Dear President-elect

Dear President-elect;

From experience and observation of 10 years on Medical Politics:

– You may have an opinion on things, however, others do too and they may hold the purse strings, the governance, or the power over you.

– They may in fact not give a fig for what you have to say… no matter how entitled you might be to say it on behalf of yourself or your members…

– You might want to be a champion and a legend, be the one who crushed the opposition, making them listen, creating benefit and change for your own advantage and that of your peers (see above)

– Others have tried, with more or less success than you will have. They were no less intelligent and possible more so, they have the same human failings, the same passion, and drive. Reflect on that when talking about their legacies.

– You are one voice amongst many, and some at this point in time hold sway because of the body politic, fashion, expediency, necessity, or because the mood of the nation, the media, and others support them for their own purposes and ends.

– Your Ego will take a bruising; you do not have a magical gift that members expect you to have. Your members have short memories, they can be caustic and unfair in their criticisms; someone should share your journey it is lonely. (See being a legend above and reflect on your campaign speech.)

– Many of your victories will be Pyrrhic. They will be supported only where it benefits others, and certainly, they are not your friends.

– Some of your potential Victories will damage others and have perverse outcomes that damage the profession. Seek advice, take time, and think ahead to the future, there is enough room for more voices than yours.

– Reflect on your biases, your culture and heritage, your place, and how it shapes your views. We are not one, we are remote, rural, regional, urban, we are first nations people, we are escaping ravages of our homes, we are gay, lesbian, bi, trans, we have loans, we are young, we are old, our life is not yours. You will have to speak for us all…

– Your remarks and reflections will be used by the media for their own ends, be prepared to defend them, or be silent.

– Being Pugnacious or Strident no longer cuts it…

– Headlines today, are tomorrows Fish & Chip paper, they will be forgotten… except as clickbait by Social media.

– Be kind to yourself, be kind to others including your “opposition” for we are all brothers and sisters to an honored profession, never forget that.

– There will be a cost… Are you prepared to expend a significant amount your time, your energy, your passion, your drive, your love, your income, your relationships to a role that may not meet the measure of your aspirations for it?

Who is the real winner in the latest stoush between pharmacists and doctors?

It’s time the health profession stopped viewing each other with suspicious and responding with derision (to media-driven provocation). Important suggestions @EdwinKryus let us be more mature in our dealings.

Doctor's Bag

Last week a state Pharmacy Guild president made a few negative comments about general practice. I thought it was neither here nor there, but what happened next was interesting.

I could not find the original column (admittedly I didn’t look very hard) so I can’t verify his exact words but apparently, he said that increased funding for GPs will only incentivise five-minute ‘turnstile’ medicine.

Most GPs would not have read or been aware of the column until, on the eighth of February, Australian Doctor Magazine, owned by the Australian Doctor Group (ADG), posted an article on their website titled “Pharmacy Guild says GPs working ‘turnstile operations’ filling time-slots with easy patients.”

Then all hell broke loose. There were 170 comments on the article from mostly angry GPs.

A few days later, on the eleventh of February, Pharmacy News published this piece: “Guild takes aim at GPs who favour…

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So what does the Productivity Commisioner Report say ?

To quote an infamous millionaire “Wake up Australia” fake news, politicians looking for simple sound bites, and the guild an opportunity to expand its business. Another political report be people without expertise in the field & flawed data. We’ve one of the best health systems there is, it could be better, but improvement will only happen through sound analysis, rationally applied principles and rebalancing the system to prevention, early intervention & addressing social issues in community. Well done Thinus, another great blog

Dr Thinus' musings

We woke this morning to the headlines screaming out:

“Aussies making ‘avoidable’ hospital visits due to poor GP access”

It makes for seemingly depressing reading in regards to how poorly GPs are looking after their patients:

  • GPs are hard to access
  • GPs cost a fortune
  • People are putting off seeing their GPs / purchasing their medicine due to costs
  • Chronic conditions are poorly managed

It is however always advisable in such cases to always seek out the source documents and see what it states without the political bias that the media on either side of the divide attach to it.

