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New device could help GPs detect Alzheimer's in minutes

GPs could soon be able to screen their patients for Alzheimer's Disease in a matter of minutes, using a handheld device the size of a credit card. The first-of-a-kind finger-prick blood test was developed by engineers at Melbourne's Monash University and it can detect the hallmark protein biomarkers of early Alzheimer's Disease within minutes. This could become an important tool for doctors in diagnosing patients before the symptoms progress. In Australia alone there are around 420,000 people living with dementia, with that number set to double by 2054. Associate Professor Sudha Mokkapati, from Monash Materials Science and Engineering, helped lead the development of the testing device. "Detecting very early disease in large populations could dramatically change the trajectory of this burdening disease for many patients, and shave millions off associated healthcare costs," Mokkapati said. "We've completed testing that shows the technology is highly advanced by design and capable of detecting ultra-low levels of several disease biomarkers in blood." The device also has the potential to remove the need for laboratory-based pathology tests, making diagnoses faster and cheaper. The university is currently seeking funding to complete the next stage - clinical validation, which will help bring the device one step closer to reality. "Most patients with neurodegenerative disease are typically diagnosed at advanced stages. Sadly, treatments targeting late-onset disease provide limited therapeutic benefit," Associate Professor Matthew Pase, at Monash's School of Psychological Sciences, said. "Earlier screening could change the outlook for many patients diagnosed with cognitive impairment, increasing the chance of halting or slowing symptom development and the rapid progression of the disease." Image: Monash University/ Nine

Caring

How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> A growing number of complaints against older doctors has prompted the Medical Board of Australia to <a href="https://www.medicalboard.gov.au/News/2024-08-07-Medical-Board-consults-on-new-approach-to-keep-late-career-doctors-in-safe-practice.aspx">announce</a> today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table. The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine. The second would require only general health checks for doctors over 70. A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx">professional code of conduct</a>, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo. <h2>Haven’t we moved on from set retirement ages?</h2> It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “<a href="https://law.unimelb.edu.au/__data/assets/pdf_file/0019/2061019/02-Blackham.pdf">still valid in a modern society</a>”. However, unlike judges, doctors are already <a href="https://www.medicalboard.gov.au/Registration/Registration-Renewal.aspx">required to renew their registration</a> annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct <a href="https://www.ahpra.gov.au/Notifications/Further-information/Guides-and-fact-sheets/Performance-assessments.aspx">performance assessments</a> if and when they are needed. <h2>What has prompted these proposals?</h2> This latest <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD24%2f33840&dbid=AP&chksum=vCEdxXaBs0%2bMeMZFxSb7SQ%3d%3d&_gl=1*3ol06k*_ga*MzU1NjAzMTc1LjE3MjMwMDA1Nzc.*_ga_F1G6LRCHZB*MTcyMzAwMDU3Ny4xLjEuMTcyMzAwMDU4My4wLjAuMA..">proposal</a> identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years. Studies of medical competence in ageing doctors show <a href="https://qualitysafety.bmj.com/content/29/2/113">variable results</a>. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour. The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors. In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70. In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015. While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate. It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients. <h2>So what distinguishes the two new proposed options?</h2> The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80. Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions. Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia. The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia. In practice, both of these proposals appear to allow doctors to manage their own general health confidentially. <h2>The law tends to prioritise patient safety</h2> All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/hprnl428/s3a.html">That provision</a> basically says patient safety is paramount and trumps all other considerations. <figure class="align-center zoomable"><figcaption></figcaption></figure> As with legal <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2010-104a#sec.3">regimes regulating childcare</a>, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional. Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3383892">punished</a>” for errors in practice. All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care. <h2>Could these proposals amount to age discrimination?</h2> It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws. For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/ada2004174/s22.html?context=1;query=inherent;mask_path=au/legis/cth/consol_act/ada2004174">who are</a> “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”. In broader terms, a licence to practise medicine is often compared to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797044/">licence to drive</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236877/">pilot an aircraft</a>. Despite <a href="https://www.smh.com.au/national/nsw/mandatory-test-older-drivers-facing-discrimination-says-pensioner-group-20170607-gwm45u.html">claims of discrimination</a>, New South Wales law requires older drivers to undergo a medical assessment <a href="https://www.nsw.gov.au/driving-boating-and-transport/driver-and-rider-licences/older-drivers-and-riders/assessments">every year</a>; and similar requirements affect older <a href="https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.casa.gov.au/guidelines-medical-assessment-aviation&ved=2ahUKEwil-9GXlOKHAxUdslYBHdN_EboQFnoECBkQAQ&usg=AOvVaw0SgpoCCKjNriMN20fs16rq">pilots and air traffic controllers</a>. <h2>Where to from here?</h2> When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different. How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, <a href="https://www1.racgp.org.au/newsgp/professional/ahpra-eyes-mandatory-health-checks-for-older-gps">others have suggested</a> this would only exacerbate shortages in the health-care workforce. The proposals are open for <a href="https://www.medicalboard.gov.au/News/Current-Consultations.aspx">public comment</a> until October 4.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236305/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, Law lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-olds-too-old-to-be-a-doctor-why-gps-and-surgeons-over-70-may-need-a-health-check-to-practise-236305">original article</a>. </div>

Body

Are you up to date with your COVID, flu and other shots? It might depend on who your GP is

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Too many older Australians are <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">missing out</a> on recommended vaccinations for COVID, flu, shingles and pneumococcal that can protect them from serious illness, hospitalisation and even death. A new <a href="https://grattan.edu.au/">Grattan Institute report</a> shows vaccination rates vary widely from GP to GP, highlighting an important place to look for opportunities to boost vaccination. Many people get vaccinated at pharmacies, and those vaccinations are counted in our analysis. But we looked at GPs because they have a unique role overseeing someone’s health care, and an important role promoting vaccination. We found that for some GPs, nine in ten of their older patients were vaccinated for flu. For others, the rate was only four in ten. The differences for shingles and COVID were even bigger. For pneumococcal disease, there was a 13-fold difference in GPs’ patient vaccination rates. While some variation is inevitable, these differences are large, and they result in too many people missing out on recommended vaccines. <h2>Some GPs treat more complex patients</h2> A lot of these differences reflect the fact that GPs see different types of patients. Our research shows older people who aren’t proficient in English are up to 15% less likely to be vaccinated, even after other factors are taken into account. And the problem seems to be getting worse. COVID vaccination rates for people 75 years and older fell to just 36% in May 2024. But rates were even lower – a mere 11% – for people who don’t speak English proficiently, and 15% for those who speak a language other than English at home. Given these results, it’s no surprise that GPs with fewer patients who are vaccinated also have more patients who struggle with English. For GPs with the lowest vaccination rates, one-quarter of their patients aren’t proficient in English. For GPs with the highest vaccination rates, it is only 1%. GPs with fewer vaccinated patients also saw more people who live in rural areas, are poorer, didn’t go to university, and don’t have regular access to a GP, all of which reduce the likelihood of getting vaccinated. Many of these barriers to vaccination are difficult for GPs to overcome. They point to structural problems in our health system, and indeed our society, that go well beyond vaccination. But GPs are also a key part of the puzzle. A <a href="https://www.ijidonline.com/article/S1201-9712(14)01379-4/fulltext">strong</a> <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780848">recommendation</a> from a GP can make a big difference to whether a patient gets vaccinated. <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">Nearly all</a> older Australians visit a GP every year. And some GPs have room for improvement. <h2>But GPs seeing similar patients can have very different vaccination rates</h2> We compared GPs whose patients had a similar likelihood of being vaccinated, based on a range of factors including their health, wealth and cultural background. Among the GPs whose patients were least likely to get a flu vaccination, some saw less than 40% of their patients vaccinated, while for others in that group, the rate was over 70%. Among GPs with patients who face few barriers to vaccination, the share of their patients who were vaccinated also varied widely. Even within neighbourhoods, GP patient vaccination rates vary a lot. For example, in Bankstown in Sydney, there was a seven-fold difference in COVID vaccination rates and an 18-fold difference for pneumococcal vaccination. Not everything about clinics and patients can be measured in data, and there will be good reasons for some of these differences. But the results do suggest that some GPs are beating the odds to overcome patient barriers to getting vaccinated, while other GPs could be doing more. That should trigger focused efforts to raise vaccination rates where they are low. <h2>So what should governments do?</h2> A comprehensive national reform agenda is <a href="https://grattan.edu.au/wp-content/uploads/2023/11/A-fair-shot-How-to-close-the-vaccination-gap-Grattan-Institute-Report.pdf">needed to increase adult vaccination</a>. That includes clearer guidance, national advertising campaigns, SMS reminders, and tailored local programs that reach out to communities with very low levels of vaccination. But based on the big differences in GPs’ patient vaccination rates, Australia also needs a three-pronged plan to help GPs lift older Australians’ vaccination rates. First, the way general practice is funded needs to be overhauled, providing more money for the GPs whose patients face higher barriers to vaccination. Today, clinics with patients who are poorer, sicker and who struggle with English tend to get less funding. They should get more, so they can spend more time with patients to explain and promote vaccination. Second, GPs need to be given data, so that they can easily see how their vaccination rates compare to GPs with similar patients. And third, Primary Health Networks – which are responsible for improving primary care in their area – should give clinics with low vaccination rates the help they need. That might include running vaccination sessions, sharing information about best practices that work in similar clinics with higher vaccination rates, or offering translation support. And because pharmacies also play an important role in promoting and providing vaccines, governments should give them data too, showing how their rates compare to other pharmacies in their area, and support to boost vaccination uptake. These measures would go a long way to better protect some of the most vulnerable in our society. Governments have better data than ever before on who is missing out on vaccinations – and other types of health care. They shouldn’t miss the opportunity to target support so that no matter where you live, what your background is, or which GP or pharmacy you go to, you will have the best chance of being protected against disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234175/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/anika-stobart-1014358">Anika Stobart</a>, Senior Associate, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/are-you-up-to-date-with-your-covid-flu-and-other-shots-it-might-depend-on-who-your-gp-is-234175">original article</a>. </div>

