If There Is One Area Where Experience Really Counts It Is Obstetrics!

If there is one type of medical emergency that always really scared me it was obstetric emergencies!

If things go pear – shaped, having an expert with 20+ years of obstetric experience is really vital to get the best outcome consistently.

With 2 people at risk I always found these emergencies a huge worry and nothing could relax like the presence of a grey-haired obstetrician who was there to help and had seen it all before!

Calls grow for urgent fix to private birthing crisis

The shutdown of private birthing units is set to blow the national health budget, with new modelling showing the decline of private births could cost taxpayers an extra $1bn a year.

Natasha Robinson

8:30PM April 13, 2025.

The shutdown of private birthing units is set to blow the national health budget unless there is an urgent fix, with new economic modelling showing that even on relatively conservative estimates, the decline of private births could cost taxpayers an extra $1bn a year.

The extraordinary figure would wipe out a large chunk of the extra money the commonwealth and states are set to pour into public hospitals in coming years, with many thousands of women left with little option but to rely on public hospital antenatal clinics and to give birth in public labour wards.

Economic analysis of birthing trends by Monash University professor Emily Callander presented at a recent medical forum shows that if a 50 per cent decline in births in the private system were to eventuate – a not unrealistic estimate – then taxpayers would subsidise public system antenatal care and labour ward delivery to the tune of $1bn annually. The costs are amplified because the analysis also revealed that birthing in the more efficient private system, which is partly paid for by private health insurance premiums, costs taxpayers less than if women gave birth in a public hospital.

Eighteen birth units have closed in private hospitals in Australia over the past seven years, about 10 of them in the past three to four years.

“A decline in private births means that there is of course an increase in public births,” Professor Callander told the recent Australian Birth Forum hosted by the National Association of Specialist Obstetricians and Gynaecologists. “This has a very important impact upon the costs to public funders.”

The upcoming analysis, which is pending publication in a major scientific journal, arose from analysis of a large dataset of 350,000 births between 2016 and 2019. The data was rigorously adjusted to account for clinical factors, socio-economic status and other variables so the births could be compared like for like.

Professor Callander, the only economist in the country specialising in women’s and children’s health, has presented high-level results at scientific meetings over the past year from her research with Monash University colleague Professor Helena Teede that indicates birthing is significantly safer for women and babies under the continuous care of obstetricians in private hospitals, and at a cheaper overall cost. 

The reason that like births are cheaper in the private system irrespective of consumers footing out-of-pocket costs and insurers subsidising care is likely that care is more efficient in the private system with greater continuity, and that intervention is planned and more commonly avoids adverse outcomes. It also seems that public hospitals are much less likely to count costs when it comes to birth whereas private hospitals are under financial pressures and control costs well.

Importantly, the cost of managing complications such as massive haemorrhages or baby resuscitation is greater in public hospitals because these complications are much more common. Litigation relating to catastrophic events is on the rise against public hospitals.

Professor Callander said if the nation were to see a 10 per cent total decline in private birthing units, the net cost impact would result in public hospital funders tipping in an extra $189m per year. If there were a 30 per cent decline, taxpayers would foot a $380m bill. If there were a 50 per cent decline, public hospital costs would soar to just shy of a $1bn increase per year, increasing to $1.5bn if private birthing became extinct in Australia.

That was exactly the prediction delivered in a paper published in the Medical Journal of Australia last year that examined Australia’s declining fertility rates and public and private birthing trends. The paper posited that private birthing would be extinct in Australia by 2030.

The Australian’s medical columnist, Stephen Robson, an obstetrician and professor of medicine at ANU, undertook the economic analysis. A co-author of that paper, Catholic Healthcare Australia director of health policy Katharine Bassett, said the Callander research bolstered the case for an urgent fix to Australia’s declining private birthrates and escalating private birth unit shutdowns. CHA is in a unique position to comment as it runs both private and public hospitals.

“This latest research shows the collapse of private maternity services isn’t just a crisis for families – it’s a major blow to taxpayers,” Dr Bassett said. “Public hospitals, which are already stretched beyond capacity, simply do not have the capacity to take on this additional burden.

“Private hospitals deliver high-quality, efficient maternity care and give women real choice, but right now they’re being asked to deliver that care at a loss. CHA is calling for a national private price to ensure insurer funding reflects the true cost of delivering safe, sustainable maternity services.

“Every private birthing unit that closes isn’t just a loss for one community – it triggers a ripple effect across the entire health system, increasing pressure on public hospitals and driving up costs for everyone.”

Dr Nisha Khot, president of the Royal Australia and New Zealand College of Obstetricians and Gynaecologists, at the weekend described private birth units shutdowns as “the canary in the coalmine” for what might lie ahead as pressures on public hospitals increase.

Former health minister Greg Hunt, now an honorary Melbourne enterprise professor at the University of Melbourne, has put forward a five-point plan to address the crisis, including national laws on maternity and birth, changes to the private health insurance tier system and risk equalisation pool.

Private Healthcare Australia CEO Rachel David said insurers were also extremely concerned about the viability of private maternity services, and were working with the commonwealth on policy ideas to address the crisis. PHA is pointing to scope of practice changes in a recent commonwealth review and wants obstetricians, midwives and GPs to lead shared care maternity models in the private hospital system.

