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How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>A growing number of complaints against older doctors has prompted the Medical Board of Australia to <a href="https://www.medicalboard.gov.au/News/2024-08-07-Medical-Board-consults-on-new-approach-to-keep-late-career-doctors-in-safe-practice.aspx">announce</a> today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.</p> <p>The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.</p> <p>The second would require only general health checks for doctors over 70.</p> <p>A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx">professional code of conduct</a>, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.</p> <h2>Haven’t we moved on from set retirement ages?</h2> <p>It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “<a href="https://law.unimelb.edu.au/__data/assets/pdf_file/0019/2061019/02-Blackham.pdf">still valid in a modern society</a>”.</p> <p>However, unlike judges, doctors are already <a href="https://www.medicalboard.gov.au/Registration/Registration-Renewal.aspx">required to renew their registration</a> annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct <a href="https://www.ahpra.gov.au/Notifications/Further-information/Guides-and-fact-sheets/Performance-assessments.aspx">performance assessments</a> if and when they are needed.</p> <h2>What has prompted these proposals?</h2> <p>This latest <a href="https://www.ahpra.gov.au/documents/default.aspx?record=WD24%2f33840&amp;dbid=AP&amp;chksum=vCEdxXaBs0%2bMeMZFxSb7SQ%3d%3d&amp;_gl=1*3ol06k*_ga*MzU1NjAzMTc1LjE3MjMwMDA1Nzc.*_ga_F1G6LRCHZB*MTcyMzAwMDU3Ny4xLjEuMTcyMzAwMDU4My4wLjAuMA..">proposal</a> identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.</p> <p>Studies of medical competence in ageing doctors show <a href="https://qualitysafety.bmj.com/content/29/2/113">variable results</a>. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.</p> <p>The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.</p> <p>In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.</p> <p>In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.</p> <p>While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.</p> <p>It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.</p> <h2>So what distinguishes the two new proposed options?</h2> <p>The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.</p> <p>Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.</p> <p>Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.</p> <p>The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.</p> <p>In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.</p> <h2>The law tends to prioritise patient safety</h2> <p>All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/act/consol_act/hprnl428/s3a.html">That provision</a> basically says patient safety is paramount and trumps all other considerations.</p> <figure class="align-center zoomable"><figcaption></figcaption></figure> <p>As with legal <a href="https://legislation.nsw.gov.au/view/html/inforce/current/act-2010-104a#sec.3">regimes regulating childcare</a>, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.</p> <p>Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3383892">punished</a>” for errors in practice.</p> <p>All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.</p> <h2>Could these proposals amount to age discrimination?</h2> <p>It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.</p> <p>For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals <a href="https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/ada2004174/s22.html?context=1;query=inherent;mask_path=au/legis/cth/consol_act/ada2004174">who are</a> “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.</p> <p>In broader terms, a licence to practise medicine is often compared to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797044/">licence to drive</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236877/">pilot an aircraft</a>. Despite <a href="https://www.smh.com.au/national/nsw/mandatory-test-older-drivers-facing-discrimination-says-pensioner-group-20170607-gwm45u.html">claims of discrimination</a>, New South Wales law requires older drivers to undergo a medical assessment <a href="https://www.nsw.gov.au/driving-boating-and-transport/driver-and-rider-licences/older-drivers-and-riders/assessments">every year</a>; and similar requirements affect older <a href="https://www.google.com/url?sa=t&amp;source=web&amp;rct=j&amp;opi=89978449&amp;url=https://www.casa.gov.au/guidelines-medical-assessment-aviation&amp;ved=2ahUKEwil-9GXlOKHAxUdslYBHdN_EboQFnoECBkQAQ&amp;usg=AOvVaw0SgpoCCKjNriMN20fs16rq">pilots and air traffic controllers</a>.</p> <h2>Where to from here?</h2> <p>When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.</p> <p>How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, <a href="https://www1.racgp.org.au/newsgp/professional/ahpra-eyes-mandatory-health-checks-for-older-gps">others have suggested</a> this would only exacerbate shortages in the health-care workforce.</p> <p>The proposals are open for <a href="https://www.medicalboard.gov.au/News/Current-Consultations.aspx">public comment</a> until October 4.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/236305/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/christopher-rudge-108366">Christopher Rudge</a>, Law lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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/how-olds-too-old-to-be-a-doctor-why-gps-and-surgeons-over-70-may-need-a-health-check-to-practise-236305">original article</a>.</em></p> </div>