Body

Australia can afford to bulk bill all GP visits. So why don’t we?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/yuting-zhang-1144393">Yuting Zhang</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/karinna-saxby-1045932">Karinna Saxby</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Being able to afford health care is a <a href="https://www.abs.gov.au/media-centre/media-releases/more-people-putting-seeing-health-professionals-due-cost">pressing issue</a> for many Australians. And encouraging GPs to bulk bill is <a href="https://theconversation.com/cheaper-medicines-and-a-new-approach-for-mental-health-care-will-the-budget-make-us-healthier-229612">one measure</a> the government is taking to ease the strain. So what would it take for GPs to bulk bill everyone? In our <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-8462.12553">recent paper</a>, we calculated this is possible and affordable, given the current health budget. But we show recent incentives for GPs to bulk bill aren’t enough to get us there. Instead, we need to adjust health policies to increase bulk-billing rates and to make our health system more sustainable. <h2>How do the incentives work?</h2> In recent years, the government has introduced various incentives to try and encourage GPs to bulk bill (so patients pay nothing out-of-pocket). The most recent has been the “<a href="https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments#1-november-2023-changes">triple bulk-billing incentives</a>” or “triple bonus” for short. These have been in place since November 2023. Under these incentives, GPs in metropolitan areas are paid a A$20.65 bonus if they bulk bill concession card holders or children under 16 years. GPs in rural and remote areas are paid $31.35-$39.65 extra. These bonus payments are in addition to regular Medicare rebates GPs receive. But when we looked at whether these latest incentives are likely to work to boost bulk billing, we found a city-country divide. <h2>City GPs may not be convinced</h2> We worked out the triple bonus will not help most people in metropolitan areas. That’s because in these areas the bonus is much lower than what patients currently pay out-of-pocket. In other words, if GPs did bulk bill these groups, their income would be lower than what they could have charged. So the bonus wouldn’t be enough incentive for them to bulk bill. For example, we found in greater Melbourne, the average out-of-pocket costs for a non-bulk billed GP visit <a href="https://melbourneinstitute.unimelb.edu.au/research/HALE-Hub/data">is about</a> $30-$56 depending on the suburb. This is much higher than the $20.65 triple bonus amount in metropolitan regions. We see similar patterns across all metropolitan areas. <h2>But country GPs may be swayed</h2> The picture is different in rural and remote areas. Here, the average out-of-pocket cost for a non-bulk billed GP visit <a href="https://melbourneinstitute.unimelb.edu.au/research/HALE-Hub/data">varies substantially</a> – around $28-52 in rural regions and $32-123 in remote areas. The highest cost on the mainland was $79 but GP visits on Lord Howe Island were the most expensive overall, at $123. For patients living in areas where their actual payment is less than the bonus amount, the incentive does help. In other words, it would be financially advantageous for GPs to bulk bill these patients, but not where the out-of-pocket costs are higher than the bonus. Our <a href="https://melbourneinstitute.unimelb.edu.au/research/HALE-Hub/data">online map</a> shows where GPs are most likely to bulk bill. The map below shows how out-of-pocket costs vary around Australia. <iframe id="SPzgj" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/SPzgj/" width="100%" height="400px" frameborder="0"></iframe> <h2>How about bulk billing for all?</h2> The picture is a little more complex when we start talking about bulk billing all GP visits – regardless of location or patients’ concession card status. We worked out this would cost about $950 million a year for all GP services, or $700 million a year for face-to-face GP consultations. This is within reach under the current budget, especially for face-to-face GP consultations. The government has earmarked <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/budget-2023-24-building-a-stronger-medicare#:%7E:text=%243.5%20billion%20in%20bulk%20billing,40%2Dyear%20history%20of%20Medicare">$3.5 billion</a> over <a href="https://archive.budget.gov.au/2023-24/bp2/download/bp2_2023-24.pdf">five years</a> for the “triple bonus” incentives. That’s $700 million a year. <h2>We can afford to, but should we?</h2> Introducing free GP visits for all would require careful consideration, as it would encourage more GP visits. This might be a good thing, particularly if people had previously skipped beneficial care <a href="https://www.abs.gov.au/media-centre/media-releases/more-people-putting-seeing-health-professionals-due-cost">due to high costs</a>. However, it may encourage more people to see their <a href="https://www.sciencedirect.com/science/article/abs/pii/S1574006400801675">GP unnecessarily</a>, taking away limited resources from those who really need them. This could ultimately increase wait times for everyone. So providing free GP visits for all may not be efficient or sustainable, even if it’s within the budget. But paying more than $50 for a GP visit, as many do, seems too expensive and also makes the health-care system less efficient. That’s because primary care is <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/primary-health-care">often considered</a> high-value and preventive care. So if people can’t afford to go to the GP, it can lead to more expensive hospital and emergency room costs down the track. So we need to strike a balance to make primary care more affordable and sustainable. <h2>How do we strike a balance?</h2> One, concession card holders and children should get free primary care regardless of where they live. This would allow more equitable care to populations who need health care the most. Bulk bulling children is a <a href="https://www.sciencedirect.com/science/article/abs/pii/S016726812200292X#:%7E:text=Beside%20the%20benefits%20for%20the,and%20Kuh%2C%202002%3B%20Centers%20for">long-term investment</a>, which may delay onset of diseases, and prevent intergenerational poverty and poor health. Two, the government could also provide free primary care to all people in rural and remote areas. It can do this by lowering the triple bonus to match what GPs currently charge. Over time, GPs and the government can evaluate and <a href="https://www.auspublaw.org/blog/2023/4/the-civil-conscription-sub-clause-in-section-51xxiiia-of-the-australian-constitution-no-impediment-to-reform-of-medicare">negotiate</a> fair prices for GPs to charge. This can be adjusted in line with inflation and other measures. Three, the government can increase Medicare rebates (the amount Medicare pays a doctor for a GP visit) so patients not covered above only pay about $20-30 a visit. We consider this an affordable amount that will not result in more use of primary care than necessary. Four, the government can design a policy to reduce unnecessary GP visits that take away limited GP time from high-need patients. For example, patients currently need to see GPs to get <a href="https://theconversation.com/specialist-referral-rules-havent-changed-much-since-the-70s-but-australias-health-needs-sure-have-144506">referral letters</a> although they already have an established specialist for their ongoing chronic conditions. Five, the government can provide GPs funding needed to improve patient outcomes and reward GPs who provide <a href="https://bmjopenquality.bmj.com/content/10/1/e001127.abstract">high-quality preventive care</a>. The current fee-for-service funding model hurts good doctors who keep their patients healthy because doctors are not paid if their patients do not come back.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230204/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/yuting-zhang-1144393">Yuting Zhang</a>, Professor of Health Economics, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/karinna-saxby-1045932">Karinna Saxby</a>, Research Fellow, Melbourne Institute of Applied Economic and Social Research, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/australia-can-afford-to-bulk-bill-all-gp-visits-so-why-dont-we-230204">original article</a>. </div>

Money & Banking

It’s so hard to see a doctor right now. What are my options?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Deciding whether to wait and see if your health condition improves or go to a GP can be a difficult task. You might be unsure about where to go, whom to see, how much it will cost and whether you’ll need to take time off work. These choices can create significant barriers to accessing health care in Australia. There is often limited information available about the pros and cons of the different options. Often, we stick to what we know, unaware of better alternatives. But making the wrong decision about how to access care can impact both your health and finances. So what are your options? And what policy reforms are needed to improve affordable access to care for all Australians? <h2>How quickly can I be seen?</h2> Access depends on how long it takes you to speak to a GP, or be seen in an emergency department, or by a community pharmacist, or a nurse practitioner whom you can see directly. Access depends on where you live and the time of day. The rise of telehealth means GPs now get paid to talk to you on the phone, which is great for many minor ailments, medical certificates, repeat scripts or getting test results. Call centres such as <a href="https://www.healthdirect.gov.au/">Healthdirect</a> have been available for some time and now <a href="https://www.vved.org.au/patients/">virtual emergency departments</a> can also see you online. There are even GPs who only provide their services <a href="https://www.instantscripts.com.au/gp-online/">online</a> if you can pay. A phone call can save you valuable time. Before COVID, you needed to take half a day off work to see a GP, now it takes five to ten minutes and the GP even calls you. Things get more tricky outside of normal working hours and at weekends – appointments are harder to come by, it is unlikely you will be able to see a GP whom you know, and out-of-pocket costs might be higher. If you can’t wait, your local emergency department is likely to be more accessible, or you might be lucky enough to live near a bulk-billed Medicare <a href="https://www.health.gov.au/find-a-medicare-ucc">urgent care clinic</a>, where you don’t need an appointment. Tomorrow’s federal budget <a href="https://www.smh.com.au/politics/federal/more-free-urgent-care-clinics-part-of-8-5-billion-health-commitment-20240511-p5jcse.html">will include</a> funding for another 29 urgent care clinics, on top of the 58 already operating. But things are much worse if you live if a rural or remote area, where choice is limited and you need to wait much longer for GP appointments or travel long distances. Telehealth helps but can be expensive if it is not with your usual doctor. <h2>Who will I see?</h2> Access depends on who you will see. At the moment, this will usually be your GP (or, depending on the severity of your health concern, your community pharmacist or local emergency department staff). But to see your preferred GP you might need to wait as they are usually very busy. But a <a href="https://www.health.gov.au/resources/collections/issues-papers?language=en">review</a> of “scope of practice” in primary care aims to free up GPs’ time and use their skills more effectively. So in future, you could receive more of your health care from qualified nurses, nurse practitioners, pharmacists and other health professionals. But which tasks can be delegated to other health professionals is a significant bone of contention for GPs. For GP practices facing significant cost pressures, safely delegating tasks to other less costly health professionals also makes good business sense. <h2>How much will it cost?</h2> Access depends on out-of-pocket costs. Bulk billing of GP services reached a peak of <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-state-and-territory-december-quarter-2023-24?language=en">89.6%</a> in the September quarter of 2022 but plummeted to 76.5% by the September quarter of 2023. Last November, bulk billing incentives for children under 16 and those on concession cards were tripled, and between November and December 2023 bulk billing had <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/bulk-billing-slide-stopped-thanks-to-albanese-government?language=en">increased</a> from 76.5% to 77.7%. They key issue for patients is that it remains uncertain whether a GP will bulk bill you. You often don’t know this until you get into the consultation, at which point you can’t back out. Unless the whole practice bulk bills and so it is guaranteed, it’s entirely up to the GP whether you are bulk billed. It’s difficult to think of any other service where you don’t know how much you will pay until after you have used it. <h2>How can policymakers improve access to care?</h2> Government policies to strengthen primary care have focused on giving patients improved access through telehealth, urgent care clinics and <a href="https://www.health.gov.au/resources/publications/strengthening-medicare-taskforce-report?language=en">Strengthening Medicare</a> initiatives, which are currently being developed. But uncertainty surrounding out-of-pocket costs can deter people from seeking medical attention, or delay care or go instead to the emergency department or urgent care clinic where there is no out-of-pocket cost. <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">Cost is a factor</a> that leads to 20% of those with a mental health problem and 30% of those with chronic disease to delay or avoid visiting a health professional. Those most in need are more likely to miss out on necessary visits and prescriptions, sometimes with disastrous consequences. A recent <a href="https://academic.oup.com/qje/advance-article-abstract/doi/10.1093/qje/qjae015/7664375?login=false">study</a> shows people can die if they stop heart medications due to increased out-of-pocket costs. The next task for policymakers should be developing policies to guarantee there are no out-of-pocket costs for those on low incomes. This could be a worthwhile investment in our health and should be included in tomorrow’s budget.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229191/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, Professor of Health Economics, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/its-so-hard-to-see-a-doctor-right-now-what-are-my-options-229191">original article</a>. </div>

Caring

"Your GPS is wrong": Hilarious outback sign causes double takes

In the ongoing battle between technology and good old-fashioned road signs, it seems the good people of Quairading, a tiny town in Western Australia, have taken matters into their own hands. The battleground? Old Beverley Road, a path that might be best described as the Bermuda Triangle of rural routes. A local Facebook post revealed the existence of at least two signs urging drivers to defy their GPS and embark on a detour through the town. The signs don't beat around the bush either, bluntly stating, "Your GPS is wrong, this is not the best route to Perth". It's a brave move, considering most people tend to trust their navigation apps more than their own instincts (or road signs). The post quickly became a social media sensation, garnering over 15,000 likes and hundreds of comments. One person couldn't contain their excitement, proclaiming, "Finally vindicated, I've been telling my GPS they're wrong for years!" Some conspiracy theorists speculated that this was all part of an elaborate marketing scheme by Quairading to boost tourism. "I think it's a clever ploy by Quairading to make tourists drive through their town," one person suggested. "Maybe stop for coffee, etc. Marketing 101." If it is intentional, hats off to Quairading for the creativity; they've managed to turn road safety into a guerrilla marketing campaign. Quairading Shire president Jo Haythornthwaite responded to the comments by setting the record straight, explaining that Google and GPS suggest Old Beverley Road as a shortcut to Perth, but in reality, it's a slippery, gravel-covered disaster waiting to happen. According to her, "What Google does not recognise is that their suggestion of taking the Old Beverley Road leads travellers and tourists onto a low-lying road that has 15kms of gravel, is very slippery when wet, and is prone to flooding." To combat the persistent GPS misguidance, the Shire tried the diplomatic route, requesting that Google update its algorithm to favour the safer alternative. Unfortunately, it seems Google was either too busy directing people to non-existent streets or enjoying a virtual road trip to pay attention. Frustrated but undeterred, the signs were erected as a last-ditch effort to send a clear message: "Turn around! Or prepare for an off-road adventure you didn't sign up for!" The signs, much like a seasoned comedian, delivered the punchline: a noticeable decrease in traffic along Old Beverley Road. While Quairading might not have exact numbers, they've declared victory in their quest to keep road users safe. As Ms Haythornthwaite put it, "So, without knowing specific numbers, we believe that, although some continue to use the less safe route of the Old Beverley Road, many travellers are taking notice and following the signage." And so, the small town of Quairading triumphs in the great GPS versus road sign showdown. Perhaps, in the grand scheme of things, we all need a little more trust in the wisdom of quirky road signs. After all, who knows the terrain better than the locals who've been there, done that, and put up the signs to prove it?

Travel Trouble

No, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing

<a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection. Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you. We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria. More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely. <h2>Giving GPs the tools to say no</h2> In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs. Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis. In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs. Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>. For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes: <ul> <li> using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary </li> <li> giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed </li> <li> giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own. </li> </ul> All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders. To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them. <h2>Giving doctors feedback on their prescribing</h2> National programs and interventions can help GPs use antibiotics more wisely One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement. The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed. However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>. In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others. The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>. <h2>Clearer rules and regulations</h2> Rules and regulations are crucial in the fight against antibiotic resistance. Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse. However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for. Other regulations or policy targets could include: <ul> <li> ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia </li> <li> ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics </li> <li> encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later. </li> </ul> <h2>Australia lags behind Sweden</h2> Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use. Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done. In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>. It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control. In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”. <a href="https://theconversation.com/profiles/mina-bakhit-826292">Mina Bakhit</a>, Assistant Professor of Public Health, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> and <a href="https://theconversation.com/profiles/paul-glasziou-13533">Paul Glasziou</a>, Professor of Medicine, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-antibiotics-arent-always-needed-heres-how-gps-can-avoid-overprescribing-213981">original article</a>.

Caring

Everything you need to know about major Medicare shake-up

Medicare is undergoing its biggest shake-up in decades, making it easier for more than 12 million Aussies to visit their GP. Thanks to the sweeping reforms that came into effect on Wednesday, Aussies can now get cheaper visits to GPs and increased access to telehealth services. It is estimated that 12 millions Australians, or three in every five patients, will find it easier to see a bulk-billing GP after incentive payments for the practice tripled in a major boost. General practitioners who bulk-bill concession card holders, pensioners and patients aged under the age of 16 will now receive a $20.65 bonus if they are in a metropolitan area, while the incentive has risen to $39.65 for GPs in regional areas. The previous rates were $6.85 and $13.15 respectively. The tripling of the bulk-billing incentive payment applies to all face-to-face and telehealth GP consultations of up to 20 minutes. The plan was hailed as a "game changer" by the Albanese government, as Health Minister Mark Butler said, "Today is the biggest investment in Medicare for decades." Prime Minister Anthony Albanese added, "Medicare is at the centre of our health system [and] the primary healthcare that GPs deliver makes an enormous difference to people." "[This] happens to be good for the taxpayer as well because... a slight condition dealt with early [and] treated properly ensures it doesn't become an acute condition." Medical and GP advocates welcomed the reforms, saying it will make a big difference to millions of Aussies facing cost-of-living pressures. "But we know more work can be done," Australian Medical Association president Steve Robson said. "We will continue working with the government on developing new programs and initiatives that strengthen primary care and ensure GP-led care is affordable and accessible for all patients." Image credits: Shutterstock

Caring

I think I have the flu. Should I ask my GP for antivirals?

