We thoroughly enjoyed having ‘GP extraordinaire’ Dr Kirsten Meisinger, MD visit our practice all the way from the Cambridge Health Alliance in Boston, USA. Great conversations about teams and value-based care, leadership and growth. So much fun and wisdom, thank you Kirsten!
Jas and Gurleen also got to spend time with the team at Hills Family General Practice, exciting to see what they’re up to and great to be able to participate in shared learning opportunities with our wider community of practice!
One thing that our team at Rosedale Medical Practice believes in strongly is that we should never stop learning. We believe that our approach to shared learning puts us in a great position to better serve our patients and our community.
At the Health Literacy Hub and Consumer Enablement Guide Launch in Parramatta today.
Good to sit amidst my colleagues from WentWest, Western Sydney Local Health District, NSW ACI, NSW CEC and ACSQHC.
Great speakers from Australia, UK and the USA, lots to learn and some very practical solutions to address the issue.
Range of key slides below from defining the scope of the problem to addressing issues across the medical neighbourhood.
1. Poor health literacy is common
60% of adult Australians have poor health literacy and struggle with tasks such as locating information on a bottle of medicine.
2. Poor health literacy is linked to multiple long-term health effects
3. We must create health literate systems
Health literate systems rely on increasing the skills and confidence of consumers, as well as reducing the complexity of communication.
4. Solutions can be quite simple
Simple solutions – Teach back simple and easy to implement, immediately effective; Improve readability;
5. Co-design relies on a bottom-up approach
Adopt a bottom-up approach backed by top-down commitment to systems change. Understand, listen to, and work with the nest in order to “look after the nest”
6. Consumer and clinician enablement vital
Shared decision making via evidence-based medicine and patient-centred communication skills leads to optimal patient care
7. Invest in general practice and primary care
87% of population see a GP at least once a year and less than 1% of population do not have a GP. Success hindered by change in complex heath behaviours, genetic and physiological risks as well as multiplicity of information and pathways
8. Align with quadruple aim
Achieve consistency by working towards common goals – align with quadruple aim
A pleasure to host the final GP Leaders Dinner for the year on Wednesday at El-Phoenician Restaurant in Parramatta.
The WSyd GP Leaders Dinner continues to be an incredible forum for collaboration and shared learnings. A diverse range of topics.
1) Social media and podcasts;
2) Consumer-clinician collaboration through The King’s Fund Collaborative Pairs model – brought to Australia by Consumers Health Forum of Australia and delivered in partnership with Primary Health Networks; to
3) Measuring and publishing measures of high-performing primary care in Australia
Great to spend the evening with my passionate colleagues and hear a diverse range of perspectives, united by a common thread of delivering exceptional care to the community.
WentWest Ltd and our partners have embraced the concepts of the Patient-Centred Medical Home and our GP Leaders are leading the nation in implementing the principles of person-centred, comprehensive, coordinated, accessible and evidence-based interdisciplinary primary care.
Feature profile originally published by the Australian Medical Association in the NSW Doctor magazine.
‘As a general practitioner and Clinical Director of Governance for WentWest, Dr Jaspreet Saini has a multi-focal perspective on primary care.’
It was the last leg of their family vacation in India. Dr Jaspreet Saini’s family was travelling from Punjab to Delhi, where they planned to fly back to Australia. His parents had hired a private driver to take them the almost 400 kilometres to the airport. Two-thirds of the way through the trip, the driver had a micro-sleep at the wheel.
Drifting into the oncoming lane, the hired car collided with a truck, which nearly forced their 4-wheel-drive off the bridge and into – what would have been certain death – the water below.
Dr Saini, who was only 10 years old at the time, was sitting in the backseat playing cards with his little sister. Remarkably, his parents and his sister were relatively unscathed by the accident. Dr Saini however, was not. During the horrific crash a metal pole came flying through the front windshield of the car striking him in the middle of the face.
