E-poll question:

Choose up to four things you feel carry most importance in allowing any group to claim it acts on behalf of the whole medical profession? [Multiple answers]

Answer	Spec	GPs
There is frequent dialogue and review of ideas between the group and the profession as a whole.	70%	76%
The reasoning behind the decisions of leaders is recorded, published soon after, and open for feedback by all doctors.	59%	57%
The views expressed arise from surveying of all doctors.	51%	60%
Leaders will accurately represent the views of members or craft groups if elected by them.	38%	29%
Doctors who pay to belong to the group make up the majority of all doctors.	18%	11%
The views expressed come from the leaders of a broad range of medical disciplines and it is not important how they became leaders.	15%	13%
The views expressed arise from surveying of all financial members of the group.	6%	9%
The decisions made and views expressed by the group follow my beliefs.	0%	10%
Other (please indicate below).	7%	5%
Uncertain.	1%	2%
Impossible – no-one can claim they represent the views of the whole profession.	37%	30%

E-poll Question.

Background. AMA WA does not release the number of financial members it has. "Members" can encompass non-financial, non-voting medical students, honorary members, retirees and associate members. We wondered if WA doctors had some idea of AMA WA financial membership, restricted to doctors who are eligible to vote during AMA WA elections and such like.

A guestimate! What percentage of all doctors in WA do you believe are financial members of the AMA?

                               Specialists         GPs

<25%                     8%                     21%

25-40%                  30%                   35%

41-55%                  27%                   28%

56-70%                  25%                   10%

>70%                     6%                     1%

Cannot guess         4%                     5%

ED. We need a statistician to sort out these figures! Our reading is that most specialists say around half doctors in WA are AMA members, while most GPs say the percentage is less.

Regarding sexual abuse of children, such as at Katanning, which of the following do you think hold the most promise in preventing future recurrences? [multiple choice]

Early education of children in schools to say no and/or speak up                  76%   

Mandatory reporting for those in public office                                                62%   

Better training of people in authority such as doctors, police and teachers    62%   

Police clearances for people working with children                                        37%   

Restrictions on legal practitioners                                                                    13%   

Other                                                                                                                8%

                                                                                   

What do you think is mostly behind the sexualisation of some young girls [choose up to 4 answers]?

Television and cinema shows           84%     

Advertising                                        80%     

Media coverage                                 72%     

Peer pressure                                    69%     

Schooling                                           14%     

Environmental chemicals                   2%       

Natural biological change                  4%       

Other                                                  7%       

Uncertain                                           0%

 “Parents can minimise this if they are mindful from the beginning about what their child sees on TV and film, and the behaviour that they themselves model. The media cannot take all the blame, although overtly sexual messages are everywhere.”

“Parents! Anyone who responds ‘environmental chemicals’ needs to go back to school! Incidentally, young boys are equally precocious in their awareness of sexuality – it’s just that people don't seem to have as much of a problem with it.”

“Yes – the poor kids with parents who are trying to relive their youth by offloading parental responsibility and pretending kids are more mature than they are.”

“Parents do have a responsibility and, where I live, boundaries are often non-existent for children.”

 “I am continually horrified about the topics that are covered during prime time on the radio (e.g. during school drop-offs) and the content of songs, to name just a couple of issues that contribute to this problem.”

“I recently heard from an ex-model that she was too old at 22!”

“Bratz dolls and the like are to blame.”

“Advertising creates the need to sell more products, aided and abetted by a self-interested, self-important media and, of course, some ‘Mummies from Hell’.”

“Children imitate those older. Who didn’t want to be 16 when they were 12?”

When is it recommended to give influenza vaccine to a pregnant woman? [select one response]

Never – contraindicated in pregnancy                                                          9%        

First trimester                                                                                                2%        

Second or third trimesters                                                                             22%      

Anytime during influenza season and regardless of gestational age            52%      

Uncertain                                                                                                       14%

ED. Most doctors chose correctly, that is “anytime”.

How important is a patient’s personal ‘trust’ in you, when it comes to you performing to your best for them as their doctor?

                                          Specs        GPs

Extremely important       59%           45%

Very important                 31%           46%

Slightly important             4%             9%

Not important                    3%             0%

Not sure                             2%             0%

Doesn’t apply                     2%             0%

How much is your personal trust in another doctor, for whatever reason(s), important to you in having a good working relationship with them?

                                                  Spec            GPs

Extremely important               59%             43%

Very important                         38%             53%

Slightly important                     2%               4%

Not important                            2%               0%

Not sure                                    0%               0%

Doesn’t apply                            0%               0%

What is it the profession does that erodes public trust in doctors? According to our respondents, ‘commercialisation of medicine’ and ‘depersonalisation of medical care due to corporatisation’ are the top concerns, particularly among specialists. Hiding adverse events and mistakes from the media come next.

Tick if you think any of these actions by the profession have/are damaging the trust patients generally put in doctors? [multiple choice]

                                                                                                                Spec           GPs

Commercialisation of medicine.                                                            79%            65%

Depersonalisation of medical care due to corporatisation.                  69%            69%

Lack of transparency over adverse events reported in the media.     46%            44%

Doctors make mistakes and do not admit fallibility and apologise.     49%            33%

Incorrect public stance taken by our leaders on ethical issues.         38%            33%

Other (please indicate below).                                                              8%              19%

Uncertain.                                                                                              0%              2%

'Other' damaging reasons?

Among the 8% of specialists who chose this response, their comments pointed to: unbalanced media reporting and inconsequential retractions; ‘free’ Medicare services; some cosmetic procedures; politicisation of public hospital medicine; time constraints in the doctor-patient encounter; and doctor insensitivity and disregard for patient's concerns.

More GPs (19%) chose ‘other’ and 32 provided comments that perhaps reflected the more diverse setting in which GPs work. Media sensationalism and bias took a big hit (n=6), while doctors taking an interest in unproven alternative medicines or the popularity and competition from alternative therapies was also targeted (n=5).

Changing attitudes to patients were mentioned, including lack of compassion and humanity, failure to recognise and address the patient's agenda, and too much reliance on technology and medications and not enough attention to the social, cultural and emotional wellbeing.

We had comments about doctor greed, the immigration of poorly qualified doctors, reduced continuity of care, doctors who advertise to the public, bulk-billing, and poor advocacy for ourselves.

For some, patients took centre stage: “The patient-has-no-blame approach is problematic; trust is two way; we can do best for patients if they help us and work with us and are truthful” and “Patients often have unrealistic expectations and when these are not met, they lose trust.”

