Australian Doctors...

Recently reported by The Daily Maverick...

The Australian Medical Association ran an advertisement in newspapers offering a bounty of A$3,000 (just over R20,000) to anyone who persuades a foreign doctor to work in that country.

We're short 2500 doctors in this bloody country. Oz should leave ours alone!

Your Medical Records Belong To You

I've been engaging a lot recently with the notion of an electronic health record. For those of you who don't know, this is usually an online version of collated data to do with your health. Simply - your pathology, your doc notes, all the hospital visits, illnesses and drug usage are kept in one secure place. You can access it and most of the time, so can a healthcare provider.

For those of you that are not in tune with the medical world - this is something you have to know about as it is the backbone of the Obama administration. By having an electronic health record, there is a saving on administration as well as all the good things a centralised database brings. eg. Less duplication of tests and better management of healthcare.

Discovery Health in South Africa is launching one next year. It'll be interesting to see how the "population" engages with it.

This blog is very interesting in that it clearly outlines the fact that your medical records belong to YOU. Many people are under the misconception that your doctor owns your medical records - and that the only way to access them is via that doctor. This is not true. Your health. Your body. Your money spent to purchase medication/tests etc.

It belongs to you.

Medical Quackery - Cyberchondriacs

Stumbled across an old, but interesting post. Excerpt below:

"Experts warn there is a great deal of false and misleading information on the Internet. That’s true – I learned the hard way that eating a bucket of chocolate pudding doesn’t alleviate a headache.

But, for me, the outright quackery was far less damaging than the cold, hard, accurate facts. There is no more devastating statistic than a Survival Rate. That number rattles around your brain like it’s the solution to an equation that could save your life. You massage it, you toy with it… “If 75.2% survive, that means 24.8% don’t… and if 24.8% don’t that means almost 1 in 4…” There’s no better, darker way to learn math."

All to often in practice you get patients who come in and tell YOU what they have. They Google'd it and now know that they have some bacterial infection, or rare intestinal disease or worse. They want "augmentin" or something else they read up about... You smile as a doctor, say you just need to check, only to find out that they have a simple cold, or a viral gastro and nothing more..

Just try and Google the symptoms for Inflammatory bowel disease and I bet most of you will think that you have it...


The lesson is this. We study for more than 6 years to DISTINGUISH symptoms and diseases. Anybody can read medical textbooks or google symptoms and will think they have the answer, but medical school teaches you how to work out what is a headache and what is a brain tumour.

Clinical examination is important. You'd be suprised to know what I can diagnose the way you walk into the room, or by simply looking at the back of your eye (and you would laugh at the amount of information we get out of a touch-your-nose-then-my-finger neurological examination).

Ah... sometimes I miss clinical medicine... but only sometimes...

GUEST POST: Trusting your Doctor – Is it the Right Treatment?

Welcome to All Scrubbed Up's 4th guest blogger... Sarah Scrafford! Enjoy her views on the patient-doctor relationships. We think this one may draw some comments...

There are some people who treat their doctors like Gods – they think they can do no wrong, that they can cure any malaise, and that they have their best interests at heart. And then there are others who are extremely reluctant to trust anyone connected to the medical field, who move from doctor to doctor in search of the perfect one they can trust but never find one at all, and who generally prefer to treat themselves unless it’s a life-threatening situation. In my opinion, neither extreme is advisable – while you must trust your doctor to do the best for you, it’s also prudent to exercise caution and do a bit of research before you throw yourself at the complete mercy of a total stranger.

We hear horror stories of medical malpractices that occur because of both negligence and/or incompetency; the victims of these tragedies escape with no lasting damage if they’re lucky, but if they’re not, they could end up with chronic conditions, or worse, die. Medical lawsuits are extremely complicated affairs that end up becoming costly and difficult to prove, which is why it’s best to be prepared and do your homework before going to a doctor to seek treatment:

* Talk to other patients: Before you commit yourself to going under the knife of a particular surgeon, talk to his or her other patients so that you get proper feedback from the right sources. Long time patients are your best bet – they’re the ones who know exactly how competent and how trustworthy your soon-to-be physician is.

* Check the Internet: Some doctors have a web presence, but then again, you can’t believe their own publicity. Run a search to see if people have blogged about their efficiencies or inefficiencies – this being the age of free and available information, most people are not hesitant to air their views from a public soapbox, especially when the medium is as vast and diverse as the World Wide Web.

* Talk to your doctor itself: Some doctors are open to honest communication, and if you’re a good judge of character, you’ll know if you’re in good hands or not.

* Use relatives or close friends in the medical community: People who have close connections to the medical industry are usually in the inner loop regarding doctors and their methods of treatment. If you know someone in the medical community, don’t hesitate to pick their brains and seek their opinion.

* Bedside manner is not everything: Don’t be fooled by the bedside manner of doctors – that’s all there is to some of them. Style over substance never works, more so when it’s a question of your life. So take what doctors say with a pinch of salt, and double check your facts if you want to life a long and healthy life.

--- snip ---

This article is contributed by Sarah Scrafford, who regularly writes on the topic of Radiology Technician Schools. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.