Body

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Plastic surgeon called out for “toxic” video

<p dir="ltr">A beautician has been slammed for a video she posted online outlining the cosmetic surgery she thought a star of Stranger Things would need.</p> <p dir="ltr">Miranda Wilson, who describes herself as a nurse practitioner injector, posted a video on TikTok outlining the alterations she believed would enhance the look of actress Natalia Dyer.</p> <p dir="ltr">“We’d start by treating those masseters … to help slim the face,” Ms Wilson said, referring to Dyer’s prominent bottom jawline.</p> <p dir="ltr">She then recommended adding “a bit of chin filler just to help fill out her chin and make her face more of a heart shape”.</p> <p dir="ltr">Moving onto Dyer’s lip and brow area, Wilson said she would “add just a little bit to the lips” than “do a little Botox (to) give her a nice brow lift to help open up her eyes”.</p> <p dir="ltr">“And to top if off we’d start with some Sculptra, she does seem to have more thin skin and we want to prevent that from getting thinner and create more collagen,” Wilson said.</p> <p><span id="docs-internal-guid-9149ad08-7fff-bb3b-fff3-0b07f1571f97"></span></p> <p dir="ltr">She ended the clip with a “before and after” image of Dyer, where she complimented the actress’ slimmer jaw, pointy chin, lifted brows and pouty lips.</p> <p dir="ltr"><img src="https://oversixtydev.blob.core.windows.net/media/2022/07/tiktok-beauty2.jpg" alt="" width="1280" height="720" /></p> <p dir="ltr">However, her assessment drew large amounts of ire from viewers, who described the clip as “toxic” and “highly insulting”, with one commenter arguing that videos like hers were “one of the reasons girls today are so insecure”.</p> <p dir="ltr">Though she has since deleted the video, download copies have been uploaded and shared on other social media platforms, including Twitter, where the uproar continued.</p> <p dir="ltr">“Still can’t believe a plastic surgeon (sic) spoke on what she’d change about someone’s face without a) their consent, b) any indication that the person disliked those features and c) putting a disclaimer that the person is already beautiful as they are,” one Twitter user said.</p> <p dir="ltr">“Like I cannot believe she ‘influencerfied’ her face completely unprovoked as if it was a free consultation.”</p> <p dir="ltr">After the backlash, Wilson posted a follow-up video saying she wanted to “clear the air”, adding that she “didn’t mean to offend anyone” in the controversial clip.</p> <p dir="ltr">“I was simply offering suggestions – not on what you have to do – just on what the possibilities are,” Wilson said.</p> <p dir="ltr"><span id="docs-internal-guid-0ddeb030-7fff-db78-228d-a6f65798aa52"></span></p> <p dir="ltr">“As an advanced injector that is what we do – we look at faces and assess and look at the possibilities.”</p> <p dir="ltr"><img src="https://oversixtydev.blob.core.windows.net/media/2022/07/tiktok-beauty-1.jpg" alt="" width="1280" height="720" /></p> <p dir="ltr">She then took a photo of herself and suggested improvements, such as botox injectables, lip and cheek fillers, and a brow lift, sharing another “before and after” image and writing in the caption that “Natalia is absolutely stunning the way she is” but that her image was just an “example”.</p> <p dir="ltr">Though comments were disabled on her later video, upset viewers took to Twitter to call out her behaviour.</p> <p dir="ltr">“She posted a sorry, not sorry video where she completely missed the point of what the original complaint was,” one Twitter user said.</p> <p dir="ltr">Another questioned who Wilson’s target audience was and pondered the impact such views would have on young women.</p> <p dir="ltr">“If Natalia Dyer, a white and thin and conventional woman gets scrutinised on her appearance like this, what happens to all the young impressionable poc/mid-size/plus-size girls watching?”, they wrote.</p> <p dir="ltr"><span id="docs-internal-guid-a74d389f-7fff-ff36-d394-0b51934b7163"></span></p> <p dir="ltr"><em>Images: TikTok</em></p>

