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INSTRUCTIONS FOR THE DOCTOR

This is a short viva.

Please answer the questions of a GP supervisor about your consultation with Sharon.

Scenario

Sharon, a 39-year-old Aboriginal woman who works in retail, has just moved to your area. She was seen by a colleague last week for some scripts and your colleague suggested Sharon book in for an Aboriginal adult health check.

The limited summary in her file is as follows:

  • Past medical history

  • Diabetes

  • Medications

  • Metformin XR 2 g daily

  • Sitagliptin 100 mg daily.

INSTRUCTIONS FOR THE FACILITATOR

The doctor is expected to talk with you as a professional colleague. During the viva please ensure you ask the following questions:

  1. Why is it important to identify Aboriginal and Torres Strait Islander patients in your practice?

  2. What would you do to check Sharon’s diabetes?

  3. Sharon has just moved interstate as a newly single parent. The cost of her diabetes medications is overwhelming. What could you do to assist?

  4. What other screening would be important for Sharon at this point?

  5. You realise the practice does not see many Aboriginal patients. How could you ensure your practice is culturally safe and welcoming to Aboriginal and Torres Strait Islander patients?

  6. What resources or guidelines might help you deliver the most appropriate care for Sharon?

image CASE COMMENTARY

  1. Identifying Aboriginal and Torres Strait Islander patients is important for many reasons, including:

    • providing culturally safe medical care, e.g. male or female doctors to provide care for men’s and women’s business respectively

    • offering interpreters or cultural mentors to attend appointments

    • different disease prevalence leading to

      • — Aboriginal and Torres Strait Islander specific immunisation and chronic disease screening schedules

      • — Medicare incentives for practices and patients to improve access to care and treatment.

  2. Sharon has diabetes and needs:

    • assessment of her current wellbeing and how she is handling her diabetes

    • consideration of the suitability of her medication regime, her coherence and any barriers to taking medications

    • exploration of her modifiable risk factors: smoking, nutrition, alcohol, physical activity (SNAP) and check of BMI, waist circumference, lipid profile

    • screening for end-organ damage of her eyes (retinal screening), heart (BP, ECG), kidneys (UEC, urine ACR) and feet (skin, peripheral pulses, monofilament testing of sensation).

  3. Sharon could register for the Medicare ‘Closing the Gap’ initiative. This reduces the cost of her medications if she has no Health Care Card or eliminates costs if she has one. A combined preparation of her medications would reduce the cost and the number of pills she takes.

    She is eligible for a Medicare rebate on an Aboriginal and Torres

    Strait Islander adult health check (715) and GP Management Plan and Team Care Arrangement (721/723). The latter would give her subsidised access to a diabetes educator and/or podiatrist.

  4. Documentation of past medical history, immunisation status, family and social history, allergies and physical examination if this ...

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