WA News Doctor Polls
Poll Results
Availability of naloxone November - 2014

Nearly half of the 146 respondents to this question who were both GPs and Specialists were supportive of this question. 

Q Should naloxone be available to non-medical people to administer to someone in a crisis due to drug overdose?

Yes             45%
No               26%
Uncertain    29%

 

 
Childhood Vaccination July - 2014

165 General Practitioners (64% male) took time to give us their opinion on issues to do with childhood vaccination, all in news of late. Thanks..

Q Should parents who are conscientious objectors to the vaccination of their children still receive the Family Tax Benefit Part A end-of-year supplement of $726?

Yes             15%

No               72%

Uncertain    13%

ED. This punitive measure has been suggested by proponents of mass vaccination campaigns.

Q Should doctors be able to use ‘public health reasons’ to explain their refusal to co-sign the Conscientious Objector forms of parents who forgo vaccination for their children?

Yes            77%

No             14%

Uncertain    9%

ED. What’s good for the goose is good for the gander, it seems – GPs believe they should be able to apply a right of refusal too. Whether this is for professional, moral, or other reasons is irrelevant. It appears to be more of a case-by-case consideration. A bit like pregnancy termination, we guess. It would be a matter of treating differing patient opinions with respect and to refuse openly.

Q Just over 20% of young kids in WA are unvaccinated for different reasons, with about 2% of parents registered conscientious objectors. As far as you know, what percentage of unvaccinated kids is required before “herd immunity” breaks down and some infectious disease outbreaks are more likely as a result?

1-5%          6%

6-10%      31%

11-20%    40%

21-30%    15%

31-50%      5%

>50%         3%

ED. First, GP gender did not significantly alter responses. Next, we realise this is a very vexed question, for which “depends” is a good response! Even the experts don’t agree. Dr Chris Blyth has attempted to explain  – natural variations between infecting bugs, the longevity of vaccinations, age at vaccination, previous exposure to ‘natural’ infection, how exposure risk occurs, etc., can all play a part. Herein lies the Catch 22 – we would like to send simple messages to health consumers to vaccinate, yet at higher population vaccination rates, the medical answers may not be simple, and responding simply arms the antagonists.

 
Caesarean Rates July - 2014

165 GPs offered these opinions (64% were male), also reported in the July edition Editorial.

Q Do you believe WA's Caesarean Rate is appropriately linked to medical and obstetrical complications?

Response       Male    Female    Both

Yes                 35%      24%        31%

No                   35%      51%        41%

Uncertain        30%      25%        28%

 

Q You answered 'No' to the last question. Where do you believe most inappropriate linkage occurs?

Private Sector     73%

Public Sector         3%

Both                     18%

Neither                  2%

Uncertain              4%

 ED. 66 respondents answered ‘No’ to the first question, so received the supplementary question. There were no significant differences in responses based on GP gender.


Doctors Comment

Comments hinted at motivation, roughly in frequency order:

•    Convenience/social demand – “I hear regularly of 'convenience' caesareans”, “patients demand them, obstetricians comply”, “lots of caesareans in the private sector are mother's choice operations – not linked to medical or obstetric reasons, only personal ones”, and “too much mother and obstetrician convenience”.

•    Defensive medicine – “cause inappropriate caesareans”, “probably the fault of the lawyers”, “for medico-legal reasons”

•    Fear – “too many inductions and ops”, while another said “there are more IVF patients”

•    Other – vaginal delivery is seen as “messy, even in doctor patients”

We laughed when one doctor referred to one private hospital as “Caesar Palace”.

Supportive of caesarean

One comment supported patient choice, while another said “you can plan on safe delivery and the time you want it” while another said caesareans are safe.

A rural perspective: “As a country doc I see large numbers of patients booking caesarean sections for reasons of timing, especially rather than trialling VBAC”

“Should be performed much more readily, contrary to the foam-at-the-mouth zealots' opinion.”

“There are no prizes for achieving a vaginal birth, particularly if any risk involved. All the incentives in the system are weighted in favour of the quicker and less stressful option. The risk of caesarean section is pretty low so it's not rocket science to work out why this option is readily resorted to.”

Legitimate reasons for caesareans

“There has been a push to reduce these and allow babies to go too far overdue – I believe that 10 days over is the max and not drive oversized babies through borderline-sized pelvises. For the short-term gain this generally results in gynae problems later in life.”