Beauty & Style

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Brain surgeon claims he saw the afterlife while in a coma

<p>An academic neurosurgeon has recalled the "life-changing" near-death experience he claims he had while deep in a coma as his brain was ravaged by a rare bacterial infection.</p> <p>Dr. Eben Alexander told The Sun that before his near-death experience (NDE), his many years as a doctor made him skeptical at the idea of an afterlife, rather believing that our consciousness dies at the same time as our bodies.</p> <p>However, after his "life-changing" and "profound" NDE, the 68-year-old has experienced a "180-degree flip" in his belief system, claiming to have seen heaven with his own eyes, calling it more real and alive than the realm we currently inhabit.</p> <p>“I basically used to have a very conventional, scientific and reductive materialist view that consciousness was created by the brain, and that only the physical world exists,” Dr Alexander said.</p> <p>“And what my coma journey showed me … is that consciousness is something that is fundamental in the universe and does not originate in the brain."</p> <p>“What I experienced was the most extraordinary, memorable, detailed, and ultra-real experience of my entire life,” Alexander continued.</p> <p>“In fact, the world we live in, this material world, is more kind of cloudy and dreamlike than what I saw on the other side."</p> <p>“That world is sharp, crisp and alive – and very real.”</p> <p>On the morning of November 10, 2008, Dr Alexander woke up with severe pains in his back and what he described as "the worst headache of his life".</p> <p>After being transported to Lynchburg General Hospital, where he worked as a neurosurgeon, he discovered he had contracted an incredibly rare and aggressive form of E. coli meningoencephalitis, which had started to gnaw away at his brain.</p> <p>He was hastily placed in an induced coma and onto a ventilator, with his chances of survival diminishing by the hour.</p> <p>According to Dr Alexander, his medical records show that his brain was "very badly damaged", with his brainstem also in "deep trouble".</p> <p>As his chance of survival dipped to just 10 percent, loved ones gathered by his bedside, and although it seemed his grip on life was loosening, he insists his spirit had travelled to another realm in which he was experiencing a “re-birth”.</p> <p>“People think going through this experience, in this state of almost amnesia, must’ve been very horrific,” he told The Sun, “and yet, I knew nothing else as a possibility, and therefore, to me, it all just seemed natural."</p> <p>“This was existence. There was nothing foreboding about it."</p> <p>Dr Alexander claims he was in a dream-like forest with plush clouds, tall trees, sweeping valleys and groups of joyous people dancing.</p> <p>He says he spoke telepathically with a woman who told him, “You are loved. You are cherished. There is nothing you can do wrong.”</p> <p>His peace in this heavenly realm was soon interrupted as he was thrown into an infinite depth and darkness before waking up.</p> <p>As he regained his consciousness, he started to think he had truly glimpsed the afterlife.</p> <p>“Those memories of that kind of [infinite depth] psychotic nightmare disappeared within a week or two, compared to memories of the deep coma experience, which was sharp, crisp, vivid, alive and detailed today, as if the whole thing just happened."</p> <p>“As more than half of people who’ve had an NDE will tell you, it’s a much more real existence than this existence in the material world.”</p> <p><em>Image: Getty Images</em></p>

Mind

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Cancer surgeon writes his own joke-filled obituary before dying

