One reason why healthcare is so $$$$$$ in Australia.

Have you ever looked at a medical device and thought why is this so expensive?

Firstly, there is the price hurdle to get an item to Australia.

For example, the DermLite II Pro HR by 3Gen will cost $US895 from them; to buy the same in Australia will cost you $AU 1529 (including GST) . Given the current exchange rate that amounts to around $500 to get it into to Australia. I would have to spend three times that to actually get to the US to buy one off the shelf there. It seems someone is making a lot of money.

Unfortunately 3Gen wont sell ship to Australia but by searching eBay you may be able to find a US based seller who may and at a little bit less than the 3Gen price.

DL2HR

Then, there is definition of medical equipment which seems to be an invitation to add a couple of zero’s to the price

I use a LED H7 Lenserhead torch to do minor surgery with. I like the extra light and it does a great job. Nice whitelight. Just don’t look the patient in the eye with it on. It cost me something like $60. At a medical conference  I went to recently, a company rep tried to persuade me to consider their “medical” product. Now admittedly it did produce a nice light, but it also cost $1200. I remain content with my alternative.

A tiny grommet (sorry, myringotomy tube) placed in my young fella’s ear drum cost $150! Apparently, I can buy a fluoroplastic myringotomy tube for only $US68 for a box of 10! Mind you I was quoted $90 UPS shipping to get them here. But me and 8 of my friends would have been way ahead.

850

So why it is that we must pay so much extra for medical and surgical equipment?

I can appreciate that we need to use a higher grade of equipment which needs to be tested to greater tolerances. Afterall, industrial grade silicone proved to be the undoing of Poly Implant Prosthese.

I am not advocating buying screws from Bunnings, although I was tempted when I saw how much the Herbert screw in my scaphoid cost me, but I think that it is reasonable that the Hon Dutton and Hockey cast their eyes wider at  saving healthcare dollars than hit Australians with the proposed co-payment.

T’is the season to be sneezing, coughing and feeling absolutely yuk………

Its okay you’re not really dying, although  you feel it’s about to happen……. (in my mind I’m sing this to a famous Christmas carol)

Sorry to rehash a previous post but it is happening again.

I still think it is irresponsible to encourage someone who has an infectious illness like influenza to take a tablet so they can feel better. Go on Audrey, take Jen a cake to infect her birthday party guests…..some friend you are! Go Audrey. Go Johnson & Johnson Pacific Pty Limited.

Reckitt Benckiser (Australia) Pty Limited the makers of Nurofen Cold and Flu also puts profits ahead of common sense and evidence in their marketing.

Pfizer Consumer Healthcare has at least updated their Dimetapp web ad, no more encouraging sharing your virus in the local public pool. This can be still seen on Youtube.

Most people with a cold or influenza recover with rest, drinking plenty of fluids and use of paracetamol for the relief of pain and fever.

As reported by NPS recent systematic reviews and meta-analysis of randomised controlled trials suggest oral zinc may reduce the duration of a cold by about 1 day (24 hrs….yah) if administered within 24 hours of symptom onset in otherwise healthy adults and children.

There are specific prescription-only drugs that may be useful in influenza. These are not antibiotics; antibiotics are not useful for treating viral illnesses like influenza.

South Australia’s Health Department advises the best way to slow down the spread of influenza is to get vaccinated.  The Influenza Management Guideline for Emergency Departments and General Practice suggests isolation and face masks whilst being assessed. Furthermore, if the patient doesn’t require admission to hospital encourage the patient to stay at home and practice good hand hygiene and cough etiquette. If going outside house, strongly encourage the patient to keep at least 1 metre away from other people and to use cough etiquette. Patting kids on the head in the playground is neither.

The NSW Health Department specifically recommends symptomatic people should not attend school, child care, work or public gatherings. Is there any clinical evidence that any of these over the counter well marketed do any good? Has Reckitt Benckiser, Pfizer, Johnson &  Johnson or any number of Pharmaceutical companies conducted and published randomised clinical trials proving benefit of these products? It’s not as if there is a lack of suitable subjects. In a similar vein, Cochrane has shown there is no good evidence for or against the effectiveness of OTC medicines in acute cough. Studies often showed conflicting results with uncertainty regarding clinical relevance. And if these products don’t do any good can they do harm? Well yes and particularly in children. Sarfstein et al argue in the NEJM (Over the Counter but No Longer under the Radar) that there is no evidence of effectiveness particularly in children and documented harm. Cardiac arrhythmias, hallucinations, convulsions, altered consciousness and encephalopathy are some of the severe side effects. In the US, an FDA review implicated symptomatic cold and flu treatments in 123 deaths of children under six years of age. In Australia the TGA suggested in November 2012 that children under six should not be given these medications.

