Colleges vie for divine right to patients

The tragic and widely-reported death of a Melbourne woman last week three days after liposuction predictably attracted calls for regulation of what's been unkindly dubbed 'the vanity industry'.
Twenty six year old Lauren James had undergone a same-day thigh and buttock procedure at the Centre of Cosmetic and Plastic Surgery in Caulfield North , and the case, now before the Coroner, has prompted the usual suspects to pronounce they're the only College qualified to perform such procedures.
For example, Dr Norm Olbourne, a spokesman for the Australian Society of Plastic Surgeons, says "doctors performing cosmetic surgery should be members of the Fellowship of Royal Australasian College of Surgeons".
But the doctor in this case, Dr Tam Dieu, is a plastic and reconstructive surgeon according to the Medical Directory. and according to the Centre's website its chief surgeon, Dr Gerard Sormann, is a fellow of the RACS with a long and distinguished career in cosmetic and plastic surgery. The facility is registered with the Victorian Department of Human services.
It's no wonder the punters are confused about who should do what
A Choice article a few years back highlighted the problem, listing the organisations claiming to train and represent doctors performing cosmetic surgery in Australia:
Australia Society of Plastic Surgeons, a sub-speciality of Royal Australasian College of Surgeons;
Australian College of Cosmetic Surgery;
Royal Australian College of Ophthalmologists, a sub-speciality of the Royal Australasian College of Surgeons;
Australian Society of Otolaryngology/head and Neck Surgery, a sub-speciality of the Royal Australasian College of Surgeons;
The Royal Australian College of Surgeons;
Australasian Society for Aesthetic Plastic Surgery;
Australasian Academy of Facial Plastic Surgery;
Australasian College of Dermatologists;
Cosmetic Physicians Society of Australia; and
Sclerotherapy Society of Australia.

According to its website, fellows of the The Australasian College of Cosmetic Surgery must have three years basic surgery training and a further two years specific cosmetic surgery training. Doesn't sound so bad to me.
So to set the record straight, today 6minutes emailed the various Colleges requesting details about their training requirements.
We'll publish all responses.
And can we please put to rest the ridiculous claims that doctors working exclusively in cosmetic medicine or surgery can be 'general practitioners'? Whatever you might call them, general they ain't.

Lose-lose situation for GPs

Every time I think I’ve got my head around the UK health system, yet another reincarnation emerges.
The most recent large-scale change was the introduction of new GP contracts in late 2004, aimed at propping up a GP workforce dwindling under the pressure of high workloads, 24 hour on-call duties and significantly poorer pay than their hospital colleagues.
Under the new contracts, around two-thirds of GP pay became linked to meeting ‘quality targets’, such as predetermined immunisation rates and optimal blood pressure management.
In this latter area alone, it was estimated GP care would save 8,700 patients from a stroke, heart failure, a heart attack or angina, according to a BBC report.
So you’d think the government would have been happy when instead of meeting 70% of targets, GPs reached 90%.
But dollars, rather than patient’s lives, seem to take priority for Health Secretary, Patricia Hewitt, who now says GP profits should have been capped.
With average GP pay reaching over £100,000, Ms Hewitt claims she didn’t realise GPs would “take” so much of the increased earnings as profit, but wanted them to plough it all back into practices.
In the words of GP blogger, Dr Rant, "Who does the Secretary of State for Health believe should be allowed to make 'a profit' from the NHS?
a) The private companies that are set to share a risk free bonanza of £23 billion for being awarded contracts through the private finance initiative.
b) The 'management consultants', many of whom work for your old company, who deliver nothing yet cost the NHS more in total than the medical consultants who deliver the actual 'service' bit (as in National Health Service).'
c) GPs who run their own businesses and manage 90% of day to day NHS activity, and who were were given a legally binding contract to deliver extra work for the benefit of NHS patients.
Deputy chairman of the BMA's GP committee also hits the nail on the head. "Is the Secretary of State saying she wishes GP practices had not performed so well on quality targets thereby improving the delivery of top quality care?", he asks.
"The government signed off the contract which ties income to quality performance. She should be proud of the achievements of general practice, not denigrating doctors for delivering quality patient care."
Will make interesting reading for those in this country pushing for more blended payments.