<a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> If you test positive for COVID and you’re eligible for antivirals, you’ll likely ask your GP for a script to protect you from severe disease. <a href="https://healthdispatch.com.au/news/immunisation-coalition-urging-people-with-flu-like-symptoms-to-g">Antivirals</a> are also available to fight influenza viruses, via a doctor’s prescription. But they have a mixed history, with their benefits at times <a href="https://theconversation.com/controversies-in-medicine-the-rise-and-fall-of-the-challenge-to-tamiflu-38287">overstated</a>. It can be difficult to get an appointment to see your GP. So when should you make the effort to see a GP for a prescription for influenza antivirals? And how effective are they? <h2>What exactly is influenza?</h2> The flu is primarily a viral infection of the respiratory system that can spread through sneezing, coughing, or touching contaminated objects then touching your nose or mouth. Common symptoms include headache, sore throat, fever, runny or blocked nose and body aches that last a week or more. Influenza is actually a group of viruses, divided into several <a href="https://www.cdc.gov/flu/about/viruses/types.htm#:%7E:text=There%20are%20four%20types%20of,global%20epidemics%20of%20flu%20disease,%20https://www.cdc.gov/flu/professionals/acip/background-epidemiology.htm">sub-groups</a>. Flu A and B are the <a href="https://www.health.gov.au/resources/collections/aisr?language=en,%20https://www.health.gov.au/resources/collections/australian-influenza-surveillance-reports-2023?language=en">most common groups</a> that circulate in humans. <h2>What are flu antivirals?</h2> Influenza antivirals, target specific parts of the viral life cycle, which prevents the virus replicating and spreading. Most flu antivirals <a href="https://www.nejm.org/doi/full/10.1056/NEJMra050740">target</a> neuraminidase, an important enzyme the virus uses to release itself from cells. On the other hand, COVID antivirals work by inhibiting other parts of the viral life cycle involved in the <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">virus replicating itself</a>. Three influenza antivirals are <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">used in Australia</a>. Relenza (zanamivir) is an inhaled powder and Tamiflu (oseltamivir) is a capsule; both are five-day treatments. Rapivab (peramivir) is a single injection. These antivirals may also come with <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm">side effects</a>, such as a headache, vomiting, cough, or <a href="https://www.immunisationcoalition.org.au/resources/antiviral-treatments-for-influenza/">fever</a>. Tamiflu and Relenza generally cost A$40-50 in Australia, plus the cost of the consultation fee with your doctor, if applicable. <h2>How effective are antivirals for the flu?</h2> Antivirals have the greatest effect if started 24-72 hours after symptoms. This is to prevent the virus from reaching <a href="https://www.mdpi.com/1660-4601/19/5/3018">high levels in the body</a>. Among healthy adults, if Relenza or Tamiflu are started within 48 hours from your first symptoms, they can <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008965.pub4/full">reduce the duration</a> of symptoms such as cough, blocked nose, sore throat, fatigue, headache, muscle pain and fever by just under a day. For people who have developed severe flu symptoms or who have existing health conditions such as heart disease or chronic obstructive pulmonary disease (COPD), antivirals that start later (but still before day five of symptoms) can still reduce the <a href="https://academic.oup.com/cid/article/52/4/457/378776?login=true">severity of infection</a> and reduce the <a href="https://thorax.bmj.com/content/thoraxjnl/65/6/510.full.pdf?frbrVersion=3">chance of</a> <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215903">hospitalisation</a> and <a href="https://academic.oup.com/jac/article/72/11/2990/4091484?login=false">death</a>. In a study from the 2009 swine flu (H1N1) pandemic in the United States, treatment with antivirals (Tamiflu and Relenza) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358088/">reduced</a> the chance of needing to be hospitalised. Around 60% of hospitalisations prevented were among 18-64 years olds, around 20% in children 0-17 years, and 20% in adults aged over 65. The research is less clear about whether antivirals prevent the development of flu complications such as secondary bacterial pneumonia. They might, but so far the data aren’t clear. <h2>Are flu antivirals becoming less effective?</h2> Antiviral resistance to Tamiflu has been <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">reported</a> around the world, mostly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223162/">immunocompromised people</a>, as they <a href="https://link.springer.com/article/10.1007/s10096-020-03840-9">have</a> a weakened immune system that allows higher viral loads and prolonged viral shedding. The impact of the antiviral resistance is unclear but there is evidence indicating resistant strains can uphold their ability to replicate effectively and spread. So far it’s not clear if these stains cause more severe disease. However, government agencies and surveillance programs are constantly monitoring the spread of antiviral resistance. Currently there is <a href="https://www.cdc.gov/flu/treatment/antiviralresistance.htm">minimal concern</a> for strains that are resistant to Tamiflu or Relenza. <h2>Antivirals can also prevent the flu if you’ve been exposed</h2> Tamiflu and Relenza can also be used to <a href="https://onlinelibrary.wiley.com/doi/10.1111/irv.12046">prevent flu infections</a>, if we’re exposed to the virus or come into contact with infected people. Some studies suggest Tamiflu and Relenza can <a href="https://www.bmj.com/content/326/7401/1235.long">reduce the chance of developing symptomatic influenza</a> by 70-90%. Many health agencies around the world <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165743/">recommend</a> “prophylactic” treatment for high-risk patients in hospitals or age care setting when people have been in contact with others infected with influenza. <h2>So who should talk to their GP about a prescription?</h2> <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-antiviral-treatments-and-prophylaxis.aspx#:%7E:text=The%20Australian%20Therapeutic%20Guidelines*%20recommends,of%20severe%20disease%20from%20influenza.&text=people%20with%20chronic%20conditions%20including,heart%20disease">Australian guidelines recommend</a> doctors offer antivirals to people with influenza who have severe disease or complications. Doctors can also consider treatment for people at higher risk of developing severe disease from influenza. This includes: <ul> <li>adults aged 65 years or older</li> <li>pregnant women</li> <li>people with certain chronic conditions (heart disease, Down syndrome, obesity, chronic respiratory conditions, severe neurological conditions)</li> <li>people with compromised immunity</li> <li>Aboriginal and Torres Strait Islander people</li> <li>children aged five years or younger</li> <li>residents of long-term residential facilities</li> <li>homeless people.</li> </ul> Doctors can prescribe antivirals for the prevention of influenza <a href="https://australianprescriber.tg.org.au/articles/influenza-overview-on-prevention-and-therapy.html#r20">in</a> vulnerable people who have been exposed to the virus. Antiviral treatment also can be <a href="https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#:%7E:text=Antiviral%20treatment%20also%20can%20be,48%20hours%20of%20illness%20onset">considered</a> for otherwise healthy symptomatic patients who have confirmed or suspected influenza, if they can start treatment within 48 hours of developing symptoms. In some instances a doctors can make a clinical diagnosis of influenza based on the symptoms and known close flu positive contacts of the patient. However, it is preferred to have flu diagnosed by one of the approved diagnostic tests, such as a <a href="https://24-7medcare.com.au/influenza/australian-gp-influenza-2023-guide/">rapid antigen test</a> (RAT) or the more accurate <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/influenza_factsheet.aspx">PCR test</a>, similar to what is perfomed for COVID. There are also now combo tests that can <a href="https://www.tga.gov.au/news/media-releases/first-combination-covid-19-and-influenza-self-tests-approved-australia">distinguish between SARS-CoV-2 and influenza virus</a>. Remember, the flu can cause <a href="https://www.abc.net.au/news/2023-07-23/flu-season-hitting-children-hard-antivirals-may-help/102633722">severe illness or death</a>, particularly among people from the high-risk groups. So if you think you might have the flu, wear a mask and stay away to avoid spreading the virus to others. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210457/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/yong-qian-koo-1457640">Yong Qian Koo</a>, , <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">original article</a>.

Body

Should you register with a GP? What is MyMedicare and how might it change the care you get?

<a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> <a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> is a new voluntary scheme that allows patients to register with their usual GP, in an attempt to improve continuity of care and health outcomes. From October 1, the scheme will give registered patients access to longer telehealth consultations. Then, from next year, GP clinics with patients who are frequently admitted to hospital or are aged care residents will be able to access additional “blended” funding, which sits outside Medicare’s usual fee-for-service. MyMedicare was announced in the May budget, with A$19.7 million of funding over four years, alongside a range of <a href="https://www.health.gov.au/sites/default/files/2023-05/building-a-stronger-medicare-budget-2023-24_0.pdf">other health reforms</a>, including funding for practice nurses to improve team-based care, as well as new incentives to increase bulk billing rates. We’re still waiting on a lot of detail about how the scheme will function. But here’s what we know so far – and what it might mean for patients and GPs. <h2>What do we know about MyMedicare?</h2> The scheme is voluntary for GPs and patients. In addition to patients opting in, GPs will also need to sign up, and have been able to do so since the start of July. There will be a gradual roll out and it will take three years to cover all of Australia. Though details are yet to be confirmed, from mid-2024 individual GPs will receive “<a href="https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/resident-career-counseling-guidance-and-tips/understanding-capitation">capitation</a>” payments for patients who have more than ten hospital admissions per year. These patients are likely to have complex needs and multiple conditions and, for various reasons, may not be able to access a GP as much as they should. Though not yet confirmed, GPs are likely to <a href="https://www.ausdoc.com.au/news/the-mymedicare-enrolment-scheme-is-open-for-gp-practices-should-you-sign-up-now/">receive</a> $2,000 per patient per year, plus a $500 bonus for keeping patients out of hospital. The funding provides incentives for the GP to coordinate their care and provide the patient with access to nursing and allied health if required. It’s hoped this will stop patients going to hospital as often. There will also be similar payments for providing regular visits to patients in residential aged care facilities. <h2>Will MyMedicare make a difference to patients?</h2> Let’s consider four key areas patients are concerned about: 1) Continuity of care Research shows greater <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2753.2009.01235.x">continuity of care</a> – developing a relationship with and seeing the same provider or team for your care – improves patient outcomes and reduces costs to the health system. People who use MyMedicare to get a regular GP may see some of these benefits. But many patients already see the same GP or visit the same practice, especially those with chronic conditions. So registration with a practice may not make much difference for this group of patients. What are the other benefits of registration? 2) Reducing hospital admissions Avoiding hospitals can be beneficial – in hospitals, there are no home comforts, they are inconvenient for you and relatives, there is little privacy, and they can be costly. Patients with ten or more hospital admissions in a year have been targeted as they have more complex chronic conditions and may be from vulnerable populations. Better access to a GP could prevent patients visiting the emergency department or prevent overnight hospital admissions. Research shows financial incentives for GPs to better manage chronic disease <a href="https://journals.sagepub.com/doi/full/10.1177/01410768211005109">can reduce hospital admissions</a>. However, <a href="https://bmjopen.bmj.com/content/5/4/e007342?cpetoc=&int_source=trendmd&int_medium=trendmd&int_campaign=trendmd">hospital admissions could also increase</a> if the scheme identifies significant levels of previous unmet need. 3) Reducing barriers to care MyMedicare does not directly address many of the <a href="https://link.springer.com/article/10.1186/1475-9276-12-18">barriers to accessing GP services</a>. If GPs are getting paid more and still getting fee for service payments, will MyMedicare patients be guaranteed to be bulk billed? This has not yet been mentioned, but could be an important part of the scheme to attract patients. People with chronic disease have <a href="https://grattan.edu.au/report/not-so-universal-how-to-reduce-out-of-pocket-healthcare-payments/">two to three times higher</a> out-of-pocket costs than those who do not, and <a href="https://healthsystemsustainability.com.au/the-voice-of-australian-health-consumers/">30%</a> of patients with chronic disease would find it difficult to pay for care if they became seriously ill. Unfortunately MyMedicare will not directly reduce out-of-pocket costs, which may be the real reason why people use “free” emergency department care. 4) Making it clear and easy to sign up It is also unclear how the process of registration will work for patients. Will patients be offered a choice of alternative GPs? If chosen, will GPs be obliged to take them? At the moment, there are no public data about out-of-pocket costs and quality of care provided by different GPs, and so it will be impossible for patients to make an informed choice. Information to inform choice on a website would be useful, as is the case for <a href="https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder">specialists</a>. It’s also unclear if patients who chose to register will find it harder to move GPs or continue to see other GPs if they wish to. The advantages to patients of MyMedicare need to be made clear to encourage them to register and be supported to exercise informed choice if they wish. <h2>Will it make a difference for GPs?</h2> Patient registration can mean a more secure and predictable stream of future income for some patients and also less competition (in terms of “losing” patients to other GPs) and more continuity of care. Moving away from fee for service towards a blended payment model is <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011865.pub2/full">widely recognised</a> to support higher value health care. Yet GPs are wary of moving from fee for service to capitation payment. Capitation payments are fixed, so GPs take on more financial risk if they have more complex patients who are more costly to treat and manage in terms of time and effort. Whether the $2,000, plus $500 bonus, plus normal fee for service payments are sufficient to cover the costs of treating very complex patients is unclear. Overall, GPs will get more money, and along with the other announcements in the budget, will receive a significant investment of resources invested in primary care. Our previous <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3572">research</a> has shown a 5% increase in earnings for GPs is predicted to reduce the total number of GPs by up to 1% (equivalent to around 310 GPs in 2021) at a time of significant GP shortages. If they get paid more, they would prefer to work less. But this could also be offset because the increase in funding will hopefully make general practice more attractive as a career and so there will be more postgraduate doctors <a href="https://www.sciencedirect.com/science/article/pii/S0167629612000902">choosing to be a GP</a>. Voluntary patient registration under MyMedicare has potential to strengthen the relationship between patients and their GP, and focuses on keeping patients out of hospital and properly cared for in residential aged care. But the devil is in the detail and we will need a proper evaluation to determine the impacts on health outcomes, costs and access to health care. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/206183/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anthony-scott-10738">Anthony Scott</a>, Professor of Health Economics, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-you-register-with-a-gp-what-is-mymedicare-and-how-might-it-change-the-care-you-get-206183">original article</a>.

