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The quandary of ho-ho-hospital transport

My favourite Christmas song – or rather the one whose endless shopping centre repetition I resent the least – is the 1952 American classic ‘I Saw Mommy Kissing Santa Claus’. I’m sure you know it: “Oh, what a laugh it would have been, if Daddy had only seen, Mommy kissing Santa Claus last night.” This song reminds me of the childhood journey into adulthood: waiting for Santa, and then, eventually, becoming Santa. In my professional life, maturing from medical student to novice GP to the current peppery, grey-haired variety, I used to wait for my own Santa in the form of the ambulance ... see more

Read more from Pam Rachootin

Excitement uncovered when least expected

Emotions are reasonably predictable in a GP surgery and probably reflect the GP and patient cohort. Out here in Dunedoo people are pretty steady, and I try to be too. Excitement isn’t very common in the surgery, although I do get a bit excited when we don’t have more than two or three patients waiting at a time. I get excited too when I can take a break at lunchtime and duck out and get a newspaper or return with a tasty chai latte. Patients, I would say, are rarely ‘excited’. That’s the joy of home life, when I see real ... see more

Read more from Sara Fergusson

Politics is about survival of the fittest - words

I am quite fond of misogyny. Misogyny and syphilis. You never quite know whether to write ‘y’ or ‘i’, and these spelling quirks give me an odd thrill. Just a pity neither is curable with amitriptyline. When the Macquarie Dictionary redefined the word ‘misogyny’ the week after PM Gillard threw it at Mr Abbott, I, for one, was cheering. Not for her aim, necessarily, but it’s not often that the definition of a word hits the front page (let alone an opposition leader).  Labor PMs traditionally have a higher dictionary impact factor than their Liberal counterparts. Think of Whitlam’s cur, Keating’s soufflé ... read more...

Read more from Justin Coleman

The joy of house guests, both great and small

My 85-year-old mother, who lives in Arizona, rang to let me know she was coming for a visit. I was on her bucket list. “I just hope there’s not a hole in the bucket,” she added. Not feeling confident enough to travel on her own, she enlisted the help of her landlord and his girlfriend. The two motorcycle enthusiasts, 25 years her junior, had lovingly nursed her through a previous health crisis and were agreeable escorts. Mum was never one to hang around with deadbeats. For a while it looked dicey as to whether the three of them were coming at all. ... see more

Read more from Pam Rachootin

Country communication is a sign of the times

I reckon signs may tell a lot about one’s community, but I haven’t put it to the test. It’s just that, ‘LOST: one yellow-headed sledge hammer, left outside the post office on Thursday arvo. Please return to Paul Lawry’ is not exactly what I would expect to see in Mosman. But I saw it the other day in Dunedoo. It was outside nearly every shop in town and the service station too. There is a blackboard at the service station with the name in chalk of that week’s ‘Seafood Winner’. When you spend $50 or more, your name goes in the weekly ... see more

Read more from Sara Fergusson

The semantics of disease - or whatever you call it

APPARENTLY, it is no longer acceptable to suffer from disease (or, indeed, even to suffer).The term ‘disease’, it seems, implies defectiveness, imperfection and, to put not too fine a point on it, unpleasantness, while suffering carries with it connotations of victim­hood, powerlessness, a refusal to be held accountable.Indeed, so far has disease fallen in our estimation that merely being in close proximity to it rates almost as badly as falling prey to it.A perfect illustration of the sorry depths to which disease has sunk is to be found in last year’s Diabetes Australia/AMA Victoria language position statement recommending that healthcare ... see more

Read more from Ron Elisha

A cheeky kiss for an icon but well deserved

One of my favourite aphorisms is Kierkegaard’s: “Life can only be understood backwards but it must be lived forwards.” The wisdom of this quote resonated with me again after a friend in Los Angeles emailed me the obituary of Dr Lester Breslow, the former Dean of the UCLA School of Public Health (and before that the head of California’s Department of Public Health). The sad news instantly rekindled in me the embarrassing memory of my one and only meeting with Dr Breslow, when I was a master’s student in epidemiology in the mid-1970s. I had been invited to attend a function with ... see more

Read more from Pam Rachootin

Sometimes, life is just black and white

One of my patients came in the other day and said, “Doc, I just want to lay it on the line. I’m all ruffed up: that Highway Holmes has got me again: I’ve just about had enough.” There are two things that can stop you in your tracks as you drive from your farm into or out of town. One thing is the wildlife: roos mainly, but wombats are a dead weight and pigs are on the increase. The other thing is Highway Holmes. Roos are not unique to this area but Highway Holmes certainly is. As a highway patrol officer he ... see more

Read more from Sara Fergusson

The tragedy of the lost eternal profession

NOT so long ago, medicine was seen by many as a ‘calling’ (as was nursing and, of course, the clergy). The term has its roots in the religious notion that certain folk are drawn to a particular field of endeavour by a force greater than themselves – that they are ‘called’ by the voice of God or, perhaps, by a voice from within that embodies the spirit or the soul. The endeavour in question is usually one that involves a degree of self-sacrifice or, at the very least, sequestration from the world at large, the implication being that no sane person would ... see more

Read more from Ron Elisha

Deceiving patients and defecation

IMAGINE this scene. I am interrupted by a call while consulting. A patient has just received an invitation to participate in the national bowel screening program. She is apprehensive and asks for my advice. “I completely sympathise with your suspicions. There are so many scams around these days. But this is truly a worthwhile opportunity. With all the crap that government has been dishing out lately, this is your chance to finally give some back. “I know it’s just a small sample, but think of it as honest ‘feedback’.” If that’s not exactly what I said, that is what I was thinking. How ... see more

Read more from Pam Rachootin

Leaning on the right person

NOW I am confessing, but here is exactly how the other day went. The waiting room was busy and happy as I called in my next patient. I had seen her once before in another town where I was covering once a month for their local doctor. I had to tell her she had breast cancer and then arrange her referrals. She took the news on board without a tear. She talked about how she would organise her farm animals while she had surgery and how she would organise things for her husband as “he is quite a bit older than me”. She ... read more...

