Carmel Sparke TWO-THIRDS of peripheral intravenous catheters are inserted into areas not recommended by guidelines , an international study led by Australian researchers shows .

In the study , hundreds of health professionals assessed 40,620 peripheral intravenous catheters in 51 countries .

They found that while the forearm was the recommended site in an adult , most catheters were inserted in the hand , wrist or antecubital veins .

One in 10 were unnecessarily painful and a further 10 % had signs of malfunction , said the authors , led by Dr Evan Alexandrou ( PhD ) from Western Sydney University . Journal of Hospital Medicine 2018 ; online .

Critics slam the midwives college for awarding a reflexology course CPD points .

Jocelyn Wright THE Australian College of Midwives stands

accused of introducing “ dark age ” practices

after awarding CPD points for a training course

promoting burning dried mugwort to correct a

breech birth position .

The ancient Chinese medicine intervention

known as ‘ moxibustion ’ involves lighting the

mugwort , which is then placed near the woman

’ s fifth toe in the belief that the heat on the

acupressure point releases pregnancy hormones

. These hormones supposedly lead to

uterine contractions that move the baby .

The technique is included in a midwife

reflexology course , accredited with 62 CPD

points , run by midwife and reflexologist Dr

Lyndall Mollart ( PhD ).

heard of Adelaide University ’ s obstetrics and gynaecology unit , has slammed the course .

“ I ’ m appalled that midwifery among some practitioners could see a return to the dark ages , by introducing therapies to midwives that are unproven , not audited , and could cause great conflict among hospital clinicians where evidence-based medicine occurs ,” says Professor MacLennan .

“ We all want safe birth with minimal surgical and medical intervention . But alternative midwives cannot claim this ground without evidence for their beliefs and nonsensical woo .”

Dr Mollart ’ s course also includes the use of acupressure for reducing labour duration and pain , as well as reflexology for increasing the mother ’ s milk supply . She denied she was practising “ woo ”, saying there were a number of randomised controlled trials that suggested moxibustion could correct a breech position .

“ Of all the studies that have been done on moxibustion , there ’ s been no bad side effects

must be a reason ,” Dr Mollart said .

“ Personally , I teach midwives reflexology and acupressure . The reason I teach those two is because they ’ re not unproven . If medicine believes randomised controlled trials are the golden standard , with those techniques I can show there is evidence behind them .”

She added : “ We can ’ t bury our heads in the sand . If 50-80 % of pregnant women are using some type of complementary medicine or therapy , then we ’ ve got to make sure the health professionals who work with them at least know what the evidence is on each one .”

The Australian Midwives College also dismissed Professor MacLennan ’ s claims , saying the college encouraged midwives to understand complementary medicine techniques rather than adopting them as part of their practice .

A spokesperson stressed alternative therapies were not a substitute for obstetric consultation or referral and that the college also offered its own clinically based professional

Professor Alastair MacLennan , a former

for the baby and if it doesn ’ t turn , then there

education courses for midwives .

FROM PAGE 1

Significantly , he says

the company has more than 80 registrars

in training — more than any other

corporate .

By July next year , he insists that

Myhealth will have overtaken Primary

to become the country ’ s second-largest

GP corporate and he hopes

to match IPN in scale within the next

5-10 years .

Main GP corporates

Estimated number of doctors

2000

1800

1500 1000 500

1000

400

200

150 150

120 100 85

“ Our success really comes down to

our doctors ,” he says .

“ If you pay people big money to

join you , you select a certain type of

doctor , whereas to join Myhealth , you

have to pay money — which means

that people join who are proud of the

brand and want to be part of it .”

Half his business is owned by Crescent

Capital , a healthcare investor

with a stake in a range of businesses

including the National Home Doctor

Service , Australian Clinical Labs , Sun-

Doctors skin cancer clinics and a chain

of dental practices .

Crescent Capital had never before

been involved in “ daytime ” general

practice , says Dr Liang , but it saw an

opportunity in Myhealth ’ s model

that is as much about keeping its GPs

happy as it is about the patients .

“ Our most important customers

are the GPs themselves ,” Dr Liang

says .

But old hands such as Dr Khaled

el-Sheikh , who founded the rural corporate

Tristar Medical Group in 2003 ,

remain sceptical .

“ These new corporates are not in

the health business for the long term ,”

he tells Australian Doctor .

“ Some organisations are promoting

it to get the market hyped up so

they can sell and collect fast cash .”

But along with the hunt for dollars ,

are the investors changing corporate medicine ? For industry analyst David Low , the fundamentals of the game remain the same : patient convenience . “ From my perspective , what Primary offers and I think what Myhealth offers as well , is what a lot of patients want : a big clinic that is available for long hours , and is easier than going to your local GP and having to wait a couple of weeks and not getting an appointment ,” says Mr Low , the executive director of Australian healthcare research at investment bank JP Morgan .

The corporate investors also seem to be interested because of the cash opportunities of the technology revolution .

Myhealth , for instance , is focused on building IT infrastructure to allow electronic booking , airline-style electronic check-in computers and an app for patients .

When Dr Malcolm Parmenter took over as CEO at Primary last year , he was also talking about innovations that you suspect would have made

Dr Bateman blink — such as offering repeat scripts online to regular patients and emailing test results . He was also flagging various ideas that included setting up cubicles with stand-up terminals staffed by doctors to deal with simple presentations .

“ It ’ s a bit like casualty and there is quick throughput ,” he told Australian Doctor .

But then there is that other attraction for patients — a lasting relationship with a GP . Terry Barnes , a former health policy adviser to former health minister Tony Abbott , says : “ I think there is a convenience factor for large

corporatised practices , particularly

outside standard hours , but I think if

you ask the vast majority of patients ,

they like going to the old-fashioned

family practice .

“ Healthcare is still the most intimate

form of professional service and

people like to have an intimate relationship

with their doctor . The big corporates

are realising that .”

While the mass takeover of general

practice by corporates widely

predicted back in the 1990s has not

occurred , some doctors feel that the

only thing wrong with the prediction

is the time frame . Further growth is

Dr Geoffrey Edelsten in his practice waiting room back in 1985 .

inevitable in an environment where

governments have been unwilling to

invest .

“ While the Medicare GP financing

structure remains broadly the way it

is , it is hard to escape the conclusion

that the GP corporates will continue

to grow ,” says Dr Bill Coote , a former

AMA secretary general and long-time

GP commentator .

“ Corporates can achieve economies

of scale by exploiting opportunities

around access to capital , practice

infrastructure and facilities , opening

hours and administration .

Scepticism remains , of course . At

the National Press Club in July , AMA

president Dr Tony Bartone warned

that GPs see general practice becoming

“ increasingly corporatised , burdened

with more red tape ”.

“ This is not the future that GPs

want to see ,” Dr Bartone said .

What is clear is that there are

increasing numbers of corporate

voices — backed with big dollars —

who want to persuade GPs to think

otherwise .