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Nurses are the gems of our communities
Would you like fees with that ?
A dangerously shallow scope of knowledge
ausdoc . com . au 9 AUGUST 2024
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VIEWS FROM YOUR ONLINE COMMUNITY
Our practice has a nominal $ 10 fee |
DNR ? More like Ctrl + Alt + Del |
for three missed appointments in the past three months or $ 10 if they need to see the doctor within 24 hours of a missed appointment .
We work in a community with high needs , and this is
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Could AI become the ultimate decider for end-of-life care ? |
appropriate .
Dr Damien Zilm GP , Meekatharra , WA
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A non-medical friend was shocked |
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when he asked his dad if he would want to be kept alive if he had Alzheimer ’ s and the dad replied that he wanted full active intervention .
The dad did later get Alzheim-
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Take the reins now teach us the ropes |
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er ’ s , and the son honoured his wishes ( to the detriment of his inheritance ).
Unfortunately , we are an ableist society .
Ask your friends — medical or otherwise — if they were in a severe MVA , would they rather be killed outright or left quadriplegic ?
Over the past half century , everyone I have asked ( medical or non-medical ) voted for death .
Yet people like Stephen Hawking and Christopher Reeve fought to stay alive .
It will be hard for a machine to deal with the ‘ Pete Townshend paradox ’: the man who penned the line ‘ I hope I die before I get old ’ at 19 ( reiterating it thousands of times ) and is now 79 .
Dr Ian Hargreaves Surgeon , Sydney , NSW
AI can have an effective role in end-of-life care .
Even now , advanced AI — in conjunction with knowledge graphs and other retrieval-based context augmentation — appears fairer , less biased , more thorough and more rational when answering the most tricky medical or ethical questions I pose to it than any human I know .
I already trust my AI system to critique new ( pre- ) publications and point out flaws far more than any peer review by the big journals .
And I would much rather have a well-trained machine deciding my fate when neither myself nor my closest family can decide on my behalf , as opposed to depending on the religiously biased , arrogant , paternalistic colleague .
Dr Horst Herb GP , Cooktown , Qld
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Slamming their need for control
Medical autonomy ?
Prison doctor barred from jail by Tasmania ’ s prison boss
Having worked as a forensic doctor for a service in SA for 18 months , I am reminded of something .
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Police and prison services attract authoritarian personalities , for whom controlling and punishing anyone they perceive to have broken the rules is their reason for being in the job .
If you want to work in these environments , you need a team that will stand up for and protect each other because authoritarians will always want to reduce every issue to black and white .
Once they feel you have broken one of their rules , it is open season , and they will likely hold it against you forever .
It is not a safe working environment for healthcare on every level .
Dr Fiona Wallace GP , Latrobe , Tas
Nurses are the gems of our communities
‘ There are better doctors than me out here . I can only survive the dysfunction by coming and going ’
I love Coober Pedy . Forty-eight nationalities and most of the people living there are men of mystery .
I remember an old miner who gave me an opal for getting two years of inspissated wax out of his ears . It was worth $ 5000 .
I had to explain the workings of AHPRA before he would take it back .
As for the nurses working in these communities ?
One of my Hong Kong squash mates ( the late Farid Khan ) was a pioneer opal buyer who was stabbed in the night by a thief .
He had wounds to his hands , abdomen and jugular .
The bush nurse sewed up his jugular while she waited for the aerial ambulance .
Farid survived , although he said he was sure his attacker had not meant to kill him .
So Dr Kirsten Due in her article is spot on about the need for skilled nurses of the ilk of those trained in the days of the apprenticeship .
In my stints at Coober Pedy , I called them the A team .
Nurses can be a huge boon to medical care wherever they work , and that includes urban general practice .
They should be able to raise a fee instead of the demeaning and time-wasting game of waiting for the doctor to come and give their nod .
Professor Max Kamien GP , Perth , WA
Thank you for your thoughtful and poignant essay , Dr Due .
Since retirement , I have done a few locums in Aboriginal Medical Services — but none longer than three weeks .
Afterwards , I return to my coastal-town-and-cappuccino lifestyle .
It has been hard to put into words what I see and do in remote areas , and your article has expressed some of that confusion and conflict of emotions . And yet it feels so rewarding .
I , too , cannot praise the nurses enough who work long term in these areas and the expertise and care they show to the local community . They are living angels .
Dr Gail Waterhouse GP , Sunshine Coast , Qld
Thank you for sharing your experiences of working in remote Indigenous communities , Dr Due .
I am working in remote Papua New Guinea and recognise so much in your story .
Sometimes it is hard to see things sliding backwards rather than making any sustained progress .
It would be lovely to see communities change , but it is also the individual that counts . Each soul who seeks help is put on our path to care for and educate .
It is the smile on a mother ’ s face when a sick child gets better or seeing someone walk again after a horrible machete wound that makes it all worthwhile .
Dr Diana Zwijnenburg GP , Kompiam , Papua New Guinea
Would you like fees with that ?
Patient no-shows now costing ‘$ 5000 a week ’, says Dr Mukesh Haikerwal
Bulk- or mixed-billing , if the patient booked the appointment , then they agreed to attend at that time .
My process before I retired was to bill them $ 55 . This had to be paid before they could book another appointment .
A good excuse was always considered and emergencies were the exception , but other than that , the patient paid , and then it was all good again until the next time .
It worked too .
Dr Peter Grant Retired healthcare professional ,
Brisbane , Qld
Contempt for medical care in general has risen exponentially over the past few months .
It is related to a health system philosophy of ‘ Would you like fries with that ?’
Dr Leigh Grant Obstetrician gynaecologist ,
Mackay , Qld
GP leading the PSR :
‘ We are not a bunch of non-clinical people making opaque decisions ’
I am grateful there is a system for people to access ( partly ) subsidised medical care in Australia .
Whether Medicare does this well , without unnecessary complexity or ambiguity , is another story .
I am a newer-generation GP who has found greener pastures outside of Medicare out of frustration .
The fear of being scrutinised for well-intentioned but unacceptable billing is very real , and it is affecting the attractiveness of general practice as a specialty .
But I am grateful that a doctor like Dr Antonio Di Dio , with his clinical background and character , is now director of the Professional Services Review .
Dr Marian Dover GP , Wagga Wagga , NSW
A dangerously shallow scope of knowledge
Another radical health experiment ? The mystery of Queensland ’ s physician assistants plan
Am I supposed to believe that an undereducated ‘ Dr Lite ’ has more knowledge than a junior medical officer who has undergone the full rigours of medical school ?
If I am supervising junior doctors in a team , it might be hard to consider why I would allocate time to a physician assistant ’ s development at their expense .
I assume the physician assistant would have more practical knowledge in some areas than a junior medical officer , but this would lower over time — simply because their scope of knowledge is wide and dangerously shallow .
You can tell anyone to do a chest X-ray , blood and MSU culture and sensitivity if a patient has a fever , but will the physician assistant be able to think further ?
Dr Justin Chan Nephrologist , Canberra , ACT