Harmful effects of codeine

“The peptic ulcers can also be lethal, in fact, one of my worst moments in the last few years was when I was up all night with a young man who was otherwise well, who was bleeding torrentially from a giant ulcer in his stomach which was caused by compound analgesics,” Dr Aidan Foy, Director of General Medicine at Newcastle’s Mater Hospital.

“This can happen to anyone and it can remain hidden. There don’t have to be dealers knocking on someone’s door.” Over-the-counter painkiller addict.

“It is something that people don’t realize. I had no idea that I could get addicted to codeine.” Frankie Bean began using Nurofen Plus 24-hours-a-day to stave off the chronic pain.

Rural conference focuses on doctors’ health and training pathways

The peak national event for rural doctors is set to kick off next week in the distinctly unrural Melbourne, with a stellar line-up of presenters.

Among the speakers at Rural Medicine Australia 2017 are former Greens leader Dr Bob Brown; Dr David Gillespie, Assistant Minister for Health; and Shadow Minister for Health Catherine King.

The event will include a Presidents’ Breakfast forum facilitated by distinguished medical broadcaster Dr Norman Swan, with a panel including RAGCP President Dr Bastien Seidel and the AMA’s Vice President Dr Tony Bartone, along with Associate Professor Ruth Stewart, President of the Australian College of Rural and Remote Medicine (ACRRM).

Forum host Dr Ewen McPhee, President of the Rural Doctors Association of Australia (RDAA), says the forum will cover a range of issues, including the poor distribution of doctors between urban and rural areas, as well as political initiatives such as the implementation of a National Rural Generalist Pathway.

“Key government and opposition members will be in attendance at the breakfast and we’ll be having discussions around medicopolitical issues, but also the broader issues of Medicare and the Medicare rebate, as well as the codeine prescription issue,” Dr McPhee told Doctorportal.

Dr McPhee said some of the key themes of the conferences would be doctors’ mental health.

“This is an issue that’s really come to the forefront, particularly with the recent spate of suicides of young clinicians. We need to recognise the privations and difficulties that always challenge doctors when they go rural and we have to understand how to build resilience in our rural doctors.”

Dr McPhee said other subjects that will be discussed at the conference include the ins and outs of cannabis prescribing, and also the role of the rural doctor in sports medicine.

“We’re looking at the issues around the country doctor also being for example the local rugby GP, and what are the obligations, tips and tricks around how you look after sports people in a country town where you don’t have access to sports medicine specialists – issues like dealing with concussion, minor sporting injuries or maintaining fitness.”

Dr McPhee praised several government initiatives to improve access to care in rural, regional and remote communities.

“I think the government has done a lot. They’ve legislated for a Rural Health Commissioner; they’ve created 100 extra places for rural specialist training. They’ve developed the Junior Doctor Training Innovation fund and they’re in the process of allowing universities to develop rural training hubs to facilitate regional training of clinicians, be they specialists or generalists. There’s a lot happening in rural, but we still need to see greater investment in primary care. Funding for primary practice is at its lowest ebb – we need different models of funding and care that lead to sustainable clinicians, making sure they stay in the region and are supported in the long term.”

He said the medical training of Aboriginal and Torres Strait Islanders was another key issue in rural and remote medicine.

“Our goal is to have 1,000 Indigenous medical practitioners, and we’re sitting at around 200-300 at the moment. They absolutely need our support and we need to ensure First Nations people have the opportunities to get the training they need to become clinicians in their own communities. We’re still not doing enough and there’s no doubt it’s one of the issues we need to address.”

Rural Medicine Australia is the key annual rural medicine conference in Australia, and is jointly hosted by ACRRM and RDAA. You can access the program here.

Have a rural job vacancy? Doctorportal Jobs makes recruitment easy. Just select the Rural General Practitioner option when you post a job to reach the most qualified candidates. Or if you’re seeking a rural placement, sign up to post a private resume and let employers find you.

