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Too chicken to collect eggs
I MADE it to the post office before it closed. When I walked in, the postmistress was for once looking a little baffled. There were two fine young men before her, not from here. The burst of a French accent gave things away.“Can you help, Dr Sara?” she asked fairly desperately.Agh. “Bonjour,” I said. “Puis je-aider?”“Bonjour, parlez-vous français?” they replied.I felt pretty good for a second and had a feeling that all my French would just come streaming out.But then it didn’t.And I said, “Agh, un peu. Agh… no I don’t... non... ne parle pas français. Agh... how — can ... see more
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...
Is there a good way to break bad news?
A RECENT article in Patient Education and Counseling (2012;87:186-92) suggests that a ‘blunt’ approach is best when breaking bad news to patients. We at Humerus went out and observed two differing approaches: No nonsenseGood morning, doctor. How are you today? You’re going to die. I beg your pardon? You’re going to die. And I’d get that hearing checked before it’s too late. But... I’m here to get a repeat on my nasal spray. Is there any point? My nose is blocked. You’re dead a long time. There’s a limit on how many repeats I can give you. Are you sure? Trust me – a script’s only good for 12 months. No ... see more
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
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
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
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
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
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
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...
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
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
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
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
Tracking the changes in medicine for 25 years
TUESDAY 3 July, marks exactly 25 years since Medical Observer first landed in the mailboxes of Australian GPs, with a mission to provide the latest clinical and medico-political news, without fear or favour. On that day, the Hawke government was in power and its health minister Dr Neal Blewett had, just three years earlier, reintroduced a universal public health insurance system similar to the Whitlam government’s Medibank – now called Medicare. A plough through the medical news at that time unearths an interesting mix of issues, some of which have moved on, with great gains ... see more
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...
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
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
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...
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
Staying on your chosen path
HER father was a specialist and wanted his daughter to become one, too. But she was interested in pursuing the arts. Nevertheless, she tried to satisfy her father by studying the subjects that would prepare her for a career in medicine. It was during an anatomy practical that she had her epiphany. She had carefully dissected and pinned the stomach of her anaesthetised frog onto a board. Unfortunately, the effects of the chloroform began to wear off and the frog stirred. As she saw it struggle, its innards no longer contained within its body, she became utterly distraught. She decided that she could ... see more
The divide between ‘the haves’ and ‘have nots’
Health and education share some common ground. Both are seen as fundamental ‘rights’, and are highly regulated. The percentage mix of private and public, while not identical, is similar. Unfortunately, both are also increasingly subject to the obsession of governments with statistics and preferred ‘outcomes’. The path of NAPLAN (held this month) is illustrative for the health industry in what can go wrong with a good idea once government gets involved. In particular, I note the latest thought bubble from the RACGP about performance indicators, which is potentially handing another baseball bat to government to beat GPs around the head. The notion ... see more
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
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
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
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
When patients refuse to follow the textbook
LIKE pilots and concert pianists, surgeons cannot afford the luxury of an error. Their performance – from one flight, concert or operation to the next – must be flawless.This is what they train for, endlessly, until they can do what they need to do in their sleep, on their heads, with one hand tied behind their back and with the building/plane burning down around them.This is what they’re paid for. Perfection. It’s what they expect of themselves, an expectation that often lies at the heart of their career choice.In GP-land, where the flight plan is a tad more free-form, the ... see more
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
Seamless transfer of information is a revolution
The process of connecting individual GPs to a large public hospital and eventually its private hospital, plus a large clinic full of specialists, has been an extraordinary project. This is the first rollout of the PCEHR, and is funded by the federal government.Many of my patients have embraced the idea of having their records available to the teaching hospital 1km away from my practice where most of them end up if they require hospitalisation.There is, however, a registration process involving the patient agreeing to share medical information with the hospital. Once this is in place, I can send an electronic ... see more
An alarming approach to the benefits of work
SOME months ago I received a glossy publication entitled Australian and New Zealand Consensus Statement on the Health Benefits of Work, published by the RACP’s Australasian Faculty of Occupational and Environmental Medicine.The document, the flip side of which is entitled ‘The role of GPs in realising the health benefits of work’, strives to extol the virtues of that particular pastime.Re-reading it in the jaded comfort of Australia in 2012, I suddenly come over all Amish, having to suppress an inexplicable desire to put up a barn.Suddenly, I am in pre-war Germany, on the poop-deck of the Mayflower, in the streets ... see more
Tarring complementary medicine is anti-choice
THIS year kicked off with the unedifying spectacle of a group calling themselves the Friends of Science in Medicine demanding the wholesale banning of universities from teaching “complementary medicine”. I had to pinch myself to make sure I had not nodded off and woken up in a parallel universe where patients just did as their doctor told them, asked no questions and made no choices for themselves. I actually have to wonder whether the 400 or so luminaries on the list knew how their names and reputations were going to be used by the organisers and whether they signed on to this ... see more
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
When dignity comes second, things aren’t right
These days, with better care at home, people end up in nursing homes much later and sicker than before.My challenge is to exhort family or next of kin of my patients to fill in an advanced care directive on admission. I need to know what to do in case of deterioration. Do I send the person to the emergency department to lie on a trolley for a couple of days? Or is it a transfer into an intensive care unit for an end of life sojourn surrounded by exhausted hospital staff and inevitably futile interventions with tubes and gizmos attached to every ... see more
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
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
Will Roxon’s legacy blow away in a puff of smoke?
ON THE day former health minister Nicola Roxon was sworn in as Australia’s new attorney-general late last year, a Hobart GP, Dr Graeme Alexander, wrote in a letter to the Australian newspaper: “Her only legacy lies in the colour of cigarette packets.” Anecdotally, and based on feedback to MO and its journalists, many GPs feel the same, but is this a fair assessment of Roxon’s four years as health minister? The former minister is considered by many in the medical community to have promised much and delivered little, and to have had, if not a hostile attitude to ... see more
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
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
The midnight cowboy’s solo Hippocratic stand
RECENTLY, browsing the shelves of a local bookshop, the troubling thought came to me that the last classic had already been written. That never again would we see the like of War and Peace, Gulliver’s Travels, The Trial or Lolita.I wondered whether it was simply the sheer torrent of modern literature that made it impossible for any one work to stand out, or whether there were more sinister forces at work.As a mid-career playwright, relegated to the hinterland of Australian theatre, I had religiously been sending out my most recent manuscripts to all the usual suspects, with steadily diminishing success.Frustrated ... see more
What’s the point? Banish the boring slide show
IT WAS always going to come to this. PowerPoint, that ubiquitous Microsoft presentation program, has ruffled so many feathers worldwide that a serious political party, the Anti PowerPoint Party, has emerged in Switzerland. It’s a move many of us will find easy to understand. Prominent BBC and Financial Times journalist Lucy Kellaway said it most succinctly in a recent blog; “I don’t think [PowerPoint] livens up a dull presentation. I think all it does is sort of distract your attention from a dull presentation. “The essential problem with PowerPoint is people dump too much information onto those slides... then they try and ... see more
A paradigm shift is all it takes to save a life
RECENTLY, an eight-year-old boy by the name of Jacob Belim was diagnosed by his GP, Dr Chandra Gounder, with acute appendicitis.Dr Gounder sent Jacob to the emergency department at Liverpool Hospital, Sydney, together with a letter stating the provisional diagnosis.Dr Gounder’s letter was not read, a diagnosis of bowel obstruction was made by the staff at Liverpool, and the boy died two days later during emergency surgery at the Children’s Hospital at Westmead.Despite the death, there has been no commitment to improving communication procedures between GPs and hospital staff.To add fuel to the fire, Dr Sally McCarthy, president of the ... see more
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
A ‘carbon’ tax by any other name is necessary
IN MARCH this year there was a huge amount of commentary on the behaviour of protestors at an anti-carbon tax rally in Canberra, and debate in Federal Parliament and on talkback radio continues to be volatile, at times vitriolic.What seems to have been lost in the rhetoric is the reason that a so-called carbon tax has been proposed. Regardless of the mechanisms the Government decides upon, there has to be a serious and effective attempt at changing the way big environmental polluters do business. One of the levers available to Government is a penalty for polluting. What they are proposing is ... see more
Bowel screening and other cuts will be costly
THE high likelihood that the Gillard Government has decided to dispense with the National Bowel Cancer Screening Program comes on top of a number of other panic measures that will effectively ensure this Government will go down in history as having cynically used the mantle of health reform to destroy the Australian health system. We’ve seen the Government groping blindly around the vexed question of super clinics – which sort of exist now, but curiously only in some marginal Government seats where, not surprisingly, they duplicate existing GP services. We’ve watched as waiting lists continue to blow out in state hospitals, and ... see more
Prevention is a better option than treatment
FUNDING for the National Bowel Cancer Screening Program was effectively terminated by the Federal Government in December last year. Just recently I found myself trying to explain this to a group of medical students at UNSW who were learning about the screening program as part of their community medicine course. It became an opportunity to talk about the impact of the political process on our ability to deliver best-practice healthcare for our patients. I am the first to agree that the previous National Bowel Cancer Screening Program was fatally flawed. Even if there had not been the debacle of half a million defective test ... see more
Speaking the language of the heart – and men
WHILE progress has clearly been made in reducing rates of heart disease in this country, figures for male health remain poorer than those for women, and public health messages seem to have less impact on blokes.Anyone who has not been living under a rock for 40 years knows that smoking, being overweight and not exercising are bad for your heart. There is no shortage of information out there and no shortage of ‘programs’, either.To paraphrase an old proverb, the question is not so much about how to lead a man to water but how to make him drink.The solution is not ... see more
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
MO videos bring people and practice to you
