My patients don’t separate their physical and mental health. Medicare must stop asking us toRuth Mabhiza
Medicare’s recent warning is a slap in the face for those of us trying to provide quality, whole-person care
‘The warnings are ostensibly aimed at GPs “rorting” the system but the effect is to frighten – and punish – family physicians providing whole-person care.’ Photograph: Eric Audras/Getty Images/Onoky
She sits across the table, biting her lip.
“Do you have any other questions?” I ask, puzzled by her reaction, confident that our detailed discussion about strategies to reverse her newly diagnosed osteoporosis – and prevent another fracture – was useful.
She hesitates, just for a second, before it bursts out of her.
“I have these thoughts, and I can’t take it anymore. He follows me, and I’m scared and I just want to escape.”
Tears are now streaming down her cheeks. “Please help.”
This week, GPs across Australia received notice from Medicare. The report warned that general practitioners who see patients and bill Medicare for both physical health and mental health issues within the same consultation (at a rate higher than their peers) are to receive warnings. These GPs should repay the cost of “unnecessary” billings, or face an audit and legal proceedings by Medicare.
Here’s the problem. While the warnings are ostensibly aimed at GPs “rorting” the system, the effect is to frighten – and punish – family physicians providing whole-person care. Already, worried doctors are anxiously debating how to respond. Many feel that their attempts at compassionate care are being undermined. The answer for many is to ask the patient to return for a separate visit. This is an impractical, wasteful – and dangerous – solution.
Most patients aren’t aware of the complexities of the Medicare Benefits Scheme and how it influences physician behaviour. Medicare is supposed to incentivise providers to provide high-quality healthcare to patients at a cost that is affordable to patients and good value for the taxpayers who fund it. Skilled GPs are the frontline of this healthcare system, providing the most high-value preventive healthcare and keeping thousands of us out of hospital every year.
So Medicare’s recent warning is a slap in the face for those of us trying to provide quality, whole-person care. Medicare should be rewarding GPs who spend time and care with patients seeking physical and psychological help – not punishing them. As Tim Senior recently wrote in the British Journal of General Practice: “These consultations are long and draining but they are the crucial, life-saving ones. They only come about because people can see us about anything, including ‘trivial’ things, and because we have the opportunity to develop trust over time.”
GPs who continue to do this work will have to increase patients’ out-of-pocket payments. And sadly, this hits my most vulnerable patients – fleeing domestic violence, struggling with rent, and battling mental illness – hardest. Most of my work is bulk-billing those who cannot afford to pay, but I cannot afford this if cuts to primary care continue.
My family, friends and patients often ask me about the difference between bulk-billing and mixed-billing practices. The answer is that with patients’ Medicare rebates neglected, even frozen by government for the last five years, all healthcare providers are feeling the pinch for essential services. Some practices are responding by increasing the volume of patients (and Medicare items billed) per hour. Others are passing on the difference to patients, in order to maintain quality care: this is the gap you pay at many practices.
Investment in primary care is an investment in our society’s health. It costs much less than, say, the highly specialised, privatised model of American healthcare. Having a trusted GP who gives you their time, expertise and care when you are sick, struggling or hurting, is an incredible asset. A good GP helps us understand and negotiate the complex web of illness and healthcare.
My patients don’t separate their physical and mental health problems. It is unfair to ask them to do so. Medicare must stop demanding it of us and fund us properly for whole-person care. Last year, I wrote about the need for a slow medicine revolution. GPs and patients responded positively, in hordes. Now I’m asking you to write to your local MP to enable us to do the work: demand better Medicare rebates, ask that Medicare reward doctors who care for the whole patient, and ask for better funding for GPs working with vulnerable patients.
I want to be able to talk to my patient about her broken bone, her bone density and her social and mental health. That’s my job. I’m her GP.
• Dr Mariam Tokhi is a general practitioner in Melbourne