Tough talk: managing difficult conversations

Communication skills are uniquely relevant in the general practice setting, because no other medical practitioner offers the continuity of care that GPs afford their patients. A new workshop, conducted by the multiple award-winning Pam McLean Centre, will address some of the most challenging communications in the context of the long-term doctor-patient relationship – breaking bad news, open disclosure following an adverse event, and initiating discussions about treatment options at the end of life. The common theme is talking about things our patients really don’t want to talk about.

Models abound – SPIKES, ABCDE, BREAKS, ISBAR etc. And models have their place. But putting the models into practice can sometimes be surprisingly hard. This workshop allows doctors to put theory into practice through trial-and-error, working with a highly trained professional actor to negotiate step-by-step through the maze of emotionally-charged communication. Just like learning to intubate on mannequins, working with actors allows us to try various approaches to communication safe in the knowledge that no-one gets hurt. The workshop is based on rigorous research, including one of Prof Dunn’s PhD student’s projects, which measured heart rate and skin conductance in doctors whilst they told a woman that her husband had just died. The results will surprise you.

In this workshop, you will meet two patients (played by two highly experienced actors) who present all these challenges in a panorama of multiple presentations. There are options to practise the delivery of bad news in different emotional contexts, and to explore appropriate responses to an angry relative when there has been a serious adverse event. Finally we will investigate ways of initiating and supporting discussions around disease progression. You will have the opportunity to stop the consultation at any time and seek feedback from the patient and from other workshop participants. And Prof Dunn will provide insights from the relevant literature to help us along the path.

Click here for more information on this workshop.

More than resilience: why we need to shift the conversation around doctors’ wellbeing

You’re a keen, first-year medical student. Today, you’re practising breaking bad news to patients – actors of course, but boy does it feel like the real deal. Before you begin, the whole room stops. You all close your eyes, and practice mindfulness – just for three minutes – but as you return to the room, you find you’re truly present and ready to take on this consult. You each have your turn breaking bad news. You have to tell a father that his six year old daughter has died. You fumble through the conversation. You almost cry with him. You collect your things and leave, once all your colleagues have had a turn, but you return to that workshop later that evening through your reflective journal. What did you learn about this skill? More importantly, what did you learn about yourself? And how, when you’re faced with this in future, are you going to do better, or differently?

Medical school equipped me with a skill set in addition to that of clinical medicine. The extras included how to manage difficult relationships in the workplace, dealing with emotionally challenging experiences, how to be vigilant of my own health and wellbeing, and simple practices I can employ throughout my practice and life to make myself the best doctor I can be. These skills were reinforced in my intern education sessions and at multiple conferences. I’m now a junior doctor – an occasionally very stressed, often very busy, and at times burnt-out junior doctor.

We know doctors have high rates of emotional distress and mental health issues. But our conversation around this is fixated around teaching more personal resilience skills at medical school. I’ve been taught these skills, and many medical schools have a similar emphasis to mine. Why, then, does this continue to be the centre of our conversation on doctors’ wellbeing? Yes, we should continue to pressure medical schools, teaching hospitals and training colleges into fostering these skills in their trainees. But we urgently need to broaden the conversation.

Junior doctors are often put in positions where we are stretched to our limits both personally and professionally, with immense workloads, long hours, having to adapt to a new department, system or even hospital every five to ten weeks. On top of this, we need to remain competitive and employable by doing research, extra degrees and study for training programs. We exhaust all our energies and wellbeing strategies managing these challenges, leaving us with little to give when faced with a difficult case, complex scenario, or personal challenge.

The daisy in the desert

A daisy won’t grow in a desert. We’ve made enormous strides in teaching doctors resilience: now need to broaden our focus to the system itself. We work in an environment where the bar is set close to perfection. We rarely forgive ourselves for our mistakes. We work ourselves harder than we could have imagined, to ensure the very best for our patients. We work unpaid overtime, we skip meal breaks. Honestly, there are days when I wonder if my own creatinine isn’t higher than my patients’.

