[AMA] I'm a Young GP. Ask Me Anything and Provide Feedback

LAusGP on 09/03/2018 - 00:15
Last edited 09/03/2018 - 13:45 by 2 other users

So I recently went to an Innovation in Healthcare conference and feel inspired to change General Practice. Also with the long weekend thought I would offer a limited time AMA.

So ask me anything (within reason) you like as long as it isn't direct medical advice.

Also I'm looking to see what people would love from their GP. Put some outlandish ideas out there as well as some practical ideas.

Edit: Would love to hear what people ideally want from their GP. I'm hearing you would love to have a good GP in the first place but if you had a clinically competent GP who does listen to You- is there anything else you would want?

For context I work at a mixed billing clinic where I probably bulk bill around 25% of my patients. I've been a qualified GP for 1 year and been working in general practice in training for the 2 years prior to that. Our clinic already offers a high touch service where I spend probably 1-2 hours a day following up results and ringing patients. We also run a results line where patients can ring in to find out from the nurse at a basic level what their results are like.

Ask away!

Introduce Yourself

closed Comments

    • AusGP on 09/03/2018 - 01:10
      +68

      I'm interested to know whether you've had negative experiences that lead you to that comment? It saddens me that my friends perceptions of GPs is that we only write scripts and referrals lol.

      Some of my memorable pickups:
      - patient coming in with Gastro and I find a massive Ovarian tumour
      - lymphoma pickup after symptoms for only 2 weeks
      - Legionella
      - Carotid artery dissection (tearing)
      - cutting out a melanoma that didn't look like a melanoma (and the initial biopsy didn't show a melanoma but was a bit funny)
      - rectal cancer when patient thought it was a bit of diarrhoea
      - Type 1 diabetes in young boy
      - Tuberculosis (coincidentally one of my friends was sick for ages with this as well and I kept telling him to see his GP and his GP kept doing funny things until he finally went to hospital and got diagnosed -_-)

      So basically I'm saying GPs do heaps. Just not every GP is a good GP unfortunately….

      • sim777 on 09/03/2018 - 09:42

        I actually had the opposite experience where my GP threw different types of antibiotics/anti-virals at me before referring me to a dermatologist at which point I was given a steroid cream for eczema. ( wont go into detailed clinical symptoms)

        • AusGP on 09/03/2018 - 09:57
          +30

          Inevitably there are misses - 1 delayed diagnosis I can think of but I'm still young in my career so know that more may come. Strive every day to ensure I keep the number as low as possible. However being a GP where we're at the front line and serious things sometimes present vaguely means in all probability I will have "misses". Just have to work very hard to not miss anything and to learn from any misses or near misses.

        • No ONE on 10/03/2018 - 11:35
          -5

          So you mean GP should send patient to ED everytime they present with symptoms. If that happens, the whole help system would collapse.

        • Scrooge McDuck on 10/03/2018 - 11:57
          -2

          @No ONE:

          No, I just asked a simple question. There's no ulterior motive to it. This is an AMA, not a self-aggrandisement platform.

          The point is that successes should be measured against failures when assessing the overall value of a service.

        • radicalhaqer on 11/03/2018 - 09:51

          @RJW:

          Thanks Doc. The fact that you're putting an effort to improve and innovate is in itself says a lot about you. I wonder how comfortable and advanced are we in using machine learning/data science for diagnosis?

        • AusGP on 11/03/2018 - 13:28

          @radicalhaqer:
          I think we aren't that comfortable yet but I know there's a lot of work in specialty fields to try and leverage some of the benefits of Machine Learning - read about Watson and oncological (cancer) care sometimes.

          A couple of years ago I did hear of the Alfred Hospital (trauma hospital in Melbourne) having decision support tools in their ED for trauma cases so I'm sure in the future, they will have more advanced machine learning algorithms that power that!

      • TheBilly on 09/03/2018 - 09:51
        +9

        I wouldn't state that my experiences have been negative per-se as no illness I've come across to date has been permanent or severe, thankfully. Being a relatively young guy who is not at risk of any severe diseases, I have not experienced anything but dismissive GP's my ENTIRE life. This can be two reasons - they might just assume, he's young, there won't be any major issues so they follow the path of least resistance in order to get me out of the room, or I'm just being high maintenance (possible). But at the very least, I would expect a consultative and investigative process to provide the correct advice. Similarly anything marginally complex outside of a flue, just results in the GP saying "you need to go and see this person" or "you need to go and see that person" no preliminary advice or investigation given as to what it could be, or what we can do further to investigate.

