Political message in National Press Club speech

AMA President Dr Michael Gannon has called on all sides of politics to take some of the politicking out of health, for the good of the nation.

Addressing the National Press Club of Australia, Dr Gannon said some health issues needed bipartisan support and all politicians should acknowledge that.

“Some of the structural pillars of our health system – public hospitals, private health, the balance between the two systems, primary care, the need to invest in health prevention – Let’s make these bipartisan,” he said.

“Let’s take the point scoring out of them. Both sides should publicly commit to supporting and funding these foundations. The public – our patients – expect no less.”

During the nationally televised address, broadcast live as he delivered it on August 23, Dr Gannon warned political leaders that the next election was anyone’s to win and so they should pay close attention to health policy.

“Last year we had a very close election, and health policy was a major factor in the closeness of the result,” he said.

“The Coalition very nearly ended up in Opposition because of its poor health policies. Labor ran a very effective Mediscare campaign.

“As I have noted, the Government appears to have learnt its lesson on health, and is now more engaged and consultative – with the AMA and other health groups.

“The next election is due in two years. There could possibly be one earlier. A lot earlier.

“As we head to the next election, I ask that we try to take some of the ideology and hard-nosed politicking out of health.”

In a wide-ranging speech, the AMA President outlined the organisation’s priorities, while also explaining the ground it has covered in helping to deliver good outcomes for both patients and doctors.

The AMA’s priorities extend to Indigenous health, medical training and workforce, the Pharmaceutical Benefits Scheme, and the many public health issues facing the Australian community – most notably tobacco, immunisation, obesity, and alcohol abuse.

“I have called for the establishment of a no-fault compensation scheme for the very small number of individuals injured by vaccines,” Dr Gannon said.

“I have called on the other States and Territories to mirror the Western Australian law, which exempts treating doctors from mandatory reporting and stops them getting help.

“We also need to deal with ongoing problems in aged care, palliative care, mental health, euthanasia, and the scope of practice of other health professions.

“In the past 12 months, the AMA has released statements on infant nutrition, female genital mutilation, and addiction.

“In coming months, we will have more to say on cost of living, homelessness, elder abuse, and road safety, to name but a few.

“Then there are the prominent highly political and social issues that have a health dimension, and require an AMA position and AMA comment.

“All these things have health impacts. As the peak health and medical advocacy group in the country, the community expects us to have a view and to make public comment. And we do.

“Not everybody agrees with us. But our positions are based on evidence, in medical science, and our unique knowledge and experience of medicine and human health.

“Health policy is ever-evolving. Health reform never sleeps.”

The address covered, among other things, health economics: “Health should never be considered just an expensive line item in a budget – it is an investment in the welfare, wellbeing, and productivity of the Australian people.”

Public hospital funding: “The idea that a financial disincentive, applied against the hospital, will somehow ‘encourage’ doctors to take better care of patients than they already do is ludicrous.”

Private health: “If we do not get reforms to private health insurance right – and soon – we may see essential parts of health care disappear from the private sector.

The medical workforce: “We do not need more medical school places. The focus needs to be further downstream.

“Unfortunately, we are seeing universities continuing to ignore community need and lobbying for new medical schools or extra places.

“This is a totally arrogant and irresponsible approach, fuelled by a desire for the prestige of a medical school and their bottom line.

“Macquarie University is just the latest case in point.”

And general practice: “General practice is under pressure, yet it continues to deliver great outcomes for patients.

“GPs are delivering high quality care, and remain the most cost effective part of our health system. But they still work long and hard, often under enormous pressure.

“The decision to progressively lift the Medicare freeze on GP services is a step in the right direction.”

On even more controversial topics, Dr Gannon stressed that the AMA is completely independent of governments.

While sometimes it gets accused of being too conservative, he said, it was not surprising to see the reaction to the AMA’s position on some issues – like marriage equality.

“Our Position Statement outlines the health implications of excluding LGBTIQ individuals from the institution of marriage,” he said.

“Things like bullying, harassment, victimisation, depression, fear, exclusion, and discrimination, all impact on physical and mental health.

“I received correspondence from AMA members and the general public. The overwhelming majority applauded the AMA position.

