Ironically, it seems the health products with the least evidence are coming with the greatest assurances. A few years ago, a package holiday company advertised guaranteed sunny holidays in Queensland (Australia). The deal went something like this: if it rained on a certain percentage of your holiday days, you received a trip refund. An attractive drawcard indeed, but what the company failed to grasp was that the “Sunshine State” is very often anything but sunny. This is especially so where I live, on the somewhat ironically named Sunshine Coast. We had 200 rainy days last year and well over 2 metres of rain, and that was before big floods in January. Unsurprisingly, the guaranteed sunny holiday offer was short-lived. There are some things that really shouldn’t come with guarantees. The weather is one, health is another. Or so I thought… “Those capsules you started me on last month for my nerve pain didn’t work. I tried them for a couple of weeks, but they didn’t do nothin'.” “Perhaps you’d do better on a higher dose.” “Nah, they made me feel kinda dizzy. I’d prefer to get my money back on these ones an’ try somethin’ different.” “I can try you on something else, but there are no refunds available on the ones you’ve already used, I’m afraid.” “But they cost me over 80 dollars!” “Yes, I explained at the time that they are not subsidised by the government.” “But they didn’t work! If I bought a toaster that didn’t work, I’d take it back and get me money back, no problem.” “Medications are not appliances. They don’t work every time, but that doesn’t mean they’re faulty.” “But what about natural products? I order herbs for me prostate and me heart every month and they come with a 100% satisfaction guarantee. You doctors say those things don’t really work so how come the sellers are willing to put their money where their mouths are?” He decided to try a “natural” treatment next, confident of its likely effectiveness thanks to the satisfaction guarantee offered. Last week I had a 38-year-old female requesting a medical certificate stating that her back pain was no better. The reason? She planned to take it to her physiotherapist and request a refund because the treatment hadn’t helped. Like the afflicted patient above, she didn’t accept that health-related products and services weren’t “cure guaranteed”. “My thigh sculptor machine promised visible results in 60 days or my money back. Why aren’t physios held accountable too?” Upon a quick Google search, I found that many “natural health” companies offer money-back guarantees, as do companies peddling skin products and gimmicky home exercise equipment. I even found a site offering guaranteed homeopathic immunisation. Hmmm… In an information-rich, high-tech world, we are becoming less and less tolerant of uncertainty. Society wants perfect, predictable results — now! For all its advances, modern medicine cannot provide this and we don’t pretend otherwise. Ironically, it seems the health products with the least evidence are coming with the greatest assurances. A clever marketing ploy that patients seem to be buying into — literally and figuratively. I think we all need to be reminded of Benjamin Franklin’s famous words: “In this world, nothing can be said to be certain except death and taxes.” We can’t really put guarantees on whether it will rain down on our holidays or on our health, and should retain a healthy scepticism towards those who attempt to do so. This blog post has been adapted from a column first published in Australian Doctor http://www.australiandoctor.com.au/articles/11/0c070a11.asp Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Dr Genevieve Yates
almost 8 years ago
In which John discusses the complicated reasons why the United States spends so much more on health care than any other country in the world, and along the way reveals some surprising information, including that Americans spend more of their tax dollars on public health care than people in Canada, the UK, or Australia. Who's at fault? Insurance companies? Drug companies? Malpractice lawyers? Hospitals? Or is it more complicated than a simple blame game? (Hint: It's that one.) For a much more thorough examination of health care expenses in America, I recommend this series at The Incidental Economist: http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/ The Commonwealth Fund's Study of Health Care Prices in the US: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/May/1595_Squires_explaining_high_hlt_care_spending_intl_brief.pdf Some of the stats in this video also come from this New York Times story: http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all This is the first part in what will be a periodic series on health care costs and reforms leading up to the introduction of the Affordable Care Act, aka Obamacare, in 2014.