“The current decline of private maternity care is driven by a range of factors including out-of-pocket fees to see an obstetrician during pregnancy, which is a cost health funds are not legally permitted to cover,” Dr David said. “Chronic workforce shortages across the country, the cost-of-living crisis and the declining fertility rate are also adding to the burden.

“Health funds are also concerned about the high cost of gold health insurance to access maternity care. Gold cover is becoming too expensive for some people, including younger people wanting to start a family.

“We want more flexibility than the current tiering system allows, so we can tailor products to people wanting maternity cover without other expensive inclusions typically used by older people.

“Confining the most expensive medical treatments to the gold tier attracts people who know they are going to claim. This creates a high-risk pool where the cost of care compounds and rises quickly. This is often unsustainable for health funds.

“We look forward to working with health professionals, hospitals and governments to discuss this proposal and refine it, so we can find a way forward.”

Natasha Robinson and Steve Robson have declared a personal relationship.

Here is the link:

https://www.theaustralian.com.au/health/calls-grow-for-urgent-fix-to-private-birthing-crisis/news-story/8c4def7fb03db853ee1d2e9310479b18

Sadly obstetrics is an awful job – broken sleep, multiple risks and continuous medico-legal threat – and so it is a young man’s game! Many get really good at it, and just as they do, they decide to go for the quiet life! Of course, happy mums and babies are the reward!

So fixing this crisis, even with the rewards,  is going to be no easy task I reckon!

This issue might be a use-case for expert tele-medical support, but it would take some organization, and you still often need expert physical intervention.

The issue is that when things go wrong, finding the skills needed quicky to cope can be pretty tricky!

I suspect this is never going to be an easy one to fix!

David.

I Suspect Apple Did Not Really Know What They Had When They Introduced The Apple Watch!

This appeared last week:

The Australian buyers who say Apple Watch saved their lives as device celebrates 10th birthday

Jared Lynch

Byron Bay's Rick Shearman says his Apple Watch saved his life after he was swept out to sea.

27 April, 2024

A group of Australians say they are still alive thanks to Apple Watch, as the world’s top selling smartwatch marks its 10th anniversary.

Steve Jobs’ right-hand design man, Jony Ive, envisaged Apple Watch as an iPod-type device that could be worn on a wrist. But it has evolved into much more.

For Apple it represents its leap into the lucrative health monitoring market. While its AirPods Pro 2 earbuds can perform hearing tests, its watches can now detect atrial fibrillation, sleep apnoea, monitor audio levels and more. It can even automatically call an ambulance and alert a family member or friend – even if the user is unconscious and doesn’t have a phone.

Apple now dominates the $US32.05bn smartwatch market, with about a 30 per cent share, according to Statista.

This compares with its next biggest competitor Samsung at 10.1 per cent, with China’s Huawei coming third at 6.9 per cent.

So we take a look at its 10 top features and how the Apple Watch has managed to dominate the market.

Emergency SOS

Byron Bay’s Rick Shearman says he owes his life to his smart watch. Last July, he was swept 1.6km out to sea but called out emergency services using the SOS function on his Apple Watch Ultra.

Despite the swell tossing Shearman around, the Westpac Lifesaver Rescue Helicopter was able to pinpoint his exact location using the watch’s in-built GPS.

He was able to speak to emergency services via the watch’s speaker, which helped him keep calm until he was winched to safety.

Ambulance services don’t have data on how many Australians are using the device’s SOS function, nor were they able to comment about how it was assisting paramedics by feeding them precise GPS coordinates (Apple introduced in-built GPS in the Series 2 watch in 2016).

But other Australians say they would not be still alive without the watch’s “hidden features”.

Heart health

Lexie Northcott, from southwest Victoria, received an Apple Watch on her 16th birthday in 2019, but in the first year of use the device kept lighting up with low heart rate notifications.

Lexie Northcott’s Apple Watch detected low heart rates for about a year. She was later diagnosed with a life-threatening heart block.

“I’d just ignore it,” Ms Northcott said.

Dismissing it because she believed herself to be young and fit, Ms Northcott did not even mention it to a doctor until she needed treatment for a rash on her neck. But her mother Karla Northcott said they needed to push for an ECG.

It transpired Ms Northcote had a heart block – a condition where the electrical signals of your heart don’t conduct properly. She later saw a specialist in Melbourne and had a pacemaker fitted and is now back to exercising.’

Lexie Northcott’s Apple Watch detected low heart rates for about a year. An ECG revealed a heart block requiring a pacemaker to be fitted.

Fall detection

Six weeks after receiving an Apple Watch for his birthday in 2021, Bruce Mildenhall went on a cycle ride in Victoria’s Macedon Ranges, and he was glad he took his device with him.

He was knocked off his bike by a kangaroo. Despite his mind going blank, his watch automatically called an ambulance and alerted his wife.

Bruce Mildenhall owes his life to his Apple Watch, which automatically called an ambulance after a kangaroo knocked him of his bike.

“It was fairly explicit,” Mr Mildenhall said about the message the watch sent to his wife.

“It said ‘Bruce has had a hard fall, hasn’t responded, this is where he is’.

