Watch the video...

Read the Transcript...

Megan Walker: Hello, and a very big warm welcome to the Healthcare Thought Leaders Show. I'm Megan Walker, and today our very special guest is Dr Andrew Leech, an award-winning general practitioner, author, speaker, healthcare advocate and founder of the Garden Family Medical Centre in Perth. Andrew is also the recipient of the 2023 RACGP Western Australia GP of the Year, and has become one of Australia's most respected voices in child and adolescent health, family medicine, and healthcare reform.

What I really admired about Andrew when I was stalking him on LinkedIn is that while he continues to care for patients every day, he's also recognised that his impact doesn't have to end at the consulting room door. Through writing, speaking, media advocacy and creating an innovative model of general practice, Andrew is helping shape conversations about the future of healthcare and improving the lives of families right across Australia, which is what all of you are interested in and why you're here.

Today we're going to dive into Andrew's journey in a bit more detail, and what he's learned about becoming that trusted public voice, and why healthcare professionals like you have an incredible opportunity to create change by sharing your expertise safely and more broadly with the people it can impact most. So Andrew, after that very long intro, how are you? Thank you so much for being here.

Andrew Leech: That was a very kind welcome, thank you. Great to be here. You're absolutely right, we have opportunities to really share what we see and where the pain points are in the system and how to improve things. We are at that forefront, so I'm hopeful we can cover some of those things today.

Megan Walker: Wonderful. So calling you a GP advocate, I don't know if that's a title you'd reference for yourself, but what inspired you to lean more into this work? You've got your great practice, and you've become this strong voice for children, adolescents and families. Where does your inspiration come from?

Andrew Leech: Directly from the people we see, the families. I've been a GP for 15 years now. I was just trying to work it out, and it's incredible to think how quickly that's gone. Over that time I've really evolved into working closely with parents, children, adolescents, and that early developmental years where there's often challenges. I've learnt so much about what families might go through during those years and what they might experience. It's taught me more about day-to-day life struggles and mental health difficulties than any textbook would have ever taught me. It's also shown me how the world is changing and how we're having different types of stress in our lives. So I learn exactly from the people I see, and that's what inspires me, as well as my own family, of course. I can't leave this show without mentioning they're part of my inspiration too.

Megan Walker: That's amazing. So you thought you'd done enough study when you went through medical school, but now you're learning on the job every day, getting these rich insights and leaning in. Love that.

Andrew Leech: Cramming four years of medicine, I thought, well, I hope I've got enough to get out there into the real world. But the learning comes day to day. That's really where it starts, once you're working and seeing people. It's amazing how much they teach you.

Megan Walker: I noticed that you've challenged the traditional 15-minute consult model. What principles guided the creation and set-up of your clinic, going out to have your own show, and what have you learned about designing healthcare around patients as opposed to systems?

Andrew Leech: We spend a few years training as registrars in general practice, and that gives us an opportunity to go across different clinics and see what different places are like and different demographics. During that time I noticed a common trend across clinics: very traditional waiting areas with a TV, a bit of old furniture, stained carpet, old magazines. Then we had COVID, and every clinic put up the glass, that sort of glass across reception. So it becomes really clinical. As a patient, I feel that would not be as inviting as it possibly could be. There are ways we could keep it clinical, clean and safe, but make it more inviting and welcoming and holistic and nurturing.

Given mental health is now really the number one reason patients come to a GP clinic, I think it's important they're made to feel comfortable in an environment where they're going to be visiting often, or reviewing with their GP. So with the clinic itself, I thought, well, how do we really throw this upside down? Lots and lots of talking to different people and getting help and advice. It wasn't just me. At the end of it, the centre of our clinic is a garden. It's a tropical, walk-through outdoor garden inside the clinic. It's the outside in the clinic. And that's the centrepiece, and it's really growing with us, which is why it's called the Garden. Patients walk in, have their GP call them, and they can walk through this outdoor area and straight into their consult room. All the rooms surround it, so there's that natural light, which I felt was really important.

It's been quite a journey to get to that, and it's amazing that it's growing. I thought there's no sun coming into this courtyard area, but it's worked out really well. From there, just creating a clinic that allows people to spend time really working through the challenges they've had. As I was learning as a GP, we were made to have 15-minute appointments. Most registrars get a bit burnt out by this, where you're seeing four patients an hour, and you have a fairly strict schedule, eight hours a day. That is not conducive. I felt I wasn't doing a service for patients. I wasn't providing them what they needed. It was really frustrating to me. You just get through one thing, and then you have to bring them back. Our patients want to feel heard. Ultimately, if we have nothing else to give, no medicine or no treatment, if they feel validated and heard, I think we've really done our job. That's what I've appreciated now this much further along. That time is probably the key medicine, or the key aspect of that visit.

