How dangerous is after-hours medicine?

Around half of all doctors who provide after-hours house call (AHHC) services have experienced aggression in their work over the past 12 months, according to the first-ever Australian study on the subject.

Researchers from Griffith University surveyed 300 doctors employed by one of Australia’s largest AHHC providers, finding that 47% had experienced an instance of aggression over the past year. Most common was verbal abuse (48% of cases), followed by threats (27%) and vexatious complaints (13%). Property damage, physical violence, sexual harassment and stalking were all also reported by doctors.

The odds of having experienced aggression didn’t vary greatly according to gender, although female doctors were more likely to say they were concerned or anxious about aggressive behaviour in the course of their work. Overall, over 90% of doctors said they were concerned about aggression and 75% said they were apprehensive about it.

The patients themselves were the most common source of aggression (52%), followed by family members (30%) and friends of the patient (18%). To lessen the likelihood of aggression from friends and family, the researchers suggest making an effort to engage them more, when permitted by the patient.

Doctors with postgraduate fellowships were considerably less likely to have experienced aggression, an interesting finding that the study authors say probably reflects the greater training that these doctors had compared with non-fellows.

But although doctors working in AHHC services are clearly at risk of being on the wrong end of aggressive behaviour, is it any worse than what a regular-hours GP might endure? Perhaps not, the study authors say. Two studies from NSW and one from Victoria actually recorded higher levels of aggressive behaviour aimed at GPs working regular hours from their own premises. And the 47% figure for AHHC doctors is roughly the same as reported for hospital-based doctors in a 2004 study from northern NSW.

After-hours medicine certainly has a reputation for being more dangerous than other types of medical practice, but that perception may well be wrong, the researchers say.

You can access the full study here.

Seven apps and online tools to help in the fight against burnout

If you’re a doctor experiencing burnout, depression or suicidal feelings, nothing beats seeking professional help. But some online tools may help to reduce the odds of these outcomes, say the authors of a new systematic review.

The review authors, from the University of California, say only a minority of health professionals seek treatment for burnout, often due to concerns over confidentiality, stigma, career implications and time constraints. Apps and web tools, although no replacement for professional help, may nonetheless circumvent some of these barriers.

The authors searched PubMed for studies evaluating stress, burnout, depression and suicidality prevention and identified seven online tools and apps that they say could serve as a starting point to improve coping with stressors in the workplace. They add that the next steps involve adapting digital health strategies to specifically fit the needs of doctors and other healthcare providers.

Here are their top seven digital resources:

Breathing

Breathe2Relax: An app which provides breathing exercises to help users learn a stress management skill called diaphragmatic breathing. This has been shown to decrease the body’s stress response, and help with mood stabilisation, anger control, and anxiety management.

Meditation

Headspace: This app guides users through meditation sessions. Meditation has been shown to reduce depressive symptoms.
Guided audio files from the University of California San Diego: Online resources with guided meditation audios that including mindfulness-based stress reduction techniques.

Cognitive Behavioral Therapy

MoodGYM: An online cognitive behavioral therapy program shown to reduce suicidal ideation in interns.
Stress Gym: Another online program with step-by-step stress management guides.

Suicide Prevention

Virtual Hope Box: an app that helps users with coping, relaxation, distraction, and positive thinking.
Stay Alive: This app provides customized safety plans, breathing and grounding exercise tutorials. It also features an online forum.

You can access the systematic review here.

Doctorportal hosts a dedicated doctors’ health service providing support and information about burnout, depression and suicide prevention in the medical community.

For support and information about suicide prevention, call Lifeline on 13 11 14

What patients understand when you give them bad news

When you give bad news to a patient or immediate family, is their understanding likely to be accurate? Not necessarily, even when you are brutally frank about the poor prognosis, according to a recent study.

People tend to mentally soften the blow on hearing bad news, US researchers found in an experimental study involving 200 students who were asked to evaluate a range of prognoses. Even when presented with the stark statement that a patient “will definitely not survive”, participants in the study did not consider that as indicating a 100% likelihood of dying.

The researchers found that positive bias was accentuated the worse the prognosis was. Told that a patient was “very likely to survive”, participants rated the odds that the patient would survive at 89%; but when told that a patient was “very likely to die”, they estimated the odds of death at only 76%.

But they also found that using a more emotionally laden phrase to a prognosis could lessen the effects of positive bias. When told that “it is possible” that a patient would not survive, participants rated that as a 50/50 chance of survival. But if the physician used the phrase “I am concerned that [the patient] won’t survive”, participants downgraded the chances of survival to 35%.

However, the researchers didn’t find any difference in bias regarding the wording of the prognosis in terms of either dying or surviving. In other words, participants attached the same risk of death to the statement “He is unlikely to survive” as they did to “he is likely to die”.

The study authors say their research, along with previous work by other researchers, shows positive bias to be a universal defensive mechanism in response to negative information. But they add that putting numbers to the prognosis – for example telling patients or relatives that they have a 95% chance of dying within three months – is unlikely to counter the positive bias, as previous research has demonstrated that numerical prognoses are just as prone to bias.

“Practitioners should be aware of the ways in which commonly used non-numeric language may be understood in numeric terms during prognostic discussions, and check recipients’ understanding during consultations for accuracy and potential positive bias,” they conclude.

You can access the study here.

Interested in learning more? Professor Stewart Dunn will be moderating workshops in Sydney in 2018 on complex communication in health care. The workshops will cover open disclosure, breaking bad news, end-of-life conversations and dealing with conflict in the workplace. Read more about the workshops and sign up here.

What I’ve learned from 687 doctor suicides

Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months.

Everyone kept whispering, “Why?”

I was determined to find out.

So I started counting dead doctors. I left the service with a list of 10. Five years later I have 547.

[Now I’ve got 687 doctor suicides on my registry (as of 11/12/17). If you’ve lost a doctor or medical student to suicide, please (confidentially) submit names here.]

Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned me. Soon I was running a de facto international suicide hotline from my home. To date, I’ve spoken to thousands of suicidal doctors; published a book of their suicide letters (free audiobook); attended more funerals; interviewed surviving physicians, families, and friends. I’ve spent nearly every waking moment over the past five years on a personal quest for the truth of “Why.” Here are 34 things I’ve discovered:

High doctor suicide rates have been reported since 1858. Yet more than 150 years later the root causes of these suicides remain unaddressed.

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Most doctors have lost a colleague to suicide. Some have lost up to eight during their career—with no opportunity to grieve.

We lose way more men than women. For every woman who dies by suicide in medicine, we lose seven men.

Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India doctors are found hanging from ceiling fans.

Male anaesthesiologists are at highest risk. Most die by overdose. Many are found dead in hospital call rooms.

Lots of doctors die in hospitals. Doctors jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die where they’ve been wounded.

“Happy” doctors die by suicide. Many doctors who die by suicide are the happiest most well-adjusted people on the outside. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head. Doctors are masters of disguise. Even fun-loving happy docs who crack jokes and make patients smile all day may be suffering in silence. We are all at risk.

Doctors’ family members are at high risk of suicide. By the same method. Cardiothoracic surgeon Thomas Gahagan died by hanging himself, leaving behind seven children ages three to fifteen. Two died by hanging themselves as adults. Another physician died using the same gun his son used to kill himself. Kaitlyn Elkins, a star third-year medical student, chose suicide by helium inhalation. One year later her mother Rhonda died by the same method. At Rhonda’s funeral, I asked her husband if he thought his wife and daughter would still be alive had Kaitlyn not pursued medicine. He replied, “Yes. Medical school has killed half my family.”

Doctors have personal problems—like everyone else. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Working 100+ hours per week immersed in our patients’ pain, we’ve got no time to deal with our own pain. (Spending so much time at work actually leads to divorce and completely dysfunctional personal lives).

Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment.

Malpractice suits kill doctors. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court on TV, and in newspapers (that live online forever). We continue to suffer the agony of harming someone else—unintentionally—for the rest of our lives.

Doctors who do illegal things kill themselves. Medicare fraud, sex with a patient, DUIs may lead to loss of medical license, prison time, and suicide.

Academic distress kills medical students’ dreams. Failing boards exams and being unmatched into a specialty of choice has led to suicides.

Doctors without residencies may die by suicide. Dr. Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out the flawed system that undermined his career prior to his suicide.

Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 10-minute slots. When punished or fired for “inefficiency” or “low productivity” doctors may choose suicide. Pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients. Many doctors cite inhumane working conditions in their suicide notes.

Bullying, hazing, and sleep deprivation increase suicide risk. Medical training is rampant with human rights violations illegal in all other industries.

Sleep deprivation is a (deadly) torture technique. Physicians have suffered hallucinations, life-threatening seizures, depression, and suicide solely related to sleep deprivation. Resident physicians are now “capped” at 28-hour shifts and 80-hour weeks. If they “violate” work hours (by caring for patients) they are forced to lie on their time cards or be written up as “inefficient” and sent to a psychiatrist for stimulant medications. Some doctors kill themselves for fear of harming a patient from extreme sleep deprivation.

Blaming doctors increases suicides. Words like “burnout” and “resilience” are often employed by medical institutions as psychological warfare to blame and shame doctors while deflecting attention from inhumane working conditions. When doctors are punished for occupationally induced mental health conditions (while underlying human rights violations are not addressed), they become even more hopeless and desperate.

Sweet, sensitive souls are at highest risk. Some of the most caring, compassionate, and intelligent doctors choose suicide rather than continuing to work in such callous, uncaring and ruthlessly greedy medical corporations.

Doctors can’t get confidential mental health care. So they drive out of town, pay cash, and use fake names to hide from state medical boards, hospitals, and insurance plans that ask doctors about their mental health care and may then exclude them from state licensure, hospital privileges, and health plan participation. (Even if confidential care were available, physicians have little time to access care when working 80-100+ hours per week).

Doctors have trouble caring for doctors. Doctors treat physician patients differently by downplaying psychiatric issues to protect physicians from medical board mental health investigations. Untreated mental health conditions may lead to suicide.

Medical board investigations increase suicide risk. One doctor hanged himself from a tree outside the Florida medical board office after being denied his license. He was told to “come back in a year and we will reinstate your license.” Meanwhile he lost everything and was living in a halfway house.

Physician Health Programs (PHPs) may increase suicide risk. Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs. [Note: PHPs have helped some doctors with substance abuse especially]

Substance abuse is a late-stage effect of lack of mental health care. Since doctors may lose their license for seeking mental health care or get locked into PHPs; they self-medicate with alcohol, illicit drugs, or self-prescribe psychotropic medications.

Doctors develop on-the-job PTSD. Especially true in emergency medicine. Then one day they “snap” like this guy.

Cultural taboos reinforce secrecy. Suicide is a sin in many religions. Islam and Christian families have asked that I hide the suicides of family members. Indian families often claim a suicide is a homicide or an accident, even when it’s obviously self-inflicted.

Media offers incomplete coverage of suspicious deaths. Articles about doctors found dead in hospital call rooms claim “no foul play.” No follow-up stories.

Medical schools and hospitals lie (or omit the truth) to cover up suicides—even when media and family report cause of death. Medical student Ari Frosch stood in front of a train, yet his school reported he died at home with his family. Though the family of psychiatrist Christine Petrich shared that she bought a gun and killed herself (after just getting her hair done and planning a surprise trip to Lego Land and Disney for her kids) on their GoFundMe page, her employer wrote she “passed away.” Shouldn’t the department of psychiatry take a more active interest in physician suicide?

Euphemisms cover up doctor suicides. Suicide is omitted from obituaries, funerals, clinics, hospitals, and medical schools. Instead we hear “passed away unexpectedly in her sleep” and “he went to be with the Lord.”

Secrets will not save us. We’re unlikely to make a medical breakthrough on a hidden medical condition.

Doctors choose suicide to end their pain (not because they want to die). Suicide is preventable. We can help doctors who are suffering if we stop with all the secrecy and punishment.

I’ve been shunned for speaking about doctor suicide. After being invited by the American Medical Association to deliver my TEDMED talk, I was disinvited shortly before the event because they were “uncomfortable” with physician suicide.

Ignoring doctor suicides leads to more doctor suicides. Thankfully, an Emmy-winning filmmaker is completing a documentary on physician suicide this month. International film tour begins in 2018. Contact filmmaker to have a screening at your medical school or hospital.

Dr Pamela Wible is a physician based in Oregon in the United States. She blogs here.

