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Ask Dr Dave - August 1999
Last Modified 2/8/99
Dear Dr Dave
I have just taken delivery of the computer I got from the PIP and want to get going with scripts. I was about to buy the program that everybody else in town is using but I heard that it's been sold to a multinational. My mate up the coast has written his own program and he says I can have it for free. Which do you reckon is better?
Dr Clapham Omnibus Dear Clap
Writing scripts is fun. Checking your pathology is a snack. It's even enjoyable writing up your medical records and doing your letters. However, it's a pain when the paper jams in the printer, extremely frustrating when the server goes down, and a disaster when you accidentally delete your last six months of pathology data. Thus, like most things in life, there are ups and downs.
Whichever way you decide to jump, the bottom line is that you will become dependent on your software and your software supplier. Therefore, if you are going to be around for a while, you hope they will be too. In theory you can extract your data from one program and get it into the next. In practice it is never easy and usually impossible.
So who will be around for the long haul? The tendency in this networked world has been for companies to get larger by merging. This seems to be as true for car manufacturers and drug company multinationals as it does for computer companies and internet service providers. It looks like bigger is better.
The only hope for the little bloke is to work with lots of other little blokes. It's a bit hard to build a car or find a cure for the flu this way but it is possible to develop software using this model.
Developers give their users access to their code and do not charge for the use of their programs. The users may in turn make additions or improvement to the software but can do so only if they also agree to allow other users the same rights as they had.
Software like this is copyleft. In simple terms, copyleft is not copyright. For those wishing to delve further, a more detailed explanation can be found on www.fsf.org/copyleft/copyleft.html. The Linux operating system has been the most successful development under this paradigm. And you know what they say about paradigms. Shift happens.
Are there any copyleft programs in Australia? A couple of programmers have expressed interest in working with other companies and individuals. Time will tell whether they can develop a product that will match it with the big boys. Dr Dave
Dear Dr Dave
Our surgery in the bush has been approached by a large chain from the city to join their network of modern medical centres. They say I have a whole heap of money locked up in my practice and if I join them they will list on the stockmarket and I will be able to get my money out. It almost sounds too good to be true. Should I jump?
Tom Douting Dear Tom In the past, the old country doc would work until he had had enough and sell his practice to the bright young graduate fresh out of the city. He expected and usually got somewhere between 25 and 50% of his turnover as goodwill. He could command this payment because of the intense loyalty of patients, which made it so hard for a newcomer to survive without the imprimatur of an established practitioner.
The advent of Medicare caused a weakening of this doctor-patient bond. Some patients became more loyal to their supermarket chain than to their medical practitioners. Bulk billing caused a rise in the number of visits for trivial conditions from the worried well and the average number of visits per patient per year rose from four to 5.5. Squatting was easier and the value of goodwill shrank to practically zero.
The reduction in the number of general practitioners and hence the drop in the level of bulk billing will reverse this trend but a return to the good old days seems unlikely. The new paradigm (those paradigms just won't go away) recognises four components to a GP's income. There are the fixed costs of wages and consumables, a management component, a wage component (the money you need to keep your husband and children in the manner to which they have become accustomed) and a profit component.
These new medical conglomerates aim to collect the profit component from a number of general practices around the country. Once the company has proven itself over a few years, they will capitalise this profit stream by taking the company to the stockmarket. Price earning multiples of 10:1 are conservative. The only medical company listed on the Australian Stock Exchange recently traded at 200:1.
So you go in at 10 and out at 200. You cannot lose. Or can you? ASX regulations prevent you from selling for the first two years after floating. It might be that in 2002 medical shares are even more popular than now but they could turn out to be penny dreadfuls.
You might also feel a little uncomfortable about keeping up that profit component. You probably cannot do much harm at the moment because that cheaper bandage isn't that much worse than the Rolls Royce. However, if managed care comes in you can cut down on those expensive CT and bone scans and new drugs. Then you will really make a killing.
