Sex and drugs and rock and roll ... and death, all essential ingredients of a good Australian miniseries, are raised in this issue of GPSpeak.
Each year Lismore plays host to the Tropical Fruits Festival. Our cover and page 12 story feature pictures of the parade taken by talented local photographer Brad Mustow.
However, when the party's over, one can feel a little down. Staff specialist, Emanuel Vlahakis, gives practical advice to general practitioners on dealing with Gender Dysphoria (GD, page 21). Discrimination against transgender patients contributes to high levels of depression and suicidality. Recognising this risk and tapping into local resources to help such patients is a first step.
The acronym, MYEFO, sounds vaguely threatening. It is to the medical profession this year. Robin Osborne (page 18) outlines the changes to health in the Mid-Year Economic and Fiscal Outlook. Sussan Ley's doublespeak and doublethink defense of the changes attests to her being a most valued minister in the Turnbull government.
The Robinson MBS and Hambleton Primary Health Care Reform reviews are unlikely to be released before the Australian Federal Budget on May 10, 2016. Good news is not expected. The freeze on rebates and the slashing of GP training is increasingly frustrating for the profession. Dr Ruth Tinker (page 4) reflects on the teething problems of the new slimline arrangements. The Northern Rivers General Practice Network (NRGPN) remains dismayed at the loss of the superb program provided by the previous incumbent, North Coast GP Training. Getting GPs to stay in country areas is always difficult but NCGPT did an excellent job of making a career in rural medicine attractive. It will be a difficult task for the new organisation, GP Synergy, to do the same.
On page 13 Andrew Binns continues his look into the issues surrounding voluntary euthanasia. Comedian/Producer Andrew Denton, recalling the death of his father from heart failure 18 years earlier, has recently argued strongly for Assisted Dying in Australia. Denton's detailed review of euthanasia as practised in Europe and North America suggests that such systems can work. However, he notes the that there have been 27 failed attempts to introduce laws for assisted dying in Australian States since the Howard government overturned the Northern Territory's "Right of the Terminally Ill Act" in 1997. He lays the failure for the passage of these laws at the feet of Australian doctors.
Binns argues for the status quo and cites Canadian ethicist Margaret Somerville who sees cultural changes in western societies as the main driver for the voluntary euthanasia movement. While self determination may be seen as laudable, the materialistic approach to life and to death carries increased weight in our secular age. Many are uncomfortable with such a utilitarian approach.
Australian physician, Karen Hitchcock's recent "The right to die or the right to kill?" essay addresses many of the issues raised by Denton. The wish to die will usually not be due to intolerable pain, we are not bad at controlling that, but rather to feelings of despair, worthlessness or of being a burden.
If Denton is right and Australian doctors are failing Palliative Care patients we can address this by at least making it clear about what we can do in "End of Life" care. With the help of our practice nurses, local health district and private Palliative Care teams, and local hospices many patients can end their lives in comfort surrounded by their friends and families.
To support this end, the NRGPN has recently relaunched its Advanced Health Directive suite, MyChoice. The suite comprises a brief explanation of the concepts behind Advanced Health Directives, an assessment tool of the patient's and their carers' needs and the Directive itself. All of these documents and the accompanying succinct but comprehensive manual can be downloaded from the website, http://iccnc.nrgpn.org.au.
The movie, Last Cab to Darwin reviewed in the last issue of GPSpeak, describes the final weeks of Rex's life, dying from stomach cancer. His journey takes him along that long and winding road of feelings of despair, worthlessness and of being a burden. Thankfully, he makes it home safely which is what we want for all our terminal patients.
However, when the party's over, one can feel a little down. Staff specialist, Emanuel Vlahakis, gives practical advice to general practitioners on dealing with Gender Dysphoria (GD, page 21). Discrimination against transgender patients contributes to high levels of depression and suicidality. Recognising this risk and tapping into local resources to help such patients is a first step.
The acronym, MYEFO, sounds vaguely threatening. It is to the medical profession this year. Robin Osborne (page 18) outlines the changes to health in the Mid-Year Economic and Fiscal Outlook. Sussan Ley's doublespeak and doublethink defense of the changes attests to her being a most valued minister in the Turnbull government.
The Robinson MBS and Hambleton Primary Health Care Reform reviews are unlikely to be released before the Australian Federal Budget on May 10, 2016. Good news is not expected. The freeze on rebates and the slashing of GP training is increasingly frustrating for the profession. Dr Ruth Tinker (page 4) reflects on the teething problems of the new slimline arrangements. The Northern Rivers General Practice Network (NRGPN) remains dismayed at the loss of the superb program provided by the previous incumbent, North Coast GP Training. Getting GPs to stay in country areas is always difficult but NCGPT did an excellent job of making a career in rural medicine attractive. It will be a difficult task for the new organisation, GP Synergy, to do the same.
On page 13 Andrew Binns continues his look into the issues surrounding voluntary euthanasia. Comedian/Producer Andrew Denton, recalling the death of his father from heart failure 18 years earlier, has recently argued strongly for Assisted Dying in Australia. Denton's detailed review of euthanasia as practised in Europe and North America suggests that such systems can work. However, he notes the that there have been 27 failed attempts to introduce laws for assisted dying in Australian States since the Howard government overturned the Northern Territory's "Right of the Terminally Ill Act" in 1997. He lays the failure for the passage of these laws at the feet of Australian doctors.
Binns argues for the status quo and cites Canadian ethicist Margaret Somerville who sees cultural changes in western societies as the main driver for the voluntary euthanasia movement. While self determination may be seen as laudable, the materialistic approach to life and to death carries increased weight in our secular age. Many are uncomfortable with such a utilitarian approach.
Australian physician, Karen Hitchcock's recent "The right to die or the right to kill?" essay addresses many of the issues raised by Denton. The wish to die will usually not be due to intolerable pain, we are not bad at controlling that, but rather to feelings of despair, worthlessness or of being a burden.
If Denton is right and Australian doctors are failing Palliative Care patients we can address this by at least making it clear about what we can do in "End of Life" care. With the help of our practice nurses, local health district and private Palliative Care teams, and local hospices many patients can end their lives in comfort surrounded by their friends and families.
To support this end, the NRGPN has recently relaunched its Advanced Health Directive suite, MyChoice. The suite comprises a brief explanation of the concepts behind Advanced Health Directives, an assessment tool of the patient's and their carers' needs and the Directive itself. All of these documents and the accompanying succinct but comprehensive manual can be downloaded from the website, http://iccnc.nrgpn.org.au.
The movie, Last Cab to Darwin reviewed in the last issue of GPSpeak, describes the final weeks of Rex's life, dying from stomach cancer. His journey takes him along that long and winding road of feelings of despair, worthlessness and of being a burden. Thankfully, he makes it home safely which is what we want for all our terminal patients.
David Guest
Chairman NRGPN
The NRGPN welcomes letters to the editor from members, health professionals and the general public. Correspondence should be sent to The Editor,This email address is being protected from spambots. You need JavaScript enabled to view it. .
Members concerned about particular issues may also contact Northern Rivers General Practice Board Directors. The Board membership for 2016 can be found on the NRGPN website under About the NRGPN. The Board meets second monthly on the third Thursday of the month.The NRGPN also runs a members only list server. Members not on the list server and wishing to join should send an email requesting access toThis email address is being protected from spambots. You need JavaScript enabled to view it. .