This idea speaks for itself: “Most Australian universities employ people from non-clinical backgrounds (nurses, psychologists, OTs, PTs, etc) to teach medical students in clinical training. This is a recognised disadvantage for students and ultimately to patients.”

In this supplementary question, we asked a further question of 92 GPs – which ethical issues our leaders were dealing with did they feel were being handled incorrectly in the public eye. Given these results, it makes common sense for the profession’s leaders to set about explaining to all doctors why they portray particular opinions to the media.

Earlier, close to a third of surveyed doctors said the incorrect public stance taken by our leaders on ethical issues was contributing to damage done to the trust patients put in doctors. If you agree with this point of view, which of these ethical issues apply? [multiple choice]

Money misappropriation                                                     38%         

Medical mistakes by doctors                                              37%         

Sexual misconduct by doctors                                            37%         

Drug abuse while practising                                                22%         

Failure to report adverse events affecting patients         22%         

Consulting while significantly impaired                            19%         

Combat sport                                                                         11%         

Pregnancy termination                                                         8%           

Other                                                                                       6%           

Uncertain                                                                                 14%         

None – disagree with this idea                                            20%

        

Here is a representative selection of dotors' comments on the importance of trust in medicine.

Specialists

“It's fundamental. But trust has to be rewarded with very good performance.”

“Evolution of treatment protocols and supervision/mentoring is very important. Clinical outcomes are better if doctors work together in group arrangements. Stretches across to nurses employed by doctors as well. We can learn from each other and share the skills, all to the advantage of patients.”

“Unfortunately doctors tend to turn a blind eye towards the misdeeds of their colleagues.”

General Practitioners

“Trust and respect are measures of integrity – they are essential in any professional relationship.”

“The ‘other doctor’ is representing you in the management of your patient.”

“I could not work with another Dr whose management principle and ethics I could not trust.”

“Working in the medical field is like any other job. To function efficiently as a unit, trust is the most fundamental aspect; trust that your colleagues have done their best and you would expect them to trust you too.”

“I currently work with a couple of poorly trained and/or disinterested doctors and I find it exasperating.”

 “I don't refer to those I don't trust.”

“There are 'crooks' in every area of life, and medicine is no exception. Doctors, particularly some types of specialists, appear to believe they are above the law or ethics, and treat patients as statistics. I cannot trust a colleague who acts this way.”

“A percentage of medicine is psychological – trust is fundamental to allowing health improvement. Psychologically, if you trust your doctor and his/her judgment, you are more likely to heal using their advice.”

 “Sometimes you just have to take what you are offered.”

“Skill can override trust, depending on the field.”

Do you believe the Gillard government’s legislation to bring in plain packaging on tobacco in December this year is likely to be overturned on legal appeal by tobacco companies?

                        GPs            Spec

Yes                  26%            27%         

No                   46%            48%         

Uncertain        28%            25%

Do you think that doctors substantially under recognise Foetal Alcohol Spectrum Disorder in infants and children, particularly where there are brain effects but little or no physical manifestations?

                                                                                                       GPs       Spec

Yes, by missing it altogether.                                                  25%        15%        

Yes, but by attributing it to something else (e.g. ADHD).    47%         44%        

No                                                                                                    6%           7%          

Uncertain                                                                                       28%         39%        

Do you think that as a profession, we have been slow to promote ‘no alcohol’ in pregnancy for fear of putting the “guilts” onto mothers who have already had affected children?

                                        GPs               Spec

Yes                                 31%              37%  

No                                   59%              44%  

Uncertain                      10%              19%

Ed. See a good update by local paediatrician Dr Desiree Silva, head of paediatrics at Joondalup Health Campus (Click Here).

Poly Implant Prosthese (PIP) has been accused of deception in producing substandard silicone breast implants. The environmental protection agency was accused of letting the Esperance community down over the lead export scare. Chinese-made products have been adulterated and some have damaged consumers (e.g. powdered milk). Do you think today’s younger generation of doctors will be facing more incidents like these because pursuit of profits will override concerns for human health and safety?

                            GPs               Spec

Yes                      79%              80%  

No                       13%              17%  

Uncertain            8%                3%

 

Comments on Profits before Human Health

Both GPs and Specialists (n=14) said this problem has always existed, but in today’s world of communication more transparency is likely, although ongoing vigilance is necessary and it gets more complex as technology advances. Comments like:

“Just look at tobacco and asbestos. We have to be vigilant and sceptical of big business's ruthless disregard for anything other than the bottom line - reap the rewards and pass on the costs to someone else.

Just five doctors thought the situation today has improved, with comments like:

“There is greater awareness of substandard prostheses, processed foods, and other items for human use thanks to better and more transparent reporting by patient groups.

 “The medical profession will continue to be at the forefront of discovering and intervening when harm comes to our patients.

In fact, more (n=9) wanted improved transparency or regulation.

 “A lot depends on legal safeguards, penalties and whether laws to protect consumers are actually enforced” and “Australia needs a revamped TGA to evaluate and monitor implants, prostheses etc.

Many respondents (n=20) were clear that unethical pursuit of wealth, greed, and profit taking were the underlying illness, with comments like:

“Let's not start thinking we've just discovered a new relationship between capitalism and avarice.

“With the negative effects of the GFC on the bottom line of many multi-national companies, I suspect corners will be cut wrt safety to improve profits and governments will not be as vigilant.

“Sadly society has made money the short term arbiter of action - it always costs more in the long run to put the damage right

“There have always been people motivated by greed. You haven't noticed how many regulations there are for everything?!

“Deceptive corporate behaviour has been happening for a long time and companies producing devices, medications, implants etc. need close oversight, criminal penalties for perpetrators and protection for whistleblowers.

A few (n=5) mentioned government – including the sell-off of things to the Chinese and that “balancing economic growth of a free market against restrictions and limitations that protect consumers and the environment is a tricky nut to crack”.

Slightly more respondents (n=9) honed in on other doctors as co-conspirators, with comments like this:

“The more dependent we are on big corporations far distant from the frontline of care provision, the more likely it is that profit will trump outcome as the driving force.

“Yes, with drug companies forcing doctors to do stuff.

“Young doctors are likely to be more indifferent to these sort of issues as evident by their appalling insensitivity to the socioeconomic and political dimensions of health and illness.

Another seven pointed to other obvious effects within the medical profession, including:

“This not only affects the individuals involved but also adds strain to an overburdened health care system.

“Just look at the management of private hospitals - profit always takes priority over patient/personal welfare.