So we have longer consultations. Most of our GPs will do a minimum 30 minutes. My first session is one hour, and it's actually amazing how quickly that one hour disappears. I feel like it should be 90 minutes sometimes. And that's just for a four-year-old. There's so much going on in everyone's life. It's important to step back and just work through everything they need to work through, and not feel rushed.

So it all built from there. Then we developed the system of our clinic and tried to make everything seamless for patients. So if they needed support with an area, we make sure they don't have to necessarily be referred out. We can have a GP with that special interest, or we've got psychology, or we've got allied health. We've got these special interest areas we can really tackle in the one place, and that's been another way of evolving in general practice.

Megan Walker: No wonder you won GP of the Year. That is fabulous, what you've done. Can you tell us what some of the positive outcomes have been for both staff and your patients, in having this beautiful, calming environment and being listened to? How's that translating?

Andrew Leech: The other aspect of going through clinics is you recognise the importance of staff culture and team culture. It's so important that if you have a happy workplace, the patients feel it. It comes from the front, where the patients are greeted, all the way through to the nurses and the GPs. So the design was important, but the actual structure was important too, where we say, okay, we're all one team, we're all doing our bit, there's no hierarchy here. We don't have doctors sitting in this elevated realm. We're all even. I think that's worked, and we all collaborate.

We do lots of things where we catch up, and we have whole-team educational sessions. The way we connect is really special. Then we empower each of the team. We don't call them receptionists, we call them healthcare assistants, because reception is just not enough for what they do. Each healthcare assistant has their own skills, and we try to empower them to work towards goals in those skills, whether it's a leadership role, an administrative role or an educational role. They all have their own roles underneath being at the front of house as well. That's just one little pocket of the way the clinic helps build culture. The actual feel of walking into a bright, airy atmosphere, I hope also helps. Providing them with that collaborative team approach is the aim.

The benefit is retention. We're very fortunate that overall, the team has stuck together in the four or five years we've been open. We really don't have to hire too often, which is great. That's a big process on its own. If you keep your team, you also build from there.

I probably haven't fully covered the benefit to patients. Just as an example, one of the models we trialled very early was around ADHD access. I recognised that ADHD access, particularly for children and adolescents, was increasingly difficult, particularly in the public system here in WA. I don't know what it's like in Queensland, but there was a three to four year, now probably five year wait to get a paediatrician just to work on whether this child has a diagnosis of ADHD or even autism, and to then provide support. So that delay was all of primary school almost. That's the lost neuroplasticity opportunity. There's so much that happens in that time, the ripple effect on their mental health.

Being in general practice, that's what we were witnessing: some of the mental health effects, the family effects, the struggle for parents to work, the difficulties at school. There are so many aspects beyond just a label. We'd end up seeing them more and more just to try and hold things together. So the system is fairly broken. That then led to private systems filling up, the private paediatricians not only filling up and having their own wait list, but also charging more and more because of the demand. So it's becoming unaffordable almost.

So we developed a pilot system. I went to a paediatrician who's written the ADHD Go-To Guide, which is a really good book. She's a key researcher, Professor Desiree Silva. She's very approachable, so we discussed a model where we could almost streamline that care and do a lot of the background work in GP, which we can. We do these assessments where we take a history, examine, do some of the screening tools, spend some time doing all those things, blood tests, get the nurse involved. We do all that hard work, and then we present that in a case conference to the paediatrician. We might then be able to tackle a lot more in a shorter space of time. She reviews them, makes a call, and together we work on a treatment plan.

This model was so good that we're up to maybe 60 or 70 kids we've been able to work on together. The real value has been wrapping ourselves around the family and saying, okay, we're going to be meeting, talking about you with myself, paediatrician, potentially a nurse in a case conference, and really trying to establish goals, continue to progress those goals and make sure you're on track. This not only saved me time, it also saved her time. She saw a lot more than what we could have otherwise. It also reduced the stress on both of us and the families.

Out of that model, we presented to the government and showed a working concept of how this could potentially change the way we do this care in the state. Then just one month ago, the law changed to allow general practice to finally actually do this work alongside, or working with, a supervising paediatrician. So now we're doing that. I can now diagnose and treat independently, but also know I've got the backup support if I need it. We're saving them time. We really need them to be available for those complex needs care patients, but we can't get anyone in at the moment. So now we're hopefully opening that up. That was a model that really worked well for patients, and continues to work.

