Recently I was the lucky recipient of a telephone phone coaching session with Dr Angela Nguyen. I had been interested by her article on the R-Cubed website regarding the issue of bulk-billing, and how to respond when patients make that request. This was the issue we focussed on during our session. Up until then I had always agreed to bulk-bill patients when they asked, but often felt quite resentful of this especially if I felt like I had given them a lot of time and effort. But being a polite young doctor I didn’t really know what to say to patients with this request, so it was easier just to say yes.

First of all, Angela started to delve into my feelings around money. I have always found the issue of money quite awkward, and found it particularly so on entering general practice (being a fee-for-service environment rather than being salaried as a hospital doctor). I went into medicine for the interest of the job and to help other people, and would rather just be paid a flat rate and not have to deal with the money side of things. Angela explored this in more detail and got me to think about all the positive things to do with money. She also got

me to see how every time I agree to bulk-bill a patient, that is money that I have earned but instead of going towards supporting my

family, it is going to the patient instead – despite the fact that I have given them a service.

With my thoughts now adjusted towards the

concept of money, Angela got me to practice a response to the question ‘can I be bulk-billed today?’. Saying something simple like ‘This is a privately billing practice. What’s your situation – I’m curious?’ was a good way to put the ball back in the patient’s court. If they were genuinely suffering financial hardship then they could explain that, but if they just didn’t really feel like paying but didn’t have a good reason, then that would take the wind out of their sails. It was really helpful to have a prepared answer to that question, because so often it catches you a bit off guard at the end of a consultation (often as the patient is walking out of the door!), and Angela got me to practise saying it confidently so that it would be easy to say when the situation arose.

Since our session I have had the request a few times, and it really did help having gone over the issue with Angela. Out came my prepared answer, and I felt a lot more empowered to enforce the private bill where appropriate rather than caving in to the patient’s request.

I would definitely recommend telephone coaching to others, it was similar to having a session with a psychologist and it was not much different from a face-to-face session. This would be particularly helpful for rural doctors – or anyone with busy working days and no time to get to see a psychologist (let’s face it, most of us!) as the sessions can be in the evenings.

It was also great that Angela has worked in general practice so she can really identify with the issues on a personal level.

Highly recommended!

Dr J [Rural Doctor]