General Practitioner (GP)

November 4, 2017

NSW looking to ban e-cigarettes from smoke-free areas. What’s the big deal?

Once touted as a traditional cigarette replacement on the road to quitting the nicotine habit ‘electronic cigarettes’ or e-cigarettes as they are more commonly known has developed  a bad reputation.  ABC news reported on Thursday that support is growing for New South Wales to join five other Australian states (ACT, Queensland, Victoria, Tasmania and South Australia) in banning the use of e-cigarettes in smoke-free public areas where currently only traditional burned cigarettes are outlawed. So what are e-cigarettes and are they as harmful to the user and bystanders as traditional cigarettes?

What are e-cigarettes

Both traditional cigarettes and e-cigarettes do share one very common trait, the heating of the consumed material to make either smoke or vapor. E-cigarettes, instead of using smoldering or fire to burn the solid material implement an electronic heating element within  the device to vaporize a liquid thereby allowing that liquid to enter the user’s lungs much the same as traditional tobacco smoke. Proponents say that e-cigarettes are less harmful to both the user by eliminating the secondary chemicals normally found in traditional cigarettes and to those affected by traditionally passive smoke as the e-cigarette is less likely to transmit harmful chemicals throughout a space. The latter fact is what is being debated regarding the smoke-free e-cigarette ban.

Traditional cigarette risks versus e-cigarettes

Traditionally burned cigarettes have been widely studied and their harmful health effects well known. The American Cancer Society warns that there could be as many as 70 harmful chemicals in cigarettes which could lead to cancer when burned and inhaled. The same site does state that there are chemicals known to be contained in e-cigarettes which could contribute to cancer formation, however the biggest risk in e-cigarettes is the current lack of regulation and control on the ingredients, both type and quantity, which means that it is difficult to quantify their effects. A publication by New South Wales Health agrees with the American Cancer Society that there are a wide variety of levels of harmful chemicals, including nicotine, in unregulated levels within various e-cigarettes without accurate labeling. Additionally, e-cigarettes could also contain other by-products such as heavy metals which are used in the heating elements of the device. The take-home message for users of e-cigarettes is that there is an inherent danger as the e-cigarette market is mostly unregulated allowing for a range of chemicals, both listed and unlisted, to be included in the liquid active ingredients. This range of chemicals could lead to both short and long-term health effects.

The New South Wales Health fact sheet also state that there is a risk of exposure for people in the immediate vicinity of users of e-cigarettes, known as exposure to second-hand smoke. Again research into second-hand smoke with traditional cigarettes have been widely studied; and this has led to the smoke-free bans seen here in Australia and world-wide to protect non-smokers from the effects. The study into second-hand smoke amongst e-cigarettes and the effect on those around smokers is not as clear cut.

Second-hand e-cigarette smoke research and opinion

A systematic review of the effects of second-hand smoke from e-cigarettes was published by the Public Health Research and Practice group in 2016. The review looked at scholarly articles published between 1996 and 2015 regarding the study of this subject. The results showed that there were particles of nicotine, harmful chemicals similar to traditional cigarettes and heavy metals found within the vicinity of the e-cigarettes. However, the levels of these chemicals were much less. Additionally, the spread of these chemicals was overall less as the authors concluded the exhalation of traditional cigarette smoke could spread the airborne chemicals further than e-cigarettes. However, this study concluded similar results to those listed above that regulation of e-cigarette ingredients and concentrations of those ingredients have led to poor research outcomes.

The ‘vaping’ community has weighed in on this topic. The website “Vaped: by Totally Wicked” has stated:

Though studies are still ongoing on this topic, those that have been done so far strongly indicate that passive vaping poses little danger, if any. In fact, what they have managed to show thus far is that passive vaping is a non-existent problem, with ‘no apparent risk to human health from e-cigarette emissions based on the compounds analysed.’

