Monday 20 July 2009
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Skin screening shown to save lives ■ Michael Woodhead
T
he evidence is in to support whole body screening to reduce mortality from melanoma, say Queensland researchers. A study (link) by the Viertel Centre for Research in Cancer Control, Cancer Council Queensland, shows that whole body screening is associated with a 14% lower risk of being diagnosed with a thick melanoma – the type most likely to cause death. Published in the International Journal of Cancer (online 16 July), the case control study of
14% reduction in thick melanoma 3,762 patients with melanoma found that whole-body clinical skin examination in the three years before diagnosis was associated with a reduced risk of a diagnosis of a melanoma of >0.75mm thickness. There was a 38% higher risk of being diagnosed with a thin
melanoma in screened patients, which was attributed to earlier diagnosis due to the recent surge in popularity of skin screening. The results support a population-based skin screening program, subject to evaluation of cost effectiveness, the study authors say. “The current study provides the best evidence to date and, in the absence of a randomised trial, the best evidence we are likely to achieve for some time that skin screening by a doctor will reduce mortality from melanoma,” they say. What do you think? comment@6minutes.com.au
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Unhappy GPs eyeing early retirement ■ Jared Reed One in three older GPs intend to retire early, blaming poor job satisfaction, increasing red tape and the threat of burnout. An MJA (191:2:75-77) survey (link) of 178 GPs in WA found widespread disillusionment with the country’s medical system, brought about by increased bureaucracy and diminishing lifestyle through overwork. Female GPs wanted to continue working to a later age than their male counterparts,
possibly because they were more satisfied with their work as a result of part time working arrangements, the authors say. Diminishing job satisfaction and discontent are amenable to intervention, say the report’s authors, and would be a more immediate and cost-effective option over training new doctors. Fixing these external factors could help stem an outflux of retiree GPs - a vital measure given around onequarter of the Australian medical workforce are aged
over 55, they argue. "Older GPs find change difficult, and declining morale occurs partly because current medical practice is considerably different to that for which they were trained,” they write. “Measures such as encouraging men GPs to gradually reduce workloads, eliminating unnecessary bureaucratic demands, and improving financial rewards might increase job satisfaction.” What do you think? comment@6minutes.com.au
Call to scrap 'failed' Team Care Arrangements ■ Michael Woodhead Team Care Arrangements should be scrapped because they are not doing what they were set up to do and also make more work for GPs, according to an article (link) in the MJA today. There is no evidence that Team Care Arrangements are encouraging GPs to shift from episodic care of chronic disease to a more global approach, say GP researchers from Canberra. Instead, they say the onerous requirements of Team Care
Arrangements make co-ordination unwieldy and effectively freeze the patient’s management for months until the GP can obtain agreement from all providers. The care co-ordination requirements of the care plans are being widely ignored, they say. There is also evidence that Team Care Arrangements are being used to give patients access to cut price allied health services such as dentistry, psychologists and podiatry, the authors say. If the aim is to help patients with chronic health problems
move away from episodic care, a better solution would be a program to give all such patients a comprehensive patient summary, as recommended by the RACGP, they write. "[This] would enable the GP to draw up well considered treatment objectives and priorities, provide clinical information of real value to other health professionals, identify and resolve problems of co-ordination, and eliminate oversights,” they suggest. What do you think? comment@6minutes.com.au
Before prescribing, please review Approved Product and PBS Information by clicking here. Pfizer Australia Pty Ltd (ABN 50 008 422 348). 38–42 Wharf Road, WEST RYDE NSW 2114 References: 1. Sever PS, et al. Lancet 2003; 361: 1149–58. 2. LaRosa JC, et al. N Engl J Med 2005; 352: 1425–35. 3. LIPITOR Approved Product Information. 4. PBS listed February 1998 (www.medicareaustralia.gov.au). BATMAN and all related characters and elements are trademarks of and © DC Comics. (s08). LIPITOR*® Reg Trademark Pfizer Inc. Pfizer Medical Affairs 1800 675 229. www.pfizer.com.au 01/09 H&T PZR0394/6MIN
