Australian Doctor 3rd November 2023 3rd Nov 23 | Page 10

10 NEWS

10 NEWS

3 NOVEMBER 2023 ausdoc . com . au

‘ Stop catastrophising menopause for cash ’

Rachel Carter MARKETING aimed at women is painting a catastrophised picture of menopause to help sell supplements and menopause ‘ accreditation ’ for workplaces , women ’ s health experts warn .
A joint report from the Australasian Menopause Society , Jean Hailes and Monash University says the global market for menopause products and services could be worth $ 40 billion by 2030 , based on market analysis .
“ Unfortunately , there are powerful commercial incentives to create a ‘ menopause problem ’ in the minds of Australian women and Australian employers that can be ‘ fixed ’ by the purchase of goods and services ,” the report says .
Dietary supplements — for example , iodine or isoflavone products — are a major driver for the commercial boom , according to the market analysis .
Menopause supplements have no robust evidence behind them .
— Dr Karen Magraith
Dr Karen Magraith — a Tasmanian GP and the menopause society ’ s immediate past president — says , while they are rarely harmful , these products often have no robust evidence behind them .
“ Anything that is being promoted as a treatment for hot flushes , for example , has a massive placebo effect ,” she says .
“ Women may feel they get some temporary improvement , but they are also spending a lot of money .”
The report referred to a commonly cited statistic stating that nearly one million UK women quit their jobs because of menopause .
But despite being quoted in The Times , The Guardian and even UK Parliament , the figure was tracked back to a survey by insurance company BUPA that asked about fertility , pregnancy and period issues , not just menopause .
Dr Magraith said companies had used the figure widely “ perhaps wanting to jump in and say we can do something about this ”, such as accrediting menopause policies for the workplace .
The aim was usually to ensure a culture where menopause could be talked about openly , HR teams knew what menopause was and a menopausal worker could be supported .

GP failed to check notes before prescribing wrong lithium dose

Carmel Sparke A GP prescribed the wrong lithium dose to a patient despite receiving a hospital discharge summary and reports with the correct dose , an inquest has heard .
Andrew Stubbs died three months later from dialysis disequilibrium syndrome ( DDS ), a rare complication of dialysis to treat severe lithium toxicity and kidney failure .
The Coroners Court of NSW was told that the 32-year-old ’ s schizoaffective disorder had been successfully treated with lithium since 2017 .
He was admitted to Campbelltown Hospital for treatment in 2019 and then discharged with a plan to reduce his dose from 1250mg per day to 1000mg . This was subsequently done
while he was under the care of a community mental health team .
In April 2020 , Mr Stubbs was then discharged into the care of his GP , with whom he had consulted over the previous four years .
“ Andrew told [ the GP ] that he was on a dose of 500mg lithium in the morning and 750mg lithium at night ( 1250mg per day ),” NSW deputy state coroner David O ’ Neil wrote in his findings .
“[ The doctor ] considered Andrew to be a rational historian who was proactive about his own health . He therefore felt it was reasonable to accept Andrew ’ s account at the time .
“ He recorded the dose in Andrew ’ s medical record .”
The GP said he had developed a
good rapport with Mr Stubbs over the years ; however , he had been given limited guidance on prescribing lithium and only recalled prescribing the drug to two or three other patients .
As part of the clinical handover , the
‘ It had not clicked that the dose on the documents was different .’
GP was sent four documents , including a discharge summary , listing the correct dose before his conversation with Mr Stubbs .
“ In evidence , he stated it had not ‘ clicked ’ that the dose on these
documents was different , and he had overlooked it ,” the coroner said .
“ He accepted he had not ‘ doubleor triple-checked ’ ... and that he should have done so .”
Blood tests taken the following month showed that Mr Stubbs ’ lithium levels were above therapeutic levels .
But repeat blood tests were not arranged , the coroner said .
Mr Stubbs was eventually taken to Bowral Hospital , which found he had a toxic / fatal level of lithium ( 4.5mmol / L ).
On transfer to Campbelltown Hospital , he was initially administered continuous venovenous haemodiafiltration in the ICU before being transferred to the renal unit for intermittent haemodialysis . Both carried risks of DDS .
By the following evening , Mr Stubbs
was complaining of severe headaches , confusion , drowsiness and vomiting — asking nursing staff to “ just let me die ”.
After he lost consciousness a few hours later , a CT scan and then an angiogram of Mr Stubbs ’ brain showed his condition was non-survivable , with diffuse cerebral oedema , consistent with raised intracranial pressure , and herniation of the cerebellar tonsils .
In findings published last month , the coroner rejected the GP ’ s declaration he had had limited guidance for prescribing lithium .
“ As [ he ] had accepted the responsibility of prescribing lithium , it was incumbent upon him to seek support and advice as needed to prescribe it safely ,” he wrote .