Keeping up with medicine is made easier when we share clinical stories with our colleagues. On this page we share brief learnings and articles that have interested our GP liaison team during the month of April. If you come across an article, video or resource you think clinical and management teams should know about, send it to email@example.com.
I have been worried for a long time about the level of financial literacy in general practices. The fact I still have a working practice, which is paying a regular dividend to shareholders after 26 years, is mostly due to luck.
I bought the Church Street Surgery when I was 29 years old. I was a husband, a father of three small kids (we now have five), I had completed my training in general practice in a different country, and spent the previous two years in yet another country.
I had been given absolutely no financial advice since being a medical student when my bank manager seemed more than happy for me to crank up a loan - for a reason which became clear once I started paying it back.
I had been given no training in running a business, from a financial or human resources perspective. Yet, here I was, ready to ask for another loan from another bank manager for a five figure sum to buy "goodwill" a bed, desk, chair, and a share in a telephone and computer system.
I looked at the business through the lens of the accountant recommended to me by the GP selling the practice. I agreed to a two week turnaround to make a legal commitment. I agreed not to talk to anyone about it, not even the other GP working in the practice. I was a little surprised, but not alarmed to find there were two set of books - the ones the tax man saw and the "other" set. Suffice to say, my financial literacy was negligible, I knew nothing of what I was letting myself in for, but I have enjoyed the ride.
I suspect most GPs learn our business management skills "on the fly" - for me from a newsletter I subscribed to that came every few weeks, containing updates on legislation changes, tips for managing cashflow, and helpful aphorisms like "money doesn't grow on trees" and "look after the pennies and the pounds will look after themselves." I also bought and read a book called 'Running a small business in New Zealand' and after a few more years the 'DK book of business management' which had lots of great pictures in it.
I relied on a practice manager who was chosen on the basis she was the longest serving receptionist. My wife's "job" for a few years was to cash up the packets of cash I brought home once a week and take them to the bank. We understood the temptation to simply put the cash into an old terrarium in the centre of the dining table, as my predecessor had succumbed to.
But we didn't do that. I slowly worked my way through the dubious claims processes embedded in the culture of the practice, and slowly realised where all the money in the second set of books came from.
We were visited by our accountant one of those early years. A home visit, he knocked on the door carrying wine and chocolates. It was not good news. I know I am not alone.
As I became more involved in local advocacy for my community, health politics and governance of health organisations, I started to get exposed to proper profit and loss statements, and eventually took an Institute of Directors course on understanding financial papers, then did a five day company director course - which was brilliant, but a little time ago.
I recently attended the session 'Planning for your financial success' at the National Rural Health Conference because I thought it might be useful for me to refresh my knowledge, and also pick up some tips and tricks I could pass on to colleagues. The session was sparsely attended (but not too bad for that time of the day when people were still trying to work out where 'gallery three' was). The content was really pitched at individual financial sustainability and retirement planning, which was not what I'd hoped for, and as it turned out, f!@#'ing scary.
The Medical Financial Advisers who were presenting the session did well. There was a little bit of sales and marketing going on, but a forgivable level. They talked about planning, regular review, about regular saving and appropriate insurance, about various investment options, expectations and risks. They presented a tool for financial planning they have developed which can put your potential planned savings through an historical financial crisis, so you can get an idea of what would happen if just at the time you needed your money out, some Bernie Madoff (how's that for nominative determinism by the way...) did the dirty and banks went belly up.
I also connected in the exhibition hall with William Buck Chartered Accountants and Advisors who told me someone from Pinnacle had approached them and asked them to do some tailored financial literacy for GPs - they provide webinars for offline training as well as face to face training advice.
This made me think that perhaps all my harping on about it had been heard, or maybe I was just saying what everyone already knows: you can't have sustainable general practice in the absence of an understanding of how to run a business.
In addition the conference session reminded me that your own personal life is less stressful if you have a personal financial plan, and at the very least understand budgeting.
I recently attended the national rural health conference in Auckland and amongst the many gems I attended a session called O matou whakaaro: What wahine Māori (Māori women) think about smoking and trying to quit - presented by Lynne Russell from the Health Promotion Agency.
Lynne reported on a qualitative research study into the attitudes and beliefs of Māori women about smoking and smoking cessation.
It was brilliantly presented and had a lot more material than time to deliver it. The specific learning that might help deliver a higher proportion of Māori women stopping smoking than we currently do was......it's difficult! Which wasn't really a surprise because if it was easy, we'd be doing it.
Lynne suggests it starts with listening to the women, starting from where they are at, and she tells us it concludes with engaging with the whole whānau.
The study suggested we should reduce approaches that induce shame or fear - as a response to these emotions is defensiveness and disbelief. We also need to learn from the lack of trust that flows on from when, as a trusted health professional, we say thinks like "if you smoke your baby will be small and weak." When the hapu mama ends up having a 9.5kg monster and a 3rd degree episiotomy wound, this has an effect on her and her whānau's level of trust in the advice of health professionals for a long time afterwards.
It was interesting that being able to afford tobacco and still feed a family can be a source of pride. The idea being the harder "they" make it, the harder some Māori women try to make it happen - the belief being "a good mama can still afford the fags and still feed the mokopuna".
An oldie but a goodie, The Passions of the Mind by Irving Stone is a fascinating biography of Sigmund Freud and the evolution of psychoanalysis, with an insight into general medical practice at the time and the Viennese lifestyle in the second half of the 19th century and into the 20th century. A great holiday read!