Megan Walker: Congratulations, that's a huge impact, just that one piece that you've done. Pardon me, I want to talk to you all day, but you're a busy man. So you've written a book. I want you to tell us the name of the book obviously, so people can go and check it out. But also, where did that thought process come from? Was that an invitation to write, or was that a recognition of, hey, I want to get this out there? Tell us about the book journey for you.

Andrew Leech: This is actually the second book now, but I consider it a bit like journaling. I really enjoy writing things down after a day I might have experienced that were impactful or interesting. So I started to do that for the first book, around anxiety, because we're seeing more and more anxiety in children. I felt like I was sharing the same advice every single time. Try this, try this, try this. I thought, well, I just need to write this down. So I started to do fact sheets, and then thought, well, we can start to actually put this together into something we could suggest to parents or families. This is what I would normally tell you, go and read this. That first book was on child anxiety.

The second one, I thought I'd go a bit deeper because I was seeing some really complicated teenage-related issues, things they're faced with that perhaps GPs or parents or educators are not necessarily aware of. Deeper issues around identity, risk-taking, social media, all those things I was not taught at med school. The stories were incredible. Teenagers really build a trust with GPs. As you get to know them, you see them on their own, and they start to share things they haven't told anyone. As we went through, we had some success stories, and I thought, well, would you be able to write these things down and we'll put them in this book? So we started to build up a collection of different stories, and then I thought, well, we need to involve the parents, so we started to hear their perspectives and write them in as well.

So the book, Inside the Teenage Mind, which came out late last year, is a collection of the journey through some of these issues and topics we see, that others won't necessarily have that inner information on, but now we can really hear from the people living through it. That's really what it is. It's been nice to put it together. Basically I'd just like to have a voice for these people and share what they're going through, because it's quite powerful. If they're happy and comfortable with me doing that, which most of the patients are, they really want to share this. It's really good to be able to have that wider audience than just your consult room.

Megan Walker: Amazing. Have you got a third one in the works? I'm wondering if you're going to write Inside the Neurodivergent Teenage Mind.

Andrew Leech: Well, as I was putting the neurodivergent stuff in the book, I realised, okay, this is not going to fit into one chapter. So much. Just as a little aside, I've written some articles around the missed opportunities for diagnosis and support, particularly for girls. Because the DSM criteria really sucks. It's based on boys, and so many girls are dismissed in the assessment process. I get frustrated by it, because we see that they're so obviously struggling with potential autism or ADHD, but it's just a tick box exercise. No one's grabbing onto that and helping them. So yeah, that's a whole topic.

I'm also recognising the impact of dads. We don't see them much, and I've written a few things on this. Understandably, dads might be at work, the mums come in with their child, and I feel like it's a bit of a missing piece in the story. So I would really love to share some ideas around how we support dads.

Megan Walker: Love that. Oh my goodness. You're just on fire. What great work you're doing.

Andrew Leech: Oh, I don't know. Also probably burning myself out, but yeah, it's okay.

Megan Walker: I was going to say, are you looking after yourself?

Andrew Leech: Yeah, I try to.

Megan Walker: If you could change one thing about Australia's current healthcare system, gosh, could you even think of just one? What do you think? I love what you've done there with the care consult sessions. Is there anything else like that on your radar that you think could really make a difference for healthcare in Australia?

Andrew Leech: Oh geez, there are so many. Just from a Perth perspective, the mental health support for families, especially children and adolescents, again. The mental health model is very reactive and not preventative or proactive. It's like, okay, once they reach a critical point, then they go to emergency. In between, what we do is basically just try to hold them and support them, and get the right kind of help, like psychologists. But there are so many in between who don't quite fit that model, and they do need higher level care that there's not really any support for.

We have our Child and Adolescent Mental Health Service, and that's okay, but it's very limited, and the capacity is not enough for the number of families going through a mental health crisis or difficulties. So we don't want them all ending up in ED. It's a traumatic experience. This is across all different conditions. It's so stressful to go through that process. What we're lacking is a lot more of that in-between support for them, where to send them and how to help them, so they often end up repeatedly coming back to GP just to talk it through, which is a privilege, but we need to do better for them. Public across the whole country really, mental health is underfunded, under-recognised and under-supported.

Megan Walker: Absolutely. Looking ahead, what legacy do you hope to leave from your work? Give us the rocking chair test. 99 years old, you're in the rocking chair. What do you hope will have been some of the big ones you've ticked off in your career?