So let’s do some primary prevention. Let’s work on the things further upstream that affect our wellbeing. Perhaps we need to start with the simple things: making sure we take a lunch break. Or even just a water break, so we’re not so dehydrated we don’t even need to go to the bathroom. We need supportive and positive feedback, not only highlighting what could have been done better. We need leaders who encourage and support us in these endeavours. Find the issues causing your colleagues to burn out, and find a way to create change. We need to look at the bigger picture and see how we can alter the desert, not the daisy.

This conversational shift comes with a risk. Let’s go back to some high school physics – bear with me, I promise it’s worth it. Force = pressure x area. We’ve been focussing on one part of the conversation – a small area. So a little bit of pressure, and we get a reasonable force. If we broaden the conversation without the extra pressure, we risk reducing our impact. The challenge is to not get lost in the vastness of this problem – find the next, impactful step and take it, and remember the endpoint. The goal should not be more resilient doctors. It should be doctors working in environments that allow and encourage them to be healthier, happier people. That allow us to use our resilience skills to tackle challenging scenarios, not the everyday.

With all this in mind, my challenge to you is this. Find one small change to make, that will make you happier and healthier at the end of the day. Find it, and make it happen. Let’s share our simple step with a colleague from a different practice or hospital, find what they have changed and swap ideas. Let’s encourage leaders to support this, and advocate for changes that need to occur. Let’s create a subtle creep of wellbeing that isn’t taught in a lecture theatre. And then, let’s tackle the desert.

Dr Nicola Campbell is a resident medical officer currently working in regional Queensland. She studied medicine at Griffith University and aspires to be a rural GP with an advanced skill in mental health.

Doctorportal hosts a dedicated doctors’ health service providing support in the medical community.

For further support and information, call Lifeline on 13 11 14

Medicine’s gender revolution

Until the turn of this century, there was little sense in Western medicine that gender mattered. Outside the niche of female reproductive medicine, the male body was the universal model for anatomy studies.

Clinical trials mainly involved males and the results became the evidence base for the diagnosis and treatment of both genders. Medication dosages were typically adjusted for patient size and women were simply “small men”.

Medical academia has also been male-centred, with teachers, professors and researchers being mostly male. Twenty-five years ago, most college boards representing medical specialities around the world were almost exclusively male.

But in the last 20 years, mainstream medical research has begun to seriously explore gender differences and bias in academic and clinical medicine. This explicit recognition of gender — along with factors such as ethnicity and socioeconomic status — helped determine how healthy all people’s lives are likely to be.

And so, the discipline of “gender medicine” (also called sex-specific medicine) was born. Gender medicine centres opened in the early 2000s, textbooks followed and gender modules were introduced into some medical training and curricula.

In 2008, the World Health Organisation issued guidelines on “teaching gender competence”. This is the capacity for health professionals to identify where gender-based differences are significant, and how to ensure more equitable outcomes.

Gendered medicine is not only about women. It is about identifying differences in clinical care and ensuring the best health care is provided for all. It is also about ensuring equity of health care access, and about gender equity in the composition and roles in the profession.

Does gender matter?

Gender is not the same as sex, which is about biological and physical male-female differences. Gender relates to the social and cultural behaviours we attach to the biological aspects of sex; it is not binary and exists on a spectrum.

In medicine, gender impacts how, when and why a person accesses medical care, and the outcomes of that access. For instance, women seeing their doctor for chronic pain often don’t feel adequately listened to or supported.

In the area of heart health, women are less likely to seek help for a heart attack as their symptoms make it harder to identify. Studies have also found they don’t receive potentially beneficial treatments for heart disease in the same way men do, and have lower survival rates.

Women are less likely to seek help for a heart attack than men.
from shutterstock.com

In mental health, depression is more common in women and suicide rates are higher in men. The nature of diseases such as heart disease, osteoporosis and lung cancer are different between women and men too, as are their outcomes.

