Latest Blogs

Telehealth update Oct 2021

dear all, it does seem as though in the peri-COVID world we are all getting more used to video communication like Zoom and we have the opportunity WHEN appropriate to use telehealth (TH) as a way to conduct appointments.

It needs to be clear that this is simply for the moment a risk minimization strategy during the pandemic to protect the staff and patients from exposure to COVID 19. It is not intended to replace face-to-face consultations, particularly for patient, carer, or doctor convenience.

A TH consultation will miss the benefits of a face-to-face (F2F) consultation which includes a better assessment of the physical state of the patient, and improved rapport. If we have recommended or requested a F2F consultation it is important to comply with this to optimize the quality of care. If a patient requests a TH consultation, it will be approved if it is considered safe and reasonable.

You’re most welcome to request a F2F consultation if that is your preference. We do feel very strongly that patients and carers need to have received at least one CV19 vaccination. If this is not the case, please let us know prior to attendance so this can be discussed further. Mask wearing will be a requirement for the foreseeable future.

TH (or telephone ) consultations are billed the same as a F2F appointment except in occasional cases. These appointments still demand secretarial time with treatment and test bookings, script management, and letter dictation. We do not regard them as a ‘soft option ‘ requiring less time or focus from the staff or patient.

Please allocate time for your appointment and carry it out in a quiet space free from distractions. The car or dog walk is not an appropriate time to discuss medical care.

If you have concerns about the quality of the interaction during a TH appointment please feedback your concerns immediately to our office so we can address your concerns.

Warm regards all, Shane.

Update Telehealth

Unfortunately with Covid19, we are back to telehealth for the time being. If you have some issue that requires a physical examination please discuss with my staff. With masks and distancing a face to face appointment is manageable. For other patients, we will defer routine breast examinations for a recall date in September or October. Remember this is intended to protect all patients and staff and their families, but particularly those patients who are immunosuppressed.

Please endeavour to be set up for Doxy.me with an appropriate device. This is far preferable to a phone call. Please allocate the time and be in the right physical and mental space for a discussion. Have a pen and pad ready for any notes and have questions prepared and support people sitting with you. Having a consultation whilst driving or walking the dog is not ideal and will be unlikely to result in a quality outcome.

Most have so far been supportive of this process. Please note that telehealth should not be regarded as an inferior consultation and it should not be expected to be discounted. The consultation still requires expertise, thought, a letter to the GP or referring doctor and more work from my administrative staff faxing and posting scripts and investigation requests than usual. We have also had numerous requests for letters for work and travel exemptions that take time. Your understanding at this time is much appreciated

GenieCanHelp….this App looks good

Called GenieCanHelp. (looks like a neat way to keep all your meds, appointments, contacts together. Many of my patients are older and not all are IT literate (I hope that offends no one). They are however often accompanied by caring family or friends, who may be happy to store such info on their smartphones.. just a thought.

Spring thought of the day ..apps

dear all, it occurred to me how useful the smartphone would be  as  a patient management tool. That statement  may be a no-brainer but  i think it is well known how under utilised our IT systems are. Having a quick trawl through the Apple App Store (I am sure there is an Android equivalent for pretty much well everything!), there are some  free apps that can track medication lists/doses and provide reminders when scripts are due. Apps such as Evernote are great;  recordings of consultations can be kept (I hate my voice on tape but never  mind) and results can be photographed and stored. This apps can be connected to similar computer-based applications that are password protected.

Finally, the good old calendar with alarms can be used for appointments. I must say I love the Week Cal app as it nicely shows the whole week which the Apple Cal isn’t so brilliant at.

Over time , the various patient or consumer resources will become app friendly. I note with interest that there is a BreaCan Navigator app.

Happy Spring. Shane

new immunotherapy

The oncology world appears to be on the verge of revolution, not simply evolution. The notion of immunotherapy as a means of cancer therapy has been one of the oncological “holy grails” for years. Major developments have been seen in melanoma first with ipilimumab which targets CTLA-4 and augments the immune attack on cancer. The inhibitors against PD1 and PDl1 have a different mechanism blocking immune tolerance to cancer, or as I like to think of it, removing the cancer camouflage, exposing it to attack. The Austin and other institutions are now in the throes of Phase I-III studies testing these new agents. This was as a result of data such as http://www.nejm.org/doi/full/10.1056/NEJMoa1200690 where an efficacy signal was seen for the first time.

clinical trials

For those who are interested we have a whole host of studies in lung cancer at the Austin hospital testing agents targeting EGFR, ALK and PD1/PDL1. The breast cancer portfolio was a wee bit quiet  for a year but this is expanding including studies in triple negative breast cancer. Phase I studies run by A/P Hui Gan include a novel PARP inhibitor (attractive in breast and ovarian cancer  partic in the BRCA +ve patients).

We are very collaborative in Melbourne and I work closely with colleagues at Peter Mac , Royal Melbourne Hospital (only to name a few centres) to give patients the option to participate in studies that suit their particular circumstances better. This is often under the auspices of Cancer Trials Australia (see introduction).  We strongly encourage patients to consider trials. Ultimately as their clinician, I want them to personally  benefit from such participation. It is  true that altruism is maybe  an important part of developing  new and better treatments and improved outcomes in cancer medicine, and in health in general. SW Aug 2014