What can I do for you ?

In my practice in the Hollywood Medical Centre and in Canning Vale, I see people who are concerned about their bloodpressure or their risk factors for stroke, heart disease and kidney failure. Most of my patients are referred by their Family Doctor, some make an appointment on their own behalf or because they want a specialist- or second opinion.

Your family doctor is in the best position to advise you about the majority of things as he/she is well aware of your whole medical background. If you feel that a specialist visit is required you can discuss a referral with your Family Doctor or arrange to see see me in my clinic by making an appointment yourself. If you come without referral, there is however not the usual Medicare rebate, so the visit is more costly.

What will happen in my Clinic ?

The first time I see you, we will spend an hour on taking an extensive history, paying attention to your past medical events and list all your risk factors. I will then perform a thorough physical examination and we will discuss the next steps to take. We will try to eliminate as many risk factors as possible hence reducing your future risk. Apart from that we will evaluate whether you could have a secondary form of hypertension (10% of the patients have this) and this may require further tests of blood and urines or X-rays/ultrasounds/scans. Obviously it is important to have a diagnosis as this will determine what treatment is best for you.

A modern and cost-effective service: the ‘interactive clinic’

I have a new concept of hypertension treatment, called the ‘interactive clinic’. The treatment of hypertension is very complex and often needs ongoing tweaking of your medication. Obviously there can be enormous fluctuations in your blood pressure and the treatment should be adjusted to that. In a perfect world we would see each other for such an intensive follow up on daily basis. Obviously, this is not possible because of time restraints and costs for you as the the patient or your insurance. Hence the solution is that we stay in very close contact via email in the periods between visits. I usually respond to emails the very same day and you will update me with at least weekly listings of your blood pressure readings in self control. Via email, we will discuss adjustments to your medication between visits and are thus able to tweak your treatment much faster and in a safer way to obtain a lasting result.

I am of course always happy to see you on a regular basis in my clinics in Hollywood or in Cannington. Many find the personal face-to-face contact with their doctor very important, and that is always possible.

In very difficult to treat hypertension, people often use a whole lot of tablets, without a clear benefit. Modern treatment is to wean in a short time span almost all the medication and then to carefully reintroduce medication until success is achieved. We often see major successes as too much medication often only reduces the efficacy of the drugs. Some patients stack a whole pharmacy at home and often this can be reduced with similar efficacy on the bloodpressure. Also here, a close monitoring of your blood pressure is vital, as you can imagine that weaning of a lot of medication can initially cause your bloodpressure to raise.. You may feel reassured that a hypertension specialist is only an email away.

Is this all expensive ?

Like any other physician working in private, I charge for the first visit to my clinic and for the follow ups. I have a very flat fee structure. i do not charge for the intensive email follow up. If we decide that you would like to have Skype follow ups, I chage a large nominal fee for that. I see this as part of an innovative service and the best way to keep you save. Medicare will cover a significant amount of my fees but there will, like with every other specialist, a gap-payment, or as it is called, an ‘out of pocke’t fee.

What about TeleHealth ?

I think we have a two speed health system, which is bad for disadvantaged patients and in particular for patients who live rural and remote. I can do everything that I do in my private practice (apart from examining you), over video conferencing with any computer, or tablet or even smartphone at your home or with a computer in your GP.

Regretfully I see frequently patients who have been on a public hospital waiting list for 6 months or even a year, because they live remote. I could have seen them in weeks and spare them from further worsening of renal function or damage from high blood pressure.  Idealistically, I had for many years not charged anything for these very complete consultations as long as you have a referral from your GP. Recently this had to change, as Medicare decided to take the TeleHealth incentive item away, making it for me impossible to make ends meet in running this part of my practice. Obviously I also have large costs, like renting equipment, rooms, and my staff.

I hope that Teleconferencing, even if you have to make a financial contribution and get the rest in your bank account from Medicare, contributes to equality in care. You will be seen soon, receive the latest standard of care and I am just an email away if there are questions.

For Telehealth Consulting please click here