Less well known is that two-thirds of the blind people in the world are women, even when the data is adjusted for the fact women live longer. And as an example of sociological differences that need recognising, women who present with an eye socket fracture, a ruptured eyeball or eye bruise are at risk of dying, not from the injury, but from a further assault by a perpetrator of family violence.

Improving the evidence

Clinical trials are the bedrock of medical research and evidence building. Until relatively recently, they were mainly conducted with males for a number of reasons, including availability to participate and concerns about the impact on women’s reproductive health, or the impact of menstrual cycles on the trials.

Restricting difference also makes trials cheaper by reducing the required sample size (even though it leads to inaccuracies for various important subgroups).

Women were excluded because they are different, but the results were applied to them because they are nearly the same. And when women and men are included in trials, the results are usually not published separated by sex, so the findings may be inaccurate for all participants.

Even in pre-clinical research using animals, female animals have been excluded to make management and costs simpler, and reduce measurement variation.

As a result, large scale clinical trials have yielded findings based on particular population groups. For example, a 1988 study into the use of aspirin to lower the risk of heart attack was based on a six-year trial of 22,000 men.

But change is afoot in trial design. Australia’s largest medical research grant body, the National Health & Medical Research Council, for example, has introduced guidelines that require applicants to address gender equity among research participants.

Only recently have women begun to be included in clinical trials.
from shutterstock.com

What are the next steps?

We need data from clinical trials and population data that is sorted by gender, so knowledge bases can be gradually improved. Generalisations about gender can be both useful and problematic, so careful analysis is needed.

We must account for gender in all medical training, and clinical practice. This should apply to not only disciplines that relate to sex hormones such as gynaecology, but also for example orthopaedics and ophthalmology.

We need the profession itself to take the lead in encompassing gender diversity in our community. Following the lead of non-medical groups such as the Australian Institute of Company Directors, the medical profession needs to introduce targets for diverse representation on all professional decision-making bodies.

Sarah, an Australian medical student in her final year, told me the biological perspective is taught well, but the psychological and social “not so much”.

There are broader social and cultural factors that might affect the way a male patient presents versus a female.

Medical training on diversity also needs to include people who are transgender or who identify as non-gender conforming. As Sarah said:

We talk about inequalities in terms of males and females, but gender diversity isn’t mentioned at all. I shudder to think of the barriers and obstacles you might face in training if you were transgender or non-gender conforming. I haven’t heard anyone raise that.

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

What are we training medical students for?

When young people go to medical school they are called medical students. They know that they are to learn about medicine. Everything about medical school is about learning about medicine. In fact, every waking moment is about learning about medicine.

We learn about anatomy, physiology, statistics, how to read a research paper, how to do a research project, we learn about diseases, pathology, histology, how to examine patients. We learn the right questions to ask in the right way to get the information that is needed.

We endlessly learn about rare diseases, treatment protocols and how to do various procedures and operations. Our whole lives are consumed with medical information.

But is this all that there is to medical school?

Of what value is all the medical knowledge in the world if the person holding that knowledge is miserable and unwell themselves, struggling to work and struggling to cope with people?

Students graduate at the age of 24 (at least) after the most intensive periods of their lives where literally every moment is dedicated to learning as much information as possible.

It has even been said that medical school is a prolonged period of adolescence where life skills are not learned, but one simply has to learn what other people tell you.

There is no time to notice anything else about life. Finances, relationships, property, politics, community engagement……sleep….. everything comes a distant seventh to medical school and learning. Life itself is an afterthought, something that one attends to only if one has to.

Our medical students are not taught about how to conduct or engage themselves in an empowered way in day to day life. They are taught how to recall information, pattern recognise and survive ward rounds.

But how to be in all aspects of life determines how well we are in life, not how much we know about facts.

Our statistics tell us how unwell our medical students and doctors are.

Medical students and junior doctors are not taught how to take care of their own health and well-being, and in fact the very nature of the setup of medical training encourages and fosters them to ignore their own health and well-being.