“There was this bang, bang bang on the side of the ambulance and they put the window down and she said ‘You got Bruce Mildenhall in there and is he alive?’”

A good night’s sleep

Apple introduced sleep apnoea detection on its latest series of watches last September. The function is yet to be approved in Australia but represents the device’s future.

ASX-listed medical device maker ResMed has already endorsed it, saying it will help more people from “suffocating in their sleep”.

Sumbul Desai, vice-president of health at Apple, said if left untreated, sleep apnoea can have “significant consequences”, including increased risk of hypertension, type 2 diabetes and cardiac issues.

“(It is) a major health condition that impacts over a billion people worldwide,” Dr Desai said.

“But one of the biggest challenges is that 80 per cent of people with sleep apnoea are undiagnosed, so they don’t know they have the condition to detect sleep apnoea.”

Lord of the rings

Apple Watch is celebrating its 10th anniversary.

Part of wearing a smart device is positive reinforcement, after all, you want to feel good about wearing it. And Apple does this with its activity rings.

There are three: representing move, exercise and stand. A user can select their goals for each and there is an element of satisfaction when you close them all.

The rings have become that popular that last week Apple offered a limited edition award to those who managed to close all their rings in one day. all Apple Watch users are encouraged to close their Activity rings to earn a special Global Close Your Rings Day limited-edition award, along with animated stickers for Messages.

There’s a method to Apple’s madness. It says people who closed their rings regularly were 48 per cent less likely to experience poor sleep quality — defined as waking up frequently during the night — and 73 per cent less likely to experience elevated resting heart rate levels compared with infrequent ring closers.

Apple said they were also 57 per cent less likely to report elevated stress, as measured by the Perceived Stress Scale-4, a four-item questionnaire designed to assess an individual’s perception of their stress levels.

Australia’s bonus feature

Apple Watch users in Australia can access one feature that Americans can’t: blood oxygen measurements. This was introduced in the series 6 in 2020.

A blood oxygen level represents the percentage of oxygen your red blood cells carry from your lungs to the rest of your body. Knowing how well your blood performs this vital task can help you understand your overall wellness.

But Apple pulled the feature in the US as part of a patent feud with company Masimo over its blood oxygen feature. The ban did not affected Australian sales.

Loud and clear

In its series 10 watches, Apple allowed users the ability to play music for the first time from its built-in speakers, which featured a new design.

The audio might not be the same quality as listening through AirPods but if you’re doing housework and want to listen to a podcast or live radio without wearing headphones, it’s handy.

I tried it riding on my bike, downhill, whiskers rippling in the breeze – and my mother-in-law was surprised that she could still hear me clearly, despite not having the watch anywhere near my face. It was where it should be – on my wrist down near the handlebars.

Bigger and brighter screens

Apple Watch Series 10 features a wide-angle OLED display, which Apple says optimises each pixel to emit more light at wider angles, and is up to 40 per cent brighter than Apple Watch Series 9 when viewed from an angle.

Another series 10 upgrade was the screen. Apple increased the brightness by 40 per cent when viewed at an angle – which is the case when most of us glance at our watches. It also increased the size of the screen 10 per cent.

Apple achieved a bigger screen not by just increasing the size of the device but also making the screen borders – which contain the electronics – thinner and curved around the edges.

This might not seem a big deal, but Apple showed me how far it has come since the original Apple Watch, which was a square screen with thick black borders, which it tried to hide by using black backgrounds.

Keeping it classy

A frequent criticism of Apple Watches is that they aren’t in the same league as more up-market timepieces, despite outselling the entire Swiss watchmaking industry since 2019,

Apple has continued its collaboration with Hermes,  when it sold 31 million units – 10 million more than the Swiss.

But if you’re after jewellery, Apple has an agreement with Hermes, which it began with the series 2 in 2016, with pricing starting at $2109.

The partnership includes not only different hardware, like specific bands that evoke Hermes’ saddlery heritage, but also exclusive watch faces for those who prefer a bit of extra bling.

Out of your depth

The new depth gauge can measure down to 6 metres beneath the water’s surface, and the new water temperature sensor measures the temperature of the water.

It now incorporates a training load, which measures how the intensity and duration of workouts impact a user’s body over time, which can help users make informed decisions about their training each day – a similar feature Garmin offers.

There is even now a depth gauge, which comes on automatically when the watch is submerged, as Apple seeks to make it useful for more extreme activities, like scuba diving.

For those who prefer surfing or fishing, there is also a tides app. Using your location, it can immediately provide you with data about your nearest beach.

Here is the link:

https://www.theaustralian.com.au/business/technology/the-australian-buyers-who-say-apple-watch-saved-their-lives-as-device-celebrates-10th-birthday/news-story/bed3bef4d22c6311852509ad6a5532f8

I suspect, like many, that I am the proud owner of a variety of old watches which are filling up a small corner of my study drawer. Once you have used one it is very hard to think of a reason to go back except for cosmetic reasons or deep diving, They look good, are blindingly accurate, are not zillions of dollars and can save your life! What is not to like!

I reckon Apple are quietly surprised how successful they have been! If you are over 50 or so there is no reason not to have one and some good reasons to!

David.

AusHealthIT Poll Number 791 – Results – 27 April 2025.

Here are the results of the recent poll.