Read more from Staff writers

An obsession with one’s poo

BOWEL charts are a thing of the devil. I hate even mentioning them. In fact, I won’t; let’s talk about blood glucose diaries instead. A bunch of folk just like me – but sweeter – fill in a smattering of glucose columns whenever they can, missing a few days while getting on with their lives. They diarise to please their diabetic educator, who secretly knows that the patient eventually learns to write fiction and will merely go through the motions. Which brings us straight back to bowel charts. I have a middle-aged patient – let’s call her Julie, the name and gender ... read more...

Read more from Justin Coleman

The end of cradle to grave medicine?

Recently I wrote an article for the MJA in which I explored the inescapable nexus between the falling status of doctors and the rise in violence against them.1 While I experienced an absolute flood of supportive emails (far more than for any other article I’ve ever written, and from across the spectrum – from registrars to retirees), there were one or two readers who erroneously interpreted my position as favouring the ‘God model’ of medicine, where the doctor is all-powerful and his/her judgement never questioned by the patient. This, of course, is not my position and never has been. Good doctors – and ... see more

Read more from Ron Elisha

Life is a banquet of good bites

ONE has to make allowances, I told myself. But then again, there comes a time of reckoning. And this was it. Tony and I were about to discuss his less-than-perfect cholesterol results. I took out my one-page summary of dietary recommendations. “Do you have skim milk?” “We have it in the house.” That was an evasive answer if ever I’d heard one. “Do you drink it?” I asked point blank. He hesitated. I decided to change tactics and ask about his intake of forbidden foods. “Do you use butter?” “Yes.” “And cheese?” “Naturally.” “Coconut milk?” “All the time in my curries.” “And what about pies?” During the silence that followed I realised how stupid ... see more

Read more from Pam Rachootin

Busting out for God

WHEN last we bumped into Sister Mary Ignatius Blogg, she had just been commenced on the Pill. As if this in itself were not pressure enough on Vatican II, imagine my surprise when she presented with the following request: “Doc, I want a boob job.” I beg your pardon? “These babies. I want them toned and perky.” She pointed in the general direction of the massive, shapeless habit that camouflaged her tiny frame. I hardly think anyone’s going to notice. “It’s for him.” My eyes panned slowly upward. You mean..? “No – not Him! Nigel.” Who is Nigel? “He’s the one paying for this extravaganza.” She leaned forward, a ... see more

Read more from Ron Elisha

Luck has everything to do with it. Doesn’t it?

WHEN Lucy received the diagnosis every woman fears, she was told, “You have the very best kind of breast cancer. You have ductal carcinoma-in-situ (DCIS). It’s non-invasive. If we treat it early your prognosis is very good.” Months later, after multiple breast surgeries to excise the lucky cancer, Lucy found that she couldn’t straighten her elbow and it hurt to turn over in bed. In the bath one evening she found her knee swollen like a dumpy doughnut. She attended a rheumatologist. From her family history and a number of blood tests, he diagnosed psoriatic polyarthropathy. “You have the very best kind of ... see more

Read more from Pam Rachootin

A book, a doctor and a few lessons from the past

I NEVER liked studying history. Too much happened, and I wasn’t even there. My teacher was a lovely bloke, but had a marked stammer. He was always repeating himself – not unlike history itself, come to think of it. Years later I met him again as a patient, which is always an odd transposition. That disconcerting feeling that you should be calling him ‘sir’ instead of poking his belly. I told him if he didn’t relate a concise set of symptoms I’d write in the notes, ‘a poor historian’. He thought I hadn’t grown up much. History is on my mind, because I recently started ... read more...

Read more from Justin Coleman

Without CPI, how would doctors afford to eat?

THE following is a transcript of a recent interview with the new health minister, Tanya Plibersek: Ms Plibersek, why isn’t the Medicare rebate fully indexed? Isn’t it? No. I thought it was. It isn’t. Are you sure? Absolutely. No, you must be wrong. Eighty per cent of GP consults are bulk billed. Why would GPs do that if the rebate weren’t fully indexed? Social conscience? Social conscience. Yes. Is that like... something to do with the internet? That’s social network. Oh... Is that not the same thing? Not exactly, no. That’s conscience with a ‘c’? Capital, yes. Conscience... Who knew? Anyway, never mind all that. I’m sure all this indexation nonsense is taken care of. It’s not, actually. The ... see more

Read more from Ron Elisha

Trying to be more than just a referral service

BEING a GP gives one an opportunity to experience rejection on a daily basis. Consider the patient who plops down and informs you: “I just need a referral to a psychologist.” You look at your notes. She last attended your surgery a few years ago. You probe further and hear that she “needs to talk to someone”. You feel like waving your hands and saying: “What about me? I’m someone – or at least, I used to be someone.” You take a quick survey of your body: upper limbs, trunk, lower limbs, all accounted for. You confirm that you are a definite ... see more

Read more from Pam Rachootin

A shaky return to the old stomping ground

THESE summer holidays I paid a return visit to God’s waiting room. Nothing much had changed. After seven years without me, a pleasing proportion of my elderly former patients had still not had their number called. Must be the sea air. For six years I co-owned a practice in 3225, the postcode with more over-65 Victorians than any other, even including the Gold Coast. The town sleeps in the middle of the ABC’s SeaChange country but, unlike magistrate Laura Gibson, most folk wait until retirement to make their move. Seems they’re fine with the ... read more...

Read more from Justin Coleman

The nun’s story – walking a religious minefield

A FEW Fridays back, I found myself required to make one of those difficult calls that, more and more, seem to comprise the bread and butter of general practice. “Sorry to bother you, Doctor. I know how busy you are.” It was Sister Blogg, a member of the Order of the Little Company of Prudence. She seemed ill at ease, her face colouring up with a combination of communion wine and embarrassment. “I want to go on the pill.” I searched her serene visage for signs of either humour or acne, but found neither. “Who’s the lucky guy?” was what I was tempted to ask, ... see more

Read more from Ron Elisha

Will culture one day replace antibiotics?

ACCORDING to Texan researchers at the American College of Gastroenterology’s 76th Annual Scientific Meeting in Washington DC, playing Mozart while performing colonoscopies improves the adenoma detection rate. A randomised controlled study using two experienced endoscopists and comparing Mozart to no music at all, found that the adenoma detection rate in the blinded endoscopist rose from 21% to 66%, whilst the figures for the unblinded endoscopist were 27% and 36% respectively. These statistics throw up several rather troubling questions that the meeting seems to have failed to address: 1. Two-thirds of colons contain adenomata! Surely this renders them a normal variant. 2. Our most trusted ... see more

Read more from Ron Elisha

Could you summarise your life in only six words?

