Australian Doctor 4th August 2023 AD 4th Aug Issue | Page 15

NEW Events Calendar

15

VIEWS FROM YOUR ONLINE COMMUNITY

Overdiagnosis or just overstepping ?

Sorry , but I don ’ t want

MO to become the ‘ GP who prescribes ADHD medication ’

This headline made me so mad . It really made me question Professor Simon Willcock , who I previously respected a lot .

If he feels so strongly about ADHD , maybe just quietly opt out of seeing patients with ADHD rather than write something like this .

The article is unhelpful at best and harmful at worst — most likely the latter . It shows a lot of ignorance about ADHD .

ADHD is already very misunderstood and stigmatised even within the medical community .

I have heard stories of patients being distressed and not receiving adequate care at the hands of doctors who believe some of the things this author does : that ADHD is overdiagnosed ; that it doesn ’ t exist .

The author would do well to read the recently published guidelines .

Dr Lauren McCann GP , Sydney , NSW

I don ’ t want to prescribe either , but I ’ m supportive ( as I ’ m sure is the author ) of people who need treatment and GPs who do want to prescribe .

It seems to me a misstep to underestimate the effect of even subsyndromal ADHD on the health , happiness and longevity of patients affected .

I ’ m sure having a loving , supportive , educated family helps and agree that medication doesn ’ t solve everything , but it often makes working on all those other important things easier .

ADHD ’ s effect on life expectancy rivals all the other desperate health conditions our patients experience .

I saw a patient recently who had felt unheard by two other GPs after bringing up ADHD with them ; they had alluded to social media popularising the diagnosis .

Hopefully , Professor Willcock ’ s patients see the funny side of his mischievous sense of humour .

Dr Caitlin Raschke GP , Newcastle , NSW

Professor Willcock , you are not alone in your thoughts .

I have felt this way long term not only about ADHD but also about the need for a medical diagnosis for patients who have some minor autism traits , as well as early medication for anxiety and medication for minor depression .

The chronic pain corollary to which you allude is something I have thought much about .

I attended the WONCA conference in Brussels , where there were fascinating lectures on overdiagnosis .

We as GPs are being progressively forced to prescribe , investigate and diagnose against our own judgement to please others and go with the flow .

Another example ? Ordering of CT scans for minor injuries or abdominal pain , which is now excessive and will inevitably lead to iatrogenic cancer .

Dr Alan McLean GP , Wiluna , WA

I ’ ve had similar conversations with my patients as Professor Willcock .

I also see some of the traits and criteria in myself . But does it justify the use of a stimulant ?

I think the pace of daily life has ramped up , and we are experiencing sleep deprivation , chronic stress and fatigue . And yes , add a stimulant , and we will surely feel better . You can give morphine to all your patients with back pain , and they will appreciate it . You can give alprazolam to those with anxiety , and they will love it .

But is it the safe approach ?

Dr Touraj Oveisi GP , Melbourne , Vic

A high price to pay for hope

Dr Charlie Teo found

Dr guilty of unsatisfactory professional conduct

I am a patient with an advanced cancer in the brain .

I was turned down by my first neurosurgeon and advised to resign myself to the inevitable outcome . With the help of my family , I looked for a more positive solution anywhere in the world , and Dr Charlie Teo turns up .

What is there to lose ? I am dying anyway . And Dr Teo is a brilliant surgeon .

Dr Paul McGinity GP , Hobart , Tasmania

This has been a long time coming .

When working in palliative care in WA , I had a patient with a brainstem tumour who was a young woman with a husband and children .

She had seen two neurosurgeons who had advised against surgery .

The patient then saw Dr Teo for surgery in NSW for a large upfront fee in a private hospital .

She never woke up after surgery and remained in the ICU for weeks .

She was transferred to a WA public hospital , where she spent several months in a ward , never woke up and died of aspiration pneumonia .

It was an absolutely awful experience for all involved .

Dr Samuel Ognenis GP , Perth , WA

The Medical Professional Standards Committee concluded that Dr Teo charged an “ inappropriate ” $ 35,000 fee .