The study linked to this statement was published in 2012 by the journal Inhaled Toxicology. While I did not have access to the article the synopsis did state that

For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk to human health from e-cigarette emissions based on the compounds analyzed.

The issue is that the study used four e-cigarette liquids and compared to traditionally burned cigarettes. As the discussion has indicated previously there is widespread variation in chemical inclusions and concentrations as well as a lack of clear labelling which makes any comparison impossible. Therefore, research into the effects of passive smoke cannot be generalized at this point.

Another blog site, Vaping 360, lists a 2016 report prepared by the Royal College of Physicians entitled “Nicotine without smoke Tobacco harm reduction” which discussed the use of e-cigarettes as nicotine-replacement- alternatives and how traditional tobacco companies were attempting to gain ground in this market within the UK. The Vaping 360 cite quoted:

Users of e-cigarettes exhale the vapour, which may therefore be inhaled by others, leading to passive exposure to nicotine. There is, so far, no direct evidence that such passive exposure is likely to cause significant harm, although one study has reported levels of polycyclic aromatic hydrocarbons that were outside defined safe-exposure limits. It is clear that passive exposure will vary according to fluid, device and the manner in which it is used. Nicotine from exhaled vapour can be deposited on surfaces, but at such low levels that there is no plausible mechanism by which such deposits could enter the body at doses that would cause physical harm.

Nicotine-replacement legislation in Australia

But the debate over second-hand smoke and e-cigarettes could be moot here in Australia. According to the Royal Australian College of General Practitioners (RACGP) the use of e-cigarettes for nicotine-replacement are illegal.

In all Australian states and territories, it is an offence to manufacture, sell or supply nicotine as an S7 poison without a licence or specific authorisation. This means e-cigarettes containing nicotine cannot be sold in any Australian state or territory. There are several reported instances where individuals have been charged with the illegal supply of liquid nicotine for use in e-cigarettes in Queensland.16,17

A recent clarification from the Federal Department of Health has advised that nicotine can be imported by an individual for use as an unapproved therapeutic good (eg a smoking cessation aid), but the importer must hold a prescription from an Australian registered medical practitioner and only import 3 months’ supply at any one time. The total quantity imported in 12 months cannot exceed 15 months’ supply of the product at the maximum dose recommended by the manufacturer.18 Most current consumers are unlikely to visit medical practitioners for a prescription of products that are readily available over the internet. The purchase and possession of nicotine by individuals are not regulated by Commonwealth legislation except for importation as allowed under Commonwealth law.

Non-nicotine e-cigarettes are not regulated, according to the RACGP site, however if they are not specifically for nicotine-replacement therapy then their use is purely recreational and should be subject to concerns raised by state governments and health authorities as to the additive chemicals and the effects of those chemicals on non-users within the immediate vicinity. Therefore, with no specific medical need for e-cigarettes the health concerns of second-hand smoke should outweigh the desire to have a cigarette-substitute in public and should be banned.

What does all of this mean for e-cigarette use in public?

So what does this mean for Australia, and specifically New South Wales, in the debate over e-cigarettes? The debate, to me, is quite simple. E-cigarettes in Australia at this point cannot contain nicotine as per Commonwealth law. Therefore, they cannot be considered as a replacement to traditional cigarettes as has been touted elsewhere in the world. That also means they have no medical necessity to users. Non-nicotine e-cigarettes at this point are legal, however there are a number of chemicals used in various e-cigarettes which can be as harmful as in traditional cigarettes to individuals standing within close proximity to the user. Additionally, chemicals used in e-cigarettes are not regulated so the quantities and types of chemicals contained do not need to be listed. While e-cigarettes are less harmful than traditional cigarettes there is still a risk of passive second-hand exposure. So there seems to be no reason why the state government should not join the five other states in outlawing e-cigarette use in smoke-free locations throughout the state.

