tag:blogger.com,1999:blog-60468715149769205452024-03-14T19:45:19.288+11:00Surgical OpinionA soap box for a surgeon who has practiced in a wide range of environments including a Tertiary Referral Teaching Hospital, District Hospital, small Rural Hospital, Private Practice and Academic Practice. He loves being a surgeon.
He encourages all readers to forward on this blog link to friends and colleagues and to return regularly for new blog installments.
Please follow me on Twitter @DrHWooHenry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.comBlogger70125tag:blogger.com,1999:blog-6046871514976920545.post-88224518680411682352019-06-14T09:34:00.000+10:002019-06-14T10:26:20.861+10:00Those Two Tweets<br />
It is now about 3 weeks since I posted two tweets that were to create a media storm. A week later I wrote an <a href="https://www.smh.com.au/lifestyle/health-and-wellness/harrowing-and-humbling-surgeon-in-the-eye-of-a-social-media-storm-speaks-out-20190601-p51tgd.html" target="_blank">Opinion Editorial in the Sydney Morning Herald</a> to clarify those two tweets. <br />
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I have made absolutely no other comment to the media and yet this discussion has remained in the news even to this point in time. I have kept a low profile on this subject matter and allowed others to make their commentary.<br />
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I have been told to stop harrassing Dr Teo. I am being told that my tweets are defamatory, insulting and personally critical of Dr Teo. People have been quick to criticise me on the basis of hearing reports that describe my tweets as being as such, without having seen my tweets.<br />
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Let's take a look at my very first tweet:-<br />
<blockquote class="twitter-tweet" data-lang="en">
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Something is seriously wrong if a terminally ill girl with a brain tumour has to raise $120K to have surgery Dr Charlie Teo has offered to do for $60-80K. <br />
If it was valid surgery, it could/should be performed in the public system under Medicare <a href="https://twitter.com/hashtag/auspol?src=hash&ref_src=twsrc%5Etfw">#auspol</a> <a href="https://t.co/8s7L5mcuAZ">https://t.co/8s7L5mcuAZ</a></div>
— Henry Woo (@DrHWoo) <a href="https://twitter.com/DrHWoo/status/1131808554254458880?ref_src=twsrc%5Etfw">May 24, 2019</a></blockquote>
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The first part about "Something is seriosuly wrong if a terminally ill girl with a brain tumour has to raise....." is a valid observation. Anybody who does not think that there is something wrong that we are seeing this happening lacks heart. It means that we must question our existing access to health care. This is not an attack on anybody.<br />
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Now let's look at the $120K and the $60-80K part. I have been accused of making up these figures and suggesting that this is what Dr Teo actually pockets for himself. I have been told to get my facts right. These are NOT my dollar amounts.<br />
<br />
These figures are simply direct quotes from the <a href="https://www.dailymail.co.uk/femail/article-7061465/Amelia-Millie-Lucas-terminal-brain-cancer-undergo-open-brain-surgery-Dr-Charlie-Teo.html" target="_blank">linked article</a> in the tweet. The Daily Mail article derives these figures from what is stated in the Lucas family interview with Today Tonight which is linked in their article. Once again, these are just quotations from the linked article. <br />
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Now for the part about "if this was valid surgery.....". Surgery in the public hospital system has to have evidence base in order to be permitted to be carried out. If this surgery was not able to be performed in the public hospital system for whatever reason, is it wrong to question as to whether there is an issue with the public hospital system or as to whether there is an issue with the type of surgery being offered. <br />
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Now let's take a look at my second tweet:-<br />
<blockquote class="twitter-tweet" data-conversation="none" data-lang="en">
<div dir="ltr" lang="en">
On a search on GoFundMe for “Charlie Teo” there are 113 campaigns listed, that mention him as the surgeon for which donations are sought to pay for his services. <br />
I find this really disturbing. <a href="https://t.co/j4ZQRNHXvQ">pic.twitter.com/j4ZQRNHXvQ</a></div>
— Henry Woo (@DrHWoo) <a href="https://twitter.com/DrHWoo/status/1131842411099852801?ref_src=twsrc%5Etfw">May 24, 2019</a></blockquote>
<script async="" charset="utf-8" src="https://platform.twitter.com/widgets.js"></script>
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On a review of the GoFundMe website, the overwhelming number of requests for donations for surgery by any one single person was for Dr Charlie Teo. The search term "Charlie Teo" was entered into the search bar and this returned 113 results. The numbers on this search are dynamic but the screenshot attached to this tweet shows that on that particular day, there were 113. The exact numbers are irrelevant.<br />
<br />
Even if there were only 10 to 20 campaigns for just one person, I would still find this disturbing. It was no personal attack on Dr Teo but simply an observation that there were a lot of campaigns, past and present, that were for seeking money to pay for surgery by one person. If Dr Teo's services were so frequently sought that the system could not accommodate those who needed his help, then that must be considered to be very distubing. It is equally disturbing that one person seems to feature so much on this crowd funding website so it is therefore perfectly reasonable to question and discuss why this is the case. <br />
<br />
There is currently a mob mentality that is propagting that I am to blame for triggering a campaign against Dr Teo. I am disappointed in the manner to which this discussion has taken place, but through this background noise, there are at least signs that rational discussion is taking place.<br />
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I have no regrets that the issues raised are now being discussed in the public arena. No subject matter should be so sacred that the one who raises it for discussion should be vilified. <br />
<br />
Once again, we need to move away from personal narratives and discuss the bigger picture of access to healthcare, evidence of outcomes and the cost of cancer care.<br />
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<br />Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com3tag:blogger.com,1999:blog-6046871514976920545.post-35246399526652949962018-08-05T17:52:00.001+10:002018-08-05T18:40:12.301+10:00Uber and Sydney Airport<div style="color: #454545; font-family: "Helvetica Neue"; font-size: 12px; font-stretch: normal; line-height: normal;">
When Uber arrived on the scene, it was like the travelling public’s revenge on the taxi industry. We had been subjected to a lifetime of micro-aggressive behaviour directed towards passengers. We bore the brunt of an unhealthy attitude to service delivery from taxi drivers, their front line service staff and the business owners. </div>
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As soon as Uber arrived on the scene, the nasty attitudes to passengers was unleashed upon the Uber drivers who were accused of breaking the law and providing an unsafe travel experience. When thinking of safety, just think of the violent demonstrations from taxi drivers in Europe who protested against Uber as it was winning the affection of the travelling public. </div>
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Now that Uber is well and truly a part of Sydney transport, we are seeing a less palatable side to the business emerging. Apart from contractural arrangements with drivers that sees many working for below what would be minimum award wages, we are also seeing an emergence of inappropriate behaviour from Uber drivers. It is not uncommon to hear of news stories of Uber drivers stalking or sexually abusing passengers. Whilst totally unacceptable, these occurrences are relatively few considering the number of rides undertaken on a daily basis.</div>
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An annoying pattern of behaviour is emerging amongst Uber drivers doing pick ups from Sydney Airport. Here is how the scam works:-</div>
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After accepting your ride, the drivers will almost immediately call you under guise of checking whether you knew the whereabouts of the pick up location and as to whether you were already there. The signage for the Priority Pick Up area for ride share vehicles is particularly well signposted at Sydney Airport (especially at the Domestic terminal) and if you cannot follow these signs correctly, then you are beyond help. They know that you know where the pick up area is. This is simply the opportunity to then ask you about your destination. As you know, they don’t know where you are going until they pick you up. If they determine that it is going to be a short ride, they promptly cancel the ride. By cancelling the ride quickly, they will not be penalised and will not lose their place in the queue. If you won’t reveal the destination, they will assume that you wish to hide that it is a short ride and will also cancel the ride.</div>
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You could argue that this behaviour is driven by the frustrations associated with waiting for up to an hour for a pick up from Sydney Airport. On the other hand, if the drivers are not prepared to accept that they may only pick up a short ride, then they should not join the queue. </div>
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I have found that in more than half of the times that I have been picked up at Sydney Airport that I have received a call and on most of the occasions when I tell them that my destination in relatively close, they drop the ride. As earlier mentioned, when I do not give the destination, many will also cancel the ride because they understand my reasons for concealing the destination. </div>
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I have drawn this to the attention of Uber. Sadly, they appear disinterested. The public face was to appear concerned about the tweet that I sent to their Australian account but once taken off line, there was an immediate loss of interest. Its the old story of familiarity with the travelling public breeding contempt. Bring on competitors to Uber - I am ready to embrace it.</div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-1891403561334479002017-09-09T16:22:00.000+10:002017-09-11T09:35:51.395+10:00Informed medical costs - Well intentioned actions failing in delivery<div class="MsoNormal">
<span lang="EN-US" style="mso-ansi-language: EN-US;">Dr Richard
Zhu is reported to be on a mission to “<a href="https://www.australiandoctor.com.au/news/latest-news/one-person-army-gp-exposes-specialist-fees-on-webs" target="_blank">expose</a>” the out of pocket expenses
associated with initial consultations to see specialists in Australia.<span style="mso-spacerun: yes;"> </span>He has created a website called <a href="https://www.seekmedi.com/" target="_blank">SeekMedi</a> in
his “battle for greater fee transparency”.<o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">His
creation of this “one-person army” is with good intent but in its current form
is more misleading than helpful. If the website is about transparency, then it
needs to practice what is preached. My concerns are as follows:-<o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">1. The
website should<b> state it’s funding</b> (even though we know from news reports that
he personally funds it) and as to <b>how the data is collected</b>.<span style="mso-spacerun: yes;"> </span>We also know from media reports that he
personally telephones specialist practices and following discussions with their secretaries
will record the cost of initial consultations into an Excel spreadsheet - this methodology should be also be recorded for transparency. <o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">2. The website
is misleading in that the standard initial consultation fee does not factor in
<b>discretionary fee</b> discounting or bulk billing that occurs for patients who have
genuine financial hardship.<span style="mso-spacerun: yes;"> </span>The relationship
between general practitioners and the specialist to whom they refer also makes
a difference.<span style="mso-spacerun: yes;"> </span>When GP’s with whom I work regularly takes the effort to call, email, fax or write to me about a patient with financial distress, I
always oblige with fee reduction if not bulk billing.<span style="mso-spacerun: yes;"> I know my colleagues are no different in these circumstances.</span><o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">3. The
website fails to <b>time stamp</b> the published fees.<span style="mso-spacerun: yes;"> </span>What may be current at the time of
publication on the website may not be accurate at any time in the near future.
