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Longer appointments are just the start of tackling the gender pain gap. Here are 4 more things we can do

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Ahead of the federal budget, health minister Mark Butler <a href="https://www.abc.net.au/news/2024-05-10/endometriosis-australia-welcomes-govt-funding-for-endometriosis/103830392">last week announced</a> an investment of A$49.1 million to help women with endometriosis and complex gynaecological conditions such as chronic pelvic pain and polycystic ovary syndrome (PCOS). From July 1 2025 <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/historic-medicare-changes-for-women-battling-endometriosis">two new items</a> will be added to the Medicare Benefits Schedule providing extended consultation times and higher rebates for specialist gynaecological care. The Medicare changes <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">will subsidise</a> $168.60 for a minimum of 45 minutes during a longer initial gynaecologist consultation, compared to the standard rate of $95.60. For follow-up consultations, Medicare will cover $84.35 for a minimum of 45 minutes, compared to the standard rate of $48.05. Currently, there’s <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=104&qt=item&criteria=104">no specified time</a> for these initial or subsequent consultations. But while reductions to out-of-pocket medical expenses and extended specialist consultation times are welcome news, they’re only a first step in closing the gender pain gap. <h2>Chronic pain affects more women</h2> Globally, research has shown chronic pain (generally defined as pain that persists for <a href="https://www.healthdirect.gov.au/chronic-pain">more than three months</a>) disproportionately affects <a href="https://academic.oup.com/bja/article/111/1/52/331232?login=false">women</a>. Multiple biological and psychosocial processes likely contribute to this disparity, often called the gender pain gap. For example, chronic pain is frequently associated with conditions influenced by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0304395914003868">hormones</a>, among other factors, such as endometriosis and <a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">adenomyosis</a>. Chronic pelvic pain in women, regardless of the cause, can be debilitating and <a href="https://www.nature.com/articles/s41598-020-73389-2">negatively affect</a> every facet of life from social activities, to work and finances, to mental health and relationships. The gender pain gap is both rooted in and compounded by gender bias in medical research, treatment and social norms. The science that informs medicine – including the prevention, diagnosis, and treatment of disease – has traditionally focused on men, thereby <a href="https://www.theguardian.com/lifeandstyle/2015/apr/30/fda-clinical-trials-gender-gap-epa-nih-institute-of-medicine-cardiovascular-disease">failing to consider</a> the crucial impact of sex (biological) and gender (social) factors. When medical research adopts a “male as default” approach, this limits our understanding of pain conditions that predominantly affect women or how certain conditions affect men and women <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10921746/">differently</a>. It also means intersex, trans and gender-diverse people are <a href="https://www.deakin.edu.au/about-deakin/news-and-media-releases/articles/world-class-centre-tackles-sex-and-gender-inequities-in-health-and-medicine">commonly excluded</a> from medical research and health care. Minimisation or dismissal of pain along with the <a href="https://www.hindawi.com/journals/ecam/2016/3467067/">normalisation of menstrual pain</a> as just “part of being a woman” contribute to significant delays and misdiagnosis of women’s gynaecological and other health issues. Feeling dismissed, along with perceptions of stigma, can make women less likely <a href="https://link.springer.com/article/10.1186/s12905-024-03063-6">to seek help</a> in the future. <h2>Inadequate medical care</h2> Unfortunately, even when women with endometriosis do seek care, many <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.15494?saml_referrer">aren’t satisfied</a>. This is understandable when medical advice includes being told to become pregnant to treat their <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02794-2">endometriosis</a>, despite <a href="https://academic.oup.com/humupd/article/24/3/290/4859612?login=false">no evidence</a> pregnancy reduces symptoms. Pregnancy should be an autonomous choice, not a treatment option. It’s unsurprising people look for information from other, often <a href="https://www.mdpi.com/2227-9032/12/1/121">uncredentialed</a>, sources. While online platforms including patient-led groups have provided women with new avenues of support, these forums should complement, rather than replace, <a href="https://journals.sagepub.com/doi/full/10.1177/1460458215602939">information from a doctor</a>. Longer Medicare-subsidised appointments are an important acknowledgement of women and their individual health needs. At present, many women feel their consultations with a gynaecologist are <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">rushed</a>. These conversations, which often include coming to terms with a diagnosis and management plan, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/">take time</a>. <h2>A path toward less pain</h2> While extended consultation time and reduced out-of-pocket costs are a step in the right direction, they are only one part of a complex pain puzzle. If women are not listened to, their symptoms not recognised, and effective treatment options not adequately discussed and provided, longer gynaecological consultations may not help patients. So what else do we need to do? 1. Physician knowledge Doctors’ knowledge of women’s pain requires development through both practitioner <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00815-4/tables/2">education and guidelines</a>. This knowledge should also include dedicated efforts toward understanding the <a href="https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain">neuroscience of pain</a>. Diagnostic processes should be tailored to consider gender-specific symptoms and responses to <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00137-8/fulltext">pain</a>. 2. Research and collaboration Medical decisions should be based on the best and most inclusive evidence. Understanding the complexities of pain in women is essential for managing their pain. Collaboration between health-care experts from different disciplines can facilitate comprehensive and holistic pain research and management strategies. 3. Further care and service improvements Women’s health requires multidisciplinary treatment and care which extends beyond their GP or specialist. For example, conditions like endometriosis often see people presenting to emergency departments in <a href="https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/treatment-management/ed-presentations">acute pain</a>, so practitioners in these settings need to have the right knowledge and be able to provide support. Meanwhile, pelvic ultrasounds, especially the kind that have the potential to visualise endometriosis, take longer to perform and require a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0015028223020757/">specialist sonographer</a>. Current rebates do not reflect the time and expertise needed for these imaging procedures. 4. Adjusting the parameters of ‘women’s pain’ Conditions like PCOS and endometriosis don’t just affect women – they also impact people who are gender-diverse. Improving how people in this group are treated is just as salient as addressing how we treat women. Similarly, the gynaecological health-care needs of culturally and linguistically diverse and Aboriginal and Torres Strait islander women may be even <a href="https://www.mdpi.com/1660-4601/20/13/6321">less likely to be met</a> than those of women in the general population. <h2>Challenging gender norms</h2> Research suggests one of the keys to reducing the gender pain gap is challenging deeply embedded <a href="https://pubmed.ncbi.nlm.nih.gov/29682130/">gendered norms</a> in clinical practice and research. We are hearing women’s suffering. Let’s make sure we are also listening and responding in ways that close the gender pain gap.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229802/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, Senior Lecturer, School of Business, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, PhD candidate, health communication and health sociology, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, Affiliate Senior Lecturer, Faculty of Health, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, Associate Professor at NICM Health Research Institute, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/longer-appointments-are-just-the-start-of-tackling-the-gender-pain-gap-here-are-4-more-things-we-can-do-229802">original article</a>. </div>