That is less than an IMG pays the college of surgeons in their final year of training even though many IMG surgeons are already highly qualified overseas .

I once contemplated proceduralists ’ fees when I saw an exquisite bronze figurine in a Hobart art gallery window .

Sculpted by plastic surgeon Chris Edwards , I was shocked when I enquired about the cost — $ 25,000 .

It was too rich for a hand surgeon ’ s budget .

But on contemplating , that was the actual market price for the artist ’ s skill when there is no ‘ Articare ’ or insurance subsidy .

The Royal Australasian College of Surgeons was lambasting Dr Teo at the time for overcharging , so I wrote to their president regarding Dr Edwards ’ beautiful work .

If $ 25,000 was market price for a one-sixth scale bronze , what was a fair price for a life-size liposculpture by the same artist ?

I did not get a reply .

Dr Ian Hargreaves Surgeon , Sydney , NSW

The point is not the fee itself ( which cannot be ruled on as it would be illegal / unconstitutional to do so ).

It is the fact that the patient concerned was extremely

COMMENTS Cartoon Headline up to two ‘ This decks can all here be traced back to your relationship with your motherboard ’

MO Dr vulnerable and would pay anything , however high .

The sentence referring to the fee as “ improper conduct ” needs to be seen in the context of the standards committee ’ s preceding paragraph :

“ She was vulnerable and therefore unable to make a rational decision about the fee to be charged or seek to negotiate a lower fee or different basis of charging .”

Dr David de la Hunty Ophthalmologist , Perth , WA

The pen is mightier than the ego

Was I a fool in seeking a

MO second opinion ? Cherishing the kindness of specialists

A medical friend found a worrying new mole and showed it to his colleague , who examined it and , with great concern , arranged a sameday referral to a dermatologist .

While carefully performing a dermoscopy , the dermatologist proceeded to take out an alcohol swab and wipe away the pen mark .

Dr David Ringelblum GP , Melbourne , Vic

Madness not to make own morphine

Liquid morphine

Dr discontinuation could leave kids with ‘ poorly managed pain ’

How can we let this happen ? How can it even be possible that we cannot manufacture this locally ? Tasmania is home to a poppy-farming industry that supplies 50 % of the raw materials to make the world ’ s opioid analgesics .

Madness .

Dr Michelle O ’ Brien Pain medicine specialist ,

Sydney , NSW

Pharmacies can make it ! When I was a resident at the Peter MacCallum Cancer Centre in Melbourne some years ago , they made their own .

I believe it is 1mL of 10mg / 1mL morphine hydrochloride , 1mL concentrated chloroform water , 1mL orange syrup , a few drops of amaranth and then make up to 10mL with distilled water — 1mg / 1mL .

Dr Peter Wein Obstetrician and gynaecologist ,

Melbourne , Vic

COMMENTS Article Title & Date to be applied to the article headline and publish date Patient loses court battle over ‘ right ’ to record psychiatrist consult

COMMENTS With today

Guardian ’ s technology

Serif First , even

Para an followed audio digital by Guardian file could

Serif be Body altered here

.

COMMENTS Think of the CGI

Guardian of Paul Serif Walker

Body in is Furious the next 7 . Consider style Guardian the role

Serif of deepfake

First Para images followed

, the by evolving AI that

Guardian Serif can blend

Body hereGuardian real with fake .

Serif Body is the next style Guardian Serif First Para followed by Guardian Increasingly

Serif , the

Body most hereGuardian authentic interactions

Serif Body will is the become next style

Back Guardian To The Future

Serif

– First style Para face-toface with followed by Guardian pen-and-paper

Serif Body recordings here Guardian of events Serif in contemporaneous

First Para followed notes by Guardian .

Serif Body hereGuardian I wouldn ’ t trust

Serif a Body digital is the recording next style as far

Guardian as I could

Serif throw

First it Para . followed by Guardian Serif

Body I think here the tyranny we are afraid of will be owned by systems , government and people with the skill set to manipulate recordings . HYS Name Here Dr HYS Murat Location Acar here Rehabilitation medicine specialist , Sydney , NSW