<p><span style="font-weight: 400;">A US surgeon has jumped the gun and written a quirky obituary about himself before he died at 48.</span></p> <p><span style="font-weight: 400;">Dr Thomas Lee Flanagan passed on April 27, but his cause of death is not publicly known.</span></p> <p><span style="font-weight: 400;">In a post published on </span><a rel="noopener" href="https://www.legacy.com/obituaries/toledoblade/obituary.aspx?n=thomas-lee-flanigan&amp;pid=198520306&amp;fbclid=IwAR08jHG4hN-UFNjxvslLCmYy1YpR-XK5gFKXnFVh5LEzQX7epBPWJglLDss" target="_blank"><span style="font-weight: 400;">Legacy.com</span></a><span style="font-weight: 400;"> - a website dedicated to obituaries - he jokingly described himself as the “Ginger God of Surgery and Shenanigans”.</span></p> <p><span style="font-weight: 400;">“Yes, I have joined the likes of Princess Diana, John Belushi, and Steve Irwin the Crocodile Hunter in leaving while still at the top of my game as an iconic superhero who seemed almost too good to be true,” he wrote.</span></p> <p><span style="font-weight: 400;">According to the post, the army veteran and father of three said he married his wife Amy so he could make husband jokes, then had three children so he could make Dad jokes.</span></p> <p><span style="font-weight: 400;">“It did not disappoint,” he wrote.</span></p> <p><span style="font-weight: 400;">“The jokes I mean, but Amy and the kids were pretty good too.”</span></p> <p><span style="font-weight: 400;">Flanagan writes that his time “was magical” and “saw some other delightful things in my time here - Hawaiian volcanoes, Egyptian pyramids, and even the advent of air fryers.”</span></p> <p><span style="font-weight: 400;">Though he “dabbled” in a few things, including serving his country in the army and saving lives as a surgeon and MD, his real legacy is the bad Dad jokes and Facebook memes he’ll leave behind.</span></p> <p><span style="font-weight: 400;">“What was I to this world if not a beacon of light shining upon those who couldn’t scan the internet for their own hilarious and entertaining comic relief?” he wrote.</span></p> <p><span style="font-weight: 400;">“I guess what I am trying to say is that you’re welcome and you owe me big time.”</span></p> <p><span style="font-weight: 400;">He ends his obituary announcing he is riding off into the sunset “after re-enlisting with a new unit.”</span></p> <p><span style="font-weight: 400;">He continued, “Due to the unknown and cosmic nature of my next mission, this will be our last communication. It will self-destruct in five minutes.”</span></p> <p><span style="font-weight: 400;">Though his whereabouts “are now top secret” he has made new friends called Elvis and Kenny.</span></p> <p><span style="font-weight: 400;">“The Church of Tom is closed for business, but please continue to worship me, light candles, and send money. You know the deal,” the obituary read.</span></p> <p><span style="font-weight: 400;">Tributes to Flanagan also flooded in on the online condolence page.</span></p> <p><span style="font-weight: 400;">“You meant so very much to me. The world is dimmer without you in it,” a former patient wrote.</span></p>

Caring

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“Let’s get our facts straight”: Surgeon’s tense clash with Georgie Gardner

