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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

Drawings by teen Queen Victoria to go up for auction

A set of 19th century drawings made by a teenage Queen Victoria will be put up for sale at the Old Master, British and European Pictures auction in Roseberys, London next week. A few of the sketches were made when the royal - who reigned from 1837 until her death in 1901 - was still a princess and just 14 years old. Dated July 1833, the drawings depict a knight, a woman, and a veiled woman on a horseback. The fourth drawing was made a year after she ascended the throne, and depicted a woman sitting with a crown and sash, similar to herself, with the inscription: "by Her Majesty." Charlotte Russell, Head of Sales at the auction house, said: "These slightly early drawings show that maybe she was still learning a lot, that she was still honing her craft." "She was very curious and keen as an artist," Russell told CNN. Roseberys set an estimated sale price of £1,500 to £2,500 ($AU2853 to $4755) for the album with the four sketches, as well as works by other artists. Russel added that the album was likely assembled by Augusta Hayter, daughter-in-law of George Hayter, who was the Queen's court painter and painted her coronation portrait. The album also features royal ephemera, including an invitation to the coronation of King George IV at Westminster Abbey in 1821. "I'm interested to see how it performs," Russell said. Queen Victoria was very passionate about art, receiving her first drawing lesson at just eight years old. She went on to be tutored by renowned artists like Edwin Landseer, William Leighton Leitch and Franz Xaver Winterhalter. "She is known to have experimented quite a lot with different subjects," Russel said, adding that Victoria would make "little sketches of costumes of people in the areas" where she travelled. Images: Roseberys Fine Art Auctioneers & Valuers via CNN/ Shutterstock

Art

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

"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

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

"Unsung heroes" win millions in Lotto draw

A group of 50 hospital workers have had their lives changed for the better after winning a huge stake in Saturday's $20 million Lotto draw. The syndicate of healthcare professionals at Fiona Stanley Hospital in Perth had one of five division one-winning tickets, worth a staggering $4 million. The prize will be split between 50 hospital employees, with each of the facility’s “truly unsung heroes” set to receive $80,000 each. The syndicate included staff from all areas of the hospital, including nurses, orderlies, cleaners and supply staff. “I immediately ran down the corridor to my boss’s office,” the ticket holder said. “Then I messaged the group chat to let everyone know, and called those who aren’t on social media to share the good news." “This will be life-changing for a lot of people, and some really touching stories have come out of this experience.” The same group of dedicate Lotto ticket buyers have been trying their luck at a big win for more than a year. “I’ve had not much good luck. I lost my husband seven months ago,” clinical nurse specialist Genevieve Stacey said. “This is not just going to change our lives but the lives of our families as well, so it’s nice to have something good happen.” Some among the group will spend their winnings on family holidays and releasing mortgage pressure, while one staff member also plans to start her long-awaited IVF treatment. Fiona Stanley Fremantle Hospitals Group executive director Neil Doverty said he could not think of a group of people more deserving of the life-changing win. “These staff are often behind the scenes but play a critical role in the day-to-day running of our hospital and caring for our patients,” Doverty said. “They are truly unsung heroes and are incredibly deserving of this win.” Image credits: 7News

Money & Banking

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

“The gate is a no”: Apartment security gate draws ire online

While security gates are meant to be secure, one installed at a property in the UK has left many questioning just how effective it will be. A photo shared by the account Design Fails shows a security gate that seems fully functional at first glance, but includes a glaring design flaw. Though it has locks and an intercom panel, the design of the gate itself lends it to being a handy ladder that could be used to get inside. <blockquote class="twitter-tweet"> security gate that doubles as a ladder <a href="https://t.co/TQWmZBiyc7">pic.twitter.com/TQWmZBiyc7</a> — Design Fails (@epicdesignfails) <a href="https://twitter.com/epicdesignfails/status/1587076092791328768?ref_src=twsrc%5Etfw">October 31, 2022</a></blockquote> “Security gate that doubles as a ladder,” the photo caption read, with the post soon attracting over 33,000 likes, over 6,000 shares and plenty of comments pointing out its fundamental flaw. “OMG What on mother Earth was the designer’s thought doing that,” one person commented. “The gym I never thought I needed. I’d purposefully forget my access card,” another joked. “Whoever designed this gate heaven is waiting for her/him,” a third shared. “So the thieves can climb over the gate 😑,” one user noted. While some tried to defend the design by pointing out that it could be electrified, others were quick to point out the flaws in that argument too. “If its (sic) electric and still has a key, thats weird. To be a gate and a ladder, while not thinking the violator can climb over the gate too is weird. Saying its electrical and not keeping in mind that its on the street is weird. Only turning it on at night is weird,” one person clarified. “The gate is a no.” Image: Twitter