WE LIVE in a world of learning, anywhere, anytime. Constant change in medicine means that keeping up to date with new information while maintaining our knowledge and skills, learned some time ago, is a real challenge. Fortunately, advances in technology have kept pace, if not overtaken, our knowledge requirements and now offer us information at our fingertips. At MO we strive to deliver the most accurate and relevant news and clinical updates in a reader-friendly format both online and in print.We are excited to announce the arrival of new and innovative online video content on our website that will enhance our ability ... see more
GPs are first line of defence but last to know
THE live news stream was surreal: a massive black tidal wave engulfing entire towns on the north-eastern coast of Japan, sweeping away people, lives, homes and possessions.Then the threat of a nuclear incident emerged from several of Japan’s nuclear energy plants. This was going from bad to catastrophic in a major hurry.Surreal, too, was the Australian Prime Minister’s press conference some days later advising travellers returning from Japan that if they were concerned they had been exposed to radiation they should consult their GP.Brilliant! I was wondering when I was going to ... see more
From TWITS to WITS via child safety laws
I USED to receive an email document called TWITS from SDGP, the Southern Division of General Practice. TWITS stood for This Week In The South. I suppose Division sounded too divisive, and although TWITS had a derogatory connotation, I still to this day mourn its passing. Now I get the blandly named WITS (for Wednesday In The South) from GPNS, General Practice Network South. Soon the organisation will morph into a Medicare Local. I await the inevitable brainstorming sessions and name change, but that is another story. Anyway, I was very fortunate to read this week’s email. It posed an innocuous-sounding question: “Does ... see more
More than just good news: we need the truth
THE recent spate of disasters confirms that bad news ‘rates’. Whenever there is a disaster and loss of life on a grand scale, we get saturation coverage in the media. The people who bring us the news work on the assumption that bad news will attract viewers and readers, whereas good news will not. As the media is driven by ratings and circulation, you can be pretty sure that we are watching and reading about disasters. Medicine, on the other hand, is the exact opposite. There is barely a bad news research story. It must be assumed that doctors are ... see more
Good medicine is finding that sweet solution
A FELLOW who attended a pain clinic reported to his specialist team that he had benefited from treatment. He was promptly informed that he needed no further care, as he had received nothing but a placebo. That is what happens when doctors practise strict evidence-based medicine. Fortunately, I don’t. Within the legal limits, my general aim is for patients to feel better when they leave my surgery than when they came in. I can’t say that I always succeed, but that’s my goal.An elderly couple presented. The husband was suffering from cardiac disease, but had decided against further interventions. He felt it ... see more
Strategies can reduce the risk of violence at work
Once we were sacrosanct, held in the highest regard, and our practices were considered safe havens. Lately, things have changed. We’ve slipped from our pedestal and some of our patients see verbal and even physical violence as acceptable behaviour.A recent GP violence study (MO, 11 February) found many patients are losing control in waiting rooms across the country.Some 16% of Australia’s 23,000 GPs have been physically assaulted in the past 12 months; this is twice the assault rate for the general community. Verbal abuse is so commonplace that most GPs and their staff accept it as part of the job. The study ... see more
Protecting the purity of the placebo
FEARS have been raised recently about the contents of the humble placebo.While it is generally acknowledged the placebo remains the most effective medication ever devised by Western medicine, researchers are keen to reassure themselves that said placebo owes its extraordinary level of efficacy to absolutely nothing.Hieronymus Blank, CEO of Blank Laboratories, a leading producer of placebos, feels the medical fraternity has failed in its duty to protect the purity of the placebo.“At the time when my great grandfather, Hank Blank, first discovered and refined the placebo, patients knew that they were not getting the real thing,” says Blank, puffing on ... see more
Dysfunctional relationship is causing chaos
I have to admit to a frustrating sense of déjà vu with the recent COAG reform discussions.The Commonwealth-State relationship is like many dysfunctional relationships. Some of the danger signs that you are in a dysfunctional relationship are:• Your needs are not met in one way or another • Being there is not what you want but you are afraid to leave• It seems there is always something to fix in the relationship• One partner holds most of the power.It seems like forever that we have been hearing about attempts – feeble and more robust – to sort out the quagmire that ... see more
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
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 the condition associated with ... see more
Let’s leave the insults to the professionals
There are times when reality renders my job as a columnist just too damned easy.According to a recent issue of MO, controlled studies have been conducted to show that being the victim of rudeness can impair cognitive skills.In order to prove this hypothesis, students were invited to take part in an experiment whereby half of the group were insulted by a professor on their way to an examination, while the other half were spoken to politely.The first thing that strikes one about this rather abstruse experiment is that it was thought necessary to have the insults delivered by a fully ... see more
Medical practice is an art based on a science
A visit to an art gallery can be measured in a number of ways. For example, ease of parking, the convenience of opening hours and disabled access. Ultimately, the thing that really matters is the art on display.As you wander around, it’s extremely unlikely that you will spend exactly the same amount of time in front of each painting or artwork. Different people will have different likes and, as a consequence, express different opinions on the art and the gallery itself. No standardisation can be applied in this situation. A system to determine the ‘quality’ of art or a gallery itself will ... see more
Scientists getting ahead of science
ACCORDING to a recent study conducted by the University of Toronto (MO, 11 June 2010), the better a patient’s diabetic control, the more likely they are to cause a motor vehicle accident.In a study involving 795 patients over two years, it was found that each 1% drop in HbA1c was associated with a 26% rise in the incidence of motor vehicle accidents.It would seem therefore that, in the interests of road safety, we should all be releasing our diabetic patients from the burden of treatment (particularly as a 0.08% increase in the risk of breast cancer seems to have been ... see more
Diagnosing a disorder unique to our time
A NEW sub-type of PTSD has been identified: Post-Traumatic Telecommunication Stress Disorder (PTTSD). The highest risk is among the elderly. I have already diagnosed my first case. Saturday morning and it’s time to phone ‘home’ in the US. Disaster has struck. My mum’s landline doesn’t work in rainy weather. She is forced to get a mobile phone. A mistake is made and the same number is assigned to both phones. My mum spends two weeks in Phone Inferno, giving garbled messages to machines and finding ways to pay twice for the same non-existent service. She has a list of names, angels and demons she has ... see more
GPs in the front line of the superbug war
“ALL I need is a script for antibiotics, Doctor. I have an infection.”We’ve all heard this familiar refrain from patients. But what will happen if antibiotics cease to be effective? Infections could run rampant, following their natural history, and our patients would succumb to diseases previously thought to be under control. Apparently it’s a scenario that is just around the corner. New strains of multidrug-resistant bacteria have emerged and threaten to swamp our capacity to fight infections. The Lancet Infectious Diseases1 recently questioned the future efficacy of antibiotics in light of rapidly rising cases of multidrug-resistant bacteria.Professor Tim Walsh has discovered ... see more
Mandatory reporting erodes doctors’ rights
DOCTORS are notoriously reluctant to ask for help at times of crisis or when we have a health problem.We have all sorts of excuses: can’t find the time, don’t know who to trust, it isn’t that serious, too embarrassed to admit to any weakness, can manage it better myself. We all know we should have our own GP, but in practice most of us still self-diagnose and self-manage until it gets to the tricky stage when you can’t take out your own gall bladder or do a DIY colonoscopy. So the news that since the introduction of mandatory reporting laws, the number ... see more
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
Marking time with the minority government
IT’S interesting times on the Hill in the post-election wash-up. While pharmacists continue to build profits with generic drugs discounted by up to 80%, the generic pharmaceutical industry is maintaining its ‘bleat’ that the current memorandum of understanding (MOU) between the pharmaceutical industry and Government should be rejected because ‘drugs will cost patients more’!The MOU – which I have referred to in previous columns – has a number of significant implications for prescribers and for ensuring patients have access to their medicines of choice in the future. Whatever the argument, it’s difficult to work out whether the incentive for the generic industry ... see more
Amazing shrinking ex-president a Bill that fits
THERE has been much discussion over the past few weeks of ex-US president Bill Clinton’s extraordinary weight loss. It appears the once corpulent aficionado of McDonald’s and other fast foods has become enamoured with all things natural.He now eats a truly restrictive vegan diet, eschewing dairy products, meat and fish. In preparation for daughter Chelsea’s wedding in August, Bill managed to shed about 12kg thanks to the diet.Turns out it’s not just the wedding that caused this profound change in his lifestyle. In 2004, he underwent quadruple coronary artery bypass surgery, but due to his famously intemperate ... see more
If you’re asking me, you may need a tool
THERE is a new screening tool for depression (MO, 23 July).Referred to as the PHQ-2 (Patient Health Questionnaire), it is an abbreviated, two-question form of the longer PHQ-9.As the name suggests, it consists of two questions: “Have you experienced depression in the last two weeks?” and “Have you experienced a lack of pleasure in the last two weeks?”The tool exhibits good sensitivity (86%) but poor specificity (78%).The primary question to emerge from the introduction of this tool relates not so much to the presence or otherwise of depression as it does to the definition of the term “tool”. In other ... see more
Coming soon to your surgery: iMisdiagnosis
FOR the fad-spotters out there looking for the next big thing, look no further than the burgeoning market in health-related iPhone apps.This week there was news of one that claims to monitor a person’s sleep patterns and has the extraordinary ability to wake people “at the most appropriate moment”, whatever that means. It also comes with an in-built iPsychologist, which plays back recorded motivational messages while you sleep!No doubt the food coaches, kilojoule counters, BMI calculators and exercise prompts have some potential health benefits, but where is the evidence for some of these other apps? What about peer review? How ... see more
Discharge letters that work
Too often a patient either leaves hospital without any discharge letter or the letter isn’t sent in a timely fashion, so appropriate follow-up care is compromised. Fortunately, in the present climate of self-management, there is a solution. It came to me from a patient without a medical background:Dear Pam,Day 5 at hospital (name withheld). Here’s an un-medical progress report. (I’m sure the consulting doctor will write to you anyway).I was pretty out of it on Saturday when I landed on your doorstep – it meant so much to be able to see you straight away – thank you. You were spot-on with the ... see more
Public health campaigns need more scrutiny
IN dealing with the human body, nothing happens in isolation. There is no pharmaceutical that is totally free of side-effects, and no procedure without complications. In general practice, we see this because we deal with the whole person, not just a system or disease.Yet there is one field of medicine where no warnings are given about possible unintended or even harmful effects. Where broad recommendations are made, and it is felt that everyone should heed the advice. Indeed, unintended effects seem to be barely considered. Yet GPs are expected to comply with the edicts handed down.This field of medicine is public ... see more
A match made in heaven for redheads
SOME years ago, when Julia Gillard was Opposition spokesperson on health, she came up with a scheme she referred to as Medicare Gold, whereby all persons older than 75 years of age would receive all medical care free of charge.Now as Prime Minister, she has come up with a far more radical scheme: Medicare Red.As the name suggests, Medicare Red (MR) is a scheme whereby all those persons exhibiting red hair will receive all medical care gratis. No explanation (beyond the bleeding obvious) has been given for this somewhat narrow and abstruse criterion.In defending her decision to implement MR, Gillard ... see more
Are you in the groove, or just stuck in a rut?
