AusDoc 12th Dec | Page 17

ausdoc. com. au 12 DECEMBER 2025

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VIEWS FROM YOUR ONLINE COMMUNITY

Blockage comes to a head

RACGP and dermatology college strike code of silence pact on GP isotretinoin prescribing

Every other profession is creeping into GP scope— pharmacists now prescribing, nurses next in line— yet the most highly trained, broadbased medical specialists in the entire system, GPs, are still blocked from prescribing retinoids for severe acne.

It is absurd.

Dr Tom Parmakellis GP, Sydney, NSW

Retinoids are teratogenic, so you need a doctor experienced in contraception— namely, a GP.

And they may worsen or cause mental health issues, so you need a doctor experienced in managing mental health issues— again, a GP.

It is hard to imagine an argument against GPs prescribing retinoids.

Dr Jennifer Brownless GP, Melbourne, Vic

The current rules are the definition of a racket if ever there was one.

Patients are sent back to me to follow up on their contraception, LFTs and mental health while dermatologists pocket $ 500 from my patient for a 10-minute consult for which I have done all the groundwork.

No wonder GPs are sick of this absolute crap.

Dr Jason Cooke GP, Sydney, NSW

The system is inhumane, overwhelmed

Junior doctor suicides

— the story of a father who lost a son

As a practising doctor of many years now, my take is that corporate thinking has taken over.

Administrators have far too much say in the decision-making without input from people at the coalface. So policies are inhumane. Just the dollars matter, and care goes out the window.

Too often, no-one is in charge and no-one is listening.

David’ s suicide is an absolute tragedy. My heartfelt sympathy to all affected by his death.

The weasel words in response are a disgrace. They say nothing. Dr James Deves Otolaryngology— head and neck surgeon, Central Coast, NSW

It’ s time to debug our systems

Failed consult? The battle to explain why my patient’ s ChatGPT treatment plan was wrong

The answer is simple: move on. Get a patient who respects you. We cannot do our jobs unless we are respected.

If our patients respect us, they trust us, and if they trust us, they tell us the truth and co-operate with us in managing their health.

We ask difficult, intimate, embarrassing and intrusive questions, and we carry out difficult, uncomfortable and even painful examinations. Respect is sometimes given, and when it is, it is usually earned. But just sometimes, it must be demanded. If it is demanded and still not delivered, then move on. There are plenty of patients who need you.

Associate Professor Chris Hogan GP, Melbourne, Vic

I am also very sorry for this father’ s loss. But I also have some sympathy for the rostering people at the hospital.

When it is said David should have been given his annual leave, the reason it is refused is usually because there is no-one to cover.

Hospitals do not have enough staff, and often, that is not through a lack of trying to recruit.

The system is overwhelmed. It is hard to fix.

Dr Rachael Foster Dermatologist, Perth, WA

No respite for the vulnerable

Professor Brendan

Murphy on the challenge of our time: specialist fees and out-of-pocket costs

I am a private respiratory physician. At present, in SA, a senior public colleague with my experience would be on $ 550,000- $ 650,000 salary, before adding the long list of extra benefits; you all know what they are.

I can tell you with my hand on my heart that I have worked a lot harder and seen thousands more patients face to face than my public colleagues and peers, but my yearly income has rarely approached 65 % of these figures.

And I am expected to bulk-bill or lower my gap fees?

Some of my cleverer patients have asked me why I charge the gaps. I explain to them what I have written above. I also mention continuity of care, car parking onsite and that I never run late.

I perform lung function tests onsite, with a paid casual technician. I also have a practice manager looking after the two of us, as well as two part-time personal assistants.

Many of my public and private patients have my mobile, and I expect them to call me directly if they present acutely unwell to any ED( public or private). Dr Evan Tsirgiotis Respiratory and sleep medicine physician, Adelaide, SA

There has been a tremendous failure of the public hospital system in providing specialist care.

Private specialists were not intended for everybody because there used to be enough space in clinics and on theatre lists in public hospitals.

Unfortunately, the parlous state of public hospitals has driven a huge sector of the population into a place where they are exposed to the pro-inflationary environment experienced by any small business operating in Australia.

Medical inflation runs at almost double the CPI.

Furthermore, the public hospital unavailability does make it a seller’ s marketplace for private services.

Unfortunately in medicine, and surgery in particular, technology makes things better— but never cheaper.

Until public hospital spending can keep up with demand, we will not get a respite for specialist fees for that group who are vulnerable to the increasing costs.

Dr Peter Sumich Ophthalmologist, Parramatta, NSW

It may be the pits, but it’ s good TV

Meet the Aussie emergency physician who writes the Emmy award-winning drama‘ The Pitt’

At least there is one good thing to come out of the systemic underfunding and understaffing of EDs and hospitals the world over— some darn good TV!

Well done to Dr Mel Herbert on a great career.

Dr Patrick Baker GP, Melbourne, Vic

A costly and onerous‘ solution’

Does the GP training program prepare you to prescribe ADHD drugs safely? The RACGP says yes

GP diagnosis and prescribing look like a simple solution to the access problem.

However, there are some complications.

The guidelines alone are more than 200 pages.

Okay, the structured interview looks simple enough, but the criteria indicate that corroboration is required.

We should be able to work through a diagnosis in an hour or two, perhaps less with good background information.

But unfortunately, only psychiatrists can claim for thirdparty interviews( as far as I know). So that is a few hundred dollars that someone will have to fund( patient) or forgo( doctor).

Yes, there is an online course— almost $ 1000 for the one I could find.

My last point: Non-stimulant medications— atomoxetine, guanfacine— are not subsidised unless the patient is being treated by a psychiatrist or paediatrician.

Dr Andrew Rees GP, Toowoomba, Qld