Sharing some resources on COVID 19 & Pregnancy

Some highlights

Most information suggests that if you get COVID19, unlike influenza, you are no more likely to get sick than if you weren’t pregnant. And unlike Zika or Rubella virus, the placenta protects your baby.

The importance of hand hygiene and how washing washing washing our hands and our children’s hands is the most important prevention we can take to stop spreading this virus.

The advice not to stop breastfeeding or wean your baby until this crisis is over. Breastfeeding can provide a level of immunity to your baby and is not known to pass on the virus.

The usual immunisation schedules will still be more important to keep everyone as healthy as possible during this crisis, do get your children and babies to their regular appointments.

Do not allow anyone who has not washed their hands to touch your baby!

Make sure the information you are using to make important decisions comes from a reliable source.

Information for Mothers

Raising Children Network

Health Direct

Queenland Health

Video from Associate Professor Rebecca Kimble, Clinical Advisor – Obstetrics and Gynaecology explains what you need to know if you or a family member is pregnant at this time of COVID-19.

Maternity flavoured blogs from Dr Wendy Burton at Maternity Maters and GP-Can

Photograph: Anthony Wallace/AFP via Getty Images


For Health care providers

Queensland Health

Perinatal care of suspected or confirmed COVID-19 pregnant women from Queensland Health. (26 March 2020)

Royal Australian & New Zealand Collage of Obesteriucs & Gynaecology 

Royal Collage of Obesterics & Gynaecology

American College Obstetrics and Gynecologists

CDC

National Perinatal Association

WHO

Cochrane gynaecology and fertility – includes a spreadsheet summary of published papers


Podcasts to listen to

Two podcasts about COVID in Pregnancy by Penny Wilson, MD and Heidi James.

https://www.emrap.org/episode/rop2020march19/rop2020march19

https://www.emrap.org/episode/rop2020april3rd/covidin

Covid-19: how does it affect pregnancy? Sarah Boseley speaks to Prof Sonja Rasmussen about how the virus might affect mothers who are expecting and their unborn child

Chris Stallman from MotherToBaby service regarding coronavirus exposure in pregnancy and while breastfeeding.

Good GP interviews obstetrician and gynaecologist Dr Robyn Aldridge on the impact of COVID-19 on pregnant women, pregnancy and the unborn child.

From Babytalk Alison McMillan the Chief Nursing and Midwifery Officer for the Commonwealth Department of Health and Adjunct Associate Professor Karleen Gribble from the School of Nursing and Midwifery, Western Sydney University.

2020 Baby – Caring for pregnancy women in the pandemic with Dr Pamela Douglas and Wendy Burton


Vertical transmission from mother to baby prior to birth

An early review of 31 cases and a smaller study of 9 cases reported in the Lancet found no vertical transmission found which is reassuring. But then a report of possible vertical transmission of COVID19 from mother to baby in utero. This was based on a baby having positive IgM which is not thought to cross the placenta. However PCR testing for the virus was negative. The accompanying editorial.

 

Articles

https://www.sciencedirect.com/science/article/pii/S2589933320300379?via%3Dihub&fbclid=IwAR2bcXf9TPnstjeg4UQSE2uQxlsJTE9gKxmbqr1bTHHSDRKY2-HbEp21d-8

Conclusion: In mothers infected with coronavirus infections, including COVID-19, >90% of whom also had pneumonia, PTB is the most common adverse pregnancy outcome. Miscarriage, preeclampsia, cesarean, and perinatal death (7-11%) were also more common than in the general population. There have been no published cases of clinical evidence of vertical transmission. Evidence is accumulating rapidly, so these data may need to be updated soon. The findings from this study can guide and enhance prenatal counseling of women with COVID-19 infection occurring during pregnancy.

https://www.journalofinfection.com/article/S0163-4453(20)30109-2/pdf

Early report of the effects of COVID 19 on pregnant women

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092922/

A narrative review

https://www.ncbi.nlm.nih.gov/pubmed/32217113

Commentary from AOCG

 

If you want to do you own medical literature search

Pubmed search

CSA/Getty Images


Non medical commentary

The COVID-19 pandemic could have huge knock-on effects on women’s health, says the UN – World Economic Forum April2 2020

Pregnant in a time of coronavirus – the changing risks and what you need to know – The Conversation March 28 2020

“The babies keep coming”: What the coronavirus pandemic means for people giving birth – Vox March 25 2020

COVID-19 Is No Reason to Abandon Pregnant People – Scientific American March 26 2020

 

More Covid-19/SARS2 CoV Resourses

Stuff I have been watching and learning from with science without hype. I won’t weight down with quantity, my previous post has more details.