Your thoughts? Until next time,

Ray

 

 

References

ABC News- E-cigarette ban in smoke-free areas of NSW attracts Government support

http://www.abc.net.au/news/2017-11-02/fight-to-ban-e-cigarettes-in-smoke-free-areas-of-nsw/9109858?pfmredir=sm

Web MD- The Vape Debate: What You Need to Know

https://www.webmd.com/smoking-cessation/features/vape-debate-electronic-cigarettes#2

American Cancer Society- Harmful Chemicals in Tobacco Products

https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/carcinogens-found-in-tobacco-products.html

New South Wales- Are electronic cigarettes and e-liquids safe?http://www.health.nsw.gov.au/tobacco/Factsheets/e-cigs-are-they-safe.pdf

Centers for Disease Control- Secondhand Smoke (SHS) Facts

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm

Public Health Research and Practice- A systematic review of the health risks from passive exposure to electronic cigarette vapour

http://www.phrp.com.au/issues/april-2016-volume-26-issue-2/a-systematic-review-of-the-health-risks-from-passive-exposure-to-electronic-cigarette-vapour/

Vaped: by Totally Wicked- SHOULD YOU WORRY ABOUT PASSIVE VAPING?http://www.totallywicked-eliquid.co.uk/vaped/passive-vaping/

Inhaled Toxicology- Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality.

https://www.ncbi.nlm.nih.gov/pubmed/23033998

Vaping 360- Is second hand vapor harmful?

http://vaping360.com/is-second-hand-vapor-harmful/

Royal College of Physicians- Nicotine without smoke: Tobacco harm reduction

https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

November 1, 2017

2017 worst influenza season in Australia since 2012 with New South Wales hit the hardest

Quick facts

  • Influenza is a very contagious respiratory virus which is spread by sneezing or coughing commonly.
  • There are two strains of influenza with many variations due to proteins within the DNA. This allows continual mutations from year to year.
  • Worldwide 3-5 million people become infected every year with 250,000 to 500,000 deaths annually.
  • In Australia approximately 18,000 people are hospitalized each year with 3,500 deaths.
  • The World Health Organization has been monitoring and producing vaccines for influenza since 1952 with 142 monitoring centres in 112 countries.
  • Five international centres produce the vaccines used every year, including one in Melbourne.
  • While criticism of the level of outbreak for 2017 in Australia is mixed statistics showed that there were more reported cases this year than at any point since 2012
  • Of the 217,559 cases of influenza reported in Australia up to October 2017 over half (101,793) were reported in New South Wales.
  • Officials recognize an issue with how the influenza outbreak was handled in Australia this year, however they are divided on possible solutions to prevent a repeat in years to come.

 

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With 2017 thought to have been a horror year for influenza in Australia, I thought I would  research where our flu vaccines come from, how are they chosen and why has this year in particular been so bad?

A little about influenza

Flu, or more correctly known as influenza, is a respiratory virus which has similar symptoms to that of a common cold. The difference is the severity and quality of those symptoms. Surprisingly there are only two strains of influenza: A and B. However, within those two strains are combinations with varying protein chains of H and N. This is what gives the influenza virus the ability to mutate and evade eradication. Influenza can strike at any time of the year; however the colder months are more likely to see the spread of the virus. One possible explanation I heard a few years ago is that during the colder months people are more likely to congregate together indoors which would allow influenza to spread more readily. This could be due to the fact that influenza transmits via airborne means such as sneezing and coughing.

Globally the World Health Organization (WHO) estimates that between three to five million cases of severe influenza occur each year worldwide and of those 250,000 to 500,000 cases result in deaths. Australia specifically sees 18,000 hospitalizations for influenza annually with an average of 3,500 deaths. Influenza is also estimated to account for 10% of all yearly workplace absenteeism in Australia.

Worldwide vaccine efforts

As a virus you cannot cure it with antibiotics; once infected all you can do is wait it out. However, vaccines work by introducing a weak or dead strain of the virus into the body where antibodies can be produced which when confronted with the influenza virus will kill the virus before it takes hold of the host’s body and produce debilitating symptoms. The production of antibodies can take three to four months before fully effective so experts recommend having the flu vaccine early in the season to allow for immunity to develop.