Body

Scotland appoints a man as "period dignity officer"

Local authorities in Scotland have come under fire for appointing a man to the role of "period dignity officer". A group of colleges and local councils in Tay region in eastern Scotland announced the appointment of Jason Grant, who will be responsible for coordinating the region's response to a new law that makes menstrual products free to access in the country. Jason Grant previously worked as a student wellbeing officer at a local college before being appointed to the controversial role, which has caused outrage. Many critics believe a woman would be better suited to the role, and were confused why a man would be considered for the job. Retired tennis star Martina Navratilova commented on the news of his appointment, calling it "f**king ridiculous" on her Twitter account. "Have we ever tried to explain to men how to shave or how to take care of their prostate or whatever?!? This is absurd," she wrote. Barrister Charlotte Proudman also questioned why a man was appointed to the role. "I remember at school, girls used sanitary pads because tampons were unaffordable," she tweeted. "What experience does Jason Grant have of this? I'm all *for* men's support - but let's have women lead on our experiences." Grant's role is the first of its kind in Scotland. "He will coordinate and streamline the approach to 'Period Dignity' across the area by working directly with the colleges and local authorities," Grainger PR said in a press release announcing the appointment. "Jason will lead a regional campaign across schools, colleges and wider communities, raising awareness and understanding of the new Act and ensuring that the Scottish Government funding is allocated appropriately," it said. The Period Products Act came into force earlier this week and means that menstrual products, including tampons and pads, will be made available free of charge in public facilities in Scotland. Image credits: Getty Images / CNN

