IF you haven’t heard of FIFO, rest assured it is not the name of latest rap star but something more commonplace — fly-in fly-out workers.FIFO’s sociocultural and economic impacts have been much discussed, particularly with respect to mining communities. There are even websites and…

THE Royal Australian College of General Practitioners has been active in the copayment debate, not least with its #CoPayNoWay campaign.The Senate inquiry into out-of-pocket medical expenses put the Royal Australasian College of Surgeons (RACS) under the spotlight, particularly when the RACS suggested…

HEALTH workforce policy, health funding policy and university education policy are fascinating ingredients in a 2014 political melting pot. Yet the resultant amalgam remains a mystery.In the 2009‒10 federal Budget, the Labor government removed the cap on funded university places (except in medicine)…

AS is typical at any gathering of doctors since the federal Budget, during lunch with a staff specialist friend we discussed the patient copayment.He mentioned that is was a good thing to try to curb the Medicare cost blow-out in general practice. However, my friend became somewhat dyspeptic when I…

CHILL out Chicken Littles — that’s my message to the public, welfare groups, politicians and doctors with respect to the $7 copayment for a GP consultation announced in the federal Budget.I have not witnessed such an avalanche of expertise and prophesy since the soothsayers of the Y2K bug,…

UNTIL that moment, it felt like any other day — morning walk, breakfast, shower and off to do a ward round.Then I picked up the bedside chart of Mr X in Room 3. “Hmm”, I thought. “This feels a little heavier than usual.”I opened the folder to be confronted by an 11-page…

AROUND this time of year many NSW country towns hold their annual shows, with all sorts of entry tickets available, such as single entry or a day pass.At our local show one poor bloke was protesting at the gate, saying he had paid for a ticket but had been called away. The gatekeeper wanted him to pay…

THE media often describes summer as the silly season — there is usually not much worth reporting.I escaped most of the silly season by going on a trip to Europe with my family, but couldn’t help contrasting their medical systems and actions to the way we do things here in Aussie medical…

A FEW doctors gathered around the piano in a Canberra bar one late December night to celebrate the end of another great year of serving patients, expanding medical knowledge and maintaining Australia’s status as the healthiest nation in the world.They broke into song with a familiar tune …On…

THE Abbott government wants to make spending cuts across the board. In health this is especially pertinent because of an ageing population and the need to fund new treatments.Doctors were nonplussed with the previous government’s decision to freeze Medicare rebates until July next year. So far,…

FOR a number of conditions, team-based care is increasingly held up as the gold standard in management but while working in teams can have great benefits, we need to be vigilant that teams don’t become self-serving and inefficient.A colleague and retired anaesthetist, Dr Jim Wilkinson, recently…

EVEN though voters consistently place health high on their list of important issues, both sides of the political divide somehow managed to dodge the issue in the recent election campaign.“Voting for change” and “6-point plans” seemed to grab the media’s attention rather…

WHAT do acarbose, nizatidine and The Ashes have in common? Not much — but they do all appear in this article.I recently attended a diabetes update and was bedazzled by the advances in diagnosis, classification and treatments of this common disease.Especially interesting was the Comprehensive Diabetes…

“SCRAP the cap” has been the most unifying campaign for the medical profession since the indemnity crisis about 12 years ago.The federal government’s decision to cap tax deductions for activities related to continuing professional development (CPD) crosses all specialties and has the…

MOST Western societies appear to be shifting more and more to reliance on governments to fill roles once played by families, churches and other community associations.The notion of self-reliance being supplanted by reliance on government is nowhere more apparent than in the health sector. In Australia,…

ALL the argy-bargy from this month’s federal Budget about budget surpluses and deficits has made me wonder about the budget woes we doctors face.It seems some doctors might also be struggling to achieve a budget surplus as Medicare rebates — frozen in the 2013 Budget until July 2014 —…

AFTER countless “emergency” calls for incorrect triage — especially those that disrupt sleep and busy office sessions — I am well aware of the inconsistencies of the emergency department. I am therefore relieved that the Emergency Triage Education Kit (ETEK) is under review. Triage is a French…

HOW does a paediatric umbilical hernia relate to the supply of GPs in Australia? Professor Bob Birrell, a demographer from Monash University who is no stranger to controversy, recently released a report titled “Too many GPs” outlining evidence on an oversupply of GPs and remedies for this. Health…