Caring

Should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts

<a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, <a href="http://www.theconversation.com/">The Conversation</a> Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters. A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions. “Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>. By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns. So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts. Brett Montgomery - GP academic Yes, sometimes – but with great care. I agree that weight stigma is damaging, and insensitively raising weight in consultations can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251566" target="_blank" rel="noopener">hurt people's feelings and create barriers</a>to other aspects of health care. I also agree people can sometimes be “overweight” yet <a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0287218" target="_blank" rel="noopener">quite healthy</a>, and that common measures and categories of weight are <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">questionable</a>. On the other hand, I know obesity <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Obesity-prevention-and-management.pdf" target="_blank" rel="noopener">is associated with</a> heart disease, joint problems, diabetes and cancers. GPs should be ready to help people with their weight when they want help. <a href="https://www.bmj.com/content/377/bmj-2021-069719.full?ijkey=FnARkmvxLOMFvlb&keytype=ref">Our assistance somewhat effective</a>, though sadly dietary efforts often have minimal effect on weight in the long term. Meanwhile, treatments causing larger weight changes (<a href="https://insightplus.mja.com.au/2021/10/bariatric-surgery-public-system-access-still-terrible/">surgery</a> and <a href="https://www.nature.com/articles/s41366-022-01176-2">some medicines</a> are often financially inaccessible. I feel safe discussing weight when my patient raises the issue. Fearing hurting people, I often avoid raising it myself. I focus instead on health rather than weight, discussing physical activity and healthy diet – these are good things for people of any size. Emma Beckett - Nutrition scientist No. It’s not likely to succeed. Large systematic reviews bringing together multiple studies of multiple weight-loss diets show weight loss is not generally maintained long term (<a href="https://pubmed.ncbi.nlm.nih.gov/32238384/">12 months</a> to <a href="https://www.nature.com/articles/0802982">four years</a>). The idea that weight is about willpower is outdated. The current body of evidence <a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">suggests</a> we each have a weight set point that our body defends. This is determined by genetics and environment more so than education. There may be associations between weight and health outcomes, but losing weight <a href="https://theconversation.com/just-because-youre-thin-doesnt-mean-youre-healthy-101185">does not necessarily equate</a> with improving health. Fat stigma and fatphobia are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866597/">harmful too</a> and can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/">compromise access to health care</a>. Instead, consider asking a better question. Healthy eating reduces disease risk <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935663/">regardless of weight</a>. So maybe ask how many vegetables are your patients eating. Would they like to see a dietitian to discuss strategies for a better-quality diet? Liz Sturgiss - GP/researcher No. A <a href="https://pubmed.ncbi.nlm.nih.gov/33211585/">US study</a> estimates it would take a family doctor 131% of their work hours to implement all preventive health-care recommendations. It's impossible to address every recommendation for preventative care at every consultation. One of the key skills of a GP is balancing the patient and doctor agenda. <a href="https://www.obesityevidencehub.org.au/collections/treatment/weight-bias-and-stigma-in-health-care">Weight stigma</a> can deter people from seeking health care, so raising weight when a patient doesn't have it on their agenda can be harmful. A strong <a href="https://academic.oup.com/fampra/article/38/5/644/6244494?login=false">therapeutic relationship</a> is critical for safe and effective health care to address weight. Weight is always on my agenda when there is unexpected weight loss. If a patient has rapid weight loss, I am concerned about an undetected <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283307/">cancer</a> or infection. Additionally, I am increasingly seeing patients who are unable to afford food, who often have <a href="https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/introduction">poor oral health</a>, who lose weight due to <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12580">poverty</a>. Weight loss for the wrong reasons is also a very concerning part of general practice. Nick Fuller - Obesity researcher Yes. GPs should play a role in the early detection of weight issues and direct patients to evidence-based care to slow this progression. <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Research</a> shows many people with obesity are motivated to lose weight (48%). <a href="https://pubmed.ncbi.nlm.nih.gov/31032548/">Most</a> want their clinician to initiate a conversation about weight management and treatment options. However, this conversation <a href="https://pubmed.ncbi.nlm.nih.gov/32385580/">rarely occurs</a>, resulting in <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">significant delays to treatment</a>. Starting the conversation presents challenges. Although obesity is a complex disease related to multiple factors, it's still <a href="https://pubmed.ncbi.nlm.nih.gov/25752756/">highly stigmatised</a>in our society and even in the <a href="https://pubmed.ncbi.nlm.nih.gov/23144885/">clinical setting</a>. Sensitivity is required and the wording the clinician uses is important to make the patient feel safe and avoid placing blame on them. Patients often <a href="https://pubmed.ncbi.nlm.nih.gov/20823355/">prefer terms</a> such as “weight” and “BMI” (body mass index) over “fatness,” “size” or “obesity”, <a href="https://pubmed.ncbi.nlm.nih.gov/27354290/">particularly women</a>. Measuring weight, height and waist circumference should be <a href="https://pubmed.ncbi.nlm.nih.gov/33621413/">considered routine in primary care</a>. But this needs to be done without judgement, and in collaboration with the patient. Helen Truby - Nutrition scientist Yes. A high body weight contributes to many chronic conditions that negatively impact the <a href="https://www.aihw.gov.au/australias-health/summaries">quality of life and mental health</a> of millions of Australians. Not all GPs feel confident having weight conversations, given the sensitive nature of weight and its stigma. GPs' words matter – they are a <a href="https://doi.org/10.1111/nbu.12320">trusted source</a> of health information. It’s critical GPs gain the skills to know when and how to have <a href="https://doi.org/10.1186/s12875-019-1026-4">positive weight conversations</a>. GPs need to offer supportive and affordable solutions. But effective specialist weight management programs are few and far between. More equitable access to programs is essential so GPs have referral pathways after conversations about weight. GPs' time is valuable. Activating this critical workforce is essential to meet the <a href="https://www.health.gov.au/resources/publications/national-obesity-strategy-2022-2032?language=en">National Obesity Strategy.</a> <a href="https://theconversation.com/au/team#fron-jackson-webb">Fron Jackson-Webb</a>, Deputy Editor and Senior Health Editor, <a href="http://www.theconversation.com/">The Conversation</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-gps-bring-up-a-patients-weight-in-consultations-about-other-matters-we-asked-5-experts-209681">original article</a>.

Body

Gastro or endometriosis? How your GP discusses uncertainty can harm your health

You wake with stomach pain that worsens during the day and decide to see your doctor. You describe your symptoms and your doctor examines you. Then the doctor says, “From what I hear, I think you could just have a stomach bug. Rest and come back in three days.” This might be a less definitive answer than you’re after. But doctors can’t always be sure of a diagnosis straight away. As <a href="https://link.springer.com/article/10.1007/s11606-022-07768-y">my review</a> shows, doctors use various ways of communicating such uncertainty. Sometimes there is a mismatch between what doctors say when they’re uncertain and how patients interpret what they say, which can have harmful consequences. <h2>Why does uncertainty matter?</h2> Doctors <a href="https://link.springer.com/article/10.1007/s11606-017-4164-1">cannot always explain</a> what your health problem is or what caused it. Such diagnostic uncertainty is a normal and <a href="https://doi.org/10.1001/jama.2022.2141">ever-present part</a> of the processes leading to a diagnosis. For instance, doctors often have to rule out other possible diagnoses before settling on one that’s most likely. While doctors ultimately get the diagnosis right <a href="http://dx.doi.org/10.1136/bmjqs-2012-001615">in 85-90%</a> of cases, diagnostic uncertainty can lead to diagnostic delays and is a huge contributor to harmful or even deadly misdiagnoses. Every year, <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">an estimated</a> 21,000 people are seriously harmed and 2,000-4,000 people die in Australia because their diagnosis was delayed, missed or wrong. That could be because the wrong treatment was provided and caused harm, or the right treatment was not started or given after the condition had already considerably progressed. More than <a href="https://www.mja.com.au/system/files/issues/213_07/mja250771.pdf">80% of diagnostic errors</a> could have been prevented. Three medical conditions – infections, cancer and major vascular events (such as strokes or heart attacks) – are the so-called “<a href="https://doi.org/10.1515/dx-2019-0019">Big Three</a>” and cause devastating harm if misdiagnosed. In my review, the top three symptoms – fever, chest pain and abdominal pain – were most often linked to diagnostic uncertainty. In other words, most of us will have had at least one of these very common symptoms and thus been at risk of uncertainty and misdiagnosis. Some groups are less likely to be diagnosed correctly or without inappropriate delay than others, leading to <a href="https://doi.org/10.1001/jama.2022.7252">diagnostic inequities</a>. This may be the case for <a href="https://www.liebertpub.com/doi/10.1089/whr.2022.0052">women</a>, and other groups marginalised because of their <a href="https://onlinelibrary.wiley.com/doi/10.1111/acem.14142">race or ethnicity</a>, <a href="https://doi.org/10.1016/j.socscimed.2020.113609">sexual orientation or gender identity</a>, or <a href="https://doi.org/10.1001/jama.2022.7252">language proficiency</a>. <h2>How often do you hear ‘I don’t know’?</h2> My research showed doctors often make diagnostic uncertainty clear to patients by using explicit phrases such as: “I don’t know.” But doctors can also keep quiet about any uncertainty or signal they’re uncertain in more subtle ways. When doctors believe patients prefer clear answers, they may only share the most likely diagnosis. They say: “It’s a stomach bug” but leave out, “it could also be constipation, appendicitis or endometriosis”. Patients leave thinking the doctor is confident about the (potentially correct or incorrect) diagnosis, and remain uninformed about possible other causes. This can be especially frustrating for patients with chronic symptoms, where such knowledge gaps can lead to lengthy diagnostic delays, as reported for <a href="https://doi.org/10.1016/j.ajog.2018.12.039">endometriosis</a>. Subtle ways of communicating uncertainty include hedging with certain words (could, maybe) or using introductory phrases (my guess, I think). Other implicit ways are consulting a colleague or the Internet, or making follow-up appointments. If patients hear “I think this could be a stomach bug” they may think there’s some uncertainty. But when they hear “come back in three days” the uncertainty may not be so obvious. Sharing uncertainty implicitly (rather than more directly), can leave patients unaware of new symptoms signalling a dangerous change in their condition. <h2>What can you do about it?</h2> 1. Ask about uncertainty Ask your doctor to share any <a href="http://dx.doi.org/10.1515/dx-2021-0086">uncertainty and other diagnostic reasoning</a>. Ask about alternative diagnoses they’re considering. If you’re armed with such knowledge, you can better engage in your care, for example asking for a review when your symptoms worsen. 2. Manage expectations together Making a diagnosis can be an evolving process rather than a single event. So ask your doctor to outline the diagnostic process to help manage any <a href="http://dx.doi.org/10.1136/ebm.14.3.66">mismatched expectations</a> about how long it might take, or what might be involved, to reach a diagnosis. Some conditions need time for symptoms to evolve, or further tests to exclude or confirm. 3. Book a long appointment When we feel sick, we might get anxious or find we experience heightened levels of fear and other emotions. When we hear our doctor isn’t certain about what’s causing our symptoms, we may get even more anxious or fearful. In these cases, it can take time to discuss uncertainty and to learn about our options. So book a long appointment to give your doctor enough time to explain and for you to ask questions. If you feel you’d like some support, you can ask a close friend or family member to attend the appointment with you and to take notes for you. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/gastro-or-endometriosis-how-your-gp-discusses-uncertainty-can-harm-your-health-196943" target="_blank" rel="noopener">The Conversation</a>.

