Posts Tagged ‘Australia’

For those concerned by proposed changes to Oz guidelines for Doctors re complementary medicine: what the proposed changes are

April 8, 2019

Actual proposed  Oz guidelines for doctors re complementary and unconventional medicine, from https://www.medicalboard.gov.au/News/Current-Consultations.aspx are copied in below.  Much of the concern seems to be from those who have not read them.  Read before worrying, then you will sound more sensible if you comment in the way described on the medicalboard.gov.au site.

The consultation is called

Public consultation on clearer regulation of medical practitioners who provide complementary and unconventional medicine and emerging treatments

Guidance for all registered medical practitioners

This section of the guidelines includes guidance for all registered medical practitioners including those doctors whose patients use complementary and unconventional medicine and emerging treatments, but who don’t themselves provide these treatments.

  1. Discussion with patients

The use of complementary and unconventional medicine and emerging treatments is increasing. It is therefore important that all medical practitioners are aware of these areas of practice and how they may affect their patients and impact other treatments, regardless of whether they themselves provide or recommend these treatments. There are resources available for medical practitioners when discussing complementary and unconventional medicine and emerging treatments with their patients.[1]

Good medical practice for all medical practitioners involves:

  • Asking your patients about their use of complementary and unconventional medicine and emerging treatments regardless of whether you provide or recommend these treatments.
  • Taking into consideration your patient’s use of complementary and unconventional medicine and emerging treatments when determining appropriate management for your patient.
  • Respecting your patient’s right to make informed decisions about their health and their right to choose complementary and unconventional medicine and emerging treatments.

 

 

Guidance for registered medical practitioners who provide complementary and unconventional medicine and emerging treatments

This section of the guidelines includes guidance for registered medical practitioners who provide complementary and unconventional medicine and emerging treatments.

  1. Knowledge and skills

Safe patient care relies on the medical practitioner having the knowledge and skills in the area of medicine in which they practise. This is both for the treatments being provided and the conditions for which patients seek treatment. This is particularly important where treatments may not be part of standard medical training, for alternative uses of conventional treatments and for new and emerging treatments that are continuously evolving.

Good medical practice for medical practitioners providing complementary and unconventional medicine and emerging treatments involves:

  • Ensuring you have current knowledge and skills for your scope of practice to ensure safe patient care.
  • Only offering treatments if you have the appropriate training, expertise and experience in both the treatment and the condition being treated.
  • Arranging appropriate and timely specialist referral, when indicated.
  • Undertaking necessary training if you intend to change your scope of practice to include complementary and unconventional medicine and emerging treatments.
  1. Conflicts of interest

Conflicts of interest can arise when providing complementary and unconventional medicine and emerging treatments. This is the case when there are high costs involved as well as because of the experimental and commercial aspects of some treatments.

Good medical practice for medical practitioners providing complementary and unconventional medicine and emerging treatments involves:

  • Always acting honestly and only in your patient’s best interests when providing complementary and unconventional medicine and emerging treatments.
  • Ensuring that you do not have a financial or commercial conflict of interest that may influence the advice and/or treatment that you give your patients.
  1. Informed consent

Patients have a right to know if the treatment they are being offered is not considered to be ‘conventional medicine’. They have the right to know the evidence for its efficacy and safe use.

Medical practitioners proposing complementary and unconventional medicine and emerging treatments must obtain informed consent from their patient. Good medical practice involves:

