Fifteen things good doctors should avoid – Choosing Wisely II

Less is moreThis is important reading if you’re a doctor.

And maybe of some interest even if you’re not.

Following this year’s successful launch of the Choosing Wisely Australia campaign by NPS Medicinewise, we have produced a second round of recommendations about unnecessary tests, treatments and procedures.

I chair the RACGP working group, and we have just shortlisted the  fifteen items shown below. Yesterday we sent the list to all RACGP members for a ‘top five’ vote, although many wanted to vote for all 15!

This is part of the important conversation among doctors and patients that sometimes, less is more. Over-testing and over-treating can harm patients both directly, and also by robbing time and resources that would be better spent on things that are actually helpful.

No surprise if some items are a tad controversial – we have deliberately focused on tests and treatments that are commonly used by Australian doctors.


  1. Don’t routinely perform a pelvic examination when doing a Pap smear or prescribing an oral contraceptive
  2. Don’t advocate screening mammography in women < 50 yo or > 74, unless high-risk
  3. Don’t order colonoscopy as screening test for bowel cancer in the 98% of population where faecal occult blood testing (FOBT) is recommended

Continue reading

Posted in medical education, Naked Doctor | Tagged , , , , , , , | 1 Comment

Don’t just sign on the dotted line: assessing fitness to drive

Dr Justin Coleman:

My friend and colleague Genevieve Yates tells her tragic story of losing her partner to an elderly car driver earlier this year. She reminds us that driving is a privilege, not a right, and that doctors who sign ‘fitness to drive’ paperwork have a responsibility which extends beyond the person sitting in front of them.

Originally posted on Genevieve's anthology:

The RACGP 15 conference is on in Melbourne next month and as part of the focus on social media, there is a Pecha Kucha competition.  Members of the Facebook group, GPs Down Under, are being encouraged to prepare a Pecha Kucha talk – a 6min40sec talk comprising of 20 slides, each lasting 20 seconds – on a topic about which we feel passionate.

I have put together a talk to try to raise awareness of the importance of the doctor’s role in assessing our patients’ fitness to drive. I also talk about the valuable “virtual” support that can come from online communities.

I hope that by sharing my personal story in this way, it will help encourage other doctors to be more mindful.  This might just result, indirectly at least, in someone’s husband, wife or child being spared. Of course, I have no way of knowing if it will, but…

View original 36 more words

Posted in Uncategorized | Leave a comment

The neglected art of stopping medications

Whenever a medication is re-prescribed, some thought should be given to the important art of ‘deprescribing’.

Doctors are taught far more about starting medications than stopping them, and most pharmaceutical research ignores the ‘cessation’ question altogether. Each 6-monthly round of prescriptions inevitably seems to include more than the last.

Some categories of drugs are particularly prone to outstaying their welcome, long after the initial problem has resolved – just think of antidepressants, opioids and vitamin B12 injections.

Our team of five GPs on the Choosing Wisely Australia initiative decided to highlight the example of stomach antacids as a classic example of over-prescription.

These ‘proton pump inhibitors’ (PPIs) are wonderfully effective at reducing acid reflux symptoms, but unfortunately patients tend to stay on them long after the symptoms have resolved. Not only for months, but years – even decades!

Why? Well, heavy marketing helps, and also the aforementioned relative lack of education and discussion among doctors about pressing the ‘delete’ button in their prescribing software.

DEPRESCRIBING: the one topic you can guarantee never makes the agenda during a pharmaceutical-sponsored education evening!

Last week I put my creative juices to work, and produced this 3-minute video about deprescribing PPIs. It took far more hours’ work than I like to admit (I had to learn to draw, for a start!), so please do share it on your own social media if you can.

Even if you’re not a prescriber yourself, a share might go a little way towards highlighting the issue. By the time we all get old and juggle ten medications, we’d better hope plenty of research and educational effort has been put into deprescribing!


Posted in Naked Doctor | Tagged , , , , , , , | 2 Comments

GPs Down Under

Pic by Doc Paul

Pic by Doc Paul

I GPDU; do U?

If that sentence makes any sense, you’re probably already a member of the Facebook group GPs Down Under. And a good interpreter of poor syntax. It’s the only phrase I’ve ever written which has been turned into a badge, useful for starting conversations at medical conferences and stopping them at parties.

GPs Down Under has changed my life. Well, not in the way my wife has, or salted caramel ice cream.

But the GPDU discussions with colleagues from around Australia have, more than anything else in the past year, enhanced both my clinical judgement and enthusiasm for my chosen career.

Last year a couple of GPs, granted asylum here from the terrorised British NHS, started a ‘closed’ Facebook page for GPs to discuss an interesting article, a patient treatment conundrum, or medical politics.

Members could post photos of de-identified patients with permission, and of identified health ministers without it. Continue reading

Posted in medical writing | Tagged , , , , , | 3 Comments

Newsflash: doctor sees patients on time

The doctor will see you shortly Pic by

The doctor will see you shortly
Pic by

BRISBANE: At a suburban clinic yesterday, every single patient during the morning session was called into their appointment on time.

Dr Justin Coleman, GP at Inala Indigenous Health, described the extraordinary circumstances to reporters camped outside his surgery today.

