Sunday, April 14, 2024

Grant Russell | Patient Centred Care

by Editor

Grant Russell is Professor of Primary Care Research and Director of the Southern Academic Primary Care Research Unit (SAPCRU) within the Department of General Practice at Monash University.

After working as a GP in Perth, he first undertook research at the University of Western Ontario and later at the University of Ottawa, where he was greatly influenced by Professors Moira Stewart and Bill Hogg, before taking up his current post at Monash University.

He is a world renowned academic whose work is focused on patient centred care and on understanding and measuring the impact of primary care on patients, clinicians and general practices. He has undertaken many senior leadership roles in academic and educational organisations.

“I’m still a true believer in family medicine/ primary care and I think that there is a very wonderful career that can be forged.  And it’s based in many ways, and I learned this from Moira Stewart, around the relationship with the individual and, if that can be valued and treasured, then a lot of the rest can fall into place.”

 

“To me it’s about power but it’s about sharing of power, sharing of responsibility, and a knowledge of oneself, and helping to have deep knowledge of the people who we’re caring for. “

 

Enjoy the conversation, watch the video, listen to the podcast, read the narrative

Grant Russell: I started off by going into general practice in Perth and always feeling that, whilst I love and continue to love consulting and just being with patients through the day, I always loved having another little string to my bow.  I did GP obstetrics until we were priced out of the market with insurance in the early 90s, and then palliative care in general practice for a while, and then I answered an advertisement by putting in an application to get a scholarship to do a PhD.  And I could go anywhere in the world to do it, and I was very lucky to go to the University of Western Ontario to Moira Stewart’s team.  It was one of the best decisions that I’d ever made. It changed my life. We were there for a couple of years, wife and a couple of kids, and then we went back to Perth. 

Then one day, the phone rang and Bill Hogg, was on the other end and he said – “We’ve got too much money and we need to have some people to do the work”. And I said- “Bill it’s all too crazy at the moment, we’ve just opened a practice and blah blah blah”.  So, every month for the next six months, the phone rang again and he kept on ringing, and the deal got better, and by the end I just couldn’t say no.  So, I was with the unit at the CT Lamont in Ottawa for four and a half years.

Then we decided, let’s get the growing family back to Australia.  And since then I’ve been at Monash University in Melbourne.  I’ve tried to get over to Perth as much as I can but there was an issue of a global pandemic which made things a little bit difficult for a few years!  So, we’re in Melbourne and started to set up, essentially, a health service linked research unit in the outer suburbs of Melbourne.  It was a fascinating area with a lot of refugees and that then led to a number of other collaborative projects.  It’s been an interesting journey which I couldn’t really have predicted, but I continue to see patients a couple of days a week and still really enjoy that.  It’s interesting how it all gets put together eventually.

DMacA: In your time you’ve worked with Bill Hogg and Moira Stewart, and now you’re one of the key opinion leaders.  So, what do you tell your junior colleagues when they’re setting out on their career?

GR:  I’m still a true believer in family medicine/ primary care and I think that there is a very wonderful career that can be forged.  And it’s based in many ways, and I learned this from Moira Stewart, around the relationship with the individual and, if that can be valued and treasured, then a lot of the rest can fall into place.  I think you need to choose a practice of people that you can talk to, and who understand you and you understand them.  And I think the more multi-disciplinary that we can be, multidisciplinary is a context that we can in embrace, that is good for us in a professional sense.

As far as adding education research to your life, I think one of the things I’ve said to young doctors has been to make sure you can be a clinician first.  There’s a lot of encouragement, certainly in Australia, to do your PhD straight away.  We’ve had a number of people that we’ve been in contact with who’ve done that and, at the end of it, they’ve wondered and worried what is the future?  So, I guess that, from my point of view, it is a very rich opportunity to be a family physician and that those first five years after graduation, through the training programs and beyond are really critical.

DMacA: That’s a really important message for the individual practitioner, in terms of their own personal career and the value of family medicine, but one of the difficulties now is that general practice/ primary care/ family medicine, is under such pressure politically internationally.  So what is your external message. How can we measure the impact of primary care?

GR: Barbara Starfield showed us that the four pillars of primary care are fundamental to measuring its success: Its ability to provide access in an unfettered way, that care can be provided with continuity, that care is comprehensive and, in what is a critical role for the family physician in a complex health system, is to help coordinate the care of others, the care of the individual with others.  All of those things are measurable and one of my truisms or aphorisms is that any health intervention that across the system threatens access, continuity, coordination, and comprehensiveness in primary care, is not likely to be beneficial at population level because we are so intimately reliant upon the fact that family practice does those things-  family practice/primary care and we can’t be too precious about our professionals in the primary care sector. Yes, I think that’s one of the big lessons – disrupt first-person access and disrupt continuity at your peril if you’re a health bureaucrat. 

DMacA: Let me take you back because your academic career doesn’t fit the exact formula.  You are primarily a family doctor, you started off and created a practice, and you were embedded in primary care.  So, let’s talk about patients because clearly they are the most important component of everything we do.  And you’ve written about the importance of patient centered care.

GR: I guess there’s a couple of things.  Everyone’s got their own definition patient centred care but it’s rarely fully articulated or rarely clear even to ourselves. So I was thinking today about- what are the really seminal things that have helped shape the way I think about things.  And the first is Michael Balint’s ” The doctor, his patient, and the illness”. Its a bit of a sexist title but it’s a magnificent book and, if anyone hasn’t read it they should, and that was pretty closely followed by Ian McWhinney’s writings around patient centered care and the meaning of illness.  I wouldn’t even have been 30 when I read this, and it just transformed the way that I looked at caring for people, caring for the individuals that were coming to see me.  It was a real gift and I guess it’s a reflection on medical schools that I couldn’t leave with that being something that was fully engendered.  I would hope and would anticipate, but I’m not absolutely convinced, that medical students can leave their professional, their undergraduate training, with a good understanding of patients and their care.  To me it’s about power but it’s about sharing of power, sharing of responsibility, and a knowledge of oneself, and helping to have deep knowledge of the people who we’re caring for.  And, you know, the evidence is pretty robust. 

Mead and Bower, major writers around patient centered care (“Patient-centredness: a conceptual framework and review of the empirical literature”), made a point not that long ago in that they wondered if we’re being a bit too hard on clinicians.  Their point, and a number of others, and this was what I was writing about in the editorial, was that it’s the moral imperative of patient centered care that really matters.

DMacA: You’ve talked about patient centered care. Tell me your own experience as a patient. Did that change your view on things?

GR: That is a great question.  Without going into too much detail or without going to detail at all, I’ve not been short of the odd health issue myself.  And there’s been serious health issues within our kids.  And, it’s funny, I think I’m very attuned to listening to it, listening for it and, when it happens, I feel it’. So, wow, I mean it’s from a personal perspective, it reinforces the value.  This person has listened to me and they’ve maybe shared a little bit of their own viewpoint on it but have just helped us go together, reinforce our relationship in a healing sense towards me. 

With one of our kids, who had a serious illness, it was the lack of patient centeredness and the degree of formulaic care that made us advocate for really substantial changes, and I think that was a really valuable thing.  But, you know, that was really hard.  I’m a medical professional, and speak the language -all that sort of thing – and it just highlighted how difficult it can be to just try and renegotiate the model of care in which you embed it.  But that was a very interesting. It’s a very good question.  I’m very happy that you’ve asked that.

DMacA: Grant it’s always a pleasure to talk to you and thank you very much for sharing your life, your educational influences and, indeed, your personal influences.

Thank you very much indeed.

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