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GPs and their Computers - November 2009
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Around 10% of the GPs we emailed responded to our August poll on GP computer use, with around 60 of the 241 respondents offering further comment.
What impact has the consulting desk computer had on the majority of your doctor-patient encounters?
Improved my clinical effectiveness 31%
Prevented medication errors 27%
Allowed quicker patient turnover 13%
Hindered my interaction with patients 9%
Decreased the amount of red tape 5%
Frustrated and slowed me 5%
Other 10%
Not surprisingly, the overwhelming majority of respondents thought the introduction of computers into their practices had a beneficial affect. While there may be operational advantages for time-poor doctors working in groups, bombarded by paperwork from all directions, it is interesting to note that nearly 1 in 10 of our respondents felt that computers hindered their patient interaction. Anecdotally, it is not uncommon to hear health consumers complain that their doctor spends more time staring at the screen than interacting with them. Maybe a consumer survey next would be good feedback!
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Diabetes trends - June 2009
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With diabetes on the rise, a greater analysis of prevention and treatment strategies is imperative. 175 GPs took time out to give us their opinions on this issue.
Key Findings
6 in 10 GPs think more aggressive glycaemic control targets of HbA1c 6.5-7.0% will help reduce cardiovascular morbity.
More than 6 in 10 feel not enough is being done in the community to prevent diabetes.
2 in 10 have patients who manipulate insulin for weight control.
3 in 10 call for more educators as the first step to improve diabetes services.
Do you think meeting more aggressive ‘glycaemic control' target of HbA1c 6.5-7.0% in younger Type 1 diabetics is worth it in terms of reducing their future cardiovascular morbidity?
Definitely 60%
Maybe 28%
Not convinced 11%
No opinion/does not apply 1%
Do you think the same aggressive HbA1c 6.5-7.0% target is a worthwhile strategy for adult Type 2 diabetics?
Definitely 49%
Maybe 29%
Not convinced 21%
No opinion/does not apply 1%
The GP's role in maintaining lower, more aggressive glycaemic control targets
77 GPs commented on this issue, with more than half discussing the importance of the doctor/patient relationships and the need to encourage patient compliance. Many complained that ensuring patient compliance was "frustrating" but "worthwhile".
On the negative, some GPs raised concerns such as "Aggressive targets are only possible in a research environment and almost impossible in real life" and "Does any discussion go into the patient's responsibility in managing their health problem?". One exacerbated GP said, "It is like pushing water uphill and I have given up with some patients who despite every endeavour to help themselve rock up to the surgery with a coke in their hand!" Another warned, "Bear in mind any side effects of aggressive control".
One GP felt the need to "‘scare' patients more, and so highlight the benefits of better control." Focussing on obesity and regular reviews by GPs or practice nurses were also flagged as solutions.
Do you think enough is being done in our community to prevent diabetes?
Yes 20%
No 65%
Uncertain 15%
What would be one thing you would like done to prevent diabetes?
Of the more than 100 comments, many common themes emerged such as "ban all fast food" and "ban fast food advertising", a "fat tax", "better screening", "exercise", and more "education" (including labeling on foods and spot checks of high risk patients).
More thoughtful, specific comments included:
"We do not have a lifestyle system that promotes physical activities and we have poor public transport."
"Traffic light-type food warnings: e.g. red for confectionary cereals, so small amounts infrequently are ok, green for porridge, etc. so people understand which foods are better for you."
"As a society, we fluff around issues and fail to be blunt enough. We should be much more direct. For example, obesity can lead to DM2, which can lead to dud kidneys; no blood to toes; blindness, and it is your responsibility to look after yourself, drugs shouldn't be the only answer."
Have any of your insulin-dependent diabetic patients deliberately manipulated their insulin to lose weight?
Yes 19%
No 42%
Uncertain 30%
Does not apply 9%
To improve diabetes services in WA, what single resource would you ramp up first?
More diabetes specialists 3%
More diabetes educators for patients 28%
More nursing resources in general practice 17%
More lifestyle coaching for patients 41%
Other 11%
Other responses included "Diabetic trainers for patients similar to the fitness trainers in gyms", "Government advertising", "Make healthy food cheaper and increase price of fat-laden foods", "It is not the services that need to change, it is the patients' sense of fixing their own problem" and "Upskilling of GPs and patients; most diabetes management lies in the hands of people with diabetes themselves." |
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Your say on Pain Management and Mental Health services - May 2009
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Medical Forum's dual editorial themes for this month were Mental Health and Pain Management - areas we all struggle with, at times. Add to these the contentious issue of violence in the practice and this e-poll managed to fire up opinions from 181 GPs.
