AMA in the News

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Specialists exposed in new website for public to rate doctors, Sydney Morning Herald, 29 July 2016

AMA President Dr Michael Gannon said 86 per cent of doctors already charged the recommended fee. He said that he understood the desire for greater information, but a website owned by health insurers has potential to produce asymmetry in a whole lot more dangerous way than relying on GPs.

Medicare freeze U-turn tipped, The Australian, 26 July 2016

Dr Gannon said he did not expect the rebate freeze, which was introduced by a Labor government and then extended by the Coalition, to be taken to the next election.

Designer babies, Adelaide Advertiser, 25 July 2016

Dr Gannon, who is an obstetrician, said gender selection for family balancing was not an appropriate use of medical science.

Doctors expect Medicare win, West Australia, 22 July 2016

Doctors expect Malcolm Turnbull to surrender over the Medicare rebate freeze, with the AMA saying it would be gobsmacked if the Government took the policy to the next election.

Celebs should know: fame won’t heal what ails you, Sun Herald, 17 July 2016

AMA Vice President Tony Bartone said that an off-the-cuff comment by an ill-informed celebrity can overturn years of public education about good health care.

Medicare hike proposed by AMA, Northern Territory News, 16 July 2016

Dr Gannon said an increase in the Medicare levy should be considered as a way of ending cutbacks to hospital funding.

Ministers warned PM about voter backlash over super, The Australian, 12 July 2016

Dr Gannon said the AMA had warned the Government under both Mr Turnbull and former Prime Minister Tony Abbott that health policies from the 2014 Budget were bad and must change.

Medicare levy rise ‘should be on table’, The Australian, 8 July 2016

Dr Gannon said it was time to have a proper discussion about the sustainability of Medicare, arguing an increase to the 2 per cent levy should be considered.

It’s Medi-crunch, Herald Sun, 7 July 2016

Dr Gannon said the Coalition should end the Medicare rebate freeze, halt price rises for medicines, leave bulk billing incentives in place and boost hospital funding.

Kids off the scale, Herald Sun, 7 July 2016

Dr Gannon said it was time to invest in the future to “reap the benefits in the years to come”. Some parents find it hard to make healthy choices when energy-rich foods are so readily available.

AMA calls for review of Medicare rebate freeze, Canberra Times, 6 July 2016

Dr Gannon said the Medicare rebate freeze had always been bad policy, and the election outcome proved it was bad politics as well.

Turnbull trips on Medicare misstep, Weekend West, 2 July 2016

Dr Gannon said GPs were reporting being at “breaking point”, and some had already changed their billing practices. He warned fees could “easily” rise to $15 a patient, which could cause some to defer seeking care if the Medicare rebate freeze wasn’t abolished.

Radio

Dr Michael Gannon, 702 ABC Sydney, 29 July 2016

Dr Gannon said he had a lot of concerns about a new rate-my-doctor-style website. He questioned the purpose of the website. While he supported the stated aim to reduce bill shock for patients having private medical care, he said the size of the problem isn’t as great as some might assert.

Dr Tony Bartone, Triple J Hack, 28 July 2016

Dr Bartone said catching bi-polar early can give suffers the chance to cope with their disorder better.

Dr Michael Gannon, 6PR Perth, 27 July 2016

Dr Gannon said health professionals alerting national security authorities of a patient’s activities could be breaching client confidentiality. He said one of the reasons that patient confidentiality was so important was that people should feel that they had the ability to seek help if they were sick, including mental illness.

Dr Michael Gannon, 3AW Melbourne, 25 July 2016

Dr Gannon said allowing gender selection for a third child using IVF would open the door for people to have IVF for no reason other than “family balance”.

Dr Michael Gannon, Radio National, 21 July 2016

Dr Gannon said after meeting with Health Minister Sussan Ley that he would be gobsmacked if the Coalition maintained its Medicare rebate freeze to the next election.

Dr Tony Bartone, 5AA Adelaide, 18 July 2016

Dr Bartone said changes to diabetic subsidies only affected type 2 diabetics who were not on insulin, and after the first six months patients could still get access to subsidised strips if a doctor deemed it appropriate to manage their care.

Dr Michael Gannon, 2GB Sydney, 15 July 2016

Dr Gannon said it was disappointing the Coalition didn’t focus on health much during the election campaign.