“Those who opposed the AMA stance said that we were being too progressive, and wading into areas of social policy.

“The AMA will from time to time weigh in on social issues. We should call out discrimination and inequity in all forms, especially when their consequences affect people’s health and wellbeing.”

Last year, the AMA released an updated Position Statement on Euthanasia and Physician Assisted Suicide.

It came at a time when a number of States, most notably South Australia and Victoria, were considering voluntary euthanasia legislation.

There was an expectation in some quarters that the AMA would come out with a radical new direction. But it didn’t.

“The AMA maintains its position that doctors should not be involved in interventions that have as their primary intention the ending of a person’s life,” Dr Gannon said.

“This does not include the discontinuation of treatments that are of no medical benefit to a dying patient. This is not euthanasia.

“Doctors have an ethical duty to care for dying patients so that they can die in comfort and with dignity.”

The AMA also takes Indigenous health very seriously.

Dr Gannon travelled to Darwin last year to launch the AMA’s annual Indigenous Health Report Card, which focused on Rheumatic Heart Disease.

“In simple terms, RHD is a bacterial infection from the throat or the skin that damages heart valves and ultimately causes heart failure,” he said.

“It is a disease that has virtually been expunged from the non-Indigenous community. It is a disease of poverty.

“RHD is perhaps the classic example of a Social Determinant of Health. It proves why investment in clean water, adequate housing, and sanitation is just as important as echocardiography and open heart surgery.

“The significance of challenging social issues like Indigenous health, marriage equality, and euthanasia is that they highlight the unique position and strengths of the AMA.

“The AMA was recently ranked the most ethical organisation in the country in the Ethics Index produced by the Governance Institute of Australia.

“People want and expect us to have a view – an opinion. Sometimes a second opinion.”

Chris Johnson

A transcript of the full address can be found here:
media/dr-gannon-national-press-club-address-0

Best place to be when there is an adverse reaction

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

Vaccination is one of the most successful and cost-effective health interventions. GPs know that while vaccinations are generally safe, very occasionally a patient will have an immediate adverse reaction. This occurred recently in my practice and highlighted why general practice remains the best place to receive a vaccination.

Best practice dictates that vaccination should be provided by a medical practitioner or by a nurse under the supervision of a medical practitioner. However, the efforts of other health professionals, such as pharmacists, to get involved in providing vaccinations, leaves me concerned at the potential consequences for patients. Opting for convenience, patients may not understand the benefits of care from a medically trained practitioner, who has the facilities and clinical capacity to identify and manage a rapidly evolving adverse reaction.

In my example, a child who had received their 12-month immunisation experienced facial redness and swelling at the injection site within two minutes of receiving the vaccine. We were well equipped to respond accordingly.

The speed of the reaction had us monitoring for the development of any breathing difficulties, which thankfully did not arise. However, had the child gone into anaphylaxis we were equipped and skilled to immediately respond. The child was administered 2ml orally of a corticosteroid and monitored.

The adverse reaction was also promptly reported and the child’s parents provided with information and a plan of management, including what this might mean for future vaccinations. Now that the reaction has been recorded in the child’s medical record, we will ensure even closer medical supervision is provided at the 18-month immunisation.

As GPs, we owe it to the parents of the children we care for to ensure that questions they have about immunisation are answered honestly and backed up with scientific evidence such as that provided in the Australian Academy of Science’s The Science of Immunisation/Questions and Answers.

As family doctors we are the most trusted source of advice for parents, see the vast majority of children a number of times per year during their first six years and deliver almost three-quarters of all their vaccinations. We have significant opportunity during this period to embed within the family construct the value of having a regular GP.

Last month the AMA’s Family Doctor Week highlighted the important role GPs play in caring for the community. Immunisations, in many cases, provide important opportunities to check in on our patients and see how they are faring. Not only is immunisation an important part of preventive health care, it provides the opportunity to speak to people about their other health care needs

Despite what must have been a very worrying experience for the young child’s family, I know the standard of care we delivered was best practice. They saw the value of GP care first hand and I have little doubt that this family will be back to see me again, safe in the knowledge that quality is at the heart of everything we do as GPs.

