EDITOR I completely agree with everything Australian Doctor medical editor Dr Kerri Parnell says. She is fantastic ... except when she is wrong. And she is wrong on the issue of diversity in general practice (‘Let’s celebrate the diversity of GP ‘doers’ and ‘talkers’’, Gut Feelings, 22 October).
General practice has become so diverse there are no GPs left. We have too many Indians and no bloody chiefs. It is all very well having doctors who do acupuncture on Wednesdays, doctors who do skin cancer clinics until 3pm and doctors who write heart-warming stories for medical journals .... but who is going to drive the bus?
We need less diversity and more bread-and-butter GPs who will just roll up their sleeves and do the job. Part of doing the job is running a practice. If most doctors just want to do a few sessions here and there, the only people left to run the show will be Kmart and Woollies.
General practice is an exciting, demanding and rewarding job. It is a full-time job that requires 100% commitment. Some people may wish to dabble in a bit of general practice while they are on their way to some other passionate interest, but that is cold comfort to the patient who calls on Sunday with a sick kid.
I say if you want to be an archaeologist, astrophysicist or author, then study the arts. Why not leave the medical degree to the many young Australians who really have a vocation want to own this wonderful job and accept the commitment that it requires?
Dr George Quittner
Mosman, NSW
INSULTING AD
EDITOR Maybe it was just a bad week, or maybe it was seeing a woman who had lost two children in a house fire, but tonight the advertisment for Pravachol, featuring Roy Orbison, annoyed me even more than it usually does.
This tragic man lost his two little children to a house fire, and, if I remember correctly, his wife to a road accident. It is an insult to him, and to us as a profession, that we allow advertising to trawl such depths.
Dr Carole Hungerford
Bathurst, NSW
SKIN WARS
EDITOR Skin cancer clinics have been in operation for more than 15 years (‘Warning advised on ‘specialist’ skin cancer clinics’, 22 October). In the early days they were run by solo GPs with a special interest in sun-induced malignancies. Since this time, a lot of work has been relieved from the dermatology community and this has created a lot of financial friction. This friction is worse now that entrepreneurial corporates are in the game.
I have witnessed good and bad practices in skin cancer clinics. The bad ones are usually entrepreneurial — doing biopsies willy-nilly to make a buck, with some doing nothing but excisions and others without even a diathermy machine.
But let’s be fair — some dermatologists are no different to these skin cancer GPs. Some charge Medicare for removing skin cancers based on ‘specialist opinion’ (and as we all know, even in very good hands, basal cell carcinomas can only be reliably diagnosed in up to three-quarters of the time on clinical grounds alone), some do three-monthly reviews on low-risk patients and some don’t even know how to hold a scalpel.
At our small private clinic we do everything that closed-shop dermatology training would equip their trainees to do — and as such our existence is not a threat but a highly regarded service to the community, GPs and specialists in our area, and, dare I say, the HIC.
And in a decade of providing quality services we have never been sued.
But the point is this: we should stop this turf war, and instead help one another to enhance our patient care.
Dr Dai Tran
Parramatta, NSW
COX-2 CONCERN
EDITOR The voluntary withdrawal of rofecoxib (Vioxx) from the market because of cardiovascular side effects has caused concern about other drugs in the same class of COX-2 inhibitors, despite extensive data to suggest the effect was specific to rofecoxib.
It is important to note that celecoxib has an approximately 50% safer GI profile than NSAIDs, without any evidence of the cardiac side effects that were seen with rofecoxib over a similar period of observation.
Furthermore, there is a potential cost issue. Celecoxib was at least as good, if not better, than diclofenac plus omeprazole in a randomised, double-blind six-month treatment trial involving arthritis patients with a high risk of GI adverse events. While a message from this paper is that a COX-2 alone is at least as effective as NSAID plus omeprazole, the cost issue remains ‘potential’ because neither treatment arm was particularly good at preventing ulcer recurrence or bleeding in this high-risk group of patients, many of whom were on low-dose aspirin. Clinical trial data are needed on celecoxib plus a proton-pump inhibitor versus celecoxib plus placebo, in this high-risk patient group.
Dr Timothy Florin
Director of gastroenterology
Mater Health Services’ Adult Hospital;
Associate professor of medicine
University of Queensland
Chan, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: Results of a randomized double-blind trial. Gastroenterology, 2004; 127(4):1038-43.
‘CAN DO’ HORROR
EDITOR The appointment of Ms Kate Carnell as ADGP CEO is astonishing. The article ‘One helluva ride’ (News Review, 15 October) paints a rosy picture of a disgraced politician. Her record in public office reads like a fiscal horror story, and it’s time GPs are made aware of her murky past.
This former ACT Chief Minister and Treasurer was forced to resign from office for financial mismanagement. The self-promoting, freewheeling ‘Can do’ Kate faced a no-confidence motion in the ACT Legislative Assembly for a massive taxpayer-funded blow-out in expenditure on the redevelopment of Canberra Stadium.
The Auditor General’s report, which was generally scathing, concluded that some of her actions were not lawful. Add to that, the Canberra Hospital implosion tragedy and her grandiose plans for V8 supercars taking over Canberra (with millions of dollars sucked out of the ACT taxpayers’ purse), among other things.
So, rather than the knackery, after a failed attempt to gain election to the Senate in 2002, Ms Carnell finds herself a plum job as chairwoman of General Practice Education and Training.
And now chairwoman of the ADGP — like the ADGP, with its recent financial debacle, really needs someone with her track record. Oh, and only part time, too. And I forgot to mention, ‘Can do’ is also executive director of the National Association of Forest Industries (read old-growth forest logging advocate). Further, appointing a former pharmacist (who was involved in securing the monopoly pharmacies maintain at our patients’ expense) as head of a doctors’ representative group is a symbolic sign of the state of general practice. I can’t wait to hear her vision for divisions.
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