WHEN I lived in Denmark, I behaved like a Dane. That meant I took a winter holiday to go cross-country skiing in Norway. Every morning at 4 am, the ski lodge would send workers out on snowmobiles to pack down the night’s new snowfall and create perfectly spaced tracks. I would wax my skis, put my feet in the tracks and glide along. Because the going was so much harder out of the tracks, I rarely left the designated trail. Trudging along, pretending I was a Nordic athlete, was exhilarating. I never thought of it as being in a rut. To me, I ... see more
Slogging through the path of most resistance
YOU’RE nearing the end of a long day, and still with four patients to see. The next patient is in just for a flu shot. At last, a chance to catch up.In your rush, however, what you don’t notice (until you open the door) is that the next patient is Billy, the most recent in a seemingly inexhaustible line of Bloggs. Your heart sinks.The lad is asthmatic and, from behind, Blogg Primus (otherwise known as his mother) prods him into the room. You note his left arm is heavily plastered with EMLA cream under cling wrap. “Is this going to hurt?”“Oh, ... see more
Furphies lore: a guide for the pollie-boggled
THERE are four fallacies about medical practice in Australia:1. Patients need to have all of their health services in one location.A lot of my elderly patients winter in Queensland, driving there from South Australia. Don’t tell me that if they attend my surgery they can’t find their way to a physio in the neighbourhood.2. The government doesn’t have a decent mental health strategy.By keeping Medicare descriptors sufficiently vague, all GPs become vulnerable to breaking the law. The Government is hoping we will end up in prison. Why? Because that is where most of the mental health patients have moved, ever ... see more
Bless you, dobbers, and all your good work
ONE of the greatly underestimated pieces of medical equipment in a GP’s office is what I affectionately refer to as the Dobber’s Chair. It has pride of place in my room, and I find it particularly useful for my less forthright or less insightful patients.You can usually recognise the self-appointed dobber from the waiting room. “Mind if I come in too? I’ll only stay for the first part,” says the accompanying person, soon to adopt the role of Chief Dobber. I love my dobbers. They make my life so much easier. Remember in medical school when we were taught that whatever cigarette consumption ... see more
Time we stopped paying lip service to prevention
HERE is a glimpse into the not-to-distant future. There is a crisis in transport care. As the election unfolds, politicians are being called upon to ensure adequate funding is made available for all the issues affecting transport. There is an increasing need for mechanic workshops to repair all the cars that are breaking down. “There are just not enough workshops for all the cars which need our service,” says the head of the AMA (Australian Mechanics Association). “We call on the Government to adequately fund car mechanics, now and into the future.”Similar calls come from suppliers of oils and lubricants, as well as the ... see more
Capitation scheme is set to divide and conquer
AS with many significant changes in general practice, the diabetes registration scheme could slip in under the radar.Last year’s Bennett Report (1) has become a reference book for those proposing changes in the name of ‘health reform’. What is not appreciated is that the report recommends extending block funding beyond voluntary registration for diabetes.Coronary heart disease, lung and colorectal cancer, chronic obstructive lung disease, chronic kidney disease, depression, osteoporosis, arthritis and asthma are all being considered for classification as ‘registrable’ diseases.Primary medical treatment for a registered medical condition is financed by block funding, not Medicare rebates. This strikes at the ... see more
Take the gloves off GPs in diabesity fight
THE issue of overweight and obesity is a complex and often controversial one. But no-one can dispute the facts. The world- leading Australian diabetes expert Professor Paul Zimmet, who carried out the groundbreaking AusDiab Study, believes that unless there are effective intervention policies adopted, up to half the Australian population could have type 2 diabetes or face imminent diagnosis by 2040. It will be a time when adults outlive their children – and ‘diabesity’ will cost this nation more than an affordable share of GDP as a result of complications and death from this insidious killer.One of his eminent colleagues, Professor ... see more
Signing your life away
NORMALLY, as a humble GP, it gives me some degree of pleasure and satisfaction to discover a new clinical sign or entity.However, when one discovers such an entity in oneself, the pleasure is somewhat diluted.As is not uncommonly the case, symptoms were first noted in the toilet, a room to which modern medicine, for all its sophistication, remains deeply indebted. After the obligatory struggle, and on successfully completing my travails, I reached for the toilet paper but found that rather than applying it to the part of my anatomy which stood (or sat) in need, I was actually signing it.Of course ... see more
Exposing the great general practice cover-up
BY AND large, patients divide into three very distinct groups: Those who alight from your examination couch leaving it looking like the Somme, those who immediately attempt to return the examination sheet to its pre-examination state, and those who leave no impression on the sheet whatsoever.Which group a patient falls into will give you as much predictive information about that patient as any other aspect of their history or examination.1. Sheet-manglersA subset of patients in this group are simply morbidly obese, so that their movements, once perched upon the examination couch, resemble the efforts of beached whales to rejoin their ... see more
Abbott vs Gillard: battle for health is heating up
THE date is set and the federal election campaign has begun in earnest – but which of the two former health leaders and long time adversaries will win their latest showdown?Since their duels over the health portfolio during the Howard era, both former health minister Tony Abbott and former shadow health minister – now Prime Minister – Julia Gillard have risen to lead their respective parties, creating a rare opportunity for health. Or does it?Despite ousting Kevin Rudd from the Lodge, Ms Gillard is standing by the much-criticised GP Super Clinics initiative launched during ‘Kevin07’. Already promised is a new $7 ... see more
It's a crying shame that more tears aren't shed
THIS week I made a patient cry. Maybe that’s not completely true. She was heading in that direction already and I just added a little push. I was in one of my Doc Martin moods.The patient had a rash. I had previously given her a prescription that had worked. When she stopped treatment, the rash recurred. She was desperate.“You need to re-start your medication.”“But it came back; I want a cure.”“There is no cure.”That’s when the tears began forming. Huge, Brontosaurus-size tears.“That’s what dermatology is all about; managing skin diseases that never go away.”Maybe those weren’t my best-chosen words. Now ... see more
So you think you’ve got talent?
THOSE of us who have had the misfortune to be subjected to television programs such as Australian Idol, Australia’s Got Talent or So You Think You Can Dance, might’ve wondered about the fate of all those thousands of unsung (if only) wannabes who didn’t make it to the final cut.Where do these people (I assume we share a sufficient amount of genetic material to validate the use of such a word) disappear to after they have excoriated the ears, the minds and the sensibilities of those who have borne witness to their singular form of public humiliation?Are they absorbed back ... see more
So, why did you leave your country?
AUSTRALIA, like most western countries, relies heavily on a steady influx of international medical graduates to keep its health services running. Our top four ‘donor’ countries are Britain, India, New Zealand and South Africa. Together, they have ‘donated’ some 20,000 doctors. Indeed, Australia is becoming progressively more reliant on IMGs, with the 2006 census showing that half of our doctors were born overseas. Some commentators view this migration as an ‘unethical poaching’ of doctors from countries in the developing world, which can ill-afford to lose doctors. This view is echoed in other ‘importing’ countries – Britain, Canada and the US.This fails ... see more
A new care team evolves – the husband and wife
FOR the last month I have been providing team care. I am simultaneously playing doctor and nurse as Hubby assumes the role of patient (a misnomer if ever there was one), gradually recuperating from open heart surgery. My doctor self has to occasionally curb her arrogance and the unreasonable demands placed on my nursing persona, who finds she gets frustrated by a lack of professional recognition. It is difficult to set appropriate duties such that each caregiver can perform their role effectively. “Why can’t Nurse Pam and Dr Pam just respect one another a little more?” I hear myself mutter. On arrival home ... see more
Let’s dedicate ourselves to better work conditions
MISOGYNY is still alive and well in the medical profession. I was recently disappointed to read impassioned letters from male GPs in various journals, laying all the problems of general practice at the feet of female GPs. Women GPs were maligned for working part-time, therefore not being available to their patients 24 hours a day. In contrast, the male GPs portrayed themselves as selfless and self-sacrificing, ready at all times to administer to the needs of their patients. These men appear dedicated to their careers, to the complete exclusion of everything else, and I can only imagine the effect this must ... see more
Time savers are the kindest cut of all
WE all take shortcuts in our daily practice, not that this is a bad thing. Time-saving is essential so we can pack yet more into a working day, and feel we have thoroughly deserved that glass of wine or stubby by the evening. Well, that’s how I justify my standard drink! Maybe you have enjoyed the benefits of using macros to instantly produce a nice summary for the 10th ‘sooky’ child today – by typing “snotty and annoying”, the now medico-legally acceptable “Coryzal for a few days, dry cough, not feverish, eating and drinking well. On examination – apyrexial, no respiratory ... see more
Preserving the fine ART of advocacy
IN the traditional village culture of southern Italy, if there was a doctor in the village, he was often referred to as the avvocato. Basically, he was the guy in the village you went to when you were in trouble – the advocate, the guy who went into bat for you. The primacy of the role of advocacy in primary care is under threat in the modern world. It is being swamped and sidelined. I see three steps to advocacy:1. Acceptance. If we cannot show acceptance straight up, we will get nowhere. If the patient feels unaccepted because they have piercings and tattoos, or ... see more
Do-it-yourself medicine
DNA hacking may render doctors’ diagnoses redundant, according to Belgian industrial designer Tuur van Balen.He has been trying to hook up humans to microorganisms so that we may all become “our own doctors and pharmacists”.The idea is to build a synthetic immune system, an external network of microorganisms that will sense maladies and grow the necessary cures.According to Mr van Balen – who is collaborating on this project with the Imperial College, London, no less – it’s the ultimate in personalised medicine.Every evening a person hooks up to bubbling cauldrons of yeast-like organisms, kept alive with sugar and water, and ... see more
Beware slow creep of care cutbacks
PRIVATE practice is under constant change, manipulated by a plethora of vested interest groups, faceless academics, ill-informed politicians, legal representatives, and at the hub of it all, the bureaucrats forming legislation and health officials adhering to their long-term agendas. But have the interests and rights of those using the services been really considered or dismissed with lip service and platitudes? Privacy laws that at first glance appear to be protecting patients’ confidentiality in reality have affected the free flow of information between practitioners, the obtaining of results from pathology, radiology and hospital sectors. Patient files are now being accessed by Medicare both ... see more
Chronic disease not a certain disaster
IN all the discussions about health and aged care reform, one assumption is made. That is that there is an inherent inevitability about ever-increasing demand for services due to an inexorable increase in rates of disease and the need to look after elderly people who cannot care for themselves. What if this does not have to be the case? News stories within the same week got me thinking about this. Firstly came the ridiculous use of the buzz word ‘tsunami’ (an unusually large sea wave produced by a seaquake or undersea volcanic eruption) being applied to projected increases in Alzheimer’s disease ... see more
Civility under the weather
The conventional wisdom is that the Middle East has been, remains and always will be a giant, volatile powder keg because religious extremists of different persuasions, if left in a room together, cannot help but find fault with one another’s brands of extremism. The truth, of course, is a tad more complex: the Middle East owes its political volatility to the stability of its weather. This column is not the first to make such a connection. The term ‘long, hot summer’, though based on the stories of William Faulkner, has now entered the lexicon as a byword for a seething cauldron of ... see more
The war is on: stand up and be counted
THERE'S a war out there in case you haven’t noticed. With health at the heart of the next election, its intensity will increase. The war is about you and me and what we do. Unless we stand up and be counted, there will be nothing left for our most loyal supporters, our patients. Should we worry about the skirmishes of “voluntary” patient enrolment, pay for performance and the place of super clinics? Well, yes. They are all part of the game. But what is the main game? The Government’s agenda is to replace you with a cheaper substitute. We know that GPs are highly “valued” ... see more
How hard can it be to make things simple?