Drug info decades old

If you’re like me you rarely look at a drug’s formal product information, or PI. For detailed drug queries my computer software fails to answer I turn to sources other than the PI, such as the Therapeutic Advice Information Service (TAIS).
Nonetheless, I would have expected Product Information, supplied by the manufacturer and approved by the Therapeutic Goods Administration (TGA), to be accurate and up-to-date.
Unfortunately, according to two articles in this week’s MJA such assumptions are misguided. While the accuracy of information provided by the drug’s sponsor company is likely at its zenith at the time of registration, it may soon be outdated and should have a compulsory use-by date, says Australian Prescriber editor, Dr John Dowden.
With the pressure to approve drugs quickly, sometimes after phase II trials, new information will probably emerge soon after marketing, he says, quoting a US review of over 500 new drugs that found over 10% were subsequently withdrawn or acquired a ‘blackbox’ warning.
And while out-of-date PIs may not directly individual clinicians, Product Information is often the source people turn to when seeking detailed drug information as well as setting boundaries for advertising, consumer information (CMI) and forming the basis of MIMS.
In Australia, it is the sponsor’s responsibility to update product information, a costly exercise which may not take top priority especially in the case of old, less profitable drugs, says Dr Dowden.
And although previously government-funded, the TGA now relies on income from fees and charges from industry, resulting in a ‘risk management approach’ to regulation, he says.
Supporting this view, a prominent endocrinologist in the same issue of the MJA says PIs on thyroid medication are frequently ‘inadequate, inaccurate or outdated”, such as advice that thyroxine should always be commenced at a low dose.
Some PIs are around than 20 years old, says Professor Jim Stockigt, of Melbourne’s Monash University, yet financial disincentives currently deter pharmaceutical companies from updating them.
Surely we can come up with a better system than this.

Club-based childcare on the nose

My first day back today after Christmas holidays on the coast, a vastly more leisurely experience these days with teenagers than smaller children, even if they get a bit bolshie when asked to haul themselves out of bed before midday.
With five families however, eating out is not so easy and we were forced to hit the clubs to find an establishment able to cope with all 23 of us.
And while club food was predictably unremarkable, the extent of gaming facilities in ‘Clubland’ struck me as nothing short of scandalous – cavernous, dimly-lit rooms with row after row of poker machines clinking and blinking as bored-looking gamers pressed their buttons mechanically in the hope of a windfall.
Most shocking of all was the flyer at one club promoting “Kids Fun Days”, where kids are promised “Movie, Disco & Prizes to be won!” for just $6 a day including lunch and a drink.
There’s a catch however; parents must remain on club premises, and given the profitability of gambling, there’s little doubt where clubs are hoping parents will head. I guess it’s a step up from leaving kids in the car.
We’ll probably see more of this type of thing, especially in NSW, now that the NSW government is allowing clubs to open in shopping centres despite its previous and public apprehension about such a move.
Naively, the minister responsible for gaming, Grant McBride, says a requirement for clubs to have separate entrances than the shopping complexes will protect people for irresponsible gaming. Give me a break. For a UK doctor’s honest account of just how insidious gambling can be, see his blog .
So addictive is gambling for some people that they’ll lie, cheat and steal trying to win back their losses - I suspect they’ll manage the separate entrances.
Perhaps craziest of all is that under the new plan, gamblers will simply pop in to the adjacent mall’s ATM to get a cash advance on their credit card, presently not allowable at club ATMs.
Fortunately, gambling leaves me cold. Otherwise I’d be betting it’s the clubs who’ll be the winners in this move.