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 Ruston: My questions are around e-cigarettes or e-vaporisers, or whatever they are supposedly called. Continue reading
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
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
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
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
Gandalf ponders a management plan dilemma
My GP registrar’s body language suggested the tute was going poorly, although I blamed the topic: ‘Dealing with uncertainty’.
In retrospect, I could have stuck to medical examples, instead of opening with Gandalf’s dilemma about when best to attack Sauron.
My plot synopsis inexorably led us even further from doctor-patient interactions and into the dark tunnels of Moria. At which point I noted the aforementioned body language sending mixed messages—she was nodding, yet also pacing furtively backwards towards the door.
She stopped, embarrassed. ‘When can we discuss actual doctors having to deal with uncertainty?’
‘I’m not sure,’ I replied. Then, warming to the theme, added, ‘Deal with it!’
The US Choosing Wisely
What interventions do you think GPs should do less of? Do you think we sometimes prescribe inappropriately or order too many tests? I’m not talking about individual anecdotes, but widespread trends accepted as ‘normal’ in some parts of Australian general practice.
I am chairing the RACGP working group for the NPS MedicineWise Choosing Wisely initiative, tasked with developing a list of five tests or treatments which GPs should be doing less of, or not doing at all.
Published for the first time ever, below are 28 suggestions and our shortlist of ten. We will hone these down to the five best ones and formally launch them on 29 April 2015. Continue reading
Photo taken by the author just before eating fish and chips.
I love being a doctor. I love the variety, the capacity to touch lives. But most of all, I love the holidays.
The very best bit of my job is not doing it, and instead doing the crossword on the beach.
I won’t name my favourite holiday town for fear of spoiling it: quite frankly, I don’t need you there. Instead, I’ll code it anagrammatically.
Your presence would be superfluous, because sQueencliff already overflows with relaxed doctors: many so relaxed they’ve retired or died. I know these things because for six years I was these retired doctors’ doctor, and I also lived opposite the cemetery. Probably should have split that sentence into its two unrelated halves, actually.
It’s more fun being a relaxed doctor than looking after one. Whenever I holiday in a small town I always envy the local GPs, but of course in my imagination I’m sandy footed and solving cryptic crosswords between appointments.
“Do your urine sample at the surf club just past that jetty, Mr Jones, while I complete 6-down: ‘sQueencliff, idyllic village’. No rush.”
Bowel charts are a thing of the devil. I hate even mentioning them. In fact, I won’t; let’s talk about blood glucose diaries instead.
A bunch of folk just like me, but sweeter, fill in a smattering of glucose columns whenever they can, missing a few days while getting on with their lives. They never bingo all eight sugar boxes on the one day, because they are normal, fallible human beings. They diarise to please their diabetic educator, who secretly knows that the patient eventually learns to write fiction and will merely go through the motions. Which brings us straight back to bowel charts.
Examining the motions is acceptable only in very isolated social groups: mainly microbiologists or dung beetles. Even then, it’s only ever someone else’s sh**. Describing your own waste products in any more than vague terms is, as I say, diabolical.
I have a middle-aged patient—let’s call her Julie: the name and gender have been changed to protect his identity. Actually, his real name is Julian. Julian is a hypochondriac with a comprehensive approach to health—all known diseases are divided into those he has had already and those still to come. Although he is essentially a good person, Julian owns a bowel chart. Unsatisfied with the date and time column, he devotes two thirds of his page to description. And, unlike my diabetics, this white space is never left unsullied. Continue reading
Gandhi looking for salt
Recently I have found myself becoming more pugilistic and less pusillanimous.
Or, to use fewer ‘pu’ words, more disputative and less tentative. Simpler still – and with apologies to women and rats – more man and less mouse.
Not for me the Gandhian civil disobediences and passive salt marches of yesteryear.
No, never again will I walk the long route to buy condiments. Gandhi’s passivity ruined a good pair of sandals, when he could have bought the salt locally and yes, even forcefully.
My refusal to be pushed to the back of the queue in the supermarket spice section is just one minor example of my newfound capacity to stand up for myself. It also fits nicely with my new preferred descriptor, ‘seasoned warrior’.
It all began with a few letters to the editor in the online medical media. I padded up nonchalantly for replies, but soon found myself facing Mitchell Johnson on a dry Perth wicket. Continue reading