ONE of the tales in SUM, a book by David Eagleman, depicts an afterlife where similar experiences are grouped together. So you spend 15 months in succession looking for lost items and five months thumbing through magazines on the toilet. All the time you spent zipping zippers in your life are similarly condensed into one giant extravaganza of zippering in your afterlife.As a GP, I can immediately envision an afterlife with three years of telling patients that they still have one more round left on their script, even though it already indicated “five out of five”.It must have taken years for ... see more
GP autonomy is threatened by reforms
THE health care reform debate is now raging like a bushfire. All and sundry are getting ‘hot under the collar’ about what is perceived to be ‘reform’, and this is distracting us from a looming danger. So, when super clinics; patient enrolment; national registration; independent nurse practitioners; midwives with MBS and PBS status; pharmacies “providing” primary care; pay for performance etc – are front page headlines – we rant and rave and rush to put out these grass fires.But we are not keeping an eye on the fire-ball that is headed for our home (read ‘our profession’). Surely, it can’t escape us ... see more
In practice, just following orders is no bad thing
GOING all the way back to the late and not-so-great Adolf Eichmann, the iconic refrain that serves as a standing apologia for all that is morally bankrupt is still trotted out to this day: “I was just following orders.” So patently bereft of ethical justification is this excuse for an excuse that it has become synonymous with cowardice, opportunism and perfidy.Indeed, it has drawn the entire process of taking instruction into utter disrepute. Not that there is anything inherently disreputable about doing what you’re told. Most GPs, in fact, would be only too delighted if their patients were a little better at it. Mrs ... see more
Anatomy’s invisibility cloak needs to come off
ONE of the craziest and most counter-intuitive moves ever made was the decision about 25 years ago (coincidentally, shortly before my oldest child was to start school) to drop grammar and spelling from the primary school curriculum. At the time, I was horrified, but the education department boffins were convinced they were right and would not listen to the protests of parents with a different view.This left a group of children with motivated parents to conduct covert grammar and spelling tuition at home while the remainder were destined to become semi-literate, relying on the future invention of spellcheck on their yet-to-be-invented ... see more
The investigative benefits of being a nosey GP
ALL the bean counting, checking and manual preparation of accreditation of my practice keeps me awake at night. And it’s no wonder. The process has become much more complicated than I recall. My practice and procedures manual has become a monster document with more than 230 pages of text. Medical equipment needs to be calibrated and checked for performance. Recently, over coffee, a colleague of mine suggested that the most important equipment that a doctor uses on a daily basis is never checked for performance. I puzzled over his meaning. He then told me our eyes, ears and noses provide us with ... see more
Good health often depends on good timing
The cardiothoracic surgeon’s secretary told us she once had a patient who’d been waiting months and months for her operation. The secretary finally had a date available and phoned the patient. “I can’t do it then,” the patient replied. “The lino man is coming.” We all chuckled, but the secretary had reason to tell us this story. Hubby had just rejected the first date offered to him for his mitral valve repair and double bypass. Hubby didn’t want to have open heart surgery on his birthday. To him, that seemed like tempting fate. He was aware of Mark Twain’s prediction: “I came in with ... see more
Rudd playing blame game on health
In 2007, Prime Minister Kevin Rudd said he wanted to “end the blame game” on health. On 3 March 2010, he released his blueprint for hospital reform. Last week, he debated Opposition Leader Tony Abbott at the National Press Club. Health reform is vital national business, and Mr Rudd should be given credit for putting forward a plan. It’s a plan with plenty of holes – for example, there are no extra health services for at least four years – but he is starting an important national discussion on healthcare. There are still unanswered questions on general practice, prevention, IT, aged care, ... see more
Read more from Dr Stephen Parnis - Vice President, AMA Victoria
Egyptian mummies unravel true origins of atherosclerosis
THE atherosclerotic consequence of a diet high in saturated fat is well known today, but it’s not, apparently, a modern disease.Egyptologists with access to high-tech methods of investigating ancient mummies have demonstrated clogged arteries occurred among the rich and privileged thousands of years ago.Atherosclerosis has in fact been observed in human remains of ancient Chinese elites, and among peoples whose diet was exceptionally high in animal fats, such as Eskimos from 400 BC.Computed tomography of Egyptian mummies of high social status shows evidence of vascular calcification and atheromatous deposits, researchers say.By putting together evidence from the scans and translations of ... see more
Novel plan to build a better health system
With the medical workforce shortage in Australia looming large, help has come from an unexpected source. The Builders Labourers Federation has put forward a novel plan whereby brickies could provide an alternative point of contact for primary care.The plan has been received enthusiastically in Canberra, where health officials have praised the work of brickies in the field.When interviewed this week, a health spokesperson had the following to say: “I mean, let’s face it – brickies are the backbone of this nation. What better foundation could there possibly be for healthcare than bricks and mortar?”Well, actually, the foundations are in concrete. “Even better! ... see more
Is hypnosis a breath of fresh air for respiratory disorders?
Hypnotists are usually considered to be entertainers from a bygone era, like ventriloquists or hat-and-cane vaudevillians. But this colourful history gives the technique a bad rap when it comes to consideration of its usefulness in clinical settings, proponents say. There is no consensus definition for clinical hypnosis. But practitioners say it has nothing to do with taking control of an unwitting subject by swinging a pocket watch in front of their eyes.On the contrary, all hypnosis is self-hypnosis, they say.In a recent article in a paediatric respiratory journal, Professor Ran Anbar, president-elect of the American Society of Clinical Hypnosis and a New ... see more
Outrage over doctor-owned pharmacies misguided
WHEN the AMA suggested the overturning of well-entrenched laws forbidding doctor ownership of pharmacies last week, the move drew inevitable howls from the Pharmacy Guild. If the guild is to be believed, any doctor with a financial stake in a pharmacy would jettison clinical professionalism and order a fresh crate of prescription pads. Cash registers in GP-owned pharmacies would overflow as patients struggled home with armfuls of drugs they did not need. What the Pharmacy Guild appears to have forgotten, is that general practice is one of the most tightly monitored and regulated professions in the country. The guild’s outrage will be even ... see more
We need to take charge of end-of-life debate
THE advance care directive program being conducted in NSW offers a great opportunity for GPs to encourage patients and relatives to face up to discussing the complexities covered by the term ‘end-of-life issues’. Helping families to confront this area can be approached gently by persuading them to read the literature available about advance care directives. My GP had a guide in his computer from the Central Coast Division of General Practice. In addition, a booklet, My health, My Future, My Choice (available at www.advancecaredirectives.org.au), uses a set of case examples to show the type of statements that need to be covered. The end-of-life ... see more
Mental health nurse is an angel of patient advocacy
A MENTAL health nurse seemed like an like an impossibility for me. I have realised for some time that many of my patients had serious mental health issues and that the public system was failing them systemically. Kings Cross is a magnet to the homeless and the mad. They feel comfortable here; there has always been a tolerance of outrageous behaviour on the streets. Many of my patients lived rough in parks or cars or couch surfing in other people’s flats. When the mental health nurse initiative was announced, I searched far and wide to employ somebody to assist me. Alan was in ... see more
Simple tests could fast-track psychiatric disorder diagnosis
CLINICAL diagnosis of psychiatric conditions may soon be aided by simple biochemical tests, researchers report. In fact, a group based at Cambridge, UK, say a blood test for diagnosing schizophrenia could be marketed this year. Dr Sabine Bahn, director of the Cambridge Centre for Neuropsychiatric Research, believes proteomics holds the key to faster and earlier schizophrenia diagnosis. Proteomics is the study of the structure and function of proteins. Proteome information can identify proteins associated with a disease, which can then be used as targets for new drugs Dr Bahn’s research involves screening skin, serum and immune cells to find irregularities that may reflect pathology ... see more
FOBT a poor excuse for bowel cancer screening
WHICH of your patients would you choose to get bowel cancer? What about your friends? Family? Yourself? What if you knew there was a test with a better than 90% success rate in preventing the most common cancer in Australia, but you didn’t order it? Instead, you arranged a one-off, far inferior but far cheaper test which meant you were “doing something” but missing 30% of cases of bowel cancer? Sure, you would reduce the incidence of advanced cancers by about 15-20%, but how would you face the ones who slipped through the net who could have been saved? Imagine the conversation with ... see more
Reform delay suits Rudd, not health system
WHAT does 2010 have in store for the health sector? A Federal takeover of all hospitals? A new social health insurance system for all Australians? New health one-stop shops springing up all over the country? None of the above? All of the above?While 2008 was marked by the establishment of overlapping commissions and committees on health system reform, 2009 was marked by radical proposals from said commissions and committee, followed by extensive, and seemingly endless, consultation. Indeed the 87th community consultation on health reform took place in Fremantle last Thursday.Without downplaying the need to consult on and refine the proposals ... see more
Climate change will impact allergic and respiratory disease
Climate change is not something that might happen in the future. It is happening now - since the middle of the 20th century, Australian average temperatures have risen about 1°C. There have been more heatwaves, decreased frosts and cold days, and a rainfall shift from eastern Australia and southwest WA to the northwest (www.bom.gov.au/climate/change). Last year (2009) was Australia's second warmest recorded year (annual mean temperature almost 1°C above 1961-90 average). Victoria, South Australia and NSW all recorded their warmest July-December periods on record. Last decade (2000-2009) was our warmest on record, continuing a trend of warmer decades since the 1940s ... see more
More care plan education needed for allied health
Care plans, chronic disease management plans, multi-disciplinary and team care arrangements… whichever name you give them and however long they’ve been around they continue to cause many a GP to sigh with frustration. Try as I might to keep an open mind I think my early experience coloured my view of these plans in one of their earliest incarnations. I politely asked an ophthalmologist to “contribute” to one for a patient with diabetes and the response was certainly less enthusiastic than I had expected. He not only refused to participate but told me in no uncertain terms not to bother sending him ... see more
Habitat, war and human health
THAT war wreaks ecological devastation is hardly a new observation: the first century Roman historian Tacitus famously described the military approach of his age as “they make a wasteland and call it peace”. In our era, the rapidly escalating environmental impacts of war are a critical public health concern. Over 160 million people died in the wars of the 20th century, the proportion of civilian deaths growing from 14% in WW1, to 90% in the ‘small wars’ of the post-Soviet era. The financial burden is almost as appalling, with current global military expenditure running at $US 1.4 trillion per annum, and ... see more
Public health and food industry must bridge gap
Like most developed countries, Australia is facing an unprecedented burden of chronic disease. Driven by poor diets, inadequate physical activity and smoking, lifestyle diseases account for an ever-larger proportion of ill health. Clinical medicine is left to pick up the pieces and primary care physicians bear the brunt of the assault. A multitude of interventions to mitigate the adverse effects of lifestyle make the General Practitioners life somewhat easier. Blood pressure and cholesterol lowering medications improve hypertension and lipid parameters and will greatly reduce the risk of premature events. These therapies were mostly discovered off the back of collaborations between the pharmaceutical ... read more...