<p>One of Australia’s most acclaimed and reputable medics, neurosurgeon Charlie Teo has come face to face with Georgie Gardner in a tense interview on the<span> </span><em>Today<span> </span></em>show this morning.</p> <p>He appeared on the show to set the record straight, after users on Twitter criticised Dr Teo for his hefty costs forcing many of his patients to use crowdfunding services so they can afford the surgery.</p> <p>Gardner started off the interview by quoting Henry Woo, a professor from the University of Sydney, who was the catalyst of the social media storm that erupted.</p> <p>Prof Woo tweeted: “Something is seriously wrong if a terminally ill girl with a brain tumour has to raise $130,000 to have surgery Dr Charlie Teo has offered to do for $60-80,000.”</p> <p>Gardner then began her line of questioning as she asked the doctor to provide answers as to why his life changing surgery is not covered by Medicare and the public hospital system.</p> <p>However, the interview took a drastic turn as Dr Teo took the reigns and told Gardner to get her “facts straight”. He then went into detail about where the money goes.</p> <blockquote class="twitter-tweet tw-align-center" data-lang="en-gb"> <p dir="ltr">Dr Charlie Teo defends the high cost of his procedures, instead putting the onus on other neurosurgeons who won't swallow their egos and says "I would do it free of charge" if Australia's healthcare system covered the costs. <a href="https://twitter.com/hashtag/9Today?src=hash&amp;ref_src=twsrc%5Etfw">#9Today</a> <a href="https://t.co/mwjmuMU8Se">pic.twitter.com/mwjmuMU8Se</a></p> — The Today Show (@TheTodayShow) <a href="https://twitter.com/TheTodayShow/status/1133489260051410944?ref_src=twsrc%5Etfw">28 May 2019</a></blockquote> <p>“Let’s get our facts straight first,” he said. “The fact is, although some patients do have to pay over $100,000, that doesn’t all go to the surgeon or even the team.</p> <p>“It is in a private hospital, which is accounting to their shareholders. They have to make a profit.</p> <p>“So, for example, that $120,000 bill that Henry Woo is talking about, $80,000 to the private hospital. $40,000 then gets dispersed among not only the surgeon, the assistant, anaesthetist, pathologist, radiologist, radiographer.</p> <p>“It is not that great an amount to each individual person, when you get your facts straight …”</p> <p>Carrying on, Gardner then pressed into how much Dr Teo would receive after completing the surgery.</p> <blockquote class="twitter-tweet tw-align-center" data-lang="en-gb"> <p dir="ltr">Something is seriously wrong if a terminally ill girl with a brain tumour has to raise $120K to have surgery Dr Charlie Teo has offered to do for $60-80K. <br />If it was valid surgery, it could/should be performed in the public system under Medicare <a href="https://twitter.com/hashtag/auspol?src=hash&amp;ref_src=twsrc%5Etfw">#auspol</a> <a href="https://t.co/8s7L5mcuAZ">https://t.co/8s7L5mcuAZ</a></p> — Henry Woo (@DrHWoo) <a href="https://twitter.com/DrHWoo/status/1131808554254458880?ref_src=twsrc%5Etfw">24 May 2019</a></blockquote> <p>“I got $8000,” he said. “But it is really not the total amount that each person gets. It is really the fact that people do have to pay for their private healthcare.</p> <p>“It is a little bit unfair. If I was a child with cancer and in a foreign state who wants the very best care, I think you should be able to be done in the public system.</p> <p>“But unfortunately, if you are done in the public system a few people have swallowed their egos.”</p> <p>He claimed that a “centre of excellence” can operate on patients from interstate free of charge in the public system.</p> <p>“But, to be called a centre of excellence you need at least three or four neurosurgeons to say that, that doctor is doing something different to us and that is not going to happen,” he said.</p> <p>The neurosurgeon also revealed how he offers surgery at no cost to the patient if they are unable to cover the sum or don’t have private health insurance.</p> <p>“They have two options,” he said. “They come to the private system in NSW and get done privately where they have to pay.</p> <p>“Or I say to them, ‘Listen, if you can get your neurosurgeon from your state to invite me to your hospital, I will operate free of charge in the public system with benefits not only to you but will benefit hopefully the whole neurosurgical community where they can learn my techniques’. Have I ever been taken off on that offer? Never.</p> <p>“All they need to do is swallow their ego.”</p> <p>According to Dr Teo, it’s that same ego that started the fiery Twitter feud.</p> <p> “The whole Twitter thing is all about trying to destroy or discredit my reputation,” he said. “I would say to that person, ‘Listen, there is a lot better things to do we should be doing as doctors rather than trolling through websites looking for ways to discredit a colleague’.</p> <p>“Get back to your lab, try and find a cure for prostate cancer. I will try and find a cure for brain cancer, thank you.”</p> <p>Dr John Quinn, the TACS executive director of surgical affairs said that patients should not have to resort to crowdfunding to be able to afford treatments.</p> <p>"The College of Surgeons is not in favour of patients funding treatments by GoFundMe or other means like re-mortgaging their homes and accessing funds from their superannuation," he said.</p> <p>"If urgent treatment is required, all of these treatments are available in a public hospital at no cost.</p>

Caring

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10 secrets surgeons won’t tell you

