I have had an interesting week on the web. In response to an article on the website www.6minutes.com.au entitled "Should Nurses be Doctors?" I responded with a clarication about the role and qualifications of nurse practitioners. Well! I have never been in receipt of such vitriol in my life! Assumptions about who I was, supposed claims of being "hardworking and smart", 'massaging my ego" and so on and so forth from GPs and others.
Anyway I then enlisted the support of the nurse practitioners and NP candidates who are APNA members to add their contributions to the debate, which they did very ratioanlly and calmly (in comparison to some of the other contributions). The whole discussion became a much broader discussion about nursing as a profession and then towards the end about best management of exercise induced asthma.
Despite acknowledging that GPs who contribute to web forums such as this may not be your typical GP, the expereince highlighted some things for me of concern. there were alot of assumptions made about who I was and what I was saying which were not in writing. Do they do this with patients? Likewise there was very selective use of evidence. Finally ideology was expressed as fact - and that for me is the essential difficulty for all of us in this debate.
Should we engage in such silly debate? I suspect yes - we need to keep calmly and rationally stating the evidence and the facts. As more and more on the ground GPs enjoy the experience of working alongside nurses of all level and skill bases and in a collegiate and respectful manner, debates such as these will become obsolete as they are becoming in other countries such as the UK.
Wednesday, June 24, 2009
Wednesday, June 17, 2009
Medical and nursing groups together
On Tuesday I attended a Roundtable meeting in Canberra again which had medical and nursing groups together. It was a follow on from the same roundtable last year which we organised alongside the ANF and the College of Nurse Practitioners. Last year we placed the advanced nursing roles in primary health care evidence on the table for consideration by all present. This year we launched the Position Statement on Primary Health Care- a nursing view.
It was an incredibly productive and rational discussion. All the areas we agree on and disagree on were debated and a commitment was expressed by all present to continue talking in a more formalised way with each other.
From APNA's perspective, we would like to see a productive approach taken to discussion of the 'for and on behalf 'of issues, how the access of NPs to the MBS and PBS is going to play out to the best advantage of patients and practices, how we can get greater clarity of roles and accountability between members of the general practice team.
It was an incredibly productive and rational discussion. All the areas we agree on and disagree on were debated and a commitment was expressed by all present to continue talking in a more formalised way with each other.
From APNA's perspective, we would like to see a productive approach taken to discussion of the 'for and on behalf 'of issues, how the access of NPs to the MBS and PBS is going to play out to the best advantage of patients and practices, how we can get greater clarity of roles and accountability between members of the general practice team.
Tuesday, June 2, 2009
Swine flu after all
After finishing off the previous blog, the GP called and let us know that Lucy does in fact have swine flu. Since we were informed that we were clear on Sunday, I am not sure we have done much for the government's containment strategy! I fortunately stayed home to work as I was concerned about our accountant Dinusha catching even the normal flu as she is 12 weeks pregnant.
Obviously a key message for my general practice- a positive test for influenza A is a reason to keep a level of quarantine up whilst waiting for swine flu results, not a dismissal of swine flu; removing of masks etc when my other daughter visited the practice with tonsillitis may have also been somewhat premature; and getting some concrete information on the quarantine required for all of us while we wait for communication from DHS. As hubby has been going to work Monday and Tuesday, is quarantine for Wednesday and Thursday going to mean anything.
I guess it is a lesson in going with your gut feeling and the silent spread of this virus- Lucy had no known contact with a confirmed case but my gut still said get her tested as it was such a sudden onset and obviously highly infectious amongst her friends (only one of whom have been tested to my knowledge- one GP said it wasn't required as like us there was no confirmed case contact). Waiting 4 days for the test result has probably not helped the spread of the virus! Having to pay for the test (need to have contact with a known confirmed case to not pay) and the Tamiflu (similar) made me very conscious of the fact that I could and felt it was warranted - despite being made to feel every inch the paranoid mum! As I said in the previous post- I was not worried for Lucy but the spread of the virus.
My feeling is that we must be approaching the sustain phase of the virus any moment now in Victoria. Despite the measures in place, the virus is circulating widely. Many families are not testing and I can only imagine the pressure some of the practices must be feeling to manage the requests for tests etc.
My hope is that our voluntary quarantine avoided someone vulnerable getting this virus before a vaccine is available, hope that our few days of thinking we were not affected has not harmed anyone and we will rejoice in getting our contact wiht teh swine flu over nice and early!
