.
These attitudes are compounded by resitance to change in technology.
Technology in any form is to be managed by the ‘Software Guys’. These guys maintain the setup from server , network and workstations to printers. These guys struggle! Too many times the system goes haywire. When the system is down, the stress levels go up and up. Having to deal with the frequent disruptions in software and hardware have lead to a complete state of inertia amongst the doctors, the practice principle in particular. “No changes allowed”. End of story.Besides they are “Too Busy”. Too busy for all that stuff. Too busy for making changes now. Too busy for making changes tomorrow or next week. Here the belief is really “the task is too onerous”. They have refused to try to change because of ingrained attitudes and beliefs.

They have failed to realise that change is really not difficult when implemented incrementally. They have also failed to seize the opportunity that EPC items are presenting for the GP fraternity, to in fact become the sorely needed torch bearers of preventive care. EPC items can be interpreted wrongly by GP’s, who see nothing more than an hour of paperwork preceding a referral.
EPC items are in fact an opportunity to implement preventive care, make changes, review medical management, catch up on missed immunisations, write an overdue ophthalmolgist referral , order that overdue colonoscopy, educate patients, implement routine followup schedules, etc etc etc.
Maybe we are just not good at it or maybe not trained well enough for it. Maybe its just too hard.
Problem is – The GPs there are largely right. EPC items are overly complex and often misdirected. But at least we have EPC items to facilitate change.
This has nothing to do with their medical competence or quality of medicine. In fact they are all highly regarded and train other GP’s. One is an examiner for a university faculty of medicine.
It is all about attitude.I have enjoyed attending the APCC conferences where attitudes are different. Here practice mangers, practice nurses and GP’s come looking for change, seeking ideas with eyes, ears and minds open. Generally reception to the ideas embellished in the DCP is well taken up by GPs here.

I have learned a great deal in analysing what makes GP’s tick. It is what makes me believe now that most changes in preventive care management over the next few years will come from non GP’s. Teams of nurses, educators, ‘allied this’ and ‘allied that’ are zoning in, making changes now, filing the void and taking up slack.
Unless the minds of the GP’s of tomorrow are open, focused on change and able to seize opportunities presented………………………….End of Story.
 August 2010

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