Our high rates of mental ill health, suicide and physical ill health are a painful reflection of these low standards of self-care in medicine.

Medical students are not taught how to take care of finances.
They are not taught how to be empowered and to run a business.
They are not taught the basic skills of marketing and business administration that people in engineering or even beauty school are taught, even though finally after a prolonged period of education and working they will be working in businesses in the community.
They are not taught how to have relationships with people that are equal, loving and caring that go beyond the arrangement of role of doctor and patient.
They are not taught about the importance of caring for their physical bodies, and indeed much of medical culture in fact promotes the stressing of the human body and mind, asking it to go beyond its limits without care for how it needs to be literally cared for.
They are not taught how to take care of their mental health, with instead judgement and criticism, condemnation and the drive for unattainable perfection being the daily ingrained forms of communication in medicine, none of these building self-esteem or self-worth.

The health and well-being of us doctors is poor. We are not happy; over 50% of us are burnt out. Our suicide rates are at least 2 times higher than the general public, with some studies pointing to 5.7 times higher, and these are only the suicides that we know of. We have higher rates of anxiety and high psychological distress than the general public.

The pressures on us doctors are very real and put simply, in the health care profession we are barely surviving, and most certainly not thriving.

We know medical facts, but we do not know how to take care of ourselves and keep ourselves well in life.

Doctors are disempowered as people and do not consider themselves as human beings with equal human rights, and instead in the role of ‘doctor’ in training learn to simply accept and put up with the circumstances that they find themselves in.

They agree to working arrangements that would not be accepted anywhere else in the corporate world, with many of them seeing bullying as so normal that they don’t even realise that they are being bullied, or that they are engaging in bullying.

Working relationships in hospitals are toxic between doctors and between doctors and other health care professionals. And let’s not even begin with the relationships that doctors have with administration!! This is accepted as ‘normal’ and something to ‘survive’.

Toxic relationships build bad teams and are bad for our mental health and well-being. This has a knock on effect on patient care.

We know that there are multiple determinants of health and well-being. We need to address all of these in our lives to build health and well-being

How are we in relationships? Are we loving and caring?
How are we with food? Is it for indulgence and coping with life, or nourishing the body?
How do we take care of our bodies?
How are we with our finances?
How are we with taking care of ourselves, valuing and empowering ourselves?
How are we with sleep?
How are we with our self-talk, our emotional and mental health?
Do we know how to be who we truly are in all aspects of life? Or are we boxing ourselves in, acting in different ‘roles’ in different circumstances?

As health care professionals we need to be the ones to lead the way in the health and well-being stakes to inspire our patients.

Instead at present as a whole we are more anxious, stressed and suicidal than the general public. Something is wrong here.

There are many reasons that our doctors are not thriving.

Rather than focussing on developing doctors who are simply minimally ‘resilient’ to the current stresses and strains, I propose that as part of our care and responsibility for those we train, that we prepare people to be well in life as a whole, in both medical school and in doctor training in hospitals.

If we don’t prepare our students to be well, then we are leaving them vulnerable with an incomplete education in the world. And thus far the statistics are speaking for themselves.

We need to prepare our students to be well. And we need to design our systems to support our doctors to be healthy and well and not simply ask them to put up with systems the way that they are when they are not honouring of dignity, decency or respect of general human rights.

Care for people is the foundation of health care. To move forward as an institution that leads the way in health care we need to place care for all people firmly at the foundation of our training and our work ethos, beginning with our medical students.

As part of that care, it is important for us to design programs that not only teach students about the nitty-gritties of medical knowledge and information but arm them with the tools to thrive and to live well in all areas of life; how to take care of themselves, value themselves and empower themselves in all areas of life.

Our educational processes and health care systems themselves need to empower our doctors and our students.

Only then will we have a profession that is healthy, well and able to consistently care for others in all avenues of life.

Dr Maxine Szramka (pictured above) is a Sydney-based consultant rheumatologist. She blogs regularly at Dr Maxine Speaks.