Doctorportal hosts a dedicated doctors’ health service providing support and information about suicide prevention in the medical community.

For support and information about suicide prevention, call Lifeline on 13 11 14

What alcohol does to your looks: study

The received wisdom holds that alcohol consumption has a visibly ageing effect – but it’s an assumption that’s remained untested in a prospective study until now. Danish researchers looked at the effects alcohol and smoking on four visible age-related signs: arcus corneae (an opaque ring around the cornea), xanthelasmata (plaque on or around the eyelids), earlobe crease and male-pattern baldness – all of which have been associated with higher cardiovascular risk and mortality.

The researchers used a random sample of nearly 12,000 adults from the Copenhagen City Heart Study, a population-based, a large-scale prospective study that has been running since 1976. For this sample, the mean follow-up was 11.5 years.

A strong association was found between biological ageing of the body and heavy alcohol and tobacco consumption, affecting three of the four indicators. Only male-pattern baldness was not consistently associated with drinking or smoking.

Women who consumed 28 or more standard drinks per week had a 33% greater risk of arcus corneae, while men who had 35 or more standard drinks per week had a 35% greater risk of the same condition.

But the good news for more moderate drinkers is that the occurrence of age-related signs in this group was similar to that of non-drinkers. Moderate drinking counts as one drink per day for women and two drinks for men.

Low to moderate alcohol intake has been associated with health benefits in several studies, although that finding has been controversial and many argue that it is not causal.

The study authors from the University of Southern Denmark cautioned that the study was observational and couldn’t determine causality between smoking, drinking and ageing. They pointed out that the study didn’t account for stress or other factors potentially underlying both alcohol use and cardiovascular risk.

But they noted previous research suggesting mechanisms that might link alcohol consumption to premature ageing. One such study looked at male alcohol intake and telomere length, which is a marker for ageing. This study showed even minor alcohol consumption in midlife was significantly associated with shorter telomere length, with a 10-year difference in biological age between teetotallers and the highest consumption level.

You can read the full study here.

What does the research tell us about coffee’s health benefits?

A recent headline in the Australian newspaper claimed “A short black a day can keep heart attack at bay”:

American scientists have unearthed fresh evidence that coffee exerts protective effects against heart failure and stroke.

According to the researchers, for every extra cup of coffee drunk per week, there was a 7% reduction in risk of heart failure and an 8% risk reduction for stroke.

So, is this more good news for coffee lovers, or a case of be careful what you read?

As the researchers explain in the media article:

We don’t know if it’s the coffee, compounds in the coffee or behaviour associated with drinking coffee.

The data comes from observational studies showing an association between coffee consumption, and heart failure and stroke. It does not prove causation. It shows that people who drank more coffee had lower rates of heart failure and stroke, not that drinking more coffee was responsible for reducing this risk.

There may be other reasons why people with heart failure and those who have had a stroke drink less coffee, for example, being on fluid restrictions for medical reasons, or not being able to move independently enough to make a cup of coffee.

That doesn’t mean you should avoid having another cup of coffee. A review of 20 observational studies from 2014 found those who drank the most coffee had longer life expectancies than those who drank the least or no coffee.

Again, these studies showed correlation not causation, but the evidence to suggest coffee is good for you is mounting.

How was the research conducted?

This story came from an abstract of a presentation to the American Heart Association’s 2017 Scientific Sessions on November 14. The researchers used data from more than 12,000 adults in the Framingham Heart Study to look for eating and drinking habits associated with heart disease.

The study used a powerful new statistical approach called random forest machine-learning methods. This uses all the individuals’ data to construct multiple decision trees and work out what the common patterns are when predicting their health outcomes. The researchers said this technique was a bit like the algorithms used in the marketing programs that predict our shopping behaviours.

The researchers confirmed that high blood pressure, high blood cholesterol and older age increased the risk of heart disease. They also identified that higher intakes of coffee predicted a lower risk of heart failure and stroke.

Important questions about the research are unclear: how coffee intake was assessed, whether decaffeinated coffee was included, and exactly how much was consumed each day or over the week.
Tim Wright/Unsplash

Lastly, the researchers created a statistical model that included the well-documented heart disease risk factors – age, sex, total and HDL (good) blood cholesterol levels, blood pressure, smoking and diabetes – that are used to calculate a person’s Framingham Risk Score. This is a person’s ten-year probability of developing cardiovascular disease, including stroke, heart failure and atherosclerosis (fatty deposits that clog arteries).