Dr Michael Gannon, ABC North West WA, 11 July 2016

Dr Gannon discussed the re-election of the Turnbull Government and said the Government needed to unravel the freeze on the Medicare rebate.

Dr Michael Gannon, ABC News Radio, 6 July 2016

Dr Gannon talked about Medicare scare campaign claims and said the Federal Coalition health policy laid fertile ground for the allegations.

Dr Michael Gannon, SYN FM, 5 July 2016

Dr Gannon said the AMA had been calling for a sugar tax for a number of years. Overweight and obesity was the second highest contributor to the burden of disease in Australian. Dr Gannon said a sugar tax alone would not fix the problem, but it should be part of a holistic approach.

Dr Michael Gannon, Radio National, 1 July 2016

With opinion polls showing the Federal election outcome on a knife-edge, Dr Gannon said a six-year freeze on Medicare rebates would invariably mean bulk billing became a thing of the past in many doctor surgeries.

Television

Dr Michael Gannon, Seven News, 21 July 2016

Doctors are pressuring the Government to end its Medicare rebate freeze to avoid another scare campaign at the next election. After talks with the Health Minister, the AMA President Dr Michael Gannon said he would be gobsmacked if a change wasn’t made.

Dr Michael Gannon, Sky News, 6 July 2016
Dr Gannon said Labor’s campaign threat that the Coalition would privatise Medicare was not true, but was part of a scare campaign that worked. He said unravelling the GP freeze would go a long way to assuaging the concerns of the AMA and the medical profession.

Dr Michael Gannon, TEN Eyewitness News, 1 July 2016
Dr Gannon warned that patients could be asked to fork out up to an extra $25 to see their doctor thanks to the Government’s freeze of the GP rebate.

Dr Michael Gannon, ABC News 24, 1 July 2016
Dr Gannon said the AMA was ready to work with whoever was elected but, the AMA was concerned about the freeze on Medicare rebates, as GPs were at breaking point.

PM takes direct role in health

Prime Minister Malcolm Turnbull has taken a much more hands-on role in health policy as the Coalition Government seeks to improve its performance in an area that emerged as a major area of political weakness at the Federal election.

Just days after winning the knife-edge 2 July poll, the Prime Minister met with AMA President Dr Michael Gannon, and it has been revealed that late last month he took the unusual step of personally attending the first high-level meeting between Health Minster Sussan Ley and senior Health Department bureaucrats since the election.

In a speech announcing his new Ministry on 18 July, Mr Turnbull revealed he had already met with Dr Gannon and anticipated working closely with doctors over the next three years.

“I am confident we will have a better working relationship with the AMA and its GP membership,” the Prime Minister said.

The Prime Minster followed this up a week later by joining with Ms Ley in meeting Government health officials to discuss the Coalition’s election agenda and plans for health.

The intense focus on health at the highest levels of the Government reflects widespread acceptance in Coalition ranks that it was an area of vulnerability that was ruthlessly exploited by Labor during the election campaign, costing it many votes and bringing it to the brink of a first-term loss.

The importance of health in the election was underlined by an Essential Media report that found health trumped all other policy concerns in the minds of voters, including the economy.

Sixty per cent of voters said health policies were very important in deciding who they voted for at the recent election, with Medicare a close second at 58 per cent. Economic management came third at 53 per cent.

Reflecting this, a majority of voters (55 per cent) said investing in health should be the top priority for Government, compared with 31 per cent for education and 27 per cent who wanted spending cut to reduce the deficit.

Ms Ley, who was accused by some within the Coalition of ‘going missing’ during the election campaign, welcomed the Prime Minister’s interest in her portfolio.

“I am delighted that we have kicked off the current term of Government with a high-level conversation, because of course he is interested in health, as he is in every single area of government,” the Health Minister told ABC radio. “It’s terrific for me to have a Prime Minister so dedicated to the cause and so understanding of the need for a health system that supports all Australians, one that we can both pay for and deliver.”

Reflecting on the tight election result, Mr Turnbull indicated that the Coalition needed to change its approach in health, raising hopes that unpopular decisions like the Medicare rebate freeze and public hospital funding cuts might be revisited, though Ms Ley was non-committal.