‘The younger generation of doctors will be facing more problems with the safety of their patients when a lot of sub-standard materials/medicines and pressure to choose the cheaper institution/hospital/health insurance oriented cheap ones.

“We doctors need to keep highlighting our concerns, but, ultimately, it is the patient who must make the informed choice - we need to provide them with ways to find out that information.

Five saw contributions from the legal system, mainly the need for more documentation stemming from a more litigious culture within society, and “many class actions/media scares” keeping us honest.

A large group (n=19) felt changes in society contributed to the dilemma, such as “Deception is more prevalent” and “The public want the service at the lowest price”. To this we add…

“As the economy becomes increasingly globalised, companies may be tempted to sell products which do not meet Australian standards.

“It's scary... What pollution, synthetic, plastic toxins are we all exposed to.... it is anyone's guess what these things are doing to us?!

“Organisations are motivated to maximise profits for shareholders rather than be profitable by serving the community's needs.

With over 2,600 words written by both GPs and Specialists around waste in the medical system, we have attempted to summarise the main points here. If anyone has more to add on the Key Pointers outlined below, please contact us (CLICK HERE). The E-poll question was:

Clinicians can tell us a lot about inefficiencies or waste in our health system, whether public or private. In your experience with patient care, can you recall being annoyed by something you consider was repeatedly wasteful of human or other resources?

Key Pointers

These responses are roughly in order of frequency…

• Metal instruments in disposable theatre/suture packs.
• Disposable single-use everything in theatres – drapes, gowns, instruments (surgical packs), nurses or doctors opening/discarding unwanted sutures, bottles of antiseptic.
• Bureaucrats contributing nothing to patient care and not solving staffing or other problems at all or in time e.g. "change management" meetings that go nowhere. Health management grows while patient care diminishes.
• Duplication and repetition of tests – pathology or radiology done in private because it is not available in public; requester does not review previous results; repeated in outpatients because referring GP doesn’t send; inadequate handover from A&E to GP; unnecessary testing of ‘the worried well’ where reassurance would suffice; blood tests being repeated between public, private and corporate (workplace medicals) sectors; time wasted in the phone queue chasing results at Pathwest.
• Excessive paperwork – parking at QEII; conference travel for HCN; in Health Dept in trying to achieve anything; research projects seeking Ethics Committee approval; waste in producing care plans for hospitals or general practice.
• Slow public theatres, compared to private.
• Inappropriate admissions. Elderly patients transferred needlessly to a tertiary hospital when treatment could be given in ACF; elderly patients go from ward to intensive care because staff not briefed on NFR etc measures.
• Patient assisted transport system (PATS): misuse by doctors and patients alike.
• Nursing homes and hospitals do not use patients drugs brought from home.
• Poor doctor communication: specialists saying they are not aware of other patient problems when they are listed in the referral; referral between specialists when they do not have previous investigations or referral results.

Other Noteworthy Anecdotes

“State/Commonwealth 'cost shifting' – immature politicians acting like school kids playing bouncy ball with taxpayers’ money."

“I am working in the public mental health service. I am disgusted with the futile and wasteful efforts of redesigning and reinvention of wheels in health care delivery/management structures. The higher executives far away from ground realities, doing their (mis)administration, aiming only at cost containment, is demoralising the staff and depriving the patients."

“Disposable suturing sets – use one instrument, the rest is waste! For heaven’s sake, can’t we consider some Third World countries that will use and need it? Mandatory work in these countries will be an eye-opener for many who know no better."

“I really dislike it when health authorities change their name or logo, which leads to new stationary being printed and the previous lot wasted."

“I work in the occupational health and perform pre-employment medicals. Mining companies have a policy that each change of site [by a worker] requires a new medical, often including audiograms and spirometry. Some contracted workers have medicals every few months and some, who go up for a week or so to each site, have a new medical every few weeks. Each full medical costs about $400. The waste is enormous in cost and time. One contractor advised that for a week’s contract he has to allow for three weeks’ of medicals and inductions costing him thousands and contributing to the overall costs for any new project, with some not cost-effective."

“The major waste I see is medical expertise (especially our junior doctors) being wasted on overly complex discharge summaries and paperwork which was previously handled by nursing staff and allied health. There is far too much wasted on employing multiple nurse managers in the public hospital system."

“The massive over prescribing of antibiotics, especially by the six-minute medicine doctors, is scandalous both financially and ethically. It takes longer to educate the patient about viral illness than to buy into their beliefs that antibiotics cure colds."

“Every day, in the European Union, the same amount of food that is being consumed is thrown away. Just out of date, wrong shaped cucumbers, blemishes on apples, the list goes on. That really bothers me more than anything else and is indicative of a worldwide attitude of being precious and entitled."

What do you think of attempts to simplify patient access to services for the elderly such as one-stop enquiry lines?

47%  Badly needed for all (patients and relatives).

21%  Yes, but for some services only

7%   Current system works well – no change needed

22%  Uncertain

2%   None of the above

Comments on simplifying patient access to aged care services

The 33 medicos who commented found the issue complex.

Seven confessed they knew nothing (or next to nothing) about the issue, and in particular, an enquiry line. Confusion reigned for a quarter of the respondents, with comments such as:

“Isn’t that what Carelink is?” and “Perhaps this could be the role of Medicare Locals, but I haven’t a clue what they are going to do,” and “Oh dear, yet another service I do not know about!”

Three pointed to technology, such as:

“Need to remember the elderly can find technology difficult (e.g. automated phone service) and many don't have computers. They need to speak with a real person. Few people seem to know about the Commonwealth Carelink number.”

Three had concerns about replacing the GP, such as:

“If patient care is removed from GPs’ responsibilities, it will be taken over by lesser trained bureaucrats and rapidly become another dog's breakfast.”

Nine medicos felt the system needs a good shakeup, such as:

“Current system is far too disjointed and fragmentary,” and “Ignorance of services available is a major barrier to care. It would be cost-effective in the long run to invest in coordination of care from early contact, including phone/online/face-to-face,” and “From the hospital perspective, every year there appears to be more bureaucratic nonsense and less appreciation for the complex clinical care that this vulnerable group of people requires. The pressure to discharge from tertiary centres is disturbing,” and “The trouble with one-stop enquiry lines is that they are often of limited utility. How often does ‘Health Direct’ direct people to their local GP or hospital ED? Passing the buck is frustrating, a duplication of services, and of limited value. I think an on-call geriatrician service for primary care providers would be useful, but again, it would be limited by cost, availability, and medicolegal liability for phone advice.”