  • Providing your patient with enough information, preferably in written form, for them to make informed decisions about proposed assessments, investigations and treatments.
  • Providing your patient with clear information about:
    • the extent to which the assessment, investigation and treatment is consistent with conventional medicine and accepted by the medical profession or if it is considered alternative and/or experimental
    • the degree to which, and how, diagnostic investigations and tests have been formally evaluated and what is known about their reliability, safety and risks
    • the degree to which, and how, the proposed treatments have been formally evaluated or proven and what is known about their safety, side effects, risks, likely effectiveness and a realistic likelihood of benefit for the proposed use.
    • the range of possible outcomes, taking into consideration the patient’s expectations
    • the likely number of investigations and treatments required and the costs involved
    • other treatment options (including conventional treatments), their risks, likely benefits and efficacy based on the best current available information.
  • Ensuring that patients who may be vulnerable because of the serious and/or chronic nature of their condition and/or because conventional medicine has not been effective, are not exploited or unduly influenced.
  • Ensuring that information provided about complementary and unconventional medicine and emerging treatments does not create unrealistic patient expectations.
  • Informing your patient of their right to seek a second opinion regarding their treatment and options from another independent medical practitioner when proposing treatments that are complementary, unconventional or emerging.
  1. Assessment and diagnosis

Some medical practitioners providing complementary and unconventional medicine and emerging treatments use diagnostic methods and tests that are not considered to be part of conventional medicine.

Good medical practice in the assessment and diagnosis of patients involves:

  • Ensuring the assessment and examination of your patient is comprehensive and considers all relevant information.
  • Ensuring that any recommendation for investigations or tests is based on the best current available information.
  • Performing and/or ordering any generally recognised diagnostic investigations and tests that would be reasonably expected for appropriate patient care.
  • Ensuring you consider appropriate differential diagnoses for each individual patient.
  • Ensuring that your diagnosis is supported by sound clinical judgement and informed by the best current available information.
  1. Treatment

Providing a treatment in the absence of an identified therapeutic need can unnecessarily expose a patient to risk of harm. Patient harm can also result if the provision of complementary and unconventional medicine and emerging treatments results in delays in accessing more appropriate treatments for the patient.

Good medical practice when providing complementary and unconventional medicine and emerging medicine involves:

  • Ensuring that you do not discourage the use of conventional treatment options when this is clinically appropriate.
  • Only recommending treatments where there is an identified therapeutic need, quality and safety can be reasonably assured and that have a reasonable expectation of clinical efficacy and benefit.
  • Ensuring that the provision of any complementary and unconventional medicine and emerging treatments comply with any relevant Therapeutic Goods Administration requirements.[2]
  1. Patient management

Good patient care is supported when there is good communication with, and coordination of care between, all treating practitioners. When the provider of complementary and unconventional medicine or emerging treatments does not have a role in the patient’s regular medical care it is important to ensure that there are measures in place for the coordination of care. Follow-up of patients is particularly important where treatment is provided that is experimental and/or part of a formal research clinical trial – both for the patient’s wellbeing and for the contribution to medical knowledge.

Good medical practice for the care of your patients to whom you are providing complementary and unconventional medicine and emerging treatments involves:

  • Documenting information including the diagnosis, treatment, efficacy, side-effects and known risks of interactions in the patient’s medical record.
  • Ensuring that you take responsibility for appropriate monitoring and follow-up of patients to whom you are providing complementary and unconventional and emerging treatments. This is even more important when you are providing experimental treatments.
  • Encouraging your patients to tell their other health practitioners about their use of complementary and unconventional medicine and emerging treatments.
  • With permission from your patient, communicating with their other treating doctors (if applicable). You should inform other treating medical practitioners of the investigations, the diagnoses, treatments, known risks of interactions and patient progress.
  • Reporting adverse events to the relevant authority to assist safety monitoring.
  1. Advertising

Some patients who seek complementary and unconventional medicine or emerging treatments may be vulnerable to advertising that may lead to unreasonable expectations. The advertising provisions in Section 133 of the National Law include that a regulated health service must not be advertised in a way that is false, misleading or deceptive or creates an unreasonable expectation of beneficial treatment.