This bondage isn’t right

BY DR JOHN ZORBAS, CHAIR, AMA COUNICL OF DOCTORS IN TRAINING

There’s a key difference between bondage and bonding. One is a contract between two or more parties, requiring informed consent, and designed for the mutual benefit of all involved. The other is a terribly flawed stick that the Australian Government seems intent on bashing medical graduates with, in a poorly informed attempt to provide a rural workforce.

In Australia, we have two medical bonding programs: the Bonded Medical Places (BMP) scheme and the Medical Rural Bonded Scholarship (MRBS). There are several different versions of these schemes, if you count the number of different contracts that now exist since their inception, but they can broadly be summarised as follows. The BMP scheme provides participants with a Commonwealth Supported Place (CSP) in medical school in exchange for a return of service of one to six years in rural and regional Australia. The MRBS scheme provided participants with a CSP in medical school and by the time it was axed a scholarship of $26,310 a year in exchange for six continuous years of work as a specialist in rural and regional Australia. Sounds simple enough, but the more you dig, the more you realise just how bad a deal this is for these future doctors and the patients they’re supposed to be serving.

You see, the first major flaw in this plan is that bonding just doesn’t work. Funnily enough, if you force someone to do something on your terms in an uncertain and inflexible manner, it turns out that people don’t appreciate the experience and they don’t come back. When bonding in medical school was first conjured up, the AMA provided evidence that similar schemes overseas, especially in North America, had failed to provide any form of sustainable medical workforce. More than 13 years have now passed and an exceedingly small number of scheme participants have completed their return of service. In fact, more participants have withdrawn or breached their agreement than those who have completed their return of service. Not exactly a ringing endorsement.

Compare this with the other measures and programs that are supported by the AMA. We know that having a rural background significantly increases your chance of going rural, and we have strongly supported increasing the quota of students from rural backgrounds. We floated the idea of Regional Training Networks in 2014, to help allow those who wanted to work and stay rural obtain fellowship in a more sustainable manner and reduce infrastructure duplication in what is already a resource poor area of medical training. We supported the Prevocational General Practice Placements Program and, following its abolition by the Abbott Government, subsequently developed an alternative proposal for a Community Residency Program (CRP), to enable doctors to have meaningful rural experiences in their pre-vocational years, while they work out exactly what career they want to pursue. And we have long supported an increased rural focus in the Specialist Training Program (STP), allowing registrars to be adequately funded to work in rural areas on progression to fellowship. It’s a suite of measures that encourages positive experiences and supports trainees along their often complicated and difficult path.

But the Government has chosen to focus on draconian bonding schemes. Let’s explore the MRBS for a second, mostly as initially on paper it looks very attractive. You take a 17-year-old undergraduate student and you promise them $26,310 tax free and a place in medical school for a return of service. Sounds reasonable. Except what 17-year-old understands Medicare? Hell, how many healthcare workers and bureaucrats even understand Medicare? Do we adequately explain to them that leaving the scheme will result in a 12-year ban from Medicare, effectively killing their medical career there and then, simply because of a change in their life situation and circumstances? Do we explain to them that as they train to become a rural general practitioner, they will be effectively forbidden from working in the city for short periods of time, preventing them from upskilling in crucial rural skill sets such as emergency medicine, obstetrics and anaesthetics? Do we explain to the orthopaedic trainee that they only have 16 years from the start of medical school to complete their requirements? Caveat emptor is one thing, but conscriptive blackmail is another.

And even if you are one of the few to complete your return of service, just how happy will you be at the end of it all? What doctor, having had to deny themselves the opportunities of personal and professional development at the behest of such an authoritarian scheme, will look kindly on rural Australia? When you take away mastery, autonomy and purpose, you’re left with a bitter, angry human. That’s not the kind of person that rural Australia deserves.

The AMA Council of Doctors in Training is continuing to lobby government to adjust the BMP and MRBS for the good of its participants and the Australian public that it purports to serve. Nobody is arguing that a return of service isn’t owed, but it certainly shouldn’t function like this. If you or someone you know is affected by these schemes, we’d like to hear about it. Please contact me at cdt.chair@ama.com.au and let’s see if we can’t loosen the bureaucratic nipple clamps, just a little bit.

