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Readers' forum

Issues of death and dying stirred much debate among Australian Medicine readers following Professor Kenneth Hillman’s powerful piece on the dilemma confronting many in the medical profession in treating patients who may be approaching the end of their lives (see Reflections on dying, from an intensive care physician). Predictions the nation will face a severe shortage of GPs and specialists in the next 13 years (see Severe shortage of GPs and other specialists looms) also drew much comment. Several readers argued authorities were only making the situation worse by preventing many older doctors from continuing to practice.

17 Dec 2012

Issues of death and dying stirred much debate among Australian Medicine readers following Professor Kenneth Hillman’s powerful piece on the dilemma confronting many in the medical profession in treating patients who may be approaching the end of their lives (see Reflections on dying, from an intensive care physician). Predictions the nation will face a severe shortage of GPs and specialists in the next 13 years (see Severe shortage of GPs and other specialists looms) also drew much comment. Several readers argued authorities were only making the situation worse by preventing many older doctors from continuing to practice.

Medibank Health Solutions’ attempts to sign up specialists to its Defence health contracts continued to draw the ire of many, as did lengthy delays on the authority prescription service.

Reflections on dying

Most of the time there is no dispute between ICU specialists and non-ICU specialists about who can and can't survive but, after 40 years in the game, I now find that many ICU specialists want to turn off post-op patients that the surgeons think deserve better support. ICU's need to be very careful not to become sites of engineered euthanasia. ICU specialists need to stay within their area of expertise and respect the specialisation of their colleagues.

Anonymous

As an anaesthetic registrar who has worked in ICU recently, this issue is frequently vexing. We should have advanced care directives routinely on high-risk patients. We continue to do surgery of increasing complexity and challenge in ever-older patients. Some surgeons are realistic about what is achievable; others seem less so and appear to believe that just because something is technically fixable, it should automatically be fixed, without considering the health context.

Anonymous

Euthanasia

I have just finished a seven-month journey caring for my mother who had brain cancer. She died two weeks ago. Her end was not peaceful or dignified and she had pleaded with her palliative care doctor, her GP, her partner and my sisters and I to end her suffering - none of us could. She reached this point just two weeks before she died. Her last two weeks were a nightmare, for her and for her loving family. Surely she should have had the right to end her life before the suffering became unbearable. We have to change the law...and soon.

Anonymous

Doctor shortage

On 1 July 2010 the Australian Health Practitioners Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) disenfranchised hundreds of senior doctors who could contribute to the medical work force in a small but significant way. Currently it is proposed by AHPRA/MBA to further cut this contribution by terminating the Limited Registration Public Interest Occasional Practice (LRPIOP) registration category after 30 September, 2013.

AHPRA's estimate has been that about 1800 doctors currently on LRPIOP registration will be affected.

Dr Frank Johnson (not verified)

I wholeheartedly agree with Dr Frank Johnson. Medicine is one of those professions in which the number years of clinical experience can exponentially expand the ability to solve a patient’s problems, encourage, educate and mentor colleagues, give community advice and direction, and make sense of new therapies. The actions taken by APHRA to throw the years of service and accumulated knowledge of some of our best doctors into the abyss of regulatory administration is wasteful and deplorable.

Robert Goldsmith (not verified)

Prescription phone line

I think the authority system is useful as a break on wholesale overuse of medications. It makes one think about the appropriate and evidence-based use of each one. Expensive antibiotics, with potential for increasing resistance, and narcotics would likely be even more over-used if not for authority restrictions.

Ian Turner

The authority system is a joke. The clerks manning the lines don't know what the authorised conditions mean anyway, so I merely parrot the authorised conditions as exactly as possible to speed up the whole process.

June Choo  

E-PIP

GP workload, fluency with technology, and level of disinterest have been underestimated. We can't get many or timely discharge summaries from the tertiary sector, let alone with use of secure messaging. Big cost for only partial efficacy.

Megan Elliott-Rudder (not verified)

This is a dog’s breakfast area at present

Peter Winterton  

Health of Nations book review

Adrian Mooney turns a blind eye to why doctors in developing countries make the heart-breaking, life-altering decision to leave home and hearth, family and friends, culture and career, for a foreign land where they will often have to work in a foreign language. The reasons are legion, varying by country and over time, and are discussed fully in my book, A Unique Migration: South African Doctors Fleeing to Australia.

Peter Arnold 

I am grateful for the review. I had hoped that my ideas might provoke debate and where there is agreement (as in Dr Rollins' case) that we are failing on health globally, others who disagree with my analysis might put forward alternative explanations for why we are failing. I believe that debate needs to happen. Also, regarding citizens' juries, the book does explain clearly how these are chosen, but Dr Rollins clearly missed that or didn't read that chapter.

Gavin Mooney (not verified)

Defence contracts

I signed their contract, sent it, heard nothing, then the ADF contacted me asking why I wouldn’t sign the contract. I’ve sent it three times more, each time Medibank say thanks for sending the contract.....then I haven’t gone on the preferred provider list. Medibank still refer patients to me, then they don’t notify the patient or the ADF, and I get no shows. This organization is incompetent.

Anonymous

I offered to take the 50 per cent cut in rates for anaesthesia if everyone at MHS also took a 50 per cent pay-cut. Because they did not accept my offer, I am continuing to treat Defence patients at AMA supported rates. If Defence does not continue to pay my usual fee, then I will cease treating Defence personnel.

Alec Harris (not verified)


Published: 17 Dec 2012