There is the potential to create unrealistic expectation from patients as to
the fees and out of pocket expenses which might actually turn out to be greater.<span style="mso-spacerun: yes;"> </span>The most accurate indication is the quote
given to patients at the time of making their appointments.<span style="mso-spacerun: yes;"> </span>The website should include a disclaimer about the fact that fees do change over time as well as to time stamp when Dr Zhu had
made a phone call to a specialist office and recorded the quoted fees. <o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;"><br /></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">4. The <b>data is incomplete</b>. Many specialists are missing from the list. The website should state that this is the case and indicate if missing specialists will be included later as well as why certain specialists are included and others not. </span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">5. Specialist
fees as recorded do not factor in the <b>time allocated</b> by the specialist to
review the patient. Some specialists book patients in as frequently as 5 minute
time slots and are able to achieve this through the use of medical and
non-medical assistants. Other specialists may spend as long as an hour with
their patients on an initial consultation.<span style="mso-spacerun: yes;">
</span>Within the same specialty, the variations in time spent with a new
patient can vary considerably.<span style="mso-spacerun: yes;"> </span>The role
of assistants who play a role in initial assessment is not considered in the
initial consultation fees.<span style="mso-spacerun: yes;"> </span>It is also
becoming increasingly common to see advanced specialist trainees in private
rooms. <o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">6. Specialist
fees do not give accurate guidance as to the likelihood of <b>subsequent out of
pocket expenses </b>should any intervention be required.<span style="mso-spacerun: yes;"> </span>It is not uncommon for a number of specialists
to load most of their ‘income generation’ into their procedures rather than
consultation fees. It is therefore not uncommon for some of the most expensive
specialists with regard to procedural costs to have very average or even below
average initial consultation fees. Initial consultation fees are only one
aspect of out of pocket expenses. <o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US;">I am not
against transparency in specialist fees but if we are to embark upon this path,
it needs to be done in a professional, collaborative and transparent approach.<span style="mso-spacerun: yes;"> </span>A divisive lone wolf approach will
never achieve acceptance. I have written to Dr Zhu to seek his comments but to date have received no reply. If and when he replies, an addendum to this piece will be published. <o:p></o:p></span></div>
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Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-58368579035711729212016-06-28T21:27:00.000+10:002016-06-28T21:30:36.430+10:00What do you do when a patient asks to speak to another patient who has undergone cancer surgery?<div style="color: #454545; font-family: Helvetica; font-size: 12px; line-height: normal;">
Not infrequently, I am asked by my patients if they could speak with any other of my patients about their experience of having undergone radical prostatectomy surgery for prostate cancer. In the past, I have done my best to assist with this request but in more recent years I have moved away from supporting this. I have a couple of reasons for doing this.</div>
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Firstly, it could be argued that selecting patients for such a discussion is like cherry picking. It is arguably little different from a patient testimonial on a website where the most favourable outcomes are provided although unlike the latter, it does not breach AHPRA regulations for advertising. </div>
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Secondly, patients under long term care for cancer treatment are potentially vulnerable. As doctors, we should never underestimate the desire of patients to please us and the potential for some patients to fear displeasing us by refusal to submit to any request we make of them. </div>
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In writing this, I do not mean to suggest that I am critical of those who provide their own patients as a resource for other patients seeking support or real life experiences. I know that this is done by the vast majority of clinicians with the very best intentions. There may be a time a place for this, particularly with uncommon diseases or unusual clinical circumstances. </div>
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My approach is to now to keep an arms length. I now place my patients in contact with a choice of the local prostate cancer support group or the Prostate Foundation of Australia who are able to provide such a service in addition to their excellent information resources. From time to time, my patient will be placed in touch with somebody who just happens to also be a patient of mine and that is absolutely fine with me. I feel comfortable with this transparency and I am also gratified by the positive feedback from my patients who have undertaken this suggested approach.</div>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-11452501664887572642016-05-01T23:04:00.001+10:002016-05-01T23:04:25.589+10:00How I Almost Did Not Become a Urological Surgeon.<span style="font-family: "helveticaneue"; font-size: 12px;">If anybody had suggested that I would become a urologist when I was a medical student or even as an intern, I would have told them that they were dreaming. My exposure to the field was fairly minimal during my time as a medical student and the thought of operating amidst urine just did not spark the slightest interest. If anything at all, I was interested in becoming a plastic surgeon or a general surgeon. </span><br />
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At the commencement of internship, we were all allocated to do at least one surgical term out of the 5 terms for the year. I was allocated urology for my surgical rotation. It was known to be horrendously busy and quite ironically, the two interns allocated to that rotation were probably lucky to ever have time to empty their bladders. I was horrified at the thought of doing the surgical specialty that was of least interest to me. I quickly got in touch with a friend whose career interest was in psychiatry and he was completely unfazed about which surgical term he would do. The swap was made and I got out of urology and did a plastic surgery rotation instead. I just loved my time doing Plastics and by the end of the term, I was virtually unmovable in my desire to be in that specialty. </div>
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For the second post graduate year (or resident medical officer year), it was again a fairly general year and to my horror, I was again allocated urology. I thought ‘hang on a sec, isn’t urology meant to be an intern rotation?’ Given that the term was so stressful for two interns, it was thought that it would be better to replace one of the interns with an RMO. Having that extra year of experience was going to make a huge difference. I again hit the phones and on this occasion could not find anybody who was willing to do a swap. Begrudgingly, I accepted the fact that I would have to do this rotation. In spite of the adversity, I threw myself into the job and to my great surprise found the specialty extraordinarily interesting. Urologists were both physicians and surgeons of the genitourinary tract and were not beholden to masters in any other specialty group in order to have a practice livelihood. On top of this, the urologists to whom I was to be exposed to, took great interest in my work ethic and general interest in surgery. Their kindness and support for me had a profound impact on me although I was still steadfastly obsessed with having a career in Plastic Surgery. </div>
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My primary career focus during my RMO year was to pass my surgical primary examination which at that time has a pass rate of around 25%. It was at that time, a clear barrier to restrict entry into the surgical profession. Fortunately I passed the examination on my first attempt which was pretty good going since my undergraduate academic record at university was fairly ordinary (after I discovered the medical revue, I never saw another credit or distinction grade for the remainder of my medical degree). I now had to think carefully about where my next career move would be. Something that I had noticed about the plastic surgery trainees at the time was the fact that they were all relatively old compared to other trainees. At that time, those entering into plastic surgery training would first complete their general surgical training and then spend a year or more in non-accredited plastic surgery positions before commencing core training. I came to realisation that the majority of those who were undertaking plastic surgery training were going to nudging 40 years of age by the time they were ready to commence independent surgical practice. I thought that this was crazy and that I did have a life to live and made the tough decision to abandon the idea of training in plastic surgery. My mind kept me returning to my time in urology and I soon became convinced that this was where my future lay. </div>
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As is so often the case, it can be the mentors that you meet in the field rather than the field itself that can initially draw you towards it. </div>
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To this day, I have no regrets.</div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com2tag:blogger.com,1999:blog-6046871514976920545.post-36588526480777301562016-04-03T11:29:00.002+10:002016-04-07T18:44:44.869+10:00Payment for Citation Offer Withdrawn - but should never have been offered in the first place.This Blog post needs to read in conjunction with the earlier entry on the same subject matter.<br />
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"<a href="http://surgicalopinion.blogspot.com.au/2016/04/payment-for-journal-citation-possibly.html" target="_blank">Payment for Journal Citation? Possibly Academic Publishing at its Worst.</a>"<br />
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I wrote to the Editor in Chief to express my concern over his recent email about offering financial reward for citing papers from his journal. I received a prompt response to the effect that the offer was to be withdrawn. My plan is to now write to the President of the professional organisation to which this periodical is their official journal. Whilst the offer is stated to have been withdrawn, it still represented poor judgement and raises a real question about integrity. <br />
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You might ask as to why I have not yet resigned from it's editorial board? Whilst I still have a seat there, my voice can still be heard or at least I would hope more likely to be heard. There are many reputable individuals on their editorial board and I sincerely hope that they have aired their concerns as well. <br />
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I plan to push for this matter to be heard by the Executive of the professional organisation to which the journal is attached and if the organisation is to have any integrity, there needs to be some strong action to demonstrate that even the thought of this misconduct is not to be tolerated. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOw5NScc6SG3sMxSphmPlXDjjoLUHFBuSIu3H8qtKV0tCq6JqHEqISJDDwpgx64uJ53CP5P-SgidLfPAwvhf5MlB7FICDLoKI7lnnt87zIMI2lBLxn9TSTOdaAM5V3PaSthzjItS1KgGYt/s1600/Screen+Shot+2016-04-03+at+12.43.24+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="139" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOw5NScc6SG3sMxSphmPlXDjjoLUHFBuSIu3H8qtKV0tCq6JqHEqISJDDwpgx64uJ53CP5P-SgidLfPAwvhf5MlB7FICDLoKI7lnnt87zIMI2lBLxn9TSTOdaAM5V3PaSthzjItS1KgGYt/s320/Screen+Shot+2016-04-03+at+12.43.24+AM.png" width="320" /></a></div>
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I will update readers as more information comes to hand.<br />
<br />Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-44198449329532197912016-04-03T00:51:00.000+11:002016-04-03T11:32:57.660+10:00Payment for Journal Citation? Possibly Academic Publishing at its Worst.<div style="font-family: HelveticaNeue; font-size: 12px;">
Many of you who have read my blog or are following me on Twitter, would be well aware of my thoughts about academic publishing. I have always done my best to be careful about which journals I would consent to have my name associated with in any way. </div>
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As a general rule, I will be more receptive to invitations to review manuscripts or even invitations to join an Editorial Board if the journal is associated with a bona fide professional organisation or if the journal is indexed on Pubmed (increasingly being referred to as the ‘white list’). Whether the journal had an impact factor was of lessor importance but if the journal were to quote any of the bogus impact factors such as the Index Copernicus, Journal Impact Factor, Global Impact Factor or Universal Impact Factor, this would also lead to rejection of any approach. There is no purpose of these bogus impact factors other than to mislead and to fool academics into believing that it was something to do with the established Thomson ISI Impact Factor. Additionally, any journal currently listed on the Beall’s list of predatory journals was also a definite NO. </div>
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About two years ago, I was invited to join the editorial board of a journal that was the official organ of a professional society that was known to me and the journal was indexed in Pubmed. I was pleased to receive the invitation and gratefully accepted the invitation. Whilst the journal has been indexed in Pubmed, it was still going through the process of being assessed for journal citation indexing and therefore receiving a Thomson ISI impact factor. It seems that this journal’s time has come and I received an email asking me to make a special effort to cite papers from the journal, particularly from the years 2014 and 2015. The Editor in Chief announced that for each cite, I would receive a fee of US$50 with a maximum of US$500 annually. </div>