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In other news ... Free flu shots will be offered to pregnant women, Aborigines and the chronically ill government plans to spend $44 million over four years to cover an extra 2.2 million people with vaccinations for seasonal flu, The Australian says. (read more)
Pathology companies are urging GPs to only ask the laboratory to bulk-bill a patient if the doctor believes the patient to be "financially disadvantaged", according to The Australian. (read more) Woodheaters cause more lung damage than cigarette smoke and should be banned, say medical experts in Tasmania, according to the Examiner. (read more)
The AMA in Queensland has renewed its calls for more general practitioner training places, saying an extra 100 trainees are needed each year to address the shortage across Australia, reports the ABC. (read more) Patients will be able to see their medical records online in an e-health revolution proposed by the National Health and Hospitals Reform Committee, according to the Herald Sun. (read more)
One in four welfare claimants are unable to afford a visit to a doctor when a family member is sick, according to a new report in the Courier Mail. (read more) Doctors should to be forced to participate in a national survey to gauge whether there is an appropriate mix of doctors in Australia, says a new report on the ABC. (read more) A Canberra gynaecologist is contesting a $170,000 payout to a former patient who claims he botched her hysterectomy, says the Canberra Times. (read more) Children with potentially lethal nut allergies can have their immune system retrained to tolerate the allergens, reports The Age. (read more)
After 13 years and $15 million a doctor is still fighting a legal battle against his former employer over claims that a stressful leadership course triggered mental health problems, says the Australian. (read more) Hospital interns are being left alone to care for scores of patients and working 36-hour shifts, the ABC reports. (read more) A girl born without a pancreas is now thriving thanks to doctors at Melbourne’s Royal Children’s Hospital, says the Herald Sun. (read more)
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Lipitor PROTECTING GRANDMA SINCE 1998 1-4
PBS Information: Restricted benefit. For use in patients that meet the criteria set out in the General Statement for Lipid-Lowering Drugs. Before prescribing please review Approved Product Information in the primary advertisement in this publication. References: 1. LIPITOR Approved Product Information. 2. PBS listed February 1998 (www.medicareaustralia.gov.au). 3. Sever PS, et al. Lancet 2003; 361: 1149–58. 4. LaRosa JC, et al. N Engl J Med 2005; 352: 1425–35. BATMAN and all related characters and elements are trademarks of and © DC Comics. (s08). LIPITOR*® Reg Trademark Pfizer Inc. Pfizer Medical Affairs 1800 675 229 www.pfizer.com.au 01/09 PZR0394/6MIN
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You said it... Part-time GPs leave patients perplexed (link)
Medico-legally, the riskiest GPs in general practice are part time GPs - you should see the plethora of case law in relation to handover problems with doctors. All care and no responsibility does not work - accreditation standards give cold comfort in the eyes of the law in relation to recalls and reminders. 90% of the problem is the wrong attitude. If you think the practice or patient will take care of it, unfortunately the law has a different view. It is easily resolved with good practice systems and training, including
a mutual respect and shared ownership of the patients’ problem, including the patient. There is no such thing as being part-time responsible for a patient. Change the attitude and you will solve the problem. David Dahm Pharmacists know a bit about drugs, don't they, and even help doctors and patients. I'm one myself, and had four useful interventions in two days this week. Use your pharmacists. And no, they don't want to take away your trade. Really we don't, it's your trade union people who throw the scares. Peter Allen
Chiropractors want doctors banned (link) I have been safely performing spinal manipulation for 34
GENERAL PRACTICE – YOUR FUTURE? Primary is an option for you to consider L Greater take-home income – General Practitioners with Primary contracts for the last five years had 2-3 times their prior (pre-Primary) take home income L $ capital payment now – more than most have saved in their last decade of practice L Better equipment, staff and facilities L Your time is spent on patient care L No need for administration and paperwork L Reduced professional indemnity costs L Better clinical practice and independence Primary Health Care Limited established by general practitioners for a better form of general practice. It is successful and run by general practitioners. It has continued to develop over the last 21 years and is currently expanding. The current expansion offers opportunities for all general practitioners. Primary Health Care offers a form of practice viable to all parties and has a continued and growing patient acceptance.