Body

Three-year-old dies after dental visit

A mother in the US has been left broken-hearted and in desperate need of answers after a simple dental procedure for her three-year-old son resulted in his passing. Nancy Valenzuela, a mother of three from Scott City, Kansas, said she took her son, Abiel Valenzuela Zapata, into Tiny Teeth Pediatrics Dentistry for a check up. A simple procedure was necessary – a teeth extraction after a nasty gum infection. “We didn’t expect to come out of there without a child,” Valenzuela explained. Abiel died on Tuesday after being transported to a Wichita hospital. Valenzuela revealed she and her son had visited two dental offices in southwest Kansas, but was told both times that her son needed to have teeth pulled. She sadly went on to say her boy was fine before he went into surgery, and only asked for comfort while getting a shot. “I told him, ‘Papi, everything’s going to be okay. You know you’re fine,’” said Valenzuela. Wichita police officers later reported that the anesthesiologist claimed Abiel was doing fine for about 30 minutes under sedation. However, disaster slowly ensued for the family. While the specific details surrounding Abiel’s procedure, the doctor reported he’d never seen “anything like that”, especially in someone so small without any known allergies. Valenzuela said she didn’t know there was a medical emergency at the office for her son until he was brought out to the ambulance. “As a mother, you feel like you failed him because you didn’t do anything to protect him,” she said. “I really thought that I made the right choice.” Valenzuela sadly never saw her son alive again, but that didn’t stop her from making one final promise to him. “‘I couldn’t do anything for you, but I will investigate.’ It’s what I told him. It’s the only thing I can do and bring awareness,” she said. The mother said it’s been difficult on her other children, including Abiel’s older brother. “I asked him later on in the night, ‘Where is Abiel,’ and he pointed up, and he said he is with God,” she said. She said the family would have to take it one day at a time. “He’s in a better place, he was just so young, and we loved him a lot,” said Valenzuela. Police officer Trevor Macy said in a statement that there is no criminal investigation underway “at this time.” The Tiny Teeth Pediatric Dentistry has released a statement on the three-year-old’s death. “Tiny Teeth Pediatric Dentistry is devastated by the death of Abiel Valenzuela Zapata,” the statement reads. “Like Abiel’s family, we, too, want to understand how this tragic event may have occurred. “Our practice has never experienced an incident like this, and we had no reason to expect this procedure would be anything other than routine. “We would like to thank the EMS first responders who arrived only a few minutes after we called 911. “They continued the CPR efforts we had begun and worked feverishly to save Abiel.” The family has set up a GoFundMe account to raise money for funeral costs.

Caring

MAJOR free change coming for Aussies over 50

The government has announced any Australian over 50 will now have access to a free consultation from a doctor to discuss COVID-19 vaccinations. Federal Health Minister Greg Hunt announced the new measure on Friday. “To assist our GPs, to assist and support those who are coming forward for vaccinations, there will be a new Medicare item for over-50s to allow for a general practice consultation,” Hunt said. “It will be done by GPs ... It will be bulk billed.” Karen Price, president of the Royal Australian College of General Practitioners, said it was urgent the measure be made. “We are dealing with increasing vaccine hesitancy right across the country,” she said. “I’m seeing it in my own practice in Melbourne, almost all my patients have questions about the COVID-19 vaccines.” <blockquote class="twitter-tweet"> Health Minister <a href="https://twitter.com/greghunt?ref_src=twsrc%5Etfw">@GregHunt</a> MP says the decision to recommend AstraZeneca only for people aged over 60 "doesn't change the goal of having every Australian given the opportunity to be vaccinated this year." <a href="https://t.co/DuesjfbtCV">pic.twitter.com/DuesjfbtCV</a> — Sunrise (@sunriseon7) <a href="https://twitter.com/sunriseon7/status/1405650956948180992?ref_src=twsrc%5Etfw">June 17, 2021</a></blockquote> The AstraZeneca vaccine is no longer recommended to anyone under the age of 60, so Prime Minister Scott Morrison is attempting to change major measures for the vaccine rollout after meeting with state and territory leaders on Friday. Experts are maintaining that while it is rare, the risk of extremely rare but serious blood clots heavily outweighs the benefits of that particular jab. The recommended age has been revised up from 50, meaning all eligible people under 60 will be offered Pfizer. Hunt has maintained his confidence in the Pfizer jab and said re-booking people in their 50s who were down to get a first AstraZeneca jab would likely lead to a fall in vaccination rates. “The interesting point here was that some in that group, who were not intending to be vaccinated in the near term, may well choose to be vaccinated,” he said. Only four percent of adults have received both doses of the COVID vaccine, seriously lagging behind the rest of the world in vaccination rates.