Obviously a key message for my general practice- a positive test for influenza A is a reason to keep a level of quarantine up whilst waiting for swine flu results, not a dismissal of swine flu; removing of masks etc when my other daughter visited the practice with tonsillitis may have also been somewhat premature; and getting some concrete information on the quarantine required for all of us while we wait for communication from DHS. As hubby has been going to work Monday and Tuesday, is quarantine for Wednesday and Thursday going to mean anything.
I guess it is a lesson in going with your gut feeling and the silent spread of this virus- Lucy had no known contact with a confirmed case but my gut still said get her tested as it was such a sudden onset and obviously highly infectious amongst her friends (only one of whom have been tested to my knowledge- one GP said it wasn't required as like us there was no confirmed case contact). Waiting 4 days for the test result has probably not helped the spread of the virus! Having to pay for the test (need to have contact with a known confirmed case to not pay) and the Tamiflu (similar) made me very conscious of the fact that I could and felt it was warranted - despite being made to feel every inch the paranoid mum! As I said in the previous post- I was not worried for Lucy but the spread of the virus.
My feeling is that we must be approaching the sustain phase of the virus any moment now in Victoria. Despite the measures in place, the virus is circulating widely. Many families are not testing and I can only imagine the pressure some of the practices must be feeling to manage the requests for tests etc.
My hope is that our voluntary quarantine avoided someone vulnerable getting this virus before a vaccine is available, hope that our few days of thinking we were not affected has not harmed anyone and we will rejoice in getting our contact wiht teh swine flu over nice and early!
Monday, June 1, 2009
Reflections on swine flu
As most of you know, APNA is based in Melbourne, Victoria and in recent times we have been somewhat in the grip of a swine flu outbreak!
Last Wednesday night, my 14 year old daughter Lucy woke us up in the wee hours with a high temperature and sore throat. Over Thursday she remained unwell and developed a cough. Being the usual offhand Mum that I am, I just let her sleep it off. I stayed home however just to keep an eye on her but I was not overly concerned as the swine flu was in the northwestern suburbs and we live in the east of Melbourne.
I had been asked earlier in the week to attend a teleconference on the Thursday evening at 6pm with the Chief Medical Officer Dr Jim Bishop along with other Presidents or CEOS of the different GP related groups - RACGP, AMA, RDAA, AGPN etc. It was with a slight sense of irony that I had to ask to have the call made to my home as I was home looking after my daughter with "flu-like' symptoms.
The teleconference was very interesting and there was alot of talk about the impact on practices, what practices should do to minimise risk to patients and staff, supplies of protective equipment and how to identify a swine flu positive patient who is 'going bad'. As most of you know, we have had a mild version of the swine flu in Australia but for those overseas who have died, they went downhill very quickly, as in 48hrs. there was much discussion about the communication with the community and it was at this point that I raised my confusion. As a relatively well-educated health professional, even I was confused as to what I was supposed to do with Lucy. I was not concerned about her clinically, but she fit the criteria of flu-like symptoms. She had no known contact at that stage but it was not unfeasible (is this a word?) that she may have come into contact with some of the girls at another girls highs school which did have confirmed cases- there had been a Yr 9 social at the local boys high school which most of Lucy's friends all attended. I had rung my general practice in the morning but the message was that if I felt comfortable looking after her, don't bring her in.
After the teleconference, I was more uncertain. 6 of Lucy's friends had all now experienced the same symptoms. I called Nurses-on-call who were trying to reassure me about her condition, but as I kept explaining I was not 'worried' about her or that she might have swine flu, I was concerned about the notion of spreading it around.
On Friday, I ended up taking her to the GP. She refused to sit in the special waiting room section with a mask, so we had to sit in the car until the receptionist rang us. we then put on masks and rushed through to a designated consulting room. She was tested and swabbed and we were ushered out the back door - nothing like feeling somewhat undesirable!
Over Friday, we heard that 2 more local schools had had confirmed cases. As the rest of us were starting to feel unwell, we basically took it easy and stayed at home. On Saturday, daughter number 1 woke up with swollen tonsils and feeling very unwell. Took her to the GPs, same procedure except the practice nurses saw us first to establish our story - all of us and nurse wearing masks etc. The GP looked at Elly, established that she had tonsillitis and this meant that swine flu was unlikely for some reason so all masks and gowns etc removed. We were allowed to exit through the front door this time!
Saturday - not test results. One of Lucy's friends confirmed as swine flu but Lucy had not had direct contact with her since a couple of days before she got sick. GP rang at lunchtime to say we would not get the results till late Monday or Tuesday. the advice was that as we had not had direct contact with a confirmed case, we were not required to be quarantined and I went out to supermarket to get some food. It still frustrated me though that if she turned out to be positive, we would have been roaming around the local shopping centre etc.
