Letters
TWEET OF THE WEEK
A GP lesson in manipulation
Letters
Your Views
EDITOR I feel really sorry for this GP(‘ Heartsink: A GP is sued by a long-term, non-adherent patient’, 10 November). I have had exactly this experience, with the patient producing one issue after another— always wanting an external fix and never willing to take responsibility.
Since when do we as doctors say:“ Oh it seems you are a bit broken— well, I want nothing to do with that, off you go.”? I advise my registrars in this kind of situation to lower their expectations of things they can fix because experience says not everything can be fixed. It is a very big step to sack a patient and it is likely to trigger legal action. The GP did not fail— the system did.
Dr Clare Smith
GP, Kingston, Tas EDITOR Are we now to worry about patients who have chronic medical conditions, and who are manipulative and non-compliant because we can be sued, in spite of all we do for them? It doesn’ t matter whether the payout is small or big— this is ridiculous and unfair. Where is patient responsibility?
Dr Arnold Dela Cruz
GP, Kedron, Qld EDITOR Our softly, softly approach isn’ t working. Our treatments used to be called‘ doctor’ s orders’. Now
FROM THE WEB
TWEET OF THE WEEK
“ The‘ viral vs bacterial’ paradigm has had its day as the sole determinant for antibiotics.”
— Dr Evan Ackermann @ EvanAckermann
Follow us at @ australiandr they’ re more like optional talking points open for negotiation. The pendulum has swung too far to the patient’ s benefit. It’ s time to counsel patients that our treatment plan is not optional and that if they don’ t comply, they are no longer a patient.
Dr Gavin Nichols
GP, Coffs Harbour, NSW EDITOR This may be a case of missed diagnosis of borderline personality disorder( BPD). The strategies to treat BPD are pretty straightforward and eminently
Students or sergeants?
( Med schools should look for resilient students: Dean, 10 November) Professor Richard Murray is right: medical students need to harden up. Being a hospital doctor is like being in the army. There’ s a serious job to be done, it ain’ t going away, and there’ s not enough of you. If you can’ t hack it, leave. Even if we had shorter hours, more support and more doctors, what would we have? A cohort of soft, entitled prima donnas. Rather than attract and select fragile practitioners who are technically competent, attract and select resilient practitioners who are technically competent. They’ re the ones who’ ll get the job done.
Dr Solly Zilman What should the proposed selection process include? Sleep deprivation torture, bullying / criticism by seniors, working unpaid shifts lasting 12 + hours without food or toilet breaks, then waiting a few months to see which applicants are still alive at the end? Blaming junior doctors’ lack of resilience as contributing to the rate of suicides in our profession only
highlights how out-of-touch some senior doctors are. It is no longer acceptable to say‘ we had things much tougher in our day’ with regard to things like working hours and sexism. That does not help. It is simply a way for senior doctors, who should be looking out for the welfare and mental health of their juniors and supporting them, to bury their heads in the sand about the problems facing our workforce. Many of us have lost friends and colleagues to suicide. So take some responsibility, and stop victim-blaming. Very rarely are junior doctors or medical students responsible for the culture of their workplaces. Dr Laura Smith
teachable to GPs, yet we don’ t currently teach them. We avoid labelling people with this disorder and can thereby deny them the required interventions for the commitment phase of the treatment plan that often needs to happen in GP surgeries.
Not all of us are cut out to work with people with BPD because we get sucked in by the understandable— but not acceptable— behaviour of judging them as manipulators, noncompliant, unfixable, or a waste of
Fentanyl fallacy
( Do GPs really have a problem with fentanyl? 7 November) I have five patients on fentanyl patches and only one has terminal cancer. All of them have been stabilised for many years, having been up-tritrated from the Norspan patch. I always remember one 80-yearold patient who was quite distressed with non-cancer pain, exhibiting pseudodementia till she was put on a fentanyl patch. She then went back to her normal, happy self and lived for many years afterwards. Many a coroner and judge attempt to practise medicine without a licence.
Dr Peter Stephenson
our time and energy. Perhaps this case could be used as a wake-up call for us to do better at diagnosing and treating the very real, very complex, exasperating yet treatable biological disorder called BPD.
Dr Pauline Helen Cole psychiatrist, Wembley, WA EDITOR I believe the MDO worked very poorly for this GP. They should have vigorously defended the case, and they should be named and shamed. Dr Mark Robertson GP, Surry Hills, NSW
Dr Craig Lilienthal replies: WHILE we might feel this is a vexatious claim, the GP allowed the situation to drag on for 10 years and compromised her professional standards. She did not establish a working diagnosis or seek a second opinion from a GP colleague. She appeared to have given up all attempts to manage the patient, who seems to have dictated the course of events. The medicolegal message is:“ Don’ t let yourself be manipulated by your patients”.
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College’ s true role
( Most GPs want college to retract euthanasia stance, 9 November) I am 100 % in support of the Victorian( and mooted NSW) euthanasia legislation. However, I am also 100 % convinced that the college should not have a particular policy position on this issue, or others that are contentious, whether in favour or against. It must be left to the conscience of the individual practitioner.
Dr Robert Douglas The college is a very important body, but they do not represent their members in medical politics, and should let the body that has been doing it for years and understands the nuances to continue in the job, that is, the AMA. I would humbly suggest the college get back to their core role of education and standards.
Dr Shaun Rudd It is not exactly true that“ most GPs” feel this way. Most GPs who filled out the survey feel this way. This survey represents approximately 2 % of all GPs. Is this sample representative of the entire GP population. Please get tighter with reporting, Oz Doc.
Dr Carolyn Ee
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