WITH everyone feeling time pressure, I was intrigued by the concept of a book of six-word memoirs. Written by the famous and the unknown, they were utterly entertaining, sometimes quite poignant, at other times humorous, often reflected shortcomings, and definitely suited my attention span.  Their brevity undoubtedly would appeal to many postmodern readers.  Most amazing was how a few well-chosen words could reveal so much about an individual. So I thought it would be fun to ask my friends and family how they would summarise their lives in six words. A disabled family member wrote: “Active life, then it all stopped.” A friend who miraculously ... see more

Read more from Pam Rachootin

Chiropractors: living in an alternative reality

LAST year, the Chiropractic Council of NSW dismissed a complaint against chiropractor Nimrod Weiner, who had given a two-hour public lecture on the dangers of vaccination, thereafter posting an audio of the lecture on his website. In it, he claimed that cot death (SIDS) was ‘in many cases, vaccination death’.  In the same lecture, however, he neglected to point out that the rate of SIDS had fallen dramatically over the past decade, despite a sharp rise in the immunisation rate and, indeed, the sheer number of vaccines made available over the same period. He also failed to allude to the disappearance off the ... see more

Read more from Ron Elisha

When kids swallow the darndest things...

I RECEIVED a frantic call in the afternoon.Mum had been driving while Chloe was licking a lollipop in the car. On arrival at their destination, no lollipop stick could be found despite repeated searches.“She must have swallowed it,” Mum told me.“What should I do?”“How is she?”“Fine.”My alarm bells weren’t ringing even after the incident triggered a long-forgotten memory. Wasn’t there a dire prophesy about an old lady who swallowed a fly?“Well, I really think you would have heard some sounds of distress. I don’t think that she silently swallowed the stick.”“That’s what my mother said, too, when I told her.”“Why don’t ... see more

Read more from Pam Rachootin

Why fashion matters in general practice

AN 18-year-old patient saw me at the local car boot sale. I was in casual clothes – namely my wild, multicoloured tulip-print pants from the op shop. The following week the girl’s mother presented to the surgery. “My daughter told me to tell you that she thinks you’re a funky lady. And she wants dibs on your clothes if you are ever having a chuck-out.”“Wow,” I replied. “To think a teenager would want to wear clothes from her 58-year-old GP.”“And if you’re not having a chuck-out soon, she’d like you to put her in your will.”That silenced me.“I’ve already told her ... see more

Read more from Pam Rachootin

A great leap backwards for the busy GP

I HAVE always been intrigued by time travel, if a bit sceptical. Then I stumbled on a hidden truth – it really is possible to go back in time. When you squeeze as much as I do into your morning before work, you just might discover something significant before breakfast.I’m not exactly sure why the cosmos has chosen me to reveal this precious treasure. Maybe it had something to do with a power outage on a sizzling summer’s day, or it was the change from daylight saving time? Perhaps someone fumbled when setting the alarm clock. Whatever the reason, something ... see more

Read more from Pam Rachootin

The virtual reality in e-health

THERE’S widespread concern that patients will have control of their own soon-to-be-introduced e-health records, with the ability to add and delete as they see fit. If my own experiences during an e-health record pilot program are anything to go by, such concerns are well-founded.Mrs Blogg, a lumpy 50-year-old, enters and I upload her record.It says here that you have a Master’s in Rocket Science.“I was always interested in space. My uncle Nigel had a dog that was third in line to go into orbit on Mercury 3, but he was kennelled with a mutt who contracted the mange, and that ... see more

Read more from Ron Elisha

Symptoms? Heck, I’m not sick, I just want tests

“ONCE a day or maybe twice a day, I can’t really describe it, but my ear burps. Have you ever heard that symptom before?”“No.”“Or maybe it’s more like a sigh. My ear sighs.”I remain silent, suppressing the overwhelming urge to break into my impersonation of a hyena.“Then again, it might be described as a fart.”My self-control is waning. I have to say something to relieve the build-up of pressure now nearing the exploding point. So I blurt out: “Maybe it’s a fart that has been redirected.” “Hmm... yes, redirected...” I can see that he is seriously considering this possibility. “It’s a weird feeling,” ... see more

Read more from Pam Rachootin

Making it click and painless

IN HIS 2006 movie Click, Adam Sandler plays Michael Newman, a workaholic who comes across a ‘universal remote’ that allows him, with a simple click, to fast forward the unpleasant bits of his life. Ultimately, of course, in the inescapable tradition made famous by Frank Capra, Newman comes a cropper, realising there is no gain without pain.Fast forward to the offices of the TGA, wherein a device bearing an uncanny resemblance to the universal remote is being given the bureaucratic stamp of approval.With names lifted straight from the pages of a Superman comic, the Nervoscope and the Activator are devices that ... see more

Read more from Ron Elisha

The trials and tribulations of a GP’s life

ONE feels time galloping along when filling out a patient’s driver examination form and realising that you have been treating the person for more than two decades.“Yes, I was one of your first, right after Polly,” the patient confirmed.We reminisced and I had to chuckle to myself. Polly was still my patient, too.When I first met Polly, as a new GP, I remember thinking, “How am I ever going to provide the healthcare of a 72-year-old?”I didn’t realise that once you’ve made it to your 70s, you were already a survivor. Now Polly is 94, and things are just starting ... see more

Read more from Pam Rachootin

When Christmas and Hanukkah come early

PROSTATE screening uncovered an elevated PSA in one of my patients. He attended again some time in September. I explained that I had better do a rectal exam. He reminded me he usually had that test around Christmas. “Well, just think of it as though Christmas has come early this year,” I said.And this year, Hanukkah – the Jewish holiday that celebrates a miracle – came early, too. That same week in September, another patient, a male in his early 40s, presented with a 24-hour history of abdominal pain. He was tender in the left lower quadrant. He probably just had ... see more

Read more from Pam Rachootin

Escaping can be as easy as playing with clay

LAST year I wrote a serious article in Australian Family Physician about how the pursuit of creative endeavours could reinvigorate doctors. The resounding silence after the publication of that piece convinced me of one thing: I’d have to do it alone.But where does one start? I needed guidance. I found it in the most convenient of places: my surgery. My patients had lots of advice about how to get involved in the arts.One of my patients told me about an IT-based adult education program that she attended. So I signed up for a course in Photoshop.Although the main thing I learned ... see more