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I was shocked. My immediate thought was to send in my resignation straight away. Given that this journal is associated with a professional society, I wondered if it was better to attempt to make change from within by writing to the editor and expressing my concern. Should I write to the EIC and give him the opportunity to have a rethink on this strategy? Should I simply tender my resignation immediately? I certainly am not dependent on having membership to this journal's editorial board as an indication of my professional standing. Have a look at the attached email. </div>
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I am also absolutely and utterly appalled by the poor spelling in the email. </div>
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What are your thoughts? </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdIZxHWqorj-gg7FFJhy43Q_JEaWYssfAZycxAxREXGGuUj-p468L7lOXx8rrWZlVzjLYgZI5H_BpiessdXt-SmchnSHf8mLLOaeNGXmysU5zqhzIMXkScymCOeQ7THKugPR5ZczvVEH02/s1600/Screen+Shot+2016-04-03+at+12.43.24+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdIZxHWqorj-gg7FFJhy43Q_JEaWYssfAZycxAxREXGGuUj-p468L7lOXx8rrWZlVzjLYgZI5H_BpiessdXt-SmchnSHf8mLLOaeNGXmysU5zqhzIMXkScymCOeQ7THKugPR5ZczvVEH02/s400/Screen+Shot+2016-04-03+at+12.43.24+AM.png" width="400" /></a></div>
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I can reassure readers that I will certainly not accept any fees for citing papers. I only cite papers if I consider they are relevant to a given manuscript. Nothing more and nothing less.</div>
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As a disclosure, I list my current Editorial Board memberships, minus the one in question. I also make mention that I am an Associate Editor of the Prostate Cancer and Prostatic Diseases journal.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWVINmWhCQrByrh_9HYK9tJcX00q5qu_Otcy-PHl0teak300BQE9Tz7kVX30uptLTFtgr-Oymh1XdkWcLxwYx7UNnviioJJyRfjuk61fQ39lqMrf47GV5Gw0jRmyIyAOWkc3p1GOfBpuru/s1600/Screen+Shot+2016-04-03+at+12.25.51+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="89" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWVINmWhCQrByrh_9HYK9tJcX00q5qu_Otcy-PHl0teak300BQE9Tz7kVX30uptLTFtgr-Oymh1XdkWcLxwYx7UNnviioJJyRfjuk61fQ39lqMrf47GV5Gw0jRmyIyAOWkc3p1GOfBpuru/s320/Screen+Shot+2016-04-03+at+12.25.51+AM.png" width="320" /></a></div>
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<span style="font-size: x-small;"><u>Additional note 2 April 2016</u></span><br />
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<span style="font-size: x-small;">Please take a look at this update to see the response of the EIC to my email of concern</span><br />
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<span style="font-size: x-small;"><a href="http://surgicalopinion.blogspot.com.au/2016/04/payment-for-citation-offer-withdrawn.html" target="_blank">Payment for Citation Offer withdrawn.</a></span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-18228301239388103612015-11-05T20:34:00.002+11:002015-11-05T20:35:54.640+11:00No Justice For Those Who Have Suffered Bullying, Discrimination and Sexual Harassment with Increased Surgical College Subscription Payments.<div class="MsoNormal">
As Fellows of the Royal Australasian
College of Surgeons, we pay annual subscriptions. There is not a whole lot of practical choice
but for us to pay these subscriptions if one wishes to be a practicing surgeon
in Australia. It has just been announced that the subscriptions for 2016
are going up and by a lot. </div>
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Whilst the
Consumer Price Index is sitting around 1.5%, it has just been announced that it
will be going up by 6% to cover the cost of implementing recommendations of the
Expert Advisory Group (EAG). </div>
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As a reminder, the EAG had documented the serious extent to which
bullying, discrimination and sexual harassment (BDSH) has existed within the
male Anglo-Saxon dominated surgical establishment. </div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG4R-1SM-aa-cC1kFXs91ESjCm0JRHyzHm67ApPyELqKCZ3PpuROFOku1UHZSdRjCmRoLTzeK_tcwkrgrgfUbmsMWfX1VqerNk9a7iD6OpP_BAl0PqqDo08YUbm5eLzTd_N6qtHnuAw06a/s1600/Screen+Shot+2015-11-05+at+7.48.07+pm.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="97" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiG4R-1SM-aa-cC1kFXs91ESjCm0JRHyzHm67ApPyELqKCZ3PpuROFOku1UHZSdRjCmRoLTzeK_tcwkrgrgfUbmsMWfX1VqerNk9a7iD6OpP_BAl0PqqDo08YUbm5eLzTd_N6qtHnuAw06a/s320/Screen+Shot+2015-11-05+at+7.48.07+pm.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Text from the RACS email advising of the fee increase</td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
This increase represents a gross injustice
for those who have suffered from bullying, discrimination and sexual harassment
during their formative years in building a career in surgery. Having been subjected to such treatment, they
now must pay more for having had the privilege to have had such an experience. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Meanwhile, the main perpetrators of such
behavior remain unpunished and will not as they should, bear the brunt of the
additional costs for the RACS to make good on their past behavior. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZMHQpqrJhRdzqNHx4rq_0CAMbthgBYiveA8HOX3_YNimLURbMam0oHJ_VPJbNQPnEzj2q6_VfLJVxqKqpdbo-VOH8koa-DU3tHYMsXWgH6Gi2X1rb39mv5a65bXEbQbLg0u3a7K-8Kt3O/s1600/Screen+Shot+2015-11-05+at+7.58.58+pm.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZMHQpqrJhRdzqNHx4rq_0CAMbthgBYiveA8HOX3_YNimLURbMam0oHJ_VPJbNQPnEzj2q6_VfLJVxqKqpdbo-VOH8koa-DU3tHYMsXWgH6Gi2X1rb39mv5a65bXEbQbLg0u3a7K-8Kt3O/s320/Screen+Shot+2015-11-05+at+7.58.58+pm.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">These are fees that I paid in 2015 for the privilege of being a Fellow.</td></tr>
</tbody></table>
<div class="MsoNormal">
But the reality is that implementing EAG
Recommendations is going to be a costly exercise and it is money that cannot be
covered from its financial reserves. Apart from these costs, the RACS remains at significant risk of litigation and financial
settlements in the event individuals find the courage to commence legal proceedings. The RACS doesn’t really have a choice but to
fund the implementation of EAG Recommendations through a significant increase
in Fellowship subscriptions and to apply this across the board. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The fact that the RACS is understandably
unable to adjust for who should or should not pay a greater or smaller
contribution to cover these costs does not change the fact that it lacks justice. It will undoubtedly leave a bitter taste for
many Fellows who will begrudgingly pay their subscriptions for 2016.</div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
<span lang="EN-US">I do have one axe to grind over the manner
by which this increase is being applied. Rather than a general revenue
surcharge buried into our overall subscription, I strongly believe the increase
above CPI should be listed as a separate line entry to send a clear message to
all Fellows that they are paying for the indiscretions of past and present
surgeons engaging in BDSH.<span style="mso-spacerun: yes;"> </span>Without this,
the reason for the 'bumped up' subscriptions will be quickly forgotten.<span style="mso-spacerun: yes;"> </span>The issue of BDSH and it being addressed by
the EAG represents a very significant watershed moment in the history of the
RACS.<span style="mso-spacerun: yes;"> </span>It should not be devalued by being
buried into general business.<span style="mso-spacerun: yes;"> </span>I appeal
to the RACS to make it a separate line entry.<span style="mso-spacerun: yes;">
</span>Call it an "EAG Levy" or "EAG contribution" or whatever.</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is just important to make it transparent. Make it visible. Do not allow it to be forgotten. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Maybe it is all just about trying to make a
good impression – I’m sure you will agree that the RACS needs to do everything
it can do to improve the impression it gives to the general public and its
Fellows. It will cost the RACS nothing
to implement this. The cost of giving a negative impression......... </div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US">Related blog pieces</span></div>
<div class="MsoNormal">
<a href="http://surgicalopinion.blogspot.com.au/2015/09/action-must-speak-louder-than-words.html" target="_blank">Actions must speak louder than words - RACS and the EAG</a></div>
<div class="MsoNormal">
<a href="http://surgicalopinion.blogspot.com.au/2015/05/bullying-culture-in-surgery-has-nothing.html">Bullying culture in surgery</a></div>
<div class="MsoNormal">
<a href="http://surgicalopinion.blogspot.com.au/2015/05/cardiac-surgeons-were-once-untouchable.html">Cardiac surgeons were the worst perpetrators of bullying behaviour</a></div>
<div class="MsoNormal">
<a href="http://surgicalopinion.blogspot.com.au/2015/09/the-royal-australasian-college-of.html">RACS Elections and Candidate Review</a></div>
<div class="MsoNormal">
<a href="http://surgicalopinion.blogspot.com.au/2015/10/congratulations-to-fellows-of-racs-who.html">Election results shows that there is appetite for change in the RACS</a></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com1tag:blogger.com,1999:blog-6046871514976920545.post-62190839434057506082015-10-08T11:16:00.002+11:002015-10-08T11:16:32.818+11:00Congratulations to Fellows of the RACS Who Have Voted For Diversity on College Council<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">We have seen an amazing result for the 2015 Royal Australasian College of Surgeons Council elections. </span><br />
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><b>All six women candidates were elected out of a total of 8 vacancies and from a field of 38 candidates.</b></span><br />
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">In an earlier blog piece, I expressed concerns about diversity of the RACS Council. These are a few tweets expressing my concerns.</span><br />
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With only 6 women out of 38 candidates for the 8 vacancies on council, I held grave fears that much needed female representation on the RACS Council would not improve. The numbers of candidates, only 10 of 38, who made any mention of issues relevant to the EAG Report was woefully low. I am so glad to be proven wrong.</div>
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Rather than just hope that RACS Fellows would take the effort to consider voting, it was important to get the message out there as to why voting was especially important on this occasion.This meant, spreading the word on social media, directly speaking with colleagues and mass emails. I hope that my efforts made a contribution to the final outcome. </div>
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I was however, touched to receive a direct message from the RACS on Twitter stating </div>
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<span style="font-family: Consolas;"><b><i>"thank you for your efforts in promoting the elections, and supporting the candidates, across social media, it was greatly appreciated"</i></b></span></div>
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The EAG Report has had the RACS in the spotlight. To have an election result with the all too common outcome where all successful candidates were male, would have been a damning indictment on the College after all that has been said about a culture that needs to be overhauled. </div>
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The results indicated that there is real appetite for change and demonstrates that there is indeed every reason to be hopeful about the future of the RACS as it catches up with community expectations. </div>
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Congratulations to all of the successful candidates and let's hope that they live up to their promise to help change the culture within the field of surgery. Congratulations also to voting Fellows of the RACS for demonstrating that there is an appetite for change.</div>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-85683362131316985672015-10-02T22:28:00.000+10:002015-10-02T22:32:43.709+10:00Deceptive Surgical Billing Practices<div class="MsoNormal">
<span lang="EN-US">Last year, the Royal Australian College of
Surgeons issued a Press Release on the matter of <a href="http://www.surgeons.org/media/20896466/med_2014-07-28_excessive_fees_unethical_and_inappropriate.pdf">excessive
surgical fees.</a><span style="mso-spacerun: yes;"> </span>The then President states
“Although government data shows that almost 90 per cent of medical services in
the private sector last year had no associated costs to patients we are still
seeing reports in the media of excessive and even extortionate fees”.<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">How does the Government and other health
organization’s get hold of this data?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Lets look at the typical billing situation.
When a surgeon bills a patient for a surgical service in the private sector, the
entire fee is provided on an invoice with a breakdown of costs as appropriate.<span style="mso-spacerun: yes;"> </span>The privately insured patient will take the
invoice to Medicare Australia and their Health Fund.<span style="mso-spacerun: yes;"> </span>Medicare and the Health Fund will pay 75% and
25% of the Medicare Benefit Schedule (MBS) Fee respectively. Most surgeons
charge above the MBS fee and the difference between their surgical fee and MBS
fee is the out of pocket gap payment that is the responsibility of the patient.