His family rushed him to a local public hospital. It had no electricity. The medical staff were going to do a quick clean and a few stitches, using unsterile equipment and in bad lighting conditions.
Fortunately, a taxi driver offered to take them free of charge to a nearby private hospital. The difference between the two facilities cannot be overstated. In addition to being a clean and modern environment, the facility employed a plastic surgeon with 25 years’ experience. The doctor ended up doing 32 stitches across his eyebrows and nose.
The experience had a profound effect on Dr Saini.
“That showed to me the potential that existed within medicine to be able to help people when they are at their most vulnerable and that really touched me and inspired me to pursue a career in medicine,” said Dr Saini, who – two decades later – now works as a general practitioner in Blacktown
Despite pointing out evidence to the contrary, Dr Saini insists he was lucky.
“It could have been a lot worse. Everything was stacked against us in terms of where the accident occurred. It was a 4-wheel drive against a truck and both going at reasonably high speeds,” he said. “In the grand scheme of things we were very fortunate that my parents and sister were ok and really it was just a metal pole and I was able to be operated on by a good surgeon.”
It’s that same glass half full optimism that makes Dr Saini a good doctor – his ability to turn what some might view as a negative experience into a character building moment.
He describes his years as a medical student as being hugely challenging – not so much in terms of learning the volumes of material (that’s a given), but the feeling of isolation from his family and friends.
“It was very, very tough. I was basically learning how to be an adult. I was 17 at the time I started med school – 17, young, naive, impressionable, going into a new city and basically learning everything from scratch.”
Dr Saini was born in India, but moved to Australia when he was two years old. Since then, he’s called Blacktown home for most of his life.
His parents, which he speaks of with incredible fondness, first lived in a block of units, before moving to a small house, and then eventually trading up to the bigger house they live in today. While his parents weren’t particularly well off, Dr Saini says they prioritised the education of their children.
“Essentially, they left no stone unturned to make sure my sister and I received an education that would help enable us to achieve what we wanted to achieve. Mum and Dad worked very hard to try and support us. We got the bare basics and that was about it. But what we did get as a luxury was education.”
So when he left home in 2006 to go to medical school at Monash University in Melbourne, it was a decision his family supported, but one that separated him for his close-knit community and support network.
“It was definitely a challenge. I lived out of a suitcase for much of university, because there were some years there that I would have to move every six weeks from one place to another.” Dr Saini spent a lot of time in country Victoria. He recalls one particular stint in Moe, Victoria – a mining and farming town of about 15,000 people. His student accommodation was about a kilometre from the next closest living soul. The funeral parlour, however, was right across the street. The funeral parlour was actually connected to the local hospital via an underground tunnel, which was used as a direct means of transporting bodies.
“It was absolutely spooky. I did have a housemate at the time, but she would go and visit her family on the weekends, so on the weekends it was just me completely alone. Where I’m from in India, we have these preconceptions that it’s going to be haunted and that was a very frightening experience to be around a funeral parlour.”
He jokes lightly about his fear of ghosts, but what was real was the loneliness he felt at this time.
“It taught me a lot about being a human. It taught me emotions, it taught me what it means to be isolated and what it means to be anxious and depressed. And as a doctor now, it was really such an important life lesson, in order to be able to understand that and to really understand where patients are coming from when they come talk to me as well.”
Upon graduation, Dr Saini was accepted into an internship at Blacktown Hospital. The homecoming couldn’t have come at a better time.
“Internship is really, for all doctors, an incredibly challenging experience, so being around family at that time was so necessary for me.”
His interest wavered between anaesthetics, surgery and paediatrics, which made choosing a specialty pathway very difficult. However, in general practice he saw an opportunity to do a little bit of everything he enjoyed. It also gave him a chance to build relationships with patients and follow them along their journeys through life.
Anyone who has had even the slightest interaction with Dr Saini will realise this is what’s called “playing to one’s strengths”.
