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2020
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Antony Scholefield FEDERAL laws on inciting suicide are intended to encompass phone consults on voluntary euthanasia , placing GPs at legal risk of $ 200,000 fines , the Attorney-General has said .
As states have legalised voluntary assisted dying ( VAD ), questions have remained over whether a 2005 amendment to the Criminal Code Act , banning “ using a carriage service to counsel suicide ”, would apply to VAD telehealth consults .
But it is only now the Federal Government has acknowledged that the law could be used in this way , in a submission to a Federal Court case brought by Dr Nick Carr .
The Melbourne GP is attempting to secure a judicial ruling that VAD should not be classed as suicide to allow doctors to talk about VAD with patients , particularly those in rural and remote areas , over the phone and via email .
But Attorney-General Mark Dreyfus ’ submission to the court , released to Australian Doctor , says the “ enactment of the Voluntary Assisted Dying Act did not alter the meaning of the word ‘ suicide ’ in the Code ”.
It said the references made in the 2005 amendment to suicide meant “ the intentional taking of one ’ s own
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CVD guideline revamp FROM PAGE 1 major development — coronary artery calcium ( CAC ) score .
Cardiologists had long campaigned for CAC scoring to be included in the guidelines as a tool for reclassifying those at low or intermediate risk with additional risk factors or when considering adjusting pharmacotherapy .
This change acknowledged the more widespread use of CAC scores even in the absence of an MBS item to fund the test , Professor Jennings said .
Emeritus Professor Mark Harris , who was not involved in the guidelines ’ development , said it was a “ big shift ” from the previous calculator .
“ It is mainly relevant for patients in that intermediate risk group , which is a problematic group in general ,” said Professor Harris , the former executive director of the Centre for Primary Health Care and Equity at UNSW Sydney .
“ Being able to push them up into the high-risk group if they have got these other risk factors or reclassification factors is helpful from a GP ’ s point of view .”
But he was “ puzzled ” by the new
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Emeritus Professor Mark Harris .
‘ New guidelines are a big shift for risk thresholds .’
risk categories , where the thresholds for each category were five percentage points lower than in the previous guideline .
Professor Jennings explained that the change reflected the improved accuracy of the newly adopted risk equation , but he said a more detailed explanation would be published in The Medical Journal of Australia in the coming weeks .
“ It is partly to do with the mathematics and partly the adaption of the data to the Australian population .”
He said the guideline authors did not expect more patients to be classified as high risk under the changes .
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“ The idea was to identify the top 25 % of the community , similar to the previous thresholds .
“ However , rates in the community have fallen since 2012 , and that calls for lower thresholds in itself , as well as the well-known overestimation of risk with earlier calculators .”
But Melbourne cardiologist Professor Prasanna Venkataraman said the new calculator could result in more patients being considered high risk , though this “ probably just reflects changing thresholds for starting statin therapy ”.
He added that the “ cautious ” recommendations around the use of CAC scores were sensible .
“ Recommending GPs request a test which will essentially be a $ 200 out-of-pocket expense to patients is somewhat fraught ,” said Professor Venkataraman , from St Vincent ’ s Hospital , Melbourne .
Other changes in the guidelines included :
• A wider age range for assessing CVD risk , with the upper age bracket increased from 74 to 79 in recognition of longer life expectancy
• Recommendations for assessing all Indigenous Australians aged 30-79 — rather than 35-74 — and screening for individual risk factors for Indigenous patients aged 18-29
• New information about the association between CVD risk and pregnancy complications , including pre-eclampsia and gestational diabetes .
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Alarm over workforce numbers FROM PAGE 1 $ 2.2 billion this year on the teaching , training and research in acute public hospitals . In primary care , it was around 5 % of that sum .
He also took aim at the “ hidden curriculum ” imposed on medical students during their hospital-based training .
“ It has been a longstanding issue , where people are immersed in big tertiary hospitals in a city setting .
“ It is well documented that negative talk about general practice as a career is not an uncommon phenomenon .
“ What are the messages … about what success looks like , and how does that shape aspirations and career choices ?
“ Who is the winner among your peers ? Perhaps , more powerfully , what does the loser look like ?”
He said James Cook University fought to offset the brainwashing with “ deliberate , high-quality , immersive experiences with good GPs ”.
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But while universities had considerable influence , he said , they had no power over payments for supervision in general practice or its infrastructure for teaching .
Professor Murray , a former president of Medical Deans Australia and New Zealand , also stressed there was no agreed ideal proportion of graduating
Professor Richard Murray .
‘ Negative talk about general practice as a career is not uncommon .’
students who should be choosing general practice .
But he said if around half chose general practice or another generalist specialty , that was “ probably about right ”.
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