Public Hospital Doctors role central to AMA

BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS

I’d like to state my thanks for all the input and interest from PHD members at our recent National Conference. It was invigorating to experience your enthusiasm for the many issues directly affecting public hospital doctors. An important issue about which I do want to remind you is actually how you “describe” yourself for AMA membership purposes. In order to keep the CPHD vibrant and relevant to key issues, we must have a solid base. Today we can choose our membership category more accurately. I hope more doctors based in public hospitals, particularly those with a Specialist qualification, will choose to identify in the public hospital doctor membership category as opposed to their medical craft group if they have one, when it comes to identifying their AMA membership as you will be invited to do soon, and thus remain engaged with the CPHD.

Vale Dr Patrick Pritzwald-Stegmann

Multiple issues are before the CPHD. None is more relevant than safety in the workplace. On July 21, a Memorial Service was held for AMA member Dr Patrick Pritzwald-Stegmann, who died after substantial time ventilated in one of our ICUs after an alleged “coward’s punch” received in the foyer of a Melbourne metropolitan public hospital resulted in a profound brain injury. This is now a Coroner’s and police matter. I am regularly horrified at the experiences of violence in our community and our workplaces, but this is all the more poignant for me as Patrick was a recent close colleague of mine with whom I had worked extensively.

There are many intersecting issues in our community, most of which lead to the public hospital system. They include mental health issues, whether acute, chronic or acute-on-chronic, illicit drug use, perhaps loading up on mental health issues, increased passive tolerance of greater violence in and by the now metropolises (as opposed to tight-knit communities), and a general lack of respect for those providing any type of community service. Emergency service providers and our colleagues and other healthcare workers in emergency departments face the brunt, but it is throughout the public hospital system. I note that our population is growing remarkably, we have generated profound productivity improvements, but there remains a yawning gap of lack of public hospital capacity investment to match the essential hospital requirements of the complex, multi-system, elderly and/or obese, chronic illness sufferers. It is readily observable how “house full” messages contribute to patient frustration, then anger and venting in our workplace. It was equally offensive to see lauding of “this is what 182 blows to the head looks like” related to a recent violent “sport” designed to inflict brain injury. It is easy to see some might link these ingredients, resulting in an unsafe workplace for us.

In perhaps a curious coincidence, I am now chairing an Australian Standards committee revising the standard Security for Health Care Facilities. It will be a template for consideration of security risks for any and all health care facilities in Australia. Its origin related to large public hospitals, but changes in technology and hospital interventions means security issues are everywhere that medicine is practised, including hospital-in-the-home and all points travelling between, patient record security, medication and medical gas security, microorganism security, IT security, food security, let alone staff safety and security. I will be pleased to receive your thoughts on this topic. Obviously not everything will be totally relevant to all, but in these days of terrorism and bioterrorism, it will be a useful tool for risk analysis. It will be a sad day if every part time medical point of care in a high rise tower through to our major teaching hospitals needs to have the same security we now take for granted on getting to the airside of an airport, surveillance cameras or requires trained and authorised security personnel with Tasers and policing powers comparable to Protective Service Officers.

Of note, none of the above may have prevented Patrick’s injury, or some of them may have caused the alleged perpetrator to pause.

Public Hospital Funding

It is clear an expansion and greater funding of public hospital’s is required to meet the increasing demand, separate to security investments. This is about to accelerate in my view as more reduce private health insurance due to increasing premiums coupled with increasing mortgage, energy and education costs pressures. An important discussion will be how best to use the now billions of tax dollars shoring up publically listed health insurance companies’ profits and employee bonus payments, whilst squeezing the marketplace and offering frequently inadequate products to bamboozled patients seeking a tax break.

Recently the Government rejected a proposal to abolish the private health insurance rebate and effectively take funds it saves from that, along with hospital funding, to provide a standard benefit for services, regardless if they happen in a public or in a private hospital. This would effectively take Commonwealth funds from public hospitals and force patients to pay more for coverage. This would reduce the amount the Commonwealth contributes to the cost of public hospitals to a paltry 35 per cent. The 42 or 43 per cent funding we’re getting from the Commonwealth now is not sustainable for future public hospital operation.