Dr Saini exudes a warmth that cannot be taught in medical school. Soft-spoken and affable, he’s immediately likeable and it’s easy to see why he’s so well-suited to this specialty.
He credits Dr Michael Crampton for providing a blueprint to being the kind of doctor he wanted to be.
“I had the opportunity to work with him at his practice, which was one of the most amazing experiences I’ve ever had. I had met a man who was very passionate and caring to his patients, who knew his patients very well, but beyond that his patients knew him very well. He was the epitome of someone who knew how to build relationships and rapport with people. And when I compared my experiences with my colleagues I realised how absolutely fortunate I was to start off my career in general practice with someone I respected so much.
“He showed me what general practice can be if you’re doing it correctly. And I think he’s the one who really cemented my desire to be a good GP.”
Dr Saini also credits Adjunct A/Prof Walter Kmet, the CEO of WentWest, as being another major influence professionally.
“He provided me with an opportunity to work within an organisation that looks at how we can do things better in health.”
In terms of his personal life, he pays homage to his wife, Gurleen.
“She is such a tremendous support for me, and incredibly patient in the face of odd hours, meetings that go till late in the evening, and work/study that can often stretch into our personal lives.”
In addition to working at The Practice in Blacktown (yes, that’s name of medical centre where Dr Saini works), he spends two days a week as the Director of Clinical Governance for WentWest.
WentWest is the primary health network for the western Sydney community. Its remit is to deliver support and education to primary care and work with key partners to improve the region’s health system. In addition to overseeing the safety, risk and accountability of programs being delivered, Dr Saini looks at ways to increase the quality of those activities.
He also looks at how WentWest can engage GPs in practice transformation, as well as the means of delivering education in the community and whether that involves GPs, nurses or allied health members. These activities are conducted with input from the clinical council, which is composed of members of various health professions within primary care, as well as a consumer council.
“It’s definitely rewarding. The opportunity to roll out programs on a regional level and provide regional leadership is quite crucial because it means we can start forming strong relationships with people who are actually operating on the ground and making things work. We’ve got some practices that are quite heavily involved in the Health Care Home trials and been trying to genuinely make a difference in the way they care for patients and to go out into practices, see what they’re doing, see what the challenges and barriers are and support some of those activities is actually quite outstanding.”
According to Dr Saini, the biggest problem in delivering healthcare at the moment is fragmentation. Medical practitioners continue to work in silos, rather than a functional and collaborative system. The other major failure is lack of data.
“In an ideal future, healthcare teams will have a good understanding of their patient population. They’ll have access to data, they’ll have access to information that will help them make decisions and work with the people that they serve to make those decisions. We’ll have patients that are able to look at data in a very transparent manner and help them navigate a system that is friendlier and designed around them, rather than it being designed for the doctors.”
Being able to balance his own practice work with his work at WentWest gives Dr Saini both a close-up view of the day-to-day challenges of being a GP, as well as a long view on primary care and the opportunities that exist to make it better.
“When you work in a traditional general practice facility, you’re trying your absolute best to keep the boat afloat, so to speak, and just make sure that you’re operating at a safe and competent manner, where you’re putting your patients first.
“But you don’t really get to experience anything that changes the dynamic of general practice or start looking at how we can work better with our specialist colleagues in hospital, or how we can start working better with our allied health colleagues – there just isn’t that opportunity. So, having two days to just think about those things, to contribute ideas, to learn from others and having a bit of head space where you’re not just looking after patients, but actually starting to think about ways you can better do that is just an amazing thing to be able to do.”
“The most important question you can ever ask is if the world is a friendly place.”
For if we decide that the universe is an unfriendly place, then we will use our technology, our scientific discoveries and our natural resources to achieve safety and power by creating bigger walls to keep out the unfriendliness and bigger weapons to destroy all that which is unfriendly and I believe that we are getting to a place where technology is powerful enough that we may either completely isolate or destroy ourselves as well in this process.