“I understand people’s concerns and I am very keen that we take those concerns into account as we move forward. MYEFO [Mid-Year Economic and Fiscal Outlook] is at the end of this year, the Budget is next year, all of these things will play into to usual business of Government.”

Adrian Rollins

How health technology helps promote cardiovascular health outcomes

Health technology in the hands of cardiac patients — helpful, hindrance, or hesitate to say?

Cardiovascular disease (CVD) is a leading cause of death and hospital admissions in Australia.1 Almost a third of patients will have a recurrence such as myocardial infarction (MI), stroke, heart failure and death within 5 years.2 Reductions of at least 80% in these events can be achieved through secondary prevention behaviours, including taking cardioprotective medications as prescribed, ceasing smoking, increasing physical activity and consuming a healthy diet.3 The most comprehensive and proven of strategies to support secondary prevention is cardiac rehabilitation. This is an evidence-based, cost-effective method to reduce CVD deaths, assist recovery and promote secondary prevention through reduction of cardiovascular risk factors.

The strength of secondary prevention success in cardiac rehabilitation ultimately depends on patients’ awareness, willingness and capacity to make lifestyle changes and to engage in the required behaviours. Patients must have a strong commitment to their health to sustain secondary prevention behaviours for the rest of their lives, often without direct evidence of benefit, as CVD is asymptomatic in the majority of cases.3 However, cardiac rehabilitation is widely underutilised, with less than a third of eligible patients attending the sessions and dropout rates estimated at 25%. In the absence of support, many patients struggle with sustaining the requisite behaviours.

Medications are a prime example of this struggle. Less than two-thirds of patients are reported to persist with all prescribed medications by 1 year following MI.4 The reasons given for discontinuation are largely self-determined, emphasising the importance of the patients’ understanding and engagement.5 Similar issues are present for most secondary prevention behaviours. At 6 months after MI, 27% of patients smoked, 26% consumed an unhealthy diet and 59% did not exercise enough.3 The key reasons identified for patients’ struggles are a lack of awareness that treatments must be long term to achieve effective prevention, and forgetting to follow recommendations.5 Patient education is necessary, but specialised support is often required for sustained behaviour change. Technology, particularly mobile technology, offers a solution for support for long term behaviour change and may also augment existing secondary prevention programs, such as cardiac rehabilitation.

Adoption of mobile technologies, such as mobile phones, smart phones and tablets that provide internet access, has been widespread in Australia.6 Rapid growth in popularity and technological advances have also occurred in wearable devices for tracking behaviours, such as fitness activities, that connect with mobile phones. These technologies and related applications can efficiently enable long term support for patients and provide memory prompts for behaviours. However, there has been such rapid evolution of technologies that we ask: are health technologies helpful, a hindrance, or should we hesitate to say?

Are health technologies helpful?

The evidence indicates that well designed and often simple technologies can improve patient outcomes in multiple cardiovascular risk factors.7 The most consistent evidence of benefit from health technologies is for coronary heart disease compared with other cardiovascular diseases.8 Simple short-message service (SMS) interventions delivered regularly can improve awareness and prompt actions, which may otherwise be forgotten. Text messages double the odds of adhering to medications and the Australian TEXT ME program has improved cardiovascular disease risk factor profiles.9 Emerging evidence indicates that many more risk factors may also be addressed through text messages and mobile phone apps, and potentially decrease dropout from cardiac rehabilitation.8,10 In addition, wearable activity trackers provide reliable information on steps and time spent in moderate to vigorous physical activity, which can be monitored, used for goal-setting and shared with treating doctors.11

There may be a temptation to assume that health technology is not applicable to cardiac patients because of their older age and lack of experience; however, such patients may be more ready and willing to use health technology than previously suspected. At least two-thirds of cardiac patients (67%) use the internet and at least half (50%) use mobile technologies for health, with higher rates of acceptance of health technology in cardiac rehabilitation participants (74%).12

Are health technologies a hindrance?