From Australia

Coronacast from Dr Norman Swan and Tegan Taylor

Ian M. Mackay, a working Scientist and an adjunct Associate Professor (University of Queensland) has a PhD in virology, his blog is virologydownunder

Dr Wendy Burton has a blog call GPs-Can

From the USA

Em-RAP

With Dr Mel Herbert, Jess Mason amongst others

Video and audio files to take in with an evolving text at here.

MedCram

Great science and drawing boards with Dr. Roger Seheult

From the UK

The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare.

I reckon that will do for now so I will leave you with the message about social distancing.covid social distance

PS always remember to wash your hands.

Nothing from politicians here as they just get me angry.

How to wash your hands!

One of the early medical student days, hidden by the mists of time, I was taught by an Infection Control nurse how to wash my hands. Of course I “knew” how to wash my hands. My Mum had been making me doing it since I learnt how to wipe my bottom. In fact, I had a reasonably good idea from the years of preparing total parenteral nutrition and cytotoxic infusions in hospital pharmacy but that’s a different story.

Back to the mist, as a test we had to wash as normal, and then plate out the hand on an agar filled petri dish. It was shocking to see what grew!

Remember that virus are far too small to be seen and won’t grow as visible colonies amongst the bacteria and moulds on the on agar plate.

Imagine shaking that hand. So maybe a simple social hand wash is not enough to prevent spread of infection.  With the imminent pandemic of coronavirus, everyone is telling you to wash your hands, but do you know how and what to use?

This helpful guide from the World Health Organisation describes the essence of a good hand wash. 

handwashing

In most cases soap and water is preferable, but if there is none, the alcohol hand rub that contains at least 60% alcohol, is a suitable alternative, especially if it increases the likelihood that something will be done. 

Although, soap and water is better at removing Clostridium spores and non-enveloped viruses such as Norovirus and Rhinovirus. However, 60% alcohol does is effective against enveloped virus like Coronavirus.

Just remember, not to mix your alcohol gel with water!

Now when do you wash your hands? These times seem pretty sensible to me.

Before and after examining a patient makes sens for me as a doctor. But this list also seems pretty sensible.

  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone at home who is sick
  • Before and after treating a cut or wound
  • After using the toilet (especially if the world runs out of toilet paper)
  • After changing a nappy and cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing, especially if you sneeze or cough into your hand. This about using the cubital fossa (doctor speak for the inside of your elbow)
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage

and maybe even

  • Before or after shaking someone’s hand

hand shake

This article from The Conversation explains why I’m not being rude by not shaking your hand, just protecting you and me from possible infection.

 

2019 Coronavirus – looking beyond the headlines

I have been frustrated by the media’s propensity to exaggerate, stretch the truth, add hype and mislead and scare the public. For examples, the headlines in the Weekend Australian (1/2/20) states “Virus Deadlier than it Looks”.  So where to find information without the hysteria?

By way of introduction, human coronaviruses have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people, a little like rhinovirus. However, 2 pathogenic coronavirus have emerged from animal reservoirs  to cause global concerns. You may recall from 2002 severe acute respiratory syndrome coronavirus (SARS-CoV) and and in 2014, Middle East respiratory syndrome coronavirus (MERS-CoV)In December 2019, another pathogenic coronavirus, now known as 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, Hubei province, China, and has caused serious illness and deaths. This outbreak evolving.