Imagine you are semi-retiring soon and you are considering limiting your practice to just aged care. As things stand today, what would be a strong barrier to you doing this? [more than one choice possible]

54%  Remuneration for the effort involved is not worth it.

42%  Too much paperwork involved

42%  Lack of on-site facilities to assess nursing home patients properly.

28%  Lack of competent nursing staff to provide support

25%  Elderly patient problems are too complex and overwhelming.

22%  Lack of backup support from specialists and suchlike.

22%  Clinical practice rather limited and potentially unsatisfying.

16%  Too many end-of-the-line high care patients in aged care facilities.

16%  None of the above.

9%   Other

Would you work in aged care?

In the positive camp were comments such as: “A job for very special people,” and “It’s a great semi-retirement option. I'll be there, ” and “The clinical care of aged patients is very rewarding although relatively poorly rewarded,” and “I already focus my practice on aged care and I am nowhere near retirement myself. It is extremely rewarding professionally, and I make a decent income. The main barrier to GPs doing aged care is that they think it's too hard to arrange in a way that doesn't lose them money/time.”

Negative (or at least, pessimistic) comments included:

 “Very time consuming to assess nursing home patients and the need to be on-call for them,” and “Unrealistic expectations by residents’ family members,” and “Funding needs addressing – the bonus payment for seeing a certain number of patients per year is only available to PIP practices, which cuts out all those GPs who are specialising in aged care in semi-retirement (and I think they are the only hope for aged care as younger GPs don't seem to be taking it up),” and “Most aged care facilities are not doctor friendly. Medical record keeping is poor and variable.”

“I do go to nursing home patients now. The staff do a great job but many lack the skills to adequately assess the patient, resulting in increased visits to see the person as you are not sure from the information given how ill the patient is. I feel remuneration is very poor as a great deal is unpaid phone advice and writing multiple scripts in your own time.”

“I actually have 100 patients in ACFs and am very pro-active regarding their care. The basic problem is that too few GPs are actually organised enough to do the job well.”

Accessing specialist advice is difficult with immobile patients in aged care facilities. Tele-health, where the specialist uses an audio-visual link to the doctor or staff to advise on care, is suggested as one solution. What is your response?

33%  Helpful but only for limited clinical scenarios.

23%  Very limited uses due to the logistics and time constraints.

21%  Good in theory, virtually useless in practice.

20%  I agree – it could be a big help for most things.

2%   Uncertain

1%   None of the above

For whatever reason, what proportion of suspected adverse drug reactions in the elderly would you report to the appropriate authorities? [single answer]

33%  Rarely report

25%  Most

13%  Nearly all

3%   Less than half

5%   Less than a quarter

5%   None

7%   Uncertain

9%   Doesn’t apply

Various daily living aids are available to assist family or carers look after an elderly relative at home. Do you know how and where to access such aids?

62%  Yes

19%  No

16%  Uncertain

3%  Doesn’t apply

How well equipped do you feel to answer questions from your patients about the 2009 living wills laws?

2008   2011

1%      10%  I know the laws very well.

30%     36%  I have a good idea but don’t know specifics.

61%     51%  I know a little but would need some education on how they apply to my patients.

8%      3%  I have never heard of living wills before!            

If legislation on voluntary euthanasia in WA could be drafted with suitable safeguards, do you think it would be supported by the medical profession?

2008    2011

35%     21%  Yes

37%     56%  No

28%     23%  Unsure

This is for anyone who has cared for or been involved with patients with a terminal illness. Please tell us what you or the nurses involved generally think about the transition of care from oncologist to palliative care doctor? 

36%  Usually happens at the appropriate time

33%  Often occurs too late 

9%   Mostly not managed properly

2%   Often occurs too early

8%   Doesn’t apply                

2%   None of the above

10%  Uncertain

The palliative care transition conundrum elicited 40 responses. This is a good representative sample of opinion.

“The palliative care physicians complain the patients are not referred early enough, but usually the patients don't want to transfer. They don't want to lose their treating doctor and they don't want to ‘concede defeat’ and accept death is inevitable.”

“I see patients on the acute pain service rounds frequently that should have already been acquainted with palliative care. Often, this service is not offered to patients as part of their ongoing oncological care. Doctors remain scared of tackling this situation as it is an admission that treatment has failed ... and at this stage, patients are often left to fend for themselves as their life draws to a close.”

“Oncologists loathe admitting that they do not have a useful role any more. It is frequently up to the GP to suggest that a palliative approach would be a better option.”

“Pallative care doctors are great, but the concept of palliative care teams – often nurse lead – often frustrate the issue of transfer from oncology to palliation in the public setting.”

“I think it would be most appropriate for the palliative team to be involved in a patients care earlier rather than later. It is not necessarily always a matter of symptom control – the psychological and emotional aspect of dealing with a terminal illness is sometimes better dealt with by most palliative care teams than the busy oncologists, which impacts on the life of not just the patient, but the family as well.”

“The only problems have been where patients have entered a period of rapid decline after a long period of stability and the carers and patient have ‘missed’ the observation that the end is near.”

“Palliative care services have never been anything except brilliant in the nursing home setting. I am very obliged to the backup this provides.”

“For my dying elderly patients, it is exceptional to have the involvement of either an oncologist or palliative care specialist, even if they are dying of cancer. It would be different for younger patients in the general community, but in aged care, the GP can do it all. Palliative care assistance is easy to get as a GP – excellent service in WA.”

Do you believe Healthway funding for particular sports should be withheld altogether where those sports are also sponsored by fast food or unhealthy beverage companies?

39%  Yes
30%  Maybe, with conditions 
28%  No 
3%  Uncertain 

If a children’s sporting body drops advertising sponsorship from a fast food or unhealthy beverage company, do you believe Healthway or government should make up the difference?

45%  Yes
33%  Maybe, with conditions 
19%  No 
3%  Uncertain 

Is/has your child participated in a sport that has been visibly supported by advertising for what you believe is an “unhealthy” product?

47%  No
19%  Yes
6%  Uncertain 
28%  Doesn’t apply

32 GPs commented, and intriguingly, while a quarter of comments were dead against unhealthy food sponsorship of kids’ sports, one fifth were either ambivalent or unconcerned about who sponsored sport. Four suggested parents should be the arbiters when it comes to fast food, while another four suggest we have a ‘fast food culture’ of dishing out vouchers as a reward.

Not a worry

“Advertising by McDonalds (e.g. vouchers for food after a swim term) I feel has no more impact than the Golden Arches by the highway or what is on TV. If the profits get put into children's sports, I feel that it is a worthwhile thing!”