Doctorportal hosts a dedicated doctors’ health service providing support in the medical community.

Why it costs so much to see a specialist – and what the government should do about it

Australians pay too much when they go to medical specialists. The government can and should do more to drive prices down. A current Senate Inquiry on out-of-pocket costs will hopefully lead to some policy action.

The problem is clear to anyone who has had to see a specialist recently. About 85% of GP visits are bulk billed, but the rate of bulk billing for visits to a specialist is much lower, at around 30%. The out-of-pocket costs can be very high, hurting patients.

To work out how to reduce the out-of-pocket costs for specialist care, we first need to identify why they are so high. There are four potential reasons.

1. Government rebates?

It may be that rebates for some procedures or for attendances are set too low. Rebates are set by government and may bear no relation to the actual cost of providing a service. Unlike in Canada, there is no obligation in Australia for government to consult with medical practitioners before setting fees.

But this explanation cannot account for the very high variation in fees. If high levels of billing above the nominated fee were due to inadequacies in the fee paid by government, then this would apply to all specialists equally. But in fact, some specialists charge more than others.

2. Supply and demand?

It may be that a specialist’s ability to charge a substantial out-of-pocket premium is simply the result of high demand for a particular service in a particular location.

Certainly, if the market for specialist care was functioning perfectly, supply would adjust to meet demand. But the reality is that specialist care is not a perfect market. Even with the increase in the number of medical graduates in Australia over recent years, there are still shortages of specialists in rural and remote parts of the country.

Here, the government needs to do more. It should consider whether specialists’ productivity can be improved, or whether other health professionals could perform roles in areas of short supply. The Grattan Institute’s 2014 report, Unlocking skills in hospitals: better jobs, more care outlined some options such as nurses performing endoscopies or providing sedation, work mostly now done by medical specialists such as gastro-enterologists.

Left to their own devices, specialists tend to establish their practices in more salubrious, city locations. There’s no guarantee newly accredited specialists will set up shop where their services are needed most. So the government should offer some carrots and wield some sticks to encourage new specialists to practice in rural and remote areas.

– How much?! Seeing private specialists often costs more than you bargained for

– For real health reform, turn the spotlight on specialists’ fees

Carrots could include subsidies and other support for the first few years in rural or remote practice. Sticks might include restrictions on access to Medicare billing in areas of existing over-supply in particular specialties. This would not preclude specialists establishing practices in over-supplied areas, but rather would limit public subsidies in those areas and thus provide an incentive for newly-minted specialists to go where the need is greatest.

Medicare already provides differential rebates for general practice in different parts of the country (rural and regional compared to inner city). Why not do the same for specialist practice?

3. Market power?

High specialist charges and consequent high out-of-pocket costs may simply be the result of specialists using their market power to maximise their income. Even in areas of reasonable supply, specialists may be able to charge high fees because they benefit from established referral patterns. That is, local GPs, clinics and hospitals may refer patients to particular specialists almost by habit, without paying heed to the fees they change. Patients may not be aware of these fees until they’re committed to being treated by that specialist.

The government could limit rebates in built-up areas already serviced by other specialists.
from www.shutterstock.com

A good way to respond to market power is to strengthen the market, to use competition between specialists to drive prices down. And the first step to improving competition is to increase transparency about prices charged.

The government – and perhaps private health insurers too – should publish information on specialists’ fees: the proportion of visits that are bulk billed, how each specialist’s fees compare to the average of specialists in, say, a 10-kilometre radius, and so on.

The government should further discourage higher fees by eliminating a rebate when fees are significantly above the standard rebate. For example, rebates might be paid only if the specialist fee is less than twice the standard rebate.

4. Skill-based premiums?

The fourth reason there may be high out-of-pocket charges is that some specialists are able to charge a premium for skill – or at least they might claim that is the basis for their high fees. Unfortunately, patients have no way of knowing whether this skill-based premium is warranted.