Tests results came through Sunday morning- Influenza A not swine flu. Doctors advice that likely that we all had it.
Thankfully we could all come out of our voluntary quarantine but it made me think - the kids were sicker with this influenza than some of their cohorts have been with swine flu. Did we prevent some other innocent patient from getting influenza A in the waiting room? I hope so! Even though I have a public health background, I have not really given that much thought to the practicalities of worrying about my family or I being a source of some infection for others. I hope this whole episode makes practices rethink their protocols for all infectious conditions not just pandemic flus. And for the kids to think it is normal and not embarrassing to wear a mask in the surgery if you are potentially contagious. Maybe they can make Scanlan and Theodore masks.
Alls' well that ends well- back to work and APNA.
Last Wednesday night, my 14 year old daughter Lucy woke us up in the wee hours with a high temperature and sore throat. Over Thursday she remained unwell and developed a cough. Being the usual offhand Mum that I am, I just let her sleep it off. I stayed home however just to keep an eye on her but I was not overly concerned as the swine flu was in the northwestern suburbs and we live in the east of Melbourne.
I had been asked earlier in the week to attend a teleconference on the Thursday evening at 6pm with the Chief Medical Officer Dr Jim Bishop along with other Presidents or CEOS of the different GP related groups - RACGP, AMA, RDAA, AGPN etc. It was with a slight sense of irony that I had to ask to have the call made to my home as I was home looking after my daughter with "flu-like' symptoms.
The teleconference was very interesting and there was alot of talk about the impact on practices, what practices should do to minimise risk to patients and staff, supplies of protective equipment and how to identify a swine flu positive patient who is 'going bad'. As most of you know, we have had a mild version of the swine flu in Australia but for those overseas who have died, they went downhill very quickly, as in 48hrs. there was much discussion about the communication with the community and it was at this point that I raised my confusion. As a relatively well-educated health professional, even I was confused as to what I was supposed to do with Lucy. I was not concerned about her clinically, but she fit the criteria of flu-like symptoms. She had no known contact at that stage but it was not unfeasible (is this a word?) that she may have come into contact with some of the girls at another girls highs school which did have confirmed cases- there had been a Yr 9 social at the local boys high school which most of Lucy's friends all attended. I had rung my general practice in the morning but the message was that if I felt comfortable looking after her, don't bring her in.
After the teleconference, I was more uncertain. 6 of Lucy's friends had all now experienced the same symptoms. I called Nurses-on-call who were trying to reassure me about her condition, but as I kept explaining I was not 'worried' about her or that she might have swine flu, I was concerned about the notion of spreading it around.
On Friday, I ended up taking her to the GP. She refused to sit in the special waiting room section with a mask, so we had to sit in the car until the receptionist rang us. we then put on masks and rushed through to a designated consulting room. She was tested and swabbed and we were ushered out the back door - nothing like feeling somewhat undesirable!
Over Friday, we heard that 2 more local schools had had confirmed cases. As the rest of us were starting to feel unwell, we basically took it easy and stayed at home. On Saturday, daughter number 1 woke up with swollen tonsils and feeling very unwell. Took her to the GPs, same procedure except the practice nurses saw us first to establish our story - all of us and nurse wearing masks etc. The GP looked at Elly, established that she had tonsillitis and this meant that swine flu was unlikely for some reason so all masks and gowns etc removed. We were allowed to exit through the front door this time!
Saturday - not test results. One of Lucy's friends confirmed as swine flu but Lucy had not had direct contact with her since a couple of days before she got sick. GP rang at lunchtime to say we would not get the results till late Monday or Tuesday. the advice was that as we had not had direct contact with a confirmed case, we were not required to be quarantined and I went out to supermarket to get some food. It still frustrated me though that if she turned out to be positive, we would have been roaming around the local shopping centre etc.
Tests results came through Sunday morning- Influenza A not swine flu. Doctors advice that likely that we all had it.
Thankfully we could all come out of our voluntary quarantine but it made me think - the kids were sicker with this influenza than some of their cohorts have been with swine flu. Did we prevent some other innocent patient from getting influenza A in the waiting room? I hope so! Even though I have a public health background, I have not really given that much thought to the practicalities of worrying about my family or I being a source of some infection for others. I hope this whole episode makes practices rethink their protocols for all infectious conditions not just pandemic flus. And for the kids to think it is normal and not embarrassing to wear a mask in the surgery if you are potentially contagious. Maybe they can make Scanlan and Theodore masks.
Alls' well that ends well- back to work and APNA.
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