An avalanche of ADHD pills and skills ‘ We should be careful about prescribing these drugs willy-nilly ’: Prof Simon Willcock on GP treatment of ADHD
As a GP working with patients with ADHD for 20 years , I doubt any GP would use the medications “ willy-nilly ”.
Like any other medical / surgical / psychiatric condition , we have the support we need through specialists if we feel diagnosis and treatment are out of our scope of practice .
Like any other condition , it requires a good history and adequate testing to exclude any organic causes .
If they are excluded , then stimulant therapy is recognised as the best first-line treatment . As I have always told my patients , pills do not teach skills and they certainly do not make you smarter — they just let your smarts out .
ADHD is like diabetes and requires a holistic team approach .
It is well within the scope of many GPs , and training is available to upskill . Some GPs will choose to do it and others will not .
Dr Shelley Gray GP , Melbourne , Vic
Please , please leave the diagnosis of ADHD out of general practice ; it will be an absolute nightmare . I am still trying to get on top of the avalanche of women who , from 30 onwards , think everything happening in their lives must be menopause or perimenopause .
If we are to diagnose ADHD , we will be flooded with drug-seeking people who are on the milder end of the ADHD spectrum .
The diagnosis in adults is complex and often coexists with various other conditions . Drug abuse is also real . Just as opioids and benzodiazepines are sold at the pub , so are these stimulants .
At least having psychiatrists and paediatricians diagnose and stabilise treatment takes away the difficult conversations .
I do not want to be negotiating with patients multiple times a day around increasing doses of stimulants .
Let ’ s focus instead on putting a lid on the immoral prices being charged by psychiatrists for the diagnosis .
Dr Anna Kelly GP , Newcastle , NSW
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The blindingly ignorant leading the blind Reaping what RFK Jr has helped to sow ? Measles is back in the US
I love how some of these medical extremists will emphatically and blindly latch onto an idea , with little to no evidential support , and completely close down on one that does .
Questioning and challenging ideas is healthy and essential in medicine , but so is identifying evidence for and against ideas and adjusting our practice accordingly .
Research in the hands of people who do not understand its fundamentals is dangerous .
Dr Louise Burns Medical practitioner , Cairns , Qld
Universal bulk-billing is a fever dream Dr
Mark Butler says he
‘ could not in good conscience ’ boost rebates instead of bulk-billing incentives Dear Mark Butler , I have been a GP for 15 years . I transitioned my clinic to a mixed-billing model three years ago .
I still do bulk-billing for children and pensioners , absorbing a loss while charging a $ 40 gap fee from patients who can pay .
But I will never implement universal bulk-billing for the rest of my career .
How would you feel if I asked
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you to take a 50 % pay cut ?
You have no idea how a medical clinic runs , and you lack prior experience in the healthcare field since your only experience is working with your union .
You should stop dreaming that every patient will be bulk-billed ; it will never happen .
All your investments are misguided because you assume we will all accept your proposal !
Dr Joseph Fernando GP , Melbourne , Vic
Hate to break it to you , Prime Minister Anthony Albanese
Dr promises even more urgent care clinics : ‘ 80 % of Aussies will live within 20 minutes of one ’ I went to urgent care at the weekend with a minor fracture .
There was no X-ray on site , so I ended up in trusty ED , where care was amazing and quick . But I felt guilty for using ED resources on a Sunday .
Urgent care , if it is expanding , needs appropriate resourcing , complemented by data collection and analysis , including the economics .
Dr Danielle Chroinin Physician , Liverpool , NSW
I have worked as a private GP and in a government clinic .
It is delightful as a doctor to work in a clinic like this , with good pay and conditions .
Therefore , I suspect the cost to taxpayers per consult will be vastly more in the clinics .
But if the government cannot
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afford to fund GPs adequately under Medicare , how will these clinics be sustainable ?
Dr Ian Truscott GP , Sunshine Coast , Qld
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Moving is a clear and present danger Medical student describes his 13-day survival ordeal lost in the Snowy Mountains
A paramedic I know had a fracture in the Western Arthurs of Tasmania three days into a gruelling walk . It was a group of super-fit paramedics and ICU doctors .
They hit the emergency positionindicating radio beacon , and a helicopter arrived in just over three hours .
We should honour the colleagues who are careful , adequately trained and prepared .
Anyone who has ever read an action novel , seen a police report on the news or watched a Harrison Ford film knows , if you want to evade capture , you keep moving .
If you want to be found , you stay in one place . And that is what you tell your kids to do if they get lost anywhere .
Dr Ian Hargreaves Surgeon , Sydney , NSW
‘ Put your finger in it or your foot in it ’ Let ’ s talk about your
Dr patient ’ s anus : Doctor on his campaign to end the silence and shame Thank you , Professor Richard
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Hillman , for highlighting both the issue and the lessons of omitted physical examination .
During my almost 50-year GP career , I always remembered the words of a wise , humble and brilliant medical educator , Dr John Colvin .
He gave memorable lectures in ophthalmology to generations of medical students at the Royal Victorian Eye and Ear Hospital .
Along with his invaluable Golden Eye Rules , one of his favourite sayings was , “ More things are missed by not looking than by not knowing . So , get out from behind your big mahogany desk and have a look !”
This is something I , in turn , tried to instil in medical students during my years as a clinical tutor . Of course , we are all human and fallible , and we can miss clues and make errors .
However , omitting relevant examination when the patient is physically present is negligent and inexcusable in my book , especially with potentially serious symptom presentations or red flags .
Dr Aurelio Di Stefano GP , Geelong , Vic
As a physician trainee in the era of clinical excellence , the PR was the sine qua non of the complete physical examination .
We did not talk about it ; we did it .
The glove and KY jelly were on the clinical trolley . And the conventional wisdom was that , if you did not put your finger in it , you put your foot in it , colloquially speaking .
Dr Christopher Davis Medical practitioner , Moreton Bay , Qld
I agree . The PR exam requires good manners and communication from the doctor and should be done together with the patient , exchanging the patient ’ s sensation and our palpation findings .
Dr Andrea Dipold GP , Sydney , NSW
Emotional contribution that hits home When a GP at your
Dr practice dies Dr Mariam Bahemia , thank you for such a wonderful reflection and insight into a topic that is a challenge for all of us to consider .
After his passing , your dad is contributing through you and your life as a GP .
I appreciate the emotions that this article would have raised , but thank you for bringing such an important topic to light .
Dr Alistair Lewis GP , Melbourne , Vic
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