Again, transparency can help here. Governments and private health insurers should publish information which would help patients and their GPs assess whether a specialist’s outcome-based premium is warranted.

There are, of course, challenges associated with publicly reporting indicators of specialists’ quality of care. Agreement would need to be reached on what the key quality indicators for a range of procedures are in each specialty. Imperfect measures can be gamed, or discourage specialists from treating high-risk patients. And not all differences in performance metrics reflect actual differences in performance.

But opportunities for gaming or over-interpreting performance metrics could largely be removed by reporting performance within broad bands – for example: the bottom 25%, the central half, and the top 25% of performers. In the first instance, reporting should simply state whether, based on the specialist’s record, future performance is likely to be of a high standard.

Excessive costs for specialist care hit patients in the hip pocket and can discourage some from seeking appropriate treatment. Driving these costs down would make Australia a fairer and healthier nation.

Stephen Duckett, Director, Health Program, Grattan Institute

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

AMA’s marriage equality stance slammed

A petition demanding that the Australian Medical Association retract its support for marriage equality has garnered signatures from over 370 doctors, including many AMA members and six former AMA state presidents.

A group of doctors led by gastroenterologist and former AMA Tasmania president Dr Chris Middleton delivered the petition to AMA national president Dr Michael Gannon late last week. The group says the AMA’s position statement on marriage equality, released in May, is “fatally flawed”, particularly on the question of harm to children of same-sex parents. It also says that the AMA neglected to consult its own members before publishing its statement.

The AMA statement comes out strongly in favour of marriage equality on health grounds, stating that it is the right of “any adult and their consenting partner to have their relationship recognised under the Marriage Act 1961, regardless of gender”.

It says the lack of legal recognition can have “tragic consequences” in medical emergencies, when, for example, one spouse has to make decisions on behalf of an ill or injured spouse.

It also states that while same-sex parenting should be treated as a separate issue to same-sex marriage, “there is no putative, peer-reviewed evidence to suggest that children raised in same-sex parented families suffer poorer health or psychological outcomes as a direct result of the sexual orientation of their parents or carers”.

But the petition signatories, who include former WA AMA president Professor Paul Skerritt and former government minister and Queensland AMA president Dr John Herron, take issue with this claim.

In their critique, the signatories point to three recent studies which claim to find poorer emotional, educational or other adverse outcomes among children with same same-sex parents.

They say the AMA statement has “misled politicians and the public” on a number of other issues; it is “unworthy of the Australian Medical Association and we call for its immediate and public retraction”.

But the AMA is not backing down. In an interview over the weekend, Dr Gannon said he had expected that a portion of the AMA membership would be disappointed with the statement on marriage equality, but that he was happy to defend the process that had led to its creation.

“It was worked out through a working group made up of federal councillors and other experts,” he noted.

He said whether the AMA membership should have been polled about it was “something we will reflect on”.

But he added that the response had been “overwhelmingly supportive in terms of our position on marriage equality.”

He also reiterated the point that the issue of marriage equality was quite different from that of same-sex parenting.

“No one here is arguing about access to in vitro fertilisation or assisted reproduction for gay and lesbian people. That’s not the debate. The debate here is about marriage equality. So I think it’s important that we talk about what we’re talking about.”

He said that it was undeniably the case that a loving home is the right environment for a child to grow up in, regardless of the sexual orientation of the parents.

The AMA is not the only Australian medical body to come out in favour of marriage equality on health grounds. The Royal Australasian College of Physicians has stated that it “supports initiatives to amend legislation, policies and practices that are unfairly restricting the rights of the LGBTI population. This includes adjustments to marriage laws so that same-sex and transgender individuals can marry, regardless of their gender identity.”

The Royal Australian and New Zealand College of Psychiatrists has also put out a position statement in favour of marriage equality.

The Royal Australian College of General Practitioners, on the other hand, has remained silent on the issue.

Doctors applaud decision to end mandatory reporting

A decision by Australia’s health ministers to end the mandatory reporting laws has been applauded by industry groups.