Logo-WHO

The WHO has been responsible since 1952 for the monitoring of influenza and vaccine research through their Global Influenza Surveillance and Response System. Different influenza strains become more prominent from year to year, and strains can mutate. Therefore the WHO runs 142 monitoring centres in 112 countries. Five of those centres host World Health Organization Collaborating Centers for Reference and Research on Influenza:

  • Atlanta, Georgia, USA (Centers for Disease Control and Prevention, CDC);
  • London, United Kingdom (The Francis Crick Institute);
  • Melbourne, Australia (Victoria Infectious Diseases Reference Laboratory);
  • Tokyo, Japan (National Institute for Infectious Diseases); and
  • Beijing, China (National Institute for Viral Disease Control and Prevention)

These five centres are also produce vaccines for the different influenza strains. Monitoring of influenza occurs year-round, however production of vaccines takes approximately six months and therefore decisions on which strains (usually three to four) are included are made half a year before the major flu season starts. The actual vaccine doses are then manufactured by private companies with the strains produced by the centres above.

The 2017 influenza season

So with all of the knowledge of influenza and the work of the WHO and CDC along with other scientific groups, what happened this year? Well that depends on who you ask. According to the Australian Department of Health the peak of the influenza season was mid-August of this year. The department did state that there appeared to be higher-than-usual numbers of cases being reported, however mitigated that fact by saying that testing was more readily used and could have contributed to the larger number of reports. Influenza A seems to be the dominant culprit this past season. The department’s report also goes on to say that they number of hospital admissions this season were ‘moderate’ compared to previous years, and that the vaccines given seem to have had a good effect.

NSW health minister Brad Hazzard would disagree with the federal department of health report. According to Minister Hazzard “I think at this stage what we got unfortunately was a vaccine, with the benefit of hindsight — and hindsight is a wonderful thing — that wasn’t quite up to it.” Peter Collingnon, executive director of ACT Pathology and a physician at the Canberra Hospital Infectious Diseases, went onto say that he felt the vaccine this year had very low efficacy for the A H(3) strain responsible for so many hospitalizations and deaths. Although the vaccine supplied to Australians was up to the global standard many patients were being seen by GPs with influenza despite being vaccinated.

According to the Immunisation Coalition in Australia as of the 24th of October 2017 there were 217,559 cases of influenza confirmed.  Of those cases over half (101,793) were reported in New South Wales. The next highest rate was Queensland which only had 53,487. So in my state of New South Wales was by far the worst hit this past season. The reported number of cases nationwide, according to the Immunisation Coalition, in 2017 were significantly higher nationwide than at any point in the last five years.

The future?

wash-hands-2631777_1280

So is this a trend, or just a one-off event?  That is very hard to know. According to the information I read the experts are mixed. One possible suggestion is that our vaccine processes are out-dated and we need to re-think how vaccines are produced. Additionally, community hygiene practices could be reviewed to limit spread of influenza, particularly in peak times. What we do know is that influenza won’t be going away anytime soon. And at least for 2017 New South Wales bore the brunt of the outbreak.

As a member of the acute healthcare team I applaud every member of healthcare for their work and dedication during this flu season. Ask any person working in this industry, particularly in New South Wales, and they will tell you it was a very busy and trying time.

