WA News Doctor Polls
Poll Results
Organ and Tissue Donation - Mar11

epoll-ICU-pic252 specialists and GPs undertook this survey. More information on this important topic is available from DonateLife – 9222 222, visit www.donatelife.gov.au

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

Very confident               36.1%

Somewhat confident     40.8%

Not confident                 14.2%

Doesn’t apply                  8.7%

COMMENT

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

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

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

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

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

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

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

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

No              43.6%

Yes           23.0%

Uncertain  33.3%

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

No                    52.7%

Yes                 25.3%

Uncertain        21.8%

COMMENT

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

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

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

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

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

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

None of the above 2.7%

COMMENT

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

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

Australian Organ Donor Register    82.1%

Driver’s Licence renewal                67.8%

Medicare Website                            36.9%

Uncertain                                          4.7%

COMMENT

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

 
The e-Health Record? – Feb11

Epoll-single-figureJust before Christmas, 151 GPs took time to give their opinion on the federal government’s proposed e-Health record for health consumers. Many GPs remain to be convinced it is a good idea and, reading between the lines, they feel they will be left to patch up system failures, which will equate to more work.

The federal government is allocating $55m in grants to healthcare organisations to develop voluntary patient-controlled e-health records (PCEHR) as lead sites, prior to the nation’s e-health rollout. Limited health record repositories, discharge summaries and medication management are initial possibilities before more comprehensive systems are introduced some time after 2012. Tick the box for any likely benefit you think the e-health record will create.

Cost-effective streamlining of patient management across boundaries such as GP-hospital.     55%

Increase patient responsibility for self care.                                                                                  34%

Less paperwork for treating doctors.                                                                                            16%

Reduce medicolegal risk for those providing treatments.                                                               11%

None of the above.                                                                                                                         16%

Uncertain                                                                                                                                        17%

After WikiLeaks you would have to be joking about confidentiality.

No amount of money thrown into it will guarantee benefits are realised. There are also potential disadvantages. For example, increased clerical time/load per patient, breaches of confidentiality and security, clerical errors potentially more harmful as they will be more difficult to address, and limited resources (especially rural and remote) mean a system of paper records will need to maintained in addition to electronic records.

I am in favour of an e-Health record as today’s population is very mobile.

It’s a great idea that will hopefully improve communication between hospital and GPs, which seems to be currently fuelled by a systemic disregard and disrespect for GPs.

There could be major savings in avoiding duplication of tests. Good for patients who see more than one GP/specialist to provide continuity.

I think it will confuse and delay the majority of doctors: IT savvy doctors may do OK, but the majority will either ignore it or abuse it.

I work for WACHS and the heirarchy is pathologically resistant to e-Health and thus we spend unnecessary time faxing and scribbling and chasing up old notes.

It’s only going to create more work for GPs as patients will want to know what is in the record. Patient safety will be compromised because there will be innate pressure to not ‘out’ details that a patient could misinterpret as being defamatory.

Whilst there will be streamlining of patient management across a GP hospital boundary - this will not be cost effective. Emergency department junior staff and GPs will bare the brunt - as they always have.

Multiple issues here including patients typing in pages about their hangnail experiences, forgetting their tokens, missing out data, costs of entering data, costs of checking that it is correct etc.

Big task; most patients do not want to control the record; they want the GP to do it. They do not have the health literacy - this kind of stuff is professional consumer driven and must be seen in that light.

The patient's for whom this would be useful are unlikely to comply.

Every time we give over any form of management to government it becomes a paperwork nightmare filled with bureaucracy.

What a ridiculous idea of a patient controlled medical record. Perhaps they can do their own surgery and insert their own IUDs etc. Good grief.

I'm concerned this will lead to "lazy" history taking and perpetuation of errors. IT should be concentrating on sharing of lab and radiology initially, to reduce unnecessary investigation costs.

 
Just for Fun – Waiting Room Antics – Jan11

We asked GPs to respond to this question, "One mind-boggling thing to happen in our waiting area was….” You might be surprised by some of the answers!

Finding a baby dugite under a chair.

Wife abusing husband on the telephone.

Bleeding drunk trying to fight four police officers.

This could only happen in Midland. A local drug dealer chased a customer who owed money down the street. The addict fled into the next door pharmacy, knocked over a display and ran through our front door yelling for help. Our smallest receptionist did not faint or scream. She drew herself up to her full height and said to him, "Listen buddy I'm pregnant and in a bad mood so shut up and sit in the back room".

The mother who loudly declined to pick up her kid’s mess (pamphlets tossed everywhere) as they had been kept waiting. The rest of the patients in the waiting room promptly leapt up and cleaned up not wishing to be associated with such a woman.

The day a car reversed though the wall into the waiting room, stopping just shy of a 94 yo lady who said "Now I've seen everything".

When one of the receptionists vaulted the counter to save a patient who was fainting in front of her. Truly worthy of Jana.

When a little toddler got his head caught at the reception counter and I was called to act as the fireman and rescue him!

