Letters
TWEET OF THE WEEK
GP fracture care a bridge too far?
Letters
Your Views
EDITOR This is an interesting concept(‘ Fracture clinics want GPs to take on more referrals’, 19 June, australiandoctor. com. au).
However, dressings and casts are free to patients through the public fracture clinic, but there would be some sort of cost recovery through their GP.
The scaphoid fracture mentioned in the article is an interesting point. Gold standard care would be an MRI after one or two weeks.
With serial, normal plain films but ongoing pain, will there be a new item number for a bulk-billed MRI, or is everyone going to get irradiated with a CT scan or bone scan— both less accurate than an MRI?
Also, how many GPs are happy to do 1-2 casts for metacarpal fractures and 2-3 casts for Weber B ankle fractures?
Finally, most public fracture clinics will have a number of plaster technicians, most of whom are excellent and know more orthopaedics than the bulk of primary care medical staff.
Dr David Shooter VMO, Brisbane, Qld
EDITOR As a rural GP, I manage many fractures, but find that all
FROM THE WEB
TWEET OF THE WEEK
“ Homeopathy is based on antiquated, magical thinking. Pharmacists please stop pretending it’ s legitimate medicine!”
— Dr Brad McKay @ DrBradMcKay
Follow us at @ australiandr my patients presenting to EDs are referred to a fracture clinic, which is 800km away.
Most junior doctors believe orthopaedics is beyond them. This is worse with city GPs, who do rural locums and don’ t even attempt fracture management, but just refer.
Dr Bryan Connor GP, Cloncurry, Qld
EDITOR I still manage fractures that do not require manipulation.
Yes, I send them to X-ray, see them again, manage the injury and follow-up.
Sure, it’ s an inefficient way to make money, but I work on the
Paramedic referrals
( GPs to receive referrals from paramedics, 21 June) Like I’ ve got the time to chat to a paramedic twice a day.
Doc Holiday GPs should avoid giving any opinion or direction to paramedics on the phone without examining the patient in person. Just health information( current medications, history, etc) should be given to the calling paramedic. Decisions should be left totally to the paramedic. I seldom talk to patients on the phone for the same reason. Without seeing a patient faceto-face, it is dangerous to give medical advice.
Mehdi Zahedpur Serenity now. Ambulances having been referring patients to GPs for years— just without the communication. Finally, we have some communication. We have been asking for it for years.
Donald Rose
Paperless problems
( GP support for mandatory‘ paperless’ prescriptions, 23 June) As I lease rooms and can’ t afford to join the practice, I cannot access the practice’ s computers. I therefore must
rely on handwritten scripts, or suffer a considerable additional financial burden, which, given my age, is a lot to ask.
John Leslie Whiting How does electronic-only work if I am doing a 3am home visit?
Old Style GP Mandatory is a bit difficult. What about visiting overseas patients?
Penny
Protect yourself
(‘ Resilient’ doctors don’ t report assaults, 23 June) They should be reporting it. You can’ t expect management to address a problem that nobody is reporting. How would management justify the need to have security guards if there were no figures for them to show their bosses?
Karina
principle of not referring anything I can do myself.
If the X-ray clinic is far away, they can drop into the local ED before coming back, but they don’ t have to.
The last time I took the patient to the local ED, it looked like a triage station at the Battle of Gettysburg, so I really don’ t wish to add to their workload.
Moon boots and crutches can be purchased or hired from a third party( eg, a pharmacy), and plaster costs peanuts.
Dr Iliya Englin, VMO
Reefton Medical Clinic and Hospital Reefton, New Zealand
The ED is a very volatile environment, but the public should know that any form of abuse is not tolerated there. People working there are already under a lot of stress and do not need any form of harassment. Another case for public education.
Dr Arnold Dela Cruz I’ ve spent many years in the ED. Having good security helps and everyone has each other’ s backs. One warning to the person about escalated behaviour and if they don’ t comply and it’ s not urgent, they get booted from the department. Usually, they are alcohol or drug-related issues.
AussieDoc This is why it is important that those who work in EDs do some unarmed combat training provided by their
What it takes to be there for the long haul
EDITOR Being partnered with a school teacher, I take all the school holidays off apart from the long summer one(‘ Be kinder to yourself’, 2 June, australiandoctor. com. au). Being there for the long haul will end up being far more financially rewarding than stopping early due to burnout.
Dr Nicholas Stanley-Cary GP, Perth, WA
EDITOR‘ Being kinder to yourself’ might work if you aren’ t carrying mortgages or serious overheads. There are times when there is no choice, but to keep working, despite the stress. My precious‘ financial consultants’ near bankrupted me, and there was no choice but to keep going. Otherwise, I’ d have lost my house, my car, my rooms and probably my family. I was so cleaned out, there was no money left even to mount a legal case.
Dr Joseph Moloney Paediatrician, Goulburn, NSW
Have your say
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employer. As an ex-boxer in my youth, this helped on one occasion when a gang in a public hospital ED threatened my staff, and I warned them of my ability. It worked, but I was lucky. Perhaps we could also have an EpiPen-type device loaded with a quick sedative.
Hypocrites GP
Another option
( Pharmacies face ban on selling homeopathic products, 22 June) Another option might be to end commercial pharmacies being involved with prescribed medicines, full-stop. Let them sell their complementary‘ medicines’, their homeopathic nothingness and their giftware. Meanwhile, GP clinics can do all the dispensing via hired pharmacists, attracting all the dispensing fees and allowing any pharmacist-discovered errors to be immediately relayed to the prescriber. The move to make pharmacies mini-clinics is just wrongheaded. Clearly, the more obvious solution is to make GP clinics mini-pharmacies. After all, GPs have done as much pharmacology training as pharmacists, but pharmacists have done little to no clinical training.
Dr Zilman
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