Australian Family Physician January 2004 - Faces of general practice
Vol 33, No. 1/2 (1-96)
The theme for the January/February issue of AFP
is faces of general practice. Articles include General Refugee care
in general practice, indigenous health service, eating disorders in
adolescence, obesity in children, and guidelines for the psychosocial
care of adults with cancer.
Unity through diversity
Steve Trumble
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editor or The Royal Australian College of General Practitioners.
A queer practice
Darren Russell
Working in an inner-city, 'queer' general practice throws up its fair share of challenges. Dealing with
patients composed mainly of gay men, with sundry others including lesbians, heterosexual female sex workers, male sex workers, methadone patients (of all
sexual persuasions), and transgender individuals, means we see the human species in all its wonderful
diversity. We even see 'normal' straight blokes, although they are often of the 'metrosexual' variety.
Most days though, I feel like I'm on the set of 'Queer Eye for the Straight Guy' (if you don't know what this
is, ask your teenage daughter - she's bound to know all about it! Gay is currently very cool).
Indigenous health in my own community
Mark Wenitong
As an aboriginal doctor working as the SMO at a fairly large urban Aboriginal and Torres Strait Islander Health Service life can be pretty hectic. Picture a waiting room and outside area filled with indigenous patients waiting for consults as another minibus provided
by our health service arrives and drops off more. There are almost no brief consultations at this service and many patients have significant comorbidities and need ongoing education and support.
Rural practice in Victoria - A personal experience
Michael Lowery
Rural practice has its limitations, but to emphasise them runs the risk of doing less than justice to the many benefits of being a doctor in an solated Victorian town. I am a solo practitioner in Sea Lake, a town of
700 people, situated midway between Bendigo and Mildura in Victoria, and, as the locals express it, almost
equidistant from Melbourne and Adelaide.
Flying by the seat of my pants!
Jennifer Jackson
Avast land reels below the Gibb River road, Windjana Gorge, Leopold Ranges, Mt Ord, Adcock Range, Glenroy homestead and further to the south, the Sir John Gorge's great 'S' bend. Now the Hahn River is meeting the Little Fitzroy River on its way to the mighty flowing Fitzroy River. I am in a chartered plane on my way to Yulmbu aboriginal community at Tablelands station, 450 km east of Derby in Western Australia. It is August.
Outer suburban practice
Graham Jacobs
The low down on Melton
Located on the outer western fringe of Melbourne, Victoria, the Shire of Melton is a thriving outer metropolitan
municipality of over 53 000 residents and is an ideal location for a family general practice. The population growth is one of the highest in Victoria with 100 000 inhabitants expected to reside in 'thoroughbred country' by the year 2011, a quarter of these being children
under the age of 17 years. Melton offers its residents a unique urban/rural lifestyle with nearby pristine national parks and forests and Australia's cultural capital less than 30 minutes away by car. Young families in particular find Melton an attractive option with affordable housing, many schools and excellent recreational facilities.
A day in the life of an academic GP
Nicholas Zwar
The work of an academic general practitioner encompasses a range of roles and activities and given the
diversity there always seems to be more to do. Each day (or at least most days) on the drive to southwest Sydney, I eschew the chatter of breakfast radio
announcers to think about the issues and tasks for the day ahead. Despite this attempt at prioritisation and
time management on most occasions having dealt with the most pressing or important of the flurry of email
correspondence and spent some time interacting with staff and patients, at least half the list of tasks remains
at 6 pm. The decision then, is how much later to stay.
Where did I go right? - A career as a rural doctor, wife and mother
Ruth Stewart
I have tried to work out when I first thought, 'I want to be a doctor'. I certainly know that I was young. It
may have been the time I was playing doctors and nurses with the boy from across the road! But surely my career ambition can't stem from the pure rage I felt when he told me that girls can't be doctors. Can it?
Helping refugees integrate into our community - Reflections from general practice
Jill Benson
'All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of Brotherhood'.
Article One of the Universal Declaration of Human Rights
Complementary medicine - making it work
Vicki Kotsirilos
I must admit that I absolutely love general practice and do sympathise with the many general practitioners who are currently feeling dissatisfied with their work. As a woman GP with two young children aged 4 and 9 years, it is of utmost importance to me to have the balance right. Self care is the number one priority for me. I eat well, practise regular meditation, yoga and
walk almost daily along the beach. This way I am being a good role model for my patients and practising what I preach.
Eating disorders in adolescence - An approach to diagnosis and management
Regina Cooke, Susan M Sawyer
Eating disorders in adolescence are complex problems that may result in significant morbidity. The majority of eating disorders begin in adolescence, a time of critical importance for growth, pubertal development, cquisition of peak bone mass and psychosocial development.
Obesity in children - Tackling a growing problem
John McLennan
Childhood and adolescent obesity has
increased dramatically over the past 25
years in Australia. Currently over 20%
of Australian children are overweight or
obese. The National Health and Medical
Research Council has recently developed
the 'Clinical practice guidelines for the management of overweight and obesity
in children and adolescents'.
The summer skin check
Belinda Welsh
Skin cancer is a major public health
problem in Australia and represents a
substantial health cost. General
practitioners provide the majority of care to patients with skin cancer, so becoming familiar with the clinical features and management of these tumours is important.