        • AusGP on 09/03/2018 - 09:58
          +3

          You need to find a good GP and stick to them when you do!

        • TheBilly on 09/03/2018 - 12:01
          +18

          @RJW:

          I've been too quite a few different GP's in many parts of Sydney, enough to safely say that the majority prefer to churn through the patients as opposed to being consultative.

        • AusGP on 09/03/2018 - 12:04
          +5

          @TheBilly:

          Try a private billing clinic would be the main sure fire way to find someone more consultative. Or, see the GP registrar (trainee). Often you get better value out of them than the regular GP.

        • TheBilly on 10/03/2018 - 09:33

          @RJW:

          Thanks, I will try this for sure :)

      • thriftybunny on 09/03/2018 - 12:32
        +9

        My GP is really expensive ($75 per 10 minutes consultation) and honestly I feel like all he does is referrals and sick leave notice… & the specialists he refers are also really expensive.
        A good GP is really hard to find…

        • AusGP on 09/03/2018 - 12:45
          +4

          Hopefully that means it's because you haven't ever been very ill. But if you're unhappy with your GP, you can try a different one to see how it goes - given you're paying $75 (I actually charge $80+ for 15 min) you should walk out feeling satisfied.

        • thriftybunny on 09/03/2018 - 14:10
          +6

          @RJW: this GP is the most convenient for me to get to, my last GP bulk billed so it came as a bit of a shock. They are actually really similar in mannerism and about the same age etc.

          Maybe not so much a question for you but health care in AU is getting expensive, I pay Medicare levy + private health insurance, and every time I see any medical professional I have to pay a decent out of pocket amount on top of what Medicare/private Health insurance covers…

        • Pootie Tang on 09/03/2018 - 14:20
          +5

          @thriftybunny: 15 mins @ $127 at my churn and burn clinic. Family GP charges $27 which is all covered. It's like a used car salesman market.

        • AusGP on 09/03/2018 - 14:21
          +1

          @thriftybunny:
          Indeed that was one of the themes that's been around for years - not only is Medical expenses expensive for patients but also as a whole for taxpayers and I think it will be crunch time if we don't change our model of care to be able to do more with less.

        • syousef on 11/03/2018 - 09:35

          @RJW:

          I am still getting bulk billed. Important given I have a couple of chronic conditions (well controlled thankfully). $80 a handful of times a year is one thing, if you have it to begin with. But for those who have to see a doctor more frequently it is unreasonable. Consider a family of 4 where each family member sees a doctor 6 times a year (once every 2 months - might seem a bit much but one family member getting seriously ill would blow that). 4x6x$80 = $1920. Before medications.

          Even before I got older and required more care I was always of the opinion that the difference between a hell hole and a decent society is "free" (taxpayer/communally funded) access to the basics including medical care. I am absolutely fine with reasonable tax increases that go directly to medicare and ensuring we are all covered.

          As a family, from April we'll be paying $460/month for private and that is getting somewhat out of hand. I'm glad I'm with HCF, not BUPA given what they're pulling.

          Speaking of doing more for less, I think doctors having to give medical certificates for sick leave is a joke, unless the worker is taking a heck of a lot of sick leave. Employers need to cut workers who have the odd couple of days off with a cold some slack and not force them to see a GP or chemist when they should be in bed.

        • AusGP on 11/03/2018 - 13:24

          @syousef:
          Hi syousef, glad that you're getting good care and getting bulk billed! As you may see in some of my other posts - I do bulk bill around 25% of my patients. I have had new patients to me that I've opted to bulk bill too. We also offer reduced rates like a pensioner rate which essentially only pays me $6 more than if I bulk billed and got the Medicare incentive for bulk billing pensioners - the reason we do it is the principle of patients knowing that their care is worth something. When I worked at bulk billing clinics I got treated worse off by a select few patients than I have ever been treated by people who pay the full amount - partly its due to education and attitude but I believe partly due to them having no idea that their medical care is worth something!

