We’re only using a fraction of health workers’ skills. This needs to change
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Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.
There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.
But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.
These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.
There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.
A new vision for general practice
I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.
But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.
The future of primary care is one involving more use of the range of health professionals, in addition to GPs.
It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.
This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.
How about pharmacists?
An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.
This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.
But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.
Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.
GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.
Who pays for all this?
Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.
Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.
This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.
In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.
In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.
The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.
Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What’s Your Plant Diversity Score?
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We speak often about the importance of dietary diversity, and of that, especially diversity of plants in one’s diet, but we’ve never really focused on it as a main feature, so that’s what we’re going to do today.
Specifically, you may have heard the advice to “eat 30 different kinds of plants per week”. But where does that come from, and is it just a number out of a hat?
The magic number?
It is not, in fact, a number out of a hat. It’s from a big (n=11,336) study into what things affect the gut microbiome for better or for worse. It was an observational population study, championing “citizen science” in which volunteers tracked various things and collected and sent in various samples for analysis.
The most significant finding of this study was that those who consumed more than 30 different kinds of plants per week, had a much better gut microbiome than those who consumed fewer than 10 different kinds of plants per week (there is a bell curve at play, and it gets steep around 10 and 30):
American Gut: an Open Platform for Citizen Science Microbiome Research
Why do I care about having a good gut microbiome?
Gut health affects almost every other kind of health; it’s been called “the second brain” for the various neurotransmitters and other hormones it directly makes or indirectly regulates (which in turn affect every part of your body), and of course there is the vagus nerve connecting it directly to the brain, impacting everything from food cravings to mood swings to sleep habits.
See also:
Any other benefits?
Yes there are! Let’s not forget: as we see often in our “This or That” section, different foods can be strong or weak in different areas of nutrition, so unless we want to whip out a calculator and database every time we make food choices, a good way to cover everything is to simply eat a diverse diet.
And that goes not just for vitamins and minerals (which would be true of animal products also), but in the case of plants, a wide range of health-giving phytochemicals too:
Measuring Dietary Botanical Diversity as a Proxy for Phytochemical Exposure
Ok, I’m sold, but 30 is a lot!
It is, but you don’t have to do all 30 in your first week of focusing on this, if you’re not already accustomed to such diversity. You can add in one or two new ones each time you go shopping, and build it up.
As for “what counts”: we’re counting unprocessed or minimally-processed plants. So for example, an apple is an apple, as are dried apple slices, as is apple sauce. Any or all of those would count as 1 plant type.
Note also that we’re counting types, not totals. If you’re having apple slices with apple sauce, for some reason? That still only counts as 1.
However, while apple sauce still counts as apples (minimally processed), you cannot eat a cake and say “that’s 2 because there was wheat and sugar cane somewhere in its dim and distant history”.
Nor is your morning espresso a fruit (by virtue of coffee beans being the fruit of the plant, botanically speaking). However, it would count as 1 plant type if you eat actual coffee beans—this writer has been known to snack on such; they’re only healthy in very small portions though, because their saturated fat content is a little high.
You, however, count grains in general, as well as nuts and seeds, not just fruits and vegetables. As for herbs and spices, they count for ¼ each, except for salt, which might get lumped in with spices but is of course not a plant.
How to do it
There’s a reason we’re doing this in our Saturday Life Hacks edition. Here are some tips for getting in far more plants than you might think, a lot more easily than you might think:
- Buy things ready-mixed. This means buying the frozen mixed veg, the frozen mixed chopped fruit, the mixed nuts, the mixed salad greens etc. This way, when you’re reaching for one pack of something, you’re getting 3–5 different plants instead of one.
- Buy things individually, and mix them for storage. This is a more customized version of the above, but in the case of things that keep for at least a while, it can make lazy options a lot more plentiful. Suddenly, instead of rice with your salad you’re having sorghum, millet, buckwheat, and quinoa. This trick also works great for dried berries that can just be tipped into one’s morning oatmeal. Or, you know, millet, oats, rye, and barley. Suddenly, instead of 1 or 2 plants for breakfast you have maybe 7 or 8.
