March, 2011 — BJC Health Connected Care

Sorry, I have to cancel today

By Irwin Lim, Rheumatologist

My son has been unwell all night with asthma. We’ve been up, using his medications, trying to keep him away from a hospital admission.

During this time, I’ve been obsessing about my patient list. What I really want to do is to cancel the list as I’m tired and would prefer to stay home with him. But, this is difficult to do.

I’ve had to cancel lists before at the last minute, almost always due to a family member becoming ill. It inconveniences so many.

Patients have often arranged time away from work and may have been waiting for the appointment. The reception staff have to start their morning frantically trying to reach as many of my patients as possible to let them know. Then, the question is where to fit these appointments that have to be rescheduled?

It’s understandable that my patients may get upset. A few even take it out on the reception staff (unfairly, as they are blameless). I can only apologise.

This time, I can’t cancel the list. I know one of the patients is travelling from 4 hours away, and there’s a couple of patients I can’t delay seeing. At 6.30am, I’ve already spoken to Amanda, our practice manager. We’re going to shorten the list by moving some of the patients scheduled at the end of the day. Hopefully, there’s enough time for these patients to make other plans and to not be so inconvenienced.

I’m sure all doctors face this problem and I wonder what they do? If you’re a patient, how do you feel when your doctor has to cancel your appointment at short notice?

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.

Stop Press: Stopping recurrent fractures after suffering a fracture from weak bones (osteoporosis) is a priority. We are going to run a Refracture Prevention Program at our Parramatta rooms to try & stop bones breaking.

One fracture, two fracture, three fracture……enough!

Image: Salvatore Vuono / FreeDigitalPhotos.net

On the rainy weekend, I attended a provocative lecture by a world expert in osteoporosis, Professor Markus Seibel. He spoke about the clear need for coordinated interventions in osteoporosis.

Why bother?

“In Australia, 67,000 osteoporotic fractures occurred in 2001. By 2007, this figure had increased to 87,100 fractures and by now has probably passed the 90,000 mark. Osteoporosis costs the Australian tax payer over $7 billion per year. For the individual patient, osteoporotic fractures cause pain, disability, social isolation, depression and premature death.” This quote appears in the latest issue of Osteoblast, an Osteoporosis Australia publication.

We bother to highlight this because Osteoporosis is a BAD disease with BIG consequences.

There are many risk factors for osteoporosis, and doctors need to be vigilant for these. Unfortunately, this “silent” disease is too often forgotten.

The greatest risk for having another osteoporotic fracture is having already had one. Prevention strategies are therefore best targeted at this high risk group.

In this group, the disease is no longer silent.

Sadly, most patients presenting to hospitals with an osteoporotic fracture (also referred to as a minimal trauma fracture) are getting a surgical fix or a cast, but not assessed and therefore, not treated for osteoporosis. Between 20-50% of all patients who have suffered one of these osteoporotic fractures will have subsequent fractures.

This of course causes pain, suffering, disability and loss of independence. It also costs hospitals, and therefore governments, a lot of bedtime and money.

Professor Seibel and a team of clinicians and researchers at Concord Hospital, Sydney, recently published the 4-year follow-up results of a coordinated fracture liaison service on re-fracture rates in patients with previous minimal trauma fractures.

A simple coordinated team approach to actively identify these patients followed by diagnostic tests, and simple, standard treatment resulted in a reduction of 80% of recurrent fractures after an initial osteoporotic fracture! Health economic analyses also indicate that this sort of fracture liaison service is highly cost effective to society.

This effective prevention of a bad disease does not depend on high tech measures. It just depends on the health system caring enough to set up a simple fracture prevention service.

To date, most hospitals in Sydney do not have such fracture liaison services. I am not aware of any such services set up in the community setting.

Don’t you think it’s worth preventing the next fracture in the group of people at highest risk of developing recurrent fractures? BJC Health does.

Phil Mickelson & Psoriatic Arthritis

It’s a good day for disease awareness when a celebrity actually “comes out” and tells the world that they have that disease.

In Australia, Kylie Minogue and Jane McGrath come to mind as their battles with breast cancer brought lots of media attention. The McGrath Foundation continues to make a big difference, both in its charitable activities and in maintaining a high public profile.

Arthritis gets much less press. Much less attention.

Golfer Phil Mickelson has recently been diagnosed with psoriatic arthritis. This high profile sportsman then teamed up with two pharmaceutical companies, Amgen and Pfizer, as well as with the Joint Smart Coalition (a shared project of both the National Psoriasis Foundation and the Arthritis Foundation) to help increase awareness of this disease.

A website called On Course with Phil has been set up as an education resource for those with psoriasis.

Psoriatic arthritis is not a pleasant disease to have as Phil discovered. It’s another arthritis that is often undiagnosed and poorly managed, due to general lack of awareness about it.

While we can feel sorry for Phil, it’s a win for disease awareness.

Breaking the 80kg barrier

By Errol Lim, Physiotherapist

It has not been that hard. Breaking the 80 kg barrier is a wonderful personal milestone. It has been a few years since I have seen such numbers when standing on the weighing scales.

I won’t lie as it has taken some effort but by no means has it been torturous. Monica, my dietitian has an innate ability to motivate change especially in a facet of my life which I have held on to so dearly for my entire life – eating well. Eating has been my first love which I am sure many of you can appreciate. It has given me such pleasure but with a poor family history of high blood pressure, heart attacks and strokes, it was time for change.

I always knew that dietitians asked their clients to fill in food diaries but I did not realise the significance until doing one myself. Having to write down every single item which goes through your mouth on a piece of paper is a very powerful tool. It makes you think twice before eating something. It also gives you and your dietitian an overall picture of what you are ingesting through the week allowing for appropriate monitoring and goal setting.

I attribute my success thus far to Monica. She has not changed my diet significantly but has made me eat at more appropriate times, and given me food options and advice which I have never considered before. It is obvious that my metabolism is much improved. Weekly reviews with Monica have been necessary to allow for smaller achievable goals to be set. Her encouragement at these weekly sessions have been vital. I liken it to an athlete training hard to please their coach.

As of today, I have lost about 5.5kg in weight and my blood pressure is on the way down. I feel the best I have felt for the past 5 years, thanks to a combination of dietetic, physiotherapy and exercise management.

Perhaps this can inspire those of you who have a busy schedule just as I do. It would be great to hear from you.

Errol Lim is a physiotherapist and a director of BJC Health.