<span style="mso-spacerun: yes;"> </span>Obviously, data on the amount of the gap
payment can be recorded.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US">As a result of the publicity directed to
the excessive amounts of gap payments, some surgeons had every reason to believe that information being
collected about their practices had the potential to come back and bite them in the future.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I used to think that this data was
reliable. </span></div>
<div class="MsoNormal">
<span lang="EN-US"><b><br /></b></span></div>
<div class="MsoNormal">
<span lang="EN-US"><b>It never crossed my mind that surgeons would think of rorting this
data collection to hide the fact that they were charging exorbitant fees.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">I was contacted by an old friend who asked
to catch up with me for a coffee.<span style="mso-spacerun: yes;"> </span>Let's
call him Bart (not his real name). Bart is smart man, and smells bullshit from
a mile off. He had a story that he wanted run by me for my opinion. </span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US">His wife had undergone
surgery for breast cancer and had been referred to a plastic surgeon for breast
reconstruction.<span style="mso-spacerun: yes;"> </span>The surgical fee was
quite large at $15,000 but he was prepared to pay this as the surgeon had come especially recommended by the oncologist, whose opinion they trusted unconditionally.<span style="mso-spacerun: yes;">
</span>To be clear, he specified that he had no complaint or concern about
the amount of the surgical fee.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Bart wanted to reconcile why he was being
given <b>two separate accounts</b>.<span style="mso-spacerun: yes;"> </span>He was given one
account for the value of $5000 which was to be the paperwork to be taken to
Medicare and the Health Fund.<span style="mso-spacerun: yes;"> </span>A further
receipt was given for $10,000 which was attributed to gap payment.<span style="mso-spacerun: yes;"> </span>This receipt made no reference to being a
surgical service for which a rebate from Medicare or a Health Fund could be
obtained.<span style="mso-spacerun: yes;"> </span>Bart indicated that this
seemed to be a bizarre way of doing things and had his suspicions that this
might be something to do with deceptive practice.<span style="mso-spacerun: yes;"> </span>It is easy to see how most people would not
give it further thought since they have been billed exactly what they had been
quoted.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">He saw my lights go on as he relayed this
story to me.<span style="mso-spacerun: yes;"> </span>It was plain obvious to me that
this plastic surgeon was <b>trying to deceive the Federal Government as to exactly
what he was really charging the patient</b>.<span style="mso-spacerun: yes;">
</span>He was attempting to distract from any future attention that might be
directed to him as a surgeon who was charging in the higher echelons for his
surgical services.<span style="mso-spacerun: yes;"> As far as the government would be concerned, he was only charging $5000 for his surgical services in spite of the real fee being $15,000.</span><o:p></o:p></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US"><b>This is not illegal but I call it out for
being a deceptive and unethical practice.</b><o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US"><i>(The amounts are not the actual dollar amounts that Bart and his wife were charged but rounded to nearest sums to help illustrate the billing practice and to protect his anonymity.)</i></span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com2tag:blogger.com,1999:blog-6046871514976920545.post-40820905531490874452015-09-30T11:41:00.003+10:002015-09-30T11:54:22.703+10:00Why I've Been Using Uber Instead of Taxis<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><b>Uber is under attack</b>. </span><br />
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">That’s easy to understand. Taxi operators feel that their livelihood is at risk and state governments are losing out on tax revenue that they gouge out of the industry. To me, the arguments about safety and so forth is just disingenuous drivel to justify the attack on Uber. </span><br />
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
I have used taxis a lot but I now only use them when I really must. If I am not in a hurry, I would rather wait another 5 minutes to get an Uber ride rather than hop into an immediately available taxi. It is not because it is cheaper - in fact I would be happy to pay a similar price for the service. I am glad that Uber is disrupting the taxi industry as it seems that this is the only way to pull it into a customer focused service.</div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<i>Taxi Drivers Need to Know Where They Are Going - Using a GPS is Okay</i></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
I am fed up with taxi drivers having no idea of where important landmarks are. Admittedly, I have this problem more so in Melbourne than any other Australian city. In recent times, I had a taxi driver who did not know how to get to the Hilton South Wharf (let’s make that he had never heard of the hotel). This is the major conference hotel attached to the Convention Centre and has been open for many years. I showed him the way from the airport. When we were almost there, I pointed to the top of the hotel where the Hilton sign was easily visible. I put my head down for a few moments to check some emails and the next moment, he had missed the turn off and there we were, heading down Flinders Street towards East Melbourne. Also, within the last 12 months, I had a driver who did not know where the Royal Melbourne Hospital in Parkville was located. I do not mind if they use a GPS - at least Uber drivers do not pretend to know where everything is located and will proudly use the GPS. In the two examples given, the drivers seemed too proud to use their GPS. I have different expectations for taxi and Uber drivers in that I do expect professional licensed drivers to know where they are going. </div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<i>Clean Vehicles and Drivers Would Help</i></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
About 25% of the taxis I get into are grotty old vehicles or the driver is shabbily dressed and in need of deodorant. Just because they now need to wear a uniform has not necessarily made them look like professional drivers. Maybe if they even just tucked their shirt in and did not have breath that smelt like an ashtray, that would be a good start. Often the space around driver and the front seat is full of rubbish. To date, the vehicles I have encountered with Uber have been on average, far better than the average state of vehicles I have encountered with taxis.</div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<i>Ordering a Taxi is a Painful Process</i></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
One of the most frustrating aspects of catching a taxi is when you order one. When the operator abruptly insists that 'it will be the next available', the eye rolling on their part is palpable. You are subject to the lottery system where the 'next available’ taxi is who ever taps the accept button first. Often I get a taxi that is 15 minutes away rather than the taxi that is around the corner from my pick up site because that driver was quicker with hitting the accept button. To me, the next available taxi is the one that is closest to me that is available to accept my fare. </div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<i>Arachiac System of Standard Driver Shifts Needs to Change</i></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
The lack of flexibility of taxi shifts is also an annoyance. It seems that all taxi drivers are finishing their shifts at the same time - I am asking myself why is it that it is always at the time that I really needed a taxi pronto. This rigid approach is not customer focused. Uber has no specific shifts - drivers are available when they are available- simple as that.</div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<i>No Andrew Bolt or Alan Jones on the Radio PLEASE</i></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
The radio. This is not a big ticket item at all but becomes a complaint to supplement all the other dissatisfaction with the taxi industry. They seem to have this love of talk back radio. If taxi drivers were to be thinking about their customers, they would and should know that many people find talk back radio with the likes of Alan Jones or Andrew Bolt to be offensive. Any music of any genre is much less likely to offend a proportion of the patronage than that of toxic shock jocks. My word of advice is to just not to have talk back stations on the radio unless requested and you will offend nobody.</div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
As a grass roots user of taxi services, this is my take on it. </div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<br /></div>
<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
<b>Others may have a different take but my concerns about taxis are largely ignored and that is exactly why I am one of many who have gravitated to supporting Uber. </b></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com1tag:blogger.com,1999:blog-6046871514976920545.post-35429309340426618282015-09-24T16:09:00.000+10:002015-09-24T16:09:56.176+10:00Do patients contribute to God complex in surgeons?<div class="MsoNormal">
The recent EAG Report commissioned by the Royal Australasian College of Surgeons suggests that there is a toxic culture of bullying, harrassment and sexual discrimination in surgery. There are probably multiple reasons why this
toxic culture exists.<span style="mso-spacerun: yes;"> </span><br />
<br />
One reason that seems
to attract less attention is the attitude of self importance and self
entitlement and being beyond reproach – or in other words a God complex that
surgeons have acquired through their own experiences and being trained to think
this way from their mentors.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Hardly a working day goes by without a
patient or their relative telling me how brilliant I was in helping them in
their prostate cancer journey. I am always humbled and appreciative of these
positive comments. However, I am a very well trained surgeon who works
hard and is obsessive compulsive in trying to do the best for my patients.<span style="mso-spacerun: yes;"> </span>I’m just doing my job.<span style="mso-spacerun: yes;"> </span>I’m well paid for what I do. <span style="mso-spacerun: yes;"> </span>I have amazing job satisfaction.<span style="mso-spacerun: yes;"> </span>Often I feel that I have the best job in the
world. <o:p></o:p></span><br />
<span lang="EN-US"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqdrFQtei_W5sRapqIo3QIccZMmh_IdzzyAyAoude-8p-prBXFMmiyeXdpnWjjgj2zQJOPZUCfE09_LdWXLJ_nCxJ3l7KQFicg9RBggEfDKPH4faPqv3Fh64LL2neSQ5ehtr5la0f9FK8g/s1600/Adulation.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqdrFQtei_W5sRapqIo3QIccZMmh_IdzzyAyAoude-8p-prBXFMmiyeXdpnWjjgj2zQJOPZUCfE09_LdWXLJ_nCxJ3l7KQFicg9RBggEfDKPH4faPqv3Fh64LL2neSQ5ehtr5la0f9FK8g/s320/Adulation.jpg" width="320" /></a></div>
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">But why such adulation for a person who is
simply doing their job well?<span style="mso-spacerun: yes;"> </span>What we do
for our patients is very personal so obviously means a great deal to them.<span style="mso-spacerun: yes;"> </span>Additionally there is a significant power
imbalance, particular with knowledge and the fact that patients effectively
surrender their trust upon us when we perform surgery upon them. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
<span lang="EN-US">Patients are complicit to the God syndrome
acquired by surgeons. <span style="mso-spacerun: yes;"> </span>Health reporter
Harriet Alexander is on the money when she <span style="mso-spacerun: yes;"> </span><a href="http://www.smh.com.au/national/health/royal-australasian-college-of-surgeons-revelations-patients-complicit-in-promoting-surgeons-god-complex-20150909-gjitc6.html#ixzz3lbF82eOe">writes</a>
“For every surgeon who has a God complex, there is a bevy of complicit
patients.” <span style="mso-spacerun: yes;"> </span>If you keep telling surgeons
how brilliant they are, after enough times, they’ll really start believing
it.<span style="mso-spacerun: yes;"> </span>By all means be appreciative of the
work done by surgeons but time to stop the excessive praise for well trained
individuals who are simply doing a great job of what they were trained to do.<o:p></o:p></span><br />
<span lang="EN-US"><br /></span>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga_KHsfwZSP11-iXvmqIRn-DSED1LnUisJc3caoIDDyD3H1q1eyEPkPJW4umd7N3TlKvJz1PjBazlYowz5wzsE6zB9SDluReIuOPDW5ygmTteuK2sNvJYptto3j2jaic_gg6xR4tXgiWyu/s1600/narcism-7-638.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEga_KHsfwZSP11-iXvmqIRn-DSED1LnUisJc3caoIDDyD3H1q1eyEPkPJW4umd7N3TlKvJz1PjBazlYowz5wzsE6zB9SDluReIuOPDW5ygmTteuK2sNvJYptto3j2jaic_gg6xR4tXgiWyu/s320/narcism-7-638.jpg" width="320" /></a></div>
<span lang="EN-US"><br /></span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-71323269458758987262015-09-19T19:23:00.002+10:002015-09-20T10:02:19.857+10:00The Royal Australasian College of Surgeons elections have commenced. Will it result in positive change?<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The Royal
Australasian College of Surgeons has been rocked by the scandal of there being
a culture of bullying, harassment and sexual discrimination in the Expert
Advisory Group’s Draft Report that was handed down just over a week ago.<span style="mso-spacerun: yes;"> </span>We have seen a formal apology from the
President of the RACS and a promise that there is going to be change.<span style="mso-spacerun: yes;"> </span>RACS policy and culture is determined by RACS
Council which is made up of elected Fellows.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Without doubt,
the EAG Report is the ‘biggest ticket’ item that requires the attention of the
RACS Council. The final EAG Report and the recommendations that arise from it
will again place the RACS in the public spotlight.<span style="mso-spacerun: yes;"> </span>The RACS has been applauded for commissioning
the independent EAG Report which had every expectation of producing findings
that would be highly damaging to the reputation of the surgical profession. When the RACS announces
how it intends on tackling bullying, discrimination and sexual harassment for
the future could be a watershed moment in the credibility for the organization
and profession.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Right now is an extremely important time for the RACS. Voting in the elections for
members of the RACS Council opened on Friday 18 September and will close on
Monday 5 October 2015.<span style="mso-spacerun: yes;"> </span>How the Fellows
of the RACS vote could impact on public confidence on how serious the
organization is in tackling bullying, discrimination and sexual
harassment.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">There are 38
candidates for the 8 positions that are up for grabs.<span style="mso-spacerun: yes;">
</span>The EAG Report should be the biggest ticket item on the agenda, but only 10 candidates have made mention of issues surrounding the findings of this report.<span style="mso-spacerun: yes;"> </span>That’s right, only 10
candidates thought the issue important enough to place in their electoral
statements.<span style="mso-spacerun: yes;"> </span>Of those 10 candidates, 5
are women.<span style="mso-spacerun: yes;"> </span>It gets very interesting when
we consider that there are only 6 candidates who are women. It is clear that
women consider the findings of the EAG Report to be of considerable importance
and arguably more so than their male counterparts.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Let’s also look
