A recent foreboding article featured in NewsGP Pathology requests under the microscope warned, ‘More than 5000 GPs are about to receive a letter from the Department of Health about their pathology requests.’ This is a ritual cleanse performed by Department of Health (DoH) all in the name of fiscal prudence. They’re trying to weed out the ‘over-ordering outlier GPs’, who requested too many – wait for it – Iron Studies, B12, TFTs & Vitamin D tests between June 2019 and July 2021. That’s right, during a pandemic – when people were inside, locked down, had reduced food security and telehealth, as good as it is, removed clinical examination as an option!! Oh my…where do you start with this?😤

No. 1: 5.,000 GPs out of a workforce of 31,000, constitutes 15% so clearly NOT in any way correct to call them outliers!

No. 2: These so-called ‘nudge’ letters have arrived & sadly the recipients are not the ‘rogue doctors’, they’d perhaps hoped to catch but actually GPs who see more pregnant women, more refugees, more aged care residents.

And mostly female GPs – I might add 

Or said most eloquently, in this online piece, by Dr. Carrington: “Who are the pathology nudge letters really targeting? Judging from the response on social media, these letters seem to have been received largely by GPs who treat our most vulnerable and marginalised patients.” And don’t get me started on how much $$$ identifying and correcting said-deficiencies SAVES the health system in terms prevention.😤😤😤  Has anyone actually done the maths (aka cost benefit analysis)?! In short, no.  I am angry for my GP colleagues. This is sadly yet another example of the punitive system that they have to operate under and under which, as GOOD GPs pushing back against 5 minute medicine, they effectively have a target on their back.  And I am dismayed for our shared patients and the general public, for whom basic nutritional assessments (2 of which are well-established as the most common micronutrient deficiencies we encounter in general practice), it seems, are being deemed a poor use of tax-payer funds,  this DoH fear-mongering campaign is value for our money?!

Back to Dr. Carrington:
“Nudge letters are not harmless.

They inflict enormous anxiety and dread amongst GPs and inject a real sense of fear into clinical decision making. Many GPs are already feeling burnt out and are contemplating how to transition out of the profession. Trainee numbers are at a frighteningly low rate.
Targeting GPs in this way is inappropriate and discriminatory against those who practice high rates of women’s health, mental health and aged care.”

The biggest way we can help is accessing old results!! True. Many patients have a lot of lab results across multiple medical practices. Step one – see what they can retrieve and provide you with, such that you can pull it all together. This way: a) you know what has been assessed and when and avoid any doubling up & b) you extract maximal value from these by creating a cumulative & comparative dataset for your patient – being best placed then to ‘see their normal’ and be alert at the earliest possible time to any intra-individual shift – likely reflective of an emerging process that then c) WE CAN TAKE ACTION TO PREVENT FURTHER PATHOLOGY💪 And if you are going to write letter to a GP,  now more than ever this requires a clear understanding of the kinds of issues they face & a respectful & rational approach to communicating the merits of any follow-up investigations you might wish them to consider.

“Thank you so much for a wonderful presentation yesterday, Rachel. It gave me a new perspective on how it must feel as a GP to receive incessant demands from Naturopaths/Nutritionists to order pathology for their clients. I am in awe of your integrity, desire for patient empowerment, humility and respect for other professionals in the mainstream health arena. I felt that every single naturopath and nutritionist out in the big wide world ought to have listened to your insightful words of wisdom when it comes to shared care of our clients. We are blessed to have you as our teacher.”  – Michelle Blum (Mentee 2019) 

Want to learn more? Dear Doctor – Upskilling in Referral Writing & Interprofessional Communications