At a time in history when science has expanded human medicine and technology like no other, I am appalled and the unbelieving devotees of pseudo science. Perhaps it is the lack of science education or just a shutting down of critical faculties that leads people to trust shonky well marketed anti scientific ideas. Not to vaccinate children in 2011 should be classified a criminal offence . Those who believe in alternative therapies could be forced to use them in life threatening situations. Can you imagine getting homeopathy for a heart attack?
13 February 2011
06 February 2011
Alan has left the Cross for Byron Bay this week
A MENTAL health nurse seemed like an like an impossibility for me. I have realised for some time that many of my patients had serious mental health issues and that the public system was failing them systemically.
Kings Cross is a magnet to the homeless and the mad. They feel comfortable here; there has always been a tolerance of outrageous behaviour on the streets. Many of my patients lived rough in parks or cars or couch surfing in other people’s flats.When the mental health nurse initiative was announced, I searched far and wide to employ somebody to assist me.
Alan was in charge of community mental health triage at a local teaching hospital. He was disillusioned and looking for something different, having worked on the streets in Liverpool and London in the UK. The fit was seamless from the first patient.
I would invite him into the consultation with the patient’s approval, and then he would lead them to his cubbyhole in my tiny practice and work miracles. Alan would liaise with the housing department, getting homeless schizophrenics a place to live much faster than I ever imagined.
He would facilitate care plans and personally escort broken-toothed dental disasters 200 metres to the local dentist to make sure the first appointment was firmly in place.
He would ride his motor scooter on home visits to Woolloomooloo, where children at risk were subsisting with benzodiazepine-dependent mothers.
Now we case manage several hard-end mentally unwell patients who had fallen through the cracks of the underresourced public system. They trust Alan implicitly, and with his assistance their management has become much easier.
To give you a taste of some of our new patients, one is a highly deluded man who believes he was a boy soldier. He performs the most amazing impromptu bird impressions in the middle of a consultation and claims to have fought in the Vietnam war, Bosnian conflict, first Gulf war and even the cold war. ASIO is very concerned about him as he keeps ringing the organisation for the money it owes him for his heroic undercover operations.
Alan has performed miracles for him, applying for and succeeding in getting him priority housing and a pension he should have had years ago; getting his teeth sorted out; even getting in touch with his family to reassure them he’s okay. They had not heard from him for years and imagined he had died.
On occasions Alan will walk a dishevelled unwashed patient to the Wayside Chapel for a shower and a change of clothing. They return smiling and clean for a consultation.
In the last few months, we have been deluged with referrals from Mission Australia and the Salvation Army. Word has passed around that the homeless receive a timely and efficient service. We now have a waiting list.
These patients are the most thankful and compliant group. To see them emerge from hopelessness has been an uplifting experience for all of us in the practice.
One such patient is a deluded homeless Korean man sent to us by the Salvation Army who lives off scraps in Chinatown, sleeps outside churches in the city, and tells me about “Hella Sharon”, an imaginary woman who visits him in a car every night and uses him for sex.We are attempting to repatriate him with the assistance of his sister in Seoul. It has been a slow process to get him to trust Alan, but he is making headway.
I had never realised how much mental illness was a part of general practice until Alan came to work with me. Now I cannot imagine working without a full-time mental health nurse. My practice has become much more fulfilling since he joined me.
Cage Fighting: Sydney Entertainment Centre
IT came out of the blue: a request to be the doctor at a cage fighting competition at the Sydney Entertainment Centre.
My knowledge of this extreme sport was fairly limited, apart from the hysteria I’d seen on TV.
Mixed martial arts permits all sorts of disciplines to be used together. It involves striking and grappling techniques, so it looks like kick boxing, regular boxing and many other fighting traditions rolled into one.
These amazing pugilists have been around since the time of the ancient Greek Olympics: Pankration was introduced in 648 BC.
What was known then as the most extreme combat sport is now one of the fastest-growing spectator sports in the world.
The program in Sydney was to be broadcast live on pay TV in the United States.Men from the US, Brazil, the UK, Australia and Samoa were matched against each other in 10 separate bouts.NSW combat sports coordinator Craig Waller brought me rapidly up to speed at the weigh-in held the day before the bouts were to begin.
These were big men. They all had an entourage of coaches, attractive women and hangers-on. Most were heavily tattooed, with many of the Brazilians having religious motifs across their backs. They had been fighting since they were in their early teens in poverty-stricken favelas, where an aptitude for fighting was a meal ticket out of squalor.