at the ethnicity of the candidates. <span style="mso-spacerun: yes;"> </span>Of
the 38 candidates, 34 are Caucasian, 2 Chinese and 2 from the subcontinent.<span style="mso-spacerun: yes;"> </span>Of further interest, surgeons who either
currently hold senior positions within the RACS or have done so in the very
recent past have nominated 22 of the 38 candidates.<span style="mso-spacerun: yes;"> </span>These nominating surgeons carry very
high profiles and are highly respected within the profession and their support of a
candidate does carry weight.<span style="mso-spacerun: yes;"> </span>If this
were not the case, candidates would not seek to have their names listed next to theirs
in their electoral statements.<span style="mso-spacerun: yes;">
</span>Alternatively, rather than these candidates seeking to have such
nominators, could it be a case of like minded candidates being the ones who get
the tap on the shoulder?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The average age
of the candidates is 56 years, ranging from 34 to 72 years. The majority of
candidates are clustered between 50 to 60 years of age. There are only 5
candidates who are less than 50 years of age. There is only one candidate who
is less than 40 years of age. <span style="mso-spacerun: yes;"> </span>How dare
this person run for RACS Council you might ask?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The youngest
candidate is Dr Nikki Stamp who has everything working against her in having
any chance of being elected.<span style="mso-spacerun: yes;"> </span>Apart from
being female, she is also by far the youngest candidate and does not have the nomination support of the high profile RACS 'heavyweights'. She is however, passionate about equality in all aspects of healthcare and
determined to see the RACS make a difference with the issue of bullying, harassment
and sexual discrimination.<span style="mso-spacerun: yes;"> </span>She has her
own stories but right now there is a bigger missionat hand and in order to make a
difference, she needs to be elected to the RACS Council. She will disrupt the
RACS Council but for all the right reasons.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">If you are Fellow
of the RACS and feel serious about change, do vote for Dr Nikki Stamp.<span style="mso-spacerun: yes;"> </span>If otherwise, tell surgeons that you do know, to
not just consider her candidature, but to vote for her.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: Arial;">The RACS needs to
change but the demographics of those who seek positions on the RACS Council
makes me nervous about what the future holds.<o:p></o:p></span><br />
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;">_____________________________</span><br />
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;">For those interested, this previous piece "<a href="http://surgicalopinion.blogspot.com.au/2015/09/action-must-speak-louder-than-words.html">Action Must Speak Louder Than Words</a>" which is about the EAG Report may be of interest</span><br />
<span lang="EN-US" style="font-family: Arial;"><br /></span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-64575830697546797852015-09-14T14:26:00.001+10:002015-09-20T10:04:16.850+10:00Action Must Speak Louder Than Words<div class="MsoNormal">
<span lang="EN-US">Medical Oncologist, Dr Ranjana Srivastava
wrote on the subject of “<a href="http://www.theguardian.com/commentisfree/2015/feb/06/how-doctors-treat-doctors-may-be-medicines-secret-shame">how
doctors treat doctors may be medicine's secret shame</a> “ in the Guardian
newspaper back in February 2015. About a month later, vascular surgeon Dr
Gabrielle McMullin used a book launch speech to expose the problems of sexual
harassment in the surgical profession.<span style="mso-spacerun: yes;">
</span>She highlighted a story of where a neurosurgical trainee had refused
sexual advances and subsequent to launching a formal complaint, her career was
ruined. Her statement that<span style="mso-spacerun: yes;"> </span>“<a href="http://www.news.com.au/finance/work/surgeon-blows-whistle-on-medical-sexism-she-would-have-been-much-better-to-have-given-him-a-blow-job/story-fnkgbb3b-1227252345411">she
would have been much better to have given him a blow job” </a>made national
headlines in Australia.<span style="mso-spacerun: yes;"> </span>This opened a
can of worms and numerous stories suggesting a toxic culture of bullying,
harassment and sexual discrimination (BDSH) were aired.<span style="mso-spacerun: yes;"> </span>Under pressure, the Royal Australian College
of Surgeons acted swiftly and appointed an independent Expert Advisory Group to
investigate and to make recommendations.<span style="mso-spacerun: yes;">
</span>Six months later, the draft report of the <a href="http://www.surgeons.org/about/expert-advisory-group/">EAG</a><span style="mso-spacerun: yes;"> </span>was published and results were “quite frankly
shocking” as in the words of the President of the RACS.<span style="mso-spacerun: yes;"> </span>The report was released in conjunction with a
formal humbling RACS apology that has been uploaded to <a href="https://www.youtube.com/watch?v=lm_YLicg9Sw">YouTube</a>. <o:p></o:p></span></div>
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Prior to the release of the report, I had noticed a lot of discussion on social media and in real life on how the prevalence of bullying, harassment and sexual discrimination was overblown and stated to be no more so than in any other profession. Whilst the EAG Report makes clear that these assertions are absolutely wrong and that there is a special case for surgery that requires serious reflection and action.</div>
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On this basis, I then tweeted the following:- </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwjcGjxKRZpXzbgb8JJ-i3-dnspG3EfoeHyN4gk0goQ0S2PICzrx8dRdeDXJutsLPDig6ZPYJ5y4jPpiyLdzjeydX1NSYCRWsEuTMLnzISRc_u6z3i4ebbu6033z859_TmPIzwGdEZ3JYv/s1600/Screen+Shot+2015-09-14+at+12.37.18+pm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="132" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwjcGjxKRZpXzbgb8JJ-i3-dnspG3EfoeHyN4gk0goQ0S2PICzrx8dRdeDXJutsLPDig6ZPYJ5y4jPpiyLdzjeydX1NSYCRWsEuTMLnzISRc_u6z3i4ebbu6033z859_TmPIzwGdEZ3JYv/s400/Screen+Shot+2015-09-14+at+12.37.18+pm.png" width="400" /></a></div>
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I followed the above tweet with the following:-</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgkm6dLP9xc93QkltkvvlLFIFnVbKZm1inzsijT_8_Gq4lx0PTTRsWsjBlgl5G639JQ8r8faofjzMKBY_ETt_pfhG5xtNTaWwg0qSJc5n6cAPw4Gl_i2KQqfThNj6xWcc7NYXzrszO8jw4/s1600/Screen+Shot+2015-09-14+at+12.33.37+pm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgkm6dLP9xc93QkltkvvlLFIFnVbKZm1inzsijT_8_Gq4lx0PTTRsWsjBlgl5G639JQ8r8faofjzMKBY_ETt_pfhG5xtNTaWwg0qSJc5n6cAPw4Gl_i2KQqfThNj6xWcc7NYXzrszO8jw4/s400/Screen+Shot+2015-09-14+at+12.33.37+pm.png" width="400" /></a></div>
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The tweet above generated interest and that evening was <a href="http://t.co/JT1dfpzfej" target="_blank">aired on the Lateline</a> news program on ABC television. This tweet does not suggest in any way that individuals with all of these attributes are part of the bullying and harrassment culture but think about it; they are the ones who are least likely to be subjected to it or to see it. If they chose to, they had the best opportunity to be untouchable.</div>
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<span lang="EN-US">As expected there is some criticism
of the EAG Report as well as to my own comments.<span style="mso-spacerun: yes;"> </span>The following tweets
are more than likely to represent the tip of an iceberg for those who share similar
thoughts. It is obvious that the vast majority in this camp have gone to
ground since the release of the report but they will be observing closely and we can only hope that time will bring about attitudinal change. I commend these commentators for publicly sharing their thoughts as it informs those of us who embrace the report as to
the battles that lie ahead.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBdZ77FRlRFaUWDgTNjbI5l6Dp_MW_euoe4OxHgbWVFblHg-0ZY_lj7klKGmfMoz4gd9WDvpUqtVXfEpSJRkw6pTIZikCFiAMTQUKmA8cP-SJGWuVaMJzaroIKPqGMQ7l-zEB1BQqw9aZE/s1600/Screen+Shot+2015-09-14+at+10.50.04+am.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBdZ77FRlRFaUWDgTNjbI5l6Dp_MW_euoe4OxHgbWVFblHg-0ZY_lj7klKGmfMoz4gd9WDvpUqtVXfEpSJRkw6pTIZikCFiAMTQUKmA8cP-SJGWuVaMJzaroIKPqGMQ7l-zEB1BQqw9aZE/s320/Screen+Shot+2015-09-14+at+10.50.04+am.png" width="320" /></a></div>
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Some of the worst perpetrators of BDSH continue to be in roles of significant power. We all know who they are and even subsequent to the EAG report, there will be reluctance to report or expose them. How the RACS intends to deal with these perpetrators and exactly how they propose to change the toxic culture that exists within surgery is the major challenge ahead? Whilst the RACS has worn the brunt of criticism for BDSH in surgery, hospital administrators have got away scot free. They are equally, if not more, responsible for the reasons we have come to where we are now. We eagerly await the final report of the EAG and detail of the proposed path forward.</div>
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<span lang="EN-US">_______________________________</span><br />
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<span lang="EN-US">Those of you who have read this piece may also be interested on this </span><a href="http://surgicalopinion.blogspot.com.au/2015/09/the-royal-australasian-college-of.html">subsequent piece</a> about elections to the RACS Council.<br />
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com1tag:blogger.com,1999:blog-6046871514976920545.post-49194855320131514252015-09-10T18:09:00.001+10:002015-09-11T06:51:04.003+10:00More on Crowd Funding<div style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">
Let’s say you need to fly from Sydney to London. You are a member of the frequent flyer program with Qantas. If possible, you’d like to fly with Qantas because you feel loyal to the brand. The problem arises in that you do not have the money to buy a ticket. You set up a public crowd funding appeal and you explain how your Nanna is sick and you really need to visit her because it might be the last time you ever see each other again. We all empathise and hope that you get some support. </div>
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Somebody then points out that for the particular dates you are flying, that you could could save a significant amount of money by flying a different airline of equal quality such as Cathay Pacific or Emirates. You decline to consider this because you’d prefer to fly Qantas. Your crowd funding campaign gets some publicity and both Singapore Airlines and Etihad hear about your plight and offer to fly you for free. You gracefully decline these offers as you have always been with Qantas. People will either wish to donate to your crowd funding campaign or they won’t. That’s fair enough. You are getting bit emotional and say your confused because you’re worried about your Nanna.</div>
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You are starting to get a few donations. What if your donors knew that you had turned down the option of flying a lower cost carrier? What if your donors knew that you had turned down offers to be flown for free? If they were to find out, would donors now look upon similar crowd funding exercises with cynicism. </div>
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So what is this all about? This piece needs to be considered in the context of this <a href="http://surgicalopinion.blogspot.com.au/2015/09/crowdfunding-for-prostate-cancer.html">previous blog piece</a> (click link to read) about crowd funding for prostate surgery. </div>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-46955756975820304792015-09-06T16:54:00.002+10:002015-09-10T23:53:43.272+10:00Crowdfunding for Prostate Cancer Surgery - Just Shouldn't Be Necessary in Australia.<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">It has always saddened me to see crowdfunding campaigns to raise money for individuals to undergo live saving surgery in the private hospital sector. Notoriously, we have seen campaigns for particular specialties and we could go further if we wanted, in specifying particular surgeons whose names come up repeatedly. I was grateful that this was not something that we tended to see in my specialty of prostate cancer surgery but I guess it was only a matter of time.</span><br />
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The reason why I have thought that this would only be a matter of time was the intense competition that we see for robotic radical prostatectomy cases amongst Australian based urologists. Do a Google search and you will see a plethora of robotic surgery marketing in Australia. The fancy websites will have surgeons boasting about their extraordinary achievements in becoming experts in this aspect of surgery in their quest to entice you to utilise their services. Often there is the line of ‘most', ‘first', ‘pioneer' and so on. I was the first to do a robotic surgery operation in my hospital - I say 'big deal'. There is also the goading of site visitors to seek out a second opinion with the subtle suggestion of an expectation that they will be in better hands if they do so. </div>
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There is also an issue of cost as the out of pocket expenses can be very high.</div>
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One reason why the out of expense costs can be high are the costs of consumables. The consumables are the throw away items associated with the use of the technology. It’s an amazing cash cow for the technology companies. Hospitals have to spend huge amounts of money to buy the instrumentation and then have to pay for the privilege to use the machines by virtue of expensive servicing contracts and disposables (consumables). Private health funds are not obliged to cover the costs of the consumables used in robotic surgery. Some funds will cover part or all of the consumables costs but if your health fund does not cover these costs, you could be up for as much as an additional $4000 out of pocket. The other reason for the huge out of pocket expenses is that some surgeons feel a sense of entitlement to charge what they think they are worth. In some instances, this out of pocket expense of what is above the amount that can be claimed back from Medicare or Private Health Insurance could be over $10,000. Robotic surgery is sexy and expensive. </div>
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Thankfully, robotic surgery is available to non-insured patients at Nepean Public Hospital. Most people would not be aware that this is the case. I personally have had no issue in referring patients to Nepean Hospital and stand on my record for doing so. There is however, no incentive for surgeons to notify patients who have financial difficulties that this service exists. My colleagues performing surgery at Nepean Hospital are well trained and very competent at what they do. It would be a brave prostate surgeon to claim and prove that they were significantly better than these surgeons.<br />
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<div>
I saw this appeal appear in my Facebook feed and not surprisingly caught my attention. I do not know the circumstances behind this case at all. I wish there was some way to tell him that he can receive ‘robotic keyhole surgery’ with a ‘top surgeon’ at the Nepean Public Hospital. He seeks to raise $35000 which suggests to me that he is either uninsured or his surgeon is charging an extraordinary surgical fee. Most surgeons (I would like to think), no matter how good they think they are, will try to help out with the surgical fee if the patient is experienceing financial difficulties. Once again, I do not know the details of this case but I am saddened see a case of where prostate cancer surgery costs necessitate a crowd funding campaign.</div>