Do You Believe Pope Francis Has Been A "Good" Pope?

Yes                                                                11 (69%)

No                                                                    1 (6%)

I Have No Idea                                                4 (25%)

Total No. Of Votes: 16

A majority see him as having done an OK job

Any insights on the poll are welcome, as a comment, as usual!

Very low voter turnout. Seems like it was not a good question, My bad!

4 of 16 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

I Think This Is Worth A Read To Gain Some Insight Into What Can Trigger Awful Decline And Suffering.

This appeared last week:

Diary of a millennial anorexic: 5 rehabs and 15 lost years

Lara Bowman reveals how she went from being a happy child from a wealthy background to solitary confinement in a treatment centre.

LARA BOWMAN

20 April, 2025

Three years ago, my befuddled brain decided it wanted a cigarette. I stood up and then came the bark, “Sit down. You aren’t allowed to get up.” I had forgotten I was not allowed to get off the sofa without permission. If I needed a glass of water, I had to ask a fellow inmate in the “semi-acute psychiatric facility” to bring it to me.

I was anorexic, and the few steps to the tap were apparently too strenuous for my flimsy, palpitating heart.

Anorexia is the attempt to deny all needs but ends up making you the neediest of all. I had this realisation fittingly on the loo, trying and failing to relieve myself in front of a male nurse. Dignity long gone and used to this routine by now, I couldn’t have cared less.

I can pinpoint the beginning of my anorexia precisely. I caught the mother of all stomach bugs in July 2009, when I was 14. I was bedridden for a month. I lost about 1st in the first week, partially due to my mother’s misguided attempt to starve the bug out. She eventually succeeded, but I’m not sure she ever got her daughter back.

Emerging from my semi-catatonic state, I felt high, emotionless, untouchable. I liked it. So, I just kept going. Still unaware of the existence of a calorie, I mimicked my mother. Skip dinner; stick to vegetables and fish. Kaboom — I was still high. Like any addict, I spent the next 15 years chasing the euphoria of the first fix, but it was never quite as good. So far this morbid pursuit has resulted in seven years in five treatment centres, about thirty medications and a catalogue of psychiatric diagnoses in double digits. This is not to forget countless broken relationships, three incomplete degrees and a lot of my parents’ money.

In many ways I am an archetypal anorexic: female, privileged, perfectionist, bright and white. In my last stint in treatment, my father wrote me a letter that was read out in front of my fellow inmates. He wrote, “Lara’s childhood wasn’t perfect, but she was never hit, there was love, and she grew up with a silver spoon in her mouth. By any objective measure Lara’s life should not have been traumatic, but it patently is.” This is true. I grew up in beautiful houses in Clapham, south London, that featured in the pages of House & Garden. My mum was alternately an interior designer and a stockbroker and the mother of six children. My dad made Coca-Cola ads before he joined Ernst & Young to pay for the ever expanding family. We went to the best private schools, enjoyed lavish holidays and saw the coming and going of nine nannies.

Grown-ups would speak about my mother in awed whispers. She was the supermum of south London. We were the Clapham Von Trapps, dressed in pinafore dresses imported from Hong Kong. Despite the mob of children, the house was always spotless. Perpendicular family portraits lined the walls, our blonde hair perfectly coiffed, smiling obediently into the middle distance in matching white T-shirts.

Still unaware of the existence of a calorie, I mimicked my mother. Skip dinner; stick to vegetables and fish. Kaboom — I was still high. Like any addict, I spent the next 15 years chasing the euphoria of the first fix, but it was never quite as good.

My mother is a quintessentially type-A personality — like most anorexics, incidentally. Rigid, disciplined, hyperorganised and fundamentally controlled, she ran our lives like clockwork. Every minute was accounted for — six lives managed like well-oiled machines. The problem was that I kept accidentally knocking things over, disrupting our neatly ordered world. My mother was baffled by me. Understandably confused as to why I could read Jane Austen at eight but had a habit of tidying newspapers into the fridge, she got me tested for special needs. The psychologist likened my brain to a wardrobe with the hangers messed up on the floor. He diagnosed me with dyslexia, confirmed that I was bright but said that I had a statistically odd brain. He missed the attention deficit hyperactivity disorder, an omission that is unfortunately common for girls. People with ADHD are four times more likely to struggle with eating disorders.

My mum was an almond mum before the term was coined. One week tuna was in; the next, the mercury-infested morsel was banned. Mary Poppins-style, we would guzzle spoonfuls of various fishy oils. We would be allowed two or three Halloween sweets and the rest would still be in the cupboard the next year. We didn’t use toothpaste, as my mum feared fluoride. On playdates, I would precociously declare that Nutella was toxic and frozen pizza was for lazy people.

Being overweight was a moral failure. My father idolised actors who looked like Keira Knightley. My mother said crop tops should only be worn with a washboard stomach. While I don’t think her approach to food gave me an eating disorder, it helped provide the framework for it. All the children were subjected to the same routine. Between me and my two sisters, we have struggled with the trio of eating disorders: one had bulimia, one wrestled with binge-eating and I was anorexic. However, I am the only one who has been institutionalised.