Until next time,

Ray

 

National Centre for Immunisation Research and Surveillance- Influenza fact sheet= http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/influenza-FAQs.pdf

Centers for Disease Control and Prevention- CDC’s World Health Organization (WHO) Collaborating Center for Surveillance, Epidemiology and Control of Influenza= https://www.cdc.gov/flu/weekly/who-collaboration.htm

Centers for Disease Control and Prevention- Selecting Viruses for the Seasonal Influenza Vaccine= https://www.cdc.gov/flu/about/season/vaccine-selection.htm

World Health Organisation- Influenza (Seasonal) Fact sheet= http://www.who.int/mediacentre/factsheets/fs211/en/

Influenza Specialist Group- Influenza Fast Facts= http://www.isg.org.au/index.php/clinical-information/influenza-fast-facts-/

Australian Department of Health- Australian Influenza Surveillance Report and Activity Updates= http://www.health.gov.au/flureport

ABC news- Influenza: NSW Health Minister says current vaccine ‘not up to the job’ after deadly flu season= http://www.abc.net.au/news/2017-10-30/influenza-australia-deadly-year-prompts-calls-for-new-vaccine/9098598

Immunisation Coalition- Influenza Activity Surveillance 2017= http://www.immunisationcoalition.org.au/news-media/2017-statistics/

October 29, 2017

Where do doctor’s prescriptions end and pharmacists dispensing begin?

An article in news.com.au on Tuesday ( the 24th) has brought up an interesting question in my mind, where does the line exist between pharmacy dispensing of medications and requiring a doctor’s prescription?

The article describes the debate over restricting medications containing codeine to prescription-only, requiring patients wanting these medications to see their doctor’s first before obtaining the drug. The Thearputic Goods Administration was indicating a change in codeine-related products from pharmacy-dispensed to prescription in 2016, although debate over the issue is heading up as the deadline for the change is February next year.

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Pharmacy representatives state this would affect the quality of analgesic care for patients by requiring them to see their doctor first. Physician groups are stating that low-dose codeine found in these medications show on therapeutic benefit, and the restriction would prevent misuse. Politicians are stuck in the middle in wanting to satisfy both sides.

So what is the issue with codeine? It is addictive and potentially harmful in high doses. Codeine is an opiate, an analgesic similar to Morphine. Therefore, its properties of pain relief can lead to addiction if misused. The Sydney Morning Herald stated that 12% of Australians surveyed exceeded the recommended daily dose of analgesic medications containing codeine. While the codeine dose is quite small the issue with this worrying fact is the potential for overdosing on paracetamol and ibuprofen; both have potentially toxic effects if too much is in the human body. An article by NPS Medwise has shown that when codeine has been consumed to lethal levels, although being accidental in nature, the number of deaths are double that of deaths related to stronger prescription medication such as morphine.

So why take it away from pharmacists hands? Simply control and monitoring. Even in my role within a public hospital I see frequently patients who travel from one hospital to another asking for pain relief, sometimes discharging and presenting to multiple hospitals in the course of a day. I am sure that most pharmacists are very conscientious and ethically-responsible people. However, a patient could approach one pharmacy let’s say in the morning and buy a codeine-related product, and then travel to a completely different area in the afternoon approach another for more product. This individual may not even intend to do this, instead they may work in the city and travel from home in a completely different area by public transport. The second pharmacist would not have knowledge of the previous purchase and therefore would not question the transaction.

A doctor’s prescription requires individuals to physically see a doctor. A record of the prescriptions would exist and could be tracked. Additionally, higher consumption could trigger the doctor to investigate the reasons for the increased usage and try to eliminate the cause of pain in the first place.

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 While I have no issue with pharmacists as I think they are very competent and ethical practitioners I do support the moving the responsibility of codeine release from pharmacists to doctors.  Codeine is an opiate, and most opiates (along with other analgesics of similar strength) are classified as schedule eight restricted due to their addictive properties. The low doses of codeine and the toxic properties of the main ingredients (paracetamol and ibuprofen) mean that overdosing on these over-the-counter medications can lead to serious health consequences. Finally, as I stated above requiring a prescription can then lead a doctor to investigate, and hopefully treat, the source of pain rather than continuing to mask it through analgesics.

What do you think of codeine-related products requiring a prescription? Does it even matter to you?