So this is what the Report states (with my bias as a GP tainting the interpretation):

Money

  • The Australian Government spends $0.98 a day on GP care for every Australian
    • In the ACT they only spend $0.74 a day per person on GP care

2019-01-30 (2)

Note that the ABC article linked…

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Are Medically Prescribed Opioids Killing Australians?

Are medically prescribed Opioids killing Australians?
 
In 1996 Oxycontin a drug more powerful than Heroin hit the medical marketplace. It was touted as the cure for any pain, without addiction and without risk. Drug Companies have made many millions from this drug, at the cost of many deaths.
 
In 2018 we face an evolving crisis following America down a slippery slope, that will cost us our relatives, parents, sons, and daughters if we don’t change.
 
 
But change doesn’t start at the end of a Doctors Pen – it starts with understanding pain, understanding its necessity and better ways to treat it. It starts with opening your mind to alternatives such as physical activity, physical therapies, diet, stress management and lifestyle changes.
 
Almost daily people come to Emerald Medical Group in pain, having been prescribed oxycontin, and been disappointed that the conversation wasn’t what they wanted to hear and that they left without a prescription. Doctors have a duty of care to you that transcends any short-term contract you might perceive to prescribe a drug that you have demanded.
 
Other drugs such as Diazepam (Valium) and the Gabapentinoids (Lyrica and Pregabaline) have been proven to have almost no place in pain management. Medical Marijuana, for all the hype, has little evidence of benefit.
 
We are facing a serious crisis in rural Australian where more people suffer addiction to medically prescribed opioids than the rest of the country. Sometimes people have to live with pain, Oxycontin and other prescribed drugs don’t offer a long-term solution.
 
There are new treatments on the Horizon, but first, you must accept that salvation comes with understanding and acceptance that pain management is a journey, not a cure at the tip of your tongue.
1
Some Resources for Patients and Clinicians regards Chronic Pain Management (Thanks to Doc Paul):
Brainman series of Youtube videos:

www.youtube.com/watch?v=5KrUL8tOaQs 

Fantastic website and video explaining persisting pain, for patients: www.tamethebeast.org 

AFP pain management article: www.racgp.org.au/afp/2014/august/gp-pain-management/

NPS resources for chronic pain, including ͚pain management prescription template:
http://www.nps.org.au/…/nervous…/pain/for-individuals/pain-conditions/chronic-pain

Excellent Australian site full of pain resources, including the ͞Explain Pain book.
www.noigroup.com/en/Resources 

UK site: useful pain ͚toolkits͛: http://paincommunitycentre.org/pain-toolkits 

US site: great pain resources – www.instituteforchronicpain.org/ 

The effect of language on pain experiences: https://theconversation.com/the-right-words-matter-when-talking-about-pain-50450 

Great summary article from a Melb-based pain specialist: www.linkedin.com/pulse/top-10-chronic-pains-tips-tricks-general-dr-nick-christelis 

ABC article on chronic pain myths: www.abc.net.au/news/health/myths-about-chronic-pain/7704554 

Explanation of central sensitisations͛ role on chronic pain: www.painscience.com/articles/central-sensitization.php

Article on how our thoughts influence our pain: https://theconversation.com/got-chronic-pain-just-un-learn-to-live-with-it-39060 

More patient information: www.painaustralia.org.au/living-with-pain/what-is-pain.html 

AFP article on the inherited chronic pain patient: www.racgp.org.au/afp/2016/december/the-inherited-chronic-pain-patient/ 

Excellent site with great pain management patient resources: www.aci.health.nsw.gov.au/chronic-pain/painbytes 

Online pain management programs for patients:
https://thiswayup.org.au/how-we-can…/courses/chronic-pain/ costs $60 to enroll and needs a ͞prescription from GP; a comprehensive program developed in conjunction with the St Vincent’s Pain Clinic.

https://mindspot.org.au/pain-course available free; consists of 5 lessons and guidance through those lessons from a Macquarie University based virtual clinic psychologist

This is how your data in the My Health Record will be used

An important update from Edwin on the secondary use of data in the MyHealthRecord

Doctor's Bag

On Friday the Federal Government quietly released its long-awaited framework for secondary use of information contained within the My Health Record. It will generate discussion as it is controversial.