Coronaviruses are large, enveloped, positive strand RNA viruses Four human coronavirus (HCoV 229E, NL63, OC43, and HKU1) are endemic and account for 10% to 30% of upper respiratory tract infections in adults. Coronaviruses are ecologically diverse and bats are suggested reservoirs for many of these viruses. Rumours that snakes were involved seem to be unfounded. Other mammals may be intermediate hosts, facilitating recombination and mutation events with expansion of genetic diversity. The surface spike (S) glycoprotein is critical for binding of host cell receptors and is believed to represent a key determinant of host range restriction. This maybe the focus of a vaccination, although none are currently available.

https://www.nature.com/articles/d41586-020-00262-7

Symptoms resulting from 2019-nCoV infection at the prodromal phase, including fever, dry cough, and malaise, are nonspecific. It could be a wide range of viral or bacterial illnesses. A number of people go on to develop respiratory symptoms (cough and shortness of breath) which is some are severe and potentially life threatening without respiratory support, ie ICU. Fatality rates are thought to be lower than SARS CoV  and MERS CoV infection and influenza. Testing can be done if you are symptomatic or a close contact and involves sampling nasal (not comfortable), pharyngeal secretions and sputum (not saliva). A blood test may also be done. Testing see if you are safe to return to school or work is not recommended unless the criteria in the links above and below are satisfied. Just because your boss or school principal tells you need to be tested doesn’t make it so. I wont copy out the case definition criteria here as they may well change.

Here is what you can do to reduce your risk of not just 2019-nCoV, but also other viral and bacterial infections. Just remember that is you have any fresh cuts or your hand, the alcohol gel will sting!

Remember if you think you need medical attention, please call ahead to your GP or ED, don’t just turn up to potentially infect a waiting room of people, clinic staff and your health practitioner.  I say this, as a number of communications encourage people to see their GP immediately.

Here is a list of my sources for reputable information without the media hype.

Australian Health Department website and News feed.

This also contains the address of state based health departments which may have relevant information for the state you live in. I’m not going to say which one has the best or right information, but I do know that Health departments which suggest you should immediately visit your GP are not my favourite. Maybe in time they will hand out PPE that I need for me to do my job safely.

If you are travelling overseas, the Smartraveller website offers sensible advise.

World Health Organisation website and Twitter feed

CDC USA website and Twitter feed

There is likely to duplication of information on these sites

If you to keep up to date with the number of published cases, this WHO map will help. I would suggest you scroll out as big pink blobs at first look scary. Here is another map with red dots.

For science rather than hype here are few links

Finally coronavirus has nothing to do with beer.

Would you rather….

Everyone wants a quick fix, so would you rather have a doctor examine you then prescribe appropriate antibiotics or just pop into the pharmacy and pick a box of whatever a potted history may suggest may be suitable for you?

Personally, I am much more comfortable with the financial disconnect between prescriber and dispenser, that is the current situation in Australia. And I say that having worked as both community retail pharmacist and as a general practitioner

script pad

Prescribing is influenced by the marketing of drug companies. This makes absolute logical sense as why would drug companies spend billions of dollars for the flash brochure, pens, personal visits and other inducements. In fact, it has been suggested that more money is spent on marketing drugs than actually gets spent on research and development. Any physician who suggests they are not influences is deluding themselves. That is why I don”t see drugs reps. When you add in the profit from the  direct sale of medications from the prescriber to the patient, the situation surely becomes even more conflicted.

This Swiss paper by Kaiser and Schmid published in Health Economic concludes that the above scenario leads to an increase drug cost of some 34%.

Park et al. showed that after the the introduction of a physician dispensing ban in 2000 in South Korea, there was a significant reduction in antibiotics prescribing. The economic incentive to both prescribe and dispense was removed.

Following the reclassification of chloramphenicol eye drops to be available over the counter, there have been significant increases in the supply in the UK. Surely, there hadn’t been a coincidental epidemic of conjunctivitis? As an aside, as highlighted by Dr Casey Parker from BroomeDoc, most children presenting with acute infective conjunctivitis will get better by themselves and do not need treatment with an antibiotic.

In Australia, codeine was rescheduled to prescription only in 2018 This has lead to a massive decline in codeine use in Australia. And more importantly, a drop in harm from over use of codeine as described in this paper by Cairns et al.

Dr Mark Taylor, eloquently argues for maintaining the status quo for oral contraceptive prescribing, that is, the disconnect between prescriber and dispenser to ensure women receive safe contraceptive advise. There may be savings, but who will pay the price of under-screening for sexual transmitted infection, cervical cancer, hypertension, early pregnancy, depression etc.

