GPs role as coordinators of patient care

Project managers, GP's, or both? Dr John Crimmins shares his thoughts on the prime role GPs play in our health system as multidisciplinary coordinators of patient care.

  As GPs we always appear to define ourselves by the particular knowledge that is applicable to our discipline or a particular set of skills. We define our knowledge based on frequency of a particular attendance or a skill based on what we perceive we are expert at.

  Take the area of prevention for example. As GPs, we have a perception that this is our field as we are the holders of this areas knowledge and expertise as we do it much more frequently. We also perceive ourselves as being the experts in consultation or people skills because we do a lot of person to person healthcare.

 I’m of the view that our major skills are actually co-ordination of a patients care. This is a skill no other healthcare professional has had the training for, or professional behaviours or attitude needed to implement and it is the one professional skill that makes the GP a prime component in the health system.

  The other word for coordinator is Project manager. This is a position that has been about forever, and now there are even University degrees requiring a high entry to attend in Project management. An analogy that is timeless is in construction, from Pyramids to a modern high rise. The project manager knows a bit of what each component does, making sure it gets built on time and to the required quality… the same measures we always argue to Government that GPs have - effectiveness and efficiency in health care delivery.

  In terms of training a GP has a working idea of each healthcare professional’s role in the health system which no other healthcare professional has. This is because we do a hospital stint and taste firsthand what the other specialties do, as well as nurses. Some of us actually became quite handy at ED, surgery and anaesthetics. In contrast, some healthcare professionals have some multi-disciplinary experience, but have rarely actually worked in a GPs shoes.

 My anecdote; I visited a patient in a Private Sydney Hospital, an over 75 year old with advanced Prostatic cancer, in hospital for septicaemia. He had an ongoing fair response to chemotherapy and was under a urologist, oncologist, nephrologist, interventional radiologist… and the list goes on. 2 weeks later I saw him, now stabilised and transferred to Geriatrics ward under (yes) a new cook/Geriatrician who reordered 8 X-rays and scans so he could get up to 'speed'.

  As a GP I asked to read his notes - was refused (justifiably so as they belong to Hospital) – so I rang each doctor and within 2 days he was transferred to a rehabilitation/palliative care hospital and home within 2 weeks. The cost of poor coordination on my estimate was around $49,000 for 6 weeks in a hospital all due to no coordination of care or advocacy for the patient. I reckon a GP intervention would have saved at least $35,000.

 Why are we worried? We are the system overseers. GPs are the generalists, the first contact, but most importantly we are the coordinators of a patient's care.

Jow KosterichDr John Crimmins
General Practitioner for over 25 years with a long experience in remote rural and city based practices. He is also consultant to Reed Medical and had a working experience in medical education. As an examiner for the RACGP and facilitator training, he maintains an ongoing contact with a large number of his colleagues. He has a particular passion for disabilities medicine and public health.