Dr Dave
dguest@gmc.net.au
Discussion
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gum adhesions lynette nevin, babybears9@bigpond.com.au Posted 27/8/01 9:32 AM hi, i hope you can help me,my mum has on her lower gum, growth's of tissue,on both her lower gum and her inside lip,,it doesn't cause her any pain , however a skin surgeon, has reccommended it be removed,i am wanting to know what it is and are there any associated risks with this growth,. thanking you in advance. lyn nevin |
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Side Effects of Prolodone suppositories + Endone 5mg Lindy, MyLindyLou@hotmail.com Posted 11/1/2001 10:18 PM The sister of a friend of mine has been taking Prolodone suppositories 30mg and Endone tablets 5mg daily for many years. Recently she had a colonoscopy and was told there were many polyps present which were removed and also some suspicious looking ones up further in the bowel. She is understandably worried sick. She wants to know if there is a chance her pain medication is to blame, and if the medication could cause cancer of the bowel or anywhere else. Thank you. |
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Internal Bleeding Michael, Boobala4@aol.com Posted 17/11/2000 9:26 AM My Mom... has been in the hospital for over a week now.... she went in with a blood level of only 7.3 now after a week and a half she has recieved over 13 pints of blood.... doctors here say that the bleeding will stop .... just are not to positive of week .... the bleeding i understand is a internal mussel bleed..... any comments Michael Michael, Boobala4@aol.com Posted 17/11/2000 9:23 AM |
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control of medical records-legally Anne, davnanne@esinet.net Posted 2/11/2000 12:09 PM We're a Virginia based practice consisting of 3 physicians in a partnership that is breaking up-the senior partners (32 years and 26 years respectively) are staying together and the junior partner 9 years vested in the practice is leaving of her own volition-she wants the hard copy of the practice records for 'her' patients -many of whom have seen all three in the practice. needless to say the 'core group' wants to keep all of the hard copies of the records and give the physician that is leaving photocopies of all patient records that patients sign their record release to her form. We feel that legally this is the best way to handle the split-do you have any thoughts? Thanks |
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suture reaction glenn, glenn1@peoplepc.com Posted 28/9/2000 12:03 PM I've had an ongoing problem with adhesions due to suture reaction. The adhesions have slowed down digestion and entrapped my gallbladder, which according to a test, is not contracting. Now some want to do surgery..What is a good resource for suture material that could be used in my surgury if necessary> glenn, glenn1@peoplepc.com Posted 28/9/2000 12:03 PM I've had an ongoing problem with adhesions due to suture reaction. The adhesions have slowed down digestion and entrapped my gallbladder, which according to a test, is not contracting. Now some want to do surgery..What is a good resource for suture material that could be used in my surgury if necessary> |
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erythema nodosom ashlea, qotfu@optusnet.com.au Posted 25/9/2000 12:41 AM Hello For the last 6 weeks I have been trying to find out what is wrong with me. My GP thinks he has seen this 30 years ago and considers that lucky. Umm...initially I found 1 lump in my leg near my knees. 3days later I had 3 lumps. At first the Dr thought they were scar tissue or cysts but a week later there were 13, he did some blood tests and found I was pretty anemic. He did a scan that showed lumps with the echogenicity of fat but did not appear to be fat or cysts. A double needle biopsy gave no glory. My Dr then sent me to a surgeon for an open biopsy. By the time the 3 weeks had passed to see him the lumps had changed in nature, they have massed together sometimes take on a bruised appearance. Have appeared down my shins, hips, forearms, between the knuckles on my hands and feet. My bones and joints ache. My muscles ache, I have dizzy spells and heat rushes. My weakness had become so great that at the age of 36 I could no longer walk aroung the local supermarket for a family food shop. general housework load is almost out of the question. When I explained this to the surgeon he replied that in all his years in his specialist area he had not come across this. He suggested that an open biopsy would probably not give any further clues but would be happy to perform one in a few days if my GP still wanted to. He suggested that I either get a referral to a physician or a Medical Professor. Understandably at this reply and at having lumps for 6 weeks that were making me feel like death, and lets face it - lumps are scary things, I went to the hospital for attention, unfortunately being Friday night in a relatively small local hospital, immediate help was an unlikely prospect. I was however attended to by a lovely Dr Watts who advised me that his position was as emegency Dr and that this was not his field, but it was his suggestion that Eryt He was not able to give me much detail to the disease as his big book of everything said there seemed to be no known cause or cure. For the pain he has prescribed presnisolone. Can you please give me more information as to what to expect from this ailment and also the drug that has been prescribed. Thanking you |
