Australian Family Physician December 2006 - Workplace injury
Vol 35, (12) 929 - 1024
The theme for the December issue of AFP is
workplace injury. This month's articles include work related upper
limb disorders, occupational wellbeing, back injuries, innovative
insulins, and micronodular basal cell carcinomas. Also included is the
AFP index for 2006.
A right to be safe
Steve Trumble
2006 has been an extraordinary year for highly publicised deaths in the workplace. And what dangerous workplaces - the driver's seat of the racing car that claimed Peter Brock, the waters off Port Douglas where Steve Irwin was killed, or even the depths of the Beaconsfield coal mine where Larry Knight died while two colleagues so famously survived.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners
AFP reviewers 2006
All articles submitted to Australian Family Physician are sent for blind peer review. Reviewers provide a critical commentary on the scientific quality of the material and its interest and relevance to general practice. This task is undertaken without reward by a large number of people in order to enhance the quality and scientific credibility of published articles. Without the participation of these reviewers, AFP would not be able to provide quality material to its readership.
Work related encounters
Janice Charles, Ying Pan,
Helena Britt
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which work related problems were managed. This synopsis provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
Back injuries - Getting injured workers back to work
John Low, Roger Lai, Peter Connaughton
Back problems are the seventh most common reason for seeking care in general practice in Australia. Despite medical
advances, chronic disability from back pain is a major contributor to the burden of disease in society today.
Work related upper limb disorders
E Michael Shanahan, Peter Jezukaitis
Work related upper limb disorders (WRULDs) are among the most common workers' compensation claims. Their management is a challenge for medical practitioners for a range of reasons.
Getting the at risk patient back to work - A strategy
Bernadette Trifiletti
Achieving best outcomes in occupational injury management requires an emphasis upon identifying and managing
those factors which - in addition to the medical condition - lead to progression to chronicity. The most studied common musculoskeletal workplace injury is low back pain.
Occupational wellbeing - Management of injured workers with psychosocial barriers
Peter Cotton
Although most injured workers return to work with minimal intervention, approximately 20% show levels of distress
and disability beyond that expected for the injury. The level of morale in a workplace seems to play a major role in this. Workers who experience positive emotions leading to increased morale are more likely to be resilient following injury.
Work related stress and pain - The role of complementary therapies
Gillian Singleton, Vicki Kotsirilos
Recent workers' compensation statistics demonstrate a reduced incidence of most categories of work related
injuries between 1996-1997 and 2002-2003. However,
mental health disorders have increased by 32%, of
which 'mental stress' is the most prevalent workers
compensation claim.
Micronodular basal cell carcinomas
Anthony Dixon
Case study: Mr AB developed a firm rough surface on his medial left cheek. With increasing size his doctor organised a biopsy at the site. Histology showed micronodular basal cell carcinoma (BCC). Tumour was excised with a margin of apparently normal skin. Histology showed tumour at all margins.
Innovative insulins - Where do analogues fit?
Liza K Phillips, Patrick J Phillips
Problems with traditional bolus insulins include delayed time to onset and offset, and with basal insulins, an overnight
peak and poor reproducibility. Analogue insulins have been formulated to better emulate physiologic insulin secretion
and improve glycaemic control without increasing hypoglycaemia.
Insulin and type 2 diabetes - A simple guide to prevent ‘stuff ups’
Patrick J Phillips
Starting insulin in type 2 diabetes should follow the
KISS principle (Keep It Safe and Simple) but too often
the 'stuff ups' sneak in. This article discusses the 10
common ways to stuff up insulin therapy and how to
avoid them.
Clinical challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
A fraudulent certificate
Sara Bird
Case histories are based on actual medical negligence claims or medicolegal referrals, however certain facts have
been omitted or changed by the author to ensure the anonymity of the parties involved. General practitioners frequently
receive requests from patients for sickness certificates and, on occasion, are placed under pressure by a patient to
provide the certificate that has been requested. At the same time, certificates certifying illness are a common source of
complaints against GPs. This article provides some guidance for GPs about writing certificates certifying illness.
Integrating intuition and reasoning - How Balint groups can help medical decision making
Albert Lichtenstein, Marion Lustig
Given the need to multitask and make rapid decisions, optimal medical practice requires a doctor to use intuitive, automatic cognitive processes. It is also imperative that a doctor knows when to override intuition and routine with deliberate reasoning. Knowing when to do this requires skills in self awareness, introspection, and empathy.
Navigating through the swampy lowlands - Dealing with the patient when the diagnosis is unclear
Louise Stone
Case study: Jenny, 56 years of age, is well known to your practice. Your registrar asks for advice regarding her management. Together you summarise her history:
noninsulin dependant diabetes, irritable bowel syndrome, chronic headache, and
a background of social and emotional issues.
Book reviews
Avni Sali, David Spain
Books reviewed this month are Holism and Complementary Medicine Origins and Principles by Vincent Di Stefano and Guide to Arthrocentesis and Soft Tissue Injection by Bruce Carl Anderson.
Practising GPs teaching medical students evidence based medicine - A questionnaire survey
Marjan Kljakovic
The characteristics of practising general practitioners who teach evidence based medicine (EBM) during their clinical
work - and their attitudes toward it - are poorly known.
General practice research and research skill needs - Attitudes of GP supervisors
Jan Gartlan, Nicholas Cooling, Mark Nelson
General practice research is an important learning area in general practice registrar training. General practitioner
supervisors have a central role in registrar training. Registrar training in Tasmania has the added component of a
research project. Little is known about supervisors' research attitudes, confidence to support registrar research
projects, and research skill needs.
Clinical teaching and clinical teacher training - GPs’ attitudes and involvement
Eugen Molodysky, Jeremy Bunker, Claudia Lee, Natasha Sekelja
There are no data on the attitudes to, or involvement
in, clinical teaching or clinical teacher training among
Australian general practitioners, and little from
overseas. General practitioner undergraduate teaching
sessions decreased 5% over 1 year, suggesting possible
problems in recruiting and retaining GPs as clinical
teachers. Accordingly we designed a pilot study to
study this and to inform the further development and
enhancement of clinical teacher training programs.
Attitudes of GPs to medical management in a falls clinic service
Christopher Beer
Intervention programs that target falls risk factors can be effective. Falls clinics that use detailed multidisciplinary
assessment are relatively new in Australia and it is not known how they are perceived by general practitioners.
Are Australian medical students missing out on psychological skills?
David Antone Monash, Jeffery Richards, Grant Blashki, Graham Meadows
Common mental illnesses such as depression and anxiety can often be treated with evidence based psychological
interventions. Existing research indicates that Australian medical courses are poorly preparing their graduates for this role.
Index to volume 35, 2006
Author and subject index to volume 35, 2006.
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