Hope Alexander MPH

Archive for the ‘In The Media’ Category

Hope was invited to contribute to DVD content and attend a focus group, the outcome of which will be used to to develop a DVD for WA consumers with a long term condition.

The researchers are particularly interested in learning about the experiences/difficulties we or someone we care for have encountered in managing a long term condition and ways we have overcome them.

This study has been approved by the Curtin University Human Research Ethics Committee. The Principal Investigator is Professor Duncan Boldy of the Centre for Research into Disability and Society, School of Occupational Therapy and Social Work, Curtin University. The Project Officer is Doctor Setareh Ghahari.

For Debate

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty

William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse MJA 2010; 192 (6): 334-337(see link below)

Abstract

We use vertebroplasty for patients with the most severe pain caused by osteoporotic vertebral fractures less than 6 weeks old, and have observed dramatic pain relief in this acute setting.

A recent editorial in the Journal, written by the authors of two recent vertebroplasty trials, suggested that vertebroplasty is not an effective therapy for acute osteoporotic vertebral fractures.

The trials described in the editorial sampled a very different patient cohort to the one that we treat with vertebroplasty.

Our clinical experience and most of the published literature relating to the benefits of vertebroplasty are in striking contrast to the opinions presented in that editorial.

©The Medical Journal of Australia 2010 www.mja.com.au

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty
William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse.
Med J Aust 2010; 192 (6): 334-337.
http://www.mja.com.au/public/issues/192_06_150310/cla11439_fm.html

Invited editorial presents an accurate summary of the results of two randomised placebo-controlled trials of vertebroplasty
Rachelle Buchbinder, Richard H Osborne and David Kallmes.
Med J Aust 2010; 192 (6): 338-341.
http://www.mja.com.au/public/issues/192_06_150310/buc10020_fm.html

Western Australians will be able to make important decisions regarding their future medical treatment and lifestyle choices, under new legislation which takes effect today.

Ministerial Media Statement from Kim Hames, Deputy Premier; Health; Indigenous Affairs can be viewed here:

http://www.mediastatements.wa.gov.au/Pages/Results.aspx?ItemId=133128

Government of Western Australia Department of Health Advance Health Directives information and forms can be viewed here:

http://www.health.wa.gov.au/advancehealthdirective/home/

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

© Copyright Hope Alexander

Norman Swan on The Health Report on ABC Radio National, 10 August 2009, interviewed Anne McKenzie who is a consumer advocate in the School of Population Health at the University of Western Australia, Hope Alexander, a consumer member of their Research Advisory Panel, and Kos Sclavos, president of the Pharmacy Guild of Australia. The topic of discussion was “Labelling of medications dispensed by pharmacists”.

Labelling of medications dispensed by pharmacists

“Health consumer advocates have uncovered what they feel might be an unacceptable level of pharmacists dispensing medications with ‘use as directed’ or equivalent on the label. They argue that this is dangerous and should not happen.”

The Health Report transcript can be read here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647591.htm

The Health Report transcript can be listened to here:
http://mpegmedia.abc.net.au/rn/podcast/2009/08/hrt_20090810_0841.mp3

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 July, 2009 edition. Her article is on Page 10 and the orginal article can be accessed at http://www.medicalhub.com.au/component/option,com_docman/task,doc_download/gid,130/Itemid,228/

With the ageing population, what can the Australian health consumer expect in the way of primary health care, and by whom will it be delivered? One strategy to overcome the shortage of trained health professionals is to utilise the skills and strengths of nurse practitioners.

The article “On solutions to the shortage of doctors in Australia” states that:

• WHO estimates a current global shortage of 4.3 million health workers;

• Australia … compares unfavourably with other OECD countries in respect to doctor numbers;

• The overall shortage of doctors in Australia … is exaggerated by the disciplinary, cultural, and demographic misdistribution of the doctors relative to need and utility;

• Australia … is one of the most reliant of the OECD countries on foreign doctors; and

• An increase in spending on health promotion and disease prevention is essential.

“The majority of health professionals recognise that there is a gap in health service delivery in this country, and that nurse practitioners can contribute to filling that gap” (Cerasa, 2009).

Anecdotal evidence from patient X has a woman attending a GP surgery to have weekly dressings on her leg after day surgery. But can either of the two practice nurses reassure the patient that her wound is healing? No. Can the GP who sees the wound on an irregular basis? No, “It is OK.” What does that mean? So the patient returns to the surgeon to get a definite opinion. “Yes, the leg is healing, everything is proceeding as normal.”

If a consumer consulted a nurse practitioner specifically trained in wound care, the outcome would be much different. The skill and knowledge base would be there. Information would be given to the patient to best manage her condition: how often would dressings need to be done, for how long, and what the patient could do to resume her normal lifestyle. As a consumer, I have faith in the education and training of nurse practitioners. Many consumers have been let down by GPs who do not communicate, who do not share information and/or evidence, and who “do not want to treat old people” or “people with no money”.

As an older consumer with a chronic condition brought about by medical treatment for another condition, I would say “Yes, I am willing to consult a nurse practitioner” for routine checks and most ailments. Part of the nurse practitioner training is to differentiate between serious and minor complaints. I see their role as being similar to triage. Instead of referring a patient to a GP, it may be a referral to an exercise physiologist, a dietician, or a massage therapist.

GPs are trained in the medical model, but many consumers, particularly those with chronic conditions, and older ones, would prefer a non-drug treatment, along the lines of the New Zealand “Green prescription”. In addition, consumers find it difficult to access a GP who is willing to write an Enhanced Care Plan. Excuses given are “it takes too much time” and “we don’t get paid enough”. Consumers may well ask “But what about us?”

Hope Alexander

July 2009

© Copyright Hope Alexander