The less you eat, the less you feel

Over the summer, after my tummy bug, I was just eating boiled vegetables. I famously ate half a raisin and put it back in the cupboard for later. Initially, I was praised for my turbocharged self-restraint. “I knew you’d realise you liked salad,” my mother said. “You’ve lost your puppy fat,” my dad said.

I would stand on one leg in chemistry to “tone” and do laps of Starbucks at lunch as my peers were downing frappuccinos. Initially, I tried to keep my more left-field behaviours quiet. I feverishly watched my classmates munch cookies, overwhelmed with a mixture of disgust and jealousy. “Do you want one?” a disconcerted classmate asked. “No, I’m not hungry,” I replied. That was a lie. An early one of many. I was starving, but I was as jealous of her carefree consumption as I was of that devilishly delectable, sugar-laden bomb passing her lips.

I was ahead of the curve on food porn. My Harry Potter books were replaced by baking books. I drooled over Mary Berry’s brownie recipe so often that dribble marked the page. A pathological people-pleaser, I tried my best to keep the extent of my madness private. The mandatory 50 nightly sit-ups would be done in the bathroom. Tiles don’t creak, you see.

Then one day, Mum walked in on me while I was in the bath, curled in the foetal position. She recoiled and I heard a sob. That night I asked her to give me a bedtime cuddle. My newly protruding spine must have poked her, though. “You’re not very nice to hug any more,” she whispered in my ear.

The school called, alarmed at my weight loss and increasingly eccentric behaviour. We dutifully saw a GP, who weighed me and announced that, while underweight, I didn’t qualify for hospital treatment. GPs receive two hours of training on eating disorders, and thus, while mainly well meaning, they don’t know what they’re talking about.

My mother tried her best. She accompanied me to an endless parade of doctors’ appointments. A weekly charade would ensue. I would chug gallons of water to artificially add the pounds, put on my reasonable face and agree to eat malt loaf. They would warn me of the impending horrors of ill health if I didn’t get my act together: osteoporosis, which my mother already had; heart attacks; flaky skin; infertility; early death.

After the weekly weigh-in, I would try to eat my dinner that night but it would never last. I didn’t want to upset anyone, but I had become possessed. Consumed by the art of not consuming. Semi-starvation dulls cognitive function. The less you eat, the less you feel. What was going on in my brain is difficult to describe, and even to me sounds insane. The wires had sort of got crossed. That homely, safe satiation after macaroni cheese evoked terror rather than pleasure. Emptiness was associated with purity and dignity — even when becoming incontinent.

To eat or not to eat. Simples. This streamlining is wonderfully comforting to a tweeny brain overwhelmed by the idea of the fast-encroaching chaos of the adult world. Problem is, neural pathways have a habit of sticking.

I would eat once every two days

It is common for girls with undiagnosed ADHD to fall apart at university. Outside the strictures of school life, responsibilities and possibilities multiply. This can send the dodgy satellite system of the ADHD brain spinning. I was also burnt out. During my A-levels, I had worked 14 hours a day, timetabling every minute, and had seen so little sunlight that my tennis teacher told me I looked like a vampire and that I was going bald. Having failed to hand in an essay, I left Durham University after a term.

This precipitated a full flip into hedonism. The failed perfectionist era had started. I would rather fail on my own terms. I went on my gap yah. Had a ski season, ate lots of cake and went off to the University of Bristol the next September. I made wonderful friends and we partied hard. The next three years were a yoyo of extreme highs and lows. My chums had now joined me in my fantasy world. We would prance around festivals draped in fairy lights, propelled by a concoction of dreams and drugs until we dropped into a narcotic-induced slump. We were the worst intake that Bristol had seen in 15 years. The chaos excused my tics. I fitted right in.

I’d regularly skip dinner and down copious amounts of vodka instead. One time I met a couple while they were graffitiing on the side of the road and paid them to tattoo me. I wanted Donald Duck on my bum; they kindly suggested my shoulder. I was once interviewed by the passport office having lost five passports in two years in various clubs. They concluded that I was not a criminal but an idiot.

It took a while for this to raise alarm. My weight was propped up by alcohol and erratic night eating. I would eat once every two days and my speech was slurred. My third-year flat was nicknamed “the crack den”. I slept in my ski gear on a sheetless bed — the radiator was broken and the flat was too much of a tip to tell the landlord. Food was becoming increasingly intermittent, and for the first time I called my mother and asked for help.

Unbeknown to me, she had been working behind the scenes on an intervention. “Lara, there’s a place you should go which will help you. You can go to Cape Town over the summer and it will make everything all better.”

The insanity of my illness hit me like a sledgehammer

And so I found myself in a minibus in Cape Town, speeding past the townships to the poshest part. We passed three dead bodies. I’d never seen this kind of poverty before. We arrived at Bishopscourt, a maze of mansions cordoned off in rectangular blocks with 10ft barbed wire fences and private security cars whizzing past. The insanity of my illness hit me like a sledgehammer. Here were all these rich white girls being cajoled to eat by black nurses, and people were starving down the road.