Caring

With so many GPs leaving the profession, how can I find a new one?

Perhaps you have been happily attending the same GP for many years. They know your medical history better than anyone. Then all of a sudden they retire, or the practice closes, or it gets taken over by a bigger company and everything at the practice changes. Or maybe you’ve just had an unexpected visit to hospital and they ask who your GP is on discharge, then you realise you’re in need of one. More than 80% of Australians <a href="https://pubmed.ncbi.nlm.nih.gov/29779298/">visit a GP</a> each year and those with chronic medical conditions will attend multiple times within the same period. It’s important to have a good GP who can coordinate your care. So how do you find a new one to develop a trusted relationship with? As practising GPs ourselves, we are often asked: “Do you know a good GP?” This can be a somewhat difficult question to answer, as each person’s perception of “good” is highly subjective, dependent on many factors. Studies of peoples’ preferences have varied results. One study found the <a href="https://pubmed.ncbi.nlm.nih.gov/21334160/">listening ability</a> of the GP to be important. Other studies found patients put more value in <a href="https://pubmed.ncbi.nlm.nih.gov/18332402/">clinical competency</a>, a <a href="https://bjgp.org/content/70/698/e676">trusting relationship or continuity of care</a>. So a better question is: what GP will be a good fit for me? <h2>What factors are important to you? 6 aspects to consider</h2> Here are some tips to help speed up your search for your new GP. Remember though, it may take a few visits to develop a trusting relationship and know if the fit is right for you. <h2>1. Your health needs</h2> If you are young and healthy, a GP offering a convenient service and who is easy to book in quickly with may suffice. For those living with chronic complex conditions or disabilities who need to visit often, a consistent and thorough doctor is recommended. <h2>2. Cost</h2> Bulk-billing doctors are becoming rarer given the rising cost of services, salaries, equipment and utilities. To stay afloat, these doctors are having to see more patients in less time. This could result in a poorer understanding of you as an individual and your health values and goals. Again, this might not be a problem for simple consults. But if you get a serious disease down the track, you might wish you’d had a regular GP all along, because they would know you and your history. If you’re able to wear some extra cost but wondering how much to pay, consider the Australian Medical Association recommendation as your guide – a standard 15-minute <a href="https://www.ausdoc.com.au/news/rebate-gap-blows-out-47-standard-gp-consult/#:%7E:text=In%20its%20latest%20list%20of,currently%20sits%20at%20just%20%2439.10.">consult cost</a> is $86 with a $39 rebate from Medicare. <h2>3. Accessibility and practice size</h2> Consider the distance you need to travel and the opening hours you may need, including weekend availability. Bigger practices are more likely to be able to get you in to see a doctor, if not your doctor, and often have longer opening hours. Having more than one preferred GP within the same practice can provide more flexibility and they will each be able to access your medical records and results. You may want to enquire also about disability access and telehealth options. <h2>4. Reviews</h2> Online recommendations can be tricky to interpret. Only <a href="https://www.center4research.org/believe-online-reviews-doctors/">6–8% of people</a> post online reviews for doctors. And there are plenty of people out there who have inappropriate requests or expectations of GPs, which may be their basis for a negative review. Also, someone who has been happily seeing their GP for decades is less likely to post a rating than a one-off visitor. Be sure to consider what reasons were given for a negative review – was it because of actions taken, an attitude, or a personality clash? – and how those reasons align with your preferences. In saying that, community Facebook groups are often a hotspot for discussions about local GPs and recurrent positive recommendations can and should be held in higher regard. <h2>5. New doctors</h2> There are many young GPs starting off in the profession or new to the area. Many will be fantastically caring and competent. But these doctors are not going to come with recommendations yet. These GPs often have plenty of appointment slots, and the most recent up-to-date training. Being an early adopter of their services could be to your benefit. <h2>6. Sub-specialists</h2> Many GPs have special interests and advanced skills, such as skin cancer care, musculoskeletal medicine, women’s health or mental health. They may have done postgraduate training, usually listed on the practice website along with their special interests. They are likely to have a shorter waiting time and lower costs than specialists – so consider these doctors if your needs match their expertise. <blockquote class="twitter-tweet"> The answer to solving the GP workforce crisis? Fix inequities in conditions and pay to attract junior doctors back to general practice. <a href="https://t.co/VnzF63mD4O">https://t.co/VnzF63mD4O</a> — GPRA (@GPRALtd) <a href="https://twitter.com/GPRALtd/status/1541592411776090113?ref_src=twsrc%5Etfw">June 28, 2022</a></blockquote> <h2>Other things to check</h2> About 80% of practices go through a <a href="https://www.semphn.org.au/general-practice-accreditation">practice accreditation process</a>, which proves attainment of standards set by the Royal Australian College of General Practitioners. Such practices will advertise this status on their website and at the entrance to the clinic. You can also ask about a doctor’s qualifications and about the standard consultation length. This may range from 10 to 20 minutes. Don’t be afraid to ask these questions when calling a practice about your first visit. The final and arguably most important test is how you connect when you meet them in person. Finding a GP can be like finding your favourite cardigan. You don’t know it’s your favourite until it has been worn in. Similarly you don’t know that your GP is great until you’ve journeyed with them through some potentially challenging times of your life. We encourage you to use the above tips to find a suitable GP, then give them some time to get to know you and grow a therapeutic relationship. With continuity of care, trust will grow, as will knowledge about you and your values. This will ultimately improve your overall health care experience. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/with-so-many-gps-leaving-the-profession-how-can-i-find-a-new-one-190666" target="_blank" rel="noopener">The Conversation</a>.

Caring

Why has my cold dragged on so long, and how do I know when it’s morphed into something more serious?