THERE was an interesting comment attached to my last blog comparing firefighters and doctors. Dr Ian Hargreaves wrote: “Had Dr Iannuzzi treated 100 patients, locals and fireys, in a horribly busy day of burns, breathing difficulties, and eye foreign bodies; he would have automatically been the subject…

IT has not been a good start to 2013 for my town of Coonabarabran in the north-west of NSW. Bushfires encircled our town, with about 60 families losing their homes. Even as I write, the fire rages on, predicted to burn for many more weeks. Just like in any tragedy, the fire brought out the best and…

WHEN I was a child, my mother took me to inner-city Sydney to visit Santa Claus. I would tell the successor of Saint Nicholas, bishop of Anatolia, whether I had been good and my Christmas requests. Hoping to do something similar in 2012 with my own brood, I encountered something a little different ...…

THE AMA recently emailed members and publicly called on the federal government to scrap the Pharmaceutical Benefits Schedule authority system. To refresh a few basic points, reasons for medicines requiring PBS Authorities include a drug is very expensive (eg, goserelin for prostate cancer); a drug has…

WE don’t need a list of 50 references to tell us that the health of our Aboriginal and Torres Strait Islander peoples is a blight on Australia’s reputation as a resource-rich nation with a first-rate health system. The problem of poor Indigenous health outcomes cannot be blamed solely on our health…

IN August, the Australian Senate belatedly released a much-anticipated report — The factors affecting the supply of health services and medical professionals in rural areas. Politicians established an inquiry because of concerns about poorer health outcomes and life expectancy in rural and remote…

INTERN allocations and the oversupply of doctors for training places will continue to be headline news for years to come. Not only do we have the tsunami of graduates from Australia to accommodate, we also have the large number of international students graduating in Australia and overseas-trained doctors…

THE Royal Australian College of General Practitioners has released a dashboard (sic) of clinical indicators for GPs. GP practices and external stakeholders are invited to comment on the proposed indicators by 30 July. On its website the RACGP says: “The proposed indicators deal exclusively with the…

WOULD you swap places with an international medical graduate hoping for registration in Australia? Certainly not! And would you want to be a rural practice that needs an IMG to relieve workforce pressures? Unfortunately, that’s my practice. I have been stuck in a horrible workforce crisis for the…

RECENTLY, I came across interesting trench warfare in a report about the Pharmacy Guild of Australia. “… the Guild has again attacked the Consumers Health Forum of Australia [CHF] for daring to question any of its practices … CHF has been targeted for saying the Guild should ‘concentrate on…

FEELING in a penitential mood, I wondered which consultations are the worst — the heart sink patients. Is it the narcotic drug seeker who gives the sob story about his dog chewing his authority script for OxyContin only 2 days into the 30-day course? Or is it the 160 kg diabetic smoker who just cannot…

LATE last year, an interesting article in the MJA and the subsequent letters regarding conflicts of interest caught my interest. The authors summarise conflicts of interest as: “Is there anything ... that would embarrass you if it were to emerge after publication and you had not declared it?” They…

REMEMBER when you could buy a Paddle Pop for 20 cents? My mum tells me she could buy one for 5 cents. Now you pay at least $1.20 — that’s money inflation. Remember when a medical degree gave you enough qualifications to open a practice? Not only that, but to also enough income to buy a house, a…

NOT a day goes by without a general practice patient bemoaning the inability to see a specialist in a timely fashion. When I work in the city, patients complain that they cannot get in to see a specialist soon enough. In my main practice in the bush, particular specialities often don’t exist at all…

HOCUS-POCUS. Ever wondered about this term? It is used by magicians when performing tricks — and tricks are just illusions. Nobody is exactly sure where the term originated, but the best theory is that it is a parody of the Roman Canon of the Mass. Those of us with a classical slant will still remember…

SHOULD more doctors be salaried? It seems to have become an age-old debate in the medical profession. Recently, the MJA featured “opposing views” for and against salaried doctors. Every time I read or hear this debate it is a procedural specialist pitted against a hospital staff specialist. Surely…

SEVERAL generations of Australians have enjoyed a health system that balances public and private medicine in a manner that is, in theory at least, fair, accessible and affordable. However, in recent years, private models of hospital and outpatient care have come under considerable pressure, as commercial…

FOR the last few years at this time of new beginnings, I have dispensed some advice for interns (here, here, and here). Those interns have now grown up and should not be forgotten. They are now senior residents or registrars; they are almost ready to fly solo! By the third, fourth or fifth year navigating…