When the prescriber becomes the dispenser, where are the checks for errors. I have to put my hand up here and admit to making a prescribing error or two over the last 20 years. A call from an alert pharmacist has saved our patient from harm. It is well known that medication errors contribute to patient harm. The authors, showed that 2-4% of hospital admissions were medication related and deemed three quarters potentially avoidable. In both community and hospital practice pharmacists and physicians work better collaboratively, and need to improve that collaboration.

Of course, the biggest evidence for not increasing the scope of pharmacist practice is to wander up and down the shelves of homeopathic remedies, multivitamins and herbal concoctions all for sale with most having absolutely no evidence of benefit. Oh except to the proprietor’s profit margins. Webpages such as these make helpful, profit rising strategies to upsell products. I like this counterfactual from JAMA.

supplementsSo why then is the Australian Government listening to lobbying from the Pharmacy Guild to permit pharmacists to increase their scope to prescribing antibiotics for example. Of course, in the ideal world, the lobbyists would argue, that with proper training and accountability, a pharmacist would be suited to hand out antibiotics for infections. But as we all know, the ideal world doesn’t exist. Pharmacist are pushed by proprietors to upsell, delegate sales to less trained pharmacy assistants, GP pressed to fit a 20 minutes consultation into ten minutes. Politicians are elected on the platform of honesty and integrity end up handing out grants to sporting clubs in marginal seats to bolster elections outcomes. It is far from an ideal world.

Currently, I consult my patient in the privacy of a closed room. When I hark back to my pharmacy days it was in an open shop, across a counter of next to shelf full of shiny tablets and potions. Where would you like me ask some really personal questions?

It just seems logical and sensible to maintain the status quo!

SGLT2 inhibitors & euDKA risks…why?

AusDoc reports a bunch of people saying watch out for DKA in patients on SGLT2 inhibitors who may be having surgery or are unwell. You know those tongue twisters dapagliflozin, empagliflozin, ertugliflozin, etc. These drugs block sodium-glucose cotransporter 2 in the kidney to inhibit renal glucose reabsorption through an insulin-independent mechanism, which in turn lowers glucose levels through increased urinary glucose excretion. More details on the pharmacology can be found here. Thus SGLT2 inhibitors helps control diabetes type 2.

Now if you believe the pharmaceutical industry hype these drugs will prevent diabetic patient from having heart attacks and keep them off dialysis. For more useful information on this have a read of this post on BroomeDocs by Casey Parker.

These drugs have had their problems. After overcoming my fears of bladder cancer and concerns about increasing toe amputations and Fourniers gangrene, this new hazard may reduce my enthusiasm for these drugs.

So how does a drug which works to make you pee out sugar cause DKA? It would seems that this is a different type of DKA, and as none of the warning letters satisfied my curiosity for Why, I’d thought I’d hunt for a theory or two.

I am used to managing DKA in DMT1. You know, the teen who thinks that 24 beers on a Saturday night is cool and forgets to take his insulin for the next 2 days. Gets dumped in ED by his concerned mates, looking very sick (abdominal pain, shortness of breath, fatigue, nausea, and vomiting) with a glucose of 30 and pH of 6.9. Or, a young 5 year old whose parents have missed the gradual weight loss, drinking lots, peeing lots and then turns up with belly pain. This kind of DKA happens because there is no insulin to help metabolise sugar so the body switches over to fatty acid metabolism with ketoacids (eg., acetoacetate and β-hydroxybutyrate) being produced. The result is metabolic acidosis.

DKA caused by SGLT2 inhibitors is a little bit different. Glucose levels decrease with SGLT2 inhibition because you pee it out. Because glucose triggers the release of insulin, the drop in glucose levels results in less insulin production. This is good, and helps explain the drugs beneficial effect on weight unlike diabetes drugs which just make the pancreas work harder, like sulphonylureas. SGLT2 inhibitors also act independently on pancreatic alpha cells, further increase plasma glucagon levels and stimulate hepatic ketogenesis. It has also been speculated that they may decrease renal clearance of ketone bodies (making a urine dipstick for ketones less reliable), further increasing the concentration of ketones in the body. Thus a new acronym arises to describe euglycaemic or euDKA. This paper explains more of the science of this problem.