Common colds are caused by viruses. There are no effective cures, and antibiotics do not work on viruses, so treatment is targeted at managing the symptoms until your immune system has cleared the cold. So why might someone go to a doctor at all for a cold? Well, occasionally a cold might turn into something more serious requiring assessment and specific treatment, and a GP visit could be warranted. Or you may just want reassurance and advice. <h2>Don’t rush to the GP for something totally normal</h2> Problems arise when there too many unwarranted visits to GPs for cold symptoms. Studies have shown <a href="https://www.annfammed.org/content/11/1/5" target="_blank" rel="noopener">antibiotics</a> are <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja16.01042" target="_blank" rel="noopener">still prescribed widely</a> for viral colds, even though they don’t help, and this contributes to antibiotic resistance. It hastens the arrival of an era when many antibiotics simply don’t work at all. On average, children have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/" target="_blank" rel="noopener">four to six colds</a> per year, while in adults the average is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152362/" target="_blank" rel="noopener">two to three</a>. Some people are more <a href="https://www.sciencedirect.com/science/article/abs/pii/S1530156705601189?via%3Dihub" target="_blank" rel="noopener">prone</a> to colds, but we don’t know exactly why. The usual cold persists about one week, although 25% last two weeks. In one <a href="https://journals.asm.org/doi/10.1128/jcm.35.11.2864-2868.1997" target="_blank" rel="noopener">study</a> with 346 adults, the infection lasted 9.5 to 11 days. Cold symptoms may last longer in younger children. One <a href="https://publications.aap.org/pediatrics/article-abstract/87/2/129/56810/Upper-Respiratory-Tract-Infections-in-Young?redirectedFrom=fulltext" target="_blank" rel="noopener">study</a> showed an average duration of colds ranged from 6.6 to 9 days. But symptoms lasted more than 15 days in 6.5% of 1-3 year old children in home care, and 13.1% of 2-3 year old children in day care. A cough tends to last longer than other symptoms, and often beyond the actual viral infection. The average <a href="https://www.annfammed.org/content/11/1/5" target="_blank" rel="noopener">duration</a> of a cough is about 17.8 days. <h2>Discoloured sputum, cough or snot</h2> Discoloured mucus in snot or cough is a common trigger for requesting antibiotics from a GP. But as we know, antibiotics are useless against a virus. They only work against bacterial infection. In fact, thick or coloured nasal mucus secretion is common following colds. Only a tiny proportion <a href="https://europepmc.org/article/pmc/pmc7151789" target="_blank" rel="noopener">involve</a> bacterial infection. When it happens, this is termed <a href="https://www.nps.org.au/australian-prescriber/articles/treating-acute-sinusitis-3" target="_blank" rel="noopener">acute rhinosinusitis</a>. But antibiotics are not recommended unless it lasts more than ten to 14 days and there are <a href="https://europepmc.org/article/pmc/pmc7151789" target="_blank" rel="noopener">signs</a> of bacterial sinusitis infection, such as: <ul> <li>symptoms worsening after improvement in the original cold</li> <li>return of fever and</li> <li>strong facial pain.</li> </ul> A prolonged cough after colds is usually caused by an irritated throat or the clearing of sticky mucus coming down from the nose. The cough may sound moist (so wrongly called “chesty”) due to the phlegm, but only small amounts of phlegm are coughed up. Yellow or green coloured mucus is often interpreted as a <a href="http://theconversation.com/health-check-what-you-need-to-know-about-mucus-and-phlegm-33192" target="_blank" rel="noopener">sign</a> of bacterial infection. But yellow or green sputum alone <a href="https://www.tandfonline.com/doi/full/10.1080/02813430902759663" target="_blank" rel="noopener">does not</a> mean you have a serious bacterial infection. One study found being prescribed antibiotics under these circumstances <a href="https://erj.ersjournals.com/content/38/1/119" target="_blank" rel="noopener">failed</a> to shorten recovery time. Nasal saline sprays and washes can be used to rinse out the nose and sinuses and possibly <a href="https://dtb.bmj.com/content/57/4/56" target="_blank" rel="noopener">shorten</a> rhinosinusitis and cough after colds. <h2>Could it just be hayfever, or another underlying issue?</h2> Hayfever or allergic rhinitis is a common cause for prolonged symptoms after a cold, especially cough and nasal congestion and maybe also sneezing. The damage in the upper airways following a viral infection may allow airborne allergens to trigger hayfever. Self-medicating with antihistamines, nasal saline spray or intranasal steroids is worthwhile if <a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172" target="_blank" rel="noopener">allergic rhinitis</a> is suspected. There may be other reasons for persistence of cough, such as exacerbation of underlying asthma or chronic lung disease. If so, this may require a visit to your GP. <h2>What about bronchitis or pneumonia?</h2> Many people worry about developing a chest infection after a cold. Acute bronchitis is a self-limiting infectious disease characterised by acute cough with or without sputum but without <a href="https://www.nhs.uk/conditions/pneumonia/" target="_blank" rel="noopener">signs of pneumonia</a> (such as high temperatures and feeling breathless). Most acute bronchitis cases are caused by viruses. Antibiotics are often prescribed, but produce <a href="https://www.tandfonline.com/doi/full/10.1080/14787210.2016.1193435" target="_blank" rel="noopener">no significant clinical improvement</a> compared with placebo, so are not recommended. Pneumonia is a potentially serious secondary disease that <a href="https://pubmed.ncbi.nlm.nih.gov/28159155/" target="_blank" rel="noopener">may follow</a> an episode of flu in a small number of cases, but is <a href="https://www.ncbi.nlm.nih.gov/books/NBK532961/" target="_blank" rel="noopener">relatively rare</a> following a cold. Symptoms and signs of pneumonia feature heavily in the list of warning signs that signal the need for a medical assessment. <h2>When should I seek medical help for a cough or a cold?</h2> Contact a GP if you experience: <ul> <li>shortness of breath or trouble breathing</li> <li>feeling faint or dizzy</li> <li>chest pain</li> <li>dehydration</li> <li>fever or cough symptoms that improve but then return or worsen</li> <li>worsening of chronic medical conditions such as asthma.</li> </ul> This is not a complete list, but may guide you on what to expect and what to watch out for. You might also contact your GP (perhaps for a telehealth consult) if you are finding your symptoms very unpleasant, or are concerned your condition is more serious or prolonged than expected. You might just need reassurance and education about self care options. This article originally appeared on <a href="https://theconversation.com/why-has-my-cold-dragged-on-so-long-and-how-do-i-know-when-its-morphed-into-something-more-serious-190429" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Body

GPs could soon prescribe creativity to improve wellbeing

<a rel="noopener" href="https://journals.sagepub.com/doi/10.1177/1757913920911961" target="_blank">A new paper</a> exploring the effects of crochet on wellbeing has sparked a wider discussion of the benefits of getting creative can be good for our mental health. After surveying more than 8000 crocheters, Dr Pippa Burns, a medical researcher at The University of Wollongong, found that 89.5 percent of respondents felt calmer from engaging in the craft, while 82 percent felt happier. These findings didn’t really surprise Burns, who also crochets. “It’s very mindful because you’re counting stitches,” she said. “You’re not thinking about who said what at work or what you need to do tomorrow. You’re just focused on what you’re creating.” A potential treatment Though the prescription of crocheting and sewing has been slow in Australia, other countries have supported the move. In the UK and Germany, more than half of GPs refer their patients to community services - including crocheting and sewing - for a range of social, emotional, or financial issues, in a practice called social prescribing. This practice has been endorsed by both the Royal Australian College of General Practitioners (RACGP) and the Consumers Health Forum of Australia. According to Burns, a more targeted education campaign is needed to help GPs and the broader public understand the benefits of social prescribing and increase its uptake. “It’s about society viewing health more holistically,” Burns said. “You don’t just have to have clinical or pharmacological interventions. You can also have creative interventions that could be just as important to someone’s recovery.” The Black Dog Institute is also conducting its own study on the benefits of social prescribing. Clients of their depression clinic have been taking part in arts on prescription workshops with the Art Gallery of NSW, with preliminary results finding participants experienced significant increases in mental health, wellbeing, and feelings of social inclusion. Professor Katherine Boydell, the institute’s lead researcher, believes social prescribing could contribute to improving health outcomes of patients, and even reduce care costs. Doing something badly An eight-week program called ‘Creativity on Prescription’, devised by social enterprise Makeshift and designed in consultation with Burns, a GP, and a psychologist, allows participants to trial a new creative activity each week. From dancing and painting to gardening, these activities aim to help participants manage anxiety, depression, and other mental health issues. “People experience a different version of themselves,” said Caitlin Marshall, Makeshift’s co-founder and a social worker. “And that’s really important for personal change to happen.” However, the biggest obstacle for many is the perception they’re not artistic or creative enough. “You can go for a run and be really crappy at running and you’re still going to get the benefit of that,” Marshall countered. “Creative practices give us the same thing.”

Mind

MAJOR free change coming for Aussies over 50

The government has announced any Australian over 50 will now have access to a free consultation from a doctor to discuss COVID-19 vaccinations. Federal Health Minister Greg Hunt announced the new measure on Friday. “To assist our GPs, to assist and support those who are coming forward for vaccinations, there will be a new Medicare item for over-50s to allow for a general practice consultation,” Hunt said. “It will be done by GPs ... It will be bulk billed.” Karen Price, president of the Royal Australian College of General Practitioners, said it was urgent the measure be made. “We are dealing with increasing vaccine hesitancy right across the country,” she said. “I’m seeing it in my own practice in Melbourne, almost all my patients have questions about the COVID-19 vaccines.” <blockquote class="twitter-tweet"> Health Minister <a href="https://twitter.com/greghunt?ref_src=twsrc%5Etfw">@GregHunt</a> MP says the decision to recommend AstraZeneca only for people aged over 60 "doesn't change the goal of having every Australian given the opportunity to be vaccinated this year." <a href="https://t.co/DuesjfbtCV">pic.twitter.com/DuesjfbtCV</a> — Sunrise (@sunriseon7) <a href="https://twitter.com/sunriseon7/status/1405650956948180992?ref_src=twsrc%5Etfw">June 17, 2021</a></blockquote> The AstraZeneca vaccine is no longer recommended to anyone under the age of 60, so Prime Minister Scott Morrison is attempting to change major measures for the vaccine rollout after meeting with state and territory leaders on Friday. Experts are maintaining that while it is rare, the risk of extremely rare but serious blood clots heavily outweighs the benefits of that particular jab. The recommended age has been revised up from 50, meaning all eligible people under 60 will be offered Pfizer. Hunt has maintained his confidence in the Pfizer jab and said re-booking people in their 50s who were down to get a first AstraZeneca jab would likely lead to a fall in vaccination rates. “The interesting point here was that some in that group, who were not intending to be vaccinated in the near term, may well choose to be vaccinated,” he said. Only four percent of adults have received both doses of the COVID vaccine, seriously lagging behind the rest of the world in vaccination rates.

News

22-year-old dies of cervical cancer after GPs turned her away 15 times

A 22-year-old woman died of cervical cancer after GPs turned her away 15 times and told her not to worry about the “Jade Goody effect”. Emma Swain pleaded with her GP for a smear test as she was experiencing symptoms, but was told she was too young by medical professionals. Instead, doctors had placed the blame on her contraceptive pill for her symptoms and told her what happened to Jade Goody was unlikely to happen to her. In 2009, TV personality Jade Goody died from cervical cancer at the age of 27. Emma first approached her doctor about a smear test in May 2013 after experiencing back pain and bleeding after sex. But her request was refused because the cervical screening is only offered to women over the age of 25. Her GP has since admitted that if the 22-year-old had been given the smear test, she may still be alive. Devastated at the loss of his daughter, Darren Swain <a rel="noopener" href="https://www.mirror.co.uk/news/uk-news/woman-22-cervical-cancer-told-23084319" target="_blank">told the Mirror</a>: “To have watched one of your children go through that and to know it could have been prevented is incredibly hard to accept. “We trusted these people – the professionals – to know what they were doing. I’ll never forgive them.” Darren, 51, said: “Basically, he told her she was worrying over nothing. He couldn’t have been more wrong. It cost Emma her life.” Over the course of four months, Emma contacted her doctor 14 times but was advised to swap her brand of contraceptive pill. She changed her pill five times during those four months. Unfortunately, Emma was diagnosed with cervical cancer in December of that year and died the following year in 2014. Emma’s family has since been fighting a six-year legal battle, one that they have recently won. Her family has been awarded compensation for her death. In a letter to the dad-of-three, Dr Stephen Golding, Dr Hendrik Parmentier and practice nurse Maureen Dillon from The Haling Park Partnership in Croydon, South London, apologised for what happened to Emma. They wrote: “We admit that if the care and treatment provided to your daughter had been of a reasonable standard, on the balance of probabilities, she would have survived.” A spokesperson for the surgery told the Mirror: “Since Emma’s death, the practice has reviewed its processes to ensure lessons have been learned.”