Until next time,

Ray

News.com.au- MPs push to water down ban on codeine sales without prescription

New Scientist- Australia bans non-prescription codeine to fight opioid crisis

Therapeutic Goods Administration- Update on the proposal for the rescheduling of codeine products

Sydney Morning Herald- More than 2 million Australians exceeding recommended medicine dosage, worrying doctors

NPS Medwise- Codeine-related deaths: a cause for concern

June 2, 2017

Concerns raised about investigation of premature deaths in aged care facilities.

One day after this and other sites posted about Joseph Ibrahim’s calls to investigate the causes of what a coroner’s report called premature deaths in aged care two other articles have surfaced regarding the same issue.

Falls in residential aged care facilities

In an article in the Medical Journal of Australia Dr. Stephen Judd, chief executive of Hammond care- an aged care provider, discusses potential consequences if nursing home regulation were to be tighten in an attempt to lessen premature deaths from falls.

“If staff think they are going to get rapped over the knuckles if Mary falls over when she goes outside, they’ll lock the door so she can’t get out,” he said.

“All life is about risk; we have to encourage people to enjoy life, not just keep themselves hermetically sealed in a life of boredom,” he said. “Rather than trying to eliminate risks, we must manage risks intelligently.”

Interestingly I wonder if Dr. Judd is aware that most nursing homes do have locks on exterior doors to prevent residents with dementia from travelling outside? From my experience in aged care many, if not most falls, occur in the resident’s bedroom when the patient is found close to their bed. While I have not statistics evidencing this fact, I am sure Dr. Ibrahim’s report would reveal this.

Additionally, I also find it interesting that Dr. Judd stated that ‘staff’ would be responsible for denying freedom for fear of retaliation. Staff of nursing homes answer to the corporate bodies of said homes, so wouldn’t the fear they would be reacting to not come from the disciplinary action from corporate executives should preventable deaths not reduce? The article also reiterates the principles that I discussed in my previous post regarding the role of residential aged care. There exists a conflict between patient safety and freedom of choice. If a resident is unsteady on their feet and a falls risk but fiercely independent and wants to walk around a facility, does that facility have a right to restrain the resident to reduce falls?

Suicide prevention in residential aged care

Yesterday an article in the Australian Ageing Agenda by  Darragh O’Keeffe discusses the federal government’s stalemate on a decision of how to allow residents of Residential Aged Care Facilities (RACFs) to access the Better Access to Mental Health scheme (BAMH). The BAMH scheme, according to the federal Department of Health’s website

” Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.”

However, according to Dr Margot McCarthy, deputy secretary of ageing and aged care, there is still discussion around how the scheme would be made available to residents in care facilities.

If an elderly member of the community was having depressive thoughts surely the GP would jump at the chance of engaging in this service to allow more treatment options for their patients. The same should be true for residents living in aged care facilities. The Medicare funding does change when a person goes into RACF care, however that should not change the available services to them. I hope that in the near future the Department of Health and Department of ageing and aged care can come to an agreement and make this valuable service available for residents in RACF homes, thereby moving towards reducing preventable deaths related to mental health conditions.

What does this mean for nursing staff and residents?

While the powers-at-be continue to struggle with how to research and tackle the issue of ‘premature deaths’ nursing staff in aged care facilities will continue to be in the firing line. Without clear-cut guidelines their actions and assessments will put the responsibility for minimizing the risks sits squarely on them. For residents and families the falls, suicides and choking will continue until the federal government and corporate aged care executives agree on a standard measure along with established preventative measures to minimize, and hopefully, eliminate the term premature deaths in aged care from existence.

References

The Medical Journal of Australia: Aged care falls deaths: a question of balance

The Australian Aged Agenda: No end in sight to aged care’s mental health blockage

The Department of Health: Better access to mental health care: fact sheet for patients

 

May 31, 2017

Australia, better healthcare than America- absolutely!

stethoscope-840125_1280

 

I came across this article and had to write about it. Marie Shieh, a doctor trained in America and now practices in Australia, has written a piece for the The Telegraph. In it she states emphatically that Australia’s health care is better than Americas. Full stop, no qualifiers. And as a former consumer and provider of America’s healthcare system I can agree.