“Sports are sports, no matter who sponsors.”

Parent’s responsibility

“Sponsorship money is always useful. Unhealthy products on and off are a treat. It is the duty of parents to supervise good eating habits at home, but a weekly treat of junk food is often a luxury.”

“Foods are ‘unhealthy’ mainly because they are taken in excess. I think that we need more responsible parenting and health professionals encouraging healthy lifestyle with the occasional day off.”

“Any sponsorship should be welcomed in order to promote increased activity amongst children. Parents should be smart enough to guide their children’s habits.”

“The problem with this question is that almost all brands have something which is unhealthy and healthy. The bottom line is you cannot control the choices people make except to educate them on the healthy option. What brand is completely healthy or unhealthy? MacDonalds has salads and water.”

Sponsorship helps

“In the remote and rural sports clubs, McDonalds and KFC are big partners in the championships and matches, and without those funds and support, it would not be possible to run the tournaments unless Royalties for Regions steps in to make up for the difference.”

“Many sporting ventures rely on sponsorship from fast food chains. This allows kids to have uniforms or equipment they otherwise wouldn't have. I think it's about teaching kids moderation.”

“Surely anything that contributes to encouraging or supporting them to do more sport is worthwhile? Let’s be pragmatic not just politically correct.”

An unnecessary evil

“I hated the fact at state-level championships sponsorship of Little Athletics was from a fast food company, although the actual club he attended had more ‘ethical’ sponsorships. Linking Healthway grants to getting rid of fast food sponsorships will make clubs able to turn down large financial gifts, rather than take both grants.”

“Healthway's reason for existence is to provide sponsorship in exchange for removal of unhealthy advertising in association with sport.”

“The bottom line for those companies is profit and more profit. Their sponsorship of sport is unethical, or if you prefer, immoral.”

How often do adolescents (say 12 to 16 years) ask you about issues relating to sexual health?

38% Rarely (once every few months or less) 
30%  Occasionally (once a month on average)
26%  Commonly (at least once a week) 
3%  Never 
3%  Doesn’t apply 

If they do, what sort of topics do they ask you about [select up to THREE]?

88%  Contraception/safe sex 
48%  Pregnancy 
33%  Relationship issues/problems 
16%  Puberty 
15%  Blood borne infections 
12%  Tattooing/body piercing 
18%  Other*  

* 70% of the ‘Other’ responses mentioned STIs or chlamydia. One commenter told us straight up “The common STIs! Where have you been?” Other responses were “period problems”, “mental health”, “sexual assault – and note that these ones do not come in with the parent, mostly.”

Do they usually ask in private or with their parents?

68%  In private 
25%  With a parent 
3%  Uncertain
4%  Doesn’t apply 

If parents talk to you about engaging their adolescent, what do they most commonly seek from you?

58%  Your advice on health or relationship issues (e.g. sexual health, blood borne viruses) 
18%  Referral to another provider (e.g. counsellor, family planning, school). 
3%   Printed material they can give to their child. 
2%    A good website or web-based product they can recommend to their child. 
15%  Doesn’t apply 
4%    Other*  

* We received a handful of mixed-bag answers, including “communication skills with their adolescent”, “Hey, it's not 1986!”, and “The Grim Reaper is not an issue for heterosexual teenagers!”. Two said “contraception”.

Judging by the above answers, most GPs have regular contact with adolescents, and pregnancy and contraception are the top topics, usually discussed in private. Parents seeking advice is also common. Amongst the 23 GP comments, six felt talking with teens went smoothly when approached with openness and maturity, while another six complained of their struggles to engage this difficult demographic.

The mature stance

“Talk to them as equal human beings, but with you knowing more than they do. But they know things that I don't. Give them a chance to be the knowledgeable party.”

“See them alone first. Explain confidentiality rules. Be an adult.”

“Don't patronise and don't betray confidentiality unless there are danger issues.”

“Reassurance regarding confidentiality is very important, and developing a rapport – which is not always easy. Use of website recommendations helps.”

A prickly proposition

“A difficult subject and often has to broached by the doctor because adolescents are uneasy about it.”

“Lots of adolescents find it hard to talk their parents about sexual health, relationships, and bullying at school etc.”

Or is it?

“They are really receptive if engaged properly.”

“Easier than it is made to be. They are very receptive to your moral opinion.”

Tackling all the issues

“It is important to raise issues when adolescents present with other issues (e.g. immunisation, viral infection, sore throat).”

“Usually young female comes to see me about UTI, STI, and unplanned pregnancy or pregnancy scares. Occasionally, it may be related to sexual assaults. Most of them either come in alone or with their current sexual partner. Not many come with their parents.”

 

How do you think the profession should gauge the success of Medicare Locals?

61%  The improved delivery of services to patients 
18%  The degree to which they shift focus of care from hospitals to primary care 
8%    The amount of direct GP leadership involvement
2%    The amount of funding they attract 
10%  Other* 

* About 40% of the ‘Other’ responses had no idea about Medicare Locals, with one GP even admitting they were “not familiar with this term”, while another said, “I still have no idea what Medicare Locals are!” A more articulate response was “Practical programs to help patients and form an additional resource for GPs who remain at the centre of care”, while one female GP (perhaps confused with GP Super Clinics?) said, “I think all of the above should apply … GPs should be rewarded professionally and financially for their contribution to primary health care. It is not worth me getting out of bed to attend to the clients of bulk billing practices.”

Which sentence do you most strongly identify with in describing Medicare Locals?

39%  They are a ‘work in progress’ that I am undecided about
20%  They are in reality GP Divisions by another name 
15%  They are government’s attempt to create efficiency in a health system under pressures 
2%   They will better combine various service providers without adversely affecting GPs
1%   They offer GPs some real input into shaping effective service delivery 
23%  Other 

Given the contentiousness of Medicare Locals, it was not a surprise that third of polled GPs (n=30) had a say. About 40% of these responses were “not sure” about Medicare Locals. Amongst the remainder, there were strong negative opinions.

Constructive criticism

“We need to work on the correct and relevant model for the various jurisdictions within WA in consultation with all relevant stakeholders.”

“I think they could help coordinate and improve care of patients but they also could be manipulated by governments for electoral and ideological reasons.”

“Let them do all the patient setup for e-health records. That may be a useful activity which otherwise will fall to GPs if GPs are not careful.”

“It would be better to build on GPs practices.”

Confusion and suspicion

“Has anyone really defined who they are and what they do? I get the feeling that they are just another bureaucratic body! I hope I am wrong. I feel that increased paperwork and reporting requirements as well as the less local setting (larger areas under management) will result in fewer services to local people and less well targeted programs with risk of disadvantaged groups missing out.”