Real Estate

Melissa Doyle draws inspiration from powerful survival tales in her new book

Like millions of people around the world, Melissa Doyle's life was thrown in to disarray when the pandemic hit in March 2020. While being between jobs, stuck at home, and feeling like an empty nester after her eldest child left for university overseas, Melissa found herself at what she describes as "a loose end". While reflecting on her decades-long career and the countless inspirational stories she had heard along the way, she decided to start writing her first book, titled 15 Seconds of Brave. "I wasn't quite sure what to do so I wrote a book about eight different people who have been through extraordinary experiences, some of them pretty harrowing," she told <a href="https://9now.nine.com.au/today/melissa-doyle-15-seconds-of-brave-new-book/5172dc27-f0c6-4530-97ae-a60427f75796" target="_blank" rel="noopener">Today Extra</a>. "Some of these stories I'd held in my hand for many, many years until the time was right to do something with them and this just felt right." Doyle revealed the intricate detail she went into to ensure she did the stories justice, with some of the interviews even taking one whole year to properly unravel. From a child bride who was abducted and turned into a soldier, to people who have battled inner demons and substance abuse, Doyle revisited each one with respect and dignity. "We had to go really gently, a lot of these people I have interviewed previously and I have a habit of keeping in touch with them," she said. "I can't sit down and get them to tell the most traumatic experience of their life and walk away - I check in." 15 Seconds of Brave is available now at all good bookstores. Image credits: Instagram

Books

“A serious chip on her shoulder”: Pauline Hanson refuses to see ‘foreign’ doctors

Pauline Hanson has revealed that she refuses to be treated by doctors trained outside of Australia, claiming that she doesn’t trust them and that they are not up to Australian standards. The controversial leader of the right-wing One Nation party made the revelation while slamming a proposal from Health Minister Brad Hazzard to remove barriers preventing overseas doctors from working in Australia. Mr Hazzard told the <a href="https://www.dailytelegraph.com.au/news/nsw/brad-hazzard-slams-barbed-wire-fence-blocking-foreign-doctors-from-easing-gp-crisis/news-story/c8c2564f2705459be3c745f9fca74c22" target="_blank" rel="noopener">Daily Telegraph</a> that the “barbed wire fence” of red tape medical graduates trained overseas face to practice in New South Wales has forced hundreds of doctors to quit the industry, even as the country faces a GP shortage that risks creating a healthcare “apocalypse”. “This should be ringing alarm bells in the offices of the Federal Health Department and the Royal Australian College of General Practitioners (RACGP),” he said. Speaking to Sky News, Hanson questioned the red tape Mr Hazzard was referring to and went on to claim that his plan would lower the standards in healthcare. “Lowering the standard again which I believe that if you do that and allow these foreign doctors here that are not up to our standards,” she said. “Well then you're going to play Russian roulette with people's lives.” “I personally will not go to a foreign doctor because I don't trust ... the system when I know they've allowed them into this country and most of them don't pass the first test.” To practise medicine in Australia, doctors who have earned medical degrees from overseas institutions need to be registered with the <a href="https://www.medicalboard.gov.au/Registration/International-Medical-Graduates.aspx">Australian Medical Council</a>, which can involve passing a written exam and clinical exam, including demonstrating a minimum standard of English speaking skills through proof of education in English or passing one of several exams. Hanson claimed that a lot of overseas doctors had to take the test “a couple of times” and that many couldn’t pass because “they can’t speak English” - though it is unclear which test she was referring to. “You can't be a doctor in this country if you can't communicate with the patient. It's not good at all,” she said. “If we allow these foreign doctors in that can't pass the test, they've already lowered the standard twice.” To combat this lowering of standards, Hanson said the solution should be paying GPs more to prevent them from moving into specialist areas to get a higher wage. “We've got to stop draining doctors from other countries and bringing them out here to Australia because, you know, we have a world standard in (medicine),” she continued. “The people (Australia is) bringing over from overseas, we're lowering our standards.” Her comments have come under fire across social media, with many rallying to support internationally-trained doctors and praising them for the care they have provided. “Pauline Hanson yet again demonstrated prejudice against foreign trained doctors. Maybe we should fast track our current medical students? Oh that would be lowering standards then as well! And who still has mandates? Misleading bigoted crap once again from this troublemaker!” one person noted. “To all my wonderful colleagues, Australian or from other countries, who Pauline Hanson might consider foreign. I am so sorry. You are wonderful,” one emergency physician <a href="https://twitter.com/KristinJBoyle/status/1579640575925837824" target="_blank" rel="noopener">tweeted</a>. “Our health system depends on you. Thank you for working alongside me and for treating me and my family. 🙏” <blockquote class="twitter-tweet"> My GP came to Australia from overseas, he is an excellent communicator and caring doctor, I thank him for picking up my cancer. What Pauline Hanson is doing is spewing racist bile based on her own prejudices. She is a truly awful human being with a serious chip on her shoulder — Dr Anthony (Tony) Moore 💉💉💉💉 (@PerpetualWinger) <a href="https://twitter.com/PerpetualWinger/status/1579652006733828102?ref_src=twsrc%5Etfw">October 11, 2022</a></blockquote> Another doctor wrote: “My GP came to Australia from overseas, he is an excellent communicator and caring doctor, I thank him for picking up my cancer. “What Pauline Hanson is doing is spewing racist bile based on her own prejudices. She is a truly awful human being with a serious chip on her shoulder.” Image: Sky News