Luckily I brought a large cuff for checking blood pressure, since most had biceps the size of my thighs. All 20 fighters had to be checked for HIV and other blood-borne infections before being weighed. On examination, all were extremely fit. Nobody swore or spat on the floor. I expected exponents of the martial arts to be wild men, but somewhat surprisingly, they were charming, well mannered professionals.
When I cheated and watched a short bout of cage fighting on YouTube, I thought it was a free for all, no holds barred competition, something like human cockfighting. I soon discovered that it is a strictly regulated and controlled sport. Up to a point.
Assisted by my practice nurse Matt and medical student Nici, we entered the waiting rooms of the Entertainment Centre armed with a hefty medical kit that contained sutures, local anaesthetic and skin glue. We wandered through the waiting areas observing the fighters prepare themselves for the combat ahead.
A number of them were meditating, others shadowboxing and some dancing to Brazilian music. Hooded tracksuits were the fashion order of the day.
Young female dancers in skimpy outfits completed the picture. They were, apparently, employed solely to entertain the punters between rounds and encourage the innumerate audience to count to five.
A cage fighter enters the ring with no boots and half-gloves. Each fight consisted of three five-minute rounds, with a minute in between where the seconds patch up their battered charges.
The brutality of these bouts at ringside was mesmerising. Four paramedics and two ambulances were in attendance, and the screams of the crowd soon had my pulse racing.
Fighters can use their fists and feet and entire body weight to either knock down their opponent or force him to submit.
Ringside doctors must observe the fight closely and have the authority to shut it down any time, should a combatant be badly injured or unable to continue.
At the beginning of each fight, the referee looks to the doctor for the thumbs-up sign to indicate that proceedings can begin.
The star attraction was Ken Shamrock who aged 46, still managed to trade blows with a younger opponent. He had a considerable fan club in the audience. His nose had been pulverised a number of times and looked like it could use the services of a reconstructive ear nose and throat surgeon. I figured that his flattened proboscis was not a major issue under the circumstances.
After each fight I would return to the change rooms with Matt and Nici to check for damage and my medical student in her final year became wide-eyed when she entered the backstage area that had been turned into the post-fight lounge.
There was a palpable odour of spent testosterone. The fighters slumped on chairs, their entourages of up to 10 people applying ice packs to swollen soft tissues and massaging tortured muscles.
I treated minor emergencies, such as reducing a dislocated finger. I wasn’t keen to apply traction but the Brazilian fighter looked at it with a pained expression and said with a strong Portuguese accent: “Just do it, Doctor... when I was growing up in the favela we did it all the time.”
Advocates of cage fighting reckon it channels young men's aggressive impulses and the training provides them with a tough discipline. Others suggest it is barbaric and risks serious head injury.
Certainly, the broken noses and cauliflower ears testify to sheer tenacity of the bouts. For me it was one of the most exciting experiences of my medical career, but not one I could repeat on a regular basis without ulcer medication and tranquillizers.
Mixed martial arts permits all sorts of disciplines to be used together. It involves striking and grappling techniques, so it looks like kick boxing, regular boxing and many other fighting traditions rolled into one.
These amazing pugilists have been around since the time of the ancient Greek Olympics: Pankration was introduced in 648 BC.
What was known then as the most extreme combat sport is now one of the fastest-growing spectator sports in the world.
The program in Sydney was to be broadcast live on pay TV in the United States.Men from the US, Brazil, the UK, Australia and Samoa were matched against each other in 10 separate bouts.NSW combat sports coordinator Craig Waller brought me rapidly up to speed at the weigh-in held the day before the bouts were to begin.
These were big men. They all had an entourage of coaches, attractive women and hangers-on. Most were heavily tattooed, with many of the Brazilians having religious motifs across their backs. They had been fighting since they were in their early teens in poverty-stricken favelas, where an aptitude for fighting was a meal ticket out of squalor.
Luckily I brought a large cuff for checking blood pressure, since most had biceps the size of my thighs. All 20 fighters had to be checked for HIV and other blood-borne infections before being weighed. On examination, all were extremely fit. Nobody swore or spat on the floor. I expected exponents of the martial arts to be wild men, but somewhat surprisingly, they were charming, well mannered professionals.
When I cheated and watched a short bout of cage fighting on YouTube, I thought it was a free for all, no holds barred competition, something like human cockfighting. I soon discovered that it is a strictly regulated and controlled sport. Up to a point.
