Hope Alexander MPH

Archive for the ‘Hope’s Commentary’ Category

This week Hope has been pursuing her “free” hearing aids. After the hearing test and consultation on 14 June, Hope was given to understand that her aids would be free under the Federal Government scheme. Then the rules change after the 1 July, according to the audiologist, and Hope is asked to pay $800 for the aids, plus a $1000 “care plan” to cover loss, damage and maintenance over three years. This necessitated three phone calls to the Office of Hearing Services. The jury is still out.

Today Hope submitted her abstract for the Australian National Conference on Evidence-Based Clinical Leadership. The title of her paper is “Chasing the rainbow – the difficulties experienced in accessing age and condition-specific programs”. These programs include oral health, hearing services and Enhanced Care Plans. The conference is to be held in Adelaide, one of Hope’s favourite places, in November.

Hope has been appointed to the North Metro Public Health and Ambulatory Care Executive management group as a community representative. She attended her first meeting of the group this week.

Hope has skills and expertise in public health, being awarded her Masters in 2008, and is committed to the social model of health. She is also keen to see oral health become part of mainstream health instead of being an orphan.

Hope will be attending the following Clinical Senate meeting on 26 March 2010 in Perth, Western Australia.

Event: 26 March 2010 - Pre-Hospital Assessment - Avoiding the Revolving Door

The Consumers Health Forum-nominated consumer representative on the Medical Services Advisory Committee panel reviewing Vertebroplasty, has asked for comments on consumer issues around treatments such as Vertebroplasty (or injection of bone cement into diseased vertebrae such as osteoporotic fractures).

She is keen to ensure that all consumer issues relating to potential Medicare funding for this procedure are considered in the evaluation.

The Question:
Are we aware of any consumer issues relating to the current treatment and management of painful vertebral compression fracture as a consequence of osteoporosis or vertebral malignant tumours?

In a letter to the editor of the Medical Journal of Australia (MJA 2010; 192 (3): 174-17) Paul J Graziotti states that “Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm”.

Some years earlier Vertebroplasty was described as “a promising but as yet unproven intervention for painful osteoporotic spinal fractures” by Rachelle Buchbinder and Richard H Osborne (MJA 2006; 185 (7): 351-352). It was further claimed that “Medicare funding could jeopardise the research needed to establish the benefits and risks of this procedure”.

I read elsewhere that the “slurry” they inject into the bones, can leak out and cause even more problems. Therefore I would suggest caution to anyone who may be contemplating this procedure … as yet the evidence is not available.

The Response:
I would be very wary of suggesting that this procedure be funded by Medicare until there is some strong evidence that it works, and does not cause further harm. The way I read it, the evidence is just not there, and the possibility of damage and the “potential to cause harm” has already been established.

Further information about treatment for osteoporotic vertebral fractures can be found on The Health Report ABC National Radio web site here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647587.htm

I am continually attending “Patient Safety and Quality” meetings yet the matter of hand hygiene is not raised, or even on the agenda till I bring it up.

1. “Can we wipe out … “  is about research in the UK and comes from the virtualmedicalcentre.com web site
2. MRSA consumers’ document is a WA Health Department document which can be accessed here http://www.public.health.wa.gov.au/cproot/1760/2/MRSA%20Consumers.pdf
3. “Doctors should be “horrified” by their hand hygiene-studies … is an article on research in NSW from HealthAlerts website and can be accessed via this link http://www.healthalerts.com.au/news/news.php?action=fullnews&id=541
4. Ignaz Semmelweis… discovered the importance of hand-washing hygiene by medical care-givers in 1847 …

Only after Dr. Semmelweiss’ death, was the germ theory of disease developed, and he is now recognized as a pioneer of antiseptic policy and prevention of nosocomial disease.

The below article is a guest column written by Hope, that was published in the “Medical Forum WA”  magazine, Western Australia’s Independent Monthly for Health Professionals December, 2009 edition. Her article is on Page 17 and the orginal article can be accessed at http://www.medicalhub.com.au/component/option,com_docman/task,doc_download/gid,174/Itemid,228/

The GP-patient relationship is an imperfect science, with many GPs finding it hard to diagnose properly if information is not articulated correctly or withheld. Conversely, some seniors believe GPs need to take a different approach when dealing with this growing demographic in WA.

So what do seniors want from their GP? To be listened to, taken seriously and to be able to enjoy a partnership with their health provider. I believe this leads to more productive consultations and a positive outcome for both doctor and patient.

Many seniors (like me) have at least one chronic condition, some have more. This does not necessarily mean we are ill or incapacitated. Seniors need support and information, including access to resources so that we are better able to ‘self manage’ our condition in partnership with our health providers.

Having gained weight and body fat after cancer treatment I do not want to be told “it is because you are menopausal”, “because you have had children”, “it is in your family”, or worse still “go to Jenny Craig”. It is more useful to be referred to a dietician and an exercise physiologist. In this way a plan can be drawn up to achieve my goal, that is, to manage my weight, to keep fit, to reduce the risk of other medical conditions, and reduce the risk of the cancer recurring.

With the help of my GP I can set my health goals, draft an action plan, and take responsibility for my continuing wellness.

What doctors can do to make the journey easier:

1. Suggest the patient brings all medication they are taking to the consultation. An on-going review can minimise errors such as a patient taking the same drug by another name, continuing to take medication if no longer required and confusion.
2. Ask the patient to write down a list of questions to ask the doctor, and copy the answers given by the doctor.
3. Offer the patient a print-out of all medications they are taking, the reason for taking it and dosage – including any known drug reactions. Seniors often put this list on their fridge, so in an emergency ambulance officers have access to this vital information.
4. If a doctor is uncomfortable discussing a particular issue, e.g. sexuality, refer the patient to someone who is not. Many patients have difficulties in this area because of surgery, chemotherapy and other procedures.
5. Suggest the patient request a long consultation if there are several issues to be discussed, or else make two consultations. If these are bulk-billed (for pensioners) this could perhaps save time for both doctor and patient.

And what will the doctors stand to gain? Patients who are using the knowledge and support offered to better manage their health and such conditions they may have. This may result in fewer and shorter visits, more time spent achieving positive outcomes than having to listen to the same old sad story. Many seniors are ‘experts on their own condition’ and do have a wealth of experience in coping – but we do need the relevant up-to-date information the doctor can provide.

Hope Alexander

December 2009

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