This analysis found that including coffee consumption in the equation improved the accuracy of the Framingham Risk Score in predicting heart failure and stroke by 4%.

The researchers reported finding similar trends – the 7% reduction in risk of heart failure and 8% risk reduction for stroke – in two separate studies.

What does this mean?

The study in the media headline was not about heart attack, it looked at heart failure and stroke, which are very different conditions:

Heart attack is triggered by short-term lack of blood and oxygen to the heart muscle causing some muscle cells to die
Heart failure means the heart can’t pump blood around the body adequately
Stroke is when the blood supply to the brain is interrupted by either a blockage or a burst blood vessel.

This difference is important because while something might be good for the heart muscle itself, it’s not necessarily good for the blood vessels in the heart and brain.

The data was from a conference abstract only. So it includes very limited details of the methods and results, and misses important information such as:

which variables were adjusted for in the statistical analyses (external factors that might skew the results)
how coffee intake was assessed
whether decaffeinated coffee was included, and
exactly how much was consumed each day or over the week.

While it’s great to hear about early research findings, the data has not gone through the full peer review publication process and so we will have to wait to eventually read the full paper.

Most importantly, this data comes from observational studies and shows an association between coffee consumption and heart health. It does not prove causation.

So is coffee good for your health?

If you are a smoker, it’s wise to avoid regular coffee. A review of the best evidence found a higher risk of lung cancer for smokers who drank regular coffee, although drinking decaffeinated coffee was suggestive of a lower risk.

Among those with high blood pressure, caffeine in coffee does lead to an immediate increase in blood pressure that can last a few hours. However, there is no evidence of an overall higher risk of heart disease.

For a host of other reasons including a lower risk of type 2 diabetes, prostate cancer, liver cancer, and a longer life expectancy, drinking coffee is now on the list of things to consider to improve your overall health. – Clare Collins

Blind peer review

This is a fair and accurate assessment, and accords with the data from two studies published this year on death from any cause (and heart disease and stroke). –Ian Musgrave

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle

This article was originally published on The Conversation. Read the original article.

The benefits of strength training: what the research tells us

Most of us probably know exercising is associated with a smaller risk of premature death, but a new study has found that doesn’t have to happen in a CrossFit box, a ninja warrior studio, or even a gym. Body weight-bearing exercises such as sit-ups and push-ups staved off death just as much as other forms of weight-bearing exercise.

Our study recruited just over 80,000 adults over 30 years living in England and Scotland between 1994 and 2008, who were followed up for an average of nine years. At the end of the followup period, we calculated their risk of death according to their strength-promoting exercise and how much they did.

What we found

Those who reported participation in any strength-promoting exercise (including gym workouts) averaged about 60 minutes a week and those who reported any own body weight exercises averaged 50 minutes a week. Participation in either gym workouts or own body weight exercises reduced the risk of early death by about 20%. Cancer-related deaths also decreased by 24-27%, but there was little evidence more was better.

We also compared the risk of those who met the recommendation of two sessions of strength-promoting exercise per week, with those who met the recommendation of 150 minutes of aerobic physical activity such as walking (or 75 minutes more intense, such as running) per week.

Compared to being inactive, meeting either guideline was associated with a 16-18% reduction in risk of early death.

But the results on cancer death risk told us a very different story. Those who met only the strength-promoting guideline by doing body weight exercises had a 31% lower risk of death from cancer. Those who met only the aerobic exercise guideline had no reduction in risk of cancer death.

On the other hand, reducing the risk of death from heart disease was only associated with aerobic physical activity (21% reduction).

Gyms can be daunting for beginners.
from www.shutterstock.com

Interpreting the results

Given this research is observational, there’s always a chance the relationship between exercise and early death could be due to other causes. Perhaps the people who exercised more were also just generally healthier in other ways.

To reduce the possibility of alternative explanations, we adjusted our results for age, sex, health status, obesity, other lifestyle behaviours (smoking, alcohol, diet), education level, mental health, and participation in other physical activity such as domestic activities, walking and aerobic exercise.