News

Key questions to consider when appointing an Enduring Power of Attorney

If you have already written your legally valid <a href="https://www.willed.com.au/guides/what-you-need-to-know-before-writing-a-will/">Will</a>, another key document to consider to complete your future planning is an Enduring Power of Attorney or Medical Decision-Maker. An Enduring Power of Attorney is a legal document that allows you to appoint someone to make decisions regarding legal and financial matters. Whereas an Appointment of Medical Decision-Maker (also known as an Enduring Power of Guardianship) allows you to appoint a person to make personal and healthcare decisions for you. By appointing an Enduring Power of Attorney and Medical Decision-Maker, alongside writing your legal Will, you can feel comfortable knowing that your values and beliefs will be understood and adhered to, even if you become incapacitated due to illness or injury Since an Enduring Power of Attorney and Appointment of Medical Decision-Maker gives another person the legal authority to make crucial decisions on your behalf, it’s imperative that you appoint someone you trust. While it’s common for individuals to select their spouse or adult children as their attorney and medical-decision-maker/guardian, this doesn’t have to be the automatic choice. Here are some key questions you should consider when it comes to appointing an attorney and medical-decision-maker/guardian. Do they understand your values, beliefs and wishes? The role of an attorney and medical-decision-maker (also known as a guardian) is to make decisions on your behalf when you cannot do so yourself. Therefore, it is important that you make your wishes surrounding your living arrangements, medical treatment and financial decisions known to them. Do you trust them? While it’s tempting to select someone close to you, it’s more important to choose an attorney and medical-decision-maker that you trust and who is likely to fulfil your wishes. This individual should be someone you feel comfortable discussing sensitive issues with and will follow through with your wishes even if they disagree. Do they live nearby? How close are they to you? Ideally, your attorney and medical-decision-maker should live in the same state and live close to you or your preferred hospital or care centre. By being close, they’ll be able to get to you quickly in case of an emergency. What’s the person’s character and values? When considering your attorney and medical-decision-maker, reflect on this individual’s character and values. Do they align with your values? After all, they will be making decisions that can significantly impact your life and health-care. Some questions to think about include: <ul> <li>Are they able to handle such a responsibility? </li> <li>Are they likely to follow through on the demands of being Power of Attorney? </li> <li>Will they follow through with your wishes? </li> <li>Can you trust this individual to speak on your behalf? </li> </ul> Do they have a basic understanding of medical processes? In some instances, your medical-decision-maker will also be in charge of making healthcare-related decisions on your behalf. Hence, it’s a good idea (but not essential) to select someone with a basic understanding of how medical processes work. However, that doesn’t mean you need to pick someone that works in a healthcare-related setting. The individual just needs to be open to learning about various medical treatment options and know how to ask the right questions, especially medical tests, prognoses, procedures etc. What happens if I do not have anyone to appoint as my attorney and medical-decision-maker? If you don’t have anyone you would like to appoint as your attorney and medical-decision-maker, you may be able to appoint the public trustee in your state/territory as your attorney and medical-decision-maker. Just know that if you decide to select them, you’ll lose the capacity to make your own decisions, and the public trustee will charge for these services. No matter who you choose to appoint, both your attorney and medical-decision-maker have a fiduciary duty to act in your best interests when exercising the powers granted to them, and must follow any instructions or limitations detailed in the enduring power of attorney and appointment of medical-decision-maker. After you’ve selected your attorney and medical-decision-maker, you should review these documents every two years and make any changes where necessary. Planning your estate with Willed For most Australians, writing your legal Will and planning your estate are tasks that are often left in the “too hard basket”. Traditionally it has involved a time-consuming trip to the lawyers, which can be expensive and inaccessible for many. Willed is excited to launch their new <a href="https://www.willed.com.au/estate-planning/">Complete Estate Planning Package</a>, where Australians can book a free consultation with an in-house expert lawyer who can assist in drafting all your Estate Planning legal documents for a fixed fee. The lawyer-drafted legal documents featured in The Complete Estate Planning Package include: <ul> <li>A Will</li> <li>Enduring Power of Attorney </li> <li>Medical Decision Maker/Enduring Power of Guardianship</li> <li>Advanced Care Directive </li> </ul> You can find out more about Estate Planning on the <a href="https://www.willed.com.au/">Willed</a> website, as well as our executor services to support Australians applying for Grants of <a href="https://www.willed.com.au/probate/">Probate</a> and <a href="https://www.willed.com.au/letters-of-administration/">Letters of Administration</a>. Note: The legal requirements vary in each state and territory and therefore the documents will reflect the most current and valid legislation for each individual case. This is a sponsored article produced in partnership with <a href="https://www.willed.com.au/">Willed.</a>