So my advise is to stay at home, call in sick to work or school, don’t spread the virus around, wash your hands, keep up fluids (not beer), eat some oranges (or take vitamin C for what its worth), try zinc and wait for you immune system to get you back to good health. You can try to control symptoms with paracetamol for pain, decongestant for nasal symptoms, lozenges for a sore throat.  Most symptoms apart from a cough are gone by a week.

Oh and if you smoke its a great time to given up something that is making you feel even worse!!

And lastly think about a influenza vaccination.

Save your co-payment for when you are really sick.

 

Come to Kangaroo Island

Interested in a rural lifestyle change?

Do you have valuable skills that can used in a remote area?

Consider Kangaroo Island Medical Clinic.

Contact Genevieve.Clark@kimedical.com.au or 08 8553 2880 for more details

Pension on fast track to 70

The Weekend Australian headlines suggest that by 2029 the government will have crept the retirement age to 70 years. I read that both Liberal and Labor treasurers believe pushing the retirement age will improve the sustainability of the Australian pension system in the face of improvements in life expectancy.

That’s fair enough for me, because as long as I am not shuffling around a nursing home, eating mash everything, wearing a nappy and painting the walls my poo. I intend to meaningfully continue to contribute to society with gainful employment

A few weeks ago, I went for a bike ride and had to push myself to keep up with the pack leader, who is just one year short of the current retirement age. I expect he will be going strong at 70, 80 and maybe 90.

Then I thought about some of the older than me people I have seen in clinic in the last week, some will probably reached the end of their telomeres by 65 let alone 70.

But how does Treasury’s theory account for those more weathered by the morbidity of aging?

I fear that in years to come I will be filling in even more TDRs to support disability pension claims for those whose health failure predates 70.

Just another symptoms of a society arbitrarily demarcated by chronology and gender rather more selective criteria. Like start school at 5, driving at 17…….

I wonder what would happen if I were to suggest  that women should retire latter?

 

life chartlife expectancy

 

PS

You may have read in the same article the Joe Hockey quote that one in every three children born today will live to 100. I’m not sure where he gets his statistics from but from looking at ABS data it is closer t 1% rather than 33%

 

 

Triple 000 here, will that be paramedic or taxi?

This news items sounds like a victory for common sense.

Paramedics given power to send patients to GPs in NSW crackdown trial

People on the New South Wales central coast calling an ambulance for trivial matters such as tooth aches will be taken to their local doctor instead of hospital in a new trial.  The trial will give paramedics the power to decide whether a case warrants a hospital visit or a trip to a general practitioner (GP). The move has come out of recommendations from an Auditor-General’s report and is designed to relieve pressure on emergency departments.

Ambulance Service deputy commissioner Mike Willis says it will mean less time wasted on more trivial ailments.

“Sadly sometimes people call paramedics to their home for trivial things such as sore teeth, or in fact they’ve run out of their medication. That’s not what paramedics are for, that’s what taxis are for. This trial is designed to take those patients who are not life threatening and have low acuity illnesses direct to their GP where they can be assessed.”

http://www.abc.net.au/news/2014-03-09/paramedics-given-power-to-decide-destination/5308548

It seems to me that the trial is still going to have paramedic crews acting as taxis. Instead of taking someone to an ED they are being taken to a GP. Maybe the ambulance service could just hand out taxi vouchers which can just be used to attend a health practitioner? Be it doctor, dentist or pharmacist…… iridologist, nutritionist, chiropracter??

I do see a problem for the paramedic crew as to which GP the patient may be taken to. I’m certain AHPRA would take a very dim view of any GP-paramedic collusion.

There seems to be a difference in what is an ambulance from state to state. A 2010 paper by Eburn and Bendall (The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics. Australasian Journal of Paramedicine, 2010; 8(4)) gives some background on the situation. Another example of how the laws of each Australian state differ (for no good reason) and can create confusion!

A sense of entitlement?

Recently I has a conversation with a patient who had asked me to redo a Centrelink Certificate.  According to the copy he brought in he has chronic back pain and depression that prevent both gainful employment and him actively looking for work.  Horatio (not his real name) tells gets a sore back, sometimes feels a little sad and spends most days in a variety of non-productive pursuits.

I see in his record from a few years ago a psychiatrist letter that deferred making an Axis I diagnosis until he stopped multiple substance abuse. He tells me he has quietened down a little in the last few years.

He tells me he hs given up on beer because it gives him diarrhoea! He has substituted spirits. He was  bit vague on the actually quantity in standard drinks. So I asked how much would he spend on alcohol?

Depends he said on whether he goes to the pub or just visits a mate. Finally after much umming he settled on around $100 a week.  Then add in cost of the tobacco! He hints that it is criminal that the price has risen so much recently. At least he says he doesn’t have to pay for his cannabis as he grow his own.

That would be fine (well not really) if he was gainfully employed. Except he isn’t.

He thought that it was quite alright to use his Centrelink benefits to support his non-nutritional intake and lifestyle choice. I consider whether it would actually achieve anything to challenge his view or should I just copy the previous form and move onto the next patient…….