The release of the framework to guide the secondary use of My Health Record (MyHR) system data comes just months before the participation rules for the Australian national health record change from opt-in to opt-out.

Consent for secondary use is implied if consumers don’t opt out of the MyHR. In other words, people need to take action if they don’t want their health data to be used for purposes other than direct clinical care.

To stop information flowing to third parties, consumers will have to press the ‘withdraw participation button’.

Another hot topic is the use of the data by commercial organisations which, interestingly, is permitted under the framework, provided it is ‘in the public interest’.

And, as expected, one of the…

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Is value based healthcare devaluing care?

Doctor's Bag

Value based healthcare

There’s a lot to say for high value care. High value care is healthcare that generates a large amount of benefit for patients and the community compared to the resources invested. But there are also concerns.

Value based healthcare links outcomes with costs: ‘Value’ is derived from measuring health outcomes against the cost of delivering these outcomes. Although it makes sense to fund care that gives us the greatest health benefits, some argue that ‘value’ is more than outcomes.

Dr Jan Kremer is a Dutch Professor in patient-centred innovation and has a passion for patient-focused quality and innovation. In a recent blog post he questioned value based healthcare, stating that value has a different meaning to different people – ranging from efficiency to solidarity, equity and quality of life.

The right things

In healthcare, he said, it is not just about doing things right, but also about doing the right things. The…

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Why I may sign your fitness to drive form

Mark Raines

“Well, Mr Terry I have some bad news. The results of your tests shows me that it is no longer safe for you to drive.”

“But why, young whipper snipper, you don’t understand, I’ve been driving since before you were born……”

One of the harder things I have do as a GP is to tells someone that they should no longer drive and they need to hand in their license. I have lost a few patients along the way because we have disagreed on their ability or competency.  Generally during a consultation, I consider the patient before me, and sometimes their family. But in this situation, I have a responsibility to consider the wide community. In fact, you also have this responsibility as the F3172 form you gave me to sign for your drive medical stipulates.

“If you hold a Queensland driver licence, or are applying for a Queensland driver licence, you…

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Why Men in Maternity Matter.

An important blog on gender in medicine

Nomadic GP

In Australia, as in many other parts of the world, male doctors are becoming a threatened species in the field of obstetrics and gynaecology. Women now make up the overwhelming majority of trainees – roughly 80% across the country – and the numbers are increasing.  Our very own RANZCOG president, Dr Steve Robson, is a great advocate for women in medicine, and proudly highlights this evolving gender imbalance in his tweets and photographs. It is fast becoming the new normal.

But, as a feminist, I have some concerns.

This issue has garnered a fair bit of discussion in the international media of late, with an article published in the LA times last week stirring up some heated discussion. A number of blog posts have followed (including this, from my personal hero, Dr Jen Gunter and this), plus hundreds of comments, and some pretty robust debate on social…

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Drug seeker basted me like a turkey

Primum non nocere, and that includes not prescribing drugs of addiction. It is hard to say no, but sometimes it is kindest.

drjustincoleman

Turkey, by Ben Sanders Illustration: Ben Sandars

This month I got done over by a drug seeker. Tattoo Man basted me like a Christmas turkey, peppered me with garnished praise and slow baked his way through my seasoned outer crust. Bugger.

Usually, when it comes to slamming the script pad shut, I’m all Fort Knox.

Reception deliberately sends all hopeful newcomers down dead-end street to my brick wall. Five minutes later they exit, loudly proclaiming to the waiting room that, in effect, my clinical decisions are being influenced by the rather unlikely combination of both my genitalia and distal GI tract.

Funnily enough, those occasions are relatively easy. My patients in the waiting room know me well enough to guess what might have happened. And everyone knows their role: the receptionists blame me, as instructed, and I blame our Practice Policy—the only thing I’ve ever written which remains unsigned.

“Sorry madam, I’d love to…

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