There is a also a case report of empagliflozin unmasking type 1 diabetes in someone who was originally thought to have type 2 diabetes. In such a person, positive GAD antibodies would change the diagnosis to LADA.

So, now I need to tell my patient who are on these drugs to come in for a checkup when they are sick and not eating or drinking well and to make sure their surgeon and anesthetist know what they are taking.

https://www.thinkingparticle.com/image/unripe-apple-banjar-valley

Finally for all you herbal fans, the first non selective SGLT inhibitor was extracted from unripe apples and the bark of apple trees way back in 1835. Unfortunately, it is broken down in the stomach and one if its metabolites causes severe diarrhoea making it not very useful to treat diabetes.

Shingle me this, shingle me that….no thank you!

Singles is caused by the same virus which caused chickenpox in children, varicella zoster virus. Once that illness is completed, the virus lays dormant in the nerve cells. When you get older or your immune system is compromised by illness or medication,  the virus reactivates and travels along nerve to cause the classic skin disease of shingles,

In last few weeks I have seen a number of patients with shingles were there has been a delay in diagnosis.

This may not surprising as the first signs of the illness may be headache, fever or fatigue. Sometimes it may be prickly, burning, throbbing, or stabbing sensation in a patch of skin anywhere on the body.

The first rash may look quite innocuous as in this photo below.

The classic description of the progression of shingles rash is from small red bumps (erythematous papules) to clear blisters (vesicles) to small pimples (pustules) which break open and crust over, usually over seven to ten days.

The rash often follows a specific pattern on the skin, and often stop in the midline. It follows the dermatomes for the right or left side of the body. If you want to learn more about dermatomes watch this video.

Shingles can be very painful, it may threaten sight and other senses depending on the affected nerves.

https://bpac.org.nz/BPJ/2014/March/herpes.aspx

Anyone who has shingles will tell you how uncomfortable it is. Actually, uncomfortable may be an understatement. The bad new is that the pain may persist even when the rash has healed. This is known as post herpetic neuralgia which may perists for several months, and require medication to keep under control. Other complications of shingles include pneumonia, a stroke or brain infection called encephalitis which may be fatal. Some people go on to have recurrent shingles.

Antiviral drugs may help hasten the recovery from shingles, but need to be started early in the course of the illness to be effective, ideally within the first 72 hours of the onset of the rash.

A vaccination (Zostervax) is available which costs about $180 but is subsided by for those between 70 and 79 years. It is recommended for anyone over 60. Vaccination reduced the herpes zoster by 51%, post herpetic neuralgia by 66% and reduces the severity of the pain.

Zostevax is a live vaccination and should not be used if you are immunocompromised. To do so risks a potentially fatal disseminated zoster infection. A potentially safer inactive, recombinant vaccine called Shingrex maybe marketed in Australia in the next few years.

The fluid that leaks from the vesicles does contain the virus, so it may cause infection in those who have no immunity to shingles, that is those who haven’t had chickenpox as a child or been vaccination. Pregnant women, newborns babies and immunocompromised people are particularly at risk. Until the rash has crusted over, it is considered infectious. Keeping the rash covered and washing hands helps reduce the spread of the virus.

If you think you have shingles, see your doctor as soon as possible. You can find out more information about shingles here.

 

 

Warning: This website and the information it contains is not intended as a substitute for professional consultation with a qualified practitioner.

It may not come as a surprise but as a doctors I use Google quite a bit. There are of course other alternative search engines; “Just Google it” has been adopted into our lexicon, whilst “DuckDuckGo it”  or “Dogpile it” doesn’t have the same ring, although some would argue they are better. But getting back to the topic.

During a consultation, I may turn to my computer and search Google for a picture to illustrate a point, for example, I think you have measles – see here is a picture of the rash in question. My consulting room is set up so we can both see the computer screen. That makes it hard to surreptitiously do a quick search as you talk. Don’t ask what happens when the computer isn’t working! My doodles are not art, but I do have books!