I was stripped, weighed and carted off to the psychiatrist. I confounded the poor man, who flatly refused to believe that I was purely anorexic. He added ADHD and bulimia to my psychiatric rap sheet, despite my complete lack of a gag reflex. The girl in front of him had lost more than 50 phones, dropped out of two universities and was still dressed in wet festival clothes, with glitter in every crevice. A form I’d just filled in asked what drugs I’d taken in the past two days. I couldn’t remember; I didn’t want to be caught lying so I just ticked everything apart from crack, meth and heroin. I’m a good girl, you see. “Your brain must be like oil and water,” he said, perplexed.

This was full-on rehab. I lasted three days before I demanded to come home. Screaming matches adjudicated by my therapist ensued. My parents flatly refused. This was fair. So I just refused to eat. No amount of cajoling stopped my hunger strike.

I discovered my spunk in rehab. Unadulterated anger exploded out of me, seeping out of my pores like the stench of vodka. After a couple of weeks I was put into solitary confinement for three days. No one supervised me. I quickly found the blind spot in the CCTV and started stuffing my food into sanitary bags and hiding them in the cupboard. This was the final straw. After a month, my mother got a call in London telling her I was in the lobby and she had to pick me up now. Difficult to do from another continent.

Then one day, Mum walked in on me while I was in the bath, curled in the foetal position. She recoiled and I heard a sob. That night I asked her to give me a bedtime cuddle. My newly protruding spine must have poked her, though. “You’re not very nice to hug any more,” she whispered in my ear.

I was bussed to another rehab centre in Cape Town. This was less bougie and presided over by a man, now dead, whose therapy style has put three people I know of into trauma counselling. By this point I could not string a sentence together; stress had short-circuited my brain. I was assigned a personal nurse. I was also thought to be a flight risk and banned from having contact with my family.

My eating disorder being challenged head-on was, to put it bluntly, torture. But the carefully constructed narrative of my life and world was also crumbling. For all his faults, this therapist could cut through your bullshit in five minutes. There were a few light bulb moments.

Maybe my childhood hadn’t been perfect? My mother’s favoured form of discipline was icy silence. After her parents’ messy divorce, she had vowed never to shout at her children. I remember wishing she would, to get it over with. Her mother had repeatedly abandoned her for a parade of men. Her response to this was to decide emotions weren’t needed. If we were worried, anxious or upset, she would tell us to get up, move on, that it was not helpful to be upset. This steely approach to life was probably solidified by being one of the few women in the City during the Eighties. The family joke is that no one has ever heard her say sorry. Like most of my siblings, I absorbed this. Hypersensitive as a child, I learnt quickly that this was a weakness to be quashed. Not eating was quite a good way to do it. Problem was, in my attempt to shrink myself into non-existence, my torment had increasingly encroached on other people’s lives. My parents once called living with me Chinese water torture.

Maybe I was a narcissistic, spoiled, selfish mess who needed to take some responsibility for her life?

I gained weight — and dropped it fast

After four months, Mum agreed to let me come home for a visit. I left my visa behind and conveniently got banned from South Africa. My therapist called me the next day; I was already drunk, en route to a rave. She asked me whether I’d forgotten the visa on purpose. I told her I hadn’t, but I would have done if I’d had the wherewithal to think of it.

I spent a year in a ridiculously ritzy halfway house. I had gained a lot of weight — more than I was meant to. My body clung to nourishment after years of famine. This, I decided, meant the shrinks and dietitians were wrong. They had stuffed me up like a battery chicken and I quickly rectified the situation. I dropped weight fast, but had no intention of being sent back to Cape Town, so slipped back into straddling the line of acceptability weight-wise — a healthy weight, but just.

At this point, I was on ten psychiatric medications. The shrinks would ask whether they were working and I would be like, “Which one? I’m on all of them.” I don’t trust psychiatrists. They all have different answers and they can’t all be right. One thing did help though: stimulant medication for my ADHD. Suddenly I could focus. I could finish an assignment. I went back to university, this time in London, and started handing in essays. All was ticking along nicely, in a semi-functional manner.

Here is the link:

https://www.theaustralian.com.au/health/mental-health/diary-of-a-millennial-anorexic-5-rehabs-and-15-lost-years/news-story/ce51b43a700a11cf8754b1497337425b

I have to say this is a terrifying view of awful personal suffering. I wonder can anyone help her out of the deep hole she seems to have disappeared down? Really a very, very sad chronicle of some awful human suffering!

David.

It Seems General Practice Is Still Struggling With GPs Pretty Fully Occupied When They Can Be Found!

This appeared last week:

Life support for primary care – but campaigns silent on deeper health system malaise

Labor’s cash injection is no panacea for our ailing medical system and it could well backfire.

Natasha Robinson

Updated 4:03PM  April 18, 2025

The defining image of this election campaign – leaving aside stage stumbles and errant footballs in the Top End – will be Anthony Albanese brandishing a small plastic rectangular-shaped prop: the Medicare card.

For most Australians, the card that has been dubbed by Labor “a little green piece of green and gold” is a means to an end: the delivery of a Medicare rebate direct to their bank account. For the Labor Party, universal healthcare and the nation’s taxpayer-funded health insurance program is its raison d’etre; one of its most compelling political stories.

But the Prime Minister’s sale of the Medicare story – in the form of a substantial boost to bulk billing with a take-home message that people will be able see a doctor for free – was challenged this week by peak medical groups, general practice academics and some frontline GPs.