Nipple pain in breastfeeding
Lisa Amir
Case history - Sandra B, a 27 year old woman, presents with a 4 day history of intense nipple pain associated with breastfeeding her 15 month old son. In the early months of breastfeeding she had experienced burning nipple pain, which had been diagnosed as a candidal infection, and had resolved with oral nystatin capsules and miconazole oral
gel on the nipples and in the baby's mouth.
Chasing tests
Patrick Phillips
Case histroy - 'I am still tired all the time, I've got no energy, I can't lose weight and people are saying I'm losing my memory. Perhaps my thyroid is under active'.
Home Medicines Review - The how and why for GPs
Graham Emblen, Emmett Miller
Patients' safe and effective use of
medicines could be far lower than many
doctors would like to believe. The Home
Medicines Review (HMR) program was
introduced into the Australian Medicare
Benefits Schedule in 2001 to increase the appropriate use of medicines and reduce the incidence of adverse events. To date, the uptake of this program has been slow.
Improved reading vision - Eye series 12
Chris Hodge, David Ng
Case history - A 69 year old woman presents to your practice for a general health check. As an aside she mentions that over the past few months her reading vision has improved so much that for most activities she does not require her reading glasses. She does not feel her distance vision has
deteriorated, however, she does mention
that she has given up night driving
because of the excessive glare opposing
headlights cause.
Clinical challenge
Steve Trumble
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.
Action research as a learning tool in general practice
Angela Chien, Shane Fennessy
This article is presented to illustrate the power of an effective learning partnership between registrar and supervisor. It is also intended to encourage other registrars to ask questions and publish their results.
Steve Trumble, Editor in Chief
Brain teaser: Droopy eyelids and double vision
Jerzy K Pawlak
Case history - A 48 year old woman
presents with a history of
intermittently droopy eyelids
and double vision. These symptoms are absent when she wakes up in the
morning and seem to fluctuate during the day. She is otherwise well.
Clinical practice guidelines for the psychosocial care of adults with cancer - Welcome support for GPs
Jane Turner, Brian McAvoy, Karen Luxford, Jane Fletcher
The 'Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer' was launched by the
Federal Minister of Health on 14th August 2003. Developed by the National Breast Cancer Centre and the National Cancer Control Initiative and approved by the National Health and Medical Research Council in April 2003, these guidelines are the first of their kind for health professionals who treat, or are involved with cancer patients at all stages of care from diagnosis, through to treatment and palliation.
How to write a medicolegal report
Sara Bird
Case histories are based on actual medical negligence claims, however, certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved.
General practitioners are frequently asked to prepare reports for a variety of medicolegal purposes including
court proceedings, worker's compensation and insurance reports. The aim of this article is to provide GPs with some practical advice on how to write a medicolegal report and the common pitfalls to avoid.
Medicare - a systems failure
Joachim Sturmberg
Medicare was implemented to guarantee
every Australian access to health care. Set up as an insurance fund, it guaranteed patients a minimum refund for a service; the decision for this refund to be accepted as full payment though was a political one.
Nondirected living kidney donation - Is Australia ready?
John Hambridge, Marina Vamos
The Renal Transplant Advisory Committee has recently approved nondirected kidney donation. If ratified at state level, it will allow volunteers to anonymously donate a kidney to any patient on the transplant waiting list. General practitioners, as well as more specialised services, may be approached by patients wishing to make such donations.
Postcards: The blood is strong
Ronald McCoy
Taking personal responsibility for our health - Nectar or a poisoned chalice?
Craig Hassed
In the process of being interviewed for an article recently, I was challenged by two rather significant questions. They come up most often in the context of cancer - although they have a far more universal importance. The discussion leading up to the questions related to the issue about to what extent coping, psychological wellbeing and lifestyle are important for cancer genesis and progression. But a problem arises in that if we are to accept that
we have some power to positively influence the pathogenesis and progression of disease then cannot this personal responsibility also become a source of personal blame?
Bush telegraph - Improving outcomes for rural and remote patients with chronic heart failure
Henry Krum, Andrew Tonkin, Leon Piterman
Chronic heart failure (CHF) is a cardiovascular disease of major public health importance. In the Cardiac Awareness Survey and Evaluation (CASE) Study, 13.2% of Australians over the age of 60 years attending their general practitioner were diagnosed as having heart failure.
Book reviews
Children with Disabilities (5th edn)
Hospital in the Home - Principles and practice
Asthma At Your Fingertips - All your questions answered about living with asthma
Talking to patients about death and dying
Teresa A Burgess, Mary Brooksbank, Justin J Beilby
Talking about death and dying, either
with patients terminally ill or well,
presents challenges for the general
practitioner. There are few Australian
educational resources and little
Australian research into this area.
Opportunistic electronic reminders - improving performance of preventive care in general practice
Oliver Frank, John Litt, Justin Beilby
Preventive care is an important role for general practitioners, yet opportunities for prevention are often missed.
Acute bronchitis in Australian general practice - a prescription too far?
Nigel P Stocks, Heather McElroy, Geoffrey P Sayer, Katherine Duszynski
To quantify how frequently general
practitioners in Australia prescribe
antibiotics for acute bronchitis, which
antibiotics are used, and whether there
are subgroups of patients who might
benefit from their use.
Smoking cessation and nicotine replacement therapy in current primary maternity care
Susan Pullon, Melanie Webster, Deborah McLeod, Cheryl Benn, Sonya Morgan
To determine attitudes, activity and
confidence among general practitioners and midwives about smoking cessation practice, and use of nicotine replacement therapy (NRT) during pregnancy and breastfeeding.