Of the patients you have referred to WA's public mental health services in the last few years, how often have delays in assessment had an adverse impact on patients?
Always 4%
Most of the time 26%
Sometimes 49%
Never 3%
Unsure 7%
Doesn't apply 11%
How often do these delays have a detrimental impact on carers or family?
Always 9%
Most of the time 37%
Sometimes 36%
Never 2%
Unsure 6%
Doesn't apply 10%
Do you think smoking amongst patients should be banned in mental institutions?
Yes 47%
No 36%
Unsure 17%
For opposing perspectives on the smoking debate, click here.
In the last two years, how often have you or your practice staff suffered violence or frightening abuse from patients?
11-20 times 9%
6-10 times 11%
1-5 times 56%
Nil 14%
Doesn't apply 6%
Unsure 4%
In patients with chronic severe pain, what best describes your view on opioid medication rotation as a treatment strategy?
Helpful 39%
Never tried 27%
There are better alternatives 20%
Not helpful 9%
Unsure 5%
Medicare Australia has a Medicine Information Line for doctor shopping on PBS scripts. How helpful do you find this service?
Very helpful 17%
Sometimes helpful 31%
Not helpful 8%
Never used 40%
Unsure 4%
Doctors can check the prescription history of new patients, or of existing patients whose behaviour causes concern, prior to prescribing S8 Opiates by calling the Pharmaceutical Services Branch of the WA Health Dept. How would you rate this service?
Very helpful 22%
Sometimes helpful 28%
Not helpful 4%
Never used 42%
Unsure 4%
What is your response to this statement: "Regular opioid prescribing should only occur in consultation with a specialist who specialises in the condition giving rise to the pain, or a recognised pain service"?
Fully agree 31%
Partly agree 35%
Disagree 25%
Strongly disagree 8%
Unsure 1%
What's wrong with WA's mental health services?
More than 80% of the 84 comments received on the state of WA's mental health services were short and disparaging. The venom was directed squarely at the underfunding and consequent understaffing of mental health resources, which in turn, leads to long wait times and aggravated patients. These comments were typified by "grossly underfunded", "Not too well catered for", "Struggling due to poor funding", and "pitiful!"
Specific feedback included:
"Child and adolescent services are disastrous, especially for those between 16 and 18. I recently spent an hour trying to find help for a severely depressed 16-year-old. PMH refused to have him as he was too old and the local adult mental health refused to have him as he was too young. Congratulations to Dr Grayden and his team at Swan Districts A+E for helping out."
"I find [mental health services] are only an option for the beginning or severe-end-spectrum cases of bipolar and schizophrenia. Anything that can be passed off to other agencies will be as soon as possible - usually before they are even discussed at the team meeting to consider whether to give the patient an appointment."
"The mental health care plans have resulted in excellent access to services for some of the relatively intelligent and well-resourced patients with minor problems. The extremely depressed still can't get inpatient beds or timely psychiatric care without going through an ED. There doesn't seem to be an acute alternative. The chronic no-hopers are sent back to the GP, but the ‘send back' letter often arrives a month later, and the patient, by then, has changed address or topped themself. Getting an email response or phone call in 24 hours from a de-identified centralised service is a bit of a help but how many doctors know about our local facilities in a rural area?"
One lone medico took a more thoughtful approach: "GPs, be the change you want to see." |
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Your say on Unplanned Pregnancy and HRT - April 2009
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Medical Forum is often at the front line of controversial medical issues, and this month's e-poll was no exception. With the issues of unplanned pregnancy, termination of pregnancy, and the mysteries surrounding HRT up for debate, 212 GPs chose to participate.
Key Findings
- 6% of GPs consider refusal to refer for termination a means of persuading patients to continue pregnancy.
- 6 in 10 GPs believe unplanned pregnancy most commonly occurs due to lack of, or incompetent use of contraception.
- More than half of GPs feel termination of pregnancy in WA is higher than desirable.
- 1 in 3 GPs believe Australia's Social Security system is contributing to more unplanned pregnancies as women are less apprehensive of the risks because of the Social Security safety net.
- Only 5% of GPs feel women are fully aware of the benefits and risks of HRT.
Confronted by a woman requesting pregnancy termination, is it appropriate for any doctor to use refusal to refer as a means of persuading that woman to continue with the pregnancy?
Yes 6%
No 87%
Uncertain 7%
In WA, is it illegal to refuse to refer to another doctor or health service for termination?
Yes 17%
No 42%
Uncertain 41%
For women seeking pregnancy termination, WA legislation requires doctors to do what?