Good medical practice when advertising complementary and unconventional medicine and emerging treatments involves:

  • Ensuring that all advertising material, including practice and practitioner websites, complies with the Board’s Guidelines for advertising of regulated health services, including the advertising requirements of section 133 of the National Law, of the Therapeutic Goods Administration and the Therapeutic Goods Advertising Code and of the Australian Competition and Consumer Commission.
  • Ensuring that you do not create the impression that you are a specialist in an area of practice that is not a recognised specialty.
  • Ensuring advertising material does not create unreasonable patient expectations of the benefits of the complementary and unconventional medicine and emerging treatments.
  1. Research and advancing knowledge

Innovation and research in new treatments is necessary to improve health outcomes. However, there must be protections in place for patients. Efforts to make advancements in treatments should not jeopardise patient safety.

Good medical practice in the research and advancement of complementary and unconventional medicine and emerging treatments involves:

  • Ensuring that research involving complementary and unconventional medicine and emerging treatments complies with the National Health and Medical Research Council’s (NHMRC) current ‘Australian Code for the Responsible Conduct of Research’ and ‘National Statement on Ethical Conduct in Human Research’.
  • Where tests and treatments are experimental, being prepared to contribute to and share new knowledge with the profession.

Acknowledgements

The Board acknowledges the following organisations’ codes and guidelines, which helped inform the development of the Board’s draft guidelines:

  • Medical Council of New South Wales (2015) Complementary health care policy
  • Medical Council of New Zealand (2011) Statement on complementary and alternative medicine

Implementation date and review

These guidelines will take effect on <date>.

The Board will review these guidelines at least every five years.

[1] For example, National Health and Medical Research Council (NHMRC), Talking with your patients about Complementary Medicine – a Resource for Clinicians, 2014 and NHMRC, Stem Cell Treatments – A Quick Guide for Medical Practitioners, 2013

[2] For example, Therapeutic Goods Administration (TGA), Australian regulatory guidelines for complementary medicines, 2018 and TGA, Australian regulatory guidelines for biologicals, 2017.

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Australian Poverty Line

October 17, 2016

Recent reports of 3 million Australians below poverty line (where defined as below 50% of median income) – currently $426.30 per week for a single person – have started some public response. One person commented online that increasing welfare wouldn’t help, as it would drive up the average income and thus leave them still below par – another voter who does not know the difference between mean and median. Depressing that they can vote…

My immediate thought was different: have a major depression, and weaken Unions so more workers join the 32% of below-current- poverty-line whose main income is paid employment. Then the dole will be above that definition of poverty, while the executives stay on salaries giving over the poverty level weekly income per executive hour!

To compare with cost of basic needs: The March 2016 Henderson poverty line for a single person, including housing, is $425.61 for a single not in work, $524.89 for a single in the workforce. (The Henderson poverty lines are based on a benchmark income of $62.70 for the December quarter 1973 established by the Henderson poverty inquiry. The benchmark income was the disposable income required to support the basic needs of a family of two adults and two dependent children. Poverty lines for other types of family are derived from the benchmark using a set of equivalence scales. )

Australia’s Newstart Allowance (single person over 22  unemployment benefit) currently is at best about $335 per week, including rent assistance, and the Government is proposing to cut the Energy Supplement from it – about $8 per week. That is why I keep calling for those on welfare to have the right to surrender 90% of their income for guaranteed, supervised basic living provided by the Government.

Do the politicians think we have no memory? Part 3

March 23, 2014

After an Australian election, if  one party gets a majority of the whole population vote but another party wins the majority of seats the losing  politicians regularly grumble, throwing around words like “gerrymander.”

Politicians say they want schools to teach students to understand and value our way of government.  They say they want schools to emphasise teaching of history, and it is an important part of our history that a great deal of care was put into setting up our system, which started peacefully and by negotiation well after the hasty and violent starts of the main European countries and the USA.   They say they want these things in the curriculum,  but I wonder whether they want voters to remember their schooling when they come to vote.