News

Have you fallen for the myth of ‘I can’t draw’? Do it anyway – and reap the reward

Drawing is a powerful tool of communication. It helps build self-understanding and can <a href="https://journals.sagepub.com/doi/abs/10.1177/0276237420923290">boost</a> mental health. But our current focus on productivity, outcomes and “talent” has us thinking about it the wrong way. Too many believe the <a href="http://www.visuallanguagelab.com/P/NC_drawingdevelopment.pdf">myth</a>of “I can’t draw”, when in fact it’s a skill built through practice. Dedicated practice is hard, however, if you’re constantly asking yourself: “What’s the point of drawing?” As I argue in a new <a href="https://www.closure.uni-kiel.de/closure8/fisher">paper</a> in <a href="https://www.closure.uni-kiel.de/start_en">Closure E-Journal for Comic Studies</a>, we need to reframe our concept of what it means to draw, and why we should do it – especially if you think you can’t. Devoting a little time to drawing each day may make you happier, more employable and sustainably productive. <h2>The many benefits of drawing</h2> I’m a keen doodler who turned a hobby into a PhD and then a career. I’ve taught all ages at universities, in library workshops and online. In that time, I’ve noticed many people do not recognise their own potential as a visual artist; self-imposed limitations are common. That’s partly because, over time, drawing as a skill set has been devalued. <a href="https://mili.eu/insights/sunday-times-essential-workers-poll-response">A 2020 poll</a> ranked artist as the top non-essential job. But new jobs are emerging all the time for visual thinkers who can translate complex information into easily understood visuals. Big companies <a href="https://inkfactorystudio.com/">hire</a> comic creators to document corporate meetings visually, so participants can track the flow of ideas in real time. Cartoonists are paid to draft <a href="https://australiacouncil.gov.au/wp-content/uploads/2021/07/Graphic-Storytellers-at-Work-GSAW-Report-Case-Study-One.pdf">innovative, visual contracts</a> for law firms. Perhaps you were told as a child to stop doodling and get back to work. While drawing is often quiet and introspective, it’s certainly not a “waste of time”. On the contrary, it has significant mental health benefits and should be cultivated in children and adults alike. How we feel influences <a href="https://www.researchgate.net/publication/261661107_An_Introduction_to_the_Diagnostic_Drawing_Series_A_Standardized_Tool_for_Diagnostic_and_Clinical_Use">how we draw</a>. Likewise, engaging with drawing affects how we feel; it can help us understand and process our inner world. Art-making can <a href="https://journals.sagepub.com/doi/abs/10.1177/0276237420923290">reduce anxiety</a>, <a href="https://eric.ed.gov/?id=EJ722383">elevate mood</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124538/">improve quality of life</a> and <a href="https://escholarship.org/uc/item/8bq69315">promote general creativity</a>. Art therapy has even been <a href="https://pubmed.ncbi.nlm.nih.gov/16288447/">linked to</a> reduced symptoms of distress and higher quality of life for cancer patients. And it can help you enter a “flow state”, where self-consciousness disappears, focus sharpens, work comes easily to you and mental blockages seem to evaporate. <h2>Cultivating a drawing habit</h2> Cultivating a drawing habit means letting go of biases against drawing and against copying others to learn technique. Resisting the urge to critically compare your work to others’ is also important. Most children don’t care about what’s considered “essential” to a functioning society. They draw instinctively and freely. Part of the reason drawing rates are thought to be <a href="http://mtoku.yourweb.csuchico.edu/vc/Articles/toku/Toku_what%20is%20manga_.html">higher in Japan</a>is their immersion in Manga (Japanese comics), a broadly popular and culturally important medium. Another is an emphasis on diligent practice. Children copy and practise the Manga style, <a href="https://www.jstor.org/stable/20716077">providing a critical stepping stone</a> from free scribbling to controlled representation. Copying is not seen as a no-no; it’s integral to building skill. As researcher and artist Neil Cohn <a href="http://www.visuallanguagelab.com/P/NC_drawingdevelopment.pdf">argues</a>, learning to draw is similar to (and as crucial as) learning language, a skill built through exposure and practice, "Yet, unlike language, we consider it normal for people not to learn to draw, and consider those who do to be exceptional […] Without sufficient practice and exposure to an external system, a basic system persists despite arguably impoverished developmental conditions." So choose an art style you love and copy it. Encourage children to while away hours drawing. Don’t worry about how it turns out. Prioritise the conscious experience of drawing over the result. With regular practice, you may find yourself occasionally melting into states of “<a href="https://en.wikipedia.org/wiki/Flow_(psychology)">flow</a>”, becoming wholly absorbed. A small, regular pocket of time to temporarily escape the busy world and enter a flow state via drawing may help you in other parts of your life. <h2>How to get started</h2> Use simple tools that you’re comfortable with, whether it’s a ballpoint pen on post-it notes, pencil on paper, a dirty window, or a foggy mirror. Times you’d typically be aimlessly scrolling on your phone are prime candidates for a quick sketch. Doodle when you’re on the phone, watching a movie, bored in a waiting room. Together with mindful doodling, drawing from observation and memory form a holy trinity of sustainable proficiency. Drawing from life strengthens your understanding of space and form. Copying other styles gives you a shortcut to new “visual libraries”. Drawing from memory merges the free play of doodling with the mental libraries developed through observation, bringing imagined worlds to life. With time and persistence, you may find yourself producing drawings you’re proud of. At that point, you can ask yourself: what other self-limiting beliefs are holding me back? Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/have-you-fallen-for-the-myth-of-i-cant-draw-do-it-anyway-and-reap-the-rewards-172623" target="_blank" rel="noopener">The Conversation</a>.