Several key issues hinder uptake and complicate recommendations for patient-facing technology in regular clinical practice. There is a proliferation of publicly available health technologies suitable for cardiac patients, particularly mobile phone apps, alongside a paucity of research-based evidence to support selection.7 Quality too is generally low, and popularity is a poor indicator. For instance, an evaluation of patient engagement, quality and safety of 1046 health care-related, patient-facing apps for chronic disease found that only 43% (iOS, Apple) and 27% (Android, Google) were actually likely to be useful.13 A recent review of mobile phone interventions for secondary prevention of cardiovascular disease did not identify any intervention that resulted in a negative impact, but six of the 28 interventions reviewed had no benefit.8 Owing to the poor quality of the studies included, it is difficult to distinguish the features that independently predict success; however, the use of text messaging, telemonitoring and interaction may have been important. In a similar way, popular weight loss apps do not incorporate successful behaviour change techniques and many have inaccurate content. The motivation of app developers must be carefully considered given the rise of pro-smoking apps disguised as educational games. At best, patients may experience no benefits from using health technology, and at worst, patients may question and disregard credible advice given by health professionals. Patients have few sources of advice for selection and use of health technologies, as physicians, like patients, have varying capacity and interest in using them. Previous experience, education, confidence and interaction with early adopters to understand how to interface with the health app and with the patient using the app are all required for success.14 Patients who are older, have little or no prior experience with technology and who have lower levels of education are less likely to be interested and have lower expectations of success or benefit from using technology for their health.12 The same could be argued for health professionals. This is important because, for health technologies that do prove useful, positive staff attitudes may offset the lower levels of expertise or interest present in older people and in those with lower education.

Should we hesitate to say?

The rapid advances in health technology, the mass of publicly available apps and programs, and the inability of research to keep pace are major factors affecting our ability to definitively determine whether health technologies are a help or a hindrance. These factors make it difficult to identify the technologies that are evidence-based and free from unintended negative consequences.15 However, there are a few shortcuts. For instance, there is no single repository for patient-based health technologies for cardiovascular secondary prevention, nor is there an accrediting or regulatory system for quality or effectiveness. There has been some attempt to catalogue apps, but the process is slow and apps are often modified by the time of publication. Regulation of health technologies, such as mobile phone apps, is poorly developed. A balance is needed between two polar possibilities: government regulation, as used for implanted medical devices, which is rigorous but slow and expensive; and self-regulation by technology companies through checklist certification, which is dependent on the company ethics.16 App stores such as those of Apple and Google currently vet apps sold in their stores, but the emphasis is on security, not on the quality or credibility of the app.17 Ultimately consumers must decide. One shortcut to ensuring credible content is to only use or recommend health technologies and health apps developed by reliable institutions, such as the Heart Foundations of Australia, Britain and Canada. However, the gains in credibility and time-saving from using this shortcut occur at a trade-off in diversity, innovation and personalisation for patients.

A principles-based approach may be more appropriate and feasible to discriminate the features of technology that encourage consumer uptake and promote appropriate behaviour change effectively. These principles have been highlighted for apps for the secondary prevention of CVD in a recent review12 and are relevant to most health technologies. Key elements to consider include simplicity, credibility of content, behaviour change components, real-time tracking, reward system, personalisation, social features and attention to privacy of data collected. A positive, but discerning attitude to patient-facing health technology is required, much the same as with any new health treatments, to maximise patient outcomes and ensure equitable access. Regular screening to identify effective health technology has become a necessary component of health professional life, equivalent to keeping up to date with effective medications and techniques. Evidence-based practice was introduced to medical curricula to help ensure the most effective treatment for an individual patient. Likewise, it is now time to introduce screening and selection systems for health technologies into health professional education.

In summary, the evidence suggests that mobile technologies will improve access to and participation in secondary prevention activities, but careful consideration is needed to ensure that the most effective and acceptable technologies are incorporated into patient care.

[Perspectives] GIRES: e-learning for transgender health training

The Gender Identity Research and Education Society (GIRES) was established as a UK-based charity in 1997 by my husband Bernard Reed with the support of transgender activists. We both serve as Trustees. We are the parents of a trans woman who transitioned in a very hostile work environment where she was continuously bullied, causing her to attempt suicide. We helped her to mount a legal challenge against her employer, which she won. The aim of GIRES is to prevent such events happening to other transgender and gender non-conforming people, and to improve their lives.

[Perspectives] Two doctors who put Worcester on the medical heritage map

Nine white ghostly faces, eerily lit from below, peer down on visitors to the medical education centre on the site of Worcestershire Royal Hospital. They are death masks, although some might have been cast in life—taken from hanged or condemned prisoners in Worcester gaol by 19th-century doctors intent on studying their subjects’ heads for telltale bumps. At the height of fascination with phrenology—the pseudo-science of determining character from “reading” a person’s skull—enthusiasts were eager to identify signs of criminal personality.