- Keep a well-stocked pantry of shelf-stable items. This is good practice anyway, in case of another supply-lines shutdown like at the start of the COVID-19 pandemic. But for plant diversity, it means that if you’re making enchiladas, then instead using kidney beans because that’s what’s in the cupboard, you can raid your pantry for kidney beans, black beans, pinto beans, fava beans, etc etc. Yes, all of them; that’s a list, not a menu.
- Shop in the discount section of the supermarket. You don’t have shop exclusively there, but swing by that area, see what plants are available for next to nothing, and buy at least one of each. Figure out what to do with it later, but the point here is that it’s a good way to get suggestions of plants that you weren’t actively looking for—and novelty is invariably a step into diversity.
- Shop in a different store. You won’t be able to beeline the products you want on autopilot, so you’ll see other things on the way. Also, they may have things your usual store doesn’t.
- Shop in person, not online—at least as often as is practical. This is because when shopping for groceries online, the store will tend to prioritize showing you items you’ve bought before, or similar items to those (i.e. actually the same item, just a different brand). Not good for trying new things!
- Consider a meal kit delivery service. Because unlike online grocery shopping, this kind of delivery service will (usually) provide you with things you wouldn’t normally buy. Our sometimes-sponsor Purple Carrot is a fine option for this, but there are plenty of others too.
- Try new recipes, especially if they have plants you don’t normally use. Make a note of the recipe, and go out of your way to get the ingredients; if it seems like a chore, reframe it as a little adventure instead. Honestly, it’s things like this that keep us young in more ways than just what polyphenols can do!
- Hide the plants. Whether or not you like them; hide them just because it works in culinary terms. By this we mean; blend beans into that meaty sauce; thicken the soup with red lentils, blend cauliflower into the gravy. And so on.
One more “magic 30”, while we’re at it…
30g fiber per day makes a big (positive) difference to many aspects of health. Obviously, plants are where that comes from, so there’s a big degree of overlap here, but most of the tips we gave are different, so for double the effectiveness, check out:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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Somatic Exercises For Nervous System Regulation – by Rose Kilian
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We’ve written before about the vagus nerve, its importance, and how to make use of it, but it’s easy to let it slip from one’s mind when it comes to exercises. This book fixes that!
The promised 35 exercises are quite a range, and are organized into sections:
- Revitalizing through breath
- Stress and tension release
- Spinal and postural health
- Mindfulness and grounding
- Movements for flexibility
- Graceful balance and focus
While it’s not necessary to do all 35 exercises, it’s recommended to do at least some from each section, to “cover one’s bases”, and enjoy the best of all worlds.
The exercises are drawn from many sources, but tai chi and yoga are certainly the most well-represented. Others, meanwhile, are straight from physiotherapy or are things one might expect to be advised at a neurology consultation.
Bottom line: if you’d like to take better care of your vagus nerve, the better for it to take care of you, this book can certainly help with that.
Click here to check out Somatic Exercises For Nervous System Regulation, and take care of yourself!
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The Couple’s Guide to Thriving with ADHD – by Melissa Orlov and Nancie Kohlenberger
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ADHD (what a misleadingly-named condition) is most often undiagnosed in adults, especially older adults, and has far-reaching effects. This book explores those!
Oftentimes ADHD is not a deficit of attention, it’s just a lack of choice about where one’s attention goes. And the H? It’s mostly not what people think it is. The diagnostic criteria have moved far beyond the original name.
But in a marriage, ADHD symptoms such as wandering attention, forgetfulness, impulsiveness, and a focus on the “now” to the point of losing sight of the big picture (the forgotten past and the unplanned future), can cause conflict.
The authors write in a way that is intended for the ADHD and/or non-ADHD partner to read, and ideally, for both to read.
They shine light on why people with or without ADHD tend towards (or away from) certain behaviours, what miscommunications can arise, and how to smooth them over.
Best of all, an integrated plan for getting you both on the same page, so that you can tackle anything that arises, as the diverse team (with quite different individual strengths) that you are.