Consider facts rather than pre-conceived ideas. For information, centre inspection and discussions: Dr Michael Monk Dr Claire Gabriel Dr Edmund Bateman Mr Nick Aitken Dr Baljit Chugh Mr Robert Wheat
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years now because it can be an effective and cheap therapy in the right hands. I believe there are osteopaths and chiropractors who only wish to obtain rapid relief for their patients, but how often do we see patients who have been going to the chiropractor week after week, for months? I find that many of these patients can obtain lasting relief after one or two manipulations and only return after months, years if ever. If the chiropractors want standards and want specific registration, then they should be prepared to be scrutinised by the Professional Services Review Board. I was taught by John Murtagh and have learnt a lot from others over the years - mainly osteopaths. I am very grateful to all. GPs can be safely taught physical therapy techniques
if they are interested, but not many trainees are. However if they are, they are quite happy to work within defined boundaries according to their skill level. John Griffiths
Bush placements irk GP registrars (link) It has been seven years since I did my compulsory rural term as part of GP training. I am a selfadmitted city person, and I can't say I enjoyed the term. It was, however, one of the best learning experiences I had through my medical education. When you are in a rural area, you learn how to make decisions, which is one of the most important lessons you can learn as a doctor. TracyS comment@6minutes.com.au
> Grampians National Park (Ararat, Victoria).
> Excellent Package (good work/life balance)
> 2 hours from Melbourne (with daily train services).
> Financial Assistance (including relocation).
> Group GP Practice. (private practice).
> 4 FT Nurses inc. C.D.M.
> Teaching Practice (VicFelix, Melb. & Deakin Uni.)
> Local Hospital (Obstetrics, Anesthetics & Surgery).
> Email for more info: admin@araratmedicalcentre.com.au
Vocationally Registered General Practitioner urgently required
Needed for busy, well established 3 doctor surgery in Canberra. Practice is in custom build facility, fully computerised, modern and has ample nursing and administrative support. Very attractive remuneration package with lot of flexibility possible in terns of conditions. No after-hours or weekend work needed, starting date ASAP. Please contact Thinus on tdmp@ozemail.com.au with CV if interested.
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PBS Information: Restricted benefit. For use in patients that meet the criteria set out in the General Statement for Lipid-Lowering Drugs. LIPITOR is indicated as an adjunct to diet for the treatment of patients with hypercholesterolaemia. Also indicated in hypertensive patients with multiple risk factors for CHD to reduce the risk of non-fatal myocardial infarction and non-fatal stroke. Before prescribing please review full Product Information available from Pfizer Australia Pty Ltd (ABN 50 008 422 348) 38-42 Wharf Road, WEST RYDE NSW 2114. LIPITOR® (atorvastatin) 10mg, 20mg, 40mg and 80mg Tablets. Contraindications: Hypersensitivity to the active substance or to any of the excipients, active liver disease or unexplained persistent elevations of serum transaminases; pregnancy and lactation. Women of child-bearing potential. Precautions: Liver Dysfunction: liver tests should be performed before initiation of treatment and periodically thereafter; patients who consume substantial quantities of alcohol and/or have a history of liver disease; myopathy (monitor cpk); risk factors predisposing to development of renal failure secondary to rhabdomyolysis; †history of haemorrhagic stroke or lacunar infarct; use of concomitant medications that may reduce activity/levels of steroid hormones (ketoconazole, spironolactone and cimetidine); interactions with other medicines: inhibitors of cytochrome P450 3A4, other HMG-CoA reductase inhibitors, antacid, colestipol, †OATP1B1 transporter inhibitors, e.g. cyclosporin, erythromycin/ clarithromycin, protease inhibitors, † diltiazem hydrochloride, †itraconazole, †grapefruit juice, digoxin, oral contraceptives. Adverse Reactions: For complete list see full Product Information. Headache, asthenia, abdominal pain, dyspepsia, nausea, flatulence, constipation, diarrhoea, insomnia, myalgia. Dosage: 10–80mg/day as a single daily dose. Presentation: 10mg, 20mg, 40mg and 80mg Tablets in foil blister packs of 30. Based on full Product Information approved on 11 July 2008. †Please note changes to Product Information. PBS dispensed price, February 2009: 10mg $42.27; 20mg $57.57; 40mg $78.62; 80mg $109.82. References: 1. LIPITOR Approved Product Information. 2. PBS listed February 1998 (www.medicareaustralia.gov.au). 3. Sever PS, et al. Lancet 2003; 361: 1149–58. 4. LaRosa JC, et al. N Engl J Med 2005; 352: 1425–35. BATMAN and all related characters and elements are trademarks of and © DC Comics. (s08). LIPITOR*® Reg Trademark Pfizer Inc. Pfizer Medical Affairs 1800 675 229 www.pfizer.com.au 01/09 H&T PZR0394/6MIN