Medical Musing (Canberra Doctor - August 2017)
Mental Health is Everything
All of us who provide health care for Canberrans understand the fundamental importance of mental health to our community. In many ways, it underpins the wellbeing of society irrespective of all other issues. Illnesses and injuries – acute and chronic – take their course against the background of our mental health and wellbeing. For this reason, it is vital that any health system place a high priority on good mental health, and on services to work towards the best possible mental health of the community.
From the perspective of my own specialty – obstetrics and gynaecology – perinatal mental health issues have become one of the foremost causes of death and debility for pregnant women in Australia. A similar dynamic is at play in most other specialties. Parents of children and adolescents with mental health issues, and the doctors caring for them, will understand the tremendous strain and burden a family can be under. They will also understand how difficult it can be to find specialist long-term care. For these reasons, it is easy to understand the sense of frustration and dismay in the Canberra community about the availability of some mental health services.
Minister Shane Rattenbury, Minister for Mental Health in the ACT Legislative Assembly, has a big job on his hands. Along with Professor Jeff Looi - AMA Board Member, Consultant Psychiatrist, and representative for the College of Psychiatrists – I am meeting with the Minister in the next couple of weeks. High on the agenda is the urgent need to recruit specialist psychiatrists for the ACT, and the critical shortage of mental health services in Child and Adolescent Psychiatry. Minister Rattenbury failed to appoint either a GP or Psychiatrist to the ACT Mental Health Advisory Council. It is a bad start and devalues the critical role doctors play in this space. I assure you this will be on the list of topics that we discuss in person.
Legislating Love
The Federal AMA launched a very public campaign in support of same-sex marriage. The campaign was not based on emotion, but on medical science. There is good evidence that couples in stable loving relationships have better health outcomes. People who are subject to discrimination – not being allowed to marry a loved one, for example – are more likely to have poorer health. The Federal AMA stance drew some criticism, but this was from a relatively small proportion of members. Open discussion and difference of opinion are the lifeblood of a civilised community, so all points of view are welcome. However, if you look at it from a health perspective, it’s difficult to make a case for legislating against love.
Medical reporting
Many of you will have media reports over the last month that were, to say the least, overblown. My favourite was the breathless reporting over mouse DNA studies of mutations around NAD metabolism, leading to ‘the greatest medical breakthrough in Australia’s history’ – a call for vitamin B3 (niacin) supplementation to end miscarriage. You may also have read reporting about ‘Paleo Pete’ and his idiosyncratic ‘medical’ opinions and advice. And don’t get me started on the reporting of transvaginal mesh surgery.
All of our practices are based on sound medical science, and we value responsible and accurate reporting of medical matters. Similarly, all of us will have had worried patients contact us in a panic, responding to some media beat-up or other. The saga of the Women’s Health Initiative study reporting in the early 2000s – sensationalised media reporting that saw one third of women cease HRT overnight for fear of cancer or heart attacks – should have taught some lessons. Sadly not, and the advent of social media and blogs has made the interpretation of medical science stories all the more difficult. The AMA is doing its best to respond the medical media stories and try to bring perspective. Wish us luck.
Cladding
I read with horror that the Centenary Hospital at Woden was clad in flammable materials. It is a place I know well, having worked there for fifteen years now. The ACT Government drew fire in the media for this (pun intended), but it is difficult to blame them for the fiasco. Fortunately an audit was highlighted the issue and the Government needs to move at speed to correct the problem. Delaying action puts lives at risk – the fire in the main switchboard at Canberra Hospital was dangerous, disruptive, and illustrates that point. The risk of fire had apparently been identified some time before the fire occurred – earlier action would have prevented what could have been a catastrophic outcome. Let’s all hope the ACT Government learns the lessons of the recent past.
Doctor wellbeing
All of use hold concerns for the health and wellbeing of our colleagues. The number of doctors who take their own lives highlights for us the stress and pressures of a life in medicine. Unfortunately, one of the impediments to doctors seeking care for themselves is the issue of mandatory reporting. I have discussed this terrible situation in previous editions of this column, and I have brought it up directly with senior officials from ACT Health. I am not sure whether the message has sunk in, but mandatory reporting is a disincentive for doctors to seek help from their colleagues. Signs are that State and Territory Health Ministers are starting to take notice, but let us all continue to press this point – in the interests of all of our health.