Reflecting on a year of tumultuous change
THE recent scorching temperatures and total fire bans affecting many of the southern states create an eerie sense of the year drawing to an end in much the same way that it began. However, looking back over the MO headlines for the year reveals that during the intervening months GPs have faced a range of challenges in clinical care and seen a host of ground-breaking reports that have thrown the spotlight on primary care and proposed significant changes to general practice.In February this year the Black Saturday bushfires in Victoria sadly claimed the life of our GP colleague Dr Chris ... see more
Monkeying around throws light on human obesity
IN a subtropical forest in Bolivia, a troupe of spider monkeys are being scrutinised by scientists, who carefully catalogue their daily consumption of fruits, leaves and insects. In an Australian laboratory, dried samples of these monkey meals are analysed for nutrients. The results of this collaborative research offers insights into how best to conserve the habitat of wild monkeys and how to best manage monkeys living in captivity. The findings are also providing new evidence for a common feeding pattern in primates, and shedding light on drivers behind the growing obesity problem in humans. Swedish behavioural ecologist Dr Annika Felton, a visiting fellow at ... see more
Pharmacists need to live up to expectations
I DON’T often find myself at the pharmacy filling ‘serious’ prescriptions. Usually, my visits involve garden-variety conditions that most mothers with young kids face.But last month I had cause to request an anticonvulsant for my daughter. It was her first script and, given that epilepsy was a new health issue being faced by our family, we were eager to get as much medication information as possible.I was expecting my local pharmacist to help me out: maybe offer some verbal advice, or at least hand me some written consumer medicine information (CMI). My expectations, it seems, were over-inflated.I got the medication, ... see more
MBS simply a complex mess of confusion
THERE is no question that Medicare Australia has grown into a behemoth. Recently a forum was held in Sydney to discuss the future of Medicare. I was asked to speak as a GP medical director of my division of general practice. It was interesting that I was the only GP in a two-day program.Obtaining information on where Medicare is heading in the future was an impossible task. There seems to be an official cloak of secrecy about disclosure, so I decided to approach it from the practical point of view of a working GP.To do this I had to access ... see more
Web offers new window to treating depression
ANXIETY and depressive disorders, the internalising or emotional disorders, are the largest cause of disability in Australia. The National Mental Health Surveys show that less than half the people with these disorders see a health professional, and only a quarter get adequate treatment. Recently, Dr Norman Swan, presenter on ABC TV’s Catalyst, hosted a program about the University of NSW’s Research Unit for Anxiety and Depression’s web-based treatment for major depressive disorder... In a randomised controlled trial of the web-based intervention versus wait list controls, 80% of the people diagnosed as having major depressive disorder completed all six online lessons, ... see more
Is NPS still an objective umpire on prescribing?
ON 6 February, the National Prescribing Service (NPS) issued a media release warning doctors and pharmacists to “exercise care” if they were considering brand substitution for antiepileptic drugs used for epilepsy. Significantly, the NPS urged both professions to be careful “even if the [drugs] are listed as bioequivalent on the Pharmaceutical Benefits Scheme”. The warning came as patients began reporting that they had been offered alternative brands to the one prescribed – despite the ‘brand substitution not permitted’ box being checked. The NPS reiterated the position statement of the Epilepsy Society of Australia, which recommends that “patients with epilepsy should first obtain the ... see more
Don’t take adventures of a lifetime lightly
AS GPs, we’re required to provide opinions on the health risks of a huge range of our patients’ activities, from driving to flying, to scuba diving in the Maldives and trekking in the Himalayas. Adventure tourism is so popular that our professional opinion is being sought more often for increasingly exotic activities. I’ve always thought it useful to have a reasonable understanding of the conditions aspiring adventure tourists are going to face before making a declaration about their fitness. An African safari with accommodation in six-star tents and porter service is a far cry from a carry-your-own trek and camp without toilet facilities ... see more
Just say ‘no’ to demanding patients
THERE are some patients in every practice who feel entitled. They do not like to be kept waiting. They demand extra services, and are often wealthy or connected. They will often use modern technology to attract your attention, demanding your mobile phone number or your e-mail address to provide them with extra access to your services. They will insist on paying you the highest level of remuneration for your work, often plying you with flattery and perhaps small gifts or favours. But soon you begin to develop a strange co-dependence that leaves you with an uneasy feeling. Celebrities are notorious for such behaviour with ... see more
Is prostate cancer screening in younger men justified? No
THERE has been recent controversy about the recommendations for cancer screening, including the age at which screening should start. In the 7th edition of the RACGP’s Guidelines for preventive activities in general practice (the Red Book) released earlier this year, the recommendation was that men aged 50-75 years be informed of the risks and benefits of screening for prostate cancer, and that routine screening using digital examination, PSA or ultrasound not be recommended. The college has not changed its position. Below is an explanation of why. Since the publication of the 7th edition of the Red Book, the results of two large ... see more
Is prostate cancer screening in younger men justified? Yes
THE Urological Society of Australia and New Zealand (USANZ) appreciates the opportunity to respond to comments made in this publication and others in response to the release of the revised position statement on PSA testing. It is fundamental to the debate to recognise that USANZ does not advocate screening, but rather offers this model as a tool for risk stratification for younger men. Much of the comment centres on the findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC).1 This landmark study of more than 160,000 men demonstrated a 27% reduction in the risk of death from prostate cancer ... read more...
Respect for nurse skills must be two-way street
IN response to Professor Kerryn Phelps’ opinion piece, ‘Beware the ‘gift’ of nurse practitioners’ (MO, 11 September), it’s useful to put the concept of nurse practitioners through a SWOT (strengths, weaknesses, opportunities, threats) analysis. Strengths: Many GPs currently work with practice nurses (PNs) and have experienced some benefits from task substitution and have developed respect for their professionalism in delivering services. Model 1 for nurse practitioners (NPs) builds on this task substitution and respect by allowing GPs to train their current PNs (provided they are university-trained and have at least five years’ post-grad experience) within their own practice to NP standard. It is ... see more
Deadly knock-on effect of logging
WHILE the call to halt logging in the Malaysian state of Sarawak has long been a ‘green’ cause célèbre, medical science has now given the world one more reason to conserve the trees. Widespread logging and slash-and-burn farming have brought humans into much closer contact with native macaque monkeys and, it transpires, with their diseases. Earlier this year it was revealed that a malaria parasite believed to be confined to the primates had jumped the species barrier. Plasmodium knowlesi has been quietly infecting humans in Malaysia for some time, but was being confused with the benign P. malariae as they look similar under ... see more
Beware the ‘gift’ of nurse practitioners
“I think there is a Trojan horse lurking in the weeds trying to pull a fast one on the American people.” George W Bush GEORGE W may not have been entirely clear on the finer details of Greek mythology, but I think general practice in Australia has its own Trojan horse lurking in the weeds. The way things go in medical politics is that the ‘powers that be’ gradually desensitise GPs to unsavoury concepts by keeping general practice lean and hungry, then drip feeding it with rescue ‘incentives’ to change behaviour. Then, once general practice is dependent on that source of income, ... see more
Time for doctors to lead the fight against climate change
GREEN is a synonym for both being environmentally friendly, and being naïve. That may not be a coincidence. Environmental activists have traditionally been painted as naïve, hemp-wearing, hippies. Times have changed. But not that much. Climate change is the human race’s biggest global health threat, the environmentalists say. These, not-so-way-out ‘greenies’ issued their warning in the final report of a year-long commission run by The Lancet and the University College London Institute for Global Health.1 But are the people who have the power to avert climate change – politicians, policy makers, industrialists etc – listening? Yes, they are. And are they committed to effective ... read more...
The online answer to relaxing on the job
READING Dr Herbert Benson’s book The Relaxation Response a few years ago, I sensed he was on the right track. So many patients had anxiety- and stress-related illnesses that teaching them to relax had beneficial effects on their general health. Now, in elegant research from Harvard Medical School, Dr Benson, founder of the Benson-Henry Institute for Mind Body Medicine, has shown relaxation can produce disease-fighting genes that protect against a variety of disorders from hypertension to arthritis. Dr Benson has long advocated the “relaxation effect” and is obviously a man who regularly practises this technique. But how do you introduce the positive ... see more
Why prions have a potential role in cancer treatment
WE’VE COME to associate those minute infectious agents composed of protein known as prion with brain degeneration in Creutzfeldt-Jakob disease. But what do we know about what these misfolded proteins get up to outside the brain? Recent findings indicate they do occur in other organs, and unfortunately they may be hard at work promoting malignant tumours. US researchers have shown that pancreatic tumours in patients who fare poorly showed evidence of incompletely processed prion proteins that were not evident in patients who had longer survival times. It suggested that prions were playing a role in determining the aggressiveness of the tumour, the scientists from ... see more
Nurse prescribing: a risky proposition?
IN Western Australia, there’s a stoush going on over the relationship between pharmacists and nurse practitioners. More pertinently, nurse practitioners who are shortly expected to be able to prescribe within certain limits. It’s a stoush doctors ought to be watching. A private enterprise group has jumped the gun on the Rudd Government, saying it has government support to develop fee-for-service prescribing for nurse practitioners in pharmacies. This support presumes, incidentally, that the growing strain on the adequate supply of health professionals is going to cause the Australian healthcare model to buckle under its own weight as the baby boomer generation becomes the ... see more
We need informed solutions, not turf wars
Why on earth would our best and brightest university students wish to slave away for 10 or 11 years of rigorous unpaid education, to become GPs? Why would they be trained in holistic care? Why become fully equipped to manage multi-system disease entities, or be enabled to collate patients’ many problems and needs into a balanced and optimal healthcare outcome, when they could simply become a nurse practitioner and get similar rebates under the MBS and prescribing rights under the PBS? Just as apples and bananas are both fruit, GPs and nurse practitioners are both healthcare professionals. But there the similarity ends. We ... see more
French general practice a liberating experience
WHEN my partner and I packed up our jobs and all our worldly possessions for an année sabbatique in the south of France, I knew I would have to experience the French health system at some point. I didn’t know a lot about the French system or French GPs, but I was interested to see how concepts of liberté, égalité and fraternité might infect it for better or worse. We had settled in a small village (with 200 inhabitants), in what is predominately a part of the food and wine basket of France – the Côtes du Rhône wine region. Unlike Australia, ... read more...
'Molecular condoms' - the contraceptive of the future?
INTERNATIONAL research into AIDS-blocking gels and creams known as microbicides received a setback last year when the most promising candidate failed to protect women in a large phase III trial. The finding that the seaweed-based gel was ineffective, although safe, followed the early halting of trials of nonoxynol-9 microbicides because they caused inflammation, contributing to HIV infection. Yet according to those monitoring the research, the HIV Vaccine and Microbicides Resources Tracking Working Group, investment in biomedical prevention strategies continues to rise. While HIV vaccine research funding fell, global investment in microbicides rose in each of the past three years, totalling $US244 million ($294 ... see more
Freebies' final wave
When I approached the tea room during a brief break between sessions this week I could barely make my way to the fridge for the bumper haul of drug company 'freebies' laid out before me. The polite and meticulously dressed drug rep was "emptying her car boot" of all those little gadgets they believe GPs love but will soon no longer be able to receive. She described a directive from above to "move some merchandise" before it’s banned by a stricter code of regulations, proposed by Medicines Australia and due to be introduced in 2010. Mind you, times have changed from the ... see more
Frontline GPs deserve swine flu vaccine first
AS the morbidity and mortality rates for swine flu continue to mount, there has been some debate about who gets the first vaccines off the production line once the clinical trials phase has been analysed. Peak GP groups have been arguing that GPs should be among the first healthcare workers to get the vaccine. I may be missing something, but isn’t this a no-brainer? I, for one, hate being a patient. Some people appear to fall with seamless ease into the role of being looked after, but I am not one of them. And from what I know about my general practice ... see more
Blue Smarties the fix for a broken back?
