The Auricle Vol 3 Edn 2

THE AURICLE

VOL 3 EDN 2

TABLE OF CONTENTS

// VOLUME 3 EDITION 1 // LETTER FROM THE EDITORS

LET’S LOOK AT THE YEAR SO FAR..............................................................................3

BRAVE NEW FEES

DECODING THE POTENTIAL MEDICARE CO-PAYMENT..................................................5

MEDICINE AS A TEAM SPORT

CAN YOU MAKE IT AS AN INTROVERT?......................................................................9

AFRAM

REFUGEE HEALTH AND HOW YOU CAN GET INVOLVED...............................................13

REFLECTIONS

TALKING WITH THOSE WHO FACE DEATH..................................................................15

Letter From The Editors Greetings all and a very warm welcome to the second edition of the Auricle for 2014!

We hope that, by now, you’ve all gotten into the swing of another stress-filled, crazy-exciting, all-out, palpitating-inducing year (does it sound like a heart attack waiting to happen?)

To catch you all up (rather haphazardly) on the happenings of Monash med kids: the preclinicals have just steamrolled over the first of many exams that are headed their way, numerous events have been attended, research projects have progressed and a new club has been MADE (that is, Medical Art Development and Enrichment)!

And yet, there’s still more to come.

Get ready for the AMSA National Convention 2014 in Adelaide, MedBall, Caduceus Cup and a Med Revue that promises all things Harry Potter.

For those of you who have lost the motivation to study and are spending minutes (hours) procrastinating on Facebook/Tumblr/Pinterest/Twitter/ Buzzfeed then change it up and read this edition of the Auricle. Debunk and demystify the controversial $6 GP co-payment scheme and explore what this new announcement really means. Learn more about refugee health and how medical students can have their voices heard. Read insights into being an introvert in medicine and encountering those who are dealing with death.

Better still, write to us! We welcome all* pieces of writing—poems, short stories, event recaps, personal anecdotes, essays, both medical and non-medical informative pieces— so submit to publications@mumus.org.

We’ll be waiting!

Best of luck for the semester ahead and till next time!

Your Publication Reps, Michelle Li (Clinical) Elizabeth Low (Pre-Clinical) * Almost all—at present, the Auricle does not accept eulogies. Stay tuned for updates on this much-debated ruling.

BRAVE NEW FEES:

Decoding the potential Medicare co-payment • Daniel Epstein and Emily Jenkins (Year V)

One of the key talking points of the new federal budget (officially unveiled on May 13th) is the so called $6 co-payment: a new $6 charge added to all GP appointments.

Implemented as part of a grander plan to stem the growing cost of Medicare, opponents of the new scheme, the Australian Medical Association (AMA) included, contend that it will cut access to primary health care, and preventative health.

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The nuts and bolts of the scheme are that all GP visits in Australia, whether bulk-billed (previously free to Medicare card holders), or with an out of pocket fee, will now carry an additional $6 charge for the patient.

There are some exceptions, with pensioners, children under 16 years of age and concession card holders being spared the fee. But for everyone else, this effectively means the end of ‘free’ bulk-billed GP appointments. There is also a cap on the number of times the fee can be charged, with a maximum of 12 times in a year (or in other words, a maximum charge of $72/year).

We’ve all heard that prevention is better than cure, and our medical courses espouse the value of preventative health to reduce the health care burden (and thus health care expenditure). So with the majority of primary prevention delivered via GPs in Australia, why is the government increasing the cost of a GP visit? The concept was initially proposed by former advisor to Tony Abbott, (back when he was health minister and leader of the opposition) Terry Barnes.

Terry was the lead author of a report by The Australian Centre for Health Research, which found that Australia could save an estimated $750 million over four years by implementing a $6 co-payment, and thus reducing an “unnecessary demand on services” that has led to a doubling in government expenditure on Medicare over the past decade.

Whilst the Federal Health Minister the Hon Peter Dutton has described this as a means of “strengthening Medicare”, the announcement of the $6 co-payment has, unsurprisingly, been surrounded by controversy. Many health professionals have questioned the actual efficacy of this proposed cost-saving measure. A large majority of health budget expenditure relates to hospital-based management and are often complications that could frequently be prevented with effective primary healthcare.

“This effectively means the end of ‘free’ bulk-billed GP appoitments.”