Bottom line: if you or a loved one has ADHD symptoms, this book can help you navigate and untangle what can otherwise sometimes get a little messy.
Click here to check out The Couple’s Guide to Thriving with ADHD, and learn how to do just that!
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Codependent No More – by Melody Beattie
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This is a book review, not a book summary, but first let’s quickly cover a common misconception, because the word “codependent” gets misused a lot in popular parlance:
- What codependence isn’t: “we depend on each other and must do everything together”
- What codependence is:“person 1 has a dependency on a substance (or perhaps a behavior, such as gambling); person 2 is trying to look after person 1, and so has developed a secondary relationship with the substance/behavior. Person 2 is now said to be codependent, because it becomes all-consuming for them too, even if they’re not using the substance/behavior directly”
Funny how often it happens that the reality is more complex than the perception, isn’t it?
Melody Beattie unravels all this for us. We get a compassionate and insightful look at how we can look after ourselves, while looking after another. Perhaps most importantly: how and where to draw a line of what we can and cannot do/change for them.
Because when we love someone, of course we want to fight their battles with them, if not for them. But if we want to be their rock of strength, we can’t get lost in it too, and of course that hurts.
Beatty takes us through these ideas and more, for example:
- How to examine our own feelings even when it’s scary
- How to practice self-love and regain self-worth, while still caring for them
- How to stop being reactionary, step back, and act with purpose
If the book has any weak point, it’s that it repeatedly recommends 12-step programs, when in reality that’s just one option. But for those who wish to take another approach, this book does not require involvement in a 12-step program, so it’s not a barrier to usefulness.
Click here to check out Codependent No More and take care of yourself, too
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Understanding Spinach Oxalates and Health
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Interesting, but… Did you know spinach is high in oxylates? Some people are sensitive and can cause increased inflammation, joint pain or even kidney stones. Moderation is key. My sister and I like to eat healthy but found out by experience that too much spinach salad caused us joint and other aches.❞
It’s certainly good to be mindful of such things! For most people, a daily serving of spinach shouldn’t cause ill effects, and certainly there are other greens to eat.
We wondered whether there was a way to reduce the oxalate content, and we found:
How to Reduce Oxalic Acid in Spinach: Neutralizing Oxalates
…which led us this product on Amazon:
Nephure Oxalate Reducing Enzyme, Low Oxalate Diet Support
We wondered what “nephure” was, and whether it could be trusted, and came across this “Supplement Police” article about it:
Nephure Review – Oxalate Reducing Enzyme Powder Health Benefits?
…which honestly, seems to have been written as a paid advertisement. But! It did reference a study, which we were able to look up, and find:
In vitro and in vivo safety evaluation of Nephure™
…which seems to indicate that it was safe (for rats) in all the ways that they checked. They did not, however, check whether it actually reduced oxalate content in spinach or any other food.
The authors did declare a conflict of interest, in that they had a financial relationship with the sponsor of the study, Captozyme Inc.
All in all, it may be better to just have kale instead of spinach:
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Fiber Fueled – by Dr. Will Bulsiewicz
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We generally know that for gut health we should eat fiber, but what of the balances of different sorts of fiber?
That’s one of the main things that make this book stand out—fostering diversity in our microbiome by fostering diversity in our diet. Specifically, diversity of fiber-containing foods.
The book is part “science made easy for the lay reader”, and part recipe book. The recipes come with shopping lists and a meal planner, though we would recommend to use those as a guide rather than to try to adhere perfectly to them.
In particular, this reviewer would encourage much more generous use of healthful seasonings… and less reliance on there being leftovers several days later (tasty food gets gone quickly in this house!)
As for the science, the feel of this is more like reading a science-based observational documentary with explanations, than of reading a science textbook. Studies are mentioned in passing, but not dissected in any detail, and the focus is more on getting the key learnings across.
Bottom line: if you’d like to boost not just the amount, but also the diversity, of fiber in your diet, and reap the gut-health rewards, this book is a great guide for that!
Click here to get your copy of “Fiber Fueled” from Amazon today!
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