Rural doctors want support

In the first part of 2016, the AMA has been involved in three studies concerning rural health care. Briefly, they are:

1. AMA Plan for Better Health Care for Regional, Rural and Remote Australia.

This plan is focused on four clear areas needing our attention: rebuilding and cherishing the ‘good ol’ country hospital’; recruitment and retention of ‘fit-for-purpose’ rural doctors; fostering a new workforce of bright-eyed, bushy tailed young doctors eager to remain in the outback; and support of rural practices – this includes CPD, infrastructure and workforce distribution.

2. Building a Sustainable Future for Rural Practice – the Rural Rescue Package.

A Joint AMA/RDAA Policy Statement. This is an easy-to-read, short paper with a rather brilliant suggestion for a two-tiered incentive system. The first tier is incentive payments and stipends to entice a happy workforce to stay and thrive in rural regions. The second tier of incentives is to encourage procedural and special skills in the rural workforce. Someone recently said that plumbers are so well compensated in the Outback that to find rural plumbing jobs is difficult. Can you imagine a future where rural medical positions were so sought after that doctors will be competing for that position?

3.The 2016 Rural Health Issues Survey.

It is this third study which is the most personal of the three. It is the voice of the rural doctors themselves speaking by way of a survey sent to them. The questions were posed by asking the doctors to rate the importance of 31 different proposals.

I was humbled when I read and re-read the results of the survey.

The way I read the results, the doctors clearly want support more than hard cash. None of the top 10 proposals would increase the income of the rural doctor. Instead, they want more of their kind with them, helping the roster, adding specialised services, locum relief, allied and ancillary staff, trainees to mentor and, of course, they want their family with them.

They also want to see support by way of “stuff”. Such amenities as walls, equipment, facilities. More evanescent, but definitely under the heading of amenities, is the need for broadband. These are doctors 500 kilometres from the nearest restaurant or movie theatre. They may be holed up on the other side of a flooded road in the Wet; they have no privacy – everyone in the community knows “the Doc”. These overworked souls need the worldwide web for sanity, for education, to communicate. Handy that it also helps with work.

Finally, they want to feel confident and competent. Every day there is a chance of going out of one’s comfort zone. They want opportunities to upskill, and support for skills that are not always needed but could be readily used. The support should come from colleges, that camera on the ceiling above the resus bed, the specialists on the phone encouraging them, and a medical board that is slow to criticise.

I tip my hat to you who answered the survey, you are fine people. You ask for things for your fellow doctors before you ask it for yourself. You are looking at the future where there is optimism, self-sufficiency and pride in your work. The choice of a rural location is not just a choice but a calling. You see yourself as part of the Outback, a key and respected member of that rural community. I see that you are trying to bring more doctors to the fold. As you watch another brilliant sunset, with a black cockatoo chiding at you and 10 roos ignoring you, be proud of your career path. You are the best. Thank you for being there.

The dead don’t rest

It’s 12 February, 2009. The time is 9pm at Newark Liberty International Airport. Dr Alison Des Forges is waiting to board a flight to take her back to her home in Buffalo, New York. Alison’s spent most of her work life in Rwanda, investigating killings, kidnappings and human rights transgressions. She was one of the loudest voices to be heard on the world stage in 1994, when she called for the recognition of what we now know as the Rwandan genocide.

She was named a MacArthur Fellow in 1999, as well as taking a senior position with Human Rights Watch. But the year isn’t 1994, and we’re not in Rwanda. It’s 2009, and she’s flying home to be with her family in the USA.

The plane has already been delayed by two hours, and the bleary eyed passengers are finally allowed to board the plane. They aren’t the only tired people on-board, however. First Officer Rebecca Shaw has made the commute from Seattle to Newark to co-pilot the flight, and complains to her pilot of feeling tired and unwell. Similarly, Captain Marvin Renslow complains of fatigue, due to a lack of rest over the preceding few days and abrupt changes to his sleep-wake cycle.