Read more from Pam Rachootin

Heart disease and me

I NEVER met my father-in-law. He had his first major myocardial infarct in his mid-thirties and was dead by age 57. But he had a big influence on me. And that effect has rippled through time, helping me to avert cardiac catastrophes in my family, as well as in my patients.In the early years of my marriage I wrote this poem:Genetics…I liked you well enough then — When I got the proper ratios. It was a numbers game, A monk, playing with sweet peas.But I grew to dislike you… Spending nights in the laboratory, Waiting for flies to breed and hatch,  breed and ... see more

Read more from Pam Rachootin

How to take rejection well

“DON’T take it personally.” That was the best take-home message for me from a full-day seminar on Clinical Controversies.The psychiatrist who gave this advice was speaking about the treatment of patients with borderline personality disorder. To paraphrase him, the patient may succeed in driving you nuts during a 15-minute consultation, but think of how hard it is for such a person to live with themselves 24 /7.I’ve expanded the recommendation; I find this approach most helpful in dealing with patients who seek my help reluctantly.They attend the surgery after failed treatment following their normal ... see more

Read more from Pam Rachootin

Doubling up with laughter in the midst of it all

OH, HOW I relish a playful spirit that lifts everyone’s mood, even in the midst of daunting times.A patient presented with sudden onset of double vision. I suspected a stroke and called an ambulance, which arrived several minutes later. The patient’s wife was impressed that three ambulance officers attended to deal with the emergency. “Well, I’m even more impressed,” my patient said. “I see six.”Another day, another presentation. A woman with infertility was explaining her history to me. “I have the motherf---er gene.”When I appeared nonplussed, she said: “MTHFR polymorphism.”At last I had a way to remember ... see more

Read more from Pam Rachootin

Here’s some serious advice

I grew up reading the advice column ‘Dear Abby’ in the Los Angeles Times. I liked the idea that one could forge a career in dispensing common sense. Mum tried to capitalise on my fascination for potted wisdom and gave me Abby’s guide to being a proper teenager.  If you asked Mum today whether the gift changed me for the better, she would wet herself laughing. Actually, she might do this anyway, but now I find myself regularly advising people on how to live the exemplary life.  I’m no Abby, but, like her, I prefer ... see more

Read more from Pam Rachootin

Constipation crises bring a family even closer

How can one ever quite forget those creamy, sweet-smelling, ochre-coloured faeces squirting out of her cloth nappy, up her torso?But alas, a mother’s occasional nostalgia, innocently shared, is taken by my ageing overseas relatives as an enduring interest in their personal plumbing adventures. In the space of a single week, three of them independently down stools and go out on a general dunny strike. I awake to detailed email accounts, which I call The Daily Loos, or Loos of the World.Uncle long ago abandoned eating and now gets his main caloric input ... see more

Read more from Pam Rachootin

The weight keeps piling on GPs’ shoulders

I’M fascinated by bird life in Australia, but, alas, I’ve never encountered the mythical Phoo bird. Apparently, it’s very much revered by a certain tribe in Africa. So much so, as superstition goes, that if a tribesman is hit by the droppings of the Phoo bird, he must not clean them off, for to do so would result in instant death.A foreign aid volunteer came to work with the villagers and wanted to rid them of their superstition. He purposely ventured into the mountainous area that comprised the Phoo bird’s habitat and waited for the ... see more

Read more from Pam Rachootin

Wake-up call or just another false alarm?

EVERY writer knows that clichés should be avoided like the plague, but unfortunately the lesson has been lost on some medicos.I was diagnosed with thyroid cancer 16 years ago. Needless to say, I was scared stiff. I thought I was ready to kick the bucket. But one of my doctors at the time, weighing up all the facts of the case, said: “You might as well worry about being run over by a bus.”Don’t get me wrong, I understand that he was trying to set my mind at ease. Let me tell you, that comment backfired. ... see more

Read more from Pam Rachootin

Making the pro ranks of the impossible sport

AS ONE of those new, multicultural Australians you hear so much about these days, I have tried my best to fit in. Shortly after my arrival in 1982, I realised that everyone was expected to be consumed by their love of at least one spectator sport. I have sampled them all, but could get passionate only about the game of gladiatorial politics.Really, how do they do it? Week after week, wrestling with the art of the possible? Take a position. Take a revised position. Scrap the revised position. Resume the scrapped, revised position. Then ... see more

Read more from Pam Rachootin

Tasked with breaking up the profession

JULIAN Assange isn’t the only one who can release WikiLeaks. Now it’s my turn. From sources deep within a secret taskforce set up by the Australian Health Minister, I have received the following:Minister,In order to nurture a more competitive service environment, we recommend you consider breaking up the biggest national healthcare monopoly. Doctors think that they have cornered the market on diseases. They talk as though only they can diagnose and treat illnesses competently. They need to be reminded that their role is a privilege bestowed by Government. It is not an ... see more

Read more from Pam Rachootin

Tripping off the tongue – or over the tongue?

SOMETIMES the art of medicine includes mind-reading, especially when patients confuse medical terminology. Fortunately, I enjoy the challenge of free association.A father-to-be visits and I ask about his pregnant wife. He advises me that “she is 18 weeks’ digestion”. His slip of the tongue has given me food for thought. Is his wife suffering indigestion? Or is he more worried the primary cook in the family may become less dependable? Yes, 18 weeks’ digestion conveys a lot of meaning to me about the couple.Concerning a blood test, I’m asked: “How was my homo­goblins?” Now this was a ... see more

Read more from Pam Rachootin

Capturing life and love moment by moment

NO-ONE has ever made me laugh more than my brother, Sam. Even in the bleakest moments.Even when my mother lay critically ill in intensive care, Sam got me to laugh at my gullible self. When I heard a heavily accented voice introduce himself as my mother’s doctor on the phone, I listened intently for news of her condition.“Vell, there are tubes going in and tubes going out.” “Pardon?” I replied. The explanation came again.A moment’s silence and then I got it and exploded into laughter at Sam’s attempt at impersonation.That was just before absolute tragedy struck the ... see more