IT always feels like a relief moving towards the end of the year, doesn’t it? Like somehow viruses and other global players will take a break just because the calendar is counting down. But if 2021 has taught us anything, it’s that pandemics don’t have much respect for summer holidays. This is…

THE Victorian Government’s Health Legislation Amendment (Information Sharing) Bill 2021 was rushed through its first parliamentary vote on 14 October 2021, raising many unanswered questions for patients and health care professionals in that state. The purpose of the Bill, as stated in the preliminary…

THE Australian Doctors Federation and many other medical professionals and associations are dismayed at the Australian Competition and Consumer Commission’s Draft Determination (ACCC-DD) regarding the Honeysuckle Health (HH) proposal, prompting numerous submissions. On Christmas Eve 2020, the Australian…

WHILE most of us were organising ourselves for our first COVID-19 Christmas, others were boldly plotting a major paradigm shift in our health care system. On Christmas Eve 2020, the Australian Competition and Consumer Commission (ACCC) received an application by Honeysuckle Health (HH), a merger of…

THE 2021 interns have already distinguished themselves; completing final year medical school in 2020 would have been a challenge indeed. Even though they have earned gold stars for their 2020 achievements, work now starts for real. Extending the tradition of the past 3 years, I share some tips for our…

WHILE the rest of Australia prepares for a welcome 12 days of Christmas, New South Wales rural communities and health professionals are preparing submissions against the 12 terms of reference for the inquiry into health outcomes and access to health and hospital services in rural, regional and remote…

REMEMBER 2016? That was the year the world lost some greats – George Michael, Carrie Fisher, Debbie Reynolds, Leonard Cohen, Mrs Brady, R2D2, Gene Wilder, Elie Wiesel, Muhammad Ali, Prince, David Bowie, Alan Rickman, Jon English – it was teen hero carnage. We couldn’t wait to see the calendar…

THE year 2020 has been one of upheaval and change for life in general, and general practice has not been spared. Despite being members of the largest medical specialty in Australia, GPs work under considerable strain, a topic that others and I have addressed in the past. Nominations are now open for…

“Nothing is so permanent as a temporary government measure.” Milton Friedman WHEN we look back on the coronavirus disease 2019 (COVID-19) pandemic, much shall be written on how hitherto common practices changed for good. One of the challenges for the medical profession is to defend the changes…

A “RADICAL drop” in the numbers of medical graduates entering general practice between the mid-80s and the early 2000s highlights the critical importance of breaking down the barriers to a career in primary care, say researchers. Research published in the MJA found that, using Australian Health…

In fact, smallness makes people outward looking. – Ten Remarkable Australians, Ian MacFarlane, Connor Court 2019 BEING ensconced in Coonabarabran, a small New South Wales town of about 3000 people, with an inability to travel and socialise, has presented me with time aplenty to think about all things…

THE dynamic between our public and private health sectors in Australia is something we take for granted. Australia, unlike other countries, has preferred a balanced blend of public and private health care that offers Australians choice and security should they suffer an adverse health event. There are…

JUST how many tricks can an old dog teach? Welcome to the third instalment of my tips for new interns. Let’s give 2020’s interns some tips for success: Get a mentor or two We’re now swimming in an ocean of doctors in Australia. We number over 100 000 and more medical schools seem to be opening…

WELCOME to the last issue of InSight+ for 2019! Forty-eight issues in and we’ve covered a lot of ground – from adolescent concussion to XDR typhoid. This year we formed partnerships with the Black Dog Institute and the Murdoch Children’s Research Institute to bring you regular content. We are…

Scene: the emergency department of the St Nicholas Quinternary Referral Hospital, Sun City, Australia. A security officer wheels in a trolley carrying a mysteriously clad fellow and immediately plonks him on the trauma bed. As they scooted past, the admissions clerk in a loud voice complained: “He…

I WAS dismayed when I got the email about the recent decision by the Royal Australian College of General Practitioners (RACGP), Australia’s largest medical college, to appoint former Victorian Police Commissioner Christine Nixon as the Chair of its Council. Her appointment has already made Wikipedia:…

THE recent Four Corners exposé of the failings of rural and regional hospitals was confronting. Just like many recent stories about the drought, the program jolted urban people about the desperate state of affairs in rural towns, while for rural residents it created hope that those with power and influence…