As it stands, 16% of Australian patients report either not seeing a GP or failing to get a relevant prescription filled due to financial costs [1], and this new co-payment seems likely to further reduce access to primary and secondary preventative care. Further, it has been estimated that all financial savings from this proposed surcharge will be negated if 25% of patients who do not attend their GP due to this co-payment end up in hospital, either by instead visiting the Emergency Department (ED) or through escalated health complications. A flow-on consequence of this (beyond the financial implications for the health care system) is to increase the strain on ED services, leading to increased patient wait times and acting as a barrier to healthcare for those who truly require emergency services.

A fee may also discourage seeking healthcare advice altogether by patients who are unsure whether their health complaint merits a visit to their GP – it is not difficult to imagine a patient noticing a new skin lesion but not seeking health advice due to financial costs, only to later be diagnosed with a malignant squamous cell carcinoma.

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There are several additional concerns about the introduction of a GP attendance surcharge.

While it can be argued that the maximum individual impact this payment will have is $72 annually, Australia has a proud history of universal (free) health care access, which has now been placed at risk for a potential saving of $750 million over four years.

Contrast those numbers with the recent reports that the government is purchasing 86 stealth fighter jets for a total cost of $14 billion and the financial savings from such a proposed surcharge seem insignificant.

Health advocacy groups are also concerned that this charge will ‘open the floodgates’: once such a surcharge is established, it would not be difficult for future governments to continue raising this fee to alleviate increasing health costs. It may also lead to other health areas involving co-payments, with such a fee already being discussed for ED services.

Much of what we know about the co-payment system is still conjecture, with the government yet to make an official announcement regarding the proposal. Keep your eyes out for the federal budget release on May 13 for the likely announcement of the GP co-payment and more details on the implementation of the system.

ADDENDUM: The Commission of Audit report was released on May 1 and recommended health co-payments to be set at a higher value than as described above.

The report recommends a $15 GP co-payment for the first 15 visits per year, after which the co-payment reduces to $7.50 per visit. Concession card holders would be charged $5 per visit, then $2.50 per attendance after the first 15 trips.

Other recommendations include an increase in the Pharmaceutical Benefits Scheme (PBS) co-payment and the introduction of a co-payment involving emergency department attendances for non-urgent conditions. The implementation of such recommendations would have significant consequences regarding patient access to health services, as outlined above. The government will make its intentions known regarding this report in the upcoming federal budget to be released on May 13.

References [1] C. Schoen, R. Osborn, D. Squires, and M. M. Doty, “Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries,” Health Affairs Web First, published online Nov. 14, 2013.

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MEDICINE AS A

TEAM SPORT Sarah Meirav Baker (Year V)

Before embarking on the journey of becoming a medical undergraduate, each student will ask the same question: “Is medicine for me?”

I recently typed that exact question into Google and, unsurprisingly, found that the type of person who studies medicine needs to be hardworking, dedicated, enjoy challenging situations, and be academically oriented. There were many mentions of that clichéd phrase often thrown around in the entry interviews – the need to have “a fascination for the body”. I was aware of all of this prior to beginning my degree, and as soon as I got the final tick of approval from my grandmother, I was confident that I fitted the mould of a student doctor.

In my final year as a medical student and while applying for jobs next year as an intern, I am forced to rethink the qualities that make for a good doctor. Indeed, each hospital likes specific personal attributes: St Vincent’s hospital has a focus on academic excellence; The Austin values an interest in research; and Monash Health is looking for a “well-rounded” individual.

However, the common link between the hospitals is the emphasis on working in a team. Our CV’s and interviews are expected to demonstrate what great team players we are.

From week one of med school where it is compulsory to attend an introductory camp, focusing on icebreakers and other group activities, the importance of teamwork is thrust upon us like an electric blanket; heating the cold, but suffocating the warm. We are expected to partake in group assignments, group presentations, and group ward rounds. In year 4A, we risk failing if we’re brave enough to remain a “solo student” and not form a study group.

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Susan Cain, studied this phenomenon in her book “Quiet: The Power of Introverts in a World That Can’t Stop Talking”. She’s labeled it “the New Groupthink”. Cain observes that society has moved from a place of appreciation for privacy and solitary work to a place where most people “work in teams, in offices without walls and for managers who prize people skills above all”.

One third to a half of the population are introverts, meaning they feel most alive and energized when engaging in individual activities. And don’t be fooled into thinking that introverts can’t lecture or teach or dance or perform or entertain. Some of the most engaging educators and artists are introverts – brilliantly “noisy” when they want to be, but getting their energy from those quieter times.

So why is there such a focus on group work, catering more to those extroverts who are energized and thrive when around other people? Why do students feel guilty for preferring to work alone and why do they feel the need to mask their gentler independence for acceptance on both a social and professional level?

In a course where teamwork is not only encouraged, but also required on a regular basis, is there a place for introverts?