NOT so long ago, blue Smarties and M&Ms were about the only use for the food colouring No. 133 (Brilliant Blue). These days it’s also an ingredient in ice-cream, cake icing, bubblegum-flavoured jelly and sports drinks. Apparently, Americans consume an average 16 mg of the dye every day. Now some neuroscientists have discovered that a similar compound can prevent the secondary damage from spinal cord injury, at least in rats. It’s hypothesised that paralysis might be reversible if there was an intervention to prevent the secondary expansion of molecular damage during the hours following an initial acute spinal cord injury. Researchers from the Centre for Translational Neuromedicine at ... see more
Yes Minister, it’s Judgement Day for number-crunching
REMEMBER those fun children’s magazines filled with activities to stimulate young minds? I loved trying to identify what was missing from a picture or connecting the dots to create an amazing drawing. I thought with wistfulness that I was past the games that I fondly remembered doing as a youngster. But now I learn that I was wrong. For the longer one stays in general practice, the greater the opportunity to regress. If you are puzzled or perplexed, I can assure you it won’t be for long. Welcome to medicine for dummies, the category to which GPs have been relegated. This weekend I ... see more
GP concerns forgotten during Rudd’s health reform roadshow
I KNOW I’m not the only GP to feel that the swathe of reforms proposed in the National Health and Hospitals Reform Commission’s final report could represent the most significant change to healthcare since the introduction of Medicare. But what I don’t understand is the deafening silence that appears to be coming from the major lobby groups that purport to represent us. Headlines are being dominated by other groups – specialists, public hospital staff and, irksomely, dentists. Where is the commentary on how the changes could affect GPs? Many recommendations in the report fill me with fear and uncertainty over the direction of ... see more
Terminally ill on a one-way ticket to Switzerland
DIGNITAS is a Swiss-based assisted-suicide clinic. Recently, a number of people in the UK have elected to end their lives in Zurich, despite not having life-threatening illnesses. Evidence from the Journal of Medical Ethics in the UK has indicated that 21% of people being assisted to suicide with Dignitas had a non-fatal disease process.1 Perhaps the most poignant of these is the case of Daniel James, a 23-year-old Briton who became a quadriplegic after a spinal fracture while playing rugby. In England, this case and others have sparked a debate about the legitimacy of suicide for those who may have productive lives ahead of them. Since 2002, 115 Britons ... see more
Possessed by useless objects of our affection
DO you remember learning about the early stages of child development, and how the concept of separation anxiety helps to explain the challenging behaviour of some 18 month olds? Well, more and more I am beginning to sense that separation anxiety isn’t just a one-off milestone affecting toddlers. My research suggests it’s a lifelong affliction. Now, I am in no way suggesting that the object of one’s attachment remains one’s mother. My theory is that one’s identity in later years is defined by inanimate objects. These items are seen as essential to the sufferer’s persona. I will refer to them here collectively ... see more
Get patients in on the campaign
DOWNLOADS Patient registration handout Patient petition Draft letter to local Member One of the things that struck me when I first read MO many years ago was that we GPs give the impression of being a whining, cantankerous and, at times, paranoid lot. But, as they say, just because you’re paranoid, doesn’t mean they’re not out to get you. Make no mistake: The Rudd Government is out to get us. When one reads of our Federal Health Minister delivering an inflammatory and highly adversarial ‘Light On The Hill’ address, or of a Normandy-style flotilla of 31 Government Super Clinics, or suggestions from the Government’s National Health and ... see more
Scientists winging their way to new insights on glucose
NATURE not only inspires artists, but scientists too. Who would think that the lacy wings of the cicada could be harnessed to advance nanotechnology? Diabetes Australia provided seed funding for novel research in which scientists at Swinburne University in Melbourne are using a technique called surface-enhanced Raman Scattering to develop a device that could replace the finger-prick glucose test. Research Fellow Dr Paul Stoddart happened to see a magnified photo of the pattern on a cicada wing and believed it was just the kind of nanostructure he needed to apply to the prototype optical fibre sensor which may ultimately be used to monitor glucose. Dr Stoddart spent a few weeks ... see more
Govt’s swine flu record doesn’t inspire confidence
THERE have been moments over the past few weeks, while watching the events of the swine flu pandemic unfold, that have provided a certain level of bemusement for GPs at the frontline. Especially as we were feeling fairly sure that this was a mild illness and perhaps an over-reaction played out in the media. But at the time of writing, we now know of some relatively healthy young people fighting for their lives on cardiac bypass machines, and pregnant mothers being ventilated to save their babies. I am feeling a new level of concern arising among my colleagues and patients, and a responsibility ... see more
Don't be afraid to get help for stress
AS A medical student I recall being told that, among all the professions, doctors had one of the highest rates of divorce and suicide. It seems to have been well established even back then, but there was little discussion around the possible reasons for this, and certainly no instruction on ways to avoid becoming part of these statistics. Some have proposed that, traditionally, a career in medicine attracts personality types that are at high risk of suffering from stress and burnout, yet others feel it’s the nature of the work that results in high rates of mental illness and dysfunctional relationships. From the earliest days after medical school, becoming part ... see more
Platypus could help solve cancer mysteries
REMEMBER Syd? He was the platypus mascot for the 2000 Olympic Games in Sydney. Recognisable to Australians, he was apparently uncuddly and too weird to set alight the worldwide stuffed toy market. In evolutionary terms, the platypus is indeed weird. It is a monotreme, a rare order of mammals that lay eggs instead of giving birth to live young. It’s also our oldest living relative, and the success last year of an international team in sequencing its genome has given researchers such as geneticist Dr Frank Grutzner a new toolkit for investigating human disease. Dr Grutzner, from the University of Adelaide’s school of molecular and biomedical science, hopes that comparative ... see more
Swine flu is only a curtain raiser to the main event
THE year is 2010. Just as scientists had feared, the continued circulation of swine flu around the world has resulted in significant mutations. After the virus was transmitted through a number of other species (including armadillo, wildebeest and yak), it returned to Australia to infect kangaroos and become a highly lethal strain when passed on to humans. The nation has now returned to its characteristic crisis response mode (complete chaos) as the spectre of decimation by roo flu hits the nation. The virus has evolved to have a case fatality of 70 per cent. This disaster has brought about changes in relations ... see more
Medical ethics murky in worlds of megastars
THE recent death of Michael Jackson echoes the passing of the king of rock and roll, Elvis Presley. Both music megastars had physicians at their beck and call. Cardiologist Dr Conrad Murray was with Jackson in the moments before he died, having allegedly injected the star with Demerol, known in Australia as pethidine, a highly addictive opioid pain reliever. Tapes from the 911 call allegedly indicate Dr Murray was performing CPR on Jackson before his transfer to hospital. It is likely that Jackson had a chronic pain syndrome, and had become addicted to potent painkillers. His pain was associated with previous injuries sustained in falls and in his extraordinary musical career. Over ... see more
Helping men manage their own health
WHAT do men want and what do men need? When it comes to caring for our male patients, it’s these questions that demand our attention. Last week we kicked off our focus on men’s health and the timing couldn’t have been better. The Federal Government is expected to release a national men’s health policy later in the year, so in the lead-up it makes sense to throw the spotlight on this issue. Some would say it’s an imperative. A key message conveyed by the stories and comments is that men face a significantly increased risk of chronic disease and death from many preventable causes, yet they seek our help ... see more
Dispensing home truths on pharmacy
ONE of the unfathomable mysteries of the universe as we know it is the great unanswered question... why is it that anyone can own a medical practice, but pharmacies can only be owned by pharmacists? Moreover, why is it that a new pharmacy can’t open within 1.5 km of an existing one, but a new general practice can open up next door to an existing one without any restrictions? The strange anti-competitive rules applying to pharmacy seem to be completely out of step with the strict policy governing every other type of business structure in Australia. Pharmacy ownership, operation and practice are fundamental issues for general practice. While a number ... see more
Drawing positives from a week of calamities
I WAS on to this brilliant diagnosis and told my patient that “it just came to me”. (That’s doctor’s speak for “I was up all night worrying that I missed a neurosurgical emergency so that’s why I called you early this morning while you were still in bed asleep”.) My patient was impressed. “Wow, like Newton in the bathtub.” “I think it was actually Archimedes,” I replied. I needed further evidence to support my eureka moment. Unfortunately, that required a more rigorous medical exam, including an assessment of anal tone. My bleary-eyed patient was good-natured about my request. I eventually sent her to the emergency ... see more
More to those grey hairs than meets the eye
IN the 1950s only about 10% of women dyed their hair when they started to go grey, but now it’s more than 70 per cent. According to Anne Kreamer, who wrote a memoir (Going Gray, Little Brown) about her decision to let nature take its course with her locks, this is a concerning cultural trend both disempowering women and reflecting societal reluctance to accept old age gracefully. Grey does have a bad name, not just because it symbolises growing old, but also because people instinctively link it to stress – getting ‘grey hairs’ from worrying about the kids, the mortgage or the ... see more
Promotion of fad diets must not be taken lightly
I FIRST heard about the ‘Thin by Friday’ diet when my teenaged daughter asked me if I would follow it with her. She’d read about it in Grazia magazine. I was able to discourage her by explaining that fad diets usually don’t work, and after I warned her of the probable weight gain afterwards, she was pretty happy to abandon the idea. However, I was left with a sense of unease about why she was considering such a diet. Alarm bells went off when I heard the diet seemingly being endorsed on a local radio station. It’s no surprise that young people ... see more
Don’t let home visits become a lost art
HOME visits are dead, especially to the elderly housebound. So few GPs now visit patients at home that it seems to have become a lost art. All sorts of excuses are presented. Some corporations that employ GPs consider home visits a poorly remunerated waste of time. They prefer their doctors to sit poised on the edge of their chairs maximising throughput, item numbers and income. Young doctors prefer not to venture out of their consulting rooms because a home visit is time consuming and may involve travel. But the home visit has a lot to recommend it. For only when you step over ... see more
Designs on altering the gene pool
IN 2001 US researchers unveiled the world’s first transgenic monkey, cutely named ANDi (or ‘inserted DNA’, spelled backwards). He was a rhesus monkey born after a gene for green florescent protein (GFP) had been inserted in unfertilised rhesus eggs which were then artificially inseminated. But it wasn’t entirely successful as, despite his cells carrying the gene extracted from fluorescent jellyfish, ANDi failed to glow under ultraviolet light. He was the first primate to be genetically altered, a step which carries the promise of creating models for human diseases, including neurodegenerative conditions such as Parkinson’s and Lou Gehrig’s, for which lab rats are inadequate ... see more
When the flypaper of the mind comes unstuck
MY writing is like an archaeological dig. I’ve got no idea what the trowels, paint brushes and sifting screens will expose. One reader suggested that I am mining patient behaviour. “You’re no different from the rest of us GPs, except that human oddities stick to your memory like flypaper.” Actually, these days nothing much sticks to my flypaper at all. I am forced to engage in vigorous mental gymnastics to maintain my brain power. So I regularly recite the words from the mini-mental exam: “apple”, “table” and “penny” and practise serial sevens as insurance against what the medical boards might be dreaming ... see more
Some conflicts of interest are more equal than others
If it’s wrong for doctors not to disclose conflicts of interest with the pharmaceutical industry, how come they can hide their vested religious interests? Religions indoctrinate. They promote their doctrine. It follows that many religious clinicians are indoctrinated about issues affecting their practice. And the doctrine affects their doctoring. A Catholic doctor’s views on issues such as contraception, euthanasia and abortion are biased; a Jewish doctor’s views on circumcision are partisan, and a Scientologist’s views on antidepressants or ADHD treatments are equally one-sided. And these views must affect their practice. Surely these biases should be declared, if they impact on patient care, especially in ... read more...