Legal

Want to record your doctor’s appointment? Check if it’s legal first

As you fire up your computer for a telehealth appointment, or prepare to walk in to see your doctor, you may be wondering whether to record your appointment. You might even think about doing it without asking permission first. But recording without permission might be illegal depending on where you live, according to our latest research, <a href="https://www.mja.com.au/journal/2020/214/3/overt-and-covert-recordings-health-care-consultations-australia-some-legal">published today</a>. And there may be repercussions for you and your health-care professional. Why record a consultation? When feeling unwell, or overwhelmed with a new diagnosis, it can be hard to take in and remember important health information your health-care practitioner provides. Recording your appointments can help. It can help you <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/pon.4592">recall and understand</a> what you discussed. You can also <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/pon.4789">share</a> information about your diagnosis or ongoing care with family and friends. Many health professionals <a href="https://mhealth.jmir.org/2020/1/e15593/">support</a> the idea of their patients recording their appointments. Can technology help? In the past few years there has been increasing interest in using digital technology to help people record their health-care consultations. In Australia, we developed the <a href="https://formative.jmir.org/2019/1/e11111/">SecondEars smartphone app</a> at Peter MacCallum Cancer Centre to allow people diagnosed with cancer to record on their phone, with back-up copies sent directly to their health service for storage. In the <a href="https://pubmed.ncbi.nlm.nih.gov/28684387/">United States</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27593087/">Europe</a>, health services and clinics are developing in-house recording software and technology. Most smartphones also have basic recording software that lets you record with or without asking your health professional. And amid the <a href="https://theconversation.com/video-and-phone-consultations-only-scratch-the-surface-of-what-telehealth-has-to-offer-146580">boom in telehealth due to COVID-19</a>, it’s worth remembering videoconferencing software (such as Zoom) also has built-in recording functions. What happens if I record? Imagine you are going to record without telling your doctor, nurse or other health-care professional, or plan on sharing the recording later with other people. What does the law say? We found this differs in each part of Australia, depending on where you are when you create or share the recording. The law doesn’t differ by the type of recording; audio and video are treated the same. In some jurisdictions (<a href="https://www.legislation.vic.gov.au/in-force/acts/surveillance-devices-act-1999/040">Victoria</a>, <a href="https://www.legislation.qld.gov.au/view/html/inforce/current/act-1971-050">Queensland</a>, <a href="https://legislation.nt.gov.au/en/Legislation/SURVEILLANCE-DEVICES-ACT-2007">NT</a>, <a href="https://www.legislation.nsw.gov.au/view/html/inforce/current/act-2007-064">NSW</a>, <a href="https://www.legislation.act.gov.au/a/1992-57/">ACT</a> and <a href="https://www.legislation.tas.gov.au/view/html/inforce/current/act-1991-021">Tasmania</a>) patients don’t need permission to record their appointment with a doctor, nurse or other health professional if the recording is just for their own use. So, if you want to record to remember what the doctor told you about upcoming surgery or how to take your medicines, you can, even without asking first. In <a href="https://www.legislation.sa.gov.au/LZ/C/A/SURVEILLANCE%20DEVICES%20ACT%202016.aspx">SA</a> and <a href="https://www.legislation.wa.gov.au/legislation/statutes.nsf/law_a1919.html">WA</a>, you usually need the health professional’s consent before recording. In these states, a person who makes a covert recording for their own use can even face a fine or prison term (for