Read more from Pam Rachootin

Why it’s worth your salt to read the fine print

I WAS surprised by the blood pressure reading: 150/100. How could this skinny, exercising, diet-conscious teetotaller have hypertension? Perhaps another case of white coat syndrome? But I could think of a few reasons why that was not a rational explanation. First, there was not a white coat in sight. Second, the patient was someone who was very comfortable in a clinical environment – me. And third, the real clincher: I was taking my own blood pressure. Hmmm. I began to curse those risk factors beyond my control. There was genetics. Yes, it is always comforting to have one’s parents to ... see more

Read more from Pam Rachootin

Sometimes surrender is the right choice

WHEN I learned that Edith had died in hospital, it got me to do some serious soul-searching. She had been an inpatient for five months. We used to joke that Edith was as resilient as a jack-in-thebox. No matter how many episodes of serious illness pushed her down, somehow she always sprang back. Her optimism and love of life helped her to overlook the sad state of her bodily affairs. Indeed, I do not think that many would have the grace to accept the degree of morbidity that she did, without complaint. She was independent and fiercely so, but began to ... see more

Read more from Pam Rachootin

So many darned cockroaches, so little time

WHEN my mum wakes up in the middle of the night, she knows better than to lie in bed tormenting herself about her inability to get back to sleep. She understands that at the age of 84 it is important to make use of all of her remaining time. That’s why she jumps up and goes on a scouting expedition, her nightly cockroach hunt in the shed.There has been a roach epidemic of late in the US Wild West, where she lives. She has found that nocturnal forays can destroy a dozen or more of ... see more

Read more from Pam Rachootin

Pathologists: the elites of the medical world

I SWEAR that I haven’t used illegal phone tapping to break this story. I can prove it, too. Because the fact is, it has been known for years that there is a crisis in the pathologist workforce. But what are we going to do about it? Their demographics are as bad as ours. I worry too many of them may retire before I do.Have you ever considered how inconvenient it’d be to practise medicine without having access to reputable pathology testing? Although it doesn’t seem to be a problem for a lot of the alternative folk out there, ... see more

Read more from Pam Rachootin

A work-shy lifestyle is a full-time job these days

BEING poor in Australia just got a whole lot more complicated. Like most things in the 21st century, poverty has become far more competitive. The bar that defines what used to be described as ‘the bread line’ has been raised to the point where it now converges on the patisserie. There’s even talk of yet another TV reality show – Australian Idle – in which the country’s young and shiftless display their prowess in exploiting the many and varied services now available to the New Indigent. The hi-tech requirements demanded of the modern vagrant ensure that ... see more

Read more from Ron Elisha

Giving patients the odds can be a risk in itself

PEOPLE misunderstand the concept of risk. And nowhere is that more dangerous than when navigating the cancer minefield.I know one fellow who initially decided against having a skin lesion excised when the dermatologist informed him that there was a 45% risk of it being a melanoma. The patient figured that since the odds were in his favour, why go ahead with what was most likely unnecessary surgery?It took some convincing to turn him around. Now I do not wish cancer on anybody, but in this case, after our protracted discussions, I admit that ... see more

Read more from Pam Rachootin

Being human with all of its many conditions

IT WAS one of those days...I had convinced a patient to immunise his family for a trip to South-East Asia, despite the travel agent telling him that no immunisations were required. “No immunisations are mandatory for getting back into Australia,” I explained, “but that isn’t the same thing as giving yourself protection from serious infections common in the developing world.”Reluctantly he accepted scripts for the vaccines. I thought my mission was accomplished, but then he arrived back without all of the vaccines I had prescribed.“Well, I decided I didn’t want the flu vaccine because I never get the flu, and then ... see more

Read more from Pam Rachootin

Running around in circles to lose weight

I AM very direct with patients lately. “What are you doing about your weight?” I ask. I’ve received responses that vary from the defensive to the absurd. Probably the most frequent response is, “I’ve joined the gym.” Hardly anyone ever tells me, “I go to the gym.” Apparently, handing over one’s credit card is about as close to exercising as one can hope to come these days. “At least I’m not depressed anymore,” one patient replied. I think that implies that I should be thankful that one of her problems is under control. Maybe there is a hint of a threat here too. If ... see more

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Constipation crises bring a family even closer

AS A new, breastfeeding mother, I was preoccupied with the digestive functions of my infant daughter. How can one ever quite forget those creamy, sweet-smelling, ochre-coloured faeces squirting out of her cloth nappy, up her torso?But alas, a mother’s occasional nostalgia, innocently shared, is taken by my ageing overseas relatives as an enduring interest in their personal plumbing adventures. In the space of a single week, three of them independently down stools and go out on a general dunny strike. I awake to detailed email accounts, which I call The Daily Loos, or Loos of the World.Uncle long ago abandoned eating ... see more

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Here’s some serious advice

I grew up reading the advice column ‘Dear Abby’ in the Los Angeles Times. I liked the idea that one could forge a career in dispensing common sense. Mum tried to capitalise on my fascination for potted wisdom and gave me Abby’s guide to being a proper teenager.  If you asked Mum today whether the gift changed me for the better, she would wet herself laughing. Actually, she might do this anyway, but now I find myself regularly advising people on how to live the exemplary life.  I’m no Abby, but, like her, I prefer dishing it out to taking it.Dear ... see more

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St Nic’s lateral thinking a gift for GPs this Christmas

It’s the holiday season again and the little elves in Canberra are scurrying about to ensure it will be a memorable one. Saint Nicola is busy practising her “Ho, ho, hos”. What goodies will she have in store for GPs this year?She has already given us an appetiser with her pre-Christmas bonus. Who wouldn’t be excited by a 60 cent increase in a Level B consult? The air is heavy with anticipation.The RACGP has filled us with squeals of delight with its announcement of another triennium of requirements, heralded by a new abbreviation: QI. First I tried to guess its meaning. ... see more

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How to make pathology user friendly

GROWING up, my brothers and I explored new worlds, peering down a brass microscope. We were thrilled to examine the wing of a fly, a fragment of leaf or the life teeming within a drop of pond water.So I can understand the enthusiasm that awaits newcomers to the discovery of the microscopic world. What I can’t understand is how to deal with the increasing number of patients who are duped by ‘live blood analysis’.They almost swoon telling me about the projected images of their very own blood cells. A running commentary is supplied along with amazing revelations regarding, among other ... see more

