It’s taken a little while for me to collect my thoughts on this one. Initially there was a little flash of anger, frustration and a good deal of huffing and puffing when I heard about the RACGP guidelines recommending GPs say no to any requests from naturopaths for further investigation of their shared patients… but I’m over that now. In an interview on 702 ABC Sydney radio last week, Stephen Eddy, the vice president of ATMS, responded to these guidelines by suggesting that a blanket directive for GPs to ignore all requests from all naturopaths about all testing didn’t really sound sensible or appropriate. Here here! Surely, in the pursuit of evidence based medicine and discerning practice decisions, each case should be considered on an individual basis. I think Stephen Eddy gives GPs more credit for being able to make these judgements than their own association!
What will this change for all the caring, clever, collaborative naturopaths working out there in shared care situations with GPs? Hopefully not much.
The reality is that most of us are well-known and well-regarded by the doctors we regularly share care with. We ultimately defer to their judgement about whether an investigation is warranted under a subsidy and are respectful of their position, their accountability for requesting those tests and in line with this, present a strong rationale for the merit of any investigation. Many of the GPs I work with are often grateful for input on this level having seen the success of this approach. An honest GP will be the first to tell you, the subtleties of pathology testing and interpretation beyond anything drastically outside of the reference range is not something that was given a lot of attention in their training. For those practitioners who have taken the time to become better educated in this area – this offers a great opportunity for sharing our strengths and learning from one another.
What if you’re new to practice or haven’t yet identified and established that network of collaborative GPs? What will this mean for you?
Is referral letter writing and shared care a thing of the past? I hope not, for our patients sake, because therein lies the best patient outcomes. Making contact and connections with individual doctors who are independent in their decision making and take a more open-minded approach is still an option. You need to establish yourself as a practitioner who only requests investigations with a solid rationale and has a good background understanding and this can be conveyed either in person or via a series of positive shared care interactions.
One of my favourite GPs to work with says, ‘I’m not an integrative GP, I just don’t know everything you know! and a well-known psychiatrist I’ve worked with is renowned for saying, “I’m a doctor, therefore I’m a scientist and a scientist can’t only look at some of the evidence!’ If only the RACGP could embrace some of this humility and open-mindedness
The other option that is fast emerging is of course that we order the tests directly from the same pathology companies the GPs use and, as you may be aware, these companies are starting to come to us keen to open up direct access. This is fast becoming a competitive market and we are in a good position to benefit from this with cost competitiveness now being an issue. Laverty pathology in NSW are a great example of this – they want your business! They are setting up direct accounts with pathology referral forms, online results access, specimen jars…you name it and are offering the tests at the same price Medicare pays them! (which, by the way, is significantly cheaper than those ‘naturopathic’ pathology companies can offer the same services). Watch this space for more developments and if your local pathology providers haven’t approached you yet then give them a call and ask what they can offer you and your clients.
In spite of these developments I still think to make all our patient testing a user-pays system where results only come to you and aren’t automatically shared with the other practitioners working with the patient is not the ideal. I’m all for collaboration and each health professional bringing to the table our individual strengths and areas of knowledge.
Given we still have a situation in Australia where for example, thyroid function tests indicative of hypothyroidism (or even just a raised TSH according to Professor Eastman, Australia’s recognised medical authority on iodine) does not automatically prompt GPs to investigate the client’s iodine status to rule this simple nutritional cause out, in spite of a documented high prevalence of iodine deficiency in Australia… well I think we’re still in a good position to make some suggestions. No?