Put your advice to a litmus test: GPs urged to upskill with a taste of their own medicine

I would like to think the advice I give to patients is exactly the advice I would take myself if I had their conditions. But I’m increasingly concerned this is not true.

Maybe there is something about HealthPathways that makes me feel I have to be obedient and trust its wisdom – assuming wisdom and evidence are the same thing.

I have challenged myself recently by asking myself, “What would I do if I was this patient?” Amazingly often, the answer isn’t in HealthPathways at all.

So, here’s a test for my readers. Circle your answer to each question and total the circled numbers at the end.

Question 1

If you were having an acute painful attack of gout but were otherwise well, would you:

1. Take an NSAID with omeprazole?
2. Take colchicine?
3. Ask your GP mate what they would actually do if they were in your position?
4. Take prednisone?
5. Take prednisone and an NSAID and omeprazole if you remembered, and have colchicine at home if needed?

Question 2

If you had had two attacks of gout in 12 months and had a uric acid of 0.45mg but were otherwise well, would you:

1. Take allopurinol every day for the rest of your life?
2. Ask your rheumatologist mate what they would actually do if they were in your position?
3. Change your diet and stop drinking?
4. Wait and see, but demand a back-pocket script for an NSAID, prednisone and colchicine?

Question 3

If your blood pressure was 152/80 and your cardiovascular risk 2 per cent, would you:

1. Take bendrofluazide?
2. Take an ACE inhibitor?
3. Take an ARB?
4. Get seven days of 24-hour BP monitoring?
5. Ask your cardiologist mate what they would actually do if they were in your position?
6. Go salt free and switch to a full-on diet and exercise regime to lose 10kg?

Question 4

If you had newly diagnosed diabetes with a glycated HbA1c of 59, would you:

1. Take metformin?
2. Pay for empaglifozin?
3. Tell your GP you can’t take metformin due to IBS and get dulaglutide today?
4. Ask your endocrinologist mate what they would actually do if they were in your position?
5. Pay for a dietitian, start exercising, try to lose 10kg and recheck in three months.
6. Call Dr Glen about the keto diet because he says type 2 diabetes can be reversed and even though you are unsure of the evidence, you need some hope.

Score of 5

You are a fantastic GP who knows most of HealthPathways and delivers them methodically. I bet you have met all your performance targets.

Score of 5–10

You are also a great GP, with occasional left-field thinking which you ought to rein in because the Health and Disability Commissioner may look dimly on you if you have not followed HealthPathways exactly.

Score 10–15

You’re gonna need a lot of specialist mates to ask. Why don’t you just trust HealthPathways?

Score 16–20

You are a pretty good GP, possibly one of those old fellas that strays into their own opinion a bit too often. You need to read HealthPathways more.

Score of 21

You have serious cognitive dissonance. If you keep recommending treatments you don’t agree with, you will surely burn out or leave medicine soon.

I think I got top score in that test. First time I’ve ever been top of the class in medicine.

I love HealthPathways. Truly. Imagine trying to remember all the stuff in there.

But sometimes I want more information, for example, how many people with two attacks of gout end up with joint destruction? Is there 10-year data on the keto diet for diabetes? Is my specialist mate being honest about what they would do? What is the Number Needed to Treat for a blood pressure of 152/80?

To be honest, it seems strange that nearly all the advice these days is to start medicines earlier. There’s a lot of money in health prevention medications and it’s always good to ask whether Big Pharma is playing a hand in the evidence.

Preventive medicine is hard work. We are trying to get people who feel perfectly well to take up to five medications so they still feel good in 10 to 15 years. Really? I mean swallow those pills every single day, sometimes twice a day? And feel no better? It’s quite a hard idea to sell.

It works okay with patients who are obedient biomedical believers and trust their doctor, but not every patient is a believer.

Would we swallow those pills ourselves? Maybe, but perhaps not straight away.

Oh dear. My total cholesterol just came back at 7.

Whatever your score, I’d love you as my GP.

But I’m off to see one of those lifestyle medicine doctors.

Lucy O’Hagan is a medical educator and specialist GP working in the Wellington region