Upfront: The doctor who wasn't

Upfront: The doctor who wasn’t

“How did it get so late so soon? Its night before its afternoon. December is here before its June. My goodness how the time has flewn. How did it get so late so soon?” – Dr Seuss

Theodor Seuss Geisel (1904–1991), better known as Dr Seuss, is one of the most famous and well loved children’s authors of all time. He is perhaps one of the first names that come to mind when thinking of a list of famous doctors…but is he? In actual fact, Theodor Geisel was not a doctor at all. His father always hoped that he would earn a doctorate at Oxford and his pen-name was an acknowledgement of this.

In the 1950s, illiteracy among school children was a significant problem in the USA. A report concluded that children were not learning to read because their books were boring. Dr Seuss decided to come up with a list of 220 words which he felt were the most important and he used these words to write an entire book – The Cat in the Hat. As the result of a bet several years later, Seuss composed a work using a mere 50 words – the result was Green Eggs and Ham. Dr Seuss understood that a message is best received when delivered in a concise and straight forward manner.

“Sometimes the questions are complicated and the answers are simple.” – Dr Seuss

One of the most important lessons we have learned at bpac this year is that our messages need to be concise. Health professionals are obliged to stay on top of latest research, patients are increasingly more informed and demanding of service, paperwork has evolved into a mountain and there is precious little time to achieve this all. It is our job to collect the evidence, call in the experts, reach a conclusion and pass on this information and guidance to our clinicians in a concise and easily readable format.

When evaluating the impact of our programmes, we consistently receive feedback both when our messages are concise; “It was very useful and contained excellent, clear guidelines” and when, perhaps, we need to be a little less wordy; “Try and avoid over repetition in the space of three or four pages, we are not thick - twice is adequate!”

Time is important. Many of our readers complain that there is simply too much information and not enough time to read it all; “It is a pity with the time constraints of running a busy practice that much of this good material goes unread. Unfortunately everyone that sends their bit of paper is so convinced of its importance that the good stuff gets drowned by the irrelevant minutiae”. We work hard to select topics and deliver messages that are important to our audience; “Fantastic read, really helpful, as always bpac provide a great user friendly service. bpac publications seem to understand what GPs need and the limited time we have to update ourselves”.

“You have brains in your head. You have feet in your shoes. You can steer yourself in any direction you choose. You’re on your own. And you know what you know. You are the guy who’ll decide where to go.” – Oh, the Places You’ll Go, Dr Seuss, 1990

GPs and health professionals must take a pragmatic approach to interpreting the medical evidence and applying it at both a practice and patient level; “There is academia and “real life” - what I say when I am answering a quiz & what I do when time is short and patients are being querulous & ‘difficult’ can be different....! Not because I INTEND them to be so, but sometimes it seems just easiest to take the road of least resistance”.

We know that “real practice” often takes precedence over the best, most up to date, evidence based information and expert opinion. One of our major themes for 2008 is embracing the pragmatic approach of our New Zealand primary health care clinicians.

“Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.” – The Lorax, Dr Seuss, 1971

We provide the information; GPs, nurses and pharmacists make the difference in patient outcomes. “Good campaign - just got to change the thinking of the patients now!!”

So far this year we have seen an increase in monitoring for adverse effects and metabolic disturbances in people taking lithium, a reduction in the use of antibiotics for “winter ills” in children and a reduction in the use of codeine for acute migraine. No doubt there have been many more changes, all with the common outcome of better patient care.

“Often it is only those who were motivated to read your information, and then motivated or willing to change, that take it on board”. We may not have changed the world, but what we have done matters to individual patients and the clinicians who care for them.

“Today was good. Today was fun. Tomorrow is another one.” – Dr Seuss

We are only as good as our last issue; “I found this to be the least useful of the campaigns, mainly because it did not tell me anything I didn’t already know”.

Perhaps one of the most frequent comments we receive is that information needs to be reinforced, in order to be remembered; “Very relevant to day to day general practice, follow up messages strongly encouraged”. We produce four theme issues and four responsive journals each year. This allows us to rapidly respond to topical issues and update information from previous programmes.

“And will you succeed? Yes indeed, yes indeed! Ninety-eight and three-quarters percent guaranteed!” – Oh, the Places You’ll Go, Dr Seuss, 1990

We have had a great year here at BestPractice and almost all our feedback has been positive; “excellent as it stimulates thought and review of one’s practice” and when its not; “I cannot recall anything about the programme” we do care and we do make changes.

We aim to provide clear, well-researched guidance that is practical and relevant to the needs of primary care and constantly evolving in response to our audience. Together we hope we are achieving this goal; “I will try harder. I will try harder. I will try harder. I will try harder. I will try harder…”

“And the Grinch, with his Grinch-feet ice cold in the snow,
stood puzzling and puzzling, how could it be so?
It came without ribbons. It came without tags.
It came without packages, boxes or bags.
And he puzzled and puzzled ‘till his puzzler was sore.
Then the Grinch thought of something he hadn’t before.
What if Christmas, he thought, doesn’t come from a store. What if Christmas, perhaps, means a little bit more.”
– How the Grinch Stole Christmas, Dr Seuss, 1957

Thank you to all the GPs, practice nurses, pharmacists and other health professionals who read our journals, provided feedback and made a difference this year.

Merry Christmas from the team at bpac.