“It just kind of crept up,” said the bewildered medico. “Like, the first insurance medical who forgot to bring his paperwork. We just sort of shrugged our shoulders as he left—and the meter had barely started ticking.”

“Later, one of my regulars announced ‘I only want a quick script,’ and really meant it. Literally! I think she was late for bridge,” mused Coleman, shaking his head contentedly. “Wasn’t even a phone Authority.”

Social media has been buzzing today, with @Biggie56 tweeting “This dude is NEVER L8! Gonna switch 2 Inala 4 sure!” Continue reading

Posted in Uncategorized | Tagged , , , , , | 3 Comments

e-vapes, e-health and e-xperts

Vaper confusing sucking with blowing. Pic by

An e-smoker confusing sucking with blowing.
Pic by

IT’S NOT often I start a column with a direct Hansard quote, but South Australian Liberal senator Anne Ruston provided pure gold during last month’s budget estimates hearing on NEHTA’s e-health.

The National e-Health Transition Authority is tasked with creating a universal electronic medical record – a task so Herculean, one suspects they would gladly trade places with Sisyphus.

Okay, so one should never mix one’s Roman and Greek gods, but at least my confusion wasn’t chiselled onto the Hansard…

senator rustonSenator Ruston: My questions are around e-cigarettes or e-vaporisers, or whatever they are supposedly called. Continue reading

Posted in medical writing | Tagged , , , , | Leave a comment

When a GP goes to his GP

The last time I went to a doctor, he looked like this

The last time I went to a doctor, he looked like this

I went to my GP this year. Apparently patients do that sort of thing all the time, but it felt odd, giving over the swivel chair. I hadn’t realised the degree of power inferred by a collared shirt and castor wheels.

I felt more comfortable going to someone I didn’t know; a bit of professional distance is handy—I figured about nine suburbs should do it.

The surgery was a lovely, refurbished Queenslander, and I hid around the corner of the balcony waiting room, hoping no-one would recognise me. I even resisted the urge to leave a few business cards on the chair for any patients looking for a change.

My GP didn’t know me, which suited me fine. Surprising, actually, that he hadn’t heard of my professional reputation around Brisbane. Nor read a single one of my articles. Just how I wanted it. Not even a friend of a respected colleague? No? No worries. Maybe I shouldn’t have gone quite so many suburbs. Continue reading

Posted in medical writing | Tagged , , , , | 9 Comments

Winter; discontent; you know the drill.

Contemplating a day full of flu patients

Contemplating a day full of flu patients

Winter is coming

As any Game of Thrones character will tell you – and most eventually do – winter is coming.

In the land of general practice, a long way from the nearest fur-coated dwarf or icicled king, we instead rely on six signs to detect winter’s approach.

1 The first sign is the season’s first use of the word ‘lurgy’. A word unspoken for nine months of the year, lurgy comes out of hibernation just as everything else enters it. No one knows the word origin: my guess is a bastardisation of URTI; or a contraction of metallurgy, the ancient term for metalworker’s lung (I haven’t looked it up).

2 The second sign that winter is coming depends on where you practice. In my Victorian days (the location, not the era), patients would start wearing duffel coats and scarves. Now in Queensland, I know it’s cold outside when the blokes wear long socks under their sandals.

3 The third sign is the three-child, bulk diagnosis. Continue reading

Posted in medical writing | Tagged , , , , , | 4 Comments

Weird diagnoses your doctor can select, but probably shouldn’t

Bovine roller-skating accidents? More common than you'd think. Photo: John Piercy

Bovine roller-skating accidents? More common than you’d think.
Photo: John Piercy

Has your doctor has ever diagnosed you with Hair in the Urine or Donald Duck Speech? I’m a doctor and have no idea how to treat either condition. My wild guess might be a sieve and a good gargle—in that order, reserving the gargling for the latter, obviously.

Both these bizarre conditions are found in the drop-down list of choices that my medical computer software allows me to select under ‘Reason for visit’.

Yet, wayward hair and Disney characters are by no means the oddest of the bunch: patients clearly attend their GP or emergency department for some pretty strange stuff, often enough that computer coders add it to the list.

I’m in a doctors-only Facebook group called ‘GPs Down Under’, where Dr Nigel Grebert recently challenged GPs to name the weirdest options available in their software list.

The doctors’ quirky favourites came flying. Abnormal Look, Drop Kick, and Skin Turning Black all feature in Australia’s most popular GP computer packages. They probably shouldn’t. Continue reading

Posted in medical writing | Tagged , , , , , | 1 Comment

Small things I don’t understand

Confusing red and green things in our bloodstream

Confusing red and green things in our bloodstream

Last month’s column was ‘Dealing with uncertainty’, and I haven’t got any better at it, so figured I’d stick to the theme. Might even make it a series.

This month’s uncertainty involved a haematologist—I’ve never actually met one, but that wasn’t the uncertainty. I do believe in them, based on the phone evidence.

Anyhow, I listened to him discussing cytochrome p450, then he mentioned HLA-B27, and right about there is where he lost me.

The thing is, I have trouble visualising things named with numbers. Especially little things. If you’re going to float about invisibly in the bloodstream, at least have a sensible name, like RBC.

RBC – Red (yep) Blood (gotcha) Cell (bingo)! Continue reading

Posted in medical writing | Tagged , , , , | 2 Comments