If we decide that the universe is neither friendly nor unfriendly and that God is essentially ‘playing dice with the universe’, then we are simply victims to the random toss of the dice and our lives have no real purpose or meaning.
But if we decide that the universe is a friendly place, then we will use our technology, our scientific discoveries and our natural resources to create tools and models for understanding that universe. Because power and safety will come through understanding its workings and its motives.”
• Sleep apnoea can occur at any age and is the most common type of sleep apnoea
• If you have sleep apnoea, your breathing during sleep may reduce or stop
• You may not know that this is happening
• Sleep apnoea can have many health complications
• It can be successfully treated
• Treatment will improve the quality of your life
What is sleep apnoea?
Obstructive sleep apnoea is the most common type of sleep apnoea. The other type of sleep apnoea is central sleep apnoea, which is rare. For ease of reading, we will refer to obstructive sleep apnoea simply as sleep apnoea in this article.
With sleep apnoea, you may breathe less or stop breathing during sleep for a short period of time. This is called an apnoeic episode. When this happens, your oxygen levels drop until they reach a point where they trigger your reflexes to wake you up briefly and start breathing again. This can happen many times at night and you may not know that it is happening.
We call it obstructive sleep apnoea because it occurs due to obstruction of your airways. That is, the area between the nose or mouth or lungs becomes partly or fully blocked. This is more common in sleep because your airway muscles naturally relax when you sleep.
Sleep apnoea can be treated and there are a number of treatments available.
What are the symptoms of sleep apnoea?
You may have sleep apnoea if you:
• Toss and turn at night
• Stop breathing through the night
• Wake up during the night coughing and choking
• Wake up not feeling refreshed
• Wake up with a headache in the morning
• Feel sleepy during the day
• Feel depressed, short-tempered or grumpy
• Have trouble with your concentration or memory during the day
You may not be aware of these symptoms so it is often worth asking your sleeping partner if she or he has noticed any of these changes.
What issues do people with sleep apnoea have?
Sleep apnoea can cause an early death. People with sleep apnoea are more likely to have cardiovascular (heart and blood vessel) disease compared to people that don’t havesleep apnoea.
Sleep apnoea can cause your blood pressure to go up and down at night, and increase your blood pressure during the day (this is called hypertension). If you have sleep apnoea and are also also overweight, you may be at higher risk of diabetes and high cholesterol. Together, these factors can increase your risk of having a heart attack or stroke. Luckily, if your sleep apnoea is effectively treated, you can improve your health and reduce your risk of these conditions.
Am I at risk?
Sleep apnoea can affect people of all ages, be it children or adults.
In children, sleep apnoea is more likely if a child has largetonsils or adenoids. Children can also have narrow airways due to other reasons which can increase their risk of having sleep apnoea.
In adults, sleep apnoea is more common in middle age. It ismore common if you are a man. If you are a woman, your risk increases after menopause.
You may be at higher risk if:
1) You are a middle-aged male
2) You take alcohol, sleeping tablets or some types of medications before you sleep
3) You have a blocked nose, small jaw, large tongue, big tonsils or big uvula
4) You were born with a narrow airway or have a facestructure that leads to narrow airways
How do I know if I have sleep apnoea?
You should speak to your doctor (GP) if you are worried.
Your doctor may ask you about snoring, obesity, apnoea episodes and sleepiness during the day. It can be helpful to take your sleeping partner with you on the day of your appointment. The next step is usually an overnight sleep study, which measures your sleep, breathing and oxygen levels. This can be done at home or in a sleep clinic, and is usually done with the assistance of a sleep specialist.
What is the treatment for sleep apnoea?
If you have sleep apnoea, there are many things that you can do to manage your condition and improve your health.
If you are overweight, weight loss can be very helpful and a small decrease in your weight can greatly improve your sleep apnoea.
A CPAP (Continuous Positive Airway Pressure) mask is the most common form of treatment, and works by delivering air through your nose to keep your airways open. Many people find using a CPAP machine strange at first, however are often surprised by the improvement in their daily lives.