          So I'm not against bulk billing by any means! - But why shouldn't a CEO of a mid-size company or a senior director of an international company pay for their consultation - thereby allowing me to offer my best care to all my patients regardless whether they're paying me more money or not?

          I agree - employers should stop demanding sick leave certificates for simple days off. I believe this is changing though as a lot of patients whom I offer certificates no longer need them. Even my wife doesn't need a med cert when taking a day off sick (non-medical)

        • syousef on 11/03/2018 - 21:52
          +1

          @RJW:

          The CEO should pay more. Through the tax system. I have no problem being taxed more if it's going to the right place.

          It is asinine to treat a good doctor poorly. As you can see from a lot of the comments here, good care is quite hard to come by. This is why I said a cultural shift is needed. If you find a good doctor and treat them badly, you're a fool like the idiot sawing at the branch they're sitting on.

          (From your other reply) Reporting negligence/malpractice up the chain isn't easy and you often encounter a lot of resistance and criticism and are treated as difficult. Doctors and nurses often also have no idea how to handle a patient who isn't a doctor but can read a medical journal and isn't prone to pseudoscientific babble. (By no means am I saying I can't make a mistake but I did an unrelated degree that taught me how to break down research that you don't understand). A lot assume that if you try to get involved in your care that you're an idiot thatgoogled some quack treatment. They tend to get very defensive and wary. On the flip side I've had a nurse break down and tell me she can't help me because she's not a research scientist.

          I'm in my 40s so not quite ready to kick the bucket but if I died tomorrow I'd have had a good run. I'm really fearful that my children will end up with worse care than we got. And that the attitudes to science and medicine today are slipping into those of the dark ages.

        • thriftybunny on 12/03/2018 - 06:09
          +1

          @syousef: hi jumping in, what's the difference between Bupa and HCF you are talking about? I'm with Bupa…

        • syousef on 12/03/2018 - 07:19
          +4

          @thriftybunny:

          I was talking about recent changes.
          https://www.theguardian.com/australia-news/2018/mar/01/bupa-…
          https://www.finder.com.au/bupa-medical-gap-scheme
          https://www.smh.com.au/healthcare/bupa-tweaks-controversial-…
          https://www.smh.com.au/healthcare/doctors-say-bupa-s-revised…

          The reason my wife and I went with HCF instead of BUPA (then MBF about 10 years ago) for family cover when she was pregnant was that when we enquired MBF had a policy of classifying a problem a baby was born with as a pre-existing condition, subject to a 12 month waiting period. HCF had no such restriction. We found this out asking questions in person at the shopfronts.

          My personal opinion is that with these recent changes you'd have to have rocks in your head to stick with BUPA. If they don't get a massive response in terms of members voting with their feet I'm afraid these policies will spread through the industry in Australia and bring us closer to an American system.

      • pgp82 on 12/03/2018 - 14:20
        +1

        Interesting read so far :). How did a bit of diarrhoea turn out to be rectal cancer? :o

        • AusGP on 12/03/2018 - 14:44
          +1

          It was a symptom of the cancer - most diarrhoea of course isn't cancer but if it's been going on for months in someone older than 50, golden rule is always to send them off for colonoscopy.

    • Scrooge McDuck on 09/03/2018 - 10:32
      -4

      Maybe GPs should try and figure out what is wrong with somebody and treat it.

      Constipation?

      • [Deactivated] on 09/03/2018 - 13:12
        +3

        The good ones tend to have waiting lists weeks long. If you just ring up for a same-day appointment you get the ones who aren't busy (read popular). That will colour your experience somewhat.

      • Deridas on 09/03/2018 - 13:26
        +5

        Yeah, so the world would be a better place without this "useless" profession?

        • AusGP on 09/03/2018 - 16:10
          +13

          @ensanguined:

          Care to elaborate what things you think a GP can't do? When you have diabetes that's well controlled or a thyroid problem that needs minor adjustment are you saying you want to do all of these with an endocrinologist?

          As I stated above, someone coming in for a sick note for their gastroenteritis - I actually took the time to feel their belly and found a massive ovarian tumour - that's the value of a GP and these "useless" consultations.