example, <a href="https://www.legislation.sa.gov.au/LZ/C/A/SURVEILLANCE%20DEVICES%20ACT%202016.aspx">in SA</a>, there are fines of up to A$15,000 or prison for up to three years). Can I share the recording? Sharing a recording with others — whether this is in person or online — is subject to other rules. The health professional’s consent is sometimes needed for this even if it wasn’t needed for the recording in the first place. However, in <a href="https://www.legislation.qld.gov.au/view/html/inforce/current/act-1971-050">Queensland</a>, <a href="https://www.legislation.tas.gov.au/view/html/inforce/current/act-1991-021">Tasmania</a>, <a href="https://www.legislation.nsw.gov.au/view/html/inforce/current/act-2007-064">NSW</a>, <a href="https://www.legislation.sa.gov.au/LZ/C/A/SURVEILLANCE%20DEVICES%20ACT%202016.aspx">SA</a> and the <a href="https://www.legislation.act.gov.au/a/1992-57/">ACT</a>, as long as the original recording was done within the rules, you don’t need to ask for consent to share it just with family or close friends. Sharing it more widely is another matter. Only in <a href="https://www.legislation.nsw.gov.au/view/html/inforce/current/act-2007-064">NSW</a> and <a href="https://www.legislation.sa.gov.au/LZ/C/A/SURVEILLANCE%20DEVICES%20ACT%202016.aspx">SA</a> can you do this without the health professional’s consent (as long as the original recording was lawful). While the law is messy, we think the overall answer is clear. Even if you don’t need your health professional’s permission to record your consultation, it is best to tell them you want to. What if I ask and the doctor says ‘no’? Some health-care professionals and organisations might be concerned you might share recordings on social media, or use them as a basis for a complaint. The indemnity insurer MIPS <a href="https://www.mips.com.au/articles/are-you-being-recorded">tells its doctors</a> that if the idea of recording makes them uncomfortable, they have the option to decline it. But we argue saying “no” to a patient’s reasonable request to record the consultation might harm the doctor-patient relationship, by eroding patient trust and confidence. If you want to record your medical appointment, it could be worth talking with your doctor about how the recording could help you take better care of your health, and telling them what you intend to do with it. You could also point out that advice in the United Kingdom <a href="https://www.bma.org.uk/advice-and-support/ethics/confidentiality-and-health-records/patients-recording-consultations">suggests</a> recordings can actually support doctors where there are legal disputes. In <a href="https://www.sciencedaily.com/releases/2017/07/170710135301.htm">one US institution</a>, doctors who let their consultations be recorded get a discount for their indemnity insurance, because of the reduced risk of being sued for malpractice. It makes sense, because when there’s a recording, there is less chance of a disagreement arising over who said what. Iron out any concerns early Even if making or sharing a recording doesn’t break the law, doing so without everyone’s knowledge risks harming your relationship with your health-care professional, especially if they find out about it later. Ultimately, a constructive dialogue between you and your health-care professional should iron out concerns on both sides. While it might feel challenging — and depending on where you are, the law might not require you to — it is usually best to ask for consent, so there are no surprises. Written by <a href="https://theconversation.com/profiles/amelia-hyatt-539481">Amelia Hyatt</a>, Peter MacCallum Cancer Centre; <a href="https://theconversation.com/profiles/carolyn-johnston-553277">Carolyn Johnston</a>, University of Melbourne, and <a href="https://theconversation.com/profiles/megan-prictor-453692">Megan Prictor</a>, University of Melbourne. Republished with permission of <a href="https://theconversation.com/want-to-record-your-doctors-appointment-great-idea-but-first-check-its-legal-147747">The Conversation.</a>