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Slices of life never go stale

I PRACTISE resuscitation regularly. When broccoli goes limp, I cut off a section of withered stalk, stand the head in a dish of iced water and watch the transformation. Likewise, I recycle. I can whip up a yummy pudding or stuffing from stale bread. Even more wonders are found in my daily work as a GP.Medical practice provides a window on life, with many rejuvenating interactions worth sharing.Starting in the formative years, students come to appreciate the art of satire and double entendre.A colleague told me that during anatomy class the female instructor pointed to a specimen and asked a ... see more

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For solo GPs, the days are numbered

IF you think the RACGP was being nasty when it tried to punish half the GPs in Australia for not being fellows, claiming that only fellows deserved to be recognised as medical specialists, think again. The RACGP has nothing in mind but our welfare. It is actively planning for our future, and particularly the future of solo GPs. Rumour has it that a special committee of the college has been meeting in secret. Its purpose is to find a taxidermist to stuff the last remaining solo GP in Australia.Not that solo GPs haven’t already been ... see more

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Convenience has become the new urgency

WHEN I graduated, just over a third of a century ago, sessional locums were a dime a dozen.Because of the laws of supply and demand, therefore, the lowly locum was expected to do whatever he or she was told to do. If the practice principal worked an eight-day week without a receptionist, then so did we. The patients expected it. Everyone expected it. A certain level of service. Over the years, I’ve watched this level of service drop, inexorably and irretrievably, often in inverse proportion to the degree of documentation accompanying said service. Some years ago, I was chastised by the director of nursing at ... see more

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Nightmares of the future

Nicola, Nicola, Nicola. I wish you could experience my nightmares reliving some of the scariest moments I’ve had as a doctor. What wakes me up in a night sweat isn’t scenes of blood gushing out of arteries, or patients collapsing onto the floor. The most frightening patient encounters I’ve had looked completely banal. Only a subtle hint led me to the correct diagnosis. Only years of training in medical school made the difference between saving a life or not. Come along with me, then, during my first week as a GP, in 1989. A woman presents with a sore finger. A suitcase ... see more

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An ‘add verse’ reaction to general practice

THE Health Minister has declared that GP consults are so basic they need to be reduced to a simple formula. She has chosen a literary one, so that any graduate with an arts degree will be able to participate in what is now being billed as the “GP De-evolution Revolution”. Consults will neither be time- nor complexity-based. All consults will be paid by the syllable, so long as they are restricted to 17. As a further concession to reducing red tape, the Minister has chosen the haiku and its eloquent three-line format of five, seven and five syllables. The adoption of this ancient Japanese ... see more

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Lost tribe needs to find its voice... and fast

DOCTORS are a contradictory lot. Here we have a group of people who have been certified by an independent body to fall within the highest 0.001% bracket of intellectual capability, a group renowned for its mavericks and rugged individualists, a group that boasts amongst its ranks that most formidably arrogant creation: the surgeon. And yet, when it comes to dealing with government, we find ourselves reduced to a bunch of snivelling, grovelling, ineffectual, bickering, naïve, apathetic, cap-in-hand supplicants who couldn’t industrially muscle our way out of a colostomy bag. We are the lepers of the 21st century – loathed by all, feared by ... see more

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Someone is telling porkies about one consent form

THE Government has organised a game of hand-waving charades, and we GPs have been enlisted as key players. The swine flu form looks like informed consent, and sounds like informed consent, but is it really informed consent? I think that someone is telling porkies. Initially I didn’t have a problem selling the vaccine intervention to pregnant women. I had feasted on the information meant for distribution to patients, which left me with a feeling reminiscent of definitive advice. But then I happened upon the actual product-information statement, and I realised I’d been ingesting swill: “The safety of the vaccine in pregnant women ... see more

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When the means justifies the end

AS both a playwright and screenwriter, I am acutely aware of the fact that the vast majority of dramatic premises, no matter how promising, are badly let down by their endings. The question, of course, is why? Why is it that experienced, articulate, insightful and otherwise highly skilled writers seem utterly incapable of formulating satisfactory endings to their dramatic journeys? The answer to this question is a hybrid – a combination of the Eureka Syndrome and the Hollywood Syndrome. Sufferers of the Eureka Syndrome are gripped by the power of a conceit so utterly beguiling and original that they feel impelled to commit it ... see more

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’Tis the season to be bitter

ONE of my readers has suggested I am becoming bitter and twisted. He liked me better when I was “just twisted”. I cannot tell you how much my husband has delighted in this comment. He now routinely refers to me as “B & T”. Well, yours truly, B & T, has just been invited by her editor to disprove the allegation by writing this Christmas Humerus column – the last of the year.If there is one thing we all know, preparations for Christmas must start well in advance. So I am actually writing these words on Halloween, and pondering whether this ... see more

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The new liquid gold

MOST filmgoers, watching Dr Strangelove, will deduce that when General Jack D. Ripper expounds on the subject of “precious bodily fluids” he is referring to semen. As GPs, however, we know that the most precious of such fluids is unarguably urine. No other bodily excrescence is treated with the same degree of respect accorded to this liquid gold by the average patient. Which brings to me yet another law of behavioural physics, Elisha’s Law of Contaminatory Probability: “The likelihood that a urine specimen will have leaked from its container from the time it leaves its body cavity of origin to the time ... see more

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The fight or flight dilemma

I HAVE a mug depicting a gaggle of Canadian geese. One is spreading its wings. It reminds me of my daughter, who has been living in Canada. I like to drink from the mug when I am missing her. I like to think that my Canadian goose is preparing to make the long flight home to Australia. Meanwhile, she has been granted permanent residency there. I didn’t think she would get permission to stay, but my daughter was optimistic. “I’ve researched this thoroughly,” she told me. “They grant visas on compassionate grounds, and I’m in love.” I thought she was confusing passion (for her Canadian ... see more

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No substitute for experience

THIS message comes to you from the cockpit of Flight 10997. A mere three hours ago, there was nothing to differentiate this flight from any other. A brand new jet heading into a brand new day. What we didn’t know at the time of take-off was that the airline had chosen to limit the flight crew to one junior pilot and a work experience Year 10 student by the name of Nadine. Staff shortages were cited at the time, but the one thing that nobody knew was that the junior pilot was 28 weeks pregnant. The first indication that something was amiss was ... see more