Assisted by my practice nurse Matt and medical student Nici, we entered the waiting rooms of the Entertainment Centre armed with a hefty medical kit that contained sutures, local anaesthetic and skin glue. We wandered through the waiting areas observing the fighters prepare themselves for the combat ahead.
A number of them were meditating, others shadowboxing and some dancing to Brazilian music. Hooded tracksuits were the fashion order of the day.
Young female dancers in skimpy outfits completed the picture. They were, apparently, employed solely to entertain the punters between rounds and encourage the innumerate audience to count to five.
A cage fighter enters the ring with no boots and half-gloves. Each fight consisted of three five-minute rounds, with a minute in between where the seconds patch up their battered charges.
The brutality of these bouts at ringside was mesmerising. Four paramedics and two ambulances were in attendance, and the screams of the crowd soon had my pulse racing.
Fighters can use their fists and feet and entire body weight to either knock down their opponent or force him to submit.
Ringside doctors must observe the fight closely and have the authority to shut it down any time, should a combatant be badly injured or unable to continue.
At the beginning of each fight, the referee looks to the doctor for the thumbs-up sign to indicate that proceedings can begin.
The star attraction was Ken Shamrock who aged 46, still managed to trade blows with a younger opponent. He had a considerable fan club in the audience. His nose had been pulverised a number of times and looked like it could use the services of a reconstructive ear nose and throat surgeon. I figured that his flattened proboscis was not a major issue under the circumstances.
After each fight I would return to the change rooms with Matt and Nici to check for damage and my medical student in her final year became wide-eyed when she entered the backstage area that had been turned into the post-fight lounge.
There was a palpable odour of spent testosterone. The fighters slumped on chairs, their entourages of up to 10 people applying ice packs to swollen soft tissues and massaging tortured muscles.
I treated minor emergencies, such as reducing a dislocated finger. I wasn’t keen to apply traction but the Brazilian fighter looked at it with a pained expression and said with a strong Portuguese accent: “Just do it, Doctor... when I was growing up in the favela we did it all the time.”
Advocates of cage fighting reckon it channels young men's aggressive impulses and the training provides them with a tough discipline. Others suggest it is barbaric and risks serious head injury.
Certainly, the broken noses and cauliflower ears testify to sheer tenacity of the bouts. For me it was one of the most exciting experiences of my medical career, but not one I could repeat on a regular basis without ulcer medication and tranquillizers.
My Christmas presentations: A funny wrap-up
My Christmas presentations: A funny wrap-up
31st Jan 2011
To say that I was looking forward to a break over Christmas and into January is an understatement, but fate had other plans for me.
On the eve of our trip overseas, my son had a spontaneous pneumothorax requiring surgery which quickly threw our holiday into disarray.
He was on the mend and with the hospital up the road, I decided I might as well work through the holiday period.
Now, Kings Cross is always an edgy place, but it takes on a new frisson of excitement over Christmas.
Mine was the only practice open here and, with no receptionist, I fully expected a challenge opening up for four hours a day over all the public holidays.
Nothing prepared me for the strange and unusual presentations I engaged.
Backpackers were stuck in Sydney unable to head to Queensland due to the floods and a few meandered into my waiting room on Christmas Day.
A young woman from London was obviously suffering a fever and a deep resonant cough. She had slept on the floor in Heathrow for four days in freezing conditions and proceeded to develop fulminant pneumonia on her flight to Sydney. She was now headed for the emergency department at St Vincent’s for a holiday detour.
Trans-sexuality is common in my bailiwick but a middle-aged woman I had not seen for four years presented me with a special festive season challenge.
On Christmas Day she decided that I should complete the documentation to change her gender legally to a woman.
The paperwork was complicated and required that I visually check to ensure she no longer just dressed like a woman but in fact had undergone a surgical procedure that was irrevocable. It was.
We needed a justice of the peace to countersign her gender reassignment. None was available. She left in an agitated state muttering to herself.
Sexual activity was soon firmly on the agenda. Two young men describe their Christmas Eve in glowing terms but confided sheepishly that in their inebriated state, sex had occurred without protection.
Seeming to need each other for support, they told me they could not remember the women they had been with. Could I check for a barrage of sexually transmitted infections?
Of course, the pathology lab was closed and all I could do was suggest they return on Boxing Day.
They, too, became restive.
By now I was pondering the wisdom of opening my practice doors. An assortment of middle-aged tourists then plagued me with requests for scripts of medication they had left at home. Antihypertensives, sleeping tablets and thyroid hormones were the orders of the day.
