WA News Doctor Polls
Poll Results
Kid’s Sport, Teen Talk, and Medicare Locals - August 11

 

boy_sportsdrink70x55The adolescent questions were partly prompted by the Health Department, which is keen to give children access to good information given that sexual health education is not mandatory in schools. Sports sponsorship has been in the news with the wrangle between the Sports Federation of WA and Healthway – many of our surveyed GPs did not see this as a ‘black and white’ issue. Medicare Locals have been causing disquiet among GPs, so we added questions about this vague but important topic as well. 103 GPs participated, thanks, despite mid-year school holidays.

boy_sportsdrink

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

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

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

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

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

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


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

Not a worry

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

“Sports are sports, no matter who sponsors.”

Parent’s responsibility

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

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

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

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

Sponsorship helps

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

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

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

An unnecessary evil

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

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

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

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

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

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

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

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

Do they usually ask in private or with their parents?

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

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

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

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


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

The mature stance

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

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

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

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

A prickly proposition

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

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

Or is it?

“They are really receptive if engaged properly.”

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

Tackling all the issues

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

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

 

medicare_bed_overlay

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

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

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

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

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

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

Constructive criticism

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

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

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

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

Confusion and suspicion

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

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

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

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

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

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

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

A waste of time and money

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

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

“Abolish them and fund/support GPs properly.”

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

Government interference

“Another completely unnecessary layer in the bureaucracy.”

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

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

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

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

 
Male Medicos Talk About Men's Health - July11

Crazy-Man-TNepollMen’s Health is a broad subject, so to narrow the perspective, we surveyed WA’s male Specialists and GPs on the hot issues of what underlies male violence, men’s health support services, HPV vaccination for males, and the use of chaperones when doctors examine female patients. 197 medicos participated.

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

Family breakdown 67%

A violent upbringing 67%

Exposure to violent media 54%

Relationship problems 43%

Permissive parenting 41%

Mental illness 40%

Bullying 27%

Lack of other physical outlets 25%

Absent fathers 23%

No-one to confide in 13%

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

Alcohol consumption 69%

Illicit drug use 17%

Perceived lack of consequences 9%

Trying to impress mates 1%

Ethnic differences 1%

Other* 3%

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

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

Alcohol and Drug Abuse

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

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

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

Influence of Violent Media

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

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

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

Parenting Concerns

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

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

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

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

Patient most likely will decline 35%

Often no service available 32%

Patient embarrassment 9%

Lacks time or timing inconvenient 7%

Cost prohibitive 1%

Other* 16%

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

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

List here* 10%

Rarely/Don’t refer 46%

Doesn’t apply 44%

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

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

Yes 74%

No 4%

Unsure 22%

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

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

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

Mental health 71%

Diet/Overweight 60%

Domestic violence 41%

Smoking 34%

Parenting 31%

Accident/Injury prevention 23%

Prostate problems 13%

Sexually transmitted infections 8%

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

Other* 12%

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

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

No 51%  

Yes 25%

Unsure 24%

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

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

Never 10%

Occasional, if concerned 21%

Most of the time 15%

Always 26%

Doesn’t apply 28%

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

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

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

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

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

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

 
Female GPs Talk About WA's Caesarean Rate - April11

Pregnant-woman-epollIn WA one in three women are having their babies surgically removed rather than by vaginal birth. For enlightenment on the underlying issues, female GPs comment – those with enough medical knowledge for a well-informed opinion but also a high awareness of overall female attitudes. The results from the 126 survey respondents are enthralling.

 

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

Very upset or alarmed 3.9%

Worried and want a satisfactory explanation 30.1%

Not affected in either a positive or negative way 19.0%

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

No emotional reaction 21.4%

None of the above 6.3%

 

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

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

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

The rate reflects maternal requests. 19.0%

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

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

None of the above. 17.4%

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

 

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

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

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

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

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

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

The figures reflect best practice in obstetrics. 12.6%

None of the above 7.9%

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
Cardiovascular health, exercise and weight loss - Mar11

epoll-couple-leapfrogOur questions probing cardiovascular health and its relationship with exercise and weight loss drew responses from both GPs and specialists (n=252). The results are interesting, to say the least.

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

Lack of personal motivation                       87.6%

Too busy a lifestyle                                   67.0%

Too expensive                                          38.8%

Lack of support from family and friends  21.4%

Lack of facilities                                       13.0%

Too much emphasis on weight loss        11.5%

Frightened of doing themself damage      9.9%

Doesn’t apply                                            3.9%

Other (only 3 elaborated).                        8.3%

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

Over emphasised                19.4%

At a reasonable level           41.6%

Under emphasised              37.6%

These included opinions that:

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

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

Too much advertising for products that help reduce weight.

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

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

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

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

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

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

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

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

 
<< Start < Prev 1 2 3 4 5 6 7 8 9 10 Next > End >>

Page 9 of 22