Let’s celebrate the bolt-cutter surgeon

bolt cutters

When orthopaedic surgeon Chris Phoon sent someone to a local hardware store in Bega, NSW, to buy bolt cutters mid-operation, his admin bosses weren’t impressed.

But I was.

Dr Phoon’s hospital-supplied bolt cutters snapped mid-operation and his attempt to source a pair from Canberra Hospital failed. Time for plan C.

Staring at a stubborn steel pin needing urgent removal means only one thing to a red-blooded Aussie male…Bunnings!

Quite unreasonably, in my view, the surgeon’s heroic attempt at pulling the pin was frowned upon by the hospital administrators, whose lawyers pulled the pin instead. The plan was abandoned mid-operation and the patient may be still, for all we know, languishing somewhere on the hospital’s 247-day-average surgical waiting list.

Now, I’m as guilty of poking fun at my orthopaedic friends as the next bloke—guiltier, because I put it in writing. Like when the orthopod took six days to solve a simple jigsaw puzzle and was proud, because it said “From 4-6 years” on the box.

But these bone grinders aren’t hired to lead group discussions around whether psychological therapy helps healing after a fall out of bed.

If I have a thick metal shaft poking out of my leg and the fella with big hands tells me I’m better off without it, I want to wake up with it cleaved in twain and in the bin. Keep subtlety for the soft tissues. Continue reading

Posted in medical writing | Tagged , , , , | 7 Comments

Greater transparency on specialist fees: a no-brainer

$7 and a Medicare card

The question as to whether medical specialists should make their fees more transparent has long ruffled a few feathers.

The debate is raging afresh this week, sparked by a new study of billing data that reveals wide variations in specialist fees. The study, published in the Medical Journal of Australia, finds fees can vary up to five-fold within a single specialty.

As with any service, of course, some providers are of higher quality. But this is unpredictable. And as the study authors note, the rationale for fee variations is opaque without data on quality of care in private outpatient services.

An accompanying commentary cites unpublished research by the Royal Australasian College of Surgeons which finds “no correlation between the size of the fee charged and the quality of the surgery”.

Commenters have been quick to react, noting that the cost variation may reflect differences in office rental costs, the time spent per appointment, and the experience of the practitioner.

While these may be valid arguments for the existence of cost variation, they do little to counter the contention that costs should be made more transparent for consumers.

As a rule, transparency is the grease that keeps supply-and-demand systems running smoothly, and the confusion of the specialist fee system should be no exception. Continue reading

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

Four Corners Big Vitamins exposé: cuts both ways

Vitamins, by Steven Depolo

Photo: Steven Depolo

Last night’s Four Corners exposé of Big Vitamins marketing their supplementary pills via community pharmacists would have had doctors throughout the nation nodding their heads.

We only have to walk past a pharmacy shopfront to see how rife the problem is. Clearly most pharmacist-owners see it as a profitable—some would argue, a critical—part of their business plan.

As for pharmacist-employees, most are presumably resigned to selling these supplements by the kilo, and some would perhaps believe the industry’s own hype that ‘pick me up’ vitamins really do pick people up. Even well people, with clean livers.

The issue is not so much the selling of products in a free market, but the dubious veneer of scientific credibility, beginning with exaggerated or false advertising claims and ending with a highly trained, trusted professional. As a pharmacist said on the show, “If they’re after complementary medicines, then I’m happy to provide them”.

After such media reports featuring sceptical doctors, inevitably some commenters retort by questioning why they pick on pharmacists, when the medical profession itself is so influenced by Big Pharma. Something about sinners casting the first stone.

And, you know what? They have a point. So, let’s lob a few stones in every direction, even if a wall of my own glass house cracks. Continue reading

Posted in medical writing | Tagged , , , , , , , | 7 Comments

Five reasons why I’d still encourage my child to do medicine

Back Camera

If you read the wrong kind of comments in the online medical media – as I do, religiously – you might conclude that retiring doctors are glad to be leaving the sinking ship. These disembarking medicos  proclaim they would discourage their child from ever boarding the leaky vessel. Why commit to years of study, long hours, frustrating paperwork, little respect and crappy pay?

After all, being a doctor is a tough gig these days. Especially if you stretch ‘these days’ to include one million days ago. Hippocrates noted in his opening line of the first ever book about the burden of being a doctor, “Life is short, and art long, opportunity fleeting, experimentations perilous, and judgement difficult”.

Life is less short since Hippocrates’ day, but the rest still rings true. Today’s graduates will face increasing bureaucracy and regulation. Recent reports highlight the threats of bullying from within the profession and of litigation from without—although I’d argue neither is escalating.

Would I encourage my child to do medicine? You bet I would, and here are five reasons why. Continue reading

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

GP Sceptics podcast 8: Marketing


‘Carrots & Sticks’ by Kat Ritchie

itunes-logo     soundcloud

Doctors try to ‘sell’ behaviour change to patients, who are often reluctant to ‘buy’ the message. What tricks can we learn from the modern experts at selling?

Justin and Liz bite the bitter bullet and enter the strange world of marketing.

We grill Dr Ninya Maubach, whose former life involved a PhD in marketing, but who has now seen the light and is studying medicine at ANU. That’s a powerful combo when it comes to teaching doctors how to sell a message.

Our starting point is a paper ‘Carrots, Sticks and Promises’, and it turns out that most of our attempts at behaviour change involve the least effective selling method: “I promise that if you stop this pleasurable thing today (e.g. smoking, lying on your couch), you will reap rewards in the future.”

That message is pretty easy to trump (are we still allowed to use that word?), and plenty of full-time tobacco and food industry marketers know just how to trump it.