People with chronic diseases are less likely to exercise, and more likely to die early. Therefore we excluded from the results all participants who had heart disease or cancer, as well as those who died in the first two years of the followup (because their death was most likely caused by something they had prior to the study commencing).

Other studies have examined the relationship between strength promoting exercise and early death. An American study found lifting weights or doing callisthenics was associated with a 31% decrease in risk of death from any cause, which is consistent with our results. But contrary to our results, the same study found no association with cancer death risk.

Another study among cancer survivors showed lifting weights, but not aerobic activities, was associated with a 33% lower risk of death from any cause.

What it all means

Our study suggests exercise that promotes muscular strength has unique health benefits and is at least as important for health as walking, cycling, and other aerobic activities.

We shouldn’t forget the most important principle for choosing an activity is being able to incorporate it into your routine and stick to it long term. The simplicity of body weight exercises makes them a very attractive option: they are inexpensive and require little skill and no equipment. Plus we now know they yield comparable benefits to similar gym-based activities. This is important given gyms can be daunting or unaffordable for many people.

So in addition to doing enough moderate to vigorous intensity aerobic activity, good old fashioned push-ups or chin-ups at home, in the park, in the yard, or even in the office could be an excellent option. For most people two to three sessions a week would be sufficient for general health.

The American College of Sports Medicine recommends 2-4 sets of 8-15 repetitions of each strength promoting exercise with 2-3 minutes rest between sets. As with any physical activity, the most important principle here is a little is better than nothing, and gradually build up from little to enough.

Emmanuel Stamatakis, Associate Professor; Physical Activity, Lifestyle, and Health Behaviours, University of Sydney

This article was originally published on The Conversation. Read the original article.

What you need to know about your CPD requirements

It’s hardly a secret that doctors are incredibly busy professionals. On top of all the clinical work, there are ever-increasing bureaucratic demands on practitioners, coupled with diminishing windows of opportunity to keep up with the latest advances in medical knowledge. It’s all too easy to put continuing professional development (CPD) on the backburner, leaving it for one of those mythical days when you have “more time”.

Do so at your own peril, however. There is the clinical imperative: many medical fields are moving so fast that if you don’t know about the latest developments, you won’t be able to offer your patients best practice. For example, one of the most common heart conditions, atrial fibrillation, is now being treated with a class of drugs – the so-called novel oral anticoagulants – that were pretty much unheard of not so long ago. Similarly, in just a few short years, the choice of drugs to treat type 2 diabetes has expanded considerably.

And then there’s the regulatory imperative. Many doctors are still unaware that AHPRA conducts random audits of doctors’ CPD activities. And if you haven’t fulfilled your requirements, there can be consequences. The Medical Board of Australia can impose conditions on your registration, or even outright refuse to register you. And although failure to undertake the required CPD is not a legal offence, it could be used in disciplinary proceedings against you as evidence of inappropriate practice or conduct.

Particularly vulnerable to being caught out are doctors who are not affiliated with a college – IMGs, doctors in training and non-vocationally registered doctors – don’t get the same prompts that other doctors get from their college to do their required CPD.

Doctors who do belong to a college need to meet the CPD standards set by their own college. For example, the CPD program of the Royal Australian College of General Practitioners has a mandatory Planning, Learning and Need (PLAN) activity which involves doctors looking at their practice, their patients and their patients’ demographics to work out the future CPD activities they should do over the next three years to support their skills and practice. GPs must then accumulate 130 CPD points, which must include one Category 1 activity and one CPR activity.

Doctors in training or who are non-vocationally-recognised must also demonstrate that they have fulfilled full CPD requirements. This involves a minimum of 50 hours of CPD per year, which can be self-directed. Any self-directed program must include one mandatory self-assessment reflection activity or peer review, clinical audit or performance appraisal. Activities to enhance medical knowledge, such as participation in courses, conferences or online learning, are also required.

Trainees need a signed letter or report from their supervising hospital to confirm their participation in training and education programs.

If you are randomly selected for audit, you will be sent an audit notice, and have 28 days to demonstrate that you’ve met the Medical Board of Australia’s registration requirements. These include not only your CPD requirements, but also declarations about indemnity insurance, recency of practice and criminal history. If you are found to be in breach in any of these areas, you can be reported to the Board.