Counsel the women on the risks of pregnancy termination and pregnancy. 60%
Let women know where such counselling can be obtained. 19%
Refer them to someone who does this counselling. 6%
None of the above. 5%
Uncertain. 10%
Across your patient population, how would you most commonly characterise the reasons for unplanned pregnancies?
No protection during unplanned infrequent sex. 41%
Clear-cut incompetence in the use of contraception. 20%
Genuine failure of contraception for ‘medical' reasons. 11%
No contraception use in older women who wrongly believe they are infertile. 9%
A willingness to rely on pregnancy termination or post-coital contraception. 9%
Not using contraception for religious reasons. 3%
Other. 7%
Other reasons cited included "assuming it is a safe time of the month", "dependence on the withdrawal method" (mentioned a few times!), "plain irresponsibility and financial incentives!", "intoxication", "stopping the pill for ‘a break'", and "teenagers thinking they can't get pregnant the first time."
In your personal view, do you regard the current rate of pregnancy termination in WA as:
Higher than is desirable. 53%
Acceptable, all considered. 27%
Lower than might be expected. 5%
Uncertain. 2%
None of the above. 13%
Does the Social Security system within Australia lessen the apprehension women have about unplanned pregnancies and thereby increase their incidence?
Yes 29%
No 36%
Uncertain 35%
Unplanned pregnancy prejudices
Rather than offer an old argument guided by moral compasses, here are some of the more entertaining and reasoned responses in the poll's comments section:
"Doctors are not gods. If you have moral issues with termination of pregnancy, you should refer to someone who can. This is no different than refusing to save a life because the patient is a murderer."
"I personally believe abortion is wrong and I would like to see a world where abortion never takes place. However, I strongly oppose any legislation/religious view/moral belief that prohibits abortion, because that is the wrong way to go about stopping abortions. A more correct way is to address the problems that lead to unwanted pregnancies in the first place: things like sex education in schools, resources for parents to discuss sex with their kids, wider availability of condoms (eg in high schools), and broader measures to empower women so they are able to negotiate contraception with their partner with more confidence."
"I have worked in surgeries where doctors throw the patient out and scream at them when the issue of termination comes up. Or worse still, they tide them along until it is too late to give the woman any options. This sort of behaviour I find very inappropriate."
Education not procreation
"Many low IQ woman rely on Social Security and family to raise their children, so they do not use contraception, do not see further ahead than the government grants available while the children are little, then 'dump' young people with poor parenting into society at a young age to perpetuate the cycle of unplanned pregnancies."
"I have been disheartened by the ignorance of teenagers regarding contraception. What once used to be taught in high schools is now badly taught or not taught at all after about Year 7. I have been in practice for almost 30 years and there seems to be less awareness in this age group in the last few years."
Questions and comments on HRT
See the feature HRT: After the Hype for poll results and comments on HRT. |
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Your say on Cardiovascular Health - March 2009
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The first Medical Forum e-poll of 2009 saw a welcome turnout of 254 respondents (around a 15% response rate in a 6-day window). Clearly, cardiovascular health is an issue that raises your blood pressure as a number of the questions provoked some brutally honest answers relating to patient attitudes and patient care.
What proportion of your patients on medications to treat or reduce cardiovascular risk do not receive appropriate lifestyle advice to improve their health, for whatever reason?
| >75% |
6% |
| 50-75% |
7% |
| 25-49% |
13% |
| 1-24% |
31% |
| None |
31% |
| Uncertain |
12% |
What proportion of your patients at obvious cardiovascular risk, who receive preventative health advice, do not comply satisfactorily with the advice given?
| >75% |
17% |
| 50-75% |
34% |
| 25-49% |
27% |
| 1-24% |
10% |
| None |
1% |
| Uncertain |
11% |
Of those patients who do not comply with advice, what proportion do you think would comply if given more proactive follow-up?
| >75% |
7% |
| 50-75% |
15% |
| 25-49% |
33% |
| 1-24% |
25% |
| None |
2% |
| Uncertain |
18% |
We have seen the lowering of threshold targets for lipids and blood pressure under clinical guidelines. What influence do you think the pharmaceutical industry has had over these changes?
| None at all. |
3% |
| Minor influence |
28% |
| Moderate influence |
39% |
| Major influence |
22% |
| Uncertain |
8% |
Given the growth in preventable "lifestyle diseases", do you think the medical profession is still not doing enough to implement systems to better manage chronic disease, such as opportunistic screenings, routine patient recalls, practice protocols, ancillary health workers, nurse educators, etc?