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Surviving the toughest competition in town

SOME people climb Mount Everest, others ski across Antarctica, but I get my thrills from another sport that is just as challenging. In this age of hospital avoidance, my endurance event is getting someone admitted to hospital. It takes guts. It takes perseverance. It takes a positive mental attitude. These are merely the attributes required of your patient – while to you, as trainer, coach, coxswain and jockey, falls the truly superhuman. Gaining a coveted hospital bed is a real team effort. Now the Government would have you believe that it is a personal failure on the part of the GP if ... see more

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Divide and conquer – the new VR debate

VARIOUS arms of the medical profession have made recent calls for the setting up of a violence register. In anticipation of tough new requirements, exponents of violence throughout the community are incensed, not to say enraged. “It’s going to drive a wedge right down the middle of the community,” warned an irate Mr Blogg, presently serving eight years for aggravated assault. “It’s what the Government does best – divide and conquer. So now there’s a situation where you have VR (Violence Registered) and non-VR attackers. “Already, here in the prison community, we can see VR inmates receiving special treatment. Iced VoVos for morning tea ... see more

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In relative terms, visiting rights are a minefield

MY mother knows how to lay on a guilt trip. First she calls up from Arizona for medical advice. “I don’t want to worry you, but I just took my blood pressure and it is 190/110.” I ask her to lie down and repeat the measurement in 10 minutes. It goes down to 80/60. For the next few days I get calls with wildly fluctuating readings. “Are you upset over anything?” I ask. She doesn’t speak the words, but I know the meaning of her silence. “My children never visit me.” This is an exaggeration. Both of my brothers were at her bedside in intensive ... see more

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The performing art of target practice

IT is June 2010. Patient registration and fee-for-performance targets are a reality. The hapless Mr Blogg has been called in. Mr Blogg, how are you? “Well, I...” Mr Blogg, I’m not going to beat around the bush – we’re going to have to let you go. “But... I just got here.” You’ve been given three warnings, and your HbA1c is still 8.3 per cent. Don’t you care how fat you get? “Fat? No, no – this is all muscle.” He slaps his stomach, sending fat waves coursing through his corpulent frame. Mr Blogg – you’re letting the team down. We get nothing for keeping you on, which means less for ... see more

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Designs on assembly-line care

IF you want improved healthcare for less money, get rid of the 20% of health and support personnel who work against the other 80% delivering services. Flashback to earlier this month: the patient before me was very sick. I knew her history well. I had a gut feeling as she walked through the surgery door, panting, that she might have pulmonary embolism (PE), on top of hepatitis. I rang the pathology service that was accumulating her abnormal lab results and chatted with one of their consultants. He independently settled on the same diagnosis: possible PE. I called for an ambulance, stating I was ... see more

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When advertising should really be a hard sell

SOME months ago in this column, I warned that in running courses in so-called “alternative, mind-body” therapies, the RACGP had taken its first, dangerous steps in lending credibility to non-scientific practices. Letters of righteous indignation flooded into Medical Observer, only to be undermined by the college’s own actions. For it seems that the RACGP’s flagship journal, Australian Family Physician (AFP) took full-page advertisements from The Way To Happiness program, brainchild of L. Ron Hubbard, who penned a pamphlet of the same name in 1980 as a propaganda tool for the Church of Scientology. For those of you who find mind-body therapies a ... see more

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Why it’s impossible to expect the unexpected

I HAVE been showing disturbing signs of post-dogmatic stress disorder (PDSD). GPs appear particularly susceptible. Symptoms include anguish and confusion. GPs with PDSD may be seen muttering to themselves as they attempt to reconcile conflicting messages. No matter how much training, one’s competence is always in question, and one represents a potential danger to the public. At the same time, virtually anybody else without training can do your job safely because it is so basic. As I descended further into PDSD, my consults began drifting towards addressing my own needs. Patients became supportive, seeking to reassure me. One confided that he was baffled ... see more

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Blind luck: some GPs are just born with it

WE all know about the science and the art of medicine. Most of us even know about the spirit of medicine. But few practitioners can discourse authoritatively on the pure blind luck of medicine. This is a highly technical sub-specialty, in which I hold a mail-order doctorate. I recently had a patient with recurrent bouts of fever, vomiting, cough and diarrhoea. The symptoms were severe enough to require hospitalisation. He had recently been to a third-world destination, exposed to, among other things, a gaggle of geese. There was the possibility of an exotic infection. I got advice from a gargle of microbiologists, and ... see more

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A numbers game that doesn’t add up – bar none

RECENTLY, I was sent a feedback form comparing my prescribing habits with those of my peers. According to the bar graphs enclosed, I’m prescribing about five times more clopidogrel than my colleagues. This would seem to suggest I’m prescribing blood-thinners in a profligate manner. Which is odd, inasmuch as each and every prescription for clopidogrel has been written in strict accordance with the wording of the authority. Indeed, half the time, the patient has come out of hospital already on the drug. The explanation for this extraordinary divergence in figures is in fact quite simple: my patients are old. The proportion of my ... see more

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A case for being at odds with informed consent

A PATIENT told me of a recent experience she had in hospital the night before undergoing surgery. A young, tanned, ridiculously handsome anaesthetist – who looked for all the world as if he were fresh from a stint on Australian Idol – visited for a pre-op check. As it turned out, he was one of these new-age, touchy-feely doctors, whose every dulcetly-delivered word oozed care and concern. Slowly, methodically, over a span of about 45 minutes, he informed the patient, in excruciatingly caring detail, of every conceivable thing that could possibly go wrong during surgery (with the possible exclusion of earthquake), as well ... see more

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Escaping into medicine

MY editor has called to say that we need a Humerus column on the subject of doctors with a creative side. Which is really creepy, because I also had a call from the editor of Thespian Weekly asking me to do a column on playwrights with an unimaginative side. “Nothing personal,” she is quick to reassure me. “But it must be wonderful to have that release valve. “What with all the pressures on dramatists these days to conform to the dictates of political correctness, not to mention the frustrations of rampant nepotism and the indignities of ignorant, self-serving criticism, it must be such ... see more