          Or the time someone comes in for their cold and sick note and I convince them to stop smoking - If I do that a few times then I've potentially saved a life.

          Or the time someone comes in "just for a script" for their annoying cough, but actually they were having an asthma attack (because believe it or not some people don't know what medical symptoms are!)

          Or the time someone at the end of a consultation about scripts and referrals - "oh by the way this spot has been growing over the last couple of months" - and I stay back 30 minutes and take the time to do a biopsy - and you end up cutting out a melanoma that doesn't look like a typical melanoma (and fingers crossed saved this persons life)

          Even for the specialist only tasks - which specialist?
          My late grandfather got misdiagnosed overseas because you could go directly to a specialist. He felt dizzy so the family thought maybe take him to a cardiologist. The cardiologist gave him the wrong treatment when he was actually having a stroke. A good GP would've recognised the diagnosis and sent him to hospital.
          Will you know which specialist to see when you're having vague stroke symptoms?

        • MessyG on 09/03/2018 - 18:58
          +5

          @ensanguined: Well thats the Ozbargain 2018 Most Ignorant Statement of the Year award.

        • Pineapples on 10/03/2018 - 21:16
          +5

          @ensanguined: Worth mentioning that GPs are in fact'specialists'. Just like every other specialist, they've gone through med school, residency, post graduate speciality training and a stack of exams. As a junior doctors pursuing a career in general practice, selling GPs as inferior to any other medical speciality is frankly offensive. General practice is hard work. Like any other profession (not just medical) there are people who are better at their jobs than others. I've met my share of dodgy tradies, nurses, lawyers and doctors. Doesn't mean that everyone in those professions is useless.

        • syousef on 11/03/2018 - 09:25
          +3

          @MissG:

          Ozbargain Most Ignorant Statement of the Year is a very competitive award and 2018 is young, but definitely a contender!

      • parisienne on 09/03/2018 - 18:43
        +2

        So ensanguined ,are YOU a real estate agent ?????

    • slow on 09/03/2018 - 13:16
      +3

      I agree, GPs should be experts on every possible medical condition, and be able to diagnose and treat anything by just looking at you.

      • AusGP on 09/03/2018 - 15:03

        One day that may be true - Star Trek scanners may be the norm and there'll be no specialists - just a GP to scan you with computer backed magical diagnostic tools and treat you.

    • mp3police on 13/03/2018 - 12:11

      I went to a local GP complaining of stomach pains and as if someone has been kicking / standing on my balls.
      Dr said to go home and rest and see how I felt in the morning, I refused an asked if I can get a referral to hospital which was done.
      After passing out in the waiting room of the hospital I went into an emergency operation where they found I had omental torsion and was turning gangrenous and it had affected other stuff. They had to remove portion of the omentum and appendix.

      • TheBilly on 13/03/2018 - 13:47
        -1

        Maybe GPs should try and figure out what is wrong with somebody and treat it.

        This just reiterates my initial "quite unpopular" statement. Whilst having doctors is necessary and nobody is discounting that fact. The quality of the consultation that GP's give is extremely poor and effectively useless. I don't know the reasoning as to why this is the case, but in my personal experience, the experiences of many people I know and also randoms on Oz bargain, this seems to be the case. I can count maybe 12 doctors out of 14-15 I have visited that have had a nonchalant, brush aside type approach to all queries I have presented, as a percentage this is too high.

  • Diji1 on 09/03/2018 - 00:23
    +17

    When we getting that medical Mary Jane?

    • AusGP on 09/03/2018 - 01:12
      +5

      Hmm not too sure to be honest. We tend to be cautious in medicine mainly as the profession has been burnt a couple of times with new fangled treatments….

        • one man clan on 09/03/2018 - 09:34
          +32

          Geez which doctor touched your naughty parts

        • EightImmortals on 09/03/2018 - 09:36
          +1

          @one man clan: Dr Luuuurve.

        • AusGP on 09/03/2018 - 09:52
          +7

          Care to show us where the myriad of high quality studies are? I'm going to have to call you out on those claims if you can't back it up.

          I'm sure there are studies out there - but are they good quality studies, or are they quack studies like the MMR vaccine study that destroyed confidence in MMR vaccine despite being debunked as a myth many times?

          I will be the first to admit that proven innovation in medicine still takes too long to diffuse out. Funny you mentioned scurvy as that was an example used at the innovation at healthcare conference!

          I think though we're more aware of the inertia these days. The thing is until things are proven, who's to say whether any new treatment is the one that we look back on and works, the 998 that don't work, or the 1 like smoking cigarettes that kills you quicker?

        • AusGP on 09/03/2018 - 10:54
          +7

          @EightImmortals:

          When you mentioned systematic study. In any case I was making the point - without high quality studies, research can be doubtful. Just like we are always sceptical of drug company claims, so must we also examine all other claims.

        • mrham on 09/03/2018 - 10:58
          +8

          @EightImmortals: You were rambling on that systematic studies have been going on since the 60's..

        • Tech5 on 09/03/2018 - 10:59
          +1

          @EightImmortals:

          He means that there are not many. Just because there is a systematic study of cannabis that has been going on since the 60's (I'm guessing you are making the point that there has been a lot of research), does not mean they are quality, randomized, double blind, placebo controlled clinical trials. (Which is the gold standard)

        • EightImmortals on 09/03/2018 - 11:11
          +2

          @RJW:

          Fair enough, but my claim stands, studies of cannabis in numerous contexts (heath, and other effects) has been going on for a long time. What qualifies those studies for you personally is your concern but I have a strong suspicion that you are already prescribing drugs that have not passed the same type of rigors as what you demand of cannabis.

          I wont bother posting links as I know it's pointless but keep in mind that it has been very hard for such studies to be conducted during the last 80 years of US prohibition but nevertheless other countries have been making some effort.

          But here's just a couple FWIW

          60 Peer reviewed studies.

          https://medicalmarijuana.procon.org/view.resource.php?resour…

          https://www.thecannabist.co/2016/12/30/marijuana-research-of…

          So each to their own and anyone can do further research these days, as you noted below, google is a wonderful tool. My point is however that cannabis treatment is neither 'new' nor 'fangled', and it can only be imagined thus by any doctor under the age of about 60. All the best. :)

        • Tech5 on 09/03/2018 - 11:16
          +7

          @EightImmortals:

          Having a look at these 60 studies, all I can see is a need for further study at this point in time. A lot of this evidence is based on anecdontal evidence, or surveys. These are the lowest forms of evidence. There are a couple of Phase II clinical trials, but they only measure efficacy, not effectiveness AFAIK. I.e. performance in an ideal, controlled environment, not real world effectiveness.

          And drugs that are mass marketed, HAVE actually passed the rigors required of it. They need to progress to phase III as well as phase IV trials. This is why they would be allowed by the TGA in Australia

        • k15866 on 09/03/2018 - 11:17
          +7

          @RJW: I've noticed a trend on OzB / FB / etc of people asking for high quality studies to prove everything and anything. It seems you've been trained here, so I suppose you might know this already so this is more a general rant against ppl asking for high quality evidence for everything

          The simple fact is that high quality, peer reviewed RCT / systematic reviews are time consuming and not always possible (funding, nature of pathology/treatment, patient population etc).

          And whilst this may not pertain to the cases mentioned by EightImmortals…I would think it is unrealistic to expect an RCT to be funded / supported without lower level evidence (case studies / poor quality RCTs).

          Another issue that arises is, in the absence of any high quality studies to back up a treatment, would you offer/accept a treatment that perhaps only has case study / poor quality RCT level evidence if there are no other alternatives

          Also I thought the MMR issue was less a matter of poor quality design of the study, and more about a simple manipulation of numbers (I might be wrong here)

          TL:DR: just coz there is only low level evidence to prove something, does not mean it is worthless. Use best available evidence is what I learnt. I do not have high quality evidence to prove the above

        • Tech5 on 09/03/2018 - 11:20

          @k15866:

          RJW appears to be keeping an open mind regarding cannabis use. Reading between the lines, he is basically saying what you are. High level studies are required before mass usage. However low quality evidence is an indicator of the need for further controlled studies.

        • EightImmortals on 09/03/2018 - 11:22
          +2

          @zhuang281: Do you also want a list of drugs that have those 'rigors' in the past but then later got recalled after they killed/damaged too many people?

        • Tech5 on 09/03/2018 - 11:23
          +2

          @EightImmortals:

          Exactly. You are proving my point are you not. If even drugs that have undergone these "rigors" at the highest level of evidence, can produce unwanted side effects, how can you say for sure that cannabis will not? All I'm saying is that nothing is for certain, but if Cannabis underwent more study, then it will be just a bit less uncertain

        • EightImmortals on 09/03/2018 - 11:27
          +1

          @zhuang281:I can say that with some degree of confidence because if there WERE a lot of negative side effects then they would have been noticed by someone over the thousands of years it has been used by the human race. :) Whereas those other drugs had not.

        • AusGP on 09/03/2018 - 11:27
          +2

          @k15866:

          Of course I use any available evidence. However as a GP I am in no position to recommend something that is still controversial in the medical community. Furthermore it's not like cannabis doesn't come with risks so I have to be careful.

          We are taught in uni and training about evidence based medicine - because if you don't, you might actually be doing harm. I think in Uni they gave an example of dexamethasone in certain types of brain injury. For years it was done without high quality evidence and then when they did actually go to Thailand and conducted an RCT (as it wasn't ethical to do it anywhere else apparently) - they found dexa actually harmed people. I wish I can remember what the study was specifically but its just illustrating my point.

        • Tech5 on 09/03/2018 - 11:28
          +1

          @EightImmortals:

          Not necessarily. That is the problem with anecdotal evidence. It may have been noticed, it may not have been. The problem with the general lay person (not insulting you) is that they place the wrong importance in different kinds of information. I mean, if you had half a dozen people of your friends tell you something is good, why wouldn't you believe them? After all, the group consensus cannot be wrong, right? That is the general idea behind anti-vaxxers etc.

          I am all for cannabis use in people who have no other effective options. After all, what do they have to lose. That is the point of experimental drugs. But it is not ready for mass usage yet IMO.

        • k15866 on 09/03/2018 - 11:43

          @RJW: I dont envy you guys and the decisions you guys have to make. How much guidance does the profession get when it comes to controversial treatments. Does the professional body provide guidelines (and are they black and white rules?) or is it mostly left up to the individual practitioner to research / make a judgement? Or would something struggle to get approval eg TGA, if it were controversial. It sounded like the profession has become a bit conservative re new treatments.

        • AusGP on 09/03/2018 - 12:03
          +1

          @k15866:

          Well I think for one cannabis needs to pass through TGA and then we would get guidance on how to use it. I normally use Therapeutic Guidelines to guide me in prescribing medications.

          We're conservative on new treatments mainly because in the past e.g. Glitazones - medications that were used to treat one problem, then 10-15 years later you discover it causes heart failure…

        • stonkered on 09/03/2018 - 16:38

          @one man clan:

          Dr. Bubbles.

        • MessyG on 09/03/2018 - 18:59

          Snip snip, how's dem poppies?

        • aliam on 09/03/2018 - 19:22

          Had to laugh at the "principles established by Hypocrites" comment.

          I would not want to see a hypocritical doctor.

        • sintro on 09/03/2018 - 22:06
          -1

          @RJW:

          Are you sure you are totally correct regarding the MMR vaccine and vaccines in general?

          Dr Sam Eggertsen, MD who has been in practice for 35 years investigated and explains what happened in a timeline. This was intiated due to his interaction with a patient, a mother who was concerned regarding the MMR.

          Check it out, you'll be surprised.

          https://www.youtube.com/watch?v=8LB-3xkeDAE

        • Innately Incognito on 10/03/2018 - 13:02

          @k15866: GPs are usually very unlikely to prescribe something off indication. I believe they can do this but if anything goes wrong the potential for horrible repercussions goes up substantially.

          Specialists do this more readily, probably because their knowledge on that disease state and medication tends to be more thorough.

    • Third_Gear on 09/03/2018 - 06:21
      +1

      It’s not far off and NSW is progressing quickly

      http://www.news.com.au/national/breaking-news/easier-access-…

      Not quick enough though….

    • ruddiger7 on 13/03/2018 - 17:16
      +1

      Till big pharma has 100% control of the market I would say.

  • KaTst3R on 09/03/2018 - 00:24
    +4

    Is there any difference between a generic pill with same active ingredients and branded? Some pharmacists do think that branded pills are of higher quality.