“I find the whole kerfuffle confusing, to be honest.”

“I’m really worried about GP engagement and their role in holding and division of funds.”

“Despite the vague political 'feel good' statements no-one has yet clearly explained exactly what they will do – and how this will be achieved.”

“I don't trust this process as far as I could spit it. There has been no detail at all as to what this extra layer of bureaucracy is intended to do compared with the Divisions, nor how it is to make life more efficient, nor what services are intended to deliver. I can only assume it's another way of wasting the money that could be spent on actual services by endlessly talking about or filling in forms about it or running ‘evaluations’ that take up the funding for the service.”

“At this stage, disregarded as political stunt making with no clear defined benefit yet apparent.”

“They are Julia Gillard’s and Nicola Roxon’s hope for sanity in the health system, but really, they have few good ideas.”

A waste of time and money

“They are practically not necessary and the government has spent a good amount of fund for this. Ideally, it should spend in other areas like mental health care plans, GP surgery development, etc.”

“Have not been interested to find out more as it sounds like more bureaucracy we do not need!”

“Abolish them and fund/support GPs properly.”

“Probably a waste of money except for their employees and Board Directors.”

Government interference

“Another completely unnecessary layer in the bureaucracy.”

“Another huge investment by the Gillard Government in an untried and vague concept which is drawing funds away from direct patient care.”

“Another example of government attempting to control the Medical profession.”

“They marginalise GPs in delivery of primary health care.”

“They have been taken on by Divisions of GPs claiming to represent general practice when divisions have not represented general practice for a long, long time.”

Serious violent behaviour in young men on the streets has increased. From this list, please choose those FOUR things you consider most likely lead to such violent behaviour:

Family breakdown 67%

A violent upbringing 67%

Exposure to violent media 54%

Relationship problems 43%

Permissive parenting 41%

Mental illness 40%

Bullying 27%

Lack of other physical outlets 25%

Absent fathers 23%

No-one to confide in 13%

For any violent act by a young man, please tick the single item you feel is the strongest catalyst for violence at the time:

Alcohol consumption 69%

Illicit drug use 17%

Perceived lack of consequences 9%

Trying to impress mates 1%

Ethnic differences 1%

Other* 3%

*Most suggested a cocktail of alcohol and drugs, one suggested “carefree attitude amongst peers”, and another “crime”.

Our survey respondents were concerned enough for all to offer comment (n=197), mostly around the root of violence in young blokes. Several agreed that there were many contributing factors (including “all of the above!”). We have subcategorised to assist you.

Alcohol and Drug Abuse

>40% of comments involved alcohol and illicit drug use. Here’s a sample:

“It appears often to be the result of repressed anger (related to deprivation, abuse, feelings of inferiority etc) unmasked by alcohol or stimulant use.”

“Methamphetamine abuse in young males is massively underestimated. It allows users to consume vast quantities of alcohol, lose their faculties, but remain on their feet and engage in physical violence. Organised criminals (read: bikies) are huge in WA and law enforcement seems powerless to stop them.”

Influence of Violent Media

This was the second most common theme. Here’s a representative sample:

“The link between watching violence in the media and real life violence is put aside and ignored by many. However, the evidence is now overwhelming, with a statistical link of the same magnitude as that of smoking and lung cancer.”

“The media is definitely partly to blame. You can’t hit a guy in the temple and not expect risk of haemorrhage. It is nonsense to suggest that the head hitting the bitumen is to blame for the injury.”

Parenting Concerns

A third blamed parenting. Are you listening to this, baby boomers?!:

“I think that an excessive belief in their right to tread on others comes from childhood, as spoilt brats who are never criticised during their adolescence, may be a factor.”

One empathetic doc said, “Trying to impress females (either negatively or positively, that is, just to be noticed) could be important, as well as underlying fears of inadequacy, either personally or sexually.” While a philosopher in the profession (presumably of a more mature vintage) said, “Their Great War is with themselves, their Great Depression is their lives.”

What do you think is the single strongest barrier to you referring male patients to men’s health support services in WA?

Patient most likely will decline 35%

Often no service available 32%

Patient embarrassment 9%

Lacks time or timing inconvenient 7%

Cost prohibitive 1%

Other* 16%

*Responses were split down the middle between those who didn’t refer patients because it was outside the scope of their job (such as radiologists) and those medicos who did not refer because they were unaware of services available (often due to low demand). As one quipped, “What men's health service?”

Which men’s health support service or group do you refer patients to most?

List here* 10%

Rarely/Don’t refer 46%

Doesn’t apply 44%

*The most common (in order) were: psychologists/counselling; drug & alcohol services (including Next Step), Relationships Australia, mental health services, Police Domestic Violence Support Service, Men’s Sheds, and Kinway (anger management).

Should more support services be provided to men who are on the RECEIVING end of domestic/partner abuse?

Yes 74%

No 4%

Unsure 22%

Only 21 doctors felt the need to comment. Most common related to promotion, such as “not well publicised”, “terrible”, and that “more information needs to be provided to GPs”. There is also a “ridiculous emphasis on the prostate”, one doctor said.

Another said, “We live in a misogynistic state where men are either rednecks themselves or feminist apologists who don't recognise the systemic barriers to allowing men the support they need to receive better/more equitable access to health services.” Another wanted services set up in mining regions.

Of these health issues involving men today, which THREE do you think should take priority in the allocation of community resources?

Mental health 71%

Diet/Overweight 60%

Domestic violence 41%

Smoking 34%

Parenting 31%

Accident/Injury prevention 23%

Prostate problems 13%

Sexually transmitted infections 8%

Sexuality (e.g. erections, libido) 7%

Other* 12%

* >75% (or ~9% of those surveyed) rated alcohol and drugs as the priority issue. Suicide, bowel cancer, and relationships/parenting were also mentioned.

The PBAC has recently rejected HPV vaccination for boys, saying it is not cost effective. HPV infection has been implicated in cervical, throat, and anal cancers. Do you agree with the PBAC decision?

No 51%  

Yes 25%

Unsure 24%

Ed. A few doctors commented later that HPV vaccination should be subsidised for self-identified gay males.

How often do you use a chaperone during intimate examination of female patients (e.g. vaginal examination, breast examination)?