A 35 per cent share would be a disaster in the super-stretched public system and in the private system for that matter. In recent years we’ve seen the Commonwealth’s share of funding to public hospitals drop below 45 per cent with a formula that only relies on growth in CPI and population. The AMA’s Public Hospital Report Card shows that performance in the system, such as wait times in the emergency department or for elective surgery, are not improving, or indeed are going backwards. So we can be thankful that this reduction has been ruled out.

But with consideration of the way hospitals are funded, we need to focus on priorities and things that might work in the hospital system. This especially includes quality and safety initiatives as well as increasing the utility of secondary hospitals or in the community. We must put more resources into primary care prevention as a long-term strategy for reducing the rate of increase of pressure on public hospitals.

Let’s hope governments see sense and realise that proper health care is a sound investment and saves money in the long term, and that engaging with doctors is the only way to develop sound health policy. I look forward to discussing these and other issues with you in upcoming CPHD meetings and other events.

AMA’s successful stand for sensible and safe pathology testing

BY PROFESSOR ROBYN LANGHAM, CHAIR, MEDICAL PRACTICE COMMITTEE

One could be forgiven for thinking that he AMA thinks little of pharmacists, given the nature of the media reports around the recent successful AMA campaign to stop Amcal pharmacies ordering unnecessary pathology screening tests.

The truth is quite the opposite. The AMA greatly respects the valuable contribution pharmacists make in improving the quality use of medicines. Pharmacists working with doctors and patients can help ensure better medication adherence, improved medication management, and also help in providing education about medication safety.

The AMA agrees that pharmacists’ expertise and training are under-utilised in a commercial pharmacy environment where they are necessarily distracted by retail imperatives.

That is why the AMA is fully engaged in the current review of pharmacy remuneration and regulation being undertaken by an independent panel appointed by the Federal Government.

In a comprehensive submission to the panel lodged last year, the AMA was supportive of alternate models of funding being explored that would encourage and reward a focus on professional, evidence-based interactions with patients. Our submission also supported ongoing funding of effective and cost-effective pharmacist medication management programs, particularly those targeting Aboriginal and Torres Strait Islanders, and a relaxation of the restrictive pharmacy location rules.

The panel has now released an interim report revealing its likely recommendations to Government on the future of pharmacy funding and regulation.

The proposed recommendations pick up on many of the AMA’s suggestions and concerns, and, if implemented, would radically improve the transparency of pharmacy funding and refocus government investment on evidence-based and cost effective services.

Unsurprisingly, the Pharmacy Guild of Australia is highly critical of the report, slamming it as “without merit”, “ill-considered”, “threatening” and “undermining” as well as stating it has “serious concerns about the true intention of the review”.

Some of the key recommendations supported by the AMA include:

banning the sale of homeopathic products from pharmacies altogether;

physically separating other complementary medicines from “pharmacy only” (schedule 2) and ‘pharmacist only’ (schedule 3) in pharmacies to better help consumers understand that these medicines have not been assessed for effectiveness in the same way as S2, S3 and prescription medicines;

moving the funding of pharmacist services programs from the Guild-controlled Community Pharmacy Agreement to other government funding streams to improve transparency and facilitate coordination with other primary health care programs;

removing current bureaucratic barriers to medicines programs and pharmacy services that hinder access to indigenous Australians; and

changing the pharmacy location rules with potential to improve options for pharmacy co-location with general practices.

The AMA is very supportive of the interim report and lodged a favourable submission in response in July.

Unfortunately, the Guild has already brokered a deal with the Coalition Government to shelve any changes to location rules in the foreseeable future. It will be interesting to see what appetite the Government has for taking up the panel’s final recommendations, particularly given the next Federal election date is not so far away.

Critical attention given to doctors’ health at COAG

Federal, State and Territory Health Ministers met in Brisbane this month at the COAG Health Council to discuss a range of national health issues.

During broad ranging discussions it was agreed to amend mandatory reporting provisions for treating health practitioners. Doctors should be able to seek treatment for health issues with confidentiality. They also acknowledged that protecting the public from harm is also important.

The resulting COAG communique said: “A nationally consistent approach to mandatory reporting provisions will provide confidence to health practitioner that they can feel able to seek treatment for their own health conditions anywhere in Australia.”

