Letters
TWEET OF THE WEEK
Last one in care loop gets blamed
Letters
Your Views
EDITOR The legal precedent has it that the last doctor in the loop is responsible for any and all of the patients pending disasters(‘ In the GP threesome, who is responsible for what?’ 9 June, Australian Doctor).
The courts will look to see what evidence was present at the last encounter and what the doctor did to remedy the situation at that time.
One case involved an obstetrician who saw a pregnant woman on the Thursday for antenatal care and a GP who saw her on the Saturday for an UTI. The patient, who developed eclampsia on the Monday, was able to successfully sue the GP because he had not taken her blood pressure; but not the obstetrician, who did.
Dr Paul Curson GP, Brisbane, Qld
EDITOR It can be hard enough even without the third party( the specialist) in the equation to ensure adequate review of abnormal results. There can be problems even with the idea that the doctor who orders the test is responsible for follow-up.
Consider the last doctor left in the building on a Friday evening being handed an INR of 8.0 for an uncontactable patient, and the ordering doctor is also uncontactable. Is it acceptable for the remaining doctor
FROM THE WEB
TWEET OF THE WEEK
“ Sometimes medical training feels like an aerobics class where they go‘ only 4 more! 4,3,2,1 keep going! 10,9,8’ except the numbers are YEARS.”
— Dr Lisa Pryor @ pryorlisa
Follow us at @ australiandr to say“ not my problem”? A recent coronial case in Adelaide where a woman on warfarin died of a subdural haematoma would suggest no.
At some point, we are going to want to actually leave our clinics for a period and there needs to be some sort of system to manage abnormal results during this time. The best defence against this sort of thing is to have incredibly robust, documented recall procedures, combined with buddy checking systems that everyone— doctors, reception staff and patients— understands.
Every test ordered should have a plan to follow-up the result, and a
Online attacks
( Doctor awarded $ 480k in unprecedented social media defamation case, 8 June) This is a great decision and a step in the right direction. I agree that the determination was rather modest, given the stress and trauma that this surgeon has been under for a prolonged period of time. As doctors, we are extremely vulnerable to abuse of this nature. Our reputation is king, and people seeking revenge know exactly how and where to target us— on the internet. We are affected globally as a profession in this regard. We need to band together as doctors and ban anonymous review sites. There needs to be absolute accountability for people posting about us online.
Maxine Szramka Maybe the law should be changed so that patients who make malicious or trivial complaints against doctors are responsible for the costs incurred investigating the complaints when they are dismissed.
JNH
50 is the new 30
( Taskforce says GPs should lose access to knee MRIs for over-50s, 7 June)
At our local public hospital clinic, patients can wait over a year to have an initial consultation with an orthopaedic surgeon. This restriction on the Medicare rebate for knee MRIs for patients over 50 will cause delayed diagnosis and hardship to many older patients. No matter if the patient was a triathlete or elite sportsperson prior to their injury. Patients will go back and forth to the GP with complaints of an increased level of disability.
Dr Grub A total of 150,000 MRIs in a population of 24 million. Where is the evidence that
backup system if that follow-up is not attended.
It is a pain in the rear end to set up and enforce, but ultimately, the only way to ensure everyone is safe. Dr Justin Dooland GP, Adelaide, SA
Have your say
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GPs are ordering MRIs for osteoarthritis? If people over 50 are to be forced down the expensive pathway of specialist referrals and then an MRI, will they receive a Medicare tax discount, to compensate for this discrimination?
Logan GP Unbelievable. I’ m over 50, just represented Australia in the International Triathlon Union’ s World Triathlon Series and can run a mile in around six minutes. What they’ re saying is I’ m too old and decrepit to access proper treatment If I’ m injured. In a world where life expectancy is heading towards 90 years, 50 is the new 30.
Medicare: Time to shift the focus to patients
EDITOR Media and government policies have shifted the focus of Medicare away from it being a subsidy to patients for the cost of healthcare(‘ Could the‘ Medicare guarantee’ be even weaker than we thought?’ 2 June, australiandoctor. com. au).
Here are a few ways to return the focus to being patient-based. 1. Allow the practice to be paid the Medicare subsidy at the point of care( like private health insurance), and let the patient just pay the gap amount. This would significantly alleviate the pressures currently faced by the patient wanting affordable, quality healthcare.
2. If the Medicare card holder has a concession card or is under 15 year of age, increase their subsidy by adding the MBS 10990 or 10991 item numbers to their subsidy.
3. Keep the nurse item number and don’ t limit the number of times they can visit a nurse.
4. Value allied health and include them in general Medicare subsidies. After all, Medicare is all about the patient. Dr Peter Spafford GP, Katherine, NT
australiandoctor. com. au
People are extremely active for a lot longer, so of course they are going to need active treatment. The longer we keep people like me running, the better it is for all of us and the greater the savings to the economy. Now I’ ll have to stop and get my heart attack. How much more stupidity is there to come from these dinosaurs?
David Richards
GIGO principle
( Cochrane condemned for‘ bizarre’ review of new hep C drugs, 16 June) From the get-go, the idea behind the Cochrane calculations has never found favour with me. Mathematical statistics was part of my undergraduate degree, and I would summarise it as:‘ garbage in, garbage out’.
Phillip Very disappointed by the Cohchrane Review. The clinical evidence of benefits are overwhelming. MELD( Model for End-Stage Liver Disease) scores clearly decline after effective treatment; quality of life indicators clearly increase— just a few of the benefits. No conflict of interest to report, just commonsense clinical practice and experience.
Sam Elliot
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