    • Geekomatic on 09/03/2018 - 00:42

      I took one particular Nerofen which caused a horrible reaction in me. I felt like I was choking & almost called the ambulance. The next day, my eye & cheek were bruised as if I'd been punched.

      Herron, blue pills, btw.

      Def the inert you can be allergic to.

    • Other on 09/03/2018 - 00:43

      not dr or pharmacist - but I have my own theory. When companies have branded products they invest in (advertising, etc) then protecting the brand becomes a real concern - any threat could cost an excessive amount of money, hence they will take extra steps to protect (so they may use a more expensive factory machinery or better QC checks - or more testing).

      However generic often make multiple pills and so don't have the same investment - rather cost is the major issue (as they sell for a lower price) - hence if their is a major issue they can stop making it and there is little reputation damage.

      I think the same applies to 'Woolworths or coles' branded foods.

      • rump parliament on 09/03/2018 - 22:13

        Alternatively the generics can be slightly better quality because they're manufactured using newer equipment/techniques compared to the innovator brand.

        Honestly there's rarely a significant difference, generics have to be at least 90% similar to get approved by the TGA.

    • AusGP on 09/03/2018 - 01:15
      +5

      Not really in terms of the active ingredient but the preparation is different so sometimes it's quite plausible people can get reactions to certain drugs. There are a few drugs that need to be quite brand specific for the active component like certain brands of thyroxine, warfarin, clozapine etc.

      • gimli on 09/03/2018 - 21:32
        +1

        I reckon panadol has a stronger placebo effect than panamax…

        • ascorbic on 09/03/2018 - 23:31

          I just find that Panadol doesn't taste as horrid as Panamax due to the coating.

        • lou knee on 10/03/2018 - 10:07

          @ascorbic: If you want the cheap bulk packs of paracetamol without the gross powderiness of Panamax then I like apo-paracetamol. Bonus is I also find the capsule-shaped tablets easier to swallow.

    • Gandalf the Thrifty on 09/03/2018 - 09:00

      They can have different other ingredients. Eg lactose present in generic antihistamines vs telfast which has none.

      • [Deactivated] on 12/03/2018 - 18:07

        CORRECT ANSWER. Also variances in the way the active ingredient is delivered by the carrier agent.
        All interact differently with patients, always provide feedback to the chemist and doctor.

  • indium on 09/03/2018 - 00:24
    +10

    Do you use Google to help diagnose patients?

    • AusGP on 09/03/2018 - 01:19
      +33

      Absolutely. Google is so powerful. Most times I use it to look up websites I already know are trustworthy to research a bit more. I'm not ashamed to do it as I have seen senior professors refer to Wikipaedia for some rare diseases that they've never heard of.

      The main difference between a layman and a doctor Googling is we know what's trustworthy and we are ready to call bullshit on websites that are less than reputable. Google is so powerful now that if you know what you are looking for, it is no different from the old days of flipping through a textbook.

      Beware the doctor whom isn't looking anything up at all - I have seen a few of these whom I thought were competent until you look them up on AHPRA register and see they have conditions placed on them for bad practice (have heard some shocking stories of people whom I thought were competent but just bullshitting their way through).

      • ozhunter on 09/03/2018 - 06:20
        +5

        we are ready to call bullshit on websites that are less than reputable.

        Care to tell us the trustworthy ones? lol

        • godoftoast on 15/03/2018 - 09:40

          It wont benefit you knowing which ones are trustworthy. Most of them are behind paid subscriptions. They are also laden with medical jargon and even then the information is only as useful as the user.

          Its like if I handed you a Boeing 747 manual. Youd be able to read the words but you (and I) would have no (profanity) clue on how to land the aeroplane.

      • acer4una on 09/03/2018 - 07:47

        Thanks for the tip. Just checked out my GP on the register. I’m in good hands

        • Tech5 on 09/03/2018 - 11:01
          +1

          Btw, just because they don't have conditioned placed on them in the AHPRA registry, doesn't mean they know what they are doing

        • AusGP on 09/03/2018 - 15:04

          @zhuang281:

          Absolutely true - because before any doctor had conditions put on them, they were once a clean slate lol…

        • AusGP on 09/03/2018 - 09:41
          +5

          Not all the time haha. It's not like that's all doctors rely on. We rely on our training most of the time. I only have Wikipaedia as an example but I've only seen one professor do that ;)

        • iDroid on 09/03/2018 - 11:02
          +6

          Good research requires using many sources. Wikipedia is a good valid source to mix in with others.

          IMO, you'd be foolish to not use wikipedia as part of your research.

        • ElderyMan on 09/03/2018 - 11:36
          -8

          @iDroid: Wikipedia is NOT a trusted and somewhat scientific or professional source of truth. I've seen lots of bullshit in Wikipedia pages many times. Surely, being a pro or even if you pretended to be a pro, you would have only subscriptions to the professional source of the information: knowledge base, articles, guides, etc.

        • Tech5 on 09/03/2018 - 11:41
          +2

          @paulu42:

          Wikipedia is pretty good at pointing us in the right direction for further research, or at least as a basic overview. Definitely not where you should be getting treatment and diagnostic advice though

        • iDroid on 09/03/2018 - 11:42
          +2

          @paulu42: I think you missed my point. I never said or implied that Wikipedia is a trusted source.

          I'm saying that it is a valid source as part of your research. Research requires you to use your brain as a filter and glue to put the information together.

          Ignoring Wikipedia because you can't blindly trust what is written there is closed minded. I wouldn't blindly trust any source of information. I'll use my brain, research and all information I have at my disposal and come to my OWN conclusion based on various sources.

        • ElderyMan on 09/03/2018 - 12:15

          @zhuang281: Exactly. It works for non-professionals as a good starting point but seeing a doctor that is reading Wiki to give a treatment - a nonsense for me.

        • ElderyMan on 09/03/2018 - 12:30

          @iDroid: I see your point. My point is that while Wikipedia is a good research starting point for not professional in some particular area people, it would be strange for professionals to use it for day-to-day work. I totally agree that the brain should be used for any source of the information but if you are not an expert in the topic, it is hard to see the possible mistakes which is more dangerous as such little mistakes might take the research to the completely wrong way. The reputable and professionally reviewed sources are way less risky than the sources where everyone can add any info they like.

        • iDroid on 09/03/2018 - 12:53
          -1

          @paulu42: True, but the reputable and professionally reviewed sources are not necessarily up-to-date. Advancement is at a pace where it's almost impossible to keep up. Professionally reviews sources are going to take time to catch up.

          Let's not pretend that what's in medical journals, professionally reviews sources, etc are all correct. They're not. What's considered correct yesterday is not correct today. It's not a static domain.

          Any doctor I would trust, I would also trust to use the research material they have at their disposal. I also want my doctor to be abreast of as many possible treatments for me as they can (even those not yet found in professionally reviewed sources). I'm not saying I want my doctor to start wielding magic potions on me because some Wikipedia page said it was good. They need to fall back to common sense and their education. But ignoring "non reviewed" information that may save my life is… a pretty shitty idea.

          It's all part if their research - a small but important part IMO.

        • AusGP on 09/03/2018 - 15:07

          @paulu42:

          Maybe I shouldn't have used Wikipaedia as an example. I personally never use it (for medical diagnosis that is). But I saw this Professor look it up more than 10 years ago to get a basic understanding of what some obscure 3 person eponymous disease was. We absolutely have our professional resources we use so don't fret :D

      • matthawke on 10/03/2018 - 15:55
        +1

        Wikipaedia

        Cannot tell whether ironic or inadvertent spurious use of digraph ae. Amusing either way.

    • AusGP on 09/03/2018 - 01:41
      +1

      Oh and we also use lots of resources beyond Google but because Google knows all its just much easier to pull up the website via Google in the first instance :D

      • ozhunter on 09/03/2018 - 06:22

        Oh and we also use lots of resources beyond Google but because Google knows all its just much easier to pull up the website via Google in the first instance :D

        It's why I don't go to the doctors :D

        • AusGP on 09/03/2018 - 09:42

          When you do need one hope you find a good one! ;)

    • ozlab on 13/03/2018 - 11:59

      My GP normally uses Google right in front of me and I can understand that because no one can remember and knows everything. I feel better in fact instead of guessing.

Login or Join to leave a comment
Login Join