A young patient entered the waiting room with a handkerchief over his bleeding hand and took the opportunity to show the waiting patients his severed and bloody digit which cleared the room immediately!

A patient from Iceland registering to be seen, collapsed in the ED, was resuscitated for 35 mins, sent to cath lab, stenting done for complete blockage of left coronary vessel and came out fine from hospital.

Two out of three patients waiting had exactly same name.

The hail breaking through the skylights and drenching the clientele.

The gentle collapse of a chair from the weight of obese patient as it buckled with metal fatigue, in slow motion.

A patient dancing to Roy Orbison.

The woman with bird flu fought with the man with the swine flu over who should get in first.

The mother who totally ignored the fact that her child had urinated on the floor.

The day an old lady came in with a parrot on her shoulder, the main problem being it wasn’t toilet trained.

One long waiting gregarious octagenarian publicly asking all the other 'oldies' what they had done with their lives. One had survived Dunkirk, three had been shot down during WW2 and all regarded every day since as a bonus day. Made me think about the potential for grouping appointments and introducing such people to each other.

A toddler with an incredibly smelly nappy.

A man who pleasantly waited for patients with relatively trivial complaints, then presented with his detached finger.

 
Working Trends for Practice Managers - Dec10

Epolll-desktopAn amazing 16% of the 500 busy Practice Managers answered our questions just before Christmas. Most were from general practice. For your interest, we repeated some of the questions from our April 2008 survey, so trends become more evident.

How important do you consider ongoing training (Continuing Professional Development) in giving you the tools to improve your practice management?

Critically important 37%

Very important      49%

Take it or leave it   9%

Not very important 3%

Uncertain               2%

Ed. Nearly 9 out of 10 practice managers attach importance to ongoing training as a mechanism for improvement.

COMMENTS on CPD (representative sample).

“We need to constantly update our skills, especially in the area of computer skills and understanding of new technology that keeps coming out.

“It’s very important to review all management skills regularly to ascertain that we are all performing optimally.

Would love to have access to more CPD days in the country, perhaps a central location for all country practices to attend and network.

“It's hard, and sometimes you feel like it's a waste of time, however, it can be years before you realise you've used the information without even knowing it.

“I am not trained specifically in practice management and have learned on the job, thus I highly value CPD to ensure I am following best practice and not just long established procedures that may not be up-to-date anymore.

“CPD is vital but too much emphasis is placed on doing hugely expensive courses rather than being offered more practical and cheaper opportunities.

“I think that CPD inspires enthusiasm and keeps us up-to-date, which is all important.

Do you think a system of professional accreditation for Practice Managers is a good idea?

Yes 42%

No 27%

Uncertain 31%

Ed. Although the vast majority of practice managers thought CPD was important in maintaining proficiency, less than half believe accreditation that measures proficiency is a good idea.

Does your practice provide financial support (time off, paid training) for your professional development?

                     2008       2011

Yes              77%       69%

No                20%       24%

Uncertain     3%         7%

How valued do you feel in your work?

                                    2008   2011

Highly valued             53%    35%

Valued                        40%   46%

Undervalued               7%     15%

Highly undervalued     0%      5%

Uncertain                    N/A     0%

Ed. A rising number of practice managers – now 1 in 5 – feel undervalued in their work. Is this a reflection of working conditions (e.g. wages), deteriorating relationships in the practice, or corporation (see next question)?

What do you consider to be the most important aspect(s) in achieving job satisfaction in your role as a practice manager? [multiple choise]

A happy working team                                                    96%

Transparent and honest communication with the team  57%

Flexibility                                                                         49%

Making a difference to patient care                                49%

Autonomy                                                                       36%

Other                                                                              5%

Do you feel you have sufficient autonomy in making decisions within your practice?

                   2008    2011

Yes            83%     70%

No              7%       22%

Uncertain   10%     7%

Ed. Surprisingly, practice manager autonomy is on the decline. Or does this simply reflects a higher rate of corporatisation of practices in our 2010 sample?

1. Within our samples, AAPM has not increased its representation in the last two years, which remains just over half; around 5% of practice managers still appear to be nurse trained.

4. Fewer practices seem to be investing in the professional development of their practice managers, down from 77% to 69% in the last two years.

5. The incidence of practice managers who feel undervalued in their work has trebled in the last two years, from 7% to 20%, while there has been a coinciding drop in those who felt highly valued, from 53% to 35%.

7. The proportion of practice managers who feel they are not given autonomy in decision making has trebled within our samples, from 7% to 22%.

8. Decisions on medical equipment/consumables and practice software are less the domain of practice managers than they were two years ago, when our two samples are compared.

9. In recruiting reception staff, use of the internet has increased, while word-of-mouth has decreased and use of The West Australian has decreased even more dramatically.

10. Within our surveyed sample this year, there are fewer practice managers with formal qualifications. In fact, nearly half are without any relevant qualification even though virtually all believe CPD is important, and three quarters are supported by their practices in that regard.

 
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