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A shock to the system

JUST this week, I received a letter from one of the corporates inviting me to join its illustrious ranks. Enclosed with the letter was a large, glossy booklet illustrating what I’d be missing out on if I persisted in the deluded pursuit of individualised medical care. Across a full, heavily glossed double page was a scene straight out of a Fritz Lang film. Dwarfed by lofty cathedral ceilings, flanked by imposing banks of computer hardware and separated by vast tracts of synthetic carpet, desolate clusters of nameless patients sat in their identical, modular plastic chairs, awaiting their respective therapeutic Godots. The massive, dehumanised, barn-like ... see more

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The only fear of old age is fear itself

CHRONOPHOBIA (fear of old age) – once a relatively uncommon condition – has reached epidemic proportions since the advent of the Rudd Government. Interestingly though, the nature of the condition itself has altered somewhat with a change in the political landscape. In years gone by, the chief fear expressed by sufferers was an abject terror of becoming indistinguishable from John Howard, with disability, loneliness and death a distant second, third and fourth. In these Ruddy times, however, the chief preoccupation of the chronophobe is with loss of continuity. “It’s these damned super clinics!” opined one centenarian. “Over six visits, you see six different doctors, ... see more

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First, do no harm to oneself

THE bizarre logic of life never ceases to amaze me. Virtually every week, in the medical press, we read articles, letters and discussion papers on how to handle difficult patients, aggressive patients, heartsink patients, patients who simply drive you nuts. Consequently, every week, one fully expects to open one’s Medical Observer and read the headline 'Doctor stabs patient'. And yet, without fail and with sickening regularity, precisely the reverse is true. Week after unsettling week, it is the patients who are doing all the stabbing. But why? What gives patients the right to engage in all the provocation and all the stabbing? Surely it should be ... see more

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Medical experiences to try before you die

IN this age of ticking off things to do before you perish (trendy destinations to visit, must-read books, music essentials, tantalising food sensations, and the top celebrity sexual partners), no-one has yet published a list of “to-die-for” medical experiences. Now I’m not suggesting that everyone should rush off for a bone marrow transplant. Some medical experiences definitely suck. But other adventures on the wrong end of a needle can add new dimensions to life. In my view, one should not depart planet Earth without living through at least one major health setback. In particular, a genuine life-threatening illness is to be cherished. ... see more

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Give a credit where it’s due to quiet achiever

WE are told that Australian General Practice Accreditation Limited’s (AGPAL) recent submission to the Federal Government’s National Primary Health Care Strategy reference group is to remain strictly confidential – one of only four submissions out of a total of 252 for which the public has been deemed unworthy of fore-knowledge. For an organisation whose existence is predicated upon transparency in medicine, this sudden insistence on secrecy would seem odd, bordering on hypocritical. To rub a non-abrasive, alkaline cleanser into the wound, using a gloved hand, AGPAL has refused to comment publicly on its new venture into the clandestine world of the medical ... see more

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Making reference to the end matter

A MIDDLE-AGED patient who’d had a normal colonoscopy wanted to talk about his poo. He complained that nobody was interested in the topic (except perhaps for the Freudians, and they were mostly anal retentive). I nodded sympathetically, though not fully in agreement. How could he know that there is one person in my life who has always been happy to talk about poo – my mother? When I was a child growing up in California, Mom not only encouraged lively dialogues about poo, but she could not restrain herself from singing about it. Usually this happened once daily, after breakfast, as she ... see more

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The patient most feared

IN his 1969 film, Take the Money and Run, Woody Allen has his antihero, Virgil Starkwell – a petty crim – captured, convicted and locked away. When caught breaking prison rules, he is subjected to a particularly horrific punishment – he is locked in solitary confinement for three days and three nights with an insurance salesman. As the Armani-suited, briefcase-toting salesman follows the hapless Starkwell into the tiny underground cell and the door slams shut over their heads, one experiences the sense of dread conjured up by a level of hell not imagined even by Dante himself. It is the same dread ... see more

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Clarifying the New Bigotry

IN his film Annie Hall, Woody Allen is accused by his on-screen girlfriend, one Allison Portchnik, of being a bigot. In expiation, he retorts: “Yes, but for the left. I’m a bigot for the left.” In 1977, this seemed a harmless rejoinder, humorous inasmuch as the syndrome of left-wing bigotry, though not yet enunciated in the popular press, was instantly familiar to us all. But it’s 31 years on, and the humour is wearing a little thin. The New Left brings with it the New Bigotry, which – though seemingly more benign and right-minded than the Old Bigotry – remains, nevertheless, bigotry. ... see more

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No experience necessary

WE’VE done it! What a coup! If ever there were a cause for self-congratulation, this is it! We finally got Nicola Roxon to spend a day in general practice! Wow! Well, actually – it wasn’t quite the whole day. It was more like... a session. Well, actually – not quite a whole session. More like, say... a couple of hours. And, hey – it wasn’t ‘in general practice’ per se – it was, like, in a general practice with a particular GP, seeing a tiny handful of that practitioner’s patients at a certain time on a particular day. And yet, in spite of these glaring limitations, she actually ... see more

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The right doctor for the job

MEDICARE Australia was advertising jobs. They were looking for doctors who would “improve voluntary compliance” and “identify specific non-compliance, and take action to prevent fraud and inappropriate claiming”. I thought, WOW, that is sooo me! I downloaded the “capability-based” selection criteria. To apply, I only had to come up with 24 specific examples. There’s certainly not much standing between me and a visit to your surgery now! EXEMPLIFIES GREAT SERVICE Makes it easy for their customers. Smiles, even through gritted teeth. Gets it right. Washes hands (both). Genuinely interested in their customer. Listens enthusiastically for 10 minutes about a patient’s car problems. Respects their customers’ rights. ... see more

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Beware those politicians who are all talk

WHAT is it about Barack Obama that unsettles me? Is it the fact that, when you close your eyes, what you hear is the voice of a white man mouthing white platitudes? Watching him posing on the front stoop of the White House, one cannot help but feel that he has Animal Farmed his triumph. In one of the – dare I say it – black ironies thrown up by the exigencies of political correctness, the very blackness that propelled him into the presidency is barely evident in the slim, café-au-lait features so easily mistaken for a tan by Italian Prime Minister, Silvio ... see more

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