Confession: my road to becoming a registered nurse started because of poor quality healthcare that my father received before his death. We were poor, not living on the streets poor, but we did not have a lot of money. My parents owned a printing business, and we did not have health insurance. When I was young my father was diagnosed with diabetes, then cancer and finally a heart condition. Because we did not have health insurance all of these medical conditions were treated very conservatively and without extensive examination. I believe, as a consequence of that, he suffered a major heart attack and died prematurely.

Now I know that he contributed to his condition with smoking and being overweight. But a lack of medical care significantly contributed to his death. From that moment on I was destined to be in healthcare, despite my attempts to move away from it. I have worked in palliative (hospice in America) care in the U.S. and now work in the Australian hospital system.

We have an amazing healthcare system. Yes, it is over-budget. Yes, there is over-crowding and never enough beds in our hospitals. Yes, people do (at times) come into emergency departments for things that could just as well be handled at their own doctors. But our system allows for every Australian the chance to have optimal health and to be free of medical issues, or at least have them treated to the best that our medical and nursing care can offer without fear of being unable to pay for such treatment.

I have always said that the Australian healthcare system would not work in America. The current push to repeal ‘Obamacare’ as it is called exemplifies this. Americans feel that they should be self-sufficient. And that is not necessarily a bad thing. Health insurance plans are out there to assist with costs. However, the American attitude of “if you can’t afford it we won’t pay for it” still leads to a class-based healthcare system. If you have money then you have health. As a nurse and believer in healthcare that is not right. Health is part of Maslow’s basic needs, and I feel it should be offered as a right just as security in the form of police and safety with firefighters.

maslow-pyramid

Maslow’s heirachy of needs- image source

Alas I do not feel that America will change their ways. The core beliefs of self-sufficiency go all the way back to revolutionary times. I am proud to say I am an Australian registered nurse. I am proud to say that the healthcare I and the thousands of other dedicated workers allows everyday Australians peace of mind and can allow us to continue to prosper.

 

The Telegraph: Trump is right about Australian health care, an American doctor in Australia says

May 24, 2017

Privacy concern or valuable tool: all Aussies can have an e-health record, would you?


The ABC network has written that with a new surge in federal funding the My Health Record project looks to provide all Australians with the ability to have an electronic health summary. This is a follow-on from other E-health projects trying to establish similar results. While I can understand the apprehension noted by some with regards to privacy and sharing of health information from a healthcare worker’s perspective it is a great leap forward.



In my history as a registered nurse I remember the days before electronic health records. The nature of our health system in Australia means that an individual can present at numerous public and private health institutions without any ability of those institutions knowing prior medical treatment. This is a safety concern for the patient at worst and could potentially prolong the time for effective treatment in the least.


With the implementation of the local electronic health record if I am looking after a patient who has visited another health facility within the same area, state, or even nationally connected the doctor and I can see previous treatments and tests, allowing for more accurate diagnosis and treatment. Expanding this nationally would allow those visiting or recently moved to the area to have better quality care by allowing information sharing.


It is also better for the GP. Now general practitioners must rely on discharge summaries for information about hospital treatment. However, with the electronic record the GP could access more complete information from hospital visits, aiding in their continuation of care at home. A GP could also review and place information for patients on the record in case they travel or are too sick to speak for themselves, vital information which could save their life.


There is always a potential for abuse of the system. However, I would trust that the powers-at-be would design safeguards to prevent unauthorized information sharing of electronic health records. I, for one, will be happy to welcome this advancement in Australian healthcare. According to the ABC report individuals would be allowed to ‘opt out’ of the program.

ABC news: Everyone to have a digital health record