| Yes |
77% |
| No |
11% |
| Uncertain |
12% |
For you, when patients at risk of cardiovascular disease present, what interferes with you either giving them or referring them for advice on appropriate preventative lifestyle changes (e.g. exercise more)?
| Lack of time |
38% |
| Lack of interest |
1% |
| Not confident I am giving the right advice |
1% |
| Belief that patients rarely comply |
8% |
| No-one to refer to that I trust |
2% |
| Cost factors |
11% |
| Doesn't apply |
31% |
| Other |
8% |
Patients were in the firing line in the ‘Other' responses, with "patient ignorance", "lack of interest", "appears disinterested" cropping up several times. One medico went as far as to say "patient refusal when asked if wants help with these matters. Advice is only given with their consent." Another said "many patients object to examining their unhealthy lifestyles." "Co-morbidities" was listed a few times. Some respondents took a wider view, stating "Lack of appropriate community support structures".
Before commencing patients on antihypertensives, it is recommended that to negate ‘white coat hypertension' at least one second resting BP measurement is made after 10 minutes. From your understanding of how the profession works, how often do you think this guideline is ignored, for whatever reason?
| Always |
4% |
| In the majority |
35% |
| In the minority |
37% |
| Rarely |
12% |
| Never |
2% |
| Uncertain |
10% |
Do you agree with the general concept that pharmacists become involved in screening people who attend their pharmacy for cardiovascular risk factors?
| Yes |
35% |
| No |
45% |
| Uncertain |
20% |
On a personal note, if you could turn back the clock a number of years, would you want to change your lifestyle to comply more with current cardiovascular health guidelines?
| Yes |
46% |
| No |
44% |
| Uncertain |
10% |
Of all the cardiovascular risk factors you know of, which do you believe does not get enough emphasis in medical guidelines?
Talk about jostling for position! Amongst the 208 responses to this question, there were several that you felt deserved particularly emphasis. Not surprisingly, "exercise" (and the lack thereof) topped the list, being rated by 34 doctors. The intrinsically related "obesity" was second with 21 mentions (and a further nine mentions of weight lost or weight control). Add to this, thirteen mentions of "diet", eleven of "lifestyle factors", and nine mentions of "sedentary lifestyle", and nearly half of the respondents have pinpointed the current obesity epidemic - and its underlying causes - as the biggest cardiovascular risk factors.
"Smoking" was listed 21 times, "family history" twelve times, "hypertension" six times, "alcohol" three times, and "diabetic control" three times. Other risk factors mentioned once or twice included depression, media influence, hip/waist ratio, salt intake, lipids, and sleep apnoea.
White Coat Hypertension
Many sensible suggestions on preventing cardiovascular problems were put forward among the 106 general comments. More than a few respondents felt ‘white coat hypertension' (WCH) would be a thing of the past if 24-hour BP monitors were introduced on a wide scale and rebated through Medicare. On the subject of WCH, one respondent felt that "10 minutes rest does not negate real white coat hypertension."
Patients taking responsibility
A common theme from several respondents was the need for patients to take greater responsibility for their lifestyle choices - and the consequences of poor choices. One doctor said, "Many people will openly state they would ‘rather take a pill' than limit food or increase exercise." Another said, "Most people now know what 'lifestyle behaviours' are 'good or bad' for their health and they need to be ready to want to change their behaviour. Until then, we can only keep encouraging and motivating them."
Should we bother?
There were a few respondents who felt the whole argument for cardiovascular and ‘lifestyle disease' prevention was wrong-headed (for a number of reasons). Those who felt strongest about this said, "Lifestyle changes have a very limited impact in preventing CVS disease in most people despite messages to the contrary dished out by drug companies, misinformed doctors, The Heart Foundation, and most likely the organisers of this survey."
"Drug companies are exaggerating minor, if any, benefits of their product in controlling only one aspect of a risk profile. The yardsticks are also being moved to suit more people needing a prescribed drug rather than an overall overhaul of lifestyle being made."
And more matter of factly, "Many people presenting to hospital are already on anti-hypertensives, have BP >115 systolic (usually 140-150), are elderly, and often suffer from symptoms in hot, dehydrated conditions."
Left of field solutions
Some sensible and tongue-in-cheek suggestions always creep into our e-polls. Here is a selection:
"Charge a fat tax (i.e. if over a certain weight, you pay more tax unless you can show you are losing weight). Add the fat tax to unhealthy foods, like taxing the cigarettes and alcohol."
"I believe most people who exercise frequently do it in the mornings - daylight saving is a hindrance."
