"I now incorporate FPS into my general practice work every day, whether in formal counselling sessions or incidentally..."
I work in general practice in a family clinic in Middle Park, in Melbourne’s inner southeastern suburbs. As a GP for 25 years, I have always attracted a high proportion of patients with mental health problems, but in addition, I find that aspects of mental health present in almost every consultation.
In response to this, I developed further knowledge and skills in this area, and undertook FPS training in 2008. At the time, I was taking multiple short courses, online and face to face, so I cannot recall which of those qualified as my FPS training. The patients I was seeing at the time - teenagers experiencing eating disorders, depressed new mothers, despairing office workers etc., triggered the courses I chose.
I wanted to become a Medicare-registered GP provider of FPS as I felt that would give some weight to the work I was already doing. As a GP, I was not a psychologist nor psychiatrist. I was not a “trained counsellor”, yet my experience and knowledge base gave me confidence to work in this arena. It has always been an area of practice that I really enjoy, and that I am frequently rewarded in by receiving positive feedback.
I now incorporate FPS into my general practice work every day, whether in formal counselling sessions or incidentally. An example of this is the use of psychoeducation and relaxation strategies to assist a woman who is too nervous to have a cervical screen, or using motivational interviewing to assist a patient to make lifestyle adjustments to reduce their long-term risk of cardiovascular disease.
My patients are typical of the population in an affluent inner suburban clinic. The most common conditions I treat are anxiety and depression, but OCD, agoraphobia, PTSD, social anxiety, school refusal and eating disorders also commonly present.
As a GP, I usually know my patients background history including their social and work history before they present requesting help with their mental health. This gives me a good basis from which to commence FPS, as I understand the context in which their symptoms are occurring. My patients trust that I have a scientific background and this gives them confidence that the treatment I offer is validated and likely to be effective. Without needing to waste precious therapy time on getting to know the patient, I can focus on their symptoms and management.
I am interested in all areas of mental health and I naturally gravitate towards CPD activities which further my knowledge in the areas relevant to patients I am seeing at any one point in time. I have also undertaken a Masters in Psychiatry, which I am due to complete this year. My main aim with my ongoing studies is perpetual learning in this fascinating field, but I appreciate having further qualifications adds to my credibility working in this arena.
I encourage all GPs to undertake some training in FPS as I find their use invaluable in my everyday general practice as well as for my focussed counselling sessions.
Dr Jo-Anne Zappia, VIC
“Provision of FPS to patients allowed me to help them develop management strategies for different manifestations of anxiety”
For over two decades I worked in a metropolitan Aboriginal Medical Service where consultations for stand-alone presentations of sore throats were uncommon. Complex medicine was par for the course. People were medically undertreated. Physical and psychosocial problems were often interlinked causally and with respect to disease progression: the bare face of historical and continuing injustices. Average incomes (low) and unemployment rates (high) added significant burdens to already stressful lives, and affordable quality mental health services.
I was a bulk-billing GP who loved practising a holistic approach, and had established relationships with patients who might benefit from focussed psychological strategies. I had always been interested in the theories and practice of mental health. I enrolled in a Masters of Psychological medicine that I completed on a part-time basis over 2 years. It had a focus on counselling skills, general psychiatry, and the practice of CBT.
I was very fortunate to be working in a service that was providing culturally appropriate multidisciplinary care. Provision of FPS to patients allowed me to help them develop management strategies for different manifestations of anxiety, whilst my colleagues supported them with other important modes of care. Over the years, I saw many patients with panic disorder, agoraphobia, OCD, PTSD and social anxiety. The beauty of up skilling in FPS as a GP is illustrated by thinking about comorbid cardiovascular disease and panic attacks. When a patient presents with episodes of shortness of breath and fear, you now have the training to be able to assess, triage and manage what might be symptoms of either ischemic heart disease or anxiety – and if they coexist, to manage both.
Another example of common use of FPS skills is the use of motivational interviewing when seeing patients who are using alcohol or other drugs. You will learn to go beyond asking ‘what are the pros and cons of using drug x?’ and extract every ounce of usefulness from this FPS strategy. Your patients will like your respectful curiosity, and you will enjoy the deeper understanding of substance problems that comes from using your FPS skills.
Everyone knows there are no easy fixes for mental health problems, but you will enjoy developing discernment in your application of FPS. Age, childhood experiences, culture, gender, personality, trauma exposure – and more – influence how acceptable and effective treatments are. For example, CBT can be useful as part of a treatment plan for depression; identification and challenges to common ‘thinking traps’ can be helpful. But when someone says ‘all my close relationships have ended in loss’ – and many of their close relationships have ended in loss, it’s not a challenge that’s needed, but acknowledgment and validation.
You will have a bag full of many tools and strategies ready to share with your patients, and will pass these on to your patients at appropriate times. You will learn much about the state of mental wellbeing as you support the treatment journey with your patients.