MJA journal impact factor tops 5 for first time; 16th in world THE Medical Journal of Australia has reached its highest ever journal impact factor of 5.332, according to the 2018 Journal Impact Factor, Journal Citation Reports released by the Web of Science Group, its third successive rise. The MJA’s…

DO I believe in vaccines? Yes. Do I get myself vaccinated? Yes. Do I get my children vaccinated? Yes. After reciting the above articles of immunological faith, you may consider me a “vaccine vicar” – a dedicated proselytiser on vaccines. Right? Wrong. The “Church of Vaccination” is not what…

CLINICIAN engagement in NSW Local Health Districts (LHDs) is “deficient”, “variable”, and falls short of expectations set out in a key inquiry more than 10 years ago, according to a new report. A NSW Auditor General’s report into the governance of LHDs, released on 18 April 2019, found that…

FROM 1 March 2019, the government has changed the Medicare rebates for GP visits to residential aged care facilities (RACFs), which most of us know as nursing homes. The government has pledged $98 million over 4 years to “fund increased payments to GPs to attend RACFs … This recognises the important…

THE 2019 cohort of junior medical officers is hitting the wards. The scuttlebutt is that the 2018 interns are noted for their low rate of rookie errors. Let’s give this year’s interns some tips for success: First, use the organs connected to your brain As doctors, we feel the urge to have to do…

WELCOME to the last issue of MJA InSight for 2018! It’s been another big year for us – 706 783 pageviews for the year, a rise of 24% on 2017 – and that’s down to you, our readers, so thank you from all of us. In 2019, you can expect a couple of changes. MJA InSight will be known as InSight+…

AROUND this time of year, Health Minister Greg Hunt will be donning his red suit, growing a beard and occupying his ice castle deep in the Australian Antarctic Territories. Meanwhile, patients, clinicians, health academics and health administrators from all around the country will be sending Santa Greg…

ONE of new Prime Minister Scott Morrison’s first policy announcements came on 16 September, foreshadowing an Aged Care Royal Commission. A related announcement was also made by the Minister for Senior Australians and Aged Care Ken Wyatt, which listed the foundations upon which the Royal Commission’s…

I READ Dr Aniello Iannuzzi’s two most recent contributions to MJA Insight – General practice: where the problems lie and General practice: some ways forward – with much interest. He covers a topic of great importance without holding back. While I agree with his general sentiments, I do not agree…

In the second of this two-part series, Dr Aniello Iannuzzi offers some ways forward for general practice in Australia. Part 1 can be found here. DONE well and pursued to its potential, general practice is rewarding and fulfilling. Moreover, it is unquestionably the medical specialty that has the maximum…

IN late May 2018, Dr Tony Bartone was elected President of the Australian Medical Association, the first GP in 4 years to take that position. Few GPs would contest the notion that the state of general practice has never been worse in Australia, with Dr Bartone himself indicating that urgent attention…

IMAGINE this scenario: you are a young rural doctor working in a rural hospital’s emergency department (ED). Over each acute bed is a camera and microphone, and in a bigger centre 1000 km away is an emergency physician monitoring the patients’ vital signs and your actions. A situation arises and…

SUMMER is not only the time for going to the beach; it is also the time thousands of Australians try to slot into a university course. For school leavers, university entry depends on the Australian Tertiary Admissions Rank (ATAR). As with other exams throughout school (eg, the National Assessment Program…

TO keep your energy and enthusiasm on the boil beyond the summer, I have compiled a top ten checklist for avoiding rookie errors. Talk to your patient It’s so easy to get caught up in administration, filling in forms, sitting at the computer and talking to your seniors that you, in fact, forget to…

WELCOME to the last issue – no. 48! – of MJA InSight for 2017. It’s been a big year for the MJA and InSight. The Journal has a new website which has attracted more than 3.2 million pageviews, and, after the correction of a mistake in the way it was calculated, it has a new journal impact factor…

LAST month I expressed concern about the imbalance that has arisen in health policy formulation, and last year I cautioned that as doctors, we too should have our privacy respected. The latest “consultation” being undertaken by the government not only shines the spotlight on those two concerns but…

THE draft report of the Independent Review of Accreditation Systems within the National Registration and Accreditation Scheme (NRAS) for health professions has been released and it proposes massive changes, and is not to be glossed over. To remind those who may have forgotten: “The … National Registration…