See here for more information on CPD requirements for doctors who are not affiliated with a college.

Sign up to Doctorportal Learning to access mobile-friendly medical education, track all your CPD points and activities in one place, and get assistance in meeting your Medical Board of Australia CPD reporting obligations.

Which OTC painkiller in a post-codeine world?

From February 1st next year, all codeine-based pain relief medications will become prescription-only. GPs may get a surge of patients asking for codeine prescriptions, but they will probably also get people asking them for good over-the-counter alternatives to the opioid. So what should they be telling their patients?

According to NPS MedicineWise, the best alternative for the short-term management of acute pain may be an paracetamol/ibuprofen combination pill, of which there are several OTC formulations on the Australian market.

NPS MedicineWise says the best treatment for mild pain is still paracetamol only or non-pharmacological measures, such as ice packs. But when that doesn’t do the trick, paracetamol/ibuprofen may prove more effective, as long as the patient is able to take an NSAID.

Evidence from a number of studies show that for acute pain, the combination is better for analgesia than either drug on its own, although it is not indicated for chronic pain. Paracetamol/ibuprofen has been found to be effective for a variety of pain states, including postoperative pain, dysmenorrhoea and musculoskeletal pain.

A Cochrane review has looked at the combination’s efficacy after wisdom tooth removal and found it better than either paracetamol or ibuprofen on its own for relieving pain six hours after the intervention.

Short-term studies have not identified any safety concerns for the combination other than those already known for the individual components, although one study found an increase in bleeding over 13 weeks, suggesting caution with long-term use.

Paracetamol is relatively safe, although inadvertent overdose is possible, but more precautions are needed with the use of ibuprofen. Lower doses are recommended for older people, and those with kidney disease, a history of peptic ulcers, asthma, high blood pressure or in pregnancy.

Another possible OTC alternative to codeine is diclofenac potassium, which has been shown to be effective in a variety of pain states, including acute lower back pain, tension-type headache, musculoskeletal pain, dysmenorrhoea and dental pain.

For chronic pain, analgesic medicines are only mildly effective and their use is recommended only as an adjunct (paracetamol) to non-pharmacological strategies, or in small doses for a short time (NSAIDs).

Source: NPS MedicineWise

We all have to die of something, so why bother being healthy?

It’s 6:45 on a cold and rainy Tuesday morning. The alarm blares. As you begin to wake and wonder how it could possibly be morning already, your good intentions dawn on you. It’s run morning – and it’s the last thing you want to do. As you roll over to hit the snooze button, your mind scrambles for a valid excuse.

Why bother trying to be healthy? We all have to die of something, right?

In part this is true. Regardless of our discomfort with death, we all have to die sometime, and we all have to die from something. However, this is where the truth ends.

Today in Australia, the leading causes of death are mostly preventable – or at least can be significantly delayed. Factors like poor diet and tobacco drive ailments including heart disease, stroke, diabetes (type 2), lung disease and cancers. And when you look more deeply at what ill-health brings, it’s not just death that makes the strongest case for getting out of bed.

You’ll die later

Sure you have to die of something, but you may not have to die so soon. Science suggests having a healthier lifestyle even at age 50 is associated with a four to seven year longer life expectancy.

Even at older age, improving lifestyle factors can benefit longevity. Avoiding an unhealthy weight, not smoking, maintaining a social network and engaging in leisure activities around age 75 sees a whopping five years added to a woman’s and six years added to a man’s life span.

You’ll be healthier, longer

Trying to be as healthy as you can is not just about adding more years to your life, but adding healthy years, or even decades. Populations who follow healthy forms of behaviour show a 60% decline in dementia, in addition to a 70% reduction in type 2 diabetes, heart disease and stroke when compared with unhealthier peers. Studies also find healthier 50 year-olds live longer without disability than those who are overweight or smoke.

Yes, we all have to die eventually, but we want to be happy, well, independent and pain-free leading up to our deaths.
from www.shutterstock.com

A significant proportion of octogenarians are also living healthier, more active lives. This is seen in measures of mobility, self-care, levels of pain and discomfort, and absence of anxiety and depression. But rather than being related just to age, variations in health-related quality of life are also linked to factors such as exercise, nutrition and social engagement.