"Like Rosemary Stanton's advice in the national doctors' rags recently, not enough correct diet choices are being made - I think a traffic light on foods in the shops would be a great idea. Red = small amounts infrequently, Green = a good healthy choice regularly, etc."
"Bilateral hand stapling (i.e. fix them to the thighs) would work better than any medication!" |
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Sleep Studies and the Liberal government - October08
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After taking a couple of months off, the Medical Forum/Medical Hub e-poll is back. We received 227 responses from GPs and specialists (a 10% response rate within 7 days) on sleep studies issues and the perception of the new government's health policy.
Which statement most closely matches your views on sleep apnoea services in WA?
Good services for diagnosis, poor services for treatment 14%
Should be more in the hands of trained community doctors and nurses. 14%
Too expensive and difficult for patients to comply with treatment. 29%
Everything is as it should be, allowing for the lack of qualified doctors. 15%
Other 28%
Does an anticipated delay in getting a sleep study done dissuade you from suggesting this test to some patients?
Yes 23%
No 55%
Undecided 22%
Given that obesity is the single most preventable factor predisposing to sleep apnoea, should we be doing more to correct this problem?
Yes 90%
No 5%
Undecided 5%
All things considered, do you think the new WA government will deliver better health services than the previous government?
Yes 42%
No 22%
Undecided 36%
Do you agree with the Liberals' decision to retain Royal Perth Hospital?
Yes 71%
No 17%
Undecided 12%
What do you think is the main motivation for the Liberal government to retain Royal Perth Hospital?
Better health planning in allocating health resources 36%
To increase their popularity and re-election chances 51%
Other 13%
Aside from a few "not sure" answers, ‘Other' responses to this question ranged from the sensible, such as "Common sense", "centralisation", "Lobbying by RPH staff ", "To better use central resources, and because the public want it", and "sensible retention of a longstanding site developed over a long period and well known for provision of medical services" through to the more extreme "Self interested doctor and bureaucracy pressure", "Pressure from doctors who don't want to move", and "Stops them having to think too hard."
Do you think Dr Kim Hames will do a better job than Jim McGinty as Health Minister?
Yes 59%
No 10%
Undecided 31%
Your say: Royal Perth Hospital
139 medicos made comments on RPH, Dr Kim Hames, and the new Liberal-National government. Around half of the total comments were supportive of the Liberal plan to save RPH. For example, "Royal Perth Hospital obviously has a place in the heart of many of the population of WA. It offers a certain amount of competition in the quality of hospital medical care in the State", "As an emergency hospital, it is a great idea", "Nobel Prize winner, Australian of the year, first to do cardiac angioplasty in Australia - the brand and corporate culture of the place has value and shouldn't be lost",
Several more felt Royal Perth should be scrapped in accordance with the Reid Report findings. Those naysayers said "I think it is a very retrograde step. It will potentially derail the well-conceived plans for health delivery into the future. The old turf wars between the two major central hospitals will continue. Staffing of Fiona Stanley Hospital will be difficult", "I trained at RPH and have a strong attachment to it, but why bother having a serious independent look at what is really needed if we just ignore the findings?"
"There is insufficient emphasis on the responsibility of the Commonwealth government to increase Medicare rebates in line with past and future cost indexing, thereby decreasing the justification/need for ‘gap' fees. Retention of part, whole, or changed functions of RPH should be considered only in context of comprehensive statewide co-ordinated plan for medium-long term future of the state's health service provision - not just ‘Yes' or ‘No'".
"It is daft to turn the clock backwards after all the angst and money spent."
Others believed RPH should be retained because they feared the upcoming Fiona Stanley Hospital would not deliver as promised, with comments such as: "RPH needs to be retained because Fiona Stanley will only be able to cope with growth in the Southern Metro Area. It is not big enough to cover RPH. Where will our indigenous population go to?" and "It is ludicrous to even consider removing a centrally-based highly functional hospital. We need both RPH and the southern tertiary centre (lets drop the name Fiona Stanley while we're at it)" and "Why shut down a hospital that works well? I definitely agree with opening up Fiona Stanley though, we sooo need it in the southern corridor! SJOG Murdoch is profiteering from the need and offers a poor service."
But RPH and FSH aren't the only options, according to some. "Royal Perth caters a lot for regional referrals. An alternative is to build a better and bigger regional hospital for the north combining the Pilbara and Kimberley."
Then there are the doctors who are fed up with the "political argy bargy". "RPH is an average hospital, not a world leader, and is poor in some areas. Perhaps they need to be told this and that they have a history of wasting resources for ego feeding", "Any half measures will result in both RPH and Fiona Stanley being forever inefficient", and "It is cheap populism at the taxpayers expense."