Art

Couple ‘draw’ 7,237 kilometre bicycle in name of climate change

A couple has taken a stand against climate change that can be seen from the skies, having cycled more than 7,000 kilometres to create the image of a bike to encourage others to ditch their cars. UK-based couple Arianna Casiraghi and Daniel Rayneau-Kirkhope first took it upon themselves to “draw” a 956-kilometre-wide bicycle across Europe in 2019, telling the Guardian they did it to “draw attention to the scale of climate breakdown” and get others to think about choosing bikes over cars for shorter trips. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/ChRmUTSM9j8/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/ChRmUTSM9j8/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Arianna🇮🇹 - Daniel🇬🇧 - Zola🐶🇫🇮 (@bicycleswillsavetheworld_)</a> </div> </blockquote> Though a pandemic, injuries, and poor weather made their short trip anything but, the Italian-British duo eventually finished the task. After quitting their jobs in 2019 to start the ride, Casiraghi suffered a knee injury that put a hold on their journey until November, when the cold and rain made it so miserable they had to stop again. Plans to restart the ride in March 2020 were derailed, but Casiraghi said finishing what they had started was both for a sense of accomplishment and so they didn’t let down the people who had been following their progress. Their trip, which totalled 131 days of cycling, finally came to an end on August 15 and the couple took to Instagram to share the news. “We have completed our gps-trace drawing! And what a drawing it is!” they wrote. “We cycled 7237 km through 7 countries to draw our massive bicycle and hopefully encourage one or two people to use their bike instead of the car.” The pair revealed they had also beaten several records, including the Guinness World Record for the largest GPS drawing, the unofficial record for the largest one completed by a bicycle, and “we have definitely drawn the biggest bicycle ever!” As if their feat wasn’t impressive enough, the duo also took their Italian water dog, Zola, along for the ride, using custom-built bikes that had a compartment for the pooch to sit in whenever she wasn’t running alongside. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/CeWkHS1s06U/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/CeWkHS1s06U/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Arianna🇮🇹 - Daniel🇬🇧 - Zola🐶🇫🇮 (@bicycleswillsavetheworld_)</a> </div> </blockquote> "We tried to go on small roads where possible, or off-road, so Zola could walk a bit," Rayneau-Kirkhope said. The planning of their drawing was also a complex task, with their first draft route taking them directly through Charles de Gaulle Airport. Reflecting on their trip, the couple said Casiraghi’s injury proved to be “really quite demoralising”. "We had to stop travelling in order to rest and undertake dedicated physiotherapy sessions, which unfortunately meant that our project got delayed," they said. But, people’s reactions to their journey far outshone the harder moments. "The highlight of the trip has been the incredible support that we have received from people along the road," they said. "Without them, cycling through the cold and rainy winter months would simply not have been possible with our tight budget. "We still are amazed about how open-minded and selfless people can be." As for what’s next, the pair said they would be heading home for a rest before hitting the pedals again - though their next trip won’t be so artistic. "Now, we will go home and rest before going for another cycling trip," they said. "No drawing, just pedalling in whichever direction we bloody well please!" Image: @bicycleswilsavetheworld_ (Instagram)