Never 10%

Occasional, if concerned 21%

Most of the time 15%

Always 26%

Doesn’t apply 28%

With the indecent assault case against Dr Durani hitting local headlines, the use of chaperones is again hotly debated. There are strong arguments for and against and judging by comments from our respondents, experience varies widely. About one third (31%) felt competent and safe enough to never or occasionally use a chaperone during intimate examinations. A similar proportion however (26%) used chaperones all the time.

Cost is a factor. One doctor said “chaperones should be mandatory, and the patient should have to pay extra for it – or Medicare” and “It is a bit sad I have to, and it uses resources (staff)”.

Legal protection was the crux of many comments. “As a gynaecologist, I always have a chaperone for my own protection.” Others said, “I always ask the female patient if she would like a female chaperone and document this, in the event she declines the offer”. One medico challenged the concept of chaperones altogether: “it has been shown to offer no protection – assaults and accusations of improper behaviour are just as likely in other settings.”

Risk management, linked to circumstances, was raised by around 25% of respondents. “Most of my patients are long-term, and the question of boundaries is less evident,” and “Resources militate against the use of chaperones – clear explanations of what is going to be done, and why, are an adequate replacement in my experience,” and “Always for vaginal, rarely for breast unless concerned.”

Hard line responses were few, for and against. Example: “I resent the implication that (all) men require a chaperone for (only) female patients, and that (no) women require chaperones for (any) male patients. This level of generalisation/stereotyping maintains the erroneous myth that women are victims of men according to gender stereotypes.”

Patient comfort and embarrassment came into play. “Many women don't want one – a chaperone needs to be with you and not the other side of the curtain and this extra person can make some women feel uncomfortable, and the chaperone as well.” “I often ask the husband/partner to be present – they appreciate this respect for them.” “I am guided by patient preference – most decline a chaperone, so I usually proceed without one – very occasionally I am more proactive in including a chaperone (e.g. with adolescents with no experience of intimate examinations or with patients with maladaptive personality traits).”

 

In WA, 33.3% of babies are delivered by caesarean section, and a minority (12%) of women who have had a previous caesarean will be delivered vaginally the next time. Which statement best describes your emotional reaction to these figures?

Very upset or alarmed 3.9%

Worried and want a satisfactory explanation 30.1%

Not affected in either a positive or negative way 19.0%

Content with the figures and know they can be explained 19.0%

No emotional reaction 21.4%

None of the above 6.3%

 

Thinking of the circumstances surrounding a woman approaching her first birth, which of the following explanations would be your first choice to explain the caesarean rates (above)? [multiple choice]

More women entering labour these days see vaginal birth as potentially dangerous or damaging to their bodies. 42.0%

Women are not always receiving accurate information for informed choice. 25.3%

The rate reflects maternal requests. 19.0%

The rate reflects the level of current obstetric complications. 16.6%

Doctors are offering and/or promoting caesarean for non-medical reasons. 11.1%

None of the above. 17.4%

Ed. Female GPs place maternal fears and requests well above obstetric practice in determining whether a woman facing her first birth ends up having a caesarean. However, one third believe doctors are influencing women towards caesarean, through providing inaccurate information, or directly.

 

Around 60% of all caesareans (CS) occur without any preceding labour. In WA, for the next birth after caesarean, around 85% have an elective repeat caesarean and about 12% will deliver vaginally. Which of the following explanations best explains these figures, in your view? [multiple choice]

Obstetricians are reticent to conduct a proper ‘trial of scar’. 46.0%

Previous CS generates fear of childbirth and many women thereafter regard vaginal birth as unpredictable, unsafe and potentially unachievable. 33.3%

Women are wrongly convinced that a repeat CS is the best course of action and consent to this. 23.0%

Caesarean rates simply reflect the overall high level of interventions in labour. 23.0%

Reporting in the media has normalised CS as a method of choice for childbirth. 18.2%

The figures reflect best practice in obstetrics. 12.6%

None of the above 7.9%

Ed. In the conduct of repeat births following initial caesarean, just over three quarters of female GPs say that repeat caesareans are due either to the maternal emotional effects from the first caesarean or inadequate ‘trial of scar’ by the obstetrician. Only one in ten believe the 88% repeat caesarean rate reflects best obstetrical practice.

Here is a representative sample from the 40 or so GPs who offered comment.

“[Caesarean rates] reflect the doctor’s fear of being sued and of association with an adverse outcome rather than a careful risk-benefit analysis that includes all factors e.g. increasing risk of placenta acreta, which in rural WA especially, can be expected to cause increasing morbidity. Also, the mining boom results in more requests for elective induction or caesarean on social grounds.

“Doctors have allowed this situation to evolve because it is easier to book a caesarean than hang around in the middle of the night waiting for a baby to be delivered. Perhaps women doctors are at fault by subconsciously trying to protect our sisters from the "chaos" of natural delivery, because our own lives are rigidly timetabled to juggle career and motherhood.

“As a young female doctor who has not yet been pregnant but worked in neonatal medicine, I am clear I will be having an elective C-section. I don't care to put myself, my perineum and my unborn child at unnecessary risk of injury because some people think I am 'too posh to push'. No one has the right to tell me what I should do with my body and my child when it is completely my decision. I have seen things go horribly wrong on so many occasions (albeit while working in a tertiary hospital with high risk deliveries) for the mother and the infant. I don't feel a vaginal delivery is some major accomplishment that makes another woman more 'womanly' than me or a better mother.

“Most women come to pregnancy with very strong beliefs about what method of delivery they desire. Beliefs appear to be informed by media reporting (accurate?) and firm lifestyle convictions (e.g. everything ‘natural’ is good). No amount of discussion from doctor or midwife will change these beliefs.

“I don't think [caesarean rates] are high enough. I spend much of my working day with women whose pelvic floors have been wrecked by labour, especially now that HRT, which can improve pelvic floor tone, is out of favour.

“When I did a review of this issue over 12 years in WA it was ironic that the high risk public patients had lower rates of CS than the low risk high-earning patients with private cover. Most women who opted for elective CS did so because their obstetrician promoted it as a safer controlled option and they were not aware of the real risks and impact.

“I never hear the incidence of genital herpes (said to be at least 1 in 4) mentioned as a common reason for caesarean, and it is, but for everyone's privacy it is couched in other ways.

“I had the privilege to work in a rural city with an excellent obstetrician dedicated to reducing the caesarean section rate, which she did by having a committed team of GP obstetricians and midwives to actively manage labour and support women in their quests for safe vaginal births after caesareans.

“If a woman is happy with the outcome and the caesarean for their first birth and if they have the same obstetrician, they would be highly likely to have another caesarean.

“Many women are keen for a trial of scar but for country patients this can be difficult to achieve in an appropriate centre.