So being active and eating well could mean a healthier, more independent life for longer.

You’ll feel better in the meantime

Eating healthier and exercising have also been shown to have benefits on your day-to-day wellbeing. Exercise can improve and protect mental health. As a strategy to manage mild to moderate depression, exercise can provide comparable benefits to some antidepressants, and can complement medications to improve symptoms further. Similarly, exercise can play a role in treating anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder. It can also improve your sleep quality and even benefit self-esteem and confidence.

It’s thought exercise does this by reducing your sensitivity to the symptoms of anxiety, building resilience to stressful mood states, positively altering the neurotransmitters in the brain, and disrupting or distracting you from social isolation.

Getting active can also allay general body aches and pains. An Australian study recently suggested jogging improves the composition of the cushion-like discs in your spine, reducing wear and tear. Exercise not only fortifies the discs but is also generally effective in preventing and treating pain. This is particularly important given 67% of Australians experience pain at least monthly, with inactivity being a major risk factor.

Exercise has benefits for most aspects of our physical and mental well-being.
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A healthy diet combined with exercise can also strengthen your bones, reducing the risk of fractures if you do have a serious injury.

You’ll save more and spend less

There’s good evidence, including from Australia, that eating healthy food is actually more affordable than an unhealthy diet. And smoking one pack of cigarettes per day, when combined with the health costs that result, is estimated to cost a staggering US$638,750 (A$812,556) to you and society over 50 years.

Type 2 diabetes, often associated with obesity, is estimated to result in A$4,025 per year per person in total costs without medical complications, or in excess of A$9,645 once complications develop. These costs are incurred not only through the need for treatment, but also in job discrimination, higher health insurance costs, lost productivity with sick days and poor physical function.

While no similar analysis exists for Australia, evidence from the US estimates lifetime social and public health costs of obesity at US$92,235 (A$117,332) per person, when combining medical expenditure and reduced productivity.

The direct medical costs to individuals in Australia may be lower due to our universal health system, but the costs from obesity still add up to A$873 million each year. A A$719 million per annum slice of the Australian budget is spent on the complications of physical inactivity alone, through heart disease, stroke, type 2 diabetes, breast cancer, colon cancer, depression and falls.

This isn’t noted to shame anyone or to recommend reducing care, it’s about realising policy and health inaction comes at a huge economic and social cost.

Your kids will be healthier, and maybe even their kids

Poor diet, smoking, alcohol use and a lack of physical activity can also affect your kids’ health – and maybe even the health of their kids.

Firstly, through role modelling. The kids of parents who smoke are significantly more likely to smoke themselves, and likewise with unhealthy drinking and eating. These kids are also more likely to be obese. Some of these effects could also be from socioeconomic factors.

Second, through a mechanism called epigenetics, our own health can influence the health of subsequent generations. This results from alterations in the expression of genes and not through changes in the genes themselves.

Altered epigenetics from physical inactivity, diet and environmental factors are now thought to be passed down through generations. They influence the subsequent risk of metabolic diseases such as obesity and diabetes.

Finally, being overweight, a lack of exercise and even consuming sugary drinks could actually reduce your chances of having kids in the first place. In women, being overweight increases the risk of polycystic ovarian syndrome, which causes irregular ovulation and can occasionally render women infertile.

While in men, excess weight contributes to infertility by reducing the quality of semen, as well as increasing the risks of sexual dysfunction.

The bigger picture

Living a healthier lifestyle is about making small, possible, simple and sustainable changes like taking the stairs instead of the lift – not totally rethinking the way you live.

Being healthy is about small, incremental, sustainable changes over many years.
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But while there are many compelling reasons to be healthy, personal discipline alone will never solve our chronic disease and obesity epidemics. If neighbourhoods lack safe spaces for kids to run, or fresh food is inaccessible and unaffordable, good intentions will not get you very far. Government policies need to make health easier, even preferred.

In the meantime, look to friends for motivation; your family to share and support a healthy diet; apps that map and commend the exercise you do; and your GP and important services like Quitline for assistance with alcohol reduction and smoking cessation.

Alessandro R Demaio, Australian Medical Doctor; Fellow in Global Health & NCDs, University of Copenhagen

This article was originally published on The Conversation. Read the original article.