<p>Surgeons have our lives in their hands, but most of us know more about the people who cut our hair than the doctors who cut our bodies. Here, insider tips to become a smarter, healthier patient.</p> <p><strong>1. To know which doctor is good, ask hospital employees</strong></p> <p>“Their word trumps a degree, prestigious titles, and charm.” - Marty Makary, MD, author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionise Health Care.</p> <p><strong>2. Ask about their complication rate</strong></p> <p>“If they don’t have one, they’re hiding something or haven’t operated enough to have one. No one is immune to complications.” - Arnold Advincula, MD, division chief, gynecologic surgery &amp; urogynecology, Columbia University Medical Centre.</p> <p><strong>3. Surgeons have an inherent financial conflict of interest</strong></p> <p>“That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively.” - James Rickert, MD, an orthopedic surgeon in Bedford, Indiana.</p> <p><strong>4. Are they board certified?</strong></p> <p>“For the same reason, always check if your surgeon is board-certified in his specialty. Many are not.” - Tomas A. Salerno, MD, chief of cardiothoracic surgery at the University of Miami Miller School of Medicine.</p> <p><strong>5. Don’t assume your doctor’s recommendation is best</strong></p> <p>“Referrals may be politically motivated or be given because the doctors work within the same multi-specialty group.” - Howard Luks, MD, chief of sports medicine and arthroscopy at Westchester Medical Center and University Orthopaedics.</p> <p><strong>6. Ask if you can talk to former patients</strong></p> <p>“It’s like getting references for a babysitter.” - Marc Gillinov, MD, author of Heart 411: The Only Guide to Heart Health You’ll Ever Need.</p> <p><strong>7. Some won’t mention procedures they don’t know how to do</strong></p> <p>“I’ll see patients who were told they needed an open hysterectomy, even though it could be handled laparoscopically. That’s one reason it’s good to get a second opinion.” - Arnold Advincula, MD</p> <p><strong>8. Find out who is going to take care of you after surgery</strong></p> <p>“You want to hear ‘I will see you on a regular basis until you have recovered fully.’ Often it can be residents or physician’s assistants. Sometimes it’s not anybody, especially after you’ve been discharged from the hospital.” - Ezriel “Ed” Kornel, MD, clinical assistant professor of neurological surgery at Cornell University.</p> <p><strong>9. It’s better to have an elective surgery early in the week</strong></p> <p>“Lots of doctors go away for the weekend and won’t be around to make sure you’re OK. If you go in on a Friday, and then on Saturday or Sunday something icky is coming out of your incision, you’re going to get someone who’s covering for your surgeon.” - General surgeon who blogs under the name Skeptical Scalpel</p> <p><strong>10. Some hire business management consultants</strong></p> <p>“The consultants may want the practice to sell equipment like knee braces or walkers at a markup. They may want the doctors to buy or build a surgery centre to capture facility fees. They usually want orthopedic surgeons to get an in-office MRI. Every time a doctor does this, he becomes more financially conflicted. As soon as you put in an MRI machine, you order more MRIs so you won’t lose money on it.” —James Rickert, MD</p> <p><em>Written by Michelle Crouch. This article first appeared in </em><a href="http://www.readersdigest.com.au/healthsmart/tips/48-secrets-surgeons-wont-tell-you?items_per_page=All"><em>Reader’s Digest</em>.</a><em> For more of what you love from the world’s best-loved magazine, </em><a href="http://readersdigest.innovations.com.au/c/readersdigestemailsubscribe?utm_source=over60&amp;utm_medium=articles&amp;utm_campaign=RDSUB&amp;keycode=WRA87V"><em>here’s our best subscription offer.</em></a> </p> <p><img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" /></p>

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Top UK surgeon says Ugg boots are responsible for ruining knees