International Travel

Artist can draw with both hands and both feet at the same time

Dutch artist Rajacenna van Dam has taken being ambidextrous to the next level, as she taught herself to not only use both her hands to create her art, but her feet as well. Rajacenna is a former child prodigy who, at the age of 16, was discovered as one of the world’s best and youngest hyper-realistic pencil drawing artists. Now 28 years old, Rajacenna is known worldwide for being quadridextrous, as she uses both her hands and both her feet at the same time to create up to six photo-realistic portraits at the same time. While Rajacenna knew she was talented with her hands, she was surprised to discover the talent transferred to her feet. “I love to challenge myself so I thought why not try for the first time painting with my feet while drawing in a realistic way, while being upside down and also one drawing in 3D,” she said. “It surprised me how much control I was able to have over my feet, something I never realised before. All that time I was drawing while I thought my feet were useless with art and now, I discovered they can do way more than I thought!” Rajacenna’s talent was proven during an EEG scan for a popular scientific TV program when it became clear that during drawing, there is superhuman brain activity to be registered in Rajacenna’s brain, according to neuro therapist and world’s number one EEG Biofeedback expert Bill Scott. Mr Scott said Rajacenna is an “extraordinary human being; she has a very exceptional brain”, claiming, “I have never seen this before in anyone’s brain.” <iframe title="YouTube video player" src="https://www.youtube.com/embed/enZbw1j8-ZE" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Image credits: Youtube

Art

Why bulk billing may be on the verge of collapse

If you’ve noticed that trips to the doctor are getting more expensive, you’re not the only one. With a continuing decline in the number of local GPs, a shortfall of doctors trained overseas arriving in Australia, rising operating costs and plummeting revenue from Medicare rebates, many clinics have been left with no other choice than to start charging fees, including those who need their services most. Over the past decade, the average out-of-pocket expenses for GP services have risen by 60 percent, as reported by <a href="https://www.dailymail.co.uk/news/article-11081047/Australian-GPs-say-bulk-billing-brink-collapse.html" target="_blank" rel="noopener">The Daily Mail</a>. As a result, a growing number of GPs are starting to advise their patients that they can no longer bulk-bill, a practice the Royal Australian College of General Practitioners vice-president Bruce Willett says is no longer sustainable. “It’s now got to the point where practices can no longer sustain bulk billing,” he told The Australian. Director Peter Stratmann said bulk billing no longer being a viable option has resulted in the sector heading to the brink of collapse, with clinics closing and a need to charge fees to make ends meet. “We've seen practices having to close and increasingly in the last number of weeks we've seen practices impose private billing fees, because otherwise they won't make it,” Dr Stratmann said. “They just can't make ends meet without imposing some private fees.” Dr Stratmann admitted that this will put pensioners in a difficult position and that he fears they will overwhelm the hospital system for non-urgent care. In 2021, almost nine out of ten GP visits in Australia were bulk billed with no out-of-pocket expenses for the patient, with GP bulk billing rates growing to a record high of 88.4 percent in the December quarter according to Medicare data. The news comes just days after health minister Mark Butler addressed the issues facing primary care at the annual Australasian Medical Association conference, saying it is in “worse shape than it’s been in the entire Medicare era”. “It's hard enough to get a GP right now and we know that the current generation of older GPs are pretty exhausted, particularly over the last two and a half years, and we just do not have the pipeline coming through,” Mr Butler said. 'It is probably the most terrifying trend that I see in primary care.' As part of its commitment to general practice, the federal government has established the Strengthening Medicare Taskforce, boosted by a $750 million Strengthening Medicare fund. “The government is committed to ensuring Australians get the care they need, when they need it and without worrying about the cost,” Mr Butler said. Image: Getty Images

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Have you fallen for the myth of ‘I can’t draw’? Do it anyway – and reap the reward

Couple ‘draw’ 7,237 kilometre bicycle in name of climate change

Artist can draw with both hands and both feet at the same time

Why bulk billing may be on the verge of collapse

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