Your say: Kim Hames the new government
Many of the commentators displayed a sense of optimism about Dr Hames and the new government's direction in health, especially when compared with Jim McGinty's administration.
"I dont think they have outlined clear policies yet, but they cant do worse than the previous lot. I feel very let down by Labour", "Can't be worse than Jim McGinty", and "A Mental Health Minister is a good idea so long as it equals greater involvement of the government rather than just greater bureaucracy."
"Kim Hames had a greater level of understanding in opposition and he responds appropriately and acts on issues. I have personal experience to verify this."
The Nationals influence on the new government also bodes well, according to some rural medicos. "I feel somewhat optimistic as a doctor that works in the Kimberley that we might see some improvements to our local infrastructure and staffing issues under the new government (particularly under the influence of the Nationals, perhaps!)" and "I'm more concerned with our rural local hospital, which I think is safer with the Liberal government."
One doctor felt "the new government will get a reality check." Time will tell! |
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Morality in medicine and men's health - June08
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A spirited response from 175 GPs ensured our June e-poll on men's health issues and morality in medicine had plenty of diverse opinions.
How often do you encounter men who have probable testosterone deficiency symptoms?
Very often 7%
Often (6-12 cases per year) 23%
Occasionally (6 or less cases per year) 53%
Never 17%
How often do these men have testosterone levels just above the 8 nmol/l threshold for PBS subsidised replacement treatment?
More than 50%: 20%
26 - 50%: 22%
1 - 25%: 29%
None: 6%
Doesn't apply: 23%
When you have a symptomatic patient who doesn't qualify for PBS subsidised replacement treatment do you:
Treat with a non-PBS subsidised form of testosterone 35%
Refer to a specialist 35%
Offer no treatment 13%
Other 17%
Other responses included "bend the rules", "correct lifestyle and review", "discuss the options", "exclude depression, offer physical exercise program'", and "repeat the tests".
All things considered, do you believe hypogonadism in men over the age of 45 is:
Under recognised and under treated 57%
Over diagnosed and treated. 17%
Recognised but under treated. 9%
Appropriately recognised and treated. 9%
Other (please state): 8%
One ‘other' response was "under-diagnosed in some groups, possibly over-diagnosed in others. With highly socially-inflected ‘disorders', social determinants of diagnosis (and treatment availability) are important factors." Others said "Don't know".
Do you think doctors who have moral or religious beliefs that could prevent them from taking part in medical interventions (e.g. contraception or abortion) should be obliged to inform their patients of this before engaging them in consultation?
Yes 73%
No 16%
Unsure 11%
Should government funding be withheld from films, plays, and other public artistic performances that depict smoking?
Yes 46%
No 38%
Unsure 16%
Do you think paying surgeons in the public sector per operation rather than for their time on the job would be an effective incentive to reduce surgery waiting lists?
Yes 42%
No 36%
Unsure 22%
How well equipped do you feel to answer questions from your patients about the new Living Wills laws?
I know the new laws very well 1%
I have a good idea but don't know specifics 30%
I know a little about them but would need some education on how they apply to my patients 61%
I have never heard of living wills before! 8%
If legislation on voluntary euthanasia in WA could be drafted with suitable safeguards, do you think it would be supported by the medical profession?
Yes 35%
No 37%
Unsure 28%
During your working life as a GP, have you ever accelerated the death of a terminally ill patient with the consent of both patient and relatives?
Yes 22%
No 78%
Unravelling the testosterone deficiency puzzle
We suspect the little-talked-about topics of testosterone deficiency and hypogonadism presented the tip of a medical iceberg, and many of 65 respondents who commented agreed. It was especially disturbing that several GPs knew very little on the topic, while another "learned information from a ‘drive and learn' CD."
Hard science on the subject is vague as evidenced by comments such as "Guidelines are inappropriate"; "Need evidence based practice"; "Needs more research"; and "Too much hype and too little science".
One GP felt it was all "quackery". Another found the answer in sex (doesn't everything come down to sex?) by saying "more sex will increase testosterone".
Morality in medicine: non-negotiable?
64 GPs left comments on the slippery subject of morality in medicine. Several acknowledged the difficult position of patients when they consult with GPs whose morals differ from their own. Indicative comments included "Doctors refusing to treat or refer termination seeking patients act morally and ethically questionably"; "I have heard some truly dreadful stories from patients who have tried to access doctors for terminations and been turned away. Transparency on this moral issue is essential for the patient to know before the consult"; "Patients need to be able to choose doctors whose religious and moral beliefs will not prevent them from making decisions or giving advice in a dispassionate and unbiased way"; and "We are not thereto judge people, we are there to give the best advice they can get, without bias."