“My patients are Aboriginal obese diabetics with alcohol problems so reckon CS rate justified.”

“With the older mums, more obese mums and larger distances, WA has a higher need for C sections.”

Still grappling with issues

“Should they just be offered in cases of medical or obstetric complications? Should we deny woman all right to decide on their choice of delivery?”

“Antenatal counselling important”, “patients should be given more time to deliver vaginally” and “too much science, not enough art.”

Role of the obstetricians

Five said obstetricians either had the best interests of mothers and babies in mind, were trustworthy, gave very good obstetrical care, or will choose LSCS on appropriate clinical criteria most of the time.

Other comments were not so favourable.

“The caesarean rate in the private sector is inappropriately high, and in conducting informed consent of patients regarding elective caesarean, inadequate information about the risks is commonly given”, “I don't know the evidence well enough but I cannot see why WA would have complication rates that much higher than the rest of the country and the world, so I suspect the caesarian rates are too high.” and “WHO data suggests that a rate of about 10% is essential.”

Vaginal birth after caesarean (VBAC)

One of our e-Poll respondents said, “Far too high a caesarean section rate in private for all sorts of spurious reasons e.g. big baby with a trial of labour. Only place you can safely have a VBAC these days is KEMH and perhaps other smaller government hospital with rostered on doctors 24/7.”

 

 
Impacts of the Federal Budget - June 2014

165 GPs were surveyed on issues arising from the 2014 Federal Budget and their views on political advocacy for general practice..

Do you agree with the RACGP: that if any money is collected as a GP co-payment it should go back into primary care research?

Yes                 32%

No                   45%

Uncertain        23%

 

 

.

Would you like to see the RACGP take on a greater political advocacy role for General Practice?

Yes             76%

No               15%

Undecided    9%


Comments
WA GPs strongly support the RACGP taking on a greater political advocacy on their behalf with more than three quarters of the 165 e-Poll respondents urging them on. Of the 63 who left a comment, one thought a College member should run for parliament while another thought more militancy was required.

The effectiveness of both the RACGP and the AMA to stand up for general practice was brought into question by a number of doctors – some thought the AMA was more professional and had trained advocates, while others thought the RACGP was not inclusive enough and not up to the task. One doctors put it: “RACGP is for education and standards. AMA is for political advocacy.”

“History has shown that when the RACGP gets involved in advocacy, the government has succeeded in ‘Divide and conquer’ against the AMA and thereby weakened the profession,” one said.

But for many who responded, it was with concern for general practice that was uppermost with one pleading to “stop the slow destruction of general practice” and another: “GPs need a strong voice with political clout. Does the RACGP have this? It ought to.”

“GPs need representation and unification. Someone needs to effectively advocate on behalf of us. Why should we continue to subsidise ‘free’ health care by accepting pitiful MBS rebates that in no way reflect our effort, training and experience?”

“I believe GPs are not respected enough. The nurses union and pharmacy guild are so much more powerful. Such a shame. GPs should be strongly supported and backed up in every possible way to make it sustainable to run a smooth and dynamic practice with the patients’ health and wellbeing a priority.”

ED: There was no apparent gender influence in the results.

 

.

Medicare Locals are to change under federal government direction. From what you understand so far about those changes, how do you regard them?

Negatively         21%

Positively           14%

Uncertain           65%

Comments
52 of the 165 GP respondents left a comment and most thought Medicare Locals were a waste of money and should be abandoned, labelling them “white elephants”; “useless money-spending red-tapers”; “irrelevant” and “political nonsense so far removed from real life it is a joke”.

One said MLs gave less direct support to GPs in rural areas compared to the previous set-up.

Of the few who thought they had potential, lamented the constant changing/rebranding of primary care services.

Several thought MLs should be adjusted, not scrapped. One doctor said: “MLs provide a great service to too few and at great cost”.

A supporter wrote: “Without them it is likely we will return to a much less personalised service which will be more costly and less efficient” and another described them as “very useful especially in areas of high need”.

 

Do you believe those under age 35 who receive the Disability Support Pension should have the accuracy of their disability claims reviewed?

Yes              81%
No                11%
Uncertain     8%

 

Do you think government should withdraw existing incentive payments to Emergency Departments that are meeting 4-hour rule targets??

Yes                36%
No                  41%
Uncertain       23%

 

 


 

 
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