Background  to  the Australian Electoral System

(Skip this if you know it already)

It was a deliberate choice to have States’ federal Senate numbers equal regardless of population and representing proportional votes within each State, to prevent the tyranny of the majority.   They were certainly influenced by John Calhoun’s ideas on concurrent majority as an approach to the problem, ideas still discussed this century .   It was also a deliberate choice to have each voter  have as many preferential votes as there are candidates up for election in the State,¹ a change made in 1949, even though the mathematics and vote tracing were horribly curly in the days before computerised  counting.    A voter may vote for all one party first, or one Green, one Independent, one Labor, one Liberal, and one Euthanasia party candidate, then mix up the remaining candidates in any order as long as each candidate has ves preferred number on the paper.  If a candidate has more first preferences than ve needs (one-sixth-plus-one of the votes is the quota if there are 6 seats), ves surplus votes are distributed as first preferences in proportion to the preferences of the voters who gave ver the votes.  Candidates who get less than the fraction needed to get a seat are knocked out from least votes up, and at each step the loser’s votes next preferences are distributed and the scrutineers check whether someone has got the quota.    (Messy!  I’m not making this up – check with the Australian Electoral Commission)  No wonder they introduced “Or you can tick one party’s box and we will distribute all their preferences the way they have told the us to.”

It was also a deliberate choice to have each House of Representative seat linked to its own area (and electorates other than islands are single patches of land), and that the voters from that area  vote  for  individual candidates as individuals, though the candidates  could ally to parties.  That way, local interests could be well represented by someone known to the locals.   Also, in each area, the voter has preferential votes as in the Senate – so that if they like Alan but would rather have Jan than Ursula if they can’t have Alan, they can try for Alan but know that Jan will get their vote if he fails.  They just number the order of preference in the candidates’ boxes.  This means that you don’t get someone hated by 60% of the electorate into the seat just because the 60% have slightly different ideas about the best way to do things and vote for 3 other candidates first.  If they all prefer a 4th to the 40%er, they get their way.

Demographics

For philosophical reasons, State governments have been selling off State-owned housing in expensive areas, buying housing in less expensive locations,  and subsidising private rentals for those in need – who can seldom get private rentals in the prime locations.   In addition, those short of money sell out of high-value areas to free up the money, and the wealthy seek houses close to well-known exclusive schools and other valued social resources.  This has led to the service-providers (shop assistants, teachers, police, cleaners, etc) having to travel long distances to work, and tertiary students having to travel hours to their studies, with the associated travel costs – while the wealthy are within easy foot or  public transport access of resources.  This is fair in the  eyes of those benefiting from the user-pays  approach, and they see its good points:  after all, if the State provided enough low cost housing in the  upmarket areas, the dregs of society would lower property values.  An additional benefit is that the local State schools have a better class of student and parents and thus better outcomes than in the more difficult suburbs..

You got over half the total but not enough seats.  Problem?

True, there are many reasons people vote their different ways, but let’s pretend that wealth-aligned interests are usually enough to swing the vote.  Let us assume that the electoral boundaries are fair, with pretty similar numbers in each electorate, and thus there is no real gerrymander.  Our Electoral Commission does work at being fair that way.

Pretend there are 10 electorates.

Rich party has 90% of the votes in each of 4 electorates.

Poor party has 60% of the votes in each of 6 electorates.

% of total voters                   %  of total vote             seats / 10

R 36%        P 4%                                 40%                      4

R 24%        P 36 %                              60%                      6

total votes by  party                 R 60 %        P 40 %

Total seats by party                 R   4             P  6

Don’t complain.  This was part of the design of the Australian system, deliberately included to control concentrated power groups with regional agendas inimical to the wider society.   This is in the curriculum – the intersection of History with Society and Environment.   Why don’t the journalists call the politicians on this, rather than just quoting them?

I am so annoyed that I am going to shout.  

If  you want a greater proportion of the seats, have a better distribution of your supporters across electorates. 

A good start would be:  Get out of your enclaves of power, and make housing available for the “lower orders” closer to the places that they work.  If you can’t stop the worsening inequality, at least reduce home address’s value as a predictor of socioeconomic status.  

 

¹ I know, it is really “a preferential vote” but they used be allowed to number only a limited number of preferences and I wanted to make the distinction .