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Note: This blog piece reflects circumstances specific to Australia and may have little relevance to circumstances elsewhere. In Australia, we have a public health system, which in spite of its many faults, will see that all can have access to necessary cancer treatment.<br />
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<br />
Update - see following <a href="http://surgicalopinion.blogspot.com.au/2015/09/more-on-crowd-funding.html">related blog piece (click link)</a></div>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com7tag:blogger.com,1999:blog-6046871514976920545.post-87531545343420455222015-06-06T00:38:00.000+10:002015-06-06T00:42:28.944+10:00Academic Dishonesty as a Medical Student - How Prevalent? What Does the Future Hold for Them?<div class="MsoNormal">
<span lang="EN-US">Earlier this evening, a media ‘exclusive’
was published in the <a href="http://www.smh.com.au/national/education/sydney-university-medical-students-invented-patients-for-assignments-20150605-ghgsy2">Sydney Morning Herald</a>. <span style="mso-spacerun: yes;"> </span>The article is about my own institution, The
University of Sydney.<span style="mso-spacerun: yes;"> </span>This was a huge
shock. This is the place where I was an undergraduate medical student and now
the place where I am an academic surgeon who is intimately involved in hands on
teaching of medical students.<o:p></o:p></span><br />
<span lang="EN-US"><br /></span>
<br />
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<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">The article makes the claim that students
have been cheating in their Integrated Population Medicine assignment. <span style="mso-spacerun: yes;"> </span>The first line of the article makes clear that
this was going to be unhappy reading. <o:p></o:p></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHTm5fFJTmd-w6DFxCwiGaD5ph0gg2aYSwBmBEavJ733EvLED7Jw0ckCYQ9ljX1vTl0LDjSqGAjj2eXevXM25kZ1HavWt2w5wQufM03_J5fiG8fH6OhgX5XZABAXFC07ePDcoZ0BOKP6j1/s1600/Screen+Shot+2015-06-06+at+12.28.46+am.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHTm5fFJTmd-w6DFxCwiGaD5ph0gg2aYSwBmBEavJ733EvLED7Jw0ckCYQ9ljX1vTl0LDjSqGAjj2eXevXM25kZ1HavWt2w5wQufM03_J5fiG8fH6OhgX5XZABAXFC07ePDcoZ0BOKP6j1/s320/Screen+Shot+2015-06-06+at+12.28.46+am.png" width="320" /></a></div>
<span lang="EN-US"><br /></span></div>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US">“Medical students at the University of
Sydney invented patients, falsified records and even
"interviewed" dead patients in a serious academic scandal
which has shocked the respected medical school.”<o:p></o:p></span></i></b></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US">Academic dishonesty does occur. No University
and within them, no faculty can be totally immune to this.<span style="mso-spacerun: yes;"> </span>However, in medicine, the
thought of anybody cheating would not cross the minds of many.<span style="mso-spacerun: yes;"> </span>There will in fact be some
element of denial as we think of ourselves as having ethical and moral behavior as part of our DNA and we also believe that none of us should
lack the intellectual capacity to pass an examinable task.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US">Do we really have exemplary moral and
ethical behavior that makes us stand out above the general population?<span style="mso-spacerun: yes;"> </span>I think that see enough to the contrary in
the press on an almost daily basis. It makes clear that we in the medical
profession have the same human failings as any other group.<span style="mso-spacerun: yes;"> </span>I do not need to bore you with the stories of
doctors rorting the public purse, goading patients into thinking that they need
cosmetic surgery, gross negligence in medical practice and more recently, the
uncovering of rampant sexism and bullying culture in specialty training.<span style="mso-spacerun: yes;"> </span>On the other hand, there are equally as many,
if not more, stories of amazing things that the medical profession is doing for
public health and individual patient care. The clear message is that in spite of the amazing things we can do, we </span>as medical students have the capability for academic dishonesty as anybody else.</div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US">However, why should we have a need for
academic dishonesty as a medical student?<span style="mso-spacerun: yes;">
</span>I am trying to get my head around this. <o:p></o:p></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US">The pass rates for various subjects or
assignments in the medical course are very high but this should not be
surprising because it is regularly those who have been high academic achievers
who gain entry into medical schools.<span style="mso-spacerun: yes;"> </span>It
is generally thought that if you can get into a medical course, then you should
be more than capable of passing the course.<span style="mso-spacerun: yes;">
</span>It has always been my view that if somebody ever failed a subject or
assignment in the medical course, that it was a reflection of total lack of
application or there being significant external distractions that have impacted upon attention
to their studies, rather than anything to do with intellectual ability. <span style="mso-spacerun: yes;"> </span>We are talking about less than 10% who might
fail on their first attempt and most of these students will get through on a
second attempt. Once again, there should be little need and therefore incentive
for a medical student to cheat on their examinable tasks. <o:p></o:p></span><br />
<span lang="EN-US"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US">The SMH article asserts that there is
<i><b>“proven wide spread academic dishonesty.”</b></i><span style="mso-spacerun: yes;">
</span>There is no citation or proof provided that this is the case. What
follows in the next sentence is that the University has acknowledged that there
have been three students who graduated last year who are under investigation
for academic misconduct. The article also states <b><i>“It is understood at
least 70 students from a class of more than 200 were involved.”</i></b><span style="mso-spacerun: yes;"><b><i> </i></b> </span>There is no attribution to any organization
or individual, even anonymously.<span style="mso-spacerun: yes;"> </span>If we
consider the class size as being say 350 students, this would suggest that we
have 20% of our students who are dishonest and this simply does not fit in with
my experience.<o:p></o:p></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span lang="EN-US">I have personally assisted students in
identifying or advising them of the suitability of certain patients who would
potentially volunteer to assist with their IPM assignment.<span style="mso-spacerun: yes;"> </span>As a result of significant hands on teaching
of medical students at my clinical school, I do get to know many of them quite
well and to suggest that 20% of them were dishonest simply does not stack
up.<span style="mso-spacerun: yes;"> </span>In the absence of attributing a
source whether anonymous or not, makes me suspicious about the validity of these
claims. I have asked the article journalist for a response through twitter and
hopefully she will respond to clarify these points. <o:p></o:p></span><br />
<span lang="EN-US"><br /></span>
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<span lang="EN-US"><br /></span>
<span lang="EN-US"><br /></span>
<span lang="EN-US">I am absolutely sure that academic
dishonesty does occur in my own faculty and in my own university but I am to be
convinced that it is widespread or highly prevalent.<span style="mso-spacerun: yes;"> </span>I have personally found the vast majority of
medical students that I have interacted with to be kind, personable, empathetic
and committed to one day doing the best for their patients.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">If academic dishonesty is occurring whilst
as a medical student, I do have concerns. If past behavior is to be the best
predictor of future behavior, we have every reason to be concerned if these
individuals were to be placed in a position where we count on their
honesty.<span style="mso-spacerun: yes;"> </span>Did they make up the blood test
result that I asked them about because they forgot to look it up?<span style="mso-spacerun: yes;"> </span>Did they tell me that the pedal pulses where
present even though they didn’t check them and took a gamble that they probably
would be?<span style="mso-spacerun: yes;"> </span>And one day when a patient
asks them as a specialist if they had spoken to the second opinion doctor as
they had promised but had not, the line has already been crossed.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<span lang="EN-US"><span style="mso-spacerun: yes;"><br /></span></span>
When I think of senior doctors who behaviour rattles me, I think back to their behaviour either as medical students or junior doctors and in highsight I realise that nothing has really changed. This is not to say that people are not capable of change but it worries me.<br />
<span lang="EN-US"><span style="mso-spacerun: yes;"><br /></span></span>
<span lang="EN-US"><span style="mso-spacerun: yes;"><br /></span></span>
<span lang="EN-US"><span style="mso-spacerun: yes;"><u>Related Articles</u></span></span><br />
<br />
<a href="http://surgicalopinion.blogspot.com.au/2015/05/bullying-culture-in-surgery-has-nothing.html">Bullying in Surgery</a><br />
<a href="http://surgicalopinion.blogspot.com.au/2015/05/cardiac-surgeons-were-once-untouchable.html">Bullying in CardioThoracic Surgery</a><br />
<a href="http://surgicalopinion.blogspot.com.au/2015/01/predatory-journals-academics-are-as.html">Academics Supporting Predatory Publishing</a><br />
<br />
<u>Disclosure</u><br />
<br />
Henry Woo is a medical graduate of the University of Sydney. He is a fractional salaried Associate Professor of Surgery of the Sydney Medical School of the University of Sydney.</div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com13tag:blogger.com,1999:blog-6046871514976920545.post-64496838785915075292015-05-29T11:58:00.000+10:002015-05-29T11:58:05.317+10:00Cardiac Surgeons Were Once Untouchable<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">About 30 years
ago, coronary artery bypass graft surgery (CABG) was the mainstay of treating
narrowed coronary arteries that supplied blood to the muscle of the heart.<span style="mso-spacerun: yes;"> </span>Such surgery was predominantly, if not all,
performed in the public hospital system where there were long waiting
lists.<span style="mso-spacerun: yes;"> </span>Demand outstripped supply of such
service and cardiologists were at the mercy of cardiothoracic surgeons who
could determine which of their patients they would accept for treatment and the
priority afforded to them.<span style="mso-spacerun: yes;"> </span>The CABG was
a genuinely life saving type of surgery and the high success of this surgery by
highly trained surgeons provided them with unparalleled status in the hospital
pecking order.<span style="mso-spacerun: yes;"> </span>The cardiac surgeons
received the adulation of the press and public for the life saving work that
they were performing and sure enough, they came to truly believe that they were
the heroes of the medical profession.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The behavior of
cardiac surgeons was one of self-entitlement and demand for unquestioned
respect and admiration.<span style="mso-spacerun: yes;"> </span>Whilst capable
of great empathy and care for their patients, they treated members of their
surgical team and own profession with disdain and at times unbelievable cruelty.
As providers of essential services that were in short supply and high demand,
hospital administrators would bow to unreasonable demands. They were
effectively untouchables. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Whilst there are
too many stories to mention, here a couple that I recall as vividly as if it
happened yesterday.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">When I was a junior
doctor, I had softly remarked that my nose was itchy under the theatre mask.
This was overheard by “sir” who then came up to me and squeezed my nose and
twisted and said “this will fix it” and went off laughing.<span style="mso-spacerun: yes;"> </span>The pain was excruciating and I quietly
slipped away outside the operating room pretending that it did not hurt at all.
My nose was bleeding.<span style="mso-spacerun: yes;"> </span>Once cleaned up, I
returned to the operating room and pretended that nothing had happened.<span style="mso-spacerun: yes;"> </span>I did not dare challenge him for this assault
and I also knew that nobody in the room would dare to support me for all of us
were afraid of him.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">My six months as
a surgical registrar to “sir” was a tough gig psychologically, The work itself
and at times long hours was never an issue but the constant barrage of abuse
was taxing.<span style="mso-spacerun: yes;"> </span>I was so ashamed of
admitting that it was getting to me that I recall not even discussing it with
my girlfriend of the time (who was also a junior doctor) or any friends as I felt
that I could not afford to demonstrate to anybody any sign of weakness or
potential inadequacy to make it through the rigors of surgical training. “Sir”
loved an audience and we would usually have up to twenty people in the
operating theatre to observe such as medical students and physiotherapy
students.<span style="mso-spacerun: yes;"> </span>He just adored the
physiotherapy students, particularly the attractive female ones who appeared to
get special attention and this was returned with blushing adulation.<span style="mso-spacerun: yes;"> </span>Not uncommonly, I would start closing up the
wound and he would go out to make a phone call. He would then return and yell
to the entire room <b><u>“Henry, you’re meant to be getting better, not worse”</u></b> and
would then storm out of the theatre.<span style="mso-spacerun: yes;"> </span>The
operating room would then be so quiet that you could hear a pin drop above the
noise of the anaesthetic monitoring devices. I could go on and on, but I made
it through.<span style="mso-spacerun: yes;"> </span>I survived.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">In later years I
had transferred training programs and went from being a general surgical
registrar to a urology registrar.<span style="mso-spacerun: yes;"> </span>At a
different hospital, I entered a service lift and the only other occupant was a
cardiac surgeon, a different “sir”.<span style="mso-spacerun: yes;"> </span>He
did not acknowledge me in any way but what did I care.<span style="mso-spacerun: yes;"> </span>The next floor, a wardsman entered the lift
and tripped over the lip of the elevator floor and bumped into “sir”.<span style="mso-spacerun: yes;"> </span>Yes, he committed the greatest possible crime
and touched “sir”.<span style="mso-spacerun: yes;"> </span>Over the next couple
of floors, “sir” proceeded to abuse him “how dare you blah blah blah …..” and
refusing to listen to his repeated attempts to apologise.<span style="mso-spacerun: yes;"> </span>The wardman was petrified that the surgeon
would lodge a complaint and that it would lead to his dismissal.<span style="mso-spacerun: yes;"> </span>I was so shocked that I stared in silence and
whilst he had little ability to impact on my future career, I was still too frozen
in fear to say anything.<span style="mso-spacerun: yes;"> </span>Immediately
after the event, I felt enormous guilt for having said nothing. For me it will
always be one of those moments that you remember where something could have and
should have been said.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">These stories are
pretty tame compared to others I have heard. The fortunes have changed
significantly for cardiac surgeons.<span style="mso-spacerun: yes;">
</span>Coronary stents are now used where surgery was once necessary.