Legal

The reason why 2 million Aussies are skipping their dental appointments

Dental care in Australia is a policy anomaly; for some reason, the mouth is treated very differently to other parts of the body. <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2016-17/contents/data-visualisation">About 58% of dental costs</a> are met directly from patients’ pockets, compared to 11% for medical primary care, and 12% for prescriptions. As a result of these large out-of-pocket costs, <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4839.0~2017-18~Main%20Features~Dental%20professionals~4">two million Australians each year</a> defer visits to a dentist or miss out on dental care. Poorer people are more likely to miss out. Every few years <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp0809/09rp01">the Commonwealth government introduces a new dental scheme</a> to fill the dental gap in our health system, and then a few years later the scheme is abolished with a change of government. This start-stop nature of dental policy has to change. What’s required is a long-term vision to reunite the mouth with the rest of the body. The architecture of a universal scheme Medicare is widely embraced as the central pillar of Australia’s health system. There is no logical reason why this coverage should not be extended to oral health. But we should learn from the Medicare experience. The expansion of dental access should be based on a <a href="https://grattan.edu.au/health">new, better model</a>. Here’s how this can be done. Like Medicare, a universal dental scheme should be based on a mix of public and private services State public dental services are struggling valiantly to meet demand, with <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2018/health/primary-and-community-health">waiting times of more than a year in most states</a>. Investing money into these schemes – as the Commonwealth has done for the past few years – has made almost no dent in the waiting lists. And the risk remains that extra investment will be discontinued with changes of government, as has happened in the past. Even if Commonwealth funding increased to adequate levels, it’s unlikely the state schemes could be expanded sufficiently to provide the amount of care needed. Nor would a monolithic public-only scheme, with no choice of provider, be consistent with the way the rest of health care is provided. A mixed public-private scheme could harness the existing investments by private dental practices, as has been done in the existing <a href="https://www.dhsv.org.au/public-dental-services/childdental">Commonwealth Child Dental Benefits Scheme</a>. A universal scheme should be ‘opt-in’: it should be based on dental practices agreeing to be part of the scheme Practices would be allowed to participate only if they agreed to certain conditions, most notably that they will bulk-bill all patients – thereby removing the financial barriers to dental care. Participating practices would also be required to provide information on the results of their care, and to participate in approved programs to improve the quality of their care. Quality care should be rewarded Although the universal scheme would initially make fee-for-service payments to participating practices, in a similar way to Medicare paying GP clinics when you visit a doctor, the payment system should become more sophisticated over time. This could include rewarding dentists and practices that get the best results for their patients, by supplementing fee-for-service payments with <a href="http://www.acffglobal.org/wp-content/uploads/2019/02/Towards-paying-for-health-in-Dentistry-Policy-Lab-Report.pdf/">performance-related payments</a>based on following evidence-based practice and achieving better dental <a href="https://www.ichom.org/portfolio/oral-health/">outcomes</a>. Not all aspects of oral health care should be covered under the universal scheme The priority should be to ensure the scheme funds primary dental care and treatments that are aimed at preventing problems and disease from developing. This includes check ups, treatment for tooth decay – <a href="https://www.ncbi.nlm.nih.gov/pubmed/30107377">which now may not involve drilling</a> – and dentures. The funding arrangements for the universal scheme should be designed to encourage reform and expansion of the dental workforce. A universal dental scheme will require a bigger dental workforce. All oral health professionals should be encouraged to work to the top of their expertise and qualifications. Under the new scheme, for example, oral health therapists would be able to perform many of the services now performed by dentists. How much will it cost? A universal dental scheme would cost about an extra A$5.6 billion a year. That sort of money could not be found overnight. Nor could the number of professionals required to staff such a scheme. Instead, the federal government should announce that Australia will move to a universal dental scheme over the next decade – and it should produce a roadmap to get there. The first step should be for the Commonwealth government to assume funding responsibility for oral health care for pensioners and health care card-holders – the group covered by existing state public dental schemes. The Commonwealth funding should be on the basis of the mixed public-private model described above. This initiative would cost an extra A$1 billion a year. That is a more affordable price tag – and sufficient dental professionals are already available to meet the anticipated extra demand. Offsets against this extra funding could come from savings elsewhere in the health system. Previous Grattan Institute reports have identified opportunities in both <a href="https://grattan.edu.au/home/health/hospitals/">hospitals</a> and <a href="https://grattan.edu.au/home/health/pharmaceuticals/">pharmaceuticals</a>, or from the introduction of a tax on sugar-sweetened drinks, as recommended in <a href="https://grattan.edu.au/report/a-sugary-drinks-tax-recovering-the-community-costs/">another Grattan report</a>. An A$1 billion a year investment in expanding access to dental care for pensioners and health care card-holders would eliminate the waiting lists for existing public dental services, address a key inequity in health care, and set the stage for the big reform: <a href="https://grattan.edu.au/home/health/">a universal dental scheme for Australia</a>. Written by Stephen Duckett. Republished with permission of <a href="https://theconversation.com/two-million-aussies-delay-or-dont-go-to-the-dentist-heres-how-we-can-fix-that-113376">The Conversation</a>.

Beauty & Style

The Queen officially appoints Theresa May as Britain’s second female Prime Minister

Theresa May is officially Britain’s new prime minister after accepting an invitation to govern from Queen Elizabeth II on Wednesday. The now ex-prime minister David Cameron had an audience with the queen on Wednesday evening and tendered his resignation as prime minister. May followed the ritual of “kissing the hand” of the Queen upon her appointment as the country’s first female leader since Margaret Thatcher, the prime minster minister from 1979 to 1990. A statement issued by the Palace read: "The Queen received in audience the Right Honourable Theresa May MP this evening and requested her to form a new Administration. "The Right Honourable Theresa May accepted Her Majesty's offer and Kissed Hands upon her appointed as Prime Minister and First Lord of the Treasury." <img width="499" height="340" src="https://oversixtydev.blob.core.windows.net/media/24242/queen2_499x340.jpg" alt="Queen2" style="display: block; margin-left: auto; margin-right: auto;"/> In her first speech as prime minister, outside the doors of number 10, May said she would lead a "one-nation" government dedicated to social justice and promised to make "Britain a country that works for everyone." The 59-year-old, who won the job by default after her other contender pulled out of the race, has a tough time ahead of her as she leads the negotiations for Britain’s exit from the European Union. She said Britain would "rise to the challenge" and forge "a bold new positive role" in the world. Related links: <a href="/news/news/2016/07/photos-of-princess-diana-in-1991-circulates/">Photos of Princess Diana in 1991 circulates</a> <a href="/news/news/2016/06/queen-sends-her-second-tweet/">Queen sends her second tweet</a> <a href="/news/news/2016/06/queens-scolds-prince-william/">The Queen scolds Prince William on live television</a>