When it comes to making a diagnosis, I haven’t yet had to enter “headache, fever, rash and cold hands”, well at least not in front of a patient. By the way if you do, you get a screen full of sites suggesting you have meningitis. In fact you get 10 million results. There is a lot of information out there in the Internet. When I was a younger my Mum would probably resort to her nursing text book to work out what was ailing us kids. Life was so much simpler there – books, libraries…

Obviously there will be a lot of duplication of information on the Internet. Some information will be country specific. For example, an American website may suggest taking two acetaminophen for a headache, which translated into Australian is take two paracetamol.  Of course, there is nothing wrong at looking at health resources based in other countries. But remember, different countries have different disease prevalence. If you plus headache, fever and rash into a health site based in the Congo you may diagnose yourself with Ebola or Malaria.

The challenge is quickly access reliable and easy to understand medical information that doesn’t lead to a site trying to sell you something, or one that makes unproven claims or is just plain wrong.

If you have seen this image at the bottom of a website, usually right down the bottom, with lots of other small print, it may provide you with some degree of veracity. Health on the Net certification offers a compliance certificate for websites that goes a way to reassure the reliability of the website.

Logo certificat HONCode

 

Here are my suggestions for reputable health care information

For general health

Health Direct is a government-funded service, providing quality, approved health information and advice. It has links to many other resources. It also has a Symptom Checker Tool (not a real doctor) which when I put it to the test with my headache, fever and rash, did advise I call an ambulance, use a cold compress and lie down quietly. Thankfully, it didn’t tell me I was going to die from meningitis so I didn’t have to panic. Each State Health Department has its own website offering health advise.

The Department Of Health has a webpage which links to a wide variety of health concerns for consumers.

For children’s health problem, here a couple of that are useful, Children’s Health Queensland Hospital and Health Service and The Royal Children’s Hospital Melbourne

I think the Royal Women’s Hospital Melbourne has a good website for pregnancy and women’s health questions. Jean Hailles is another good site for women’s health.

For parents try the The Australian Parenting Website

For skin problems, I think Dermnet a great website from New Zealand is very comprehensive.

The Cancer Council which has been around since 1961 providing education and support.

For Men’s health problems, Healthy Male is a good starting point.

For contraception advise, each state has its own Family Planning organisation. In Queensland this is named True. Marie Stopes is also a useful source of information.

Now I could go through each body part and nominate a site to access. For example,

Hearts at The Heart Foundation

Lungs at the Lung Foundation Australia

Bowel and liver at Gastrointestinal Society of Australia

Kidneys at Kidney Health Australia 

Allergies at Australasian Society of Clinical Immunology and Allergy

Eyes at Vision Initiative

Brains at The Brain Foundation and if it isn’t working well Dementia Australia

Pancreas (okay diabetes) at Diabetes Australia

For infectious diseases, I like to head to the US to look at the Centre for Disease Control website

For information on Mental health problems there are a number of websites. Beyond Blue, Black Dog Institute, Sane, and Headspace, just name a few. Head to Head is a Government website that tries to help people through the information overload.

For the health and computer literate, to search medical information on a specific problem, Google Scholar in conjunction with US National Library of Medicine Pubmed, are useful to find journal articles that may be useful.

If you want to test the information found in your search result, you can always see if it has been mentioned in Quack Watch!

Now I haven’t mentioned searching for answering using Web 2.0, where you throw your question or rash photo out to the crowd, hoping that someone will come up with a sensible answer. OMG that’s absolutely syphilis, may not be what you want to hear about the red spot on your hand! I use Web 2.0 a bit when I’m stuck and it has been quite useful. I am connected to doctors through Facebook and Twitter around Australia and the world.

So for your next consultation, come along better prepared, use Google by all means for I may learn something too.

 

What is Vaccine Hesitancy?

Parents care about their children. I care for mine. That is why my children are immunised.

With immunisation uptake in Northern Queensland for 1-5 year old between 92 and 95%, I don’t often meet parents who decline to immunise their children.

In our modern society we are mostly detached from life threatening complications of common vaccine preventable illnesses. It was our great-grandparents generation who were more used to seeing small children dying from diphtheria, tetanus, or measles. Most Australian have no fear of smallpox or polio because we don’t see these illnesses anymore in our community. This edition of Ockham’s Razor talked about the early attempts to control infectious disease in Australia.

