Redefining the role of GPs in primary healthcare by recognizing current trends

As the world continues to evolve, so too does the role of a GP. It is, thus, important to recognize changing trends and demographics to be able to provide the best and expected level of care to patients. Speaking at the 10th Malaysian Hybrid Conference on Healthy Ageing, Dr Thirunavukarasu Rajoo, explore the dynamics of GP practice and ways for GPs to stay relevant. While discussing the demographics and megatrends in Malaysia, Arasu said there are 8,340 GP clinics nationwide with 80 percent of these in urban and semi-urban areas—corresponding to the population dispersal of the country. Patients falling within the 19–60 age group make up 80 percent of the patients that GPs see. This broad age span poses a challenge when delivering care as patients born in different generations or decades have different expectations.  He added that 60 percent of patients are females and 70 percent are married. Women are generally influential in the decision-making processes of the household. The significance of being married is such that it allows for a GP to include the man’s wife to help in matters pertaining to the husband’s treatment. It is worth noting that 85 percent of patients seen at GP clinics have a degree, diploma, or secondary school education. This influences health-seeking behaviour and doctor-patient communication.

On the information technology infrastructure front, Malaysia has a broadband subscription of 38.45 million, which is a penetration rate of 121.1 percent. This means that most individuals will have some degree of access to information online.

Healthcare sees shift in paradigm

While patient-doctor relationships used to be heavily doctor-centric, with the doctor giving instructions and the patient merely nodding their heads in acquiesce, things have changed, said Arasu. “We have moved from doctor-centric to patient-centric care and it is no longer ‘what I said, you do’ but more along the lines of shared decision-making.” In that sense, the doctor provides patients with information and they both discuss the options, but the patient is the ultimate decision maker. 

Another change is the awareness of population health, where the health of an entire population (within a certain area) is monitored and treated as opposed to just an individual. GPs will also have to come to terms with digital health or digital therapeutics, including the wearables that will help monitor and personalize treatment to a higher degree. The healthcare of tomorrow is all about integration. Arasu said while GPs are still working in silos, both the government and private sector stakeholders are moving towards an arena where there is shared information between the two.

The most important factors that influence a patient’s decision to visit a doctor or clinic are:
1. Convenience, ease of access: availability of parking, access to other facilities, etc. 
2. Insurance coverage: ie, panel.
3. Doctor or nurses' conduct: how patients are treated.  
4. Brand reputation 
5. Quality of Care

 

What can GPs do to stay relevant?
Arasu listed a few things that GPs can do to remain relevant throughout their practice. The first is to be an advocate for good health across a patient’s lifespan. “Should you run your GP clinic for 30 to 40 years, you might see the patient and the patient’s succeeding generations. It is important to prioritize patient education on the significance and cost-effectiveness of prevention.” Patients must be taught that regular checkups at the GP clinic are a must and not just during periods of illness.

As our population grows older, Arasu urged GPs to be more inclusive in their mindset and to move away from unspoken ageism, which is prejudice against the older patients. While many older people may have lost their source of income or insurance coverage after retirement, GPs can include affordable care packages for the elderly that cover physical, cognitive, and psychological issues.

Arasu said GPs should encourage patient and carer involvement when negotiating healthcare plans to promote effective self-management. It is important for the GP to be an active listener, one who is attentive and understands what the patients are saying, respond and reflect on what’s being said, and retain the information for later.

Arasu also covered the need for GPs to acknowledge and integrate mental health conversations into consultations with older patients. GPs will need to be equipped with thorough knowledge on management options for mental health issues ie, prescription of psychotropics and other therapies. A GP is uniquely positioned to provide basic counselling and to pick up early signs of mental illness. Early detection of any disease, including mental disorders, will benefit the patient as treatment and preventive strategies can be put in place before their condition deteriorates.

GPs can also improve their utilization of digital health, a broad term that includes concepts from both technology and healthcare and covers mobile health, health information technology, wearable devices, telehealth and telemedicine, and personalized medicine. By exploiting the use of wearable devices and healthcare apps, doctors can improve their standard of care. Clinics can ideally implement a user-friendly online platform to schedule appointments, order regular prescriptions and perhaps even offer 24-hour healthcare assistance. In short, digitalization in healthcare brings about many benefits to both doctor and patient.