Prostate cancer: why screening PSA blood tests are dangerous

Released by NPS MedicineWise today, I host six short videos that discuss why doctors should think twice before ordering the blood test (PSA) that screens for prostate cancer.

It sounds like a simple, sensible thing for the GP to do – or for a bloke to request – but in fact, it can cause more harm than good.

How could PSA testing actually be dangerous? Watch and find out.

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Health consumers

The OED

The OED

To consume (v)

I have always thought negatively of the word consume. I blame the Oxford English Dictionary (OED), whose first two definitions are; destroy or expend and; spend wastefully. The OED knows both interpretations all too well – no edition of the world’s finest dictionary has ever made a profit in its 135 year history.

OED business manager memo to his 80 lexicographers:

Pls stop consuming (spending wastefully) my budget. U R consumed (destroyed & expended) by time-consuming word research. Simply look up all the words in a dictionary – duh!

The lexicographers, who have the lowest job transferability of any known profession, would be impeccably polite in their replies, concealing their vitriol behind scathing insertions of the word sic.

The negative connotations of consume don’t stop there. Even scrolling down to the ‘eat’ definition inspires visions of gluttony or its opposite extreme: that bland soup, consommé, watery enough to serve to homeopaths.

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The waiting game

Waiting...waiting By Baldiri

Waiting…waiting
By Baldiri

Fifteen years ago I wrote an article about the waiting room at the Geelong Hospital Emergency Department, noting that a higher proportion of Geelong residents visited it than any other small room in that entire city. Back then it was pretty low-key: rows of bland plastic chairs, and even the pot plant looked unwell. Triage category four unless someone had thought to rehydrate it with a litre of fluid.

The room was designed for a single purpose, at which it excelled: waiting. More people died of boredom than infection, with the risk of MRSA overshadowed by that of hospital-acquired catatonia. Unless the four-hour rule has paid dividends, a couple of patients will probably still be waiting for me. I told them I’d see them after my break, but we took generously long lunches back in ’99. They call me Godot. Continue reading

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Crowd-sourced meta-health writing: wish I’d thought of it first.

Wonky Health

A mate of mine has just obtained crowd-sourced funding to write a series of medical articles on the croakey.com website. This opinion series sponsored by individual payments will be an Australian first, if you don’t count John Laws and cash-for-comments.

Sydney GP Dr Tim Senior used a crowdfunding website to find 165 supporters for his project ‘Wonky Health’, commissioning him to publish a series of 13 articles about meta-health.

Actually, meta-health is a term I just invented, but I reckon it still makes more sense than the inscrutable ‘Wonky Health’. You missed a brain wave there, Tim.

Meta-health is all about the story behind health issues, rather than the illness process itself. How will $7 co-payments affect poorer people; how will climate change affect health; how will $7 co-payments affect climate change? Actually, I doubt Tim will bother with that last one. Continue reading

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Co-payments – handy reminders of our mortality

$7 and a Medicare card

5 + 2 = $7

Australian Doctor asked me today if they could publish my thoughts on the $7 co-payment. I have dark thoughts.

Apologies in advance to my medical specialist friends. It’s not your fault.

 

Imagine yourself in charge of Australia’s health budget – heaven forbid! On your desk are two cash-filled buckets, marked ‘primary care’ and ‘specialist/hospital care’. Your job is to remove some money from one or the other bucket, to be spent elsewhere. Unrestrained by short-term political gain and beholden to no interest groups (we are only imagining), your decision requires going back to basics.  Continue reading

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Ask yourself four diet questions. Or I will.

Quinoa by Julia (I Believe I Can Fry)

Quinoa by Julia (I Believe I Can Fry)

I just don’t have the appetite for diets. Or, more specifically, for taking a diet history. The sort of thing my health service’s dietitian does ten times daily—bless her, and all her thin colleagues.

Honestly, if the patient’s answer to my first question is ‘Weet-Bix’, I just let the rest slide. I already know they will either score better than their doctor (by definition: a balanced diet) or are lying. In fact, the main purpose of the Coleman four-question diet history is to weed out the liars and move on to something else I’m better at. Continue reading

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What’s not to love about skin rashes?

Target lesion

Man with an unfortunate target lesion on his back

Luckily beauty is only skin deep, because this rash was a beauty. Classic red rings, each containing another red circle centrally—named ‘target’ lesions after the chain store logo.

Erythema multiforme!” I announced with an Ancient Greek twang. I guess the original dermatologists were embarrassed to name any rash ‘lots of red shapes’ in English. “It’s a beauty,” I confirmed.

He looked at me dubiously. Perhaps the eye of his beholder didn’t see it. “Anything I need to avoid, doc?”

I studied the hundreds of bullseyes adorning his skin. “Duck shooting season. Next please!”

I love a good rash. Continue reading

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The secret that doctors hate revealing!!

 

Justin and Justin

BEFORE…………………………………..AFTER
One simple, easy trick revealed!

Warning: Reading this column will change your life. I reveal secrets which other doctors won’t tell you. They will hate me for it, because you need never pay for their services again.

I have recently given up doctoring, with its snail-paced, uncertain outcomes, and instead dedicated my life to writing popup facebook ads. Professional shackles removed, I can finally bring you proven cures which have been known since ancient times, but kept secure by the Doctors’ Code.

Ironically, the proof was there all along, if only you had clicked on the close-up photo of the exotic fruit seeds. It took me until age forty-five to allow my curiosity to overcome my bland scepticism, but since using their method I have become only thirty-two.

Eating nothing but these sensually-juicy plump seeds for a year not only made me lose 100.99% of my body fat; it smoothed my skin to the point where women in swimsuits continually ask me if I am Justin Bieber.

“No,” I smirk kindly, brushing some excess seeds out of my dark hair. “No, but he wishes I was.”

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Running man

Beach jogger

Photo by Januartha

I am a jogger. More specifically, I am a jogger this week. Even an actual runner, if you don’t count the uphill and flat bits. It’s been a fast-moving week.

Jogging is a fundamentally boring pastime; the only ones who claim otherwise are joggers…yawn. But after a seasonful of gastric stuffing and three months since my last soccer game, I figured a week at Noosa beach was a fine opportunity to, as our PNG neighbours so colourfully put it, ‘throwim way leg’.

I regularly prescribe one jog daily, mane before food, knowing that few patients will be eccentric enough to comply. I didn’t invent jogging—it already existed in rudimentary form before I started—but by George, I’ve helped popularise it.

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Top list of wasteful procedures in the ED and General Practice

 

Bucket list

The list
by Kaity Hemgesberg

Yesterday, JAMA published a list of  tests and treatments ordered in the Emergency Department which a group of 283 Emergency clinicians considered the most wasteful. Because accessing the list requires a log-in (which is a bit of a waste!) I have copied it here.

Below this is a similar list from the Choosing Wisely campaign where GPs were asked to vote on their most wasteful tests and treatments in 2012.

Consider doing them…and then don’t!

 

 

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