What follows is a series of errors that ultimately result in a fatal stall during the landing approach. The Captain responds incorrectly to the stall, as does his First Officer, and the errors are compounded. The plane ploughs into the house of Douglas and Karen Wielinski, and a total of 50 people perish that day, including Dr Des Forges.

To err is human, but we often don’t like facing this harsh reality. This is equally as true in medicine as it is in aviation.

Our workforce is by no means in balance, and it poses a headache for doctors and employers alike.

We’re awash with graduates, but hospitals struggle to fill gaps in rosters due primarily to a lack of workforce coordination. This leads to over-employment of current doctors, increasingly unsafe shifts, workplace dissatisfaction, absenteeism and resignations, all which continue to compound the initial problem.

Sound dramatic? Good. It should. We’re human and we’re not that special. You’d no sooner go to work with a blood alcohol level of 0.05 than you would eat your own face, but we know that after eighteen hours of continuous work, humans behave as if they’re too drunk to drive a car.

In the case of Eastman vs Namoi Cotton Co-Operative (2014), an employee was awarded $498,950 in compensation for a car crash where she drifted into oncoming traffic. The cause? Six 12-hour night shifts in a row with a two-day break. I can name at least five hospitals around Australia off the top of my head with similar rosters, and that’s without breaking an investigative sweat.

Around the time Dr Des Forges was being named a MacArthur Fellow, the AMA was adopting a National Code of Practice for Safe Working Hours.

The code was, and remains, a flexible and common sense guide to work hours. Rather than being a prescriptive and unmanageable set of rules, the code instead highlights patterns and situations which lead to unsafe working hours.

It outlines the responsibility of both the employee and the employer, recognising that fatigue management involves both parties. It’s tailored to the Australian medical workforce, and it has recently been renewed and updated by the AMA Federal Council.

In August, the Council of Doctors in Training will be conducting its five-yearly safe working hours audit, to see whether we as a country are getting better or worse at managing fatigue.

I’ve heard many emotive arguments for and against the importance of fatigue management.

I’ve heard people glorify the dark old days as a superior form of education. I’ve seen workforce units threaten doctors with future offers of employment as incentive for unsavoury rosters. I’ve seen doctors belittled by other doctors for their lack of ‘commitment’ to their vocation. But I’ve also seen a 66-year-old human rights activist, and fervent advocate for hundreds of thousands of slaughtered Rwandans, die partially as a consequence of poor fatigue management.

It is unconscionable to think that fatigue management isn’t core business for doctors, and a key element of good patient care. After all, if one person can fight for thousands of oppressed people, surely I can fight for the welfare of my patients.

Where to from here for the review of AMA policy on euthanasia and physician assisted suicide?

On 27 May Dr Michael Gannon (who would be elected AMA President two days later) chaired a forum on assisted dying (euthanasia and physician assisted suicide) at the 2016 AMA National Conference in Canberra.

The session, moderated by Tony Jones of the ABC’s Q&A program, included contributions from a panel of four medical practitioners, Emeritus Professor Bob Douglas, Dr Karen Hitchcock, Professor Malcolm Parker and Associate Professor Mark Yates, as well as AVANT medico-legal expert Georgie Haysom.

The session was well-received. Both panellists and members of the audience passionately but respectfully expressed views both supporting, and opposing, doctor involvement in assisted dying.

Discussion focussed on a broad spectrum of issues including:

the role of patient autonomy, choice and individual rights;
the treatment of the elderly, the disabled and others requiring care;
the perception of becoming a ‘burden’ to others in relation to disease progression, disability or ageing;
the concept of ‘suffering’, the fear of dying ‘badly’ and the effect a ‘bad’ death has on family members;
the difficulty of distinguishing euthanasia and physician assisted suicide from suicide generally;
the role of palliative care in supporting patients and families, the need for more education and training, and recognition of the wider health care team, including pastoral and spiritual care;
the impact on community perception of the medical profession should the role of the doctor allow for providing euthanasia and/or physician assisted suicide;
different models of assisted dying legislation such as the Oregon law (based on physician assisted suicide); and
the need to improve doctor knowledge of the law in relation to end of life care; for example, it is within the law for a doctor to provide treatment to a patient with the primary intention of alleviating the patient’s suffering that has a secondary effect of hastening death.

While opinions clearly diverged on whether or not doctors should be involved in euthanasia and/or physician assisted suicide, there appeared to be consensus on at least one major issue – the medical profession can do better to support patients and their family members at the end of life.