almost 8 years ago
Each year on the 26th of January, Australia Day, Australians of all shapes, sizes and political persuasions are encouraged to reflect on what it means to be living in this big, brown, sunny land of ours. It is a time to acknowledge past wrongs, honour outstanding Australians, welcome new citizens, and perhaps toss a lamb chop on the barbie (barbecue), enjoying the great Australian summer. It is also a time to count our blessings. Australians whinge a lot about our health system. While I am certainly not suggesting the model we have is anywhere near perfect, it could be a whole lot worse. I recently read this NY times article which talks about the astronomical and ever-rising health care costs in the US and suggests that this, at least sometimes, involves a lack of informed consent (re: costs and alternative treatment options). The US is certainly not the “land of the free” when it comes to health care. There are many factors involved, not least being the trend in the US to provide specialised care for conditions that are competently and cost-effectively dealt with in primary care (by GPs) in Australia. The article gives examples such as a five minute consult conducted by a dermatologist, during which liquid nitrogen was applied to a wart, costing the patient $500. In Australia, (if bulk billed by a GP) it would have cost the patient nothing and the taxpayer $16.60 (slightly higher if the patient was a pensioner). It describes a benign mole shaved off by a nurse practitioner (with a scalpel, no stitches) costing the patient $914.56. In Australia, it could be done for under $50. The most staggering example of all was the description of the treatment of a small facial Basal Cell Carcinoma (BCC) which cost over $25000 (no, that is not a typo – twenty five THOUSAND dollars). In Australia, it would probably have cost the taxpayer less than $200 for its removal (depending on exact size, location and method of closure). The patient interviewed for the article was sent for Mohs surgery (and claims she was not given a choice in the matter). Mohs (pronounced “Moe’s” as in Moe’s Tavern from The Simpsons) is a highly effective technique for treating skin cancer and minimises the loss of non-cancerous tissue (in traditional skin cancer surgery you deliberately remove some of the surrounding normal skin to ensure you’ve excised all of the cancerous cells) . Wikipedia entry on Mohs. This can be of great benefit in a small minority of cancers. However, this super-specialised technique is very expensive and time/ labour intensive. Perhaps unsurprisingly, it has become extremely popular in the US. ”Moh’s for everything” seems to be the new catch cry when it comes to skin cancer treatment in the US. In the past two years, working very part time in skin cancer medicine in Australia, I have diagnosed literally hundreds of BCCs (Basal Cell Carcinomas). The vast majority of these I successfully treated (ie cured) in our practice without needing any specialist help. A handful were referred to general or plastic surgeons and one, only one, was referred for Mohs surgery. The nearest Mohs surgeon being 200 kilometres away from our clinic may have something to do with the low referral rate, but the fact remains, most BCCs (facial or otherwise), can be cured and have a good cosmetic outcome, without the need for Mohs surgery. To my mind, using Mohs on garden variety BCCs is like employing a team of chefs to come into your kitchen each morning to place bread in your toaster and then butter it for you. Overkill. Those soaking up some fine Aussie sunshine on the beach or at a backyard barbie with friends this Australia Day, gifting their skin with perfect skin-cancer-growing conditions, may wish to give thanks that when their BCCs bloom, affordable (relative to costs in the US, at least) treatment is right under their cancerous noses. Being the skin cancer capital of the world is perhaps not a title of which Australians should be proud, but the way we can treat them effectively, without breaking the bank, should be. Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Dr Genevieve Yates
almost 8 years ago
What are the prospects of a non-Australian medical school graduate and non-Australian citizen to obtain a training job in Australia?
Unlike previous generations of doctors, a medical degree nowadays does not offer international flexibility with where you want to work and is very much restricted by your citizenship status. Australia has a high standard of postgraduate training which may appeal to many foreign graduates. Looking for statistics per specialty and if anybody has any personal experience to share.
about 8 years ago
Hi guys, my name is Angela! I am currently an F2 doing a year in Australia! My key interest is neurosurgery and as a neurosurgery SHO now in Adelaide, I thought I'd start a blog on a few neurosurgery/neurology issues I encounter regularly on the wards. This is aimed to help all medical students studying neurology/F1/SHO in neurosurgery. Few topics could include: Basic management of neurosurgery/neurology patients - the neurology exam Ophthalmology exam and lesion representation Understanding GCS Raised intracranial pressure Acute head injury Seizure management Cauda equina Headaches Decreased conscious level Cord compression Electrolytes imbalance in the neurosurgical patient Fluid management in the neurosurgical patient Acute meningitis Any thoughts/comments?
Angela Li Ching Ng
about 8 years ago
I'm hoping to do my elective in Australia (Sydney and Melbourne) and would love any tips or ideas regarding getting it organised. Is it better to try to contact hospitals directly? Will I be expected to pay for my placement? Anywhere that's particularly good or should be avoided?
over 8 years ago