Caring

5 unexpected side effects of over-the-counter drugs

They’re simple to use, effective and accessible, so it’s little wonder that many Aussies reach for over-the-counter (OTC) medicine when a cold or headache gets them down. In fact, national figures from the Australian Self Medication Industry show that more than 80 per cent of the adult population take an OTC drug (eg ibuprofen, paracetamol and many others) each and every month! It’s easy to see why. Life is busy enough, so who wants to be spending the better half of the day sitting in a doctor’s office? Especially when a quick trip to the supermarket or pharmacy will do. But there’s a downside to self-medicating, especially if you are not aware of the risks or ask the right questions. Here’s what you need to know. 1. Pain killers and medication-overuse headaches Using medicine to mask pain on a regular basis can actually induce headaches or make headache pain feel even worse. This is known as medication-overuse headaches or MOH, and feels like a dull constant headache that is usually worse in the morning. It can affect anyone who overuses painkillers, regardless if it’s for a headache or other pain such as arthritis or back pain. It’s a vicious cycle for anyone in pain, and according to The Headache Group and Migraine Trust in the UK, the only way of treating this condition is to stop taking the medication – but be sure to talk to your doctor about how to do this safely. Who is at risk? People who use painkillers (OTC or prescription) more than 2-3 times per week or more than 10 days in a month. 2. Mixing medicines with certain foods Did you know grapefruit and some citrus fruits can interfere with medicines in the body? Just one grapefruit, or the equivalent in juice form, can cause side effects, regardless if it is taken with the medicine or at a later time. Bitter oranges and limes can also cause an adverse reaction, whereas sweet oranges and lemons don’t seem to have the same effect, says the National Prescribing Service. Side effects may include very slow heartbeat, rapid heartbeat, kidney damage or respiratory problems. Who is at risk? People taking medicine for infection, high cholesterol, high blood pressure, or heart problems. People over 70 years old. 3. Regular use of NSAIDs Anti-inflammatory medicines such as diclofenac and ibuprofen are collectively known as NSAIDs, and these are generally safe when taken in small amounts and for short periods. However, there are risks associated with regular use, especially in older Australians (The Society of Hospital Pharmacists of Australia recommends that people over 65 years old avoid regular use of NSAIDs). Mild side effects include nausea, heartburn and indigestion. More seriously, prolonged use of NSAIDs has been linked to ulcers, kidney problems and heart problems. The National Prescribing Service (NPS) advises taking ibuprofen only when needed and at the lowest recommended dose that improves symptoms, for the shortest time possible (not exceeding 2400mg over a 24-hour period). Who is at risk? People over 65 years old, people with ulcers, stomach bleeding, heart or kidney problems, high blood pressure, asthma, anyone taking another medicine that also contains an NSAID. 4. Mixing natural remedies with prescription medicine Mixing complementary medicines such as echinacea or St John’s wort with prescription drugs may not only reduce the effectiveness of the medication, but can also put your health at risk. For example, echinacea may interact with medications that are broken down by the liver; ginkgo and chamomile may increase the risk of bleeding in people taking aspirin or warfarin; and taking St John’s wort with other medicines has been linked to serotonin syndrome, which causes tremors, high temperature and low blood pressure. Who is at risk? Anyone who mixes medicines without expert/GP advice, especially those who are taking five or more medications together, have had recent changes to their treatment plan, or have different doctors (or keep their doctor out of the loop). 5. Anticholinergic medications and sedatives As we age, we become more sensitive to certain medicines especially those with sedative properties or medicines that have an ‘anticholinergic effect’ (affecting your nervous system). Cough medicine is one example – it might work as intended now, but might make you increasingly drowsy in older age. Other common anticholinergic effects include dry mouth, constipation, blurred vision and dizziness. Common medicines include antihistamines, cough and cold medicines, medicines for nausea/travel sickness and incontinence medication. Who is at risk? Older Australians, people taking multiple medicines, or anyone who has a pre-existing brain or nerve condition, such as dementia. Top tips when considering OTC medications: <ul> <li>Take as directed, and always read the packaging very carefully (especially if purchasing in a supermarket)</li> <li>Speak to your GP if you have pre-existing health conditions or when mixing medicines</li> <li>Ask your pharmacist about side effects and inform them of any health conditions</li> <li>Stick to one GP wherever possible</li> <li>Call the NPS Medicines Line on 1300 633 424 or the Adverse Medicines Events Line on 1300 134 237 for advice. Or contact Poisons Information Centre on 13 11 26</li> <li>In an emergency, call 000</li> </ul> Written by Mahsa Fratantoni. Republished with permission of <a href="https://www.wyza.com.au/articles/health/5-unexpected-side-effects-of-over-the-counter-drugs.aspx">Wyza.com.au.</a>

Legal

GP dies months after noticing pain in shoulder

The sensation of pulling a muscle is one that’s not uncommon for many Australians. But for 63-year-old GP Pauline Vizzard, it was a sign of something worse to come. <a href="http://www.news.com.au/" target="_blank">News.com.au</a> reports family, friends and patients of the normally energetic doctor were shocked when it was revealed the shoulder pain she experienced was not caused by a torn muscle, but an aggressive cancer manifesting in her ribcage. Following her diagnosis Vizzard, who up until that point has been considered fit and healthy, was found to be riddled with disease in her organs and passed within a month. And what makes matters worse, the cause of the cancer was found to be asbestos exposure from Vizzard’s time working at a hospital in the NSW Hunter Region. “It was a surprise on everyone’s behalf,” her son Ben Harrison, 34, told <a href="http://www.news.com.au/" target="_blank">News.com.au</a>. “You sort of associate asbestos cancers with people who may work in industry for all their life, and to have someone who is so removed from what you’d normally expect to be a high-risk industry... there’s no cure for mesothelioma at all, it’s fatal 100 per cent of the time.” After fighting the disease Vizzard passed in April 2015. One patient wrote on a tribute page: “I’m finding it extremely hard to believe this every morning when I wake. Pauline was my doctor close to 30 years. I will miss her dreadfully.” Another said: “Not only a great doctor and an integral part of the Singleton community but an aunty who I have always loved and admired. Sadly missed but so fortunate to have known her.” Around 600 people still die of asbestos-related incidents around Australia each year, with a rise in DIY home renovations believed to be one of the driving forces. The Asbestos Safety and Eradication Agency’s 2016-17 report recorded an increase in occupational exposure to 70 per cent from 64 per cent the previous year." David Jones, Hunter Region executive partner from Carroll & O’Dea Lawyers, which managed Dr Vizzard’s case, said: “As the case demonstrates, mesothelioma has a long latency period after exposure, meaning that workers exposed to asbestos a generation ago might still contract the disease. “Asbestos in situ can still be found in many older public buildings and homes, and as the fabric of these infrastructures containing asbestos products deteriorates, the dangers of exposure to asbestos fibres is on the increase. Many are part of the ageing public infrastructure.” To find your nearest testing lab, call 1800 621 666. If you think you may have been exposed, register details on the <a href="https://www.asbestossafety.gov.au/national-asbestos-exposure-register">National Asbestos Exposure Register</a>.

News

5 tips for finding the right GP

Choosing a general practitioner (GP) for you or your loved ones is an important step on your health journey, but it can be a difficult and stressful decision to make. A good GP will become almost a partner in your wellbeing, as their knowledge of you and your concerns will help them notice problems you may have thought nothing of, and can make carefully informed decisions about referrals, tests, and medication with you. Unfortunately, nothing lasts forever, and there will likely come a time when you must find a new GP. Whether you’ve moved to a new area, your current GP retires, or you’re just not comfortable with them moving forward, here are our top tips for selecting the right GP for you. 1. Ask around Just as you might ask friends for advice on local tradies or coffee spots, the people you know are going to be an invaluable resource for finding your GP. This step can be a good one to take before any others, because you are more likely to hear firsthand why a friend or acquaintance likes or dislikes a certain GP. 2. Narrow your search Did you know that the Australian Government offers a handy online service to help you find medical professionals in your area? <a href="https://www.healthdirect.gov.au/australian-health-services" target="_blank">Visit this link</a> to search for a GP (or dentist, physiotherapist, psychologist, podiatrist, optometrist, etc.) near you. You can narrow down the field by selecting options that are important to you, like whether they bulk bill, accessible parking and building, and what after-hours options are available. 3. Bills, bills, bills Thinking about how a prospective GP bills can be a helpful tool to inform you about their practice. A practice that bulk bills all patients may be more concerned with seeing a greater volume of people each day to maximise their billing. While this is very convenient for some, a practitioner who charges you a gap for their service on top of the Medicare fee is perhaps more likely to spend longer with a patient for in-depth consultations. Considering which of these options is more important to you is helpful information to have going before making up your mind. 4. Bonus level If you have a number of GPs who potentially meet your needs, then it can be helpful to take a look at what extra things each have to offer you as a patient. Things to consider include: <ul> <li>Home visits</li> <li>After hours services</li> <li>Areas of specialisation (many GPs will have extra qualifications that could be helpful to you)</li> <li>Location</li> <li>Ease of booking</li> </ul> 5. Take the plunge Once you believe you’ve found a god candidate, it’s time to meet with them in person. At this first visit, be sure to speak with them about any of your specific health concerns you have – they are going to perform their best when they are armed with all the information. Remember that your initial consultation isn’t an unbreakable vow – if it doesn’t turn out to be a good fit for you, you are under no obligation to go back. What’s your best tip for someone searching for a new GP?

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