“In my practice of anaemic, diabetic, alcohol-consuming grand multis in whom PPH is common, I am surprised they all don't have caesareans.”

“Women have a right to request a caesarean. I did however have two vaginal births and would do so again!. Too often, labour and delivery is still far too paternalistic with women being told what will be best for them, with little choice over their bodies.

“When normal pregnancies are managed by specialists it is bound to happen. They should go back to managing complex or complicated cases that are referred to them by GPs managing normal labour as happens in rural areas.

“We're not much of a species if 1/3 of us cannot deliver without a caesarean! I had three normal deliveries including twins after a caesarean, so I am probably biased!

“Medicolegally, it is not acceptable to have a perinatal death due to uterine rupture and this is a real risk of trial of scar (even if rare), and avoidable by caesarean.

“The rate really represents maternal requests, including painless labour, no vaginal tears and right to choose gynaecologist, hospital, type of delivery and even the delivery date. These days we can see more written agreements that women request to be followed by gynaecologists.

With personal trainers, gyms, exercise groups, etc available these days, what are the main reasons why your patients might not comply with your recommendation for regular exercise, for health reasons? [multiple choice]

Lack of personal motivation                       87.6%

Too busy a lifestyle                                   67.0%

Too expensive                                          38.8%

Lack of support from family and friends  21.4%

Lack of facilities                                       13.0%

Too much emphasis on weight loss        11.5%

Frightened of doing themself damage      9.9%

Doesn’t apply                                            3.9%

Other (only 3 elaborated).                        8.3%

Exercise can be directed at building fitness and to facilitate weight loss, or both. In your experience, is the connection between exercise and weight loss within the community:

Over emphasised                19.4%

At a reasonable level           41.6%

Under emphasised              37.6%

These included opinions that:

Properly trained people seem to know best but info is trickling down to the fitness sector.

People with real problems don't move in the trendy gym world.

Too much advertising for products that help reduce weight.

We are too disconnected from lifestyle factors and their influence on health – instead, opting for a pill fix, fast results, and minimal personal effort and health is something people "consume", not work towards themselves.

We need to normalise exercise like walking. Overweight people and car dependant societies go together.

People think that exercise alone is okay for weight loss, or I can eat rubbish and have couple more laps in the pool.

Lack of exercise is probably the major contributor to lack of fitness and obesity in our society.

It is important to give dietary advice also, as patients may become disheartened and if exercise doesn’t cause weight loss. Understanding about caloric intake and expenditure is critical to success.

It depends on the exercise. Intermittent anaerobic exercise will lose weight, but only with no carbohydrates within two hours after and addition of protein only in the two hours after.

Exercise is good for your heart and circulation, BP, PVD and diabetes, but little help with weight loss.

I explain the calorific value of foods compared to an hour in the gym. I explain a game of rugby may use 600-700 Cals, but the pint of beer afterwards adequately covers any exercise usage in the game.

How confident are you in discussing organ or tissue donation with a well patient?

Very confident               36.1%

Somewhat confident     40.8%

Not confident                 14.2%

Doesn’t apply                  8.7%

COMMENT

While over three quarters of survey doctors had confidence in discussing with patients, the big question is whether they feel confident enough to do this reactively or proactively. It is the latter that DonateLife is promoting through its public campaign (Discover, Decide, Discuss) asking the public to register and discuss their intentions with immediate family, and they are hoping that doctors will back this campaign in whatever way they can. Certainly, the increased public awareness makes it less of a vexed question, in raising it with patients.

Over 50 respondents commented. Some said they did not think it a good idea to discuss organ donation within their specialty, such a paediatrics, orthopaedics, emergency and psychiatry.

Others were unwilling to canvas a ‘no’ approach across any discipline, particularly those who had worked in renal medicine and seemed more strongly motivated to discuss with patients.

Those who felt uncomfortable discussing said it was “naturally difficult” or there was “not much opportunity during a normal consult” or were ill-prepared when the subject was forced upon them. Others were comfortable but reactive: “Not something I routinely bring up but can discuss it if patient initiates an enquiry.”

A few doctors in hospitals said they did not normally get involved and referred the matter to the donor coordinator on call. With the newly established donor teams in major public hospitals, this approach seems reasonable.

While a few commented that doctors should “do this as a matter of course”, a similar number said they simply forgot. As if to compensate, one suggested “each patient should be given a flyer re organ donation”. Comment or flyer, either will impact on patients if initiated by the doctor.

Only one respondent was opposed on the basis of cost and that it diverted us from preventive health strategies.

Can someone who has lived in the UK during ‘mad cow’ times be an organ donor after death?

No              43.6%

Yes           23.0%

Uncertain  33.3%

Can a patient with Hepatitis C ever be considered for organ donation?

No                    52.7%

Yes                 25.3%

Uncertain        21.8%

COMMENT

Only a quarter of respondents got these two questions one right – the answer is YES in both cases. HIV is the only absolute exclusion criteria and all other medical conditions are accessed individually at the time of death of the patient, so for example, someone with diabetes or cancer could donate corneas. There are two sources of confusion around the mad cow question – there was a ban on donating if you have lived in the UK (but it has now been lifted) and a ban still applies to blood donation (but not organ donation).

Why is it important for a person to discuss their wish to be a donor with their family or next of kin?

Even if a person has registered, the family is still asked to give consent. 66.2%

The most important thing that helps a family make up its mind on consent, is firm knowledge of their loved one’s donor wishes. 64.2%

It shows they are not scared of the idea. 17.8%

Currently, organ donation is opt-out, so people who do not want to donate need to make it known. 5.5%

None of the above 2.7%

COMMENT

The surveyed doctors are to the commended for their correct multiple choice responses – the exact right order too. The family is still asked to give consent at the bedside, even if a person has registered, and agreeing to this with confidence may swing on a firm understanding of their loved one’s wishes. (Organ donation in Australia is an opt-in system.)

How can a person living in WA register their wish to be an organ and tissue donor?

Australian Organ Donor Register    82.1%

Driver’s Licence renewal                67.8%

Medicare Website                            36.9%

Uncertain                                          4.7%

COMMENT

Two thirds got it wrong in suggesting registration happens with Driver’s Licence renewal. It doesn’t. All that happens is a separate AODR brochure is enclosed with the renewal. There is no longer a box to tick on the actual renewal form and it will not show up on the Driver’s Licence. The Australian Organ Donor Register (AODR), part of Medicare, is the only way a person can register their wish to be an organ donor. See www.donatelife.gov.au