EDITOR As a former member of the AMA Council of General Practice I wish to express my feelings of regret that Prue Power has left the AMA (AMA cutback could impair GP voice, 13 June).
Prue tried very hard to find a way forward for general practice despite the dysfunction inherent in the AMACGP process.
I would like to personally and publicly thank Prue on behalf of general practice for the effort she put in, often against the odds.
Now general practice must face the reality that again questions must be asked:
Does the AMA represent what is best for GPs?
Is the planned cutback in AMACGP sitting times symptomatic of a reduced effort by the AMA for GPs?
Will the AMA ever really represent grass roots GPs?
Dr Scott Blackwell, Scarborough, WA
Pill puzzle
EDITOR I don't understand the logic behind the decision to make the morning-after pill available over the counter at pharmacies.
Is it to reduce the pregnancy rate? If we look at New Zealand, where Postinor-2 was made available on prescription from mid-2001, the abortion rate for the year 2001/02 increased by 8% in the teenage population. The figures for 2002/03 have not been published. They will be able to tell us whether Postinor-2 is effective in reducing the abortion rate.
Is it because this medicine
is good for our patients?
Postinor-2 (2 x 750µg of levo-norgestrel) is equivalent to 50 mini pills (30µg of levo-norgestrel) taken in a 24-hour period. Far from being good for our patients, it could cause depression, nausea, and all the signs and symptoms of PMT, only greatly magnified.
If the woman is already pregnant, given at a particular time, Postinor-2 can cause the virilisation of a female fetus. The UK experience of Postinor-2 has found an increased incidence of ectopic pregnancy.
Part of our job, as GPs, is to exclude pregnancy, and discuss measures to prevent transmission of STDs and future alternative methods of birth control before prescribing Postinor-2.
Are the pharmacists and their insurers happy to take on this role? I would think the questions we would be asking our patients in this situation might be awkward in a busy pharmacy.
Do we think oral contraceptives should be made available to the public over the counter? When I have seen patients requesting emergency contraception, I have discovered on careful questioning a large number have sometimes taken several doses of Postinor-2 in the one cycle. We don't know what these doses of levonorgestrel are going to do to women, nor their future offspring.
We are in the business of first doing no harm and not experimenting on our patients. What effect will the increased availability of Postinor-2 have on Australian women?
Dr Antonia Turnbull, Glynde, SA
Proven program
EDITOR The news item 'Acting on their own behalf' (News Briefs, 27 June) suggests the National Aboriginal Community Controlled Health Organisation (NACCHO) is unaware of the successful Aboriginal-developed,
-owned and -run program (based on Griffith University's Self Helping Health Care Program) that applied to multiple Aboriginal centres in Queensland from 1980 to 1989, until "killed off" by the Goss Labor Government.
In the 10 years that it ran and was evaluated, it reduced every marker of poor Aboriginal health and was hailed as a major step forward.
Perhaps NACCHO needs to reactivate a proven "wheel" rather than try to invent a new one? (My own use of the same program, and reference to the Aboriginal version, is described in Australian Family Physician 1987, volume 16, pages 1682-85, available on PubMed).
Dr A Breck McKay, Carina, Qld
Nutty squirrel
EDITOR The squirrel who oversaw the initial diabetes incentive debacle when we were paid but couldn't reconcile our books for many months is again having troubles with his nuts.
A diabetes review 12 months later is not payable if the consult is 1-2 days before the previous date. Meanwhile, the patient has returned in good faith for a review in that 12th month.
Now it is not only the doctors but also the patients who are wondering what the squirrel is doing with his nuts.
Goodbye service incentive payments -- let's cut the red tape, not waste time on problems with accounting, and get back to putting this money into rebates.
Dr Anthony Templer, Lilydale, Vic
House of cards
EDITOR In an effort to resolve the endless difficulties with entitlements and cards, I would suggest the Federal Government give everyone a pension card and withdraw the Medicare card. I think the cards should be colour-coded and if you don't agree with your colour, you have the right to challenge it.
All doctors, both GPs and specialists (we might consider them at least similar), could use the colour code to readily calculate any gaps payable. Patients would still doctor shop and chemist hop. The market would determine survival and access would be universal. No doubt the bureaucracy would treble in size and Canberra would house Australia's highest per capita income.
Dr Alexander Douglas, Nerang, Qld
In praise of PIP
EDITOR The practice incentives program is facing the chopping block ('PIP faces the chopping block', 20 June) because it causes red tape?
I have filled out about half-a-dozen forms in six years. The computer program produces all the registers. The nurses use the computers to recall diabetes patients, check on their cycle of care and recall women for Pap smears.
In terms of enhanced primary care, the nurses do our aged-care assessments and prepare care plans (which the GP reviews, modifies and signs off) for the diabetic patients. Nurses run the childhood immunisation recall system and give the immunisations. We even get PIP for having nurses now.
Good general practice is as much about good organisation as it is good medicine. I see the PIP as compensation for being well organised. PIP does not increase red tape in our practice.
Dr Steven Rudolphy, Mt Sheridan, Qld
Deeply offended
EDITOR Racism has no place in modern Australia, so I was shocked to read the deeply offensive, racist remark made in The Whitten Word (Australian Doctor, 23 May): "While I hate the Brits as much as any other red-blooded Australian ... "
Try substituting "Brits" with Aborigines, blacks, Jews, Chinese, etc and read that sentence again!
It is no more acceptable to make chauvinistic remarks against the British than it is against any other group.
Submit your feedback here: