[AMA] I'm a Medical Student Ask Me Anything

Hi All,

I'm a 30y/o Australian Medical Student from Sydney, have also studied Medical Science.

Happy to answer questions as best I can about Medical Practice / Medical School from the perspective of a Medical Student.

Just to be 100% clear Med Student - Not a Doctor incase you missed it the last three times.

Comments

  • +4 votes

    How much debt are you in now and by the end of your degree?

    • +11 votes

      I currently work and run a small business so I am forced to pay HECS as I go which is a good thing I guess. In the end I would have paid over $70k in tuition.

      •  

        That’s pretty good. MBA is around that price (and massively overrated in terms of career outcomes).

        • +2 votes

          To some, sure.

          I disagree. Mine cost around the $70k mark, i've made some excellent contacts and friends out of that degree, and it would so happen I've had 2 career advances (one of which would not have happened without the degree), and seen a 38% increase in my salary since completion.

          Who knows where i'd be without it, but i attribute the above to my MBA, and the degree will have paid itself off in under 2 years.

          In agreement with you, medical degree has alot of career prospects, but it certainly isn't a golden ticket

          FWIW, i did 2 years of a medical degree before deciding it was too much work for me at the time and switched to commerce.

        •  

          @geoffs87:

          Would you happen to know if the university you are attending makes a differemce?

          Any thoughts on the executive mba program ?

        •  

          @YLD1:
          Hi there! Honestly, I think so. Sounds like you're thinking of the eMBA @ AGSM, which is actually what i did. From what i understand, noone really worries too much whether you have an eMBA vs the Full Time program, rather they are impressed with the AGSM MBA regardless. (I think the value of the cohort of employed local students > students taking time off from work for 2 years and/or from overseas without any local experience).

          My thoughts on schools:
          - Teaching staff: many lecturers at the cheaper schools are lecturers, and while theres nothing necessarily wrong with that academically, they lack the real world experience that the MBA should be teaching. Nothing beats the ability to relate learnings to actual experiences of the lecturers, through either their own businesses or consulting work
          - Students: the better schools tend to attract a higher calibre of student, and you learn so much from those you work with throughout the program. Both from their own skills, and their experience. I was lucky that i was the youngest in my cohort by a fair bit, so i was able to take so much from those around me, but i'm sure i still offered some value to them. You also build a network of friends, i know of 2 people from my cohort of 20 that ended up with jobs by either being referred by a cohort member, or actually taking up a job in their firm.
          - Partnerships: the big consulting firms and investment banks tend to reach out to the schools for their best students to interview for roles. Not sure if this happens at the non top tier schools.
          - Program itself: my favourite thing about the AGSM eMBA is the opportunity to do a semester abroad on exchange (not that i got the chance, but wish i did), and also the International Business study tour - which i did take up and spent 2 weeks in south America learning about how businesses operate in a vastly different part of the world and different culture, made some really good friends, and had an awesome time! Beyond that, the eMBA has (or at least had) the Strategic Management Year, which was very comprehensive and full on, but allowed you to put your learnings into real world problems throughout the year, again you work closely with your cohort, and the lecturers were excellent (for the most part).

          So, i suppose in answer to your question, i think the above experiences and learnings for me, allowed me to advance in my career, and better prepared me for the more senior strategic role i currently have, and almost everyone who i went through the program with agrees. Whenever i speak to any of the senior leaders in my business (top 10 ASX listed company) and say i have an MBA, their first question is "AGSM?", their main compliment is that i was able to complete the program, while still working full time, and that shows initiative and determination, as well as skill.

          I Hope that helps?!

        •  

          @geoffs87:

          Thanks for the comprehensive response. I was looking at the eMBA at USYD but they just didnt sell it to me well.

          Seems many of the students were inexperienced and unchallenged and benefited from getting their forst challenges.

          Food for thought.

        •  

          @YLD1: No Worries, reach out if you have any other questions. I don't know much about the USyd program, sorry my post was AGSM focused.

          All the best!

  • +1 vote

    Planning on specialising in any particular field?

    • +16 votes

      At this stage I think specialising in General Practice is the most appealing. The additional training in comparison to other specialities is a far less complicated process from what I can tell so far, the RACGP offers a couple of entry pathways to its training course.

      There is a misconception around GP's that they are not specialists, although like other specialists GP's are also required to complete specialist General Practice training where at the end of the training they are awarded a Fellow of the Royal Australian College of General Practitioners. Gp's are often the first people you see with a presenting complaint and will diagnose the problem and send you to other specialists if / when required. Gp's will also collaborate with your other specialists to manage your illness / disease.

      I like the idea of GP as the work life balance is far better than other specialities.

      • +4 votes

        So true, not sure if you saw this article from the other day, sums up what you have written beautifully http://www.smh.com.au/comment/gps-need-to-be-recognised-as-t...

      • +1 vote

        By definition, doesn’t this make a GP a generalist, not a specialist? I know now that they consider GP a specialism, and while it’s an important and difficult job, the training isn’t as long or arduous as a traditional specialism. It seems more like a pat of the back from the medical colleges. In terms of work/like balance, can’t most consultants in private practice pick their own hours?

        • +2 votes

          A generalist is another speciality all together, you may have heard of internal medicine, well a general physician only see's patients that are referred to them but are actually highly specialised. They may have extensive knowledge of cardiology, infectious disease etc. https://www.racp.edu.au/trainees/advanced-training/advanced-...

          The training to become a general practitioner is between 3 - 6 years depending on what avenues you take and you also need to sit a number of exams. Don't forget a GP has a broad field of knowledge, they may need to refer you to an ophthalmologist for eye surgery but that ophthalmologist may have little knowledge on the management of certain diseases as it is not in their scope of work.

        • +2 votes

          @DrSyd: I didn’t mean a generalist as a medical term, I meant it literally. As in a GP needs to know a lot of information without being specialised in one area. While I understand it is now called a specialism, my point is that it is not what you’d call a traditional specialism, and generally the remuneration reflects this. That being said I know some entrepreneurial GPs who make 7 figure salaries through branding and expansion.

        •  

          @Burnertoasty:

          doubt this. those GPs you are talking about are probably practice owners(so likely businessman) rather than a full time clinican

        • +3 votes

          @ggkfc: I take it you don’t understand the meaning of entrepreneurial?

        • +2 votes

          @Burnertoasty:

          All consultant level professions are 'specialties'. For example my specialty is a physician. My subspecialty within that will likely be clinical haematology and haematopathology.

          You're specialised in the sense that you've chosen, trained and qualified in a select field to work. Some are more general, (general surgeons, general physicians and general practitioners) and some more subspecialised (oncology, orthopedic surgery, etc) but they're all specialised in the sense you are working in a select field.

        • +3 votes

          @polk: Yes, I understand that, but traditionally a GP was never referred to as a specialist. Maybe I’m just a stick in the mud.

        • +1 vote

          @Burnertoasty: colloquially yeah you're right. But medically we more refer to specialty and subspecialised.

        • +1 vote

          @Burnertoasty:

          The status of GP is now a specialty.

        •  

          @hypie: Thanks for repeating what has been said many times for those who can’t read properly.

        • +1 vote

          @Burnertoasty:

          I'm just making it clear that you are stuck in the mud.

        •  

          @Burnertoasty: Traditionally no - a couple of decades ago there was no specialty training for GP's. You would finish medical school, do your internship, and, frighteningly, be able to start practicing as a GP. Now there is a college of general practice like all the specialties and a training program that can be long and arduous if you decide to pursue rural medicine or a subspecialty area like GP-obstetrics, or GP-surgery etc, although that said, the GP training program in of itself is pretty tough and their exam fail rates are high. Without the exams you can't be qualified as a GP and bill Medicare (although there are some who choose not to do the program and practice as a GP but their patients would have to pay with no rebate).

          A lot of people don't know that GP training is a specialty now, it's why they cop so much disrespect.

      • -2 votes

        GP always seemed like the logical choice for me, work life balance is literally whatever you want it to be, you earn packets of money, and if a patient presents with anything remotely challenging, referral! :), see them for 5 mins charge medicare for 15-30mins and then make them pay as well or not (at your discretion).

        • +4 votes

          sounds like you have a limited understanding of general practice. contrary to popular perception it's not all cough colds and med certs. GP is a challenging specialty sometimes more so than a specialist as you are first line in diagnosing vague undifferentiated problems. specialists more often than not have the diagnosis handed to them on a platter and only deal with a set number of problems in their field.

        • +3 votes

          Sounds as if a few here have been sucked into the ‘specialist in life’ cringey attempted rebrand of general practice. Way to spend money wisely guys on all those billboards and tv adverts. Didn’t look like an inferiority complex at all…

          Way to have a chip on your shoulder about a career choice that most people outside of medicine still consider a major achievement. Perspective eh,

          Egos in medicine, out of control sometimes

        • +3 votes

          As a non gp doctor I agree that it is an extremely sensible field for work life balance. Not sure I agree with the rest of your logic though. Having to see the patients that shitty GPs do just refer in I can tell you how much or a benefit to the patient and the health system in general having a good and knowledgable GP to manage your care is.

        •  

          @xbai:

          It may be challenging but ultimately as our friend release mentions, when its tougher than a script, like surgery or more the GP writes up a referral.

          You might not like it but thats very true. GP dont do surgery, they dont have fancy machines to do chemo, most are just a GP with a script, a desk and a few basic machines like to measure BP or BGL.

          Pretty hard to do more with such a limited amoutn of equipment, no a specialist is the next level and they have considerably more challenges and more.

        •  

          @ninetyNineCents: This is completely incorrect. Some GP's may be a referral and script service but I'd argue that's a revolving door high volume bulk billing only model, and I'm sorry that's been your experience.

          A good GP will make a diagnosis, institute a management plan, follow it up, make sure it's working, and when all avenues have been exhausted then refer to a specialist. Absolutely untrue re not doing surgery, GP's do plenty of surgery ranging from simple things like mole excision right up to general surgical procedures ie appendisectomies particularly in rural areas.

          Many specialists do not have fancy machines. I'd argue that not even oncologists do - the hospital does! A neurologist has a basic toolkit that they use - GP's have the same toolkit. Specialists sacrifice the majority of their knowledge for a very very narrow slice in an area that interests them. A dermatologist would be useless for most things except skin. Any decent specialist would disagree with you re your 'next level' comment - that's not how it works. Without GP's to oversee a persons health, there would be no one able to sort out half their problems - you can't refer off to 20 specialists for things you can sort out yourself.

          I ultimately chose to do physician training and specialise instead of GP (although the hours were so appealing) because I didn't think I'd be able to retain that much knowledge across so many areas and their college has 3 exams instead of the 2 mine has. An interesting point to note too is that in my experience, a lot of the top scorers in medical school go and do GP training because they love all of medicine that much and have the courage to tackle it on multiple levels. I don't think being a specialist is more challenging than being a GP (unless you do something like, neurosurgery but then you're just a masochist), it's just a completely different challenge. I could never be a GP, it's way too hard and then to have that level of knowledge and come and read stuff like this would just be too frustrating.

        •  

          @MissG:
          Good GP's are very hard to find in my experience. I only go to bulk billing types and don't know if this is a reason. Anyway,based on my experience seeing GPs, I feel they are only good for very basic stuff. As a result, I go and seek second and third opinions from other GPs and I am sure many would do the same.

        •  

          @MissG:

          M:A good GP will make a diagnosis, institute a management plan, follow it up, make sure it's working, and when all avenues have been exhausted then refer to a specialist. Absolutely untrue re not doing surgery, GP's do plenty of surgery ranging from simple things like mole excision right up to general surgical procedures ie appendisectomies particularly in rural areas.

          99: Well GPs in the outback are not your typical GP in australia, they make a very small minority. A minority is just that, a minority and not typical.

          ~

          MissG: Many specialists do not have fancy machines. I'd argue that not even oncologists do - the hospital does! A neurologist has a basic toolkit that they use - GP's have the same toolkit.

          99: i never claimed that they did, i was just pointing out that many do.

          You seem to confuse the work of SOME and apply it to all. Some GPS may do surgeries and other extra tasks in the outback but thats not what MOST gps in the city do.

          I hope you can appreciate the differences between a FEW and MOST. A few australians break the law, most do not.

          ~

          Missg: GP's have the same toolkit. Specialists sacrifice the majority of their knowledge for a very very narrow slice in an area that interests them

          99: None of this changes or disproves my original statement. If you wish to prove me wrong by all means but actually address the matters i brought up dont start patronising me.

          I know a specialist is by definition an expert on a narrow specialised field. I also know that doctors have very little equyipment in their offices and with only that there is little they can explore or examine a person for. Taking blood samples is very basic. Therse a difference between taking blood or measuring blood pressure and the responsibility of a SPECIALIST or SURGEON etc who go to the next level and cut something out etc.

          ~

          Missg: I don't think being a specialist is more challenging than being a GP (unless you do something like, neurosurgery but then you're just a masochist), it's just a completely different challenge.

          99: Well let me ask you a simple thing. What can a GP possibly do in the space of a 15 min consultation. Theres not much you can do after the patient spends a few minutes answering questions and telling them a few things, the time is basically over. THe same would true of any other profession. If a plumber came to your house and asked you a few questions about a plumbing related problem and had to leave after 15 minutes not much would be done. The same is true of a cleaner, electrician or anybody.

          15 minutes to have a chat and learn any problem is not much time. Only simple basic things can be achieved in that time and that combined with the limited equipment reflects my initial statement.

        •  

          @negger: It's because you only go to bulk billing GP's. It's not that they can't treat you properly, it's because they don't have the time. The Medicare rebate has been frozen time and again and their wage has not risen with CPI. They are the least protected field and yet if funded properly, could drive down overall healthcare costs by keeping people out of hospital and actually having the time to improve their health. Find a comprehensive bulk billing GP would be next to impossible. To find a good one, I would suggest paying, and getting one through word of mouth.

        •  

          @MissG:

          Missg: A dermatologist would be useless for most things except skin. Any decent specialist would disagree with you re your 'next level' comment - that's not how it works.

          99: It doesnt take a genius to write a referral to send someone to a skin specialist if they have skin problems, any more than it takes a genius to call the plumber if you have a water or toilet problem in your home. I have known from personal and family experience with serious illness, your claim of a GP monitoring ongoing specialist care is bunk. A GP by definition knows less than the specialist so other than suggesting the patient try a different specialist in the same field or some close field theres not much else the GP can do, and thats what i have observed in my own personal travels.

        •  

          @ninetyNineCents: I can only speak to your initial and very simplistic statement

          " GP dont do surgery"
          "they dont have fancy machines to do chemo"
          "Pretty hard to do more with such a limited amoutn of equipment",
          "no a specialist is the next level and they have considerably more challenges and more."

          You argument that a specialist has more responsibility is interesting. I disagree. They have responsibility over the single specialised issue they've been referred for, nothing else. The GP's responsibility to the patient goes far further.

          And as for a 15 minute consultation, you appear to be completely unaware of how the Medicare item number system works, or the fact that not everyone has a 15 minute consultation. I don't need to prove you wrong, I have plenty of experience with this and you frankly, do not.

        •  

          @MissG:

          Missg: You argument that a specialist has more responsibility is interesting. I disagree. They have responsibility over the single specialised issue they've been referred for, nothing else. The GP's responsibility to the patient goes far further.

          99: Well in the eyes of the law GPs have very little responsibility. Few professions get paid if they fail to deliver. When a builder builds a house that falls over, they appear on ACA, and yet GPs consistently fail to help with many basic illnesses on a regular basis. I hope i dont have to walk you thru examples of doctors failing to diagnose basic things.

          ~~

          Missg: And as for a 15 minute consultation, you appear to be completely unaware of how the Medicare item number system works, or the fact that not everyone has a 15 minute consultation. I don't need to prove you wrong, I have plenty of experience with this and you frankly, do not.

          99: Again you dont seem to be able to read very carefully. I never implied that only 15 mins consultations exist. I was simply talking about 15 min cons because that covers the vast majority of exchanges between patients and GPs.

          Even if a GP had the whole day to spend with a paitent what exaxtly can they do with their limited equipment ?

          To keep this simple i will remind you that the vast majority of GPs have very few basic equipment to measure blood pressure and all that. I wont list them but theres only so much you can do with them. You cant operate, do chemo, etc.

        • +1 vote

          gotta love it when someone with an n=1 experience who has no idea what gp work involves takes on one with a medical background with insider knowledge with contempt

          @missG

          you know what they say about arguing with someone who brings you down to their level. best not to engage all you will do is waste your time

          @99

          i'm sorry to hear you have not had a good experience with GPs but your ignorance and prejudice is only your loss in the end, sadly for you and your family

        •  

          @xbai: Basically sums up the Internet these days doesn't it, it's populated by people who think that their opinion is just as good as someones expertise. You're quite right, it does seem pointless.

        •  

          @xbai: Clearly fishing with the right bait, I knew that one might reel something in, hence the smiley face. I have a solid understanding of general practise. I think you just took offense.

      •  

        Have looked into Anaesthetics for Work/life balance. It's awesome. similar hours to GP, but get the fun community aspect of hospital practice and when you get bored of patients complaints - off to sleep.

        I lept from the Rural Generalist to the more fun Professional drugging career of Anaesthetics ^^. not regretted since.

        •  

          Perhaps your next port of call may be forensic pathologist?? your patients are never awake to begin with..?? :) :)

          your username seems logical

  • +2 votes

    Do you derive an income - as by the looks of it you've be studying since high school ??

    • +11 votes

      When I left high school I was unsure what I wanted to do with myself, I did commence a degree in Science with the intentions of becoming a High School Teacher although I left after a short while to pursue a career as a fire fighter. I have worked for the government for 10 years now and about 6 years ago decided that I wanted to do more with my life and together with the idea of chasing fires at 3am when I am in my mid 50's didn't appeal so I decided to go about the long process of studying Medicine.

      I am fortunate that my shift work allows me to both work and study, I have to make personal arrangements to cover my shifts on occasions where I have a scheduling clash that I am unable to work around and repay these shifts often on weekends and during UNI breaks.

      • +1 vote

        How was the process of gaining entry to the med course? I'm assuming you took the UMAT and then applied around right?

        • +2 votes

          Process can be fairly difficult due to the limited amount of places and the competitive nature of securing a spot. I had taken the UMAT as I was only interested in applying to local universities that only offered undergraduate positions. The process is similar around Australia but each university has slightly different criteria on cutoff marks of the UMAT etc.

          UMAT -> Apply to UAC and University -> Contacted for interview if successful -> Sit multi mini interviews -> contacted if successful.

          The first university I applied to had specific criteria if you were local to the university and also favoured high performing current students which I was both having a GPA of 6.0 and was local however I was unsuccessful at the interview stage, not sure what I did wrong? Hardest part was having received no correspondence to say I was unsuccessful either I had to chase this up myself.

        •  

          @DrSyd: when you say you wanted an undergrad degree, do you mean the 6 Year course as opposed to the post- grad medicine (4 years)?

          I assumed you meant 6 years and this would be why you are covering some similar ground.

        •  

          @Sensiekatie: 100% correct, ideally I wanted WSU which was a 5 year undergraduate degree although I am now at UNSW completing the 6 year program. The first two years are essentially an accelerated Medical Sciences Degree with a clinical focus. Macquarie University have only this year offered Medicine as a post grad although they offer an option to do a six year program with a 2 year Med Studies beforehand.

        • +1 vote

          @DrSyd: Hey, I might have a few questions here, I understand your situation being married for 6 years to someone going through and finishing medical school. My wife received a 7.0 GPA in Biomedical Science, a 98.8% UMAT score and is one of the most genuine down to earth person I've ever met. She did not get any offers after doing her interviews. She now suspects that this was because of the lies others told in regards to the question that ask about charity work they had done. She was honest. The people she spoke to in her year mentioned they made up things like going to Cambodia to build mud huts. She got a last minute offer in the end a week before the course started.

        • +1 vote

          @DrSyd: Macquarie University should not be allowed to have a medical course. They were asked not to proceed by the medical board and as they are not government supported have crazy fees. They are contributing to the already limited places for JMO's in the system.

        • +1 vote

          @Mysterymeat: doesn’t Macquarie have voodoo medicine like homeopathy, chiropractic etc?

      •  

        At what age did you pass UMAT and entered medicine?

  • +1 vote

    Roughly by your estimate, what percentage of doctors marry other doctors, nurses/other hospital staff, since they spend so much time in contact with each other, and patients?

    • +1 vote

      I can't really comment on this as I have no idea although personally I know of other students parents whom are both Doctors or are both in the Medical profession. An interesting topic I have found is that you hear stories of Doctors who have married patients although this is strictly against the rules, you often don't hear of Doctors getting in trouble for this or being de-registered unless things turn sour.

      •  

        To the best of my knowledge it is not against any laws or even commonly held ethical guidelines for doctors to have relationships with former patients, as long as they are no longer in their care, the patient's care has not been compromised, and the doctor-patient relationship was not psychiatric in nature. Your medical defence organisation can advise.

        •  

          Having a relationship with former patients is still considered sexual misconduct. http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Sex...

          There are also guidelines for the level of relationship had with the patient i.e if it was a one off or long term patient which will be considered but unsure of what the outcome is for the doctor even if the relationship was consensual,

          i'm sure there would be case files out there somewhere.

        • +1 vote

          @DrSyd:

          Did you even read the guideline that you linked? Relationships "may be" sexual misconduct in certain scenarios but it is nowhere near as clear cut as you think.

          Doctors are humans too and the medical board understands that.

        • +2 votes

          @Save Medicare:
          Of course I did - there is no doubt that it is sexual misconduct, the onus is then placed on the doctor to prove that the relationship was not breaching the trust of the patient. This might be easy to prove in the context of only treating a patient once or twice or it might be hard to prove. In any case its enacted to ensure that there isn't an abuse of the power balance.

          Sexual misconduct includes:

          engaging in sexual activity with:
          a current patient regardless of whether the patient consented to the activity or not
          a person who is closely related to a patient under the doctor’s care
          a person formerly under a doctor’s care
          making sexual remarks, touching patients or clients in a sexual way, or engaging in sexual behaviour in front of a patient.

          It may be unprofessional for a doctor to enter into a sexual relationship with a former patient, if this breaches the trust the patient placed in the doctor. When considering such allegations the Board would take into account:

          the duration of care provided by the doctor; for example, if there had been long-term emotional or psychological treatment provided
          the level of vulnerability of the patient
          the degree of dependence in the doctor-patient relationship
          the time elapsed since the end of the professional relationship
          the manner in which and reason why the professional relationship was terminated
          the context in which the sexual relationship was established.

        • +1 vote

          @DrSyd:

          you both may be right but in different ways.
          although, if the patient does decide to report/complain(which can happen if relationship no longer becomes amicable), you may get into trouble, so not worth losing your licence over it

        •  

          @DrSyd: obviously our politician has a different guideline regarding this topic

        •  

          @IWoNdEr: His poor wife :(

        •  

          @Save Medicare:

          The problem is because its not well defined what kind of situation a relationship with a patient is misconduct and when it isn't, you're absolutely mental to risk it. There's clear cut cases where it is always misconduct (psychiatrist and patient for example). But what if you stitched their hand once in emergency? Not likely to be any misuse of the power in your relationship there, but its still open to a disciplinary arse kicking if that patient decides that you did abuse your power.
          One angry break up away from losing your medical license. Best to just avoid it.

  •  

    What are your thoughts on the big pharma boys? Do you believe in their medicines in the long term?

    •  

      One of the subjects we are taught in Medical School is all about clinical data and interpreting clinical trials,understanding the relevancy of the trials and interpreting the results. I find this topic incredibly dry although realistically it is highly relevant, the issue is that of course big pharma have agendas to push so its important for Doctors to determine if the medicine is right for the patient in the long term and interpret the results of the trials to see that they are non-biased and clinically relevant to the patient.

      Normally from what I understand this is the job of the TGA, to ascertain the safety of the drug & quality of the research and trials before drugs can go on the market. Often drugs offered by big pharma will be effective but its up to the doctor to decide if they are right for the patient.

      My knowledge on the topic is vague at best so giving personal opinion on it will come as I gain more experience although I guess what I was trying to say is that doctors will need to make informed decisions when prescribing short or long term.

      • +4 votes

        "My knowledge on the topic is vague at best ….."

        No offence intended but that seems to be the default position of most doctors these days. The good doctors keep studying after they leave doctor school and look for information outside of the controlled and manipulated information put forward by vested interests. These days of course we are lucky and have access to quality studies for a lot of things that you wouldn't have been able to access in times gone past. If you care about your patients you will walk that path in conjunction with what you have already been taught. But be aware that if you do start helping people to get better, I mean to really get better and not just hide the symptoms you may well be ostracised or targeted. That happened to my last doctor and I have read of may MANY others who suffer the same fate.

        Good luck, I hope you make a difference. :)

        • +7 votes

          Thanks :)

          Sorry when I said "My knowledge was vague…." I meant in the context of the debate that occurs in the industry as I am yet to experience that. But I agree with you wholeheartedly, doctors need to look underneath the surface to see if the drug in question really is fit for the purpose. Often marketing of drugs get in the way and its just human in a way that we get distracted from the truth when the alternate appears the better option due to crafty advertising.

          I do however feel that it is not in the intentions of the drug companies to purposefully mask symptoms and not provide cures, I think this perception comes from the haste in which drug companies release their products that are not entirely fit for purpose. But then at the end of the day they are a business and have stake holders so there is an inherit conflict of interest which could potentially drive companies to want to develop drugs to treat symptoms rather than cure disease.

        •  

          @DrSyd: Cheers, I'm not trolling here but I have a question that I have asked MANY people and never gotten an answer for. Basically, apart from anti biotics (which have their own issues but do get the immediate job done) can you tell me of ANY pharmaceutical drug that has actually CURED a patient? And by cured I mean they take the drug for a while, the issue resolves, without side effects and the patient no longer has to take that drug anymore. From what I can see most if not all of them merely mask the symptoms, do not address the underlying issues and have bad side effects requiring different drugs to counter. I'm assuming there must be some out there that actually cure people?

        • +5 votes

          @EightImmortals: Am doctor hijacking OPs post. Just thought I'd mention that "take the drug for a while, the issue resolves, without side effects and the patient no longer has to take that drug anymore" is like looking for a miracle and is often unrealistic. Medicines and procedures are recommended based on evidence, and what the current research shows.

          Everyone breaks up disease into different categories, but we can essentially break it into lifestyle (caused by one's own habits), and everything else. Hypertension (High blood pressure) is a disease that can be related to lifestyle, and so we give medications to manage that, whilst advising the patient to manage their lifestyle. The high BP won't directly kill them, but it massively increased their risk of a stroke, kidney failure, etc… If I had a pill to make somebody stop smoking and lose 20kg, I'd give it to them, but until then we work on preventing more serious complications. Same thing with type II diabetes really, weight loss is the goal, but people don't want to do that. What we can do is give them something to control their blood sugar to prevent their eyes, kidneys, and nerves deteriorating to the point where they lose quality of life.

          The other issue is that genetic diseases, cancers, etc… may have elements of lifestyle influence, but are mostly caused by one's own body. Big pharma of course pushes their agenda, but being realistic, these diseases wont be cured by a pill. They will be cured by gene therapy (eventually), or being made asymptomatic to the point where they are practically non-existent. Just trying to be straight with you, medicine is mostly preventative and less so curative. Surgery and procedures are curative, but that's not what you're asking.

          As for some other examples of successful meds, off the top of my head:
          - Anti-fungal agents
          - Topical/oral/IV steroids for a LOT of conditions
          - Lithium to manage bipolar (not curative, but very effective in managing. Psych medications are a relatively new field)
          - Hepatitis C is now curable through a few meds, which is awesome
          - Vaccines (not looking to start a debate)
          - Desensitisation treatment to remove allergies
          - The entire field of anaesthesia

          In the next few decades, I'd love to see us really solve issues with pain medications. The USA has a really f'd system of opioid abuse, and I'd hate for it to spread here. We're a drop in the bucket compared to them. The difference is big pharma is allowed to directly market to patients there, while they cannot here.

          Ending this essay, I'd like to say that the overwhelming majority of doctors don't give pharma reps the time of day. I know I don't :)

        • +1 vote

          @Liqqeh: Given we have science training and the bulk of hospitalists have at least done some research and so should have some knowledge decent study design, I'd like to think we're for the most part quite capable of assessing a study for its merits (or lack there of) rather than just believing every pharmaceutical rep headline. Our regular journal clubs would be a bit of a waste of time if we didn't.

          I thoroughly appreciate their sandwiches at our teaching sessions. I think on one occasion I've prescribed something because of a drug rep visit (didn't know we already had a particular inhaler in the hospital). I've had one occasion where I've felt a drug rep was being a bit dodgy (advocating dodgy off label use of a drug). They weren't invited back.

          Their marketing bullshit is much better regulated here than it is in the USA.

          Additional fun diseases to mention are certain 'curable' malignancies:
          -Testicular cancer ('curable' in the oncological sense even with distant metastases is pretty f'ing amazing! The side effects are pretty atrocious but having cancer in your brains pretty nasty too)
          -Plasmacytoma (generally 'curable' with a short course of radiotherapy, although always a risk of later relapsing into myeloma)
          And others..
          Wouldn't quite meet his definition though given side effects.

        •  

          @Liqqeh: Thanks for the reply, you sound a bit like my own doctor. :)

          You touched on gene therapy, were you referring to stem-cell treatment? I've heard that is moving ahead at a rapid pace at the moment without the need to harvest cells from foetuses like they did at the start back in the eighties. A lot of doctors seem unware of it as a treatment option. It seems to be helping people avoid all kinds of joint surgery and there have even been reports of cancer eradication too. Is it as widely available here as it is in the U.S. or are you not up to speed with it's use?

          As for your list I have to query a couple of those things.

          -Hep C, I've heard that at least one pill was VERY expensive (around 100K per course) but there might be others less expensive. So it does actually work but is prohibitively priced. I think the company in question profited to the tune of 25Bn on that one drugg alone.
          -Vaccines do not CURE anything, they only prevent (allegedly, no I don't want that debate either. :) )
          - anaesthesia? I thought it was just for knocking people out or having teeth filled. :) Does it have a curative use as well?

        •  

          @EightImmortals:

          Nah gene therapy stuff isn't really in use atm,I just mean its the golden dream for the next few decades. Stem cell treatments are available here privately for things like trying to restore cartilage in joints. Sadly, I don't think the evidence really supports its use because it isn't perfected. In theory, growing cartilage to replace deteriorated cartilage makes sense but I believe it doesn't integrate well with existing tissues. Modern knee replacements have a lifespan of 10-15 years and usually allow people to return to normal life. With the exception of high impact sports, but then again, how many 60+ year old are playing soccer/rugby. Won't lie to ya, I doubt there will be any widely available stuff for yeeaaars.

          Hep C medications are indeed expensive, but in Australia they are offered on the PBS so the Government eats the cost and patients pay the same as any other PBS prescription. It's usually a 12 week course, with some check ups along the way, but its all Government funded. I haven't read about the USA, but I wouldn't be surprised if they're charging stupid prices for these meds.

          As for the rest of my list, I didn't just include curable things, just medications that I consider to be game changers for the modern world. Anaesthesia is obviously not curative, but the drugs themselves are interesting, and allow for often curative procedures to happen that otherwise could not be done.

        • +1 vote

          @Liqqeh: Thanks again, Yeah I'm not dismissive of the actual advances made by western medicine but I also have to question a lot of the assumptions present in society. It doesn't make sense that we have spent the last 6 million years evolving to the point where we now need pharamceutical drugs to live normal pain free lives. But then I guess we hardly lead natural lives nor eat natural food (for most people) either. :)

          Also, anything on the PBS is paid for by the population through taxation, the idea that the government 'pays' for anything just doesn't gel for me.

          Was also reading some interesting stuff about 3D printed bits and pieces that seem to be promising for the future as well. If I can get someone to print me some teeth then I'd pay for that…

          Thanks again.

        •  

          @EightImmortals: Sorry I couldn't be more help! Happy reading!

        • +1 vote

          @EightImmortals: Eight I'm just going to pick apart your point on the cost of the hep-C drug because you've gone down the evil big-pharma etc path. I want to point something out to you for your own knowledge because while the arguments may hold up in the US, they are ignorant at best in Australia. (And stem cell harvestation doesn't need to come from embryos anymore, that is a massive area of science and you probably need to do quite a lot of reading to get up to speed).

          Drugs are incredibly expensive to produce, they take decades and hundreds of thousands of work hours and cutting edge research. And drugs aren't a homogenous thing - there are over 7000 drugs we can prescribe, of varying levels of effectiveness for their varying indications. Saying 'the drugs don't work' is nonsensical for this reason, but back to my point.

          When you read about drugs costing hundreds of thousands of dollars and aren't those companies evil etc - yes they are but not in the way you think. The price of drugs is the result of collusion between the US government, private insurers, and big pharma. There is minimal Medicare in the US and so there is literally no one to negotiate costs with the drug companies on the patient's behalf. What happens instead is that the insurers 'negotiate' the drug prices with the drug companies, so the patient gets some sort of rebate but have to bear an out of pocket cost. What happens when two private entites 'negotiate' on the part of a vulnerable consumer? They line their own pockets. The US government rubber stamps it. It's a disgrace.

          Now in Australia, we are much more left-leaning so we don't have this issue. Our government negotiates the cost of drugs on our behalf with these companies. The government is seeking to minimise the cost of healthcare so there is no way they will pay the prices the drug companies ask of US citizens. They set a price for the patient to pay (around $20-30 or $3 if health care card) and they wear the rest. So you will never find a hep-C drug costing anywhere near what you just quoted for this reason. Our therapeutic goods administration is draconian in what they will and wont approve. The curious thing about the US is that for all their bleating about 'big pharma' being evil, they don't realise that it's the result of a privatised healthcare system and view universal healthcare as a suspicious left-wing ideology, even though it would make things cheaper for them. The drug companies and insurers and the government push that suspicion so they can keep lining their own pockets.

          And finally, not all drugs are produced by big evil drug companies! Quite a few universities in Australia have discovered a drug (Gardasil being a good example), and set up a biotech company to produce it, or entered into a deal with a drug company where they earn a shitload of money, and that money stays in Australia and funds more research. This happens world wide, so oversimplying things into 'drugs and 'big pharma' doesn't really paint a truthful picture of the situation.

          And finally finally, while yes in the US drug companies advertise on TV and pay doctors lots of money and give them things, Australia has far stricter laws around that. At best for most doctors in Australia, you might get invited to dinner to hear about a drug and the dinner gets paid for. However most Australian doctors are pretty nice sensible people who don't find the idea of going out to dinner with a bunch of random doctors they don't know, to hear a dry AF lecture on some drug they don't care about, just a free meal, a really good idea. I don't know anyone who goes to them. I think I got a free pen once.

          By the way - antibiotics cure bacterial infections.

          If you again want to be oversimplistic to the point of saying 'no drug cures anything' and then argue the semantics (but not the scientifici basis) of why that's correct, then that's on you, you might win your arguments in your mind and feel very satisfied with yourself but yeah, not scientifically correct.

        •  

          @MissG: Talk about going off half-cocked.

          Firstly I never said anything about the totally dodgy privatised health care system in the U.S., we all know it exists and is the major factor in the high cost of health care in the U.S. I only mentioned that one particular HepC drug cost 100K per course and the company profited about 25BN (profited, that's after all of their development costs, so far.) On that subject the two HepC drugs Sovaldi and Harvoni cost over 20K each here in Australia but with PBS they are around $40. You EVEN AGREED that the Australian government (i.e. our tax dollars) are paying the difference so I'm not sure what your point is. Hey if it actually cures HepC then that's great, my point however was : greed. How many BILLIONS of dollars profit is enough?

          (And stem cell harvestation doesn't need to come from embryos anymore, that is a massive area of science and you probably need to do quite a lot of reading to get up to speed).

          I suggest YOU get up to speed by reading what I actually wrote.

          So not all drugs are produced by drug companies…but they actually are?

          "not all drugs are produced by big evil drug companies!" "…Quite a few universities in Australia have discovered a drug (Gardasil being a good example), and set up a biotech company to produce it, or entered into a deal with a drug company."

          BTW, any company that produces drugs is…guess what? A DRUG COMPANY. If they act ethically while helping people to overcome illness while at the same time not gouging the system for all they can get then I have NO problems with that. But then I never mentioned that either. I merely asked the question.

          "By the way - antibiotics cure bacterial infections."

          By the way, you should add that to your re-reading list of what I actually posted.

          "If you again want to be oversimplistic to the point of saying 'no drug cures anything' and then argue the semantics (but not the scientifici basis) of why that's correct, then that's on you…"

          Actually IF YOU HAD READ MY POST PROPERLY I merely asked the question because I was genuinely curious. I am grateful to the people who actually read what I posted and replied to my questions. I'm not so thrilled by people who go off half-cocked without properly reading things they reply to. So while your post may (or may not) contain some valid points they are not points that I raised (or if they were they have already been answered). I wont bother replying to any further argumentative posts.

          (edit: Here's more info about Hep C drug gouging in Australia, this one cost the taxpayer 1 BILLION dollars over 4 months (2016) http://www.abc.net.au/news/2016-12-05/hep-c-drugs-australias...

          And some more general info about the PBS, big pharma profits and gouging which seems to refute most of your other your claims (in the context of Australia): https://www.michaelwest.com.au/and-they-beat-us-in-the-pbs-t... )

      • +3 votes

        I’d recommend reading Bad Pharma by Ben Goldacre. Fascinating book at how big pharma works.

    •  

      Ferret: Are you implying that alternative medicines are responsible or a real option ?

  •  

    I went to a local GP to get a mole checked that's on my upper back, then was told that only male doctors at their clinic can make the assessment, is that normal?

    It's fair enough but I had to re-book another appointment

    • +6 votes

      This can be very frustrating, perhaps the Doctor had religious or some other reasons for not treating you (which I know might sound crazy) but it is the responsibility of the doctor to then direct the patient to another doctor who can offer the treatment.I imagine this is why she asked you see the male doctor on another day.

      For instance if your GP is a devout christian whom is against oral contraceptives they are not required to prescribe them to you but are required to refer you to another doctor who can. Terminating a pregnancy is another example, if the doctor is against terminations but the patient is adamant the doctor is required to refer the patient to another doctor.

      • +1 vote

        Interesting, thanks for the perspective

        •  

          OP is a little too big for their boots here (2nd year medicine at all 3 sydney based medical schools barely sees patients all year) and what they've said is unlikely to be the reason in this scenario.