The crux of their concern is that the growing difficulties facing Australia’s health system are so enormous that populist policies that sell well in marginal electorates in an election campaign could perversely deepen the nation’s health system crisis. The counterargument is that this huge boost to primary care will take pressure off family budgets and hospitals, keeping people well.

That millions of people cannot always afford to see a doctor when they need to is a reality in modern Australia, as documented for several years post-pandemic by the Productivity Commission and the Australian Institute of Health and Welfare.

It’s an unpalatable situation in a developed nation that prides itself on vital welfare safety nets for the disadvantaged.

The potent political message that a Medicare card – not a credit card – is all you should need to see a doctor for free in Australia harks back to a golden age of universal healthcare. It was a time when the current cataclysmic outlook for health systems around the world with rising chronic disease and an ageing population was not yet envisaged. It’s something Bob Hawke could barely have appreciated when Medicare was born 41 years ago after the Labor Accords in 1984 clinched union support for a skilfully resurrected and recrafted version of Gough Whitlam’s visionary but flawed Medibank policy.

Labor in this election is doing everything it can to link its modern Medicare story to Hawke’s original vision. Buoyed by the lift in bulk-billing rates arising out of its 2023 budget measure to triple incentives for GPs to bulk bill pensioners, concession card holders and children, the Albanese government announced even before the election was called that it would extend the triple bulk-billing incentives to all Australians, with an additional kicker boost for GP practices that bulk billed all patients.

The Liberal Party almost immediately announced it would match the policy with even greater funding but has done little to flesh out or sell the details of its own version. Liberal leader Peter Dutton couldn’t afford to be wedged: the marginal-electorate voters who could swing this election result live in a relatively small array of battleground seats. Voters in these seats, like so many Australians, are smashed by the cost of living; some are avoiding seeing the doctor and many are baffled, stressed and angry as to why they’re no longer bulk billed.

The issue is inherently connected with the other big election swinger: cost of living.

Both parties’ willingness to pour vast amounts of cash into a supercharged bulk-billing incentive program speaks to how significantly the well-documented declines in the general practice sector, from the cities to the bush, are affecting the lives of patients who will soon cast their vote.

Albanese’s antidote is simple and powerful politics. “This is all you should need to see a doctor for free in Australia … not your credit card,” the Prime Minister proclaims in social media ads. Vision pans through B-roll historical shots of the titan Hawke, who is also clutching the “little piece of green and gold”. The next shot is of Albanese in front of a rally protesting against cuts to Medicare, a visual nod to Labor’s story that “you can’t trust the Liberals on Medicare”, especially not Liberal leader Dutton, allegedly the worst health minister in 35 years (a sledge based on a medical press survey that has stuck). This moniker has sparked an array of TikTok and Instagram memes.

Labor’s Bulk Billing Practice Incentives Program promises to lift bulk-billing rates to 90 per cent of appointments. Importantly, that doesn’t mean nine out of 10 people. The number of people always or usually bulk billed is much lower. The triple incentives policy extends the existing incentive to GPs to bulk bill pensioners and concession card holders to all Australians, with an additional 12.5 per cent on top of the base incentive for practices that bulk bill all patients.

The government says the policy will increase the total Medicare payment for a short consultation from $42.85 to $69.56 in urban areas and more in regional and rural locations. That includes a 12.5 per cent boost for practices that bulk bill all patients.

According to a federal Health Department fact sheet, which extends existing modelling derived from the largest dataset of general practice billing in Australia of 6500 general practices enrolled in the practice incentives program, 4800 GP clinics will be financially better off as a result of the incentives policy. The modelling is based on the General Practice Registrars Australia earnings calculator and uses Medicare data across all 140 million GP services delivered throughout metropolitan and rural areas during 2023-24 to calculate national averages and the impact for individual GPs and entire practices.

The earnings calculator assumes a full-time GP delivers an average of four services an hour and retains 70 per cent of billings while passing 30 per cent to the general practice to cover its costs and profits.

“If an individual practice would receive more in additional Medicare payments from bulk billing every patient than it currently receives from charging some patients, then that practice would be in a better financial position from adopting full bulk billing,” the fact sheet says.

The department modelling says 4800 practices will receive an average of $344,000 in additional funding a year depending on the number and type of services delivered.

At present a bulk-billing GP earns less than their mixed billing or privately billing colleagues for providing the same number of services, according to the department, which says this policy will close that gap. The difference from November 1 to annual GP earnings if all patients are bulk-billed is relatively modest in a metropolitan area, according to this fact sheet. GPs at a full bulk-billing practice would earn $5357 more than at an average bulk-billing practice, the fact sheet says. In a rural practice, because of a bigger incentive loading, it’s much larger: $23,964 a year.

But the modelling now made public has been picked apart by doctors who have important questions about some of its assumptions, expressing disbelief that it predicts city-based doctors who bulk bill patients for every visit would collect earnings of $403,805 annually if the policy is implemented after November 1. This assumes a full-time GP delivers four services an hour and works for 3.8 hours a session, for 10 sessions a week, with four weeks of annual leave a year, retaining 70 per cent of billings and passing 30 per cent to the general practice to cover its costs and profits.