Only a small percentage of parents out rightly declined to vaccinate their children. Others have heard the charismatic social media gurus, fear adverse effects, mistrust the motives of government and the influence of pharmaceutical companies.

There are who those who don’t wish to engage in a discussion, and those who are hesitant about making a commitment to immunise. I would like to think as a GP, I have time to explore concerns and provide information that may provide reassurance.

I have put together this post to enable a more informed discussion and open the door to immunisation.

Here is a link to three video resources which I have found helpful.

 

 

The Australian Academy of Science produced this document in 2016 to help to improve community understanding of the principles of immunisations. This addresses the science, safety and efficacy of immunisations.

“Immunisation Myths and Realities” is another useful resource. It helps to address certain questions raised by those who are opposed to immunisations.

Questions answered include

  • Vaccines are unsafe
  • Vaccines are not adequately tested
  • Vaccines contain foreign proteins
  • Vaccines are contaminated with foreign viruses
  • Vaccines contain toxic additives

Another Australian resource on vaccine safety is Are vaccines safe?

Many studies have been completed which investigated the link measles, mumps and rubella vaccination and thiomersal to autism. The good thing about these studies is that the data show no relationship between vaccines and autism. The Autism Science Foundation has an extensive list of resources.

I hope this takes away the hesitancy.

 

 

 

Mandatory Reporting Deters Health Practitioners Seeking Mental Health Help

This is a copy of letter I have sent to support removing mandatory reporting from Queensland Health Practitioner legislation.

Mr Aaron Harper MP
Chair, Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee

I believe that the proposed Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 still fails to meet the stated purpose of ensuring that health practitioners have confidence to seek treatment. Rather than clarifying the matter, the ill defined “substantial risk of harm” potential creates more confusion. Who defines this, and if I were to define it as not “substantial” who is to say a lawyer or politician may define it otherwise. This lack of clarity continues to be a barrier to Health practitioners seeking effective treatment. This lack of clarity may cause more harm as earlier interventions may be deferred out of fear of reporting.

I believe that Western Australian model should be sufficient for all of Australia. That is, voluntary reports based on their professional and ethical obligations to report matters that may place the public at risk of harm.

There should be no distinction between the treatment of a registered health practitioner and that of a patient from any other occupation. Just like all other people in Australia, any health practitioner who becomes a patient should be entitled to discuss their health with their doctor in a strictly confidential environment.

A report to AHPRA can lead to a lengthy and stressful wait even if finds no case needs to be answered. Whilst awaiting the result of an investigation and determination, the burden of stress only increases on the health practitioner.

Ultimately, the suicide of a untreated health practitioner fearful of a mandatory report, who does not seek help becomes a tragedy for the person, the community, colleagues and the practitioner’s family. This is a real problem in Australia with both young and old doctors taking their lives because of mental health problems. As you maybe aware you cannot always tell a person is struggling or considering suicide by just looking at them. They have to feel that they are in a safe and confidential position to ask for help. This applies to the butcher, baker or the neurosurgeon.
Health professional suicide is a world wide problem. Canada, UK, USA, South Africa …. As you may be aware between 2001 and 2012, 369 suicides by health professionals were recorded in Australia. Drs John Moutzouris, Chloe Abbott and Andrew Bryant are just three doctors who took their own life since that data was collected. Tragically there are more.

Beyond Blue in 2013 surveyed 12,000 doctors and one third were concerned about seeking treatment that may have an adverse effect on their registration and ability to continue to work in the field they were trained. Half suggested lack of confidentiality was a barrier to seeking help.

I again ask Mr Harper that Queensland adopt the Western Australian model to protect the health professionals who serve our community. I am not aware that this model has put the public at risk of harm in that state.


Let me share this link to Dr Pamela Wible’s Ted Talk on doctor suicide in the US



The photo above is a new Dad hugging the doctor who delivered his baby.

But I think it shows how much we are all human and we all need the freedom to have a hug and not get reported if we are not OK. 

If you are in an emergency, or at immediate risk of harm to yourself or others, please contact emergency services on 000, or Lifeline Australia 13 11 14.