The president of Medical Deans ANZ has set tongues wagging with his views on the optimal type of medical student.
Opioid crisis looming
News
A different school of thought
The president of Medical Deans ANZ has set tongues wagging with his views on the optimal type of medical student.
THE mental health of doctors is one of the biggest issues in medicine. But last week, Professor Richard Murray triggered a fierce debate when he suggested changing the way medical students are selected.
Australian Doctor: Why does the medical student selection process need to be changed?
Surgeons’ antibiotic scripts in need of GP checks
Patients forced to switch as testosterone product discontinued
ANTONY SCHOLEFIELD THE withdrawal of a transdermal testosterone product will force about 2500 men to switch to alternatives within the next few weeks, an endocrinologist says.
Axiron, a roll-on formulation of testosterone used by about 10 % of men on androgen replacement therapy, will be unavailable from 4 December after being discontinued for commercial reasons,
Professor Murray: The way that medical students have traditionally been chosen has been too narrow, with a tendency to select on the basis of academic achievement.
Those with high income and professional backgrounds are overrepresented in medical school.
These people have high levels of perfectionism, are hard on themselves and do not tolerate failure, which is correlated to anxiety and depression, as well as maladaptive stress responses.
We need to look at qualities such as humanism, empathy, communication and teamwork, which are tentatively correlative with being a functioning clinician who is most likely to be adaptive to any changes.
AD: Does your focus on building more resilience as a response to poor mental health in the profession excuse bullying and harassment towards doctors?
Professor Murray: Resilience is not a substitute for toxic learning environments, toxic workplaces or toxic work practices.
I completely understand the sensitivity around the word‘ resilience’.
Some may ask why I’ m asking people to tough it out or harden up, but we are not [ asking ] people to harden up and accept toxic learning or work environments. That
Dr Manski-Nankervis says GPs can help clarify indications.
according to supplier Eli Lilly.
Melbourne endocrinologist Dr Carolyn Allan says patients will now need to secure an alternative prescription and may need their GP to help.
“ They’ ll notice it when they fill the next script, so depending on how fine they cut it, it could be a logistical issue,” she says.
“ I anticipate a problem, especially coming into Christmas,” says Dr Allan, who
Professor Richard Murray is calling for changes to medical student selection.
can never be the conclusion. It’ s bad for the healthcare workforce and bad for patients.
Having said that, it is important that we equip students and doctors with the skills to respond effectively to the inherent pressures of healthcare.
AD: The Australian Medical Students’ Association says many students are afraid to complain about bullying or harassment.
JOCELYN WRIGHT MOST post-surgical antibiotic prescribing is inappropriate and should be reassessed by GPs, say advocates for antimicrobial stewardship.
A review by the National Centre for Antimicrobial Stewardship in Melbourne finds 62 % of post-procedural prophylaxis are at odds with guidelines because antibiotics are rarely indicated beyond 24 hours.
Overuse of antimicrobials is contributing to resistance, Clostridium difficile infections and adverse events among patients, they warn.
is head of Endocrine Services in Pregnancy, Monash Health.
PBS criteria state that testosterone replacement scripts can only be initiated by an endocrinologist, sexual health specialist or urologist.
However, Dr Allan says that for this switch, GPs can write repeat scripts for patients who are already under the care of a specialist. Given the difficulties in booking a specialist appointment, some patients
Professor Murray: I am not sure I can accept that. Is it true that bad behaviour can go unreported? Yes.
We are talking about thousands and thousands of people. But is there evidence of systemic bullying and harassment? No. It’ s a problem and we do take it seriously.
People are, to a large degree, informed, supported and assisted when such problems arise in clinical learning environments. Is
Surgical patients are often sent home with five days of cephalexin for extended prophylaxis use, they write in Australian Prescriber.
Inappropriate antibiotic use is often driven by a surgeon’ s beliefs that it helps reduce risk of infection and scripts should be reviewed by GPs after a patient is discharged, they suggest.
Co-author Dr Jo-Anne Manski-Nankervis, a Melbourne GP and lecturer in primary care at the University of Melbourne, acknowledges it can be challenging for GPs to clarify indications for antibiotic use post-surgery
may be relying on this.
Alternative prescriptions include testosterone gel 1 %( Testogel), testosterone cream 5 %( Androforte), 40mg testosterone undecanoate capsules( Andriol) and 2.5 or 5mg testosterone patches( Androderm), she says.
Besins Healthcare, which distributes Testogel, has attempted to step into the breach, saying in a statement that its sachet products it perfect? No. Could it be made stronger and better? Yes, but a lot has changed over the past 20 years.
AD: Why are we hearing about more student suicides if things are supposedly getting better?
Professor Murray: What we are hearing is heightened awareness of concern and once again applying ourselves ever more resolutely to this problem. I don’ t
with the surgical team.
But she says it is important to do this when there are doubts over whether an antimicrobial is indicated.
“ I think, as doctors, we all want the best for our patients, and many GPs will have developed a referral network with surgeons who are happy to communicate with them about postoperative care.”
It is also essential that the surgical team communicates clearly with GPs about antibiotics in the discharge summary, she says. Australian Prescriber 2017; online.
provide the same testosterone dose range as Axiron.
However, it said Testogel stocks could be stretched as well, depending on demand. In April 2015, the PBS introduced tougher criteria for testosterone replacement therapy, including a ban on GP initiation of therapy and a lower threshold of testosterone levels. This resulted in a 50 % reduction in new prescriptions, according to PBS figures. think we are seeing any evidence of a spike or trend in the wrong direction.
What I see is a persistence of long- standing issues and a deep resolve to try to do better.
AD: What are medical schools doing to combat the spike in suicides?
Professor Murray: Medical schools have launched a number of initiatives such as the R U OK? campaigns, mental health first aid, mindfulness training and systems to report on bullying and harassment.
As medical schools, we have to create a supportive peer environment and encourage help-seeking behaviour to avoid burnout and stress which can lead to a descent into mental health problems.
It is not only a moral obligation but a legal obligation of medical schools to provide students with formal opportunities to access confidential advice as well as a protected right to file complaints without any risk of some negative repercussions.
Professor Murray spoke with Rachel Worsley.
Opioid crisis looming
from page 1
They note that nearly 10 % of opioids prescribed by GPs are for OA pain. The drugs are currently prescribed in 20 % of GP encounters for hip OA and in 10 % of GP encounters for knee OA.
Professor Ric Day, a clinical pharmacologist and rheumatologist at the University of NSW, said the study had flagged the current high use of opioids in OA, which was not backed by evidence.
“ Non-drug interventions are much better than drug interactions— paracetamol, NSAIDs, opioids included,” he told Australian Doctor.
“ Effect sizes for losing a bit of weight and keeping active are much greater, and [ more ] significant.”
However, Professor Day said he believed the pendulum was swinging against opioid prescribing, and the forecast of more than three million scripts would likely turn out to be an overestimate.
“ There’ s a huge focus on [ use of ] opioids, and GPs and patients are getting the message,” he said. Osteoarthritis and Cartilage 2017; online.
6 | Australian Doctor | 24 November 2017 www. australiandoctor. com. au