Andrew Leech: Well, I guess opening the clinic was a very big decision and a massive risk. Once I was starting to see some of those things I was mentioning, I thought, I don't want to finish my career without having had a go at developing and designing my own place, and really being able to make decisions that help impact and change and innovate in general practice. So being able to do that: this clinic allows me to try things, to test the waters, to bring out new services and be the decision-maker, which is amazing. Whereas when you work in a clinic, you often are limited in what you can do. That's empowered me to try these things and to make decisions that might either work or not work, but at least I'm the one making them. And also to try and improve the lives of the patients that come in, see the gaps that are there, see how I can fill and support those gaps. So that's one thing.

The other thing is, again, talking about time. I don't think 15-minute, 10-minute, 5-minute consultations are sustainable long term. The more that is supported through Medicare funding and the way the government structures this, the less service we're providing patients. The true care comes through slowing things down, giving them time, listening to them, and being available. A lot of clinics can't survive off that model, because Medicare simply doesn't quite match that with the way they fund it. So we need to really work on that and hopefully leave patients feeling heard.

Megan Walker: Amazing. Down below are contact details where you can get Andrew's book and find out more about his work, and have a look at his website as well. What advice would you have for other clinicians, allied health specialists, who like you, maybe the you five years ago, are wanting to do things better in practice, but also start stepping out into "hey, I've got things to say to media, I've got useful things to say at conferences, I want to put a book out there." What would you say to those folks? Lessons you've learned and words of encouragement to wrap us up.

Andrew Leech: Absolutely. Just start. We feel inspired by some of the work we do, and we feel fulfilled by it. It's really rewarding. Patients are often quite happy to be involved in an article, or share their experience, because they can't get their way through the system, or they're struggling, and you can be their voice. The other side of it is medical magazines and media are crying out to hear from us. They really want to know what's happening, what challenges are there. Getting it into those platforms is what raises awareness and can lead to incredible outcomes, incredible change. It's sad to think sometimes that I have to go to the newspaper to get the government to listen about funding something. However, it has worked in the past. It gets a response. So don't feel afraid to have a go. Just start small. Local magazines or local newsletters, putting forward some of your thoughts and experiences in your role as a GP or as a healthcare worker, can go so far, and then you build from there. It's amazing how you join the dots in the end. You're like, okay, so that publication or article led on to hearing from this person, like yourself, Megan. Then that led on to meeting this person. It's just amazing how you grow and expose some of those things you're really passionate about.

Megan Walker: I often say to clients, just say yes to opportunities, because it's great practice and it's another outlet for education and information. I did want to ask you, did you ever have any hesitation about AHPRA? I know some folks say to me, oh, I better not say anything because I'm so worried about that. My encouragement is always, you can do anything, so long as it's ethical and it's not overpromising and you're not purporting or misleading. What are your thoughts around, yes, that's our body, but I'm going to do it anyway?

Andrew Leech: It's a really good question. Sometimes the things I'm putting out there are provocative or thought-provoking. So what I'd suggest is stick to evidence-based thoughts. Whatever you do put out there, keep it evidence-based. AHPRA is particularly concerned if we're pushing things that might be controversial and not evidence-based. That's a good baseline to start with. Check with your indemnity if you're worried about something you might be putting out that's a little bit on the line, or a bit grey. In general, we are independent. We are also entitled to have a voice, and share what we're experiencing as human beings ourselves, but also as advocates for our patients. I haven't had any issues across that, touch wood, so far. Hopefully others can feel that they can do that as well, and not have to worry about all the legalities of it.

Megan Walker: It's feel the fear and do the greater good anyway.

Andrew Leech: Yeah, take the plunge.

Megan Walker: Andrew, thank you so much for taking a piece out of your day to share your insights. Just congratulations. One of the things I hear in folks like yourself is starting from the heart with the mission of the work that will work for the patient. When that's the centre point, the ripple effect outwards always works. When it starts with, oh, I'm going to be $30 million richer, it doesn't have the same natural impact from what I've seen in my years of banging around promoting through missions.

Andrew Leech: Starting a clinic, I wouldn't recommend as a money-making exercise. I agree with you 100%. If I can pay the bills and be comfortable, then the rest will work itself out. We go into this with a lot of risk and a lot of nervousness. But ultimately, if you do it for the right reasons, then things will work out for you.

Megan Walker: Incredible. Thank you so much. It's been an absolute pleasure talking with you. I hope everyone listening will go and buy Andrew's books, and apply to work with you if you're in Perth.

Andrew Leech: Thanks Megan. Appreciate it. Pleasure.

Megan Walker: We'll talk to you soon. Nice to meet you.

Andrew Leech: You too. See you later.

Connect with Andrew:

Website: https://www.drandrewleech.com.au/
LinkedIn: https://www.linkedin.com/in/drandrewleech/