Other useful strategies include:
• Avoiding alcohol within 2 hours of going to sleep
• Avoiding sleeping tablets
• Speaking to your doctor about other medications that you are taking
• Treating nasal congestion
• Ceasing or maintaining abstinence from smoking
For some people with sleep apnoea, surgery may be an option. You should speak with your GP about the treatments that are most suitable for you.
Owning your own smartphone or tablet is now the new normal for Australian children, new research released today shows.
The latest Australian Child Health Poll has found that almost all Australian teenagers, two- thirds of primary school-aged children and one-third of pre-schoolers now own their own tablet or smartphone.
As well as owning their own device, three in four teenagers, and one in six primary school-aged children, have their own social media accounts.
The minimum age restriction on most social media platforms is 13.
The Director of the Australian Child Health Poll, paediatrician Dr Anthea Rhodes said one of the most significant findings, that directly affected children’s health, was the impact of screen use at bedtime on sleep.
“Almost half of children regularly use screen-based devices at bedtime, with one in four children reporting sleep problems as a result. Teenagers using screens routinely at bedtime were also more likely to report experiencing online bullying. It’s best to have no screen-time an hour before bed and keep screens out of the bedroom, to ensure a better quality of sleep,” she said.
The poll also reveals that 50 per cent of toddlers and pre-schoolers are using a screen-based device without supervision. “The demands of the modern lifestyle mean a lot of parents are busy, so they use screen use as a digital babysitter. We found that 85 per cent of parents of young children say they use screens to occupy their kids so they can get things done.” Dr Rhodes said.
“There is little evidence to support the idea that screen use benefits the development of infants and toddlers, but physical playtime and face-to-face contact is proven to be critical to a child’s development. If you do offer screen time to your young child, it’s better if you watch it with them, so you can talk together about what they are seeing and help children to learn from the experience.”
When it comes to what’s happening in Australian households, Dr Rhodes said that many families are experiencing conflict over screen use and that a lack of physical activity and excessive use are big concerns to parents.
Dr Rhodes adds that the poll identified a link between parents’ screen use and their children’s use of screens.
“A strong relationship was seen between parents’ screen use and that of their children. Basically, a parent who has high levels of screen use is more likely to have a child with high levels of use. Three quarters of parents of children under six also said they do not put time limits on screen use.
However, most parents told us that they do try to limit their children’s screen use but are not sure how to do this effectively,” she said.
The current Australian guidelines for screen use in children were last updated in 2014, but Dr Rhodes says new guidelines may go some way in helping parents with their children’s screen use.
“These were developed before the widespread use of mobile screen devices. Up-to-date guidelines and resources for parents, and healthcare workers, would give parents a base for developing healthy habits when it comes to screen use,” she said.
The Australian Child Health Poll overall key findings include;
The majority of Australian children, across all age groups, are exceeding the current national recommended guidelines for screen time
Three quarters of parents of children under six do not put time limits on screen use.
Eighty-five per cent of parents of young children (aged less than 6 years) said they used screen-based devices to occupy their kids so they could get things done with one in four doing this every day of the week.
Teenagers spend the most amount of time on a screen-based device at home, of any age group, at almost 44 hours on average per week – more than the time equivalent of a full time job. Parents averaged almost 40 hours per week.
Younger children also spend a significant time using screens at home; infants and toddlers averaged 14 hours, the two to five year-olds 26 hours, and the six to 12-year age group averaged 32 hours per week.
Note: A screen-based device in this poll was defined as a television, computer, laptop, gaming console, iPhone, smartphone, iPad and other tablet.
The seventh Australian Child Health Poll is a survey of a nationally representative sample of 1977 adults aged 18 years and old. Collectively respondents had a total of 3797 children. They survey is conducted by an independent research agency on behalf of The Royal Children’s Hospital, Melbourne. Each sample is subsequently weighted to reflect the latest Australian population figures from the Australian Bureau of Statistics census data.