My last patient was a drug user who wanted to be straight for the new year and requested that I facilitate his detox over the next six days. He was heading up the coast to his parents and had to be straight or they would lock him out of the house again. A painful negotiation ensued with fruitless calls to detox centres. He left crestfallen.
As I organised myself to leave and cycle home through the by now quiet streets of Kings Cross, street people that I had seen over the last year wished me a happy Christmas and seemed amazed that a GP would be about.
“Go home, Doctor,” they yelled, holding aloft a 4 L cask of cheap plonk. One even offered to share some of his wine with me.
Working over these holidays was singularly entertaining, but even so, I reckon I’ll take Christmas 2011 off.
On the eve of our trip overseas, my son had a spontaneous pneumothorax requiring surgery which quickly threw our holiday into disarray.
He was on the mend and with the hospital up the road, I decided I might as well work through the holiday period.
Now, Kings Cross is always an edgy place, but it takes on a new frisson of excitement over Christmas.
Mine was the only practice open here and, with no receptionist, I fully expected a challenge opening up for four hours a day over all the public holidays.
Nothing prepared me for the strange and unusual presentations I engaged.
Backpackers were stuck in Sydney unable to head to Queensland due to the floods and a few meandered into my waiting room on Christmas Day.
A young woman from London was obviously suffering a fever and a deep resonant cough. She had slept on the floor in Heathrow for four days in freezing conditions and proceeded to develop fulminant pneumonia on her flight to Sydney. She was now headed for the emergency department at St Vincent’s for a holiday detour.
Trans-sexuality is common in my bailiwick but a middle-aged woman I had not seen for four years presented me with a special festive season challenge.
On Christmas Day she decided that I should complete the documentation to change her gender legally to a woman.
The paperwork was complicated and required that I visually check to ensure she no longer just dressed like a woman but in fact had undergone a surgical procedure that was irrevocable. It was.
We needed a justice of the peace to countersign her gender reassignment. None was available. She left in an agitated state muttering to herself.
Sexual activity was soon firmly on the agenda. Two young men describe their Christmas Eve in glowing terms but confided sheepishly that in their inebriated state, sex had occurred without protection.
Seeming to need each other for support, they told me they could not remember the women they had been with. Could I check for a barrage of sexually transmitted infections?
Of course, the pathology lab was closed and all I could do was suggest they return on Boxing Day.
They, too, became restive.
By now I was pondering the wisdom of opening my practice doors. An assortment of middle-aged tourists then plagued me with requests for scripts of medication they had left at home. Antihypertensives, sleeping tablets and thyroid hormones were the orders of the day.
My last patient was a drug user who wanted to be straight for the new year and requested that I facilitate his detox over the next six days. He was heading up the coast to his parents and had to be straight or they would lock him out of the house again. A painful negotiation ensued with fruitless calls to detox centres. He left crestfallen.
As I organised myself to leave and cycle home through the by now quiet streets of Kings Cross, street people that I had seen over the last year wished me a happy Christmas and seemed amazed that a GP would be about.
“Go home, Doctor,” they yelled, holding aloft a 4 L cask of cheap plonk. One even offered to share some of his wine with me.
Working over these holidays was singularly entertaining, but even so, I reckon I’ll take Christmas 2011 off.
26 January 2011
Aged Care Dilemma
Ross Gittins clearly elucidates the problem with aged care in Australia. His solution is fraught with difficulty.
I worked as a general practitioner in an aged care institution on Australia Day. It was hot and the rooms were not air-conditioned and some of my patients were suffering near heatstroke. Many people there had little in the way of assets but a few have had their assets stripped by their avaricious children who sold the family home and invest the money after obtaining a power-of-attorney. They render their elderly parents impecunious by liquidating the family home thereby throwing them on to the taxpayer for care in aged care institutions and maximising their take when the inheritance comes around.
There needs to be a plan where everybody contributes to their eventual placement in aged care facilities so that standards are maintained and the true cost is borne by the whole community.
22 January 2011
Mafia dressed down
In arresting 127 mafia linchpins in New York, New Jersey and New England, the FBI has had an impressive win against organised crime. It was a shame, however, that the mobsters arrested looked so shabby in poorly fitting jeans, trainers and tee shirts on TV. Time was, no self respecting Mafia Don would be arrested without the full sartorial elegance of the best Italian tailors and an equally well dressed brief at his side.
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