Turns out the ‘stages of change’ model  we all learned (precontemplation, contemplation)may not be so useful after all. Continue reading

Posted in podcast | Tagged , , , , , , | 3 Comments

Google Health Cards: the first test drive


Google’s new health cards became active in Australia just a few hours ago, so I figured I’d be first to give them a test run.

Health cards are Google’s attempt to give the lay public sensible and evidence-based results on searches for medical conditions.

The ‘cards’ appear as a stand-alone box to the right of the usual Google search results, and contain a few sentences and a picture.

For example, when I type in ‘cold’, the usual, familiar results appear – first is my local weather (despite today being decidedly warm!) followed by the hits from more than a billion search results.

But in addition, a new box automatically appears, labelled ‘Common cold’. It contains an artist’s impression of nose-blowing (happily, a ‘before’ image with the tissue still clean) and three clickable sections: About; Symptoms; and Treatments.

Each section typically contains a couple of brief statements and some dot points. The health information is general, but accurate, having been developed in conjunction with doctors from the Mayo clinic. No unpleasant surprises suggesting your cold might require antibiotics. Continue reading

Posted in medical writing | Tagged , , , , , | 5 Comments

GP sceptics podcast 7: EBM Hijacked!



by Kat Ritchie


itunes-logo     soundcloud

Just when you thought GP Sceptics put the E in evidence-based medicine, we pull the rug from underneath your trusting feet.

Western Australian GP Casey Parker, of Broome Docs fame, joins our twosome to become the ‘third nerd’ – a role which fits him like a cardigan and a new pair of glasses.

Casey delves into EBM’s dark recesses, where p-hackers subvert the concept of ‘significance’, and RCTs answer all the questions no one bothered asking.

Justin discusses a hot-off-the-press systematic review revealing the over-optimism of doctors.

And Liz? Liz invites us all aboard the EBM gravy train.

Bonus nerd points for any listener who comments below correctly describing when affect is a noun and effect is a verb.

This podcast is dedicated to the fond memory of the late Prof Gavin Mooney, editor of Evidence-based medicine in its place.

Thanks to Dr Kat Ritchie for her brilliant artwork.

Continue reading

Posted in podcast | Tagged , , , , , | 5 Comments

Does the weather affect our joints?


Therefore the moon, the governess of floods,
Pale in her anger, washes all the air,
That rheumatic diseases do abound.

A Midsummer Night’s Dream

Long before Shakespeare, vagaries in the weather have been blamed for flare-ups of joint pain. The rheumatic curse seems to redouble on a cold, wet day…or is it a hot, dry one?

But a new study from The George Institute casts doubt that we can ever really “blame it on the weather”.

In every place I have ever worked, patients will swear their knee or back pain has eased since they moved to that town, crediting their temporary cure to the local conditions. Curiously, this remains true regardless of where I am working at the time, whether at the bottom or the top of Australia: from the windswept southern coast to the burning central deserts or humid tropics.

Are rainfall, humidity and temperature really affecting my patient’s joints, or is there a less exciting interpretation? Perhaps joint pain is a randomly relapsing condition, and we humans love attributing causation whenever two unrelated events roughly coincide.

Previously, researchers at the George Institute published a study where 345 Australians with confirmed knee osteoarthritis recorded their pain scores. No correlation whatsoever was found between pain flares and the local weather conditions (temperature, precipitation, humidity, barometric pressure).

This negative study, which countered such a long-held belief, not surprisingly copped plenty on social media. Contrarian anecdotes flew in faster than a cold southerly over Bass Strait.

So other researchers decided to see if they could replicate the findings in different circumstances. Continue reading

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

GP Sceptics podcast 6: Obesity – Christmas edition


By Kat Ritchie

itunes-logo    soundcloud

Liz shines when discussing her pet PhD topic – managing obesity in general practice. Nicely timed for Christmas.

Which medications safely make us thinner, now amphetamines and tobacco have lost favour? And, if media images keep depicting Headless Fatties*, how can GPs raise the topic without adding to the stigma?

Justin reveals that one of Australia’s biggest GP education companies is boasting it can change our prescribing habits at will – for a hefty fee.

Build your own promotional campaign with Liz’s Magic Marketing, and discover the superpower Justin wishes he possessed but his family knows he doesn’t. gp_sceptics_small

*Not our term – the podcast and link below place this memorable idiom in context. We wouldn’t insult Santa.


Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People Yonsei Medical Journal, 2006

Headless fatties by Charlotte Cooper, 2007

Treating obesity seriously: when recommendations for lifestyle change confront biological adaptations Lancet, 2015. [But note authors’ multiple conflicts of interest]

No Advertising Please campaign 2014

They wouldn’t do that, would they? The Medical Republic, 30 Nov 2016

World Obesity image bank Free usage for non-profit purposes

Posted in podcast | Tagged , , , , , , , | 2 Comments

Anne Deveson, who destigmatised schizophrenia


THE DEATH of Anne Deveson –writer, broadcaster and social justice advocate – marks the final chapter of a life that reflected the immense change in the way Australians have perceived mental health issues over the past century.

Deveson, who died from Alzheimer’s yesterday at age 86, recalled travelling home from London 40 years ago after her father referred to her mother’s bewildering mental decline in a letter. “Bea is bats,” wrote her father, unable to articulate the subtleties of what we now know was Alzheimer’s disease.

Upon Deveson’s return, her mother described the affliction more poetically: “Anne, I’ve been in a forest and I can’t find my way through.”

If Australians’ understanding of mental illness has altered dramatically since the Deveson family arrived from Malaya as refugees during World War II, their famous daughter could claim much responsibility. Continue reading

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