Cardiologists control the flow of work to cardiac surgeons and can make or
break the success of their practices.<span style="mso-spacerun: yes;"> </span>I
have personally seen where a cardiac surgeon at a hospital I worked at was
completely starved of work to the extent that he had to take a salaried
position interstate.<span style="mso-spacerun: yes;"> </span>There was never an
issue with his clinical judgment and technical skills but with a totally
obnoxious personality from the cardiac surgeon old school, his private practice
disappeared in favour of other surgeons who were prepared to be more
personable.<span style="mso-spacerun: yes;"> </span>Cardiac surgeons can no
longer be seen to be self entitled poisonous individuals.<span style="mso-spacerun: yes;"> </span>Everybody knows that cardiologists are the
masters of cardiac surgeons and what huge fall it has been from the top of the
ivory tower. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Having said all
that is above, I have great respect for my cardiac surgery colleagues. Their professionalism
and care for my own family members who have needed their skills will always be
appreciated.<span style="mso-spacerun: yes;"> </span>I really believe I have
seen the worst and now best that these surgeons can offer. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">At least in this
surgical specialty of cardiac surgery, technology and medical advances have had
a positive affect on surgeon behavior.<span style="mso-spacerun: yes;"> </span></span><span lang="EN-US"><o:p></o:p></span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com21tag:blogger.com,1999:blog-6046871514976920545.post-53485056634898684302015-05-27T07:59:00.001+10:002015-05-27T14:23:41.665+10:00Bullying Culture in Surgery - Has Nothing Changed?<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The airing of the
Four Corners report on an entrenched culture of bullying of surgical trainees
and medical students has for the very first time pushed this matter into
the public spotlight.<span style="mso-spacerun: yes;"> </span>The obvious reason for the
suppression of this ugly behavior is the enormous power imbalance that exists
between perpetrators and victims.<span style="mso-spacerun: yes;"> </span>Medical
students, and particularly surgical trainees, are unwilling to come forward as
their career progression is totally at the mercy of those who have significant
influence over the results of their progress reports.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">I hear the
argument from a number of my colleagues who say that everybody is getting too
soft and that they dread the ability of these ‘mollycoddled children’ to handle the stress of dealing with catastrophic bleeding at 3 am in the
morning. I totally reject this assertion as justification that an intimidating
bullying culture has a role to play.<span style="mso-spacerun: yes;"> </span>I am not
aware of any evidence that a non-confrontational approach to training will impacts upon the ability to perform following
the completion of training.<span style="mso-spacerun: yes;"> </span>When we look
at the commercial airline industry, it is the meticulous training that prepares
pilots for a variety of catastrophic events.<span style="mso-spacerun: yes;">
</span>Being yelled at, publicly humiliated and often being left wondering what
it was that was done wrong (because one could not dare ask what it was that was
done wrong as one should know) is not training.<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;"><b>It is bullying
and harassment and nothing more</b>. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">I was on the receiving end of bullying during my training, particular at the hands of a cardiac
surgeon, well before I started training in urological surgery. At that time I felt that he had total and absolute control over my career. However, it was far more often that I
observed my junior colleagues being on the receiving end abuse and harassement. What
worries me is that many of my
colleagues who were bullied and harassed as junior doctors, do not reflect back
as this having been the case.<span style="mso-spacerun: yes;"> </span>This is
how the cycle of bullying continues. Their interpretation of bullying has been
reset by their experience to become a norm of surgical training. They too go on to repeat the behavior experienced
during their formative years as surgeons.<span style="mso-spacerun: yes;">
</span>The words of Dr Vyom Sharma are chilling but demonstrate great clarity
in the problems we face: – <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;"><b>"In one
moment I could just see how this all happens. Someone bullied him, he bullied
someone else, and now it's my turn." </b><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">The stories on
Four Corners make me worry and wonder if it really could be a case of where
“Nothing has changed”.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;">Maybe I should provide some
context of how things were different when I was training.<span style="mso-spacerun: yes;"> </span>I was absolutely everything that was atypical
and confrontational to the surgical establishment when I wished to undertake
surgery as a career in the late 1980's.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: Arial;"><b>I was Asian, went
to a public high school and at that time, hated rugby.</b><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<span lang="EN-US" style="font-family: Arial;">I was definitely
not “one of the boys”. Tearoom discussions were often lonely as I had no
ability or real interest to discuss the results of the last weekends’ private
school rugby game or who should play fly half for the upcoming Bledisloe Cup. <span style="mso-spacerun: yes;"> </span>Apart from clinical matters, I had very little
in common with my surgical seniors.<span style="mso-spacerun: yes;"> </span>My
colleagues who fitted the perfect surgical role model would regularly get the
pat on the back for being a ‘good bloke’ and were rewarded with more opportunities to try their hand at surgery. The diversity of surgical trainees
and subsequently trained surgeons has changed enormous since then due to
surgical training programs being taken out of the hands of individual hospitals
and therefore the hands of a very few powerful individuals.<span style="mso-spacerun: yes;"> Centralised selection for surgical training was a very positive step forward although for general surgery it was introduced after my time. </span>I remember having little support base as none of the surgeons
were really my ‘mates’ but I was fortunate to have sufficient numbers of
surgeons who saw that I had talent and were prepared to put their
reputations on the line to help me achieve my career aim.<span style="mso-spacerun: yes;"> </span>I always remember this as a reminder that
there was also a lot of good in many of the surgeons who mentored me as a junior doctor
and it was not all bad.<o:p></o:p></span><br />
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;">*****</span><br />
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;"><br /></span>
<span lang="EN-US" style="font-family: Arial;">(Note for those outside of Sydney - back in the 1980's Rubgy Union was a game that was almost exclusively played in elite private schools. Public schools and non-elite private schools tended to play Rugby League. Back then, the vast vast majority of surgeons had been educated in the private school system apart from a handful from exclusive selective public schools)</span></div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com8tag:blogger.com,1999:blog-6046871514976920545.post-72993592101341510312015-04-16T19:40:00.000+10:002015-04-16T19:49:44.929+10:00Robert H. Farnsworth - my hero in urology<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">At the Gala Dinner of the Urological Society of Australia and New Zealand (USANZ) Annual Scientific Meeting on 13 April 2015, a special man was the recipient of the Society Medal (USANZ Medal). </span><br />
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">Robert Farnsworth's achievements are well known within my profession. </span><br />
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;">The next few tweets sum up my thoughts</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOE3ssAHTa5hsTUJXFmJr4kSxDDO_W0Xc9xIiElD7xgGRDYAIzi5srrwFe8S5BxBMTAPuFve53PdnnOEhSNajoh0RE0ziiS1BMN4XVZQ1rYnnLfkHojqQjB-CzU83s5LKQma2-soxbcK6/s1600/Screen+Shot+2015-04-16+at+7.29.04+pm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUOE3ssAHTa5hsTUJXFmJr4kSxDDO_W0Xc9xIiElD7xgGRDYAIzi5srrwFe8S5BxBMTAPuFve53PdnnOEhSNajoh0RE0ziiS1BMN4XVZQ1rYnnLfkHojqQjB-CzU83s5LKQma2-soxbcK6/s1600/Screen+Shot+2015-04-16+at+7.29.04+pm.png" height="203" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnA-ehiRwLUqu0UUlSXReG7dpvyjMb6NpWKcX0Fcxqo0bRNgUdM-_6aCJeYR5rPpZzaRHIfNO7IkulpJgjM4TEbhfDRHdP7M3jOHSRIy8nMQlEkDp_WEzyLdbaJWo8Tlrdbed7xb8dApDQ/s1600/Screen+Shot+2015-04-16+at+7.28.10+pm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnA-ehiRwLUqu0UUlSXReG7dpvyjMb6NpWKcX0Fcxqo0bRNgUdM-_6aCJeYR5rPpZzaRHIfNO7IkulpJgjM4TEbhfDRHdP7M3jOHSRIy8nMQlEkDp_WEzyLdbaJWo8Tlrdbed7xb8dApDQ/s1600/Screen+Shot+2015-04-16+at+7.28.10+pm.png" height="246" width="320" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_VWiGyRJwfEHGB3PjgBOGP4jucS_GnswgeHDL5zE6ADklj0NYU0IroZriKcvQO2PCXrs78WsgW9XU1kxb9LP0sqaBBW5BOBI7IRNm2p4jZAKzxcba9rj7RXwTBqgckYqrHhHyqQzpTmsC/s1600/Screen+Shot+2015-04-16+at+7.28.33+pm.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_VWiGyRJwfEHGB3PjgBOGP4jucS_GnswgeHDL5zE6ADklj0NYU0IroZriKcvQO2PCXrs78WsgW9XU1kxb9LP0sqaBBW5BOBI7IRNm2p4jZAKzxcba9rj7RXwTBqgckYqrHhHyqQzpTmsC/s1600/Screen+Shot+2015-04-16+at+7.28.33+pm.png" height="184" width="320" /></a></div>
<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">I was in my final year of urology training when I worked for Bob. Just some of the things that I recalled from my time with him included</span></span><br />
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;"><br /></span></span>
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">1. treating everybody with equal kindness and respect, whether a janitor or internationally acclaimed professor</span></span><br />
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">2. never ever making me feel bad when there was something that I could have done better</span></span><br />
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">3. always having time for me, even for what in hindsight were trivial matters (even if this meant him going home later than planned)</span></span><br />
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<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">When I returned from additional training abroad, I entered independent practice and there were a number of occasions that I would call him for clinical advice. Even though I was now his competitor, he continued to be so willing to share his wisdom.</span></span><br />
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;"><br /></span></span>
<span style="font-family: -apple-system-font;"><span style="font-size: 12px; line-height: 16px;">It was a proud moment for all of us who have had the privelege of training under him to see him awarded the USANZ medal. He's the closest you get to a Mr Holland (as per the movie Mr Holland's Opus) that would be possible in the Sydney urology scence. </span></span><br />
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<span style="font-family: -apple-system-font; font-size: 12px; line-height: 16px;"><br /></span>Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-82905518975804298032015-04-01T22:41:00.001+11:002015-04-01T22:42:16.598+11:00If something happens to me, will I have done enough to enable a colleague to continue the care of my patient with newly diagnosed prostate cancer?<span style="font-family: Helvetica; font-size: 13px;">As an academic surgeon, I probably get to see more second opinion cases than for most in my field. My university association and digital footprint probably tends to attract these cases although I make absolutely no effort or attempt to attract these consultations. Of course there are some that arise as a result of contact with patients I have previously treated. One thing for sure is that I do not send letters out to GPs asking them to consider asking their prostate cancer patients to switch specialists. Likewise, I do not have second opinion forms on my website goading readers to switch specialists. Maybe I am totally deluded into thinking that I see more second opinion cases and that my load of such is exactly the same as everybody else. </span><br />
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Many of these consultations are for those recently diagnosed with prostate cancer. Recently, I saw a man who had undergone transperineal prostate biopsies and had been diagnosed with prostate cancer. Transperineal prostate biopsies are where the sampling needles traverse the skin of the perineum (patch of skin between the anus and the scrotum) rather than going through the rectal wall with so called transrectal ultrasound guided prostate biopsies. </div>
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The samples were labelled A1 through to A8 and B1 through to B8. There was no anatomical indicator as to where these biopsies were taken from within the prostate. To make an intelligent guess, it might be that A represents apex of the prostate gland and B represents the base of the gland but who knows other than the original surgeon doing the biopsies. There was an additional sample which was called the targeted biopsy. This would have meant nothing except for the fact that there was an MRI scan of the prostate that had indicated that there was a tumour suspicious lesion towards the centre of the gland (left transition zone to be more precise). </div>
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It was the cancer in the targeted sample that demonstrated that there was cancer that needed treating. There was also a tiny speck of cancer in one the ‘A' samples but it was low grade and probably clinically insignificant - in other words, one that could be ignored. In this situation, knowing what the A and B samples came from was academic. I knew that the cancer was in the middle of the gland and that this patient would likely do very well with so called nerve sparing radical prostatectomy. </div>
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This case did get me thinking. All sorts of questions were running through my head. What if there were clinically significant cancer deposits in the A or B sets of biopsies? I would have no idea as to where they were. The naming of these samples was not standard nomenclature but rather a special code used by the surgeon who took those biopsies. I could always write to him if I need to know to plan surgery and therefore avoid having to put a patient through another biopsy to map the cancer. What if the surgeon was not willing or obstructive because he was ‘losing’ a patient? Was this some ploy to make it harder for the patient to switch surgeons? What if something were to ever happen to the surgeon - we are mere mortals and not the demigods that some surgeons think of as themselves. If another surgeon were to have to take over the care of that patient in the event that the original surgeon became serious ill or were to become deceased, access to this ‘secret code’ of labelled specimens could be an issue. I have no answers to these thoughts but I am clear on what I do in my own practice. </div>