While welcoming the historic funding injection that few doubt will increase bulk billing rates, the Australian Medical Association and GP groups insist the policy rewards “fast medicine” and shorter consultations, when most of the patients they now see have chronic disease or mental health issues that take time to examine in a consultation.

These groups feel an opportunity for desperately needed structural reform to health systems has been lost in this election.

The question no political party seems to be asking itself is whether incentivising bulk billing for all Australians including the privileged is a smart use of money.

There’s an argument that the era of fully subsidised healthcare amid rising costs driven by chronic disease is not only fiscal folly that privileges those who can and should pay, it also will make it ever harder to shift the dial to focus on structural reform and a serious commitment to gear the system towards the prevention of disease – a reform project that Labor promised to progress four years ago.

Many of the people whose votes may swing the election result know from experience that it’s not only primary care suffering system breakdown. They may, at times, need to go to hospital, where emergency departments are buckling, ambulances are ramping and where getting access to an inpatient bed is challenging. Tens of thousands are stuck on public elective-surgery waiting lists. Countless patients need emergency care for diabetes complications, one of the most common and potentially life-threatening reasons for being admitted to hospital nationwide.

Labor is offering these people an expanding national network of urgent care clinics, open for long hours and designed to avoid people having to go to emergency departments. Urgent care clinics subsidise healthcare at no expense to the patient but are a very expensive model of care in which the ultimate bill is footed by the taxpayer at a rate about five times higher than a standard GP visit. These clinics are criticised by many doctors who say they fragment and duplicate care, but they’re highly popular with voters – and so the money flows.

Not much has been said in this election campaign about tackling the dire state of public and private hospitals. The former are critically overloaded with enormous workforce shortages and dysfunction, and the latter are in a state of near collapse, with maternity units shutting down at an alarming rate, tolling the bell on a looming private sector catastrophe.

Yet these seismic issues have been almost totally neglected in this election campaign in favour of easily digestible slogans that tap into what political parties know is a hot-button issue at their most common interface with medicine: primary care.

And so it is bulk billing that gets $8.5bn in cash as part of the Bulk Billing Practice Incentives Program. This is on the table for all, even people who are sending their kids to private school at $45,000 a year per child.

The politics of whether GPs will or should bulk bill is red-hot. Doctors proclaim that “medicine is not a shop” but a service. It’s clear that the top end of town doesn’t need bulk billing, but some doctors argue that almost everyone should pay a gap, just as they do for any other medical specialist. Those specialists also have been subject to rebate freezes for years and have not seen one iota of extra Medicare support.

Labor began a temporary freeze on Medicare rebates in 2013 that was continued by successive Liberal governments for about seven years. During that time a proliferation of incentive programs poured billions into GP clinics.

Offering incentives to drive billing practices and health service delivery are now firmly the preferred vehicle for funding GP clinics by all governments. Peak GP bodies prefer Medicare rebate lifts, but the dilemma for the government is it cannot control what GPs charge, meaning many would not bulk bill at a greater rate regardless and would bank greater income and profits rather than resolving the access and cost problems for patients.

Election campaigns and their lead-up are arguably terrible environments in which to craft health policy. Labor in fact has been advancing a Strengthening Medicine program of reforms including moving away from episodic care and getting more nurses into GP clinics, but that’s virtually unknown to voters. For the sake of votes, people are now being told they’ll be able to see a doctor for free. The policy risks shifting the dial back towards episodic care and cost, not quality. Many in the health sector are concerned that it sets up a transactional way of thinking about healthcare in primary practice.

After many years of neglect of primary care sector, what’s being delivered in the biggest investment in Medicare since its inception will please voters and will almost certainly significantly raise bulk-billing rates but at what cost to the system?

What is needed most is not only that deeper reform of outdated systems but a 180-degree turn in thinking to fund and incentivise the policies that take pressure off GPs and health systems in the first place: preventive care. It’s the game changer that families really need, yet preventive care makes up a tiny proportion of the health budget and is utterly neglected, including in this campaign.

Here is the link:

https://www.theaustralian.com.au/health/medical/life-support-for-primary-care-but-campaigns-silent-on-deeper-health-system-malaise/news-story/0dc2af3fffb02ba15bd0578a6a0cff2a

I Have to say a pretty much identical article could have been written in one of at least the past 20  years. Very little has changed and it is hard to see how much really can.

Doctors can only see so many patients a day and all those working a pretty much flat out for the whole of their working day. It seems no-one is slacking off but that there is just too much work to be covered by the available GPs. As for longer visits and various specialty activities they are even scarcer!

What is needed is more work in offloading the GP workload to ancillary services and more delivery of care in a collegiate environment where all the staff can work to their potential and their skill level. This transformation is underway but still has a way to go. Ideally we need all professionals working to their capacity with individually satisfying work. However, the nature of individual practices with limited staff presently mitigates against sensible work division and so on.

This is all gradually changing as people adapt to the new ways of work sharing and responsibilities. Come back in 10 to 15 years and I am sure we will see larger and better serviced practices with a wider range of ancillary staff. The change is clearly happening now….

I fear the day of having your own doctor who follows you through life is becoming, sadly, more of a pipe-dream.

The “medical home” concept is probably the best we can aspire to – where a practice knows you and your family pretty well and can provide most of the needed primary care.

What do you think GP should / will look like in a decade or two?

David.