“ Wear odd socks June 1 make point Drs in crisis.”

— Dr Geoff Toogood, cardiologist and mental health advocate @ gdtoogood

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College conned

( RACGP chief defends budget pact with govt, 16 May) The AMA’ s graph plotting CPI against Medicare from 1985- 2015 sort of tells the story, doesn’ t it? Most of us thought the rebates had sunk to about half of what they should be, but it’ s actually worse. So even if they lift the freeze in a year, it matters not. GPs will still be receiving only about a half of what they should. By the govt’ s own admission, 85 % of GP services are bulk-billed, so half is all they will get— forever— unless something drastic is done. There is nothing in the RACGP’ s agreement that comes close to doing this. The college was conned, and still thinks it achieved something worthwhile. How sad.

Subtractor

Rural folk miss out

( Call to cut hospital transfer time of stroke patients, 17 May) I guess those living in rural or remote locations and have a thrombotic stroke just miss out.

Rick Hambour That is great, but what about outside of the cities? It would be nice if the country areas got upgrades before the cities start

worrying about shaving off response times for their cases. These goals eat up the funding that has to be shared among the entirety of each state and territory. Clearly, there needs to be a bigger push for country funding. Not only do you have to contend with one helicopter over a larger geographical area in the country but you also have to allow for the helicopter not being operational due to servicing and / or change of shift.

Karina

It takes two to tango

( 8 reasons for GPs to grill patients about alternative therapies, 9 May) Well, it actually goes both ways. When I see a patient, I write back to all their involved

health‘ professionals’ I know of. While that’ s usually doctors, it includes physios, hand therapists, etc. Apart from the two above, I have never received a letter from a chiropractor, podiatrist, osteopath, etc. You will counter that I should make the time, but let’ s be honest— who has the time to chase down whichever quack the patient is currently seeing? And if the patient with dedifferentiated chondrosarcoma wants to go to Mexico for a vegetable cleanse, good luck to them. But it will be without my involvement. awfulpod I used to scoff at acupuncture, but then realised a less arrogant approach is more productive. And yes,

acupuncture does work, but it’ s operator-dependent. Examples of‘ alternative’ remedies now firmly in the therapeutic armamentarium also abound( eg, magnesium). So if a patient is taking something alternative, I inquire what it is supposed to do and whether it does it. If so, I exert myself to look it up. Who knows, I might even learn something.

Iliya Englin

Dose a confounder

( 4 new findings about heart attack risk with NSAIDs, 10 May) We need to look at the specifics of the study— eg, what doses were used. A recently published study( see: bit. ly / 2pNi5XN) showed the non-inferiority of celecoxib compared with a common NSAID with respect to cardiovascular safety, but they used 200mg daily of celecoxib and more than 2000mg of ibuprofen, whereas in Australia the maximum dose commonly used is 1200mg.

Fouad Dawood What about dosing of the anti-inflammatories? If we start at half-dose for the first few weeks, and then increase to full dose, is the risk reduced relatively?

Lawrencetlc

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