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Working in a team is frequently required in workplace situations and the benefits of collaborative work have been widely documented: in the military, where good communication and teamwork are paramount for reducing combat fatalities and in the health care system, to minimise patient harm from poor communication.

By the same token, Dr Daniel Siegel illustrates in his book Mindsight, that there are significant benefits to quietly focusing one’s attention and concentrating on a single task.

Carl Jung, the psychoanalyst who coined the terms introversion and extroversion, recognized that these personality traits are a continuum, where most people lie somewhere in the middle.

He appreciated the balance between opposing forces that make up human temperament.

Perhaps we too can shift our thinking to respect both qualities equally and our own instinctive nature for productivity.

A study conducted by the Department of Psychology at Carleton University found that while dispositional introverts might improve their happiness by acting in a more extroverted manner, there are upsides and disadvantages to both dispositions. I am not arguing that one “mode of being� is better than the other. I have simply come to the observation that our training system privileges one personality type.

Given that nearly 1 in 2 of us are introverts, perhaps we can swing the pendulum back to the centre, to a place where reflective work done in solitude is also valued alongside the benefits of collective endeavour.

Even before the election of the Abbot government had people researching rent prices in New Zealand, thousands across the country had become increasingly horrified as they watched politicians scramble to piece together barbarous policies to “stop the boats�.

The reintroduction of offshore processing, the excision of Australia from the migration zone and the murder on Manus Island all have their place in the bi-partisan strategy with one aim: to create a space so hopeless that remaining in warzones becomes the preferred option.

It is in this context that Australia’s medical students have united to add their spin to the chorus of condemnation spilling out across the country. The trauma inflicted by our migration policy has become irrefutable, especially when taking into account the appalling and unacceptable mental health outcomes of refugees and asylum seekers in Australian detention centres.

60-80% of detainees suffer from some form of mental illness and the rates of self-harming behaviour in detained is up to 12 times that of children in the general community.

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A F R A M MSA

OR

EFUGEE

ND SYLUM SEEKER

ENTAL HEALTH

Shaday Wheatley (Year IV)

AMSA is demanding a paradigm shift on this issue.

On the back of cumulative evidence concerning the health consequences of detention, we are urging the government to move away from policies of punishment and deterrence. Instead, we urge them to provide leadership by communicating the realities of refugee rights and treatment in Australia, and finally to support the state governments in improving access to mental health support services for refugees and asylum seekers.

In the weeks since the AFRAM campaign has been launched, close to 500 medical students have banded together to bring this cohered message to politicians and to the broader community. The building momentum of our campaign will next pick up speed on May 20, where students of every university across the country will be participating in call-outs to the representatives of their state.

To join us in the fray or find out more, visit: http://afram.amsa.org.au/ 14

REFLECTIONS David Liu (Year III)

We checked the patient’s file and entered the patient’s room, being medical students hungry for a case to learn about. To our surprise, the female name on the file had betrayed us, with a polite old man sitting on a chair next to an empty space where a hospital bed would have been.

You’re not Mrs. Sanders, are you?

The aged man grinned. He looked like he had been weathered by Australian sunshine and his wrinkles showed a smile weathered by time. He chuckled. “No, Mrs. Sanders would be my wife.”

We thought so! How long have you been married for?

“More than 50 years,” he said in a tone that meant that those had been 50 years filled with happiness. He had lived a peaceful life on a farm with his wife in a country area. “We’ve been together for a long, long time. We’re both getting old now, though. Married ever since we were still young and fit.”

Can we ask a few medical questions about what happened to your wife?

“She doesn’t feel well. Chest pain. Once, she had a heart attack and they broke a few ribs during CPR. They said that if she had another attack like that...she probably would not be able to be saved...”

Tears welled up in his eyes. They were promptly explained away as he lifted his finger up to wipe them. Here, in the chair across from us, was a man who was close to losing the sweetheart of his life forever.

“I wish... I wish they could just make a pill to save her life.” His expression grew softer, weaker. It had been defeated by fate. The statement was one of a desperate desire that would never come true.

I’m sure that if they made a pill like that, everyone would want it, I said.

“Hah... you’re right.” He smiled again, but the way he looked down shouted that he was crying without us being able to see it. “I guess... that’s just how life is.”

He was right. Many patients we talked to about their terminal cancer had said the same thing.

I’ll live the best last of my life... they say. When it’s time to go, it’s time to go... they say. Even in the most dire situation, there’s optimism - but it’s not for a hopeful outcome. It’s for a hopeful ending chapter, a book that finishes with a beautiful yet sad ending.

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