Restrict government regulation to areas of need
RECENT stories featured in Medical Observer illustrate the irony of strict government regulation where it’s frequently not needed, and the lack of it when it could really benefit both patients and doctors. The development of an “opioid policy” from professional colleges to prevent problems associated with prescription opioid use is a real sign of the times. This follows our story revealing that, without checks and balances in place, opiate prescribing has skyrocketed from 2.4 million scripts in 1992 to around seven million in 2007 (MO, 22 May). In the same issue, we ran a story about how removing 200 drugs from the ... see more
The digital dark ages
WHEN my nine-year-old phone/fax/copier/printer started failing, all copies and faxes went faint. I decided on the ecological (albeit expensive) solution; rather than condemn the unit to landfill, I took it in for repairs. After two weeks struggling without it, I went to the shop to claim back my machine. Alas, the repairman hadn’t started working on it. I waited in the store, beyond closing time, until he declared he was done. The machine worked marginally better than before, but the improvement lasted less than a week. I had spent more than $300 for the repairs, but I couldn’t face the role of disgruntled ... see more
Rudd’s health plan is based on a myth
ONE in 10 GPs reading this are planning to quit medicine within the next five years. Another survey finding? Yes – and it basically arrives at the same conclusion that numerous others have reached over the past few years. This one was based on a sample of more than 10,000 GPs and specialists around the country, conducted by the Melbourne Institute and Melbourne and Monash universities. It indicates more than half of all doctors in this country say they’re overworked and one in four feel “very or moderately dissatisfied” with their work-life balance. And up to 12% of GPs, and 13% of specialist ... see more
Food glorious food-like substances
I LOVE buying wholegrain bread, free-range eggs and heritage tomatoes at the local monthly farmers’ market. I want to eat these foods every day, just like my great-grandmother did. These days supermarkets offer tomatoes designed to travel 1000 km before they arrive on your plate, and preservative-laced sliced bread made from refined flour, but boosted with “nutrients”. The trouble, as Michael Pollan wrote in In Defense of Food (Penguin Press), is that we have let food scientists instead of farmers and grandmothers direct what we eat. At the recent Heart Foundation conference in Brisbane, Professor Kerin O’Dea, director of the Sansom Institute in Adelaide, pointed out how misleading ... see more
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
Swine flu overreaction?
CYNICS have accused health authorities of pushing the panic button unnecessarily following outbreaks around the world of a so-far mild swine flu. But one thing’s for sure – no-one is likely to rush headlong into mass vaccination. US infectious diseases experts have been recalling the swine flu “debacle” of 1976. That’s when an outbreak of swine flu hit 200 soldiers at an army base, sending health officials into a spin because it was similar to the virus causing the deadly 1918 pandemic. The Centers for Disease Control and Prevention (CDC) convinced then President Gerald Ford of the need to vaccinate the population. At the time there were 20 manufacturers able ... see more
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
Forget swine flu - normal flu is a killer
ANOTHER year, another epidemic. We’ve seen a veritable zoo of flus over recent years. Bird flu locking down parts of South-East Asia. Horse flu hitting our equine and racing industries, and locking down parts of eastern Australia. Now swine flu has arisen from Mexico cutting a swathe across... well, the world’s media. This even beats the horse flu epidemic for alarmist reporting. At the time of writing, the WHO is poised to declare a global pandemic. This classification has everything to do with the nature of spread and little to do with the clinical severity of this species of flu. There is concern that the virus may become resistant to drugs. ... see more
Is general practice a brand or just bland?
In these ‘uncertain’ times, the strong will survive and the weak… won’t. So, just how strong is general practice? I’m not asking how strong are you, an individual GP. I’m asking about general practice, the brand. The brand isn’t a GP, just as the Coca-Cola brand isn’t a can of sticky brown fizzy stuff. The brand – a brand – is an amalgam of all sorts of emotions and expectations about the product. Brands are promises of what products deliver, expressed as powerful feelings. I think general practice is more a bland than a brand. In a world where brand power prevails, ... read more...
Naltrexone implants need government scrutiny
FOR many heroin users and their desperate families, the prospect of a quick fix for addiction to this all-consuming drug has been a tantalising reality. Naltrexone implants have been inserted into thousands of Australian heroin users over the past decade, despite serious safety concerns raised by drug treatment agencies around the country. These implants are not registered with the Therapeutic Goods Administration (TGA) and are either produced here or imported from China. Clinics around the country have been inserting these devices – under the TGA Special Access Scheme – by claiming that heroin-dependent patients are critically ill and at risk of death. These implants ... see more
Reality sets in for patients facing financial hardship
IT’S not uncommon for a patient to burst into tears after being greeted with the customary “How can I help you?” Their tears are normally the result of something far less disastrous than they imagine, but in one recent consultation of mine, the situation really was dire. The patient, a woman in her early 60s, was tremulous and distraught as she related how she and her husband had been negotiating with banks for several weeks in a desperate attempt to save their home from repossession. Their business had failed, mortgage payments had become impossible, and the sheriff was due to knock on ... see more
Stalled pay shames doctors and system
THE non-payment or deliberately delayed payment of doctors and others supplying services to hospitals in several regional and rural areas in NSW, including my own, is all too common. At its worst, this drives sorely needed doctors out of the public health system and curtails the flow of vital medical supplies. However, more commonly, it creates additional unnecessary stress and costs for those providing services and supplies. The flow-on effects of this deliberate tardiness are huge. Such actions deliver shock wave-proportion negative impacts on recruitment, retention and morale. They also greatly diminish medical and nursing staff respect for health service administrators. Often the newly employed are targeted, some not seeing a pay ... see more
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
Snoring in the ear of the beholder
CAN you pick a snorer when you hear one? If you reckon you can, chances are the person next to you will disagree... While we all know that a snore involves vibration of pharyngeal tissue, there is no accepted international definition of a snore. For example, if you snore three times a minute, does that make you a snorer? Or do you have to snore seven times a minute to be classed as one? Sydney researchers set out to investigate concordance of perception about snoring, with startling results. Not only did most people disagree on whether recorded sounds of sleepers constituted snoring, but it ... see more
Time and emotion
SWEDEN. The only country in the world named after a root vegetable. And it’s remarkable for all sorts of other interesting reasons… This Northern Nordic nation has been at peace since 1814; that’s five years shy of two centuries – long enough for the US and us to have had enough practice warring we’ve got really very proficient indeed at it. The third largest country in the European Union also gave us the most popular acronym in music since Every Good Boy Deserves Football: ABBA, aka Agnetha, Björn, Benny and Anni-Frid, Thank You for the Music. Last, but not least, this ancient Viking ... read more...
Male circumcision should be routine
THE latest issue of the New England Journal of Medicine reports that male circumcision reduces the acquisition of human papilloma virus (HPV) and genital herpes (HSV-2) in men allocated to the intervention arm of a large randomised controlled trial (RCT).1 This is the latest in a flurry of papers to show the benefits of circumcision, many emanating from the three large highly publicised RCTs in Africa in which circumcision reduced the risk of heterosexual HIV acquisition by between 60 and 76 per cent.2 The implications for circumcision policy in Australia are obvious. HPV is the most common sexually transmitted infection (STI) in ... see more
Fly in, fly out surgery
MOST people would express horror at the idea of putting maggots into open wounds – at least among those outside the medical field. As Westmead Hospital’s department of medical entomology website puts it, “maggots will always have an image problem”. The department maintains a colony of blowflies (Lucilia sericata) for medicinal purposes and their maggots are sterilised and shipped off on request to doctors around Australia and overseas. Maggot medicine – or, for the squeamish, ‘larval therapy’ – has been embraced enthusiastically by some hospitals in the era of antibiotic resistance and is even reimbursed by health insurers in some countries. Maggots not only munch necrotic tissue, ... see more
Time to press the panic button
IN a week when the RACGP sends out a survival kit for GPs containing information on how to deal with difficult or violent patients and a rural New South Wales GP, Dr Hamish Steiner, appears on The New Inventors with a panic button that sends out a silent duress alarm to all other computers on a practice network, we have the awful reality of one of our colleagues, GP Theo Rothonis, being stabbed in his Waterloo practice by a 65-year-old patient. We don't know the mental state of Dr Rothonis' attacker, but Waterloo, like Kings Cross, has a higher level of ... see more
The ABC of medical acronyms
THE first briefing I received on my arrival in Canberra with the federal AMA was a four-page list of essential acronyms and abbreviations to memorise. Every committee and government department has to have a collection of these. It seemed to a newcomer that the more acronyms your department or organisation could attach to itself, the greater the air of gravitas one could generate. I kid you not. Without a working knowledge of the current acronyms, you just could not survive a week in politics. On one memorable day, the then-minister for aged care arrived a little late, and more than a little flustered, to address a meeting of the peak ... see more
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
Silence on downside of infant formula
WE all know that breast is best for nurturing infants, but where is the scientific evidence against formula feeding that doctors can present to intending mums? According to an Australian National University researcher, there’s lots of it, but it’s inevitably buried in papers with misleading titles. Among the 78 papers underpinning the American Academy of Pediatrics policy statement on breastfeeding, for example, only a handful of articles actually refer to infant formula in the title. And, rather than linking formula to morbidity, two-thirds refer to the protection conferred by breastfeeding or sound ‘neutral’. This reinforces that breastfeeding is an ‘ideal’ rather than ‘usual or ordinary’ practice, researcher Dr Julie Smith ... see more
Water essential to nation's health
OUR health is inextricably linked to water: safe drinking water, adequate sanitation, minimised water-related disease and healthy freshwater ecosystems. We all require a minimum of 50 litres of clean water each and every day for our basic needs. Unfortunately, this essential commodity may be compromised as our four great southern states become drier, with implications for everything from food supply to infant health. One of the great waterways of the world, the Murray-Darling system, is drying out. About 50% of the water flow into the river basin is via the subsurface flows, so even if La Nina rains return, the system will not be restored for years as bores have ... see more
Don’t suffer heartsink patients
IF I ask you to close your eyes and conjure up the worst heartsink patient in your practice, the images will come thick and fast. You will visualise that person in living colour with all their emotional and medical baggage. Merely recalling them can have potent physiological effects. Your blood pressure rises, your palms begin to sweat and grow cold, your pulse quickens. You are not alone. A recent US study of more than 400 doctors found that those who saw high-frequency, somatising and frustrating patients were primed for burnout (Arch Intern Med 2009;169:333-34). This confirms what we GPs at the coalface in Australia already know. Frequent fliers, endless complainers, unsatisfied ... see more
Paradox and paradocs
LET’s talk about sets. That’s sets: groups of items with things in common. Sets come in two different forms: sets that don’t contain themselves (eg, the set of dogs) and sets that do contain themselves (eg, the set of sets). Simple. So what is the set of all sets that don’t contain themselves? Not so simple. If it doesn’t contain itself, then it’s a member of the set of sets that don’t contain themselves, so it contradicts the assumption we began with – it does actually contain itself. And if you start by saying it contains itself, then this strangeness can’t ... read more...