AMA President Dr Michael Gannon commended the decision, saying: “It has been acknowledged that there needs to be a change, that there’s a problem.

“Healthy doctors take better care of their patients.”

Other items discussed by Health Ministers included:

Family violence and primary care

The Health Ministers agreed to seek further advice from Primary Health Networks on existing family violence services, including Commonwealth, State and NGO service providers in their regions, with a view to developing an improved whole-of-system response to the complex needs of clients who disclose family violence.

This is supported by evidence given by Professor Kelsey Hegarty at the Victorian Royal Commission into Violence, when she said: “PHNs and other alliances across the health services sector have a significant role to play in supporting practitioner training about family violence.”

Fifth National Mental Health and Suicide Prevention Plan

Health Ministers endorsed the Fifth National Mental Health and Suicide Prevention Plan 2017-2022 and its Implementation Plan.

Federal Health Minister Greg Hunt said it stood out from previous plans with its focus on eating disorders and suicide prevention, keys areas that had been raised by lobbyists.

“The prevalence and the danger of (eating disorders) is still dramatically understated in Australia,” he said.

“The reality is that this is a silent killer, particularly women can be caught up for years, so there is a mutual determination to make progress.”

The plan will also focus on improving Aboriginal and Torres Strait Islander mental health and suicide prevention, reducing stigma and discrimination, and better coordinating treatment and support programs.

The National Psychosocial Supports Program

The 2017-18 Budget allowed for the establishment of a National Psychosocial Supports Program that aims to provide flexible, targeted services to people with severe mental illness resulting in psychosocial disability who are not eligible for the National Disability Insurance Scheme (NDIS).

The Health Ministers agreed to establish a time-limited working group to progress a National Psychosocial Supports Program to reduce the community mental health service gap, improve mental health outcomes and reduce the inequity in service availability.

National Digital Health Strategy and Australian Digital Health Agency Forward Work Plan 2018–2022

The COAG Health Council gave the green light to the National Digital Health Strategy. Currently, 5 million Australians have a My Health record – this strategy aims, among other things, to expand this non-compulsory offer to all Australians by 2018.

Expanding the public reporting of patient safety and quality measures

Ministers agreed that the Australian Commission on Safety and Quality in Health Care (ACSQHC) would undertake work with other interested jurisdictions to identify options in relation to aligning public reporting standards of quality healthcare and patient safety across public and private hospitals nationally.

The Australian Institute of Health and Welfare last month highlighted the gaps in reporting, and in some areas, the lack of data altogether, saying: “There is no routinely available information on some aspects of quality, such as the continuity and responsiveness of hospital services.”

Health Ministers at the COAG meeting also considered the development of the next iteration of the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023; agreed to explore a National Human Biomonitoring Program by undertaking a feasibility assessment; agreed to proceed to Strengthen penalties and prohibition orders under the Health Practitioner Regulation National Law; and sought clarification of roles, responsibilities and relationships for national bodies established under the National Health Reform Agreement.

MEREDITH HORNE

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.

[Seminar] Non-Hodgkin lymphoma

Lymphomas can affect any organ in the body, present with a wide range of symptoms, and be seen by primary care physicians and physicians from most specialties. They are traditionally divided into Hodgkin’s lymphoma (which accounts for about 10% of all lymphomas) and non-Hodgkin lymphoma, which is the topic of this Seminar. Non-Hodgkin lymphoma represents a wide spectrum of illnesses that vary from the most indolent to the most aggressive malignancies. They arise from lymphocytes that are at various stages of development, and the characteristics of the specific lymphoma subtype reflect those of the cell from which they originated.

The fine art of communication in general practice

Read about our new workshop exploring complex communication in primary care – breaking bad news, end of life conversation and more…

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. This 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 us 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 of our most 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.

Sign up to our Complex Communication in Health Care learning module here.

[Comment] Account for primary health care when indexing access and quality

It is well established that primary care leads to better health outcomes, lower costs, and greater equity in health,1 and an important part of a country’s development should be the strengthening of primary health-care services. This way, the health care provided will be comprehensive and people-centred, for all ages and stages of life, incorporating and coordinating health promotion, prevention, acute and chronic care management activities, to deliver equitable access and safe high-quality care.