11 February 2019

General medicine 3.0

Societal and technological evolutions change the general practitioner into a health coach. The medical specialist and nurse are getting closer the patient.

The aging society, the increase in chronic diseases, as well as technological developments such as digital patient contact and health monitoring at home have changed the role of the family doctor. On top of that, medical specialists are becoming more closely involved treating patients, as are specialized nurses.

To provide answers to these challenges, the General Practice Association of Hasselt and Happy Aging organised a debate about General medicine 3.0.

The central question was: what does the future hold for general practitioners? How can they make a positive contribution to the changing nature of their role in the current context? 

Around 40 doctors responded to the following questions.

Is the general practitioner still the central figure?

Yes. Doctors want to keep their central position in the healthcare system and patients want to have a central health professional. There is a demand amongst patients for general practitioners to play the role of this central figure and for their Global Medical File to be managed in one place. So they can count on an integrated explanation of their health condition.

In order to fulfil this role, general practitioners also have a coordinating function, which presupposes good communication and sufficient remuneration. Multidisciplinary cooperation is required, while doctors retain responsibility for the medical aspects of patient care. There are cases in which this process goes well, but there are also cases where doctors lose track of the patient’s care programme.

Do doctors work better independently or under the same roof?

Working together with a fixed group of primary health professionals is the trend. Doctors agree that a patient’s freedom takes precedence. That is not only the case when it comes to choosing one’s doctor but also physical therapists, speech therapists and other primary care specialists. The choice for caretakers is usually made based on past experience and not necessarily on their proximity to the medical practice.

Will patients be bound to one doctor or practice?

In the future, patients will be more bound to a particular medical practice, with a preference for a specific doctor. Regular consultations with members of the medical practice will be necessary and one doctor will bear the ultimate responsibility for each individual file. Medical specialisation within the same medical practice is useful and allows swift internal referrals.

What are the possibilities for virtual contact with patients?

While digital communication has taken on an important place in our society, this is really not the case within the walls of consultation rooms. One reason is the GDPR rules concerning privacy and data protection. The lack of a clear legal framework for data protection rules out consulting patients via e-mail. Virtual contact can be useful, but it cannot be enforceable. The patient should literally ‘be seen’, according to the doctors’ motto. Moreover, doctors have ascertained that patients have difficulties really appreciating virtual consultations.

However, doctors favour the possibilities that virtual contacts have to offer, as long as there is a good technical and administrative support system. At that point, doctors can take on the role of coach and health advisor. When doctors have a gut feeling that something is wrong, a normal consultation should follow. Also, virtual contacts should be reimbursed as any other consultation.

What is the place of general practitioners amongst specialised nurses and medical specialists?

Family doctors know their boundaries when it comes to specialisation, but they also wish to be the central point of contact for their patients and to be involved in the overall health journey. Currently, many doctors are too busy and need to delegate some of these tasks. They should be careful to maintain their role as coaches and coordinators and should organise themselves individually and as a professional group. Doctors need to think about which tasks they want to hold on to.

Do family doctors need to delegate technical interventions?

It goes without saying that simple and technical interventions can be delegated to nurses. Although this is common practice in countries such as The Netherlands, there is no compensation system for tasks not performed by the family doctor. Moreover, these interventions do permit variations and doctors see them as an opportunity for clinical observation or an informal moment with the patient. Obviously, doctors have their own individual preferences in this regard.

Should doctors be paid a fixed amount or one that is tied to performance?

A balanced distribution is negotiable, but difficult to determine. The fixed remuneration is a good system because it compensates doctors for tasks they used to do for free. It is open to debate which tasks will be compensated by a fixed amount. Nevertheless, professional associations are well aware of the pitfalls of fixed fees. For example, tensions could emerge between collaborating doctors when individual activities are no longer reimbursed.

On the other hand, tying remuneration to performance has the potential to lead to greater patient satisfaction. Furthermore, there is a risk of overconsumption of care by patients when remuneration is no longer tied to performance.

How do general practitioners find the balance between professional and private life?

General practitioners typically work long and irregular hours, which has an impact on self-care and private life. Shared medical practices offer doctors the possibility to find a balance between their work and private life, with a better standard of living in exchange for the financial cost.

With regard to weekends, doctors look to the United Kingdom where doctors work an a roster system. The doctor on call only works during the weekend, without being tied to a specific medical practice or group of patients. 

This article was created through the collaboration and partnership between ING and Happy Aging.

Happy Aging als facilitator

Happy Aging stimulates entrepreneurship in healthcare (for the elderly). An extensive network of companies, healthcare organisations, institutions of knowledge, policy organisations and citizens are involved in sustainable innovation in the field. In the unique living laboratory, Happy Aging targets the final user: the elderly, caregivers and health professionals. They give feedback about their needs, wishes and limitations and test innovative products and services. In this context, Happy Aging organised a debate in collaboration with general practitioners from the Limburg region. The answers to the questions are a summary of the responses given during the debate.