<p><span>A British surgeon has warned that popular Ugg boots can cause serious knee injuries.</span></p> <p><span>Ian McDermott explained that the fleece-lined shoes don’t offer enough support and could cause “knock-kneed” stance.</span></p> <p><span>The London based-knee surgeon said he did not specifically have an issue with Ugg boots but with any soft boot, due to the lack of support it gives the wearer.</span></p> <p><span>He said the boot can lead to bad posture, knee pain and even back pain, which could require surgery to fix.</span></p> <p><span>“Sheepskin boots and high heels may look great, but vanity may come at the cost of potential physical damage to your body,” Mr McDermott told </span><em><span>The Sun</span></em><span>.</span></p> <p><span>“Unsculpted and flimsy footwear can mean that your feet aren’t fixed in one location as you walk, meaning that the lower limb is working harder, with a greater risk of damage.</span></p> <p><span>“Listen to your body and make sure to not wear flimsy boots every day," McDermott added.</span></p> <p><span>“If someone born with an inherently poor structure or with poor alignment then wears a poorly supported pair of shoes or boots, this can exacerbate the whole issue and this can then end up being the final straw that pushes them into developing symptoms and actual orthopedic problems.”</span></p> <p><span>An Ugg spokesman told </span><em><span>The Sun</span></em><span>, “UGG is the leader in premium sheepskin footwear. The UGG Classic boot provides the full experience of warmth, comfort and flexibility.”</span></p> <p><span>“The Classic II is lighter weight for increased wearability and offers added innovative enhancements, such as Treadlite by UGG outsole technology for increased traction, durability and cushioning."</span></p> <p><span>The spokesman added, “As with any shoe, we encourage customers to ensure the proper fit for maximum comfort.”</span></p> <p><span>Sydney-based podiatric musculoskeletal physician Michael Kinchington confirmed that it is important to wear supportive shoes.</span></p> <p><span>“My take on it is that [he] is basically saying ‘wear supportive shoes’ ... that if you wear footwear that is soft, unstable and not supportive and if you have postural issues then you are likely to be injured and exacerbate other conditions — I think that is a fair comment,” he told news.com.au</span><em><span>.</span></em></p> <p><span>“What I would add is that there is no harm in wearing a soft comfortable warm Ugg boot-style shoe, but use it for short periods of time. Wear it as a comfy house shoe, wear it for no more than 30 minutes of casual shopping mall walking.”</span></p> <p><span>Mr Kinchington also warned Aussies to be careful of another popular footwear as we approach summer.</span></p> <p><span>“In Australia, moving into the summer season, the use of non-supportive thongs which provides no support and very little in the way of comfort will cause more problems probably than an Ugg boot," he said.</span></p> <p><span>“If you are going to wear [thongs], then you need something with a bit of arch support in it.</span></p> <p><span>“There’s a product called Ozify Australia that actually has that support."</span></p> <p><span>Are you a fan of wearing Ugg boots in winter and thongs in summer? Tell us in the comments below. </span></p>

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Orthopaedic surgeons overcharging patients by thousands

<p>Medibank report has found some orthopaedic surgeons are overcharging patients by thousands of dollars, stressing the importance of shopping around for the best price.</p> <p>The report highlighted the shocking disparity in surgeon fees across Australia when out-of-pocket fees, complication rates and expertise are taken into account.</p> <p>The study found the average cost of a hip replacement varied by more than $20,000, while the average costs for knee replacements ranged from $17,797 to $30,285 and knee anterior cruciate ligament (ACL) repair ranged from $5076 to $13,950.</p> <p>Medibank chief medical officer Dr Linda Swan said this report was a sign patients and their referring GPs really should do their research before settling on surgeon.</p> <p>"There is a lot more to selecting a doctor than taking the first person that is recommended to you," Dr Swan said.</p> <p>"(Cost) should be part of the referral process. They should be asking questions like 'What is the expertise of this doctor?', 'How many procedures have they done?', 'What costs will I incur?', 'What hospitals will this doctor be able to walk right into?' "</p> <p>Dr Swan also argued the report should be seen as a prompt for health authorities to start investigating the disparities in price, and the forces driving this.</p> <p>"When we see large amounts of variation, then somewhere along the line something may not be working well... whether it's waste, or not having the appropriate standards of even errors in the health system.</p> <p>"It really should cause people to stop and ask questions."</p> <p>Royal Australasian College of Surgeons (RACS) president John Batten added, “"This is about looking at the quality of care in the system and how we can use these reports as an educative process: where there are surgeons that are outliers, how can they improve their practice in line with their peers?</p> <p>"We are committed to continuous improvement in clinical practice in Australia."</p> <p>What are your thoughts? Do you think we’re being taken to the cleaners by surgeons?</p>