          The real reason is more likely to be that only the male doctors at the practice have had training with the dermatoscope and are confident in their ability to identify and excise the lesion. This is particularly true in city practices where there is an abundance of dermatologists or GPs specialising in skin to refer to. Country practices will have more of their GPs skilled in dermatoscopy given distance to specialist services.

        • +1 vote

          @Save Medicare: Spot on. Although OP's response is a possible reason, most likely reason is what you have said!

        • +12 votes

          @Save Medicare:

          The man was told only male doctors can make the assessment - a normal person in this instance should have said that he would need to come back to see another doctor who is qualified. The doctor made a distinction based on sex and not qualifications leaving it unclear to the patient as to why she could not make the assessment.

          Although I believe it is likely the case that indeed the male doctors at the clinic may have been the only ones trained the doctor left the patient with the impression that this was a gender issue.

          NB: I have clin experience shadowing a plastic surgeon I know In a day surgery from time to time which commenced 4 years ago. Also there are 5 medical schools in Sydney

        • +11 votes

          @Save Medicare: Calling you out for being condescending to OP, being likely incorrect about your assumption of the purported question, and also for the half-arsed apology. If you're in the medical profession, I'm sure you know more than well enough that they need less of the likes of people like you flaunting your superiority over those your junior. Practise some humility before demanding any respect.

        • +1 vote

          @Save Medicare: UNSW has no clinical experience until they become a JMO. The JMP and Monash program (used by UWS) are better at giving their students real world experience.

        • +1 vote

          @Mysterymeat: Alright I have to call you out on this one. The final 2 years of BmedMD at UNSW is virtually full time clinical rotations including 4 weeks of Rural Placements (Longer if you are a rural applicant) Year 3 is 3-4 days per week clinical coursework and year 4 is a research project. However attached to clinical schools which are shared with other universities, WSU and UNSW share Liverpool / Fairfield.

          I think this structure has something to do with the new degree. UNSW moved from MBBS to BmedMD which is on paper a higher level of achievement as MBBS is a double degree where BmedMD (MD Component) is postgraduate. End of the day what difference does it make both allow you to practice medicine.

        • +1 vote

          @DrSyd: My best friends have medical degree's from Monash, UWS, UNSW and JMP. We often open a bottle of wine (or 5) and discuss our different education systems. Personally, I went to UWS, I was jealous of UNSW students. You get the research year and spend most of your time on theory. Even when you are doing the rotations your days are much shorter than UWS/JMP. It's an accepted fact (within our small circle). We were in hospitals from third year working from 7am - 7pm 5 days a week without pay. I felt like it was the TAFE of medical school because of how practical it was. The UNSW students seemed smarter in theory ( I went to Fairfield with some of them) but ask them to do a cannula and it was all over. Everything comes with experience at the end of the day we all gain the skills we lack.

        •  

          @Mysterymeat: Fair response - I actually really wish I got into UWS :(

        •  

          @Mysterymeat: May I ask what path you have ventured specialty wise?

        •  

          @DrSyd: GP4LYFE - My wife would never say that but she is in the shower. Like you she wants a work life balance that allows for kids and holidays/ down time. When people ask her IF she specialised she said YES I did in General Practise and they look all confused. It was NOT a last case option she had the marks to do anything but couldn't live the life of working in the hospital day in and day out. Do you know the difference between vocationally and non-vocationally trained GP's? We didn't figure this out until 4th year.

        •  

          @Mysterymeat: Thats what I like to hear, also just checking if those plates are taken GP4LYF i'm putting them on hold. I have been reading a lot about the entry pathways recently, I know im getting in early but ideally I want it to be a seamless progression so trying to get my head around it all well in advance. I thought the difference was that GP's who have been in practice for years and years prior to the RACGP were NON - VR and then those who came in after a certain time who have had to apply for general practice training to gain fellowship are VR?

          Is this the same as what you were talking about? Or are you referring to the different fellowship pathways? This is what is confusong me, I first thought you just applied, exam etc then AGPT etc more exams -> fellowship

          But there appears to be a number of ways? https://www.racgp.org.au/education/fellowship/fellowship-of-...

        •  

          @DrSyd: No it was more the pay gap between Non-VR and VR trained Doctors. Experienced Non-VR doctor's earn significantly less than those who have less experience but the RACGp. It's almost 50c to the dollar. I have some great insights to share . Let me get them down before I get to bed.

        •  

          @Mysterymeat: Sure thanks!

      • +5 votes

        The mole is on his upper back not on his penis

        •  

          I agree, it works both ways though. I have seen patients refuse to be seen by male doctors even for minor ailments.

    •  

      It's very likely that some of the male doctors in that particular GP clinic have an interest/specialise in doing the skin checks, excisions and therefore do all of them for that place.

      GPs have to cover the whole spectrum of medicine and the training is only 2 years, so many GPs develop special interest in a particular area e.g. family planning, childrens health, gynaecology etc.

      • +2 votes

        2 years? 6 years medical school, JMO, Res, GP Reg for 2 year. I count 10 years there buddy.

        •  

          Medical school teaches the theoretical and limited practical. Intern and resident do many secretarial work at hospitals and have limited decision making capabilities. Furthermore hospital and GP practice are completely different (acute vs chronic management) thus they will only have 2 years of GP experience before they are qualified.

          Why do you think other specialty training programs are minimum 5 years long on top of medical student/intern/resident if all the other years count?

        • +2 votes

          @kingmw: Are you in the medical field? The fact you know that JMO's and Residents are mainly administration staff make me feel like you have some experience. I only wanted to express that GP is a speciality with challenges and validity like any other.

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