Working with general practitioners
What's Important To Us
General practitioners have medical expertise but may have little experience with Oranga Tamariki and our role with children, young people and their families/whānau. We should make sure that general practitioners have all the information they need to provide the best service to the children and young people we refer to them and this includes involving the child or young person's family/whānau and caregiver/s in the consultation process.
This key information outlines some key considerations when working with general practitioners.
It is extremely important that the child or young person's family/whānau and caregivers are involved in all matters and appointments relating to their child's health unless this places the child's safety at risk.
Engaging the child or young person's family/whānau will encourage their active involvement and investment in their child's health, and maintain family/whānau relationships even if they are no longer the day-to-day caregiver of their child. The child or young person's family/whānau have vital information about the child or young person's medical and family history and it is likely that they will be the enduring holders of family health information for the child or young person as they mature.
In addition, their attendance can be reassuring for the child or young person.
- Before arranging a medical appointment, check that the general practitioner is the right person to carry this out. If the child or young person needs to be seen regarding allegations of sexual abuse, ensure this is carried out by an appropriate person. When a child is under 2 years and needs a full medical and developmental assessment, a paediatrician would be the best person to do this.
- For routine medical appointments it is preferable to take the child to their usual general practitioner, however if this cannot happen establish a relationship with a local trusted medical centre who can continue to see the child or young person in the future.
- Explain your role to the doctor (remember that medical staff may not know anything about Oranga Tamariki), why you have brought the child or young person to be seen, their care status, and what you are asking the doctor or nurse to do. Introduce the parents/caregiver and ensure that they feel central to the discussion.
- If you want the doctor to provide a report, they will need to know what it is for and who will be reading it. Providing the doctor with an example of a good report (with names removed) or template can be helpful. They will probably charge additional for their time to write the report.
- Expect to pay the full price for the consultation if the child or young person is not enrolled with the practice. If the child or young person has a community service card or high use health card this should be taken and will help to pay for part of the consultation. Some general practitioners provide free services for children under six years of age while others charge an additional fee.
- Ask about the best way and time to communicate with the practice - telephone, email, fax (being mindful of information being sent and the privacy of the child or young person). Most doctors do not like being interrupted when they are seeing patients so the receptionist or practice manager will most likely take a message and discuss this with the doctor when they are free. If requiring information ask whether the practice nurse or another doctor can access the doctor's notes as they may be able to provide the answers.
General practitioners' understanding of care and protection
Most doctors in general practice have expertise in looking after a wide range of general health conditions that commonly present in the community. General practitioners receive little or no formal training in social services. Most general practitioners look after very few children and young people in care and so have little understanding of the implications of care and protection, what services are available, consent and guardianship issues and the role of the social worker. They may have received incorrect advice from discussions with their colleagues.
It is important therefore not to assume the doctor or nurse knows or understands what is involved or expected of them. Explain clearly what the child or young person is there for and whether they are required to write a report. The reason why the child or young person is seen will impact on what the general practitioner will do, and what is recorded in their notes.
Child or young person's medical assessments
When a child or young person with complex needs is seen, the doctor will focus on the presenting health issue or injury and will not usually be able to undertake an holistic or needs assessment. To form an opinion on child abuse, neglect, the quality of the care provided can take hours. To thoroughly assess health status, the child or young person's development, behaviours, social interactions and intellectual and emotional functioning needs to be considered. These types of assessments are not a normal part of a general practice consultation so this should be discussed prior to the appointment to ensure the health professional feels comfortable undertaking the assessment and allocates sufficient time.
Potential complexities when working with general practitioners
Shortages of doctors in New Zealand often results in general practitioner being under pressure to see more than four patients each hour. In some circumstances a doctor may be asked to attend a family group conference when their evidence is critical, or may make a report of concern to Oranga Tamariki relating to abuse and neglect. It is likely that these will be unfamiliar and time consuming processes for the general practitioner which may impact on their willingness to come forward. That said, the strong educational emphasis that has been placed on professional reporting of child abuse is likely to encourage general practitioners to come forward. Think of ways in which you can make things straightforward for them and involve them (or their practice) in any networking or educational opportunities that may be available. This is particularly important now we are undertaking health assessments for children and young people in care.
Also, doctors are trained to be advocates of their patients. The Hippocratic oath requires them to always try to deliver what is for the "good of my patients according to my ability and my judgment and never do harm to anyone". Inevitably general practitioners and nurses have relationships with their patients that may make it difficult for them to probe into matters of child abuse or neglect. For example, the medical practice may also see other members of the child or young person's family/whānau which can make things quite complicated for the general practitioner. They may even have a social relationship with members of the extended family/whānau. In small communities this can be particularly problematic. General practitioners and other health professionals may not understand the legislation or current social policies and may find the actions of social workers interfering or not aggressive enough. Building or strengthening professional relationships is important in these situations. Creating opportunities to educate medical staff through newsletters or professional forums is a good idea. Supervisors and practice leaders may want to think about pulling a meeting together where social workers and general practitioners can talk through the issues and become acquainted. Perhaps they have a cluster group that staff can present at?