General practitioners (GPs) play a key role in the provision of health care to Australians and they are often the first point of contact for people with a health concern. Accessing allied, specialist and other health services usually requires a referral by a GP. GPs care for patients of all ages and deal with all kinds of health conditions. In partnership with other primary health care professionals, they provide health advice, screening, treatment and health promotion services.
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Access
GPs who specialise in mental health
Negotiating better care from GPs
Good relationships and finding the ‘right’ GP
GPs were an important part of the care received by the people we spoke to, in relation to both their physical and mental health. The main reasons people gave for consulting a GP were to discuss their health concerns, to access mental health services including psychologists or psychiatrists, and to review their medication or obtain repeat prescriptions. Most people reported overall positive experiences with GPs, although some reported having negative encounters.
When talking about their interactions with GPs, people spoke about access, the challenges of finding the ‘right’ GP, including one who specialised in mental health, and the importance of a ‘good’ relationship with their GP.
Evan has been seeing his GP for over 20 years and considers him a good support.
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The one that I’m having now I’ve had for maybe 20 years or more. He’s a friend of mine, a good friend of mine now, rather than a practitioner. Calls me his best patient. Isn’t that cute! Anyway that’s what he calls me.
You know, I’ll tell you why he calls me his best patient, he said, “Evan,” he goes, “you seem to come in here and you ask the right questions. You know I get patients coming in here, they don’t ask any questions, they’re not interested, they’re not, they don’t know where to go. They don’t know, they don’t want to get better. Whereas you have a curious mind”, he said, “and you ask the right questions and I’m happy to answer them for you ’cause I know that that’s how you’re going get better”.
I just ask him you know, questions like, “Is this medication going work better in a week’s time”? “In two weeks’ time”? Or, “When is it going work better?” Or, “Is it going work better like the other medication?” I ask him sort of curious questions that make me ponder upon my recovery and my wellness.
And he says they’re the right ones, yeah, so which is good for me. But I think it’s important that people just don’t walk into a practitioner’s room without not knowing, not having a plan in action, not having a plan of questions that they want to ask them. You know, because he’s there, he’s knowledgeable, make use of it you know. That’s what I see as a practitioner. He’s done a lot of schooling to be like that and he sees other people of the same nature. So he’ll be able to, he’s the best person to guide you.
Access
Most people we spoke to did not have any problems finding a GP, however a few people had experienced difficulties. Brendan discussed the challenges of living in a regional area with few GPs: ‘Where I go, you’ve got to wait at least an hour before you see someone. If you want to see the same doctor each time you’re probably going to have to wait even longer’. Ann and Vanessa also spoke about the costs associated with visiting a GP.
Ann had ‘the best GP in the world’, but sadly he died. Cost and trustworthiness were important in her search for a new GP.
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I had the best GP in the world and he passed away and that really upset me and set me back, so it took me a long time to find another GP that I trusted.
And again I work part time. I can’t afford to go to a doctor that doesn’t bulk bill, but my doctor doesn’t bulk bill so I have to make the time and make room in the budget to go and see her because I’ve spent so long now building up a relationship with her. I can’t swap and I wouldn’t swap, she’s great. But, I don’t know, I mean I would recommend my doctor to anybody, but I don’t know how to…
I wouldn’t know how to start again and find another doctor because even the clinic I go to which is just down the road, if I can’t see her I’ve asked to speak to someone, have an appointment with a doctor who’s good with mental health. And the last doctor I saw instead of her [laughs] insisted on checking my throat and I was just like, “”No, I don’t have a cold. I’ve got anxiety””. So it is hard. It is really hard. Some doctors don’t get it or don’t want to get it.
GPs who specialise in mental health
GPs who specialise in or have an interest in mental health were highly appreciated by many people. Several people commented that these GPs showed a greater understanding of mental health, were better able to differentiate mental from physical symptoms, and had a greater understanding of what it was like living with severe mental health problems. Many people described being able to build trusting relationships that enabled continuity of care with GPs who had specialised in mental health. Ann said she was able to receive appropriate care now that she has a GP who is ‘good with mental health’. In her experience, GPs without a mental health specialty ‘don’t get it or don’t want to get it’.
Charlie felt GPs who specialise in mental health were able to provide holistic, community-based care.
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Do you know what I like, which is really good, is the mentally… hang on, what’s the word for it – GPs that are trained to treat people with mental illness, the GPs themselves. And if you have a good relationship with your GP then it’s probably better than wandering in and out of mental health services.
Why is that?
Oh look, because you do go there with other issues as well, so it’s like a whole thing. And if it was really serious, you know, if it was me I’d get on to it and the GP would get on to it and then I would see a doctor or psychiatrist. But just going to see your GP, however long, it’s just better, it’s just better, it is community.
Negotiating better care from GPs
While most people had positive experiences with GPs, a few described disappointing encounters or negative aspects in their relationship with their GP. These were related to GPs’ reported poor communication skills, a lack of competence, or discomfort with working in mental health. Most people expected their GP to discuss their experience of living with a severe mental health problem with them and to feel comfortable in doing so. However, when Sarah’s GP was prescribing her antidepressants, she still felt as though she ‘wasn’t seeing anyone’ about her mental health, as her GP encouraged her to consult a specialist about it.
Cindy and Carlo both described how they felt that their mental and physical health complaints were not taken seriously by GPs and consequently felt they did not receive appropriate care. In turn this reduced the quality of their relationships with their GPs. Vanessa and Evan discovered that they needed to find out about the services they required themselves, then ask their GPs about them, because they did not automatically offer them. Simon was disappointed when he realised that his GP had referred him to a psychiatrist without mentioning his ‘major issue’ of depression. Most people were able to negotiate improvements in their care from GPs by either speaking directly to their GP or finding a new GP who they were able to build a relationship with.