One GP felt "morality [was] non-negotiable." |
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National registration and education sponsorship - May08
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357 GPs and specialists (an encouraging 25% response rate in the poll's one-week open window) took part in our April e-poll on the issues of pharmaceutical sponsorship of medical education events and national doctor registration.
Do you support centralised national doctor registration over the current state-based registration system?
Yes 71%
No 16%
Unsure 13%
Should investigations into complaints and misconduct/incompetence cases be centralised instead of the current state-based system?
Yes 27%
No 60%
Unsure 13%
Do you think current regulation of CME events is effective in curtailing the influence of sponsors over content or the choice of speakers?
Yes 40%
No 34%
Unsure 26%
How much of an influence do you think pharmaceutical company sponsorship of medical education events has on your colleagues' prescribing choices?
Very Strong 4%
Strong 13%
Moderate 36%
Weak 39%
None 8%
Given that Medicines Australia has revealed pharmaceutical companies in Australia recently spent more than $30m in six months on educational events, what do you think should be done about it?
Reduce spending 9%
Monitor spending more closely 27%
Nothing - the spending is reasonable 50%
More money needs to be spent 14%
Should drug companies be limited to sponsoring medical larger education events only (such as conferences with 100 or more delegates)?
Yes 12%
No 79%
Unsure 9%
Ultimately, who do you think will benefit most from pharmaceutical company sponsorship of CME events?
Patients 34%
Pharmaceutical companies 29%
General Practitioners 16%
Specialists 10%
Other 11%
The most frequent 'other' comment was 'all of the above' (mentioned in more than 75% of comments). Restaurants, conference organisers, trainees, and "crap journalists" were also put forward. |
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Practice manager issues - Apr08
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Practice managers are busy people, but 10% of emailed managers responded to our April e-poll on issues impacting on practice managers.
As a practice manager, which professional body best represents or serves your interests?
Australian Association of Practice Managers (AAPM) 63%
Australian Practice Nurses Association (APNA) 7%
Australian Institute of Management (AIM) 3%
None of the above 27%
What is your highest formal qualification in practice management (or a related field)?
Postgraduate 20%
Bachelor degree 7%
Diploma/Advanced Diploma 37%
Certificate 17%
No qualification 20%
Does your practice provide financial support (time off, paid training) for your professional development?
Yes 77%
No 20%
Unsure 3%
How valued do you feel in your work?
Highly valued 53%
Valued 40%
Undervalued 7%
Highly undervalued 0%
What do you consider to be the most important aspect in achieving job satisfaction in your role as a practice manager?
A happy team is the best way to job satisfaction, according to around 60% of our surveyed practice managers. "Autonomy and flexibility" were the keys, according to one practice manger, while good patient care, specifically "knowing I have made a difference to not only the practice but also the patients" was another way of keeping the job satisfying. A few respondents felt communication was integral, such as this practice manager, who said the secret to satisfaction was "good transparent and honest communication with the entire team."
Do you feel you have sufficient autonomy in making decisions within your practice?
Yes 83%
No 7%
Unsure 10%
Which areas of purchasing decision-making do you have primary control over at your practice? (multiple answers, so tallied results are higher than 100%)
Medical consumables 77%
Office consumables 87%
Equipment valued at >$500 77%
Computers and software 77%
Staff recruitment 83%
None of the above 3%
Other 40%
Other common decision-making areas included "billing standards/building works", "financial management", "marketing", "internet banking", and all " administrative processes."
What has been the most effective resource for recruiting reception staff for your practice?
The West Australian newspaper 36%
Recruitment websites (eg. Seek) 16%
Employment agencies 0%
AMA (WA) 0%
GP Divisions 0%
Does not apply 6%
Other 42%
Not surprising, the option we forgot to include in this question - word of mouth - cropped up in 90% of the 'other' responses, making it the second most popular recruitment resource for practice staff. Another response was "local newspaper". |
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Women's health and women in health - Mar08
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39% of female GPs polled (a phenomenal response rate given the seven day window) answered Medical Forum's survey on issues affecting women's health and female GPs.
Which of these health issues facing female patients do you think are seriously under-resourced in WA?
Mental health 17%
Eating disorders/body image 17%
Domestic violence 15%
Parenting/Motherhood advice 13%
Obesity/diet 12%
Pregnancy termination services 6%
Osteoporosis 5%
Sexual health 5%
Cancer screening 3%
Contraception advice 3%
Cosmetic procedures 2%
Other 2%
The most common ‘other' response was diabetes. Additional issues raised included aboriginal women, complimentary medicine, obstetric services, and interpreters.