News

Costa Cruises appoints robot staff

It might seem like the plot of a science fiction film, but it seems as though Costa Cruises and AIDA Cruises are embracing the latest cyborg technology to help passengers. From Spring 2016, Costa and AIDA will employ humanoid robots on-board their ships. Costa has an exclusive agreement (said to be worth over a million Euros) to use Pepper, the world’s first robot that has been designed to read and interpret human options. Pepper is fitted with four mics, two HD cameras, 3D sensors, touch sensors in the head and hands and can interpret human emotions by analysing variations in expressions and voice tones. The first batch of robots will be introduce on the AIDAprima and Costa Diadema in Spring, with the rest of the robots to be rolled out across the fleet by the rest of summer. Technophobes needn’t fear the possibility of a robot uprising however. Instead of steering or doing anything that you’d want a human to be doing, Pepper is on hand to provide tips on restaurants, events and excursions and can communicate in multiple languages. Michael Thamm, CEO of the Costa Group said: "With an emotional robot on board our cruise ships we are once again continuing our tradition of innovation. For us, this is an important step towards a digital future for our brands. I am confident that our guests will love Pepper". This isn’t the first time we’ve seen robots on the high seas however. Royal Caribbean’s Quantum class of ships already feature robot bartenders and the line introduced robot dance shows at Cafe 270 on both Anthem and Quantum of the Seas. And while a robot greeting staff might not be everybody’s cup of tea, you have to agree that it’s a nice little novelty to add to Costa Cruises offering. And on the plus side you don’t have to worry about the robot greeters taking all the prawns away at the ship’s buffet at dinner. Related links: <a href="/travel/cruising/2015/12/po-newly-redesigned-cruise-ships/">Inside P&O’s newly-redesigned cruise ships</a> <a href="/travel/cruising/2015/11/cruising-to-venice/">Does cruising to Venice have a future?</a> <a href="/travel/cruising/2015/11/picturesque-ports-to-visit/">8 picturesque ports to visit</a>

Cruising

Why you need to appoint a power of attorney now

A power of attorney is just as important for life planning as making a will. Many people prepare a will but do not give the same consideration to appointing an attorney until it is too late. A power of attorney is a legal document appointing a person or trustee organisation of your choice to manage your financial and legal affairs while you are alive. By appointing an attorney, you give them the legal authority to look after your financial affairs on your behalf.There are a number of reasons to consider using a power of attorney including:<ul><li>It can free you of the day-to-day demands of financial paperwork and record keeping.</li><li>You may be going overseas or around Australia and don’t want to deal with your financial affairs while you’re away.</li><li>You become unwell or otherwise incapable to manage the demands of your financial affairs.</li></ul>How to make a power of attorney – The process is fairly straightforward. You must complete an appropriate form and have it witnessed by a legally valid witness. This person can be:<ul><li>A solicitor or barrister</li><li>A registrar of a local court</li><li>An appropriately qualified licensed conveyancer</li><li>An appropriately qualified employee of a public or private trustee company</li></ul>An ordinary power of attorney is only legal while you have capacity. If you want to make sure your attorney can still operate if you lose the capacity to self-manage, you will need to appoint an enduring power of attorney.Keep in mind too that a power of attorney only deals with financial and property matters and does not cover decisions about your lifestyle, medical treatment or welfare. These aspects are covered by an enduring guardianship.A power of attorney also ceases when you die. The executor named in your will then takes over the responsibility of administering your estate.It is important to choose your attorney carefully. You need to be able to trust this person and be assured that they understand your wishes, have the skills to manage your finances and will act in your best interests. Your attorney should have the business and financial capabilities to manage your affairs properly and be capable of keeping accurate records of all dealings and transactions they undertake on your behalf.Making a power of attorney does not mean that you will lose control over your financial affairs. It simply gives your attorney formal authority to manage your financial affairs according to your instructions. Your power of attorney can be cancelled or revoked at any time provided you have the capacity to do so.

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