For those who would like to view the National Conference session, it can be accessed on YouTube at https://www.youtube.com/watch?v=eQGNkOGpuUw.

Where to from here for the review of AMA policy on euthanasia and physician assisted suicide?

The results of the recent AMA member survey on euthanasia and physician assisted suicide are being collated and will initially be discussed by the AMA’s Federal Council at its upcoming meeting in August. Members will be informed of the survey results when Federal Council has had sufficient opportunity to review them.

Along with the survey, Federal Council will consider the issues raised during the other major member consultation initiatives – the 2016 National Conference session and last year’s Australian Medicine consultation on the current AMA policy.

Federal Council will also consider background information on national and international opinions and relevant legislative initiatives before making a policy decision in relation to euthanasia and physician assisted suicide. Federal Council is likely to undertake these deliberations over their next two meetings.

The AMA has endeavoured to make this policy review transparent and inclusive to allow a wide range of member views to be heard.

We will keep members informed of the review’s progress and appreciate your patience and participation throughout the review process.

News briefs

Unnecessary EOL treatment widespread

University of New South Wales reviewers, reporting in the International Journal for Quality in Health Care, have found that more than a third of elderly patients hospitalised at the end of their life received “invasive and potentially harmful medical treatments”. The analysis of 38 studies over 2 decades, based on data from 1.2 million patients, bereaved relatives and clinicians in 10 countries including Australia, found that the practice of doctors initiating excessive medical or surgical treatment on elderly patients in the last 6 months of their life continues in hospitals worldwide. Dr Magnolia Cardona-Morrell, who led the research at UNSW’s Simpson Centre for Health Services Research, said rapid advances in medical technology have fuelled unrealistic community expectations of the healing power of hospital doctors and their ability to ensure patients’ survival. “It is not unusual for family members to refuse to accept the fact that their loved one is naturally dying of old age and its associated complications and so they pressure doctors to attempt heroic interventions,” Dr Cardona-Morrell said. “Doctors also struggle with the uncertainty of the duration of the dying trajectory and are torn by the ethical dilemma of delivering what they were trained to do, save lives, versus respecting the patient’s right to die with dignity.” The study revealed 33% of elderly patients with advanced, irreversible chronic conditions were given non-beneficial interventions such as admission to intensive care or chemotherapy in the last two weeks of life while others who had not-for-resuscitation orders were still given CPR. The researchers also found evidence of invasive procedures, unnecessary imaging and blood tests, intensive cardiac monitoring and concurrent treatment of other multiple acute conditions with complex medications that made little or no difference to the outcome, but which could prevent a comfortable death for patients.

Breast cancer treatment impacts independent living

Researchers from the US have found one in five women undergoing breast cancer treatment for a year became “incapable of performing some of the basic tasks required for independent living”. Published in Cancer, the study also found that a simple survey can help identify which women are at risk of such functional decline. Cynthia Owusu from Case Western Reserve University in Cleveland, Ohio, and her colleagues studied a group of 184 women aged 65 years and older who had been recently diagnosed with stage I to III breast cancer. The researchers used the Vulnerable Elders Survey, a 13-item self-administered tool that has been validated in community-dwelling elders to predict functional decline or death within 12 months. Patients completed the survey just prior to breast cancer treatment. Within 12 months, 34 of the 184 patients developed functional decline and seven died. The risk of functional decline or death rose with increasing survey scores. Women without an education beyond high school were disproportionately affected. “Our findings are important because the study validates the Vulnerable Elders Survey as a useful tool for identifying older women with breast cancer who may be at increased risk for functional decline within a year of treatment initiation,” she said. “This instrument offers the opportunity for early identification and will inform the development of interventions to prevent and address functional decline for those particularly at risk, such as women with low socioeconomic status.”

[Correspondence] Post-sanctions era in Iran: opportunity for science and publication

We read with interest the Correspondence from Masoud Mozafari (April 23, p 1721)1 expressing hope that lifting of sanctions in Iran will lead to an increase in collaboration with the international scientific community. Iran is a nation with a youthful and educated population, and has great potential to contribute to scientific advancement but this capacity will not be realised as long as sections of its society are denied full access to education, an observation which is deeply troubling.