Are you in favour of WA laws that regulate prostitution, including the public health aspects?
Yes 52%
No 16%
Unsure 32%
Do you think bias in advice - community agency or doctor - is currently a significant problem for women seeking termination of pregnancy?
Yes 41%
No 36%
Uncertain 23%
Do patients have good reason to complain about not getting the continuity of care they prefer, because of the high proportion of part-time female GPs?
Yes 41%
No 45%
Unsure 14%
Although there are now more female GPs than male, do the decisions around patient care made at your practice unfairly favour reflect male doctor attitudes?
Yes 19%
No 67%
Unsure 14%
What issue affecting the role of female GPs in your practice matters most to you?
Flexible work hours 62%
Equal status 15%
Decision-making 11%
Other 12%
Childcare, work/life balance, and the propensity for female GPs to do lower income "smears and tears" medicine were the big issues in the ‘other' comments. As one GP said, "I would like to be able to work more but with a very young child and no extended family support here in Perth, it is very difficult." Another said, "Having worked in several practices for varying lengths of time, I can say that the "smears and tears" cliché always comes true eventually."
Federal AMA president Dr Rosanna Capolingua's performance as a figurehead for women in medicine?
Very Good 14%
Good 37%
Average 35%
Poor 9%
Very Poor 5%
Federal RACGP president Dr Vasanatha Preetham's performance as a figurehead for women in medicine?
Very Good 17%
Good 46%
Average 32%
Poor 3%
Very Poor 2%
The most annoying traits of men who are leaders in medicine?
The proverbial hit the fan in the answers to this loaded question! From 64 comments, arrogance, rampant ego, old-school mentality, and paternalism were our respondents' most popular observations. Quickie comments included "Large egos which non-medical women continually stroke", "Don't listen to minorities", "Anti-abortion views", "Superiority and condescension", "Sexist", "Power playing", "Tunnel-visioned", "They think they speak for women", and "They think they are God". Do you know any doctors in power that may fit this bill?
Some specific feedback on male medical leaders included: "As with many male leaders, the focus is narrow and specialised", "The old fashioned tale: in my day, I worked three days straight with no sleep and little food - you are obviously not dedicated enough", "For male GPs - passing on all the pap smears to us! Also, the fact that women get the long consults while the men seem to cruise by on shorter consults!", "They don't fully appreciate the reasons why most women are part-time in medicine as most I know don't have the issues of going home to have to make dinner etc. as it is already laid out for them", "Men are improving in their attitude. Younger male GPs are also wanting more flexible working hours.", and "They don't understand women's health issues and are often healthy younger men without personal health issues."
Unfashionable male accessories were also in the firing line. Some witty medicos listed "bow ties" and "earrings" as annoying traits, and as fashion-conscious style masters, the Medical Forum team couldn't agree more!
Comment: Smears, tears, and equality fears
52 respondents added comments on a broad range of issues in the general comments section but one that cropped up a few times was the need for better payment for long consultations (to offset the "smears and tears" inequity that female GPs bear). A number of comments were summarised by "Medicare rebates to recognise the longer length consults would be great to remunerate what we're already doing." Another said, "It's much, much more than just PAP smears and babies, but you wouldn't know it."
Inequality comments included, "Despite all the progress, women are still very much the underdog, wagging our tail for the odd scrap, still thinking we need to do more study or gain more experience before we can go for that top job, whilst our male counterparts blithely apply for everything, confident they can do it. We need to get over it!", "I am getting burnt out with all the womanly caring that is expected of me", "Male doctors give awful advice about women's health sometimes and really should not do a women's health consult if they are not confident", "We need more regular meetings of female doctors in all fields in a networking sense to broaden this issue and more forums of this sort", and "Usually financially less rewarding than other areas unless you are delivering babies or doing cosmetic surgery."
Comment: Women's health in the balance
Other rallying comments on women's health issues were: "KEMH is under staffed and needs to be rebuilt and re-organised", "Sometimes, women patients short-change themselves by assuming only a lady doctor would understand. I base this on the assumption that male doctors can be as good at women's health as female doctors!", and "It is not easy to arrange female interpreters for NESB women with women's health problems. Also... perhaps the Divisions could look at an IUD sterilisation/instrument package service to supply to clinics on request and/or resourcing and supporting this to occur in GP clinics", and "70% use complementary medicine and not enough doctors are knowledgeable in this area." |
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Doctor Polls