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I always label my prostate biopsy specimens in a way so it is crystal clear as to where they have come from. If something were to ever happen to me, I could feel assured that a colleague would be in a position to take over the care of my patient. I think that this is a minimum standard of care but there seems to be no appetite to make change. </div>
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Why won’t pathologists push their referring urologists to be more diligent in writing better clinical details or appropriately label the specimens? In Australia, the vast majority of prostate cancer are treated in the private sector. In a competitive pathology environment, no pathology provider would be comfortable about demanding improved clinical documentation and labelling of pathology specimens from referrers in whom they depend on for their work. How do you think we can drive change? I certainly have my ideas but I would like to hear yours.</div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-20286988105626675872015-03-20T14:04:00.004+11:002015-03-20T14:07:32.695+11:00Poaching staff is not the done thing. Or is it?<span style="font-family: Helvetica; font-size: 13px;">It takes a lot of effort to train up a surgical assistant, particularly with complex surgery. Surgeons who have been involved in this process will by virtue of human nature and tradition of self entitlement, feel some sense of ownership for the person that they trained and the expectation of some loyalty. I am not saying that this is a correct way of thinking but it is human nature. </span><br />
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Over the past week, two of my surgical assistants were approached by a colleague in my specialty who attempted to entice them away with significantly greater remuneration. The initial reflex response was "How dare he?" and “This is totally non-collegiate”. Both of them had no interest in changing surgeons but had rightly done their own due diligence to learn more about the surgeon making the offer. They had both come to their own conclusions on the basis of feedback that they would prefer not to work elsewhere in spite of the higher remuneration. </div>
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Initially I felt a little irritated but this was very quickly followed by the rationalisation that we have an open business market in Australia and this type of activity is fair game. Whilst surgery is associated with a special relationship that the defines the patient-doctor relationship, there is a business side to it that is no different to any other business. For example, Virgin Australia is free to approach key Qantas staff that it may wish to headhunt for a role in its own organisation. Even though Qantas may have been invested enormously in training a given individual, they have no ownership of that person’s career destiny. </div>
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Whilst the behaviour of headhunting staff is nothing unusual outside the medical profession, we have to learn to adapt to the fact that we are subject to same market forces and expectations as any other business. The old boys club approach to how we do our business does not cut it anymore. This is no different to how the medical profession must be expected to deal with issues of sexism and harassment like any other profession with the same transparency and commitment. Time to get to down from the ivory tower. </div>
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-26077108544334884992015-03-13T17:35:00.002+11:002015-03-14T11:28:50.598+11:00It Was All My Fault That a Patient Died.<h2>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">Back in the late 1980’s, I was working as a junior general surgical registrar. In such a role, I was allowed to perform minor surgery, often unsupervised. Back then, general surgeons were commonly performing carpal tunnel release surgery although nowadays, they are performed predominantly by specialist hand surgeons. I operated on a man who had bilateral <a href="http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome.">Carpal Tunnel Syndrome</a>. The surgery was performed under a local anaesthetic block which means that his arm was made numb and he was able to be awake for the duration of this short case. I operated on one side. All went well. About three months earlier, he had been operated on the other side by one of colleagues (who was at the same level of training as myself).</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">Totally unbeknown to me was the fact that an intern had ordered pre-operative blood tests, an electrocardiogram and chest X-Ray in the week prior to the surgery. These tests in an otherwise well man with no co-morbidity and having a procedure under a local anaesthetic block is unnecessary. I was to learn that this was the case about 8 or so months after performing the surgery and by this time, I was working rotation at a secondment hospital.<br />I was one of two carbon copied doctors on a letter that had been written by a cancer surgeon. The other cc doctor was a respiratory physician. </span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">The surgeon described the history that had led to the presentation by this patient with symptoms. He wrote “somebody had operated on this patient and not checked his CXR which at that time showed an obvious coin lesion in the lung”. It was intimated that the patient could have been cured of cancer if diagnosed at that time had the CXR result had been checked at the time. It was very obvious that he was apportioning blame on me for not checking the result of a test that I had not even known or should have expected to have been performed. It was interesting that the same unnecessary work up had been performed for the patients first carpal tunnel operation a few months earlier. I could see exactly how this would have happened on the second occasion where an bewildered intern just followed what was done on the previous occasion.</span></h2>
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<tr><td class="tr-caption" style="text-align: center;">http://grammar.about.com/od/ab/g/Bad-News-Message.htm</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif;">I was devastated to receive this letter. I did not dare communicate with the surgeon to explain my case as I truly believed at that time, any disagreement with the surgeon would be the end of surgical career. Over the next 18 months, I continued to be copied in on correspondence outlining the patient’s demise in spite of curative attempts and ultimate death. Every time I received these letters, I would fall into depths of depression for several days but I would always develop a mechanism to cope. When the letters arrived, dread would fill my face before opening the envelope as I always knew what lay within. I would go to a room by myself and read it again and again and again. I looked at it as being my problem and could not feel I could raise it with anybody, including my partner at the time or my surgeon mentors. He had amassed incredible power in surgical politics and was not one to be reckoned with. I was totally and absolutely petrified of him.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">Periodically I would think of this case and it was not until some 15 years after the event that I would seek closure. This matter had ruminated in my head like a festering sore. This process began went I was invited to a 50th birthday party and at dinner happened to be seated next to the respiratory physician who was involved in the case. I found myself opening up to him about this story that I had kept locked away for so many years. It was quite liberating to be able to speak about it for the first time. It was amazing that he seemed to remember the case. The physician was less than complimentary about this surgeon's general behaviour over many years that had been characterised by bullying, narcism and arrogance.</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">I had copies of the letters and selected additional clinical information and certainly more than enough evidence for commencement a bullying claim. I had already briefed a high profile lawyer who was eager to take the case, Given the particular high profile of the individual and what she considered to be unjust treatment, she was prepared to commence this case without any cost to me. I reflected and asked her to allow me do one last thing before commencing litigation.</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">I took the step of writing to the surgeon who at this stage was a national figure. He was big fish to fry if I were to take the matter further. He wrote a meticulously neat hand written letter to me explaining that he regrettably had no recollection of the matter and wished that I had been able to raise the matter with him at the time. The final paragraph was repeated unreserved apology.</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">Whether the apology was disingenuous or not, I felt that I had got this matter off my chest and he was now aware of what I had experienced as a result of his actions. The act of opening up about this case and to then communicate my story to the perpetrator was extraordinarily liberating to me and to the extent that I had lost energy to commence litigation that was destined to make the press. </span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">I destroyed the documents. The matter was over from my perspective. The chapter was closed. I did not think about this story again until the recent media coverage of harassment in the medical workplace. I have my blog and here is my story. Do you have a story to tell?</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;"><br />Click below for:-</span></h2>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;"><a href="http://surgicalopinion.blogspot.com.au/2015/03/feeling-like-you-have-no-control-over.html">Background to my relationship with the surgeon discussed is covered in the short piece that precedes this post.</a></span></h2>
<br />Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-52646600808673303152015-03-13T17:30:00.001+11:002015-03-14T00:31:41.914+11:00Feeling Like You Have No Control Over Your Destiny<div style="font-family: Helvetica; font-size: 13px;">
This very short blog piece serves as some background information for the next piece.</div>
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When I was a surgeon in training, there was obvious rivalry between two members of the unit. If one of the pair liked you, your time with the other was going to be challenging if not miserable. It wasn’t necessarily vice versa because you could always be facing the wrath of both with the result of saying goodbye to your surgical career. You did not have a choice. It was like the sorting hat in Harry Potter that chooses your house. </div>
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The surgeon who did not take a shine to me was often critical and certainly made little effort to engage with me about matters unrelated to surgery. This did not worry me so much for the fact that I was in constant fear of having my career axed if I put a step out of place. I was not one of the "boys" - I was from an ethnic background, went to a public school and had no interest at that time in rugby union. I was everything that establishment surgery was not. My colleague mentioned in my next blog piece was one of the "boys" and went on to socialise with him outside the work setting.</div>
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He enjoyed having an audience in his operating room. Typically there would be 12 to 15 people and depending upon the week it might be other doctors, nursing students or physiotherapy students. On one occasion, he left me to close the wound so he could step out to make some phone calls. When I reached the skin closure, he came back into the room and yelled at me "Gee Henry, you're meant to be getting better, not worse" and stormed out of the room. For that moment, it felt like there were 100 people in the room. I was totally and absolutely humiliated. </div>
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This was the most stressful period of surgical training.<br />
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Related Blog Piece - click below<br />
<a href="http://surgicalopinion.blogspot.com.au/2015/03/it-was-all-my-fault-that-patient-died.html">It was all my fault that a patient died</a><br />
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Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com0tag:blogger.com,1999:blog-6046871514976920545.post-28803246938664318702015-03-01T18:33:00.000+11:002015-03-01T18:37:28.934+11:00How Cancer Spreads.<div style="font-family: Helvetica; font-size: 13px;">
Think of London as an overcrowded uncontrolled population of humans. Humans are like the cells that make up a cancer. Think of London as a primary cancer. I think of it as being an aggressive prostate cancer that wishes to progress but it could be any type of cancer. During the 1700’s and 1800’s, boats set sail across the oceans to find new lands to conquer. Initially, the journey provided many hazards to prevent these boats reaching their destination just in the same way that our blood stream and lymphatic channels have defences that destroy cancer cells as they enter into the circulation. Over time, new skills were acquired such as better boats, better sailing practices and the ability to fight journey related diseases such as scurvy. In a similar way, cancer cells entering into the circulation develop new skills to overcome the defence mechanisms in the circulation by mutations and are eventually able to reach their destination afar. </div>
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Once the boats reached their destination, Sydney in Australia being a perfect example, there were local challenges to be overcome in order to survive and grow. These included food and water supply as well as battling a hostile indigenous population. This is a similar situation to when cancer cells attempt to implant at a place distant to their primary location after surviving and travelling throughout the circulation. When prostate cancer arrives in bone, the immediate instinct of bone is to mount an attack against the foreign invaders. In a similar way to acquiring the skills to survive and travel through the circulation, the cells must now acquire the skills to overcome the local host defence mechanisms. When this occurs, the cells are able to set up a colony and expand and gradually consume the host organ as they had done to the primary organ. </div>
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When we look at the population of humans under the microscope during the period of British colonisation, the humans in London look the same as in Sydney. When we look at cancer cells from the primary and compare them to the ones seen in the secondary or metastasis, they likewise look the same. </div>
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To recap the British colonisation model for metastasis, London is the primary cancer, the oceans the circulation, and Sydney a secondary cancer or in other words a metastasis of London. </div>
Henry Woohttp://www.blogger.com/profile/10824214593614312990noreply@blogger.com2