WA News Doctor Polls
Poll Results
Sexy Early, Child Abuse and Flu Vax in Pregnancy – April 12

Girl-with-lipstick70x5592 General Practitioners took part. Answers point to us arming children to self-protect against abuse and question the role of the media in sexualisation of young girls. And when it comes to vaccination recommendations in pregnancy, most GPs have got it right.

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

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

Mandatory reporting for those in public office                                                62%   

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

Police clearances for people working with children                                        37%   

Restrictions on legal practitioners                                                                    13%   

Other                                                                                                                8%

                                                                                   

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

Television and cinema shows           84%     

Advertising                                        80%     

Media coverage                                 72%     

Peer pressure                                    69%     

Schooling                                           14%     

Environmental chemicals                   2%       

Natural biological change                  4%       

Other                                                  7%       

Uncertain                                           0%

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

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

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

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

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

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

“Bratz dolls and the like are to blame.”

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

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

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

Never – contraindicated in pregnancy                                                          9%        

First trimester                                                                                                2%        

Second or third trimesters                                                                             22%      

Anytime during influenza season and regardless of gestational age            52%      

Uncertain                                                                                                       14%

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

                     

 
Trust Me, I’m a Doctor - April 12

male-patient-consult70x55We talk to the 100 GPs and 71 Specialists about doctors and trust, and ask further questions of another 92 GPs. How much is the ability of doctors to assist patients built on a bond of trust, where the patient trusts the doctor to act in their best interests. Around 90% of respondents felt such a bond was extremely or very important to their success as doctors and more (97% specialists; 96% GPs) said personal trust in another doctor, for whatever reason, was equally important for a good working relationship with that doctor.

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

                                          Specs        GPs

Extremely important       59%           45%

Very important                 31%           46%

Slightly important             4%             9%

Not important                    3%             0%

Not sure                             2%             0%

Doesn’t apply                     2%             0%

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

                                                  Spec            GPs

Extremely important               59%             43%

Very important                         38%             53%

Slightly important                     2%               4%

Not important                            2%               0%

Not sure                                    0%               0%

Doesn’t apply                            0%               0%

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

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

                                                                                                                Spec           GPs

Commercialisation of medicine.                                                            79%            65%

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

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

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

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

Other (please indicate below).                                                              8%              19%

Uncertain.                                                                                              0%              2%

'Other' damaging reasons?

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

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

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

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

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

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

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

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

Money misappropriation                                                     38%         

Medical mistakes by doctors                                              37%         

Sexual misconduct by doctors                                            37%         

Drug abuse while practising                                                22%         

Failure to report adverse events affecting patients         22%         

Consulting while significantly impaired                            19%         

Combat sport                                                                         11%         

Pregnancy termination                                                         8%           

Other                                                                                       6%           

Uncertain                                                                                 14%         

None – disagree with this idea                                            20%

        

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

Specialists

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

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

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

General Practitioners

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

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

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

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

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

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

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

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

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

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

 
Drinking in Pregancy, Big Tobacco, Profit Over Health, Health Waste Concerns - March12

Foetal-alcohol-TN-epollThanks to all the Specialists (n=71) and GPs (n=100) who responded to our E-poll within the short 7-day window. We were overwhelmed by the comments made, which is great! Many answers show strong similarities between the two professional groups, particularly on the broad-brush issues.

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

smoking-girl-epoll                        GPs            Spec

Yes                  26%            27%         

No                   46%            48%         

Uncertain        28%            25%

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

                                                                                                       GPs       Spec

Yes, by missing it altogether.                                                  25%        15%        

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

No                                                                                                    6%           7%          

Uncertain                                                                                       28%         39%        

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

  Pregnant-couple-epoll                                      GPs               Spec

Yes                                 31%              37%  

No                                   59%              44%  

Uncertain                      10%              19%

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

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

piggy-bank-drmstm-epoll                            GPs               Spec

Yes                      79%              80%  

No                       13%              17%  

Uncertain            8%                3%

 

Comments on Profits before Human Health

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key Pointers

These responses are roughly in order of frequency…

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

Other Noteworthy Anecdotes

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

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

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

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

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

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

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

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

 
Palliative Care & Aged Care - November 11

old-man70x55In this e-poll, WA medicos yearn for simplified access to aged care for patients and a smoother palliative care transition but have shied away from supporting voluntary euthanasia laws. 173 GPs and Specialists spoke out on aged care and palliative care issues. Three of our questions compare with July 2008. The difference three years make….

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

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

21%  Yes, but for some services only

7%   Current system works well – no change needed

22%  Uncertain

2%   None of the above

Comments on simplifying patient access to aged care services

The 33 medicos who commented found the issue complex.

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

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

Three pointed to technology, such as:

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

Three had concerns about replacing the GP, such as:

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

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

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

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

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

42%  Too much paperwork involved

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

28%  Lack of competent nursing staff to provide support

25%  Elderly patient problems are too complex and overwhelming.

22%  Lack of backup support from specialists and suchlike.

22%  Clinical practice rather limited and potentially unsatisfying.

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

16%  None of the above.

9%   Other

Would you work in aged care?

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

Negative (or at least, pessimistic) comments included:

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

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

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

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

33%  Helpful but only for limited clinical scenarios.

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

21%  Good in theory, virtually useless in practice.

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

2%   Uncertain

1%   None of the above

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

33%  Rarely report

25%  Most

13%  Nearly all

3%   Less than half

5%   Less than a quarter

5%   None

7%   Uncertain

9%   Doesn’t apply

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

62%  Yes

19%  No

16%  Uncertain

3%  Doesn’t apply

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

2008   2011

1%      10%  I know the laws very well.

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

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

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

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

2008    2011

35%     21%  Yes

37%     56%  No

28%     23%  Unsure

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

36%  Usually happens at the appropriate time

33%  Often occurs too late 

9%   Mostly not managed properly

2%   Often occurs too early

8%   Doesn’t apply                

2%   None of the above

10%  Uncertain

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

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

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

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

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

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

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

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

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

 
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