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allergic reaction karen, shazzam@ozemail.com.au Posted 6/8/2000 1:28 PM Hi Dr Dave, I recently had surgery (Hysterectomy) After the surgery I was administered an morphine overdose. Then the following day had a internal bleed resulting in a hb or 7.3. Had to have blood transfusion. After 5 days post op came home. I noticed that i had some small pin like eruptions on my skin, which i thought might be staph so i treated it with some betadine. This did nothing. Now I am 4 weeks post op. The rash in mainly restricted to my truck, and neck. Minimal spots on arms and legs. Past surgery and contact with latex gloves have caused me irritation. I have been experiencing tachycardia, insomnia and of course some itching with this rash. The rash has progressed each day and is not improving with the use of antihystimes. My gp has done several blood test which have all come back okay apart from my liver enzymes were slightly elevated, he says this could happen if i drank a bottle of wine, so i should not be concerned. I have real physiological conditions but are of an unknown origine. Could i be having a reaction from the surgery, ? cornstarch allergy, ? allergy related to the internal suture material. I do have some medical nursing knowledge, however feel that something is causing these symptoms, which at this stage has not been detected. Are there any other tests that could show some sort of toxicity that i can ask my gp. Should i return to seem my anaesthiologist. Any suggestions would be appreciated. regards karen |
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lump Jin, yakuzax69@hotmail.com Posted 12/7/2000 4:53 PM i have recently got into an accident..where i has stiches on my head...after the accident i noticed that lump on the lower side of my tongue..do u happen to know what it is? it seems as if its filled wit PUSS..please reply if u have an explaination |
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Pain Control David, hugme@nb.sympatico.ca Posted 24/5/00 2:23 AM Hello, I am a 'Palliative Patient' and have a 'Living Will' drawn up with my mother having 'Medical Power of Attorney'. Our wishes, My Mother & I, are to be put back on the regimen of Narcotic Analgesics that my Original HIV/AIDS specialists gave me, because I have such a high tollerance to Narcotics he changed my pain meds to M.S.Contin 100mg. b.i.d. and Dilaudid HP (10mg/ml sol.) 4mg. S.C. around the clock & 2mg. S.C. prn for breakthrough. Thank you, Fr: Dave (Still in Pain on too much Morphine!!!) |
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Hi ! Cassy, edmonton_oil11@hotmail.com Posted 20/2/00 5:53 AM Hi, my name is Cassy and I am doing my science fair project on toothpaste I was wondering How does toothpaste actually clean teeth ? and How long does it work for, like how long do your teeth stay clean after one brushing ? If you could answer these questions that would be great ! Thank you Cassy C Cassy, edmonton_oil11@hotmail.com Posted 20/2/00 5:53 AM Hi, my name is Cassy and I am doing my science fair project on toothpaste I was wondering How does toothpaste actually clean teeth ? and How long does it work for, like how long do your teeth stay clean after one brushing ? If you could answer these questions that would be great ! Thank you Cassy C Cassy, edmonton_oil11@hotmail.com Posted 20/2/00 5:51 AM |
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Ask Dr. Dave January 2000 Amy Jessberger, amymonkey@netzero.net Posted 28/1/00 9:53 AM I wanted to ask Dr. Dave about the uses for boric acid. I make my own beauty products (ie. salt scrubs, facial masks, etc.). I heard that boric acid is good for acne scars on the face. Is this true? If so, do you have any reipies for this. I can not afford to go to a dermatoligist or to get facials. Maybe w/some essential oils, clays, boric acid, etc. I can fix my own face. What do you think? cheryl, creatrix@ozemail.com.au Posted 30/1/00 6:51 PM interesting Amy - i don't have answers only more questions - is boric acid similar to boracic acid or indeed borax? i've used boric acid to chase irritations from my eye (sty type beginnings) - some old yarn that seems to work wonders - heavily diluted of course. so davey - what else can we do with it? |
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Ask Dr Dave - June 1999 |
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