The greatest gift of all
IT WAS, I believe, Seinfeld who first enunciated the doctrine of regifting – the cheap, thoughtless and ungrateful act of handing a gift received from one friend or relative onto another as if it were the product of one’s own generosity of spirit. We all do it, of course, at one time or another. I myself regularly do it in the run-up to Christmas, when the surgery begins to look somewhat like a cross between a chocolate franchise and a wine cellar. Inasmuch as I’m both a teetotaller and lactose intolerant, virtually all of this produce – and there’s enough to stock ... see more
A call to arms in the war against red tape
AUSTRALIAN GPs are drowning in bureaucratic red tape, resulting in countless hours of extra unpaid paperwork and hundreds of patients missing out on care every day. Doctors around the country are constantly looking for ways to improve administration processes and increase efficiencies to free up time to spend with their patients – but, despite these efforts, the various layers of government continue to dump form after form on GPs. Six years ago, the Productivity Commission deemed the cost of regulatory burden on general practice to be more than $13,000 per GP, per year. Since then we have seen some acknowledgement of the ... see more
A stitch in time saves mind
LIKE many children of my generation, I grew up to the sound of clacking needles and the mutter of “knit one, purl one; knit one, purl one...” I thought it was a lost art until my son started high school and emerged from a home economics class with a mess of wool he claimed was destined to become a scarf. Well, I thought, at least the boys get to do it as well as the girls these days. And perhaps more of us should take it up. Research presented to an American Academy of Neurology meeting found that knitting may stave off dementia. In a study comparing 200 elderly men ... see more
Cooking up a storm
WHEN Gordon Ramsay cooks an omelette, is it art or science? An intuitive craft, divined according to aesthetic and physical principles, or a systematic arrangement of ingredients according to laws elucidated through experiment? Is the potty-mouthed prima donna an egg auteur or an egghead? And what about the egg amateur? Is my omelette art or science? Ramsay’s an artist, though what type is debatable. For me, cookery’s a science, involving formulas, weights, measures, errors and trails of spilt egg white. Cookery’s an art if you’re a talent, a science if you’re a duffer. I suspect the same may be true of clinical medicine. This ... read more...
Drugs bought online a minefield for docs
“YOU have no idea how many people are ordering whatever drugs they want over the Internet... antidepressants, sleeping pills, impotence drugs... things they know their doctors don’t want to prescribe for them. The drugs just arrive in the mail.” My patient was concerned about the safety of some of his friends, who regularly circumvent the prescribing and dispensing processes of pharmaceuticals to order them online. As if we don’t have enough to worry about in our consultations, without having to consider the drugs our patients might be ordering and consuming without our knowledge. Every time I open my email I am bombarded by advertisements for anything from discount Cialis to... well... ... see more
Oxytocin the key to romance?
I HOPE you’re still savouring that box of chocolates or bunch of roses received from a special someone last Saturday... While many look forward to giving and receiving tokens of love on St Valentine’s Day, others decry the commercialisation of romance. But for something really deflating, consider that crazy little thing called love being characterised as an “emergent property... of ancient neuropeptides and neurotransmitters”. According to US neuroscientist Professor Larry Young, human love may be just a cascade of chemicals shaped by evolution. “Poetry it is not,” he opined recently in an essay in Nature. Professor Young, from Emory University in Atlanta, Georgia, says the monogamy that distinguishes prairie ... see more
Hard line on soft drugs needs a rethink
MALE US athlete of the year Michael Phelps is in trouble. The publication of a photo depicting his use of a marijuana bong in a British tabloid recently will place in jeopardy his multi-million-dollar endorsement contracts. Not to mention his squeaky-clean reputation as a record-breaking Olympic swimmer adored by young people around the globe. What if authorities decide to charge Phelps with possession of marijuana? He will join the 800,000 Americans charged each year for this misdemeanour. Of this huge number, 82% are Latino or African American, because they are more likely to be stopped and searched by police. Phelps may not be as clean as his handlers would like. ... see more
AGPN should decide whose side it’s on
AS yet more rumblings of discontent emerge from within the divisions, perhaps it is time for the AGPN to begin a frank discussion on exactly who it represents. According to the AGPN website, more than 95% of GPs are members of their local division, making the network “the largest voice for general practice in Australia”. A voice for general practice – clear enough, one would think. Unfortunately that might need a rethink. Last year, when quizzed about GP representation, former AGPN chief executive Kate Carnell told MO: “We are not a member advocacy group, we are service deliverers. We advocate on behalf of divisions.” Divisions whose membership consists largely ... see more
New roles a prescription for disaster
THIS week, finally, we managed to get Nicola Roxon to spend a day at our surgery. Upon her arrival, she was met by reception staff who, unaware of her identity, greeted her cordially. We spoke of the difficulties of securing adequate staffing, given the amount of receptionist training now required for accreditation. Ms Roxon suggested that perhaps we didn’t really need a highly trained receptionist to carry out the less complex tasks. An untrained textile worker or even a small, docile child could just as easily perform such menial functions as saying “hello” or “how are you?”, fetching glasses of water, or washing ... see more
Residents grill government over super clinic realities
WHEN health minister Nicola Roxon visited Grafton to talk about a $5 million super clinic, more than 150 residents came to listen. It was the largest turnout to such a consultation to date, and hearing these residents talk about health services, it’s no surprise why. Local GPs closed their books years ago, forcing newcomers to present at the Grafton Base Hospital emergency department for even the most minor of illnesses. An inevitable revolving door situation has developed, where chronically ill patients are patched up and discharged, only to deteriorate and return. Those with a GP will most likely still face out-of-pocket expenses, as few doctors in the town bulk-bill. Mental health ... see more
Potential terrorist weapon found in Top End
HERE’S a bit of trivia for you: name the bacterium that can be sexually transmitted and is also slated as a potential agent for biological warfare. Even GPs in the Top End may be surprised to learn that it’s Burkholderia pseudomallei, an organism that lurks in tropical soils and causes the life-threatening disease melioidosis. According to the US Centers for Disease Control and Prevention (CDC), B. pseudomallei is a potential biological terrorist weapon. Of more immediate concern to Australians, however, is new research suggesting land management practices may be contributing to its spread. B. pseudomallei is now the most common cause of fatal community-acquired bacteraemic pneumonia seen at ... see more
No room for doctors in the digital revolution
A MERE quarter of a century after the inception of the personal computer, the little blighters have finally wormed their insidious way into that last bastion of pointless documentation – the nursing home. Wherever I go now, I must remember not only the code to get through the gate, and often another code to get through the door, but also my username, my password and then a string of clicks and commands to get me into the software. For someone who attends dozens of different aged care facilities per week and whose brain is rapidly approaching the state of those institutions’ residents, ... see more
Do the powerful have a right to privacy?
THERE’S no doubt Apple CEO Steve Jobs is unwell. His gaunt appearance has spooked many in the Apple community and, for the first time in more than a decade, he’s not the keynote speaker at the annual Macworld conference. The share price of Apple plunged 10% in one day recently when he took leave of absence. He cites a hormone imbalance as the cause of his cachectic appearance. In his letter to the Apple community, Jobs said: “[My] hormone imbalance is robbing me of the proteins my body needs to be healthy. Sophisticated blood tests have confirmed this diagnosis.” Later, he described the remedy for this problem as being “simple ... see more
Seeing the light on saffron
IN a laboratory in Canberra, a handful of rodents have been feasting on one of the world’s most expensive food commodities. The spice saffron, hand-picked from the hillsides of the Apennines in Abruzzo, Italy, no less... Saffron (Crocus sativus) is used in the Mediterranean to give flavour and colour to risotto, pasta and paella. In the Middle East and in Asia, it enhances stews and curries. And in all these cultures saffron has been used medicinally, from the Minoans’ heyday to our day. In the local supermarket, Australians may find saffron in the spice section at around $10 for a couple of tiny threads. In world trade, ... see more
Time for GPs to shine in ’09
A NEW year, a whole new set of resolutions to make and break. Time to plan for the year ahead. Or is there really much point in planning when even the experts missed predicting the financial tsunami that hit the world’s economies last year? Despite our economy’s record Budget surplus, the threat was perceived as so great that the Australian government’s response was swift and decisive. Suddenly, instead of being told that the cupboard was bare for any extra spending, there were billions of dollars to throw at a “fiscal stimulus”. Millions of Australians were given an unexpected Christmas bonus, with the government cheer squad urging an end-of-year spending spree. I am ... see more
Who’s the boss? Not the government – us
IT is time for GPs to decide who’s the boss. Lately I’ve been sensing a lot of unrest in our specialty, as the health minister starts to hint about the plans afoot in her department. I suspect that this unrest is emerging from a collective feeling of loss of control over our professional destiny. I would have thought that the parlous state of the medical workforce would have had the health minister treating GPs with at least the same gentle consideration as other endangered species like the spot-tailed quoll. Unfortunately, some of her statements are coming across like they’ve been fired from a Japanese ‘whale research’ vessel in the Southern ... see more
Stop being colour blind on child food additives
I HAD known Andrew since his conception. He was one of those first children a couple hopes for. Ticked all the boxes. Ten fingers and toes, fed well, settled easily, developmentally a little ahead of schedule. So it was a surprise, to say the least, when his parents asked for help because his preschool teachers had raised concerns about his behaviour, asking that he be assessed for ADHD and autism. To cut a long story short, it turned out that this Jekyll and Hyde story had started around the time his parents had introduced sweets as reward for toilet training. Once the sweets were withdrawn, the Andrew we knew was ... see more
While government fiddles the rural crisis continues to burn
AN ad hoc approach to reform is never to be recommended, but the Rudd government’s committee culture is unlikely to be held up as a model of best practice either. When the government came to power, it made health system reform a priority. However, to date, its only priority appears to have been setting up a catalogue of commissions, taskforces and advisory groups. Where primary care and preventive health reform are concerned, this action is arguably defendable. The proposed reforms are sweeping and will have a lasting impact. Perhaps time should be taken to get it right. But where there is a crisis ... see more