Agog over abject madness

This week the medical [1] and non-medical [2] media have been agog over this research article [3] in the 15 November MJA. Titled ‘Perceived practice change in Australian doctors as a result of medico-legal concerns’, it’s the survey responses of 2,999 Australian doctors. The findings are startling: due to the risk of medico-legal proceedings (i.e. being sued or complained about), 32% of responders are considering reducing their work hours, and 40% are considering early retirement. Naturally those who had personal experience of medico-legal proceedings were more likely to contemplate this action. Some 65% of the responders had such experience, with 14% having a current matter at the time of the survey. I’m one of this 14%. I have been since May 2008 [4]. Also the fear of medico-legal proceedings is driving health care costs up: 43% of responders said they referred more patients, and 55% said they ordered more tests. I appreciate society needs checks and balances. But the current situation’s nothing short of abject madness. And it’s a vicious cycle: the more doctors who reduce or stop work due to medico-legal proceedings against them, the greater the pressure placed on the remaining doctors. And thus they’ll be at increased risk of having medico-legal proceedings brought against them. The solution? I don’t know. But reducing the involvement in medicine of politicians, bureaucrats and lawyers would be a great start. Will it happen? Don’t answer that – it’s a rhetorical question.

When Martin met Joan

Dr Martin Van Der Weyden. I first met him in the early 1980s – at Melbourne’s Alfred Hospital where I worked in Medical Administration and he in the Haematology Department. He went on to become a Monash University Professor of Haematology in 1985. And since 1995 he’s been Editor of the Medical Journal of Australia [MJA]. (I went on to become a sheep and goat farmer.) I write of Martin today because in the current MJA issue he’s written a ripper of an editorial [1]. Martin described himself as ‘impatient, compulsive, a dreamer, tolerant, and ‘more left than right’, politically speaking’ [2]. It all shines through in this editorial. After quoting some horrid Aussie stats – up to 60% of adult Australians overweight or obese, 7½% of the total burden of disease and injury attributed to obesity, A$8.3B cost of obesity in 2008 – he proceeds to lament that the obesity epidemic’s ‘still not on the political radar’. Noting the weight explosion’s due to a mismatch between caloric consumption and energy expenditure, he points out society’s reluctance to heed the advice of Joan Collins: ‘The best exercise for losing weight is pushing yourself away from the table’. And to title his editorial he used the wry title of a recent Age editorial ‘Realistic about obesity? Fat Chance’. A few years older than I, Martin’s retiring in early 2011 [3]. As an MJA reader, I’ll miss him. I doubt I’ll be alone.

farmdoc's blog post number 687

The saying ‘use it or lose it’ is entrenched in our lexicon [1]. Though it’s broadly applicable, today I write of it in the context of medical practice. But there’s an even scarier medical scenario than poor results due to atrophied skills. And that’s when the skills haven’t been acquired in the first place. Which apparently is so regarding the physical examination part of the medical process (the other two parts are the history/interview, and special tests such as blood tests, x-rays and scans). I’ve written before about the importance of the physical examination [2, 3]. I recently read a book titled Every Patient Tells a Story – which both emphasises that importance, and laments that US medical students and recent graduates lack the ability to perform a thorough and accurate physical examination. Now the MJA’s Editor has weighed in – via this piece in the 1 March 2010 issue. He cites the ‘Stanford 25’ – ‘…25 technique-dependent manoeuvres that are now mandatory for (Stanford) trainees to learn’. And he exults in his observation that the physical examination skills of Australian doctors greatly exceed those of our US colleagues. The sorry state of US doctors’ physical examination skills means they rely more on special tests which can be expensive, so driving up US healthcare costs. The crunch time for US healthcare reform legislation approaches [4]. If it becomes law, cost caps may force US doctors to improve their physical examination skills. Ho hum.

farmdoc's blog post number 619

If the world’s divided into introverts and extroverts then no doubt I’m an introvert. Which explains why I’m a physician and not a surgeon. Because physicians are introverts whereas surgeons are extroverts. In other words, extroverts become surgeons, and who’s left become physicians. We introvert physicians, being thoughtful and sensitive folk, are oft amused by the antics of our surgeon colleagues. I’ve read no better account of this friendly rivalry, than in this article in the MJA’s Christmas issue. It’s a tongue-in-cheek parody. And like all good parodies, it contains more than a modicum of truth. I especially like the jokes: ‘What is the difference between an orthopaedic surgeon and a carpenter? The carpenter knows the name of more than one antibiotic.’ ‘How do you hide something from an orthopaedic surgeon? Put it in a book.’ And ‘Did you hear we have employed a holistic orthopaedic surgeon? He cares about the whole bone and not just the fracture’. Also surgeons’ boilerplate logic: ‘You need an operation. I will do an operation. The operation is done. You are better now. Goodbye’. Finally I had a Yuletide chuckle at the Competing interests disclaimer: ‘The author has received hospitality, friendship and gifts of wine from a number of surgeons and is keen to point out that the content of this article in no way refers to them. He is, however, not planning to have any elective surgery in the foreseeable future’. Prof. Bowden, you’re a hoot!