Australian Doctor 19th April issue | Page 15

ausdoc . com . au 19 APRIL 2024

15

VIEWS FROM YOUR ONLINE COMMUNITY

Slow and steady loses the regime

What happens to

Maria ? Why you can ’ t measure GPs using CPD audits

Dr Louise Stone , thank you for the article about the complexities GPs face in caring for complex patients with complex social problems , like Maria .

Slow medicine is undervalued by Medicare , AHPRA and many doctors .

Sadly , it can also be undervalued by the very patients who book short consults and then produce a long list of problems .

Practising the kind of medicine that lets people take their time and discuss the issues that matter to them is becoming more and more difficult .

I wonder how we can explain the difference between quantitative outcomes and qualitative outcomes to the medical board .

Dr Elizabeth Christie GP , Melbourne , Vic

Consider the following : a patient presents demanding our time now . We know we will have to fill in forms , tick boxes and jump through hoops on their behalf .

We know we cannot really make this patient any better because this particular patient does not listen and deep down they do not trust us .

As we deal with the patient , we think about the other patients in the waiting room — the ones whom we could genuinely help and will genuinely help once we have dealt with the charade before us .

We all have patients like this one , so we get it done and move on .

The name of this patient ? The Medical Board of Australia .

Dr John Mahony GP , Sydney , NSW

Practising above their ‘ payola ’ grade

Doctors have lost the battle over pharmacist prescribing and diagnosing , says top GP

Of course GPs have lost the fight to stop the fragmentation and the dangerous and inevitable dumbing down of primary healthcare in this country .

Just consider the hundreds of millions of dollars that have been poured into the coffers of all political parties in this country over the years by the Pharmacy Guild of Australia , as well as the controlling power of the fee-paying Labor Party – affiliated nurses unions in driving critical political healthcare policy decisions .

GPs have no meaningful union lobbying for them and no cash in brown envelopes to directly influence any Labor Party health policy .

The strategy is called ‘ payola ’, and it used to be considered unlawful and corrupting back in the days when radio stations played certain music in exchange for cash ‘ donations ’ from record companies .

Dr David De Leacy Pathologist , Brisbane , Qld

And while the expansion of allied health roles goes on , we get wedged in and prevented from further subspecialised practice by the vested interests .

Take Roaccutane ( isotretinoin ) prescribing . It is ludicrous that we have to do the monitoring but are not trusted to authorise its prescription . It is the same for Ritalin ( methylphenidate ) in ADHD .

We are being absolutely screwed from both ends .

Dr Jason Cooke GP , Sydney , NSW

The expansion of practice for pharmacists was a done deal from the beginning .

The issue was that nobody questioned the ‘ trial ’ of pharmacy prescribing for UTIs , which was not actually a trial .

But in the end , patients are adults and have autonomy .

And pharmacists should be allowed to do legally decided duties but , with that , take responsibility for their clinical decisions .

If they make mistakes , they need to own them .

Dr Dagmara Poprawski Medical practitioner , Adelaide , SA

Hospitals putting staff at real risk

Nurse beaten unconscious by ED patient gets $ 1.8 million compensation

This happened to the poor nurse even though the duress alarm had been pressed .

When I previously did night shifts as a resident on call and had to respond to escalating situations , I usually went home at the end of the shift carrying an increased sense of stress .

The staff who worked there every day were at real risk of coming to harm .

I commend all those who work in secured wards and units .

Dr Gabe Rodrigues Medical practitioner , Toowoomba , Qld

A friend of mine was severely assaulted recently , and the hospital also tried to put the blame on him — namely , it was his fault , the attack couldn ’ t be prevented , etc .

I was also assaulted as an intern and was threatened into returning to work the next day by HR because of the lack of staffing . I am bloody tired of this . Maybe the hospitals just need to ensure there is adequate staff .

Dr Gillian Riley GP , Canberra , ACT

And imagine how much cheaper it would be for the hospitals to pay for the staff as opposed to the legal costs .

Dr John Davis GP , Warwick , Qld

Refusing to burrow into a body of lies

The incidentaloma menace : Why GPs and radiologists need to talk

This article takes me back about 20 years when the full-body scan was all the rage .

Patients thought it was wonderful : this was something that would reveal all the hidden nasty

diagnoses in time to save their lives .

While working as a GP , I remember several patients I had never seen before presenting with a lengthy report ( no actual films , of course ) from radiologists , who no doubt had made a mint .

They would pepper the report with endless “ could represent ”, “ is reminiscent of ”, “ may warrant further imaging ”, etc .

And so the asymptomatic patient would become irate when I explained that I had never seen them before , I did not order the imaging , I would not order this imaging , that it had no scientific evidence to support it and that I would not read the report any further because we could go down a rabbit hole and spend months trying to prove an endless list of possible lesions / aberrant appearances that were probably benign incidentalomas .

I consulted my medical defence organisation , which thankfully supported my decision to refuse .

Dr Edward Grieve Public health medicine ,

Sydney , NSW

One of the most frustrating requests I received was the Queensland Health letter that ended with , “ GP to arrange CT / MRI .”

Patients , wish you weren ’ t here !

‘ How a deceased patient interrupted my trip ’ and more doctor holiday tales

The investigation was not indicated , but the patient had been told to expect it .

The saddest / strangest one was from Bundaberg Hospital , which read : “ GP to arrange echo to check for infective endocarditis .”

And this was after the patient with sepsis had been discharged .

Dr Brad Olsen GP , Brisbane , Qld

A journey shared is a great support

‘ How long have I got , doc ?’ Dr Peter Goldsworthy and his multiple myeloma diagnosis

Some years ago , we had Christmas in Canada , where my wife has some family . I received a call asking me to attend my local hospital to certify life extinct on a patient who had been brought in , having died a couple of hours previously .

I explained that I couldn ’ t oblige because ( a ) I was out of the country and ( b ), in the Canadian time zone , the patient wasn ’ t even dead yet .

Dr Simon Birchley GP , Innisfail , Qld

Peter , thanks for sharing your story .

A colleague and I are on a similar journey together — both working in the same practice .

It ’ s a tough gig on lots of fronts . Making the most of each day and looking for that joy have been so helpful .

I hope your treatment journey was not too brutal .

And I want you to know that sharing your experiences will be useful for all of us .

Dr Murray Schofield GP , Port Macquarie , NSW