Who do you let die?

Interesting article on Yahoo Answers.

Who should MDs let die in a pandemic? Report offers answers

By LINDSEY TANNER, AP Medical Writer Mon May 5, 12:14 AM ET

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Now. That's quite a thing. We've known for ages that there are systems of selection in medical environments and situations. I suppose just a little scary to see it in print.

Article goes on to say...

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

... as examples of how detailed this report gets.

What do YOU think?

There are too many humans. Perhaps life isn't quite as sacrosanct as before...

Modernising the Medical World.

In the wake of the official Google Health launch (check it out - looks interesting). Got some comment from SA Doc on modernising the medical world...

I used to work in a practise that was - for lack of a better word - archaic. You've heard of paperless offices. Now try a paper-filled practice. Everything was done in the old fashioned method of pen to paper - the invoices, the patient notes, even the list indicating the link between family name and file number.

Email? Email who? The only computer visible (under the masses of paper) is an old 486 running Windows 3.1. I actually had to relearn how to use that OS.

No matter how I tried to convince the partners to modernise they could not see the advantage. The idea that you could access any information from complete, LEGIBLE patient notes with a CTRL F was beyond them. The idea that billing and ICD10 coding could be done with a couple of drop down choices didn't compute either (pardon the pun).

I love the idea of systemising patient records and details. It makes things simple. It correlates data very well (no more missing lipograms when a page from the file goes missing). Yikes.

More doctors should organise their patients details and medical information. It makes it easier when you practice, it makes it easier for locums, it makes it easier to recall patient illness details when you need to discuss them with another doctor, it makes it easier to correlate lab results and it makes it easier to bill.

From the other side of the fence now (my crossover into the dark side of managed health), I immediately can notice when a doctor is using a system. They can give me detailed information, email me motivations / lab results. They also tend to bill more appropriately and thus (big tip here!)... have their claims approved faster!

It's a pleasure to work with them! Catch a wake up Docs. It's the 21st Century.

Medical Confessions

Har. Har. Pretty funny read...

Ever wondered if doctors are frightened of catching what you've got? What their notes really mean? Or how to get round their receptionist? We asked five doctors to spill the beans

Check it out here.

Is Depression on the rise?

GP's tend to deal with a lot of depression and anxiety (and I'm not talking about our own... who tends to us? Another question. Another post).

Is there more depression and anxiety in the 21st century or are we just getting better at recognising it?

The middle of the 20th century saw the rise in early recognition and treatment of psychiatric illnesses. In fact, most of the stigmas surrounding psychiatry, psychologists and psychological drugs were put to bed in the late 70's and early 80's. The rise of Freud and Mommy-consoling. They were heady days.

Back to the present – something is definitely up. It feels like at least 1 out of every 3 patients I see is on some type of an antidepressant or mood stabiliser. I used to have a professor who joked that lithium should be put into the water. Quick, painless alleviation of most of our problems. Imagine a world where the traffic driver is too stoned to cut you off. Wait. They are stoned. And still cut us off? Well, I did say “most” of our problems.

I see at least 3 people per week who arrive complaining of stress, an inability to cope – and of the opinion that medication (not psychological treatment) will help.

Has life really become more stressful in the 21st century? Dual incomes? Pressure for women to succeed and men to become more nuturing? Or have our parents not prepared us properly for the big bad world. Are we, as modern human beings, getting less and less capable of dealing with situations and just getting in with life?

Why do more and more people feel that they have to take medication (and/or drugs) to deal with the everyday stuff? Maybe it has something to do with the fact that everytime you pick up a YOU magazine, you're confronted with pretty looking people advising you seek out your doctor for the latest in smiley medication.

A lot of questions – and not too many answers I'm afraid.

Perhaps we should spend more time teaching stress management in schools? Or organisational skills... teach our children to be more efficient, manage money better, be more emotionally available?

Then maybe our next generation won't have to be permanently medicated to be happy and functional...

The taste of medicine…

Medicines have always inherited the somewhat unfair rep of being so vile tasting, that not even hungry dogs would go close. Why? Safety? Maybe

I am a doctor that likes to taste things before I prescribe them to kids (need to know if there’s a chance they’lll take it - or I’ve lost the battle before it has even begun – and Mom has gotta force feed).

I’m here to reassure you. They’re not all that bad.

Kerry, a previous commentor on the nose suction wonderment is right is right though, pharmaceutical companies really need to think about the taste of syrups before they make them for kids. If it’s going to taste KAK - make them in suppositories! And deal with the consequences.

But since we won’t be getting a horde of bum tablets from the pharmaceutical companies any time soon, here are examples of winners and losers in the taste category:

Winners:
Stopyne (berry flavour, yummy!)
Erythromycin (always my favourite)
Original Augmentin (bubblegum flavoured)
Prozef (strawberry flavoured – a clear winner from the kids)
Orelox (banana flavoured)
Lotem (better banana flavour)
Calpol (strawberry – the kids love this one, I personally hate the after taste!)