Vanessa has a relationship of over 25 years with her GP. She described how she had to demand a care plan that had not been offered to her previously.
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I went to a medical clinic because I was teaching near one and when I came here I didn’t have a doctor and somebody recommended a lady doctor at the local clinic which was nearby. So I went there but I always seemed to get sick on a Wednesday and that was her day off. The guy who I see would say, “I’ll see her”, so I ended up seeing him and he said, “Are you coming to me or going to her””? And I said, “Well, it looks like I’m coming to you”, and we’ve been together for like 25 years or something now.
When I left school he had me going to him every 10 days. He gave me scripts for 15 milligram of [unclear] but it didn’t impact on me really. And I used to cry. And I used to just think he was ripping me off because I had no income and I was paying the proper, the proper prices but he really was keeping an eye on me and we get along pretty well. He’s pretty good to me really. I still go to him.
I did leave and went to another lady and she said, “I’ll only see you for one thing”. Well, I usually have three or four things on a list because I don’t want to waste their time and yeah so we get along pretty well, yeah.
I do have a pretty good arrangement with my doctor and other people told me about the care plan for my head. I was eligible for a care plan for my feet and things for 11 years before he’d give it to me and it was somebody in the public system when I went to get my feet done at the podiatry and she said if he didn’t give me a care plan she would ring him and give him a piece of her mind, so I told him, so he did.
When people felt particularly vulnerable or unwell, negotiating improved care from their GP could be difficult. Charlie described how she tries to remain ‘at a certain recovery level’ so she can have more input into decisions relating to her treatment and care.
Simon described an inappropriate specialist referral he received when he was in his early 20s from his GP.
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And the first GP that referred me to a psychiatrist, not only referred me without saying that he’d actually prescribed antidepressants for me. He said that I’d never had any problems with depression.
When was this?
When I was in my early 20s.
Okay, so was this the GP that you’d had growing up?
Yes.
And he had prescribed you antidepressant?
He’d prescribed me antidepressants, and then he referred me. Now I don’t know what he said in his referral, but in the letter back to him from the psychiatrist. There’s no mention of depression whatsoever, and yet that’s always been my major problem, depression.
So in that context with your GP, do you remember him telling you had depression?
No, he tried, I went to him for depression, he put me on antidepressants but when that particular one didn’t work, he never tried another one. And then when he referred me to a psychiatrist, it was not only without mention of the depression, but he also referred me to my sister-in-law’s psychiatrist. Which in private psychiatric history, I don’t know if it’s still the same, but they do try to avoid seeing two members of the one family.
Good relationships and finding the ‘right’ GP
Like Ann, many people discussed the general difficulty in finding a GP who was ‘good’ or ‘right’ for them. Several described consulting many different GPs before finding one with whom they felt they could develop a relationship. A few people described being in the early stage of building a relationship with a new GP, while several stated that they had seen the same GP for a long time, ranging from 10 years to over 25 years.
Chris said that when a ‘good’ GP comes his way, he gets very ‘clingy’.
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He’s honest, he’s friendly. He doesn’t ask too many questions. He goes straight to the point. He asks questions, “How’s your mental state?”, I say, “Good”. He leaves that there, he doesn’t probe. He doesn’t ask me question after question, you know? That’s the best part about it. He’s flexible. I get to see him. There’s no rotation of doctors. There’s no waiting an hour or so in a clinic waiting to be seen.
I’ve seen my doctor, GP, for over 10 years now. And he’s good. He’s a good GP. And when a good doctor comes my way, I get very, very clingy. I try to keep them as my professional doctor.
Many people commented that a good relationship with their GP was important for their mental health. A good relationship was a continuing one that featured a high level of comfort, trust and rapport. Valued traits of GPs were their flexibility, honesty, friendliness, empathy, advocacy skills, and communication skills. A couple of people mentioned that they appreciated their GPs asking them about their mood, while Chris respected his GP for ‘getting straight to the point and not asking too many questions’. Jenny’s GP had personal experiences of a relative diagnosed with schizophrenia, which Jenny felt enabled him to better understand her experience.
David felt that his GP had been a ‘really empowering’ part of his mental health journey.
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So you mentioned your GP again. So how long has that person been your GP?
Oh, probably 13 years. He’s been a fantastic advocate. Initially I saw him when I moved out of home. I just sought a local GP. My prior GP had moved into a rural area due to some government grant offering GPs a chance to move to a rural area. And he’s just been with me every step of the way. You know, just really supportive and we’ve developed quite a rapport over the years.
He’s been quite flexible and he does have a bit of a reputation as taking on complex cases. He’s often running late because people have different needs on different days and that’s just something I work into my time with him. I allow a certain amount of time for any consultation and I’ll always call up reception and just check to see how he’s going and whether the person before me has gone in yet. And, you know, just make my decision on what time to turn up based on what’s happening on that day. But he’s been a fantastic advocate for me.
He’s been really with me every step of the way offering alternatives, offering input, giving me options, giving me the power to make decisions. He’s been great. He’s been a really, really empowering part of the process in what otherwise could have been totally disempowering. I could have had someone who was very high-handed and just wanted me in and out. And, you know, just another patient, part of the numbers. I think I’m a real person with my doctor. I, yeah, I think he only has real people. [laughs]