A FORTNIGHT ago, I identified 10 facets of the “antibiotic problem”. It is now incumbent on me to offer 10 solutions. Look beyond easy targets Doctors, in particular GPs, have become easy targets for all and sundry. As has already been highlighted by some readers last time, antibiotics are pumped…

SOME things that you’re sure to see every winter include children with coughs, office workers seeking medical certificates, football fever and … articles preaching to doctors about their overuse of antibiotics. The articles in question dance to the same three beats: “naughty” doctors, you overprescribe…

ONE of the signs that one is ageing in medicine is that one goes from receiving career advice to dispensing career advice. In my case, this manifests as medical students and junior doctors seeking my opinions on GP training and which college to choose. This has become more topical of late, as it is…

IN recent decades, Australian medicine has moved more in the direction of specialisation and subspecialisation. While not talked about much, I believe that this, in itself, has contributed to a maldistribution of workforce. Graduate numbers are high, but many Australians cannot access reliable, affordable…

PRIVACY is a paradox of modern society, which is immersed in more information than ever before. While millions of us appear to be addicted to sharing personal information online, the concept of privacy is still closely guarded. Technology and the law have had to erect privacy walls to protect us from…

THERE’S a flotilla of ice-breaking campaigns to thaw the Ley-Turnbull Medicare rebate freeze. Plenty has been said about the consequences for patients and practices.Given our Health Minister’s love of freezing, I propose five areas that are more amenable to lifelong ice.Australian Health Practitioner…

JOHN Kennedy once said: “We enjoy the comfort of opinion without the discomfort of thought”. Cynics may suggest that we have avoided significant discomfort in the public debate in regard to emergency health care. Professional emergency health care has been transformed over the past four decades…

EXPAT Australian writer, television presenter and public figure Clive James is dying. Last week he published a poignant poem about his waning life in The New Yorker, one of several he has written reflecting on his final illness.When asked earlier this year about his recent poems he said they were “not…

A SURGE in the number of doctors working in rural areas could be offset by other workforce changes, including doctors’ falling work hours, experts warn.While the number of GPs working in rural areas has increased by 23% between 2009 and 2013, from 6467 to 7975, these GPs worked 1.3 fewer hours…

IF you’re following the ongoing machinations of the NSW Independent Commission Against Corruption (ICAC), you may well relate to the concerns of Sydney Morning Herald columnist Elizabeth Farrelly.She wrote last week about commercial influences being allowed to shape the built and natural environment…

I AM a product of problem-based learning. At the age of 18, with vague misgivings that I was part of an educational experiment, I sat in a tutorial room at the University of Newcastle with seven similarly apprehensive colleagues, ready to “problem solve” our first case.Over the years, I’ve…

AN abundance of words have been written about the proposed copayment for some Medicare services, with views ranging from outrage to praise.The federal government’s Commission of Audit makes this assertion: “Co-payments send a clear price signal to all consumers that medical services come…

THERE is probably no better example of how differing opinions can hold up legislation than the proposed $7 copayment for GP and diagnostic services.Announced in the federal Budget 6 weeks ago, we seem no closer to resolution of the, at times, heated debate over the rights and wrongs of a copayment.…

ALTHOUGH he only had praise for his predecessor, the new NSW Premier Mike Baird began his unexpected tenure with a promise to do some cleaning up — particularly in relation to restoring public confidence that lobbyists, fundraisers and other “influence peddlers” were not the ones pulling…

WHO is responsible for health? It’s a surprisingly controversial question and the purported answers have long been divided along political lines, with the left accused of promoting a “nanny state”, and the right of victim blaming.Between these polar opposites there is broad agreement…

THIS is the last issue of MJA InSight for 2013. We hope that with one less email jostling for your attention you can start concentrating on festive cheer and relaxation.When we return on 20 January we’ll be making some minor changes to InSight. The InSight newsletter will continue to appear…

THERE is growing evidence that medication compliance is a predictor of better health for many reasons. But making it “easy” for patients to access their medications and providing the right medication are the keys to success. While a Cochrane summary showed overall compliance of about 50%, one study…

CHRISTMAS comes early for the MJA and her precocious progeny, MJA InSight. In alignment with MJA publication dates, this is the last InSight email and issue for 2012, although the “feedback” facility on each article will remain open in case you wish to keep talking amongst yourselves. In my early…