Losers:
Buscopan (the most vile tasting concoction! Why did they even bother to make it! I just tell mom’s to crush the tablet into their food.)
Prelone (yuk!)
Viral guard (what were they thinking?)

Med student dissecting kit. Buy now!

I'll never understand these bloody med students. They're quite serious about selling you the following piece of hardware. And I say hardware because, well, you kind of expect this to come out in a movie like SAW.

Feast your eyes on the cold steel available for just under $30!



AMA-approved anatomy dissection kit for first year medical students!

The American Medical Association (AMA), America�s most prestigious medical organization, worked in conjunction with DR Instruments, professors, and medical students to design this kit for first year medical students. The 10GSM kit contains the most widely used dissection tools for first year anatomy classes.

DR Instruments offers over 125 dissection tools including a wide range of dissection kits for medical school anatomy classes.

To purchase additional or replacement tools, please click on the part number for more information and to place your order!!

10GSM kit contains following tools:

- Teasing needle bent with metal chuck | Part # 38|
- Teasing needle straight with metal chuck | Part # 37 |
- Iris scissors fine point 4.5" | Part # 9 |
- Surgical scissors 5.5", one point sharp and one point blunt | Part # 5SB |
- Cartilage knife | Part # 26 |
- 1 x 2 Teeth tissue forceps 4.5" | Part # 13-T |
- Scalpel handle # 3 | Part # 27 |
- Scalpel blade # 10, pack of 10 blades | Blades for handle # 3 |
- Mall probe chrome plated | Part # 36 |
- Hemostatic forceps 5", Curved | Part # 45CD |
- Ruler 6" plastic ( Part # 30)

Buy it here, if you dare.

Perianal WHAT?!?

Had to drain a perianal abscess. Standard stuff in a government hospital, but in private practice, it's a rarity. I had forgotten how ABSOLUTELY awful they are.

Imagine the smell of a rotten goose egg, mixed with 2 day old vomit, mixed with baby poo... That's about the introduction.

AND I kept a straight face and held down the gag reflex. I am a GOD.

How you start a career in medicine...

Dear SA Doc,

Living with a doctor is a trying, gruesome experience. And while it has its pharmaceutical benefits - it remains a puzzling past time. Just why, why did you put up with 6 years of studying, 2 years of community service and then sick people (30 times a day) for the rest of your working life.

Perhaps this will help. Got it off Diane's blog.


SA Doc replies:

"Sane. Very hardworking. Nice Attitude. Hate Adults. Oh shit... I should be in Paediatrics."

Try it out - which part of this bizarre career would you end up in? SA Doc obviously needs a change :)

Doctors are underpaid.

Doctors are underpaid. If a job is measured on skill required vs. ability to muck things up... we are getting the right ass-end of remuneration. People can die if we make mistakes.

Take this example. First, we study for SIX YEARS! Then work a compulsory term in government for 2 years (at a calm, relaxed 90 hours per week). That's 8 years we could have been earning tom.

A GP earns medical aid rates for a patient. That's R180 per consultation (if you get paid). 30 patients a day (fully booked). So that's an income of R108 000 per month. Whoah there big daddy - you think that sounds good?

Practice Overheads: Nurses, receptionist, premises, office costs, disposable items (gloves, swabs, needles etc.).

Practice Equipment: An ECG machine costs R35000. And we can't survive on just that.

Medical Licenses: HPCSA registration. R800 per year. Malpractice insurance. R7000 per year. Loss of income insurance. R12000 per year.

Actually giving a damn about your patients after paying all of this: Priceless.

And that's a practice that's positively rolling in patients. AND a practice that's managed to get reasonable payment terms out of Discovery.

Did I mention we have to study for 6 years? And we have to continue studying to keep up with health patterns, developments in the industry and refresher course on the 3 billion diseases that we could face alongside the snotty noses.

I'm bitching. And saving lives. Such a philanthropist.

Why South African Doctors are hardcore (when it comes to rare tropical diseases)...

With much amusement, I noticed that TB (tuberculosis) was number 6 on that Wikipedia Watch-Out-For-This list we've been talking about.

In South Africa, TB (next to HIV) is the highest prevalent infectious disease. Even as a first year fledgling, we were taught it's TB, TB, TB until proven otherwise. I can diagnose it in my sleep. Even interns (especially interns because they deal with the crap) treat this shit for breakfast.

AND. We don't wear masks everytime we deal with patients. Our immune systems are THAT hardcore. American medicine might think that foolhardy. We just call each other Chuck and carry on with business.

A Doctor's Drivethru

What a week. You think MY job is glamorous?

60 Itchy Throats

50 Snotty Noses

30 Episodes of Gastro

10 Depression Cases

ZERO Rare Tropical Diseases.

And a patridge with a swollen knee.

ER is a but a dream right now. I'm going to start a doctor's drivethru.

State your 5 main symptoms. Answer 3 easy questions. 40% of patients get Combo Script 1 (Nose spray Deluxe, no cheese, side order paracetomol). 40% get Combo Script 2 (Super Size Probiotics with the Anti-Spasmodic special). Only 20% get to sit down and order off the menu.

I'm going to bed.