Letters
TWEET OF THE WEEK
After hours: a simple solution?
Letters
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TWEET OF THE WEEK
“ I predict that the very last doctor to be replaced by a robot will be the GP. Almost none of our work is algorithmic.”
— Dr Trisha Greenhalgh @ trishgreenhalgh
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EDITOR In my view, the ones rorting the after hours are not so much the doctors, but the patients(‘ Is after hours really doomed? Your questions answered’, 23 October). Although the decision over the exact item claimed, ie, urgent or not urgent, might be open to variable interpretation, what a doctor might not consider urgent, a worried parent may well think is.
Having done many night housecalls myself in earlier years, I can absolutely confirm that the only thing that puts the brakes on abuse of the system, is that same answer that would also control general over-use and abuse during normal hours as well.
I refer to the need to charge an appropriate gap fee.
The rebate could then be directbilled later at the surgery or doctor’ s base, and the cash payment made via cash at the time. End of problem.
In my view, if a doctor is called out by a patient who believes they have an urgent reason, and the doctor goes through the time, travel, inconvenience and degree of risk to attend that patient, then they deserve a decent fee.
Once there, if found trivial, the fee is still appropriate, it is not the doctor’ s fault the patient had exaggerated. The government seems determined to keep ignoring this simple and effective fix.
I know it works because that was exactly the system that operated in New Zealand when I was in practice there. Dr Peter Bradley, GP, Brisbane, Qld EDITOR The public should be made aware what the after-hour service is for.
College does not speak for all of us
( RACGP declares support as assisted dying laws clear major hurdle, 20 October) On what authority does RACGP president Dr Bastian Seidel say“ the bill satisfied all the professional and ethical concerns related to assisted dying”? As a lecturer in palliative medicine, it does not satisfy those concerns in my view. Any law that sets up the machinery of mercy killing will corrupt the relationship between the state and its most vulnerable citizens— some of whom will perceive this more as a‘ duty to die’ than a right to die— and the relationship between doctors and their most vulnerable patients. Dr Seidel’ s pronouncement follows the RACGP’ s gratuitous, clinically unfounded intervention on same-sex marriage— in both cases without consulting its membership. Is the RACGP now just a club with one acceptable opinion?
Dr David van Gend It’ s extraordinary how many people opposed to this compassionate law reform feel their moral code is superior to others. Why shouldn’ t it be up to the terminally ill and
suffering patient to decide what is right for them? The only people we should listen to in this debate, in my opinion, are the patients who have been in this terrible position. Their voices are out there. It’ s funny how, in all areas of medicine, we offer patients informed choices about their care except when they are suffering and dying, when opponents think patients should be deprived of a choice.
Dr Doug Gaze It would seem that the two doctors— one coordinating, one consulting— who provide an independent assessment of the patient’ s case could
It is not a substitute for a visit to their usual GP.
It is not for use in getting scripts, medical certificates or other trivial things.
There should be a triage to address each concern and if needed, patients could then be referred to a pharmacist, an after-hours service or ED if necessary.
Dr Arnold Dela Cruz GP, Kedron, Qld
be doctors who have never met the patient. This could raise the potential for missing relevant detail re social history, family dynamics, relationships, possible coercion, past psychological illness and— crucially— not being aware of the trajectory of that person’ s disease process and therefore being widely inaccurate regarding prognosis. A recent Monash University study revealed at least 10-25 % of the elderly are abused by their family and others. How can we expect an unfamiliar doctor to discern longstanding financial, emotional or psychological abuse if a
Let’ s quit buck passing
EDITOR Every time the issue of antibiotic over-subscribing comes up, there are a bunch of doctors who pass the blame onto someone else who is‘ more responsible’ for the problem(‘ GPs key as Australia faces antibiotic resistance“ crisis”’, 23 October). It’ s the public’ s fault, or hospital doctors or the animal products industry or the government or the pharmaceutical companies.
How about taking responsibility for our own actions?
Even if GPs aren’ t the biggest problem, we are still part of it. Instead of whingeing and blaming, we can grow up and face the issue like responsible adults, make some changes in our practice, work on the education of patients, maybe even be a bit enthusiastic.
Maybe one day if we work hard on this issue as a specialty, we can be leaders in reducing antibiotic use and held up as an example to others.
Dr Mark Berry, GP registrar, Morayfield, Qld
Have your say
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patient does not disclose it? The coordinating doctor and the consulting doctor need to have experience in the patient’ s illness. Unless one has experience in palliative medicine or a psychiatric discipline, it can be very difficult to diagnose clinical depression in dying patients. But that diagnosis and treatment could be enormously beneficial to their quality of life. If you believe depressed people— especially those who are undiagnosed and untreated— may make wrong decisions, couldn’ t a‘ sound mind’ be difficult to assess sometimes?
Dr Paul Jenkinson I strongly support this legislation because it is compassionate and puts the patient’ s wishes first, not the doctor’ s. The new law makes it illegal for a doctor to initiate an opinion on whether a patient should consider assisted dying. And the doctors doing the assessments not need to give an opinion on the level of their patient’ s suffering. If they find assistance to a severely suffering patient morally unacceptable, they can opt out. Don’ t cruelly deny it to those who find their own suffering unbearable.
Dr Harley Powell
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