The COAG Health Council meeting agreed that doctors should be able to seek help for health and mental health issues without the fear of being reported.

“Health Ministers agree that protecting the public from harm is of paramount importance as is supporting practitioners to seek health and in particular mental health treatment as soon as possible,” the ministers said in a communique.

RACGP President Dr Bastian Seidel agreed with the decision, saying they have been lobbying governments across Australia for some time.

“Although well intentioned, mandatory reporting laws are having the opposite of what’s intended,” he said.

“Doctors are not seeking the healthcare they need for fear of being reported. This is driving issues underground and reducing, rather than increasing, patient safety.”

Currently West Australia is the only state in Australia which does not require a treating doctor to notify authorities.

AMA President Dr Michael Gannon said in a statement: “Mandatory reporting undermines the health and wellbeing of doctors.”

“It is a tragic reality that doctors are at greater risk of suicidal ideation and death by suicide. This year we have lost several colleagues to suicide.

“While there are many factors involved in suicide, we know that early intervention is critical to avoiding these tragic losses.

“The AMA has identified that mandatory reporting is a major barrier to doctors accessing the care they need.

“The real work begins now. We need action from all our governments.

“The medical profession and the public need a sensible system that supports health practitioners who seek treatment for health conditions, while at the same time protecting patients.”

A nationally consistent approach will be considered at the November 2017 COAG Health Council meeting following a discussion paper and consultation with consumer and practitioner groups.

More information about the Council of Australian Governments’ Health Council is available on its website.

Switching medical specialties: is it feasible?

Of all the professions, medicine has one of the most rigid career pathways; it can feel like a conveyor belt that you can’t get off. But what if, during or after your training, you decide you’ve chosen the wrong specialty? Are you stuck with what you started, or is it feasible to switch horses midstream?

Around 10% of residents in the Australian system do choose to switch their specialty each year, so the answer is that it’s certainly possible. But it’s not a decision to be taken lightly, as it could involve up to three years of supplementary training.

It’s not uncommon for those in training to feel unsuited to their specialty, leaving them stressed and sometimes like they may want to leave medicine altogether. A discipline might end up being a poor match for the person’s core skills or might jar with his or her personal preferences. Registrars embarking on a career in pathology might find that they miss the patient contact and pine for the hospital wards; or alternatively a registrar in general practice might find the constant personal contact too emotionally draining.

But no decision should be made about switching specialties without considerable reflection and consultation with colleagues. Often, doctors might think they’re unhappy with a specialty when in fact other issues are at play: difficulties with a particular colleague, a desire to work part-time instead of full-time, an overly long commute or even problems at home.

“You need to look at what’s really going on in your life to see if there are ways of resolving your problems without retraining.” says Dr Caroline Elton, a UK-based psychologist and medical careers advisor.

Dr Elton says doctors finding themselves at a career crossroads should go through a “career planning process”, whereby they carry out a self-assessment to identify their interests, skills and abilities and to decide what is really important to them.

They should then look at what specialties best match their skills and priorities, learn more about them and plan what to do to be able to work in them.

Here are a few tips for doctors who find themselves wondering whether they’re in the right specialty:

Be aware that taking a step sideways will inevitably also mean taking a small step backwards:
Be proactive and seek advice from as many people as possible, both within the specialty in which you are already training, and in the one to which you’re think of switching. Don’t feel that it will be considered a black mark against you if you ask for support in leaving a specialty. Such support is crucial;
Find out as much as possible about the preferred specialty, particularly what the eventual job entails rather than just what you go through in training;
If you are still unclear about the way ahead, consider a dual training pathway;
For consultants, switching specialties is likely to be considerably harder and involve a major upheaval; be prepared to lose the protection of your consultant contract;

Source: BMJ Careers

Visit the AMA Career Advice Hub for useful information across the whole medical-life journey as well as Career Counselling Service resources. For one-on-one assistance, contact Christine Brill at careers@ama.com.au .

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