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A colorectal surgeon on why over-60s need to screen for bowel cancer

<p><em><strong>Dr Andrew Luck is the colorectal surgeon at the Lyell McEwin Hospital in Adelaide. He is a member of the Colorectal Surgical Society of Australia and New Zealand, and is a Board Member of bowel cancer prevention charity, The Jodi Lee Foundation.</strong></em></p> <p><img src="data:image/jpeg;base64,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" alt="Image result for Dr Andrew Luck jodi lee" class="rg_i" style="width: 169px; height: 192px; margin-left: 0px; margin-right: 0px; margin-top: 0px; float: left;"/>Australia has one of the highest rates of bowel cancer in the world. It’s a devastating disease, impacting far too many people in the community. As a colorectal surgeon I deal with all complaints related to the bowel, but have a special interest in the prevention and management of bowel cancer. I have been a Board Member of bowel cancer prevention charity, The Jodi Lee Foundation, since 2012 and am Chairman of its Medical Advisory Committee.</p> <p>Bowel cancer awareness is definitely on the rise and groups like The Jodi Lee Foundation are making an impact. They spread the word about bowel cancer, and more importantly that it can be prevented or cured if found early enough. It’s becoming a less taboo subject, meaning that people are more comfortable talking about it.</p> <p>People who are over 60 years of age are at a higher risk of bowel cancer than younger people. In fact, risk increases sharply and progressively from age 50. Early detection is vital to the outcome. Despite all of our modern treatments such as surgery, radiotherapy and chemotherapy, about 30 percent of people who get bowel cancer die from it, and it’s usually an awful demise, involving considerable pain and suffering.</p> <p>Bowel cancer often has no symptoms until the cancer had advanced or spread, which is why screening with the home test is essential to detecting it early. The test identifies small amounts of blood in the faeces. If a person returns a positive test, a colonoscopy is then needed to find out the cause of the bleeding. If it was due to a polyp (40 per cent of the time) and the polyp can be removed, then a bowel cancer may have been prevented. If it is due to a cancer that is already present (two per cent of the time) then the likelihood is that there will be a better outcome than if the cancer was found later, when symptoms showed.</p> <p>A patient with Stage I bowel cancer will need an operation, but has a 95 per cent chance of being alive and well in five years’ time. A Stage III diagnosis, where lymph nodes are affected, means that six months of chemotherapy is required, and the five year survival rate is around 50 – 60 per cent. A Stage IV diagnosis, which means the cancer has spread to other major organs such as the liver or lungs, is rarely curable, and has a five year survival rate of less than 10 per cent.</p> <p>It’s frustrating that people are choosing not to screen, despite the National Bowel Cancer Screening Program (NBCSP) providing free kits to a number of age groups from age 50. The simple test has the potential to save a many lives.</p> <p>The NBCSP is still several years away from being fully implemented to provide free kits every two years. All of the statistics show a benefit for these tests if they’re taken at least every two years, so it is vital that people do a test from the doctor or the chemist in the in between years.</p> <p>I urge everyone to take the home screening test regularly. You don’t want to experience what many of my patients and their families have endured.</p> <p><em>For more information about preventing bowel cancer, please visit <a href="http://www.jodileefoundation.org.au" target="_blank"><span style="text-decoration: underline;"><strong>The Jodie Lee Foundation</strong></span></a>. </em></p> <p><strong>Related links:</strong></p> <p><span style="text-decoration: underline;"><em><strong><a href="/health/body/2016/06/bowel-cancer-screening-kit-saved-my-life/">The bowel cancer screening kit saved my life</a></strong></em></span></p> <p><span style="text-decoration: underline;"><em><strong><a href="/health/body/2016/05/nick-lee-on-why-he-started-the-jodi-lee-foundation/">What I did after my wife passed away from bowel cancer</a></strong></em></span></p> <p><span style="text-decoration: underline;"><em><strong><a href="/news/news/2015/07/bowel-cancer-test-kits-thrown-away/">Majority of bowel cancer screening kits thrown away</a></strong></em></span></p>

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