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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Tech Bliss – by Clo S., MSc.
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The popular idea of a “digital detox” is simple enough, “just unplug!”, they say.
But here in the real world, not only is that often not practical for many of us, it may not always even be entirely desirable. The Internet (and our devices with all their bells and whistles) can be a source of education, joy, and connection!
So, how to find out what’s good for us and what’s not, in our daily digital practices? Clo. S. has answers… Or rather, experiments for us to do and find out for ourselves.
These experiments range from the purely practical “try this to streamline your experience” to the more personal “how does this thing make you feel?”. A lot of the experiments will be performed via your digital devices—some, without! Others are about online interpersonal dynamics, be they one-on-one or navigating a world in which it seems everyone is out to get us, our outrage, and/or our money. Still yet others are about optimizing what you do get from the parts of your digital experience that are enriching for you.
As the title suggests, there are 30 experiments, and it’s not a stretch to do them one per day for a month. But, as the author notes, it’s by no means necessary to do them like that; it’s a workbook and reference guide, not a to-do list!
(On the topic of it being a reference guide…There’s also an extensive tools directory towards the end!)
In short: this is a great book for optimizing your online experience—whatever that might mean for you personally; you can decide for yourself along the way!
Click here to get a copy of Tech Bliss: 30 Experiments For Your Digital Wellness today!
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Plant-Based Salmon Recipe
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From Tofu to Salmon
This video (below) by SweetPotatoSoul isn’t just a recipe tutorial; it’s an inspiring journey into the world of vegan cooking, proving that reducing animal products doesn’t have to mean sacrificing flavor.
The key to her vegan salmon is the tofu. However, there’s a trick to the tofu – you have to press it.
Essentially, this involved putting some paper towel on either side of the tofu, and then placing a heavy object on top; this removes excess water and, more importantly, primes the tofu to absorb the flavor of your marinade!
(You’ll want to press the tofu for around 1 hour)
Find the rest of the recipe in the 12-minute video below!
Other Plant-Based Recipes
With there being so many benefits of cutting meat out of your diet, we’ve spent the time reviewing some of the top books on vegan recipes, including The Green Roasting Tin and The Vegan Instant Pot Cookbook. We hope you enjoy them as much as you’ll enjoy this recipe:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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The Rise Of The Machines
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In this week’s health science news, several pieces of technology caught our eye. Let’s hope these things roll out widely!
When it comes to UTIs, antimicrobial resistance is taking the p—
This has implications far beyond UTIs—though UTIs can be a bit of a “canary in the coal mine” for antimicrobial resistance. The more people are using antibiotics (intentionally, or because they are in the food chain), the more killer bugs are proliferating instead of dying when we give them something to kill them. And yes: they do proliferate sometimes when given antibiotics, not because the antibiotics did anything directly good for them, but because they killed their (often friendly bacteria) competition. Thus making for a double-whammy of woe.
This development tackles that, by using AI modelling to crunch the numbers of a real-time data-driven personalized approach to give much more accurate treatment options, in a way that a human couldn’t (or at least, couldn’t at anything like the same speed, and most family physicians don’t have a mathematician locked in the back room to spend the night working on a patient’s data).
Read in full: AI can help tackle urinary tract infections and antimicrobial resistance
Related: AI: The Doctor That Never Tires?
When it comes to CPR and women, people are feint of heart
When CPR is needed, time is very much of the essence. And yet, bystanders are much less likely to give CPR to a woman than to a man. Not only that, but CPR-training is part of what leads to this reluctance when it comes to women: the mannequins used are very homogenous, being male (94%) and lean (99%). They’re also usually white (88%) even in countries where the populations are not, but that is less critical. After all, a racist person is less likely to give CPR to a person of color regardless of what color the training mannequin was.
However, the mannequins being male and lean is an issue, because it means people suddenly lack confidence when faced with breasts and/or abundant body fat. Both can prompt the bystander to wonder if some different technique is needed (it isn’t), and breasts can also prompt the bystander to fear doing something potentially “improper” (the proper course of action is: save a person’s life; do not get distracted by breasts).
Read in full: Women are less likely to receive CPR than men. Training on manikins with breasts could help ← there are also CPR instructions (and a video demonstration) there, for anyone who wants a refresher, if perhaps your last first-aid course was a while ago!
Related: Heart Attack: His & Hers (Be Prepared!)
When technology is a breath of fresh air
A woman with COPD and COVID has had her very damaged lungs replaced using a da Vinci X robot to perform a minimally-invasive surgery (which is quite a statement, when it comes to replacing someone’s lungs).
Not without human oversight though—surgeon Dr. Stephanie Chang was directing the transplant. Surgery is rarely fun for the person being operated on, but advances like this make things go a lot more smoothly, so this kind of progress is good to see.
Read in full: Woman receives world’s first robotic double-lung transplant
Related: Why Chronic Obstructive Pulmonary Disease (COPD) Is More Likely Than You Think
Take care!
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5 Ways To Beat Cancer (And Other Diseases)
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A Systematic Approach To Healthy Eating
This is Dr. William Li. He’s a physician, cancer researcher, and educator. He also founded the Angiogenesis Foundation back in 1994.
We recently reviewed one of his books, “Eat To Beat Disease”.
He has another book that we haven’t reviewed at time of writing, “Eat To Beat Your Diet“, which you might like to check out.
What does he want us to know?
He wants us to know how to eat to beat cancer and other diseases, by means of five specific angles:
Angiogenesis
This is about replacing blood vessels, which of course happens all the time, but it becomes a problem when it is feeding a cancer in the process.
Here, based on Dr. Li’s work, is what can be done about it:
A List of Anti-Angiogenic Foods for a Cancer-Fighting Diet
Regeneration
Generally speaking, we want to replace healthy cells early, because if we wait until they get damaged, then that damage will be copied forwards. As well as intermittent fasting, there are other things we can do to promote this—even, Dr. Li’s research shows, for stem cells:
Doctor’s Tip: Regeneration (stem cells)—one of your body’s five defense systems
Microbiome health
Healthy gut, healthy rest of the body. We’ve written about this before:
Making Friends With Your Gut (You Can Thank Us Later)
DNA protection
DNA gets unravelled and damaged with age, the telomere caps get shorter, and mistakes get copied forward. So there more we can protect our DNA, the longer we can live healthily. There are many ways to do this, but Dr. Li was one of the first to bring to light the DNA-protecting benefits of kiwi fruit:
Immunity
Paradoxically, what’s good for your immune system (making it stronger) also helps to protect against autoimmune diseases (for most people, for the most part).
In short: it’s good to have an immune system that’s powerful not just in its counterattacks, but also in its discerning nature. There are dietary and other lifestyle approaches to both, and they’re mostly the same things:
Beyond Supplements: The Real Immune-Boosters!
and thus see also:
Want to know more?
You might enjoy his blog or podcast, and here’s his TED talk:
Want to watch it, but not right now? Bookmark it for later
Enjoy!
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Statins: His & Hers?
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The Hidden Complexities of Statins and Cardiovascular Disease (CVD)
This is Dr. Barbara Roberts. She’s a cardiologist and the Director of the Women’s Cardiac Center at one of the Brown University Medical School teaching hospitals. She’s an Associate Clinical Professor of Medicine and takes care of patients, teaches medical students, and does clinical research. She specializes in gender-specific aspects of heart disease, and in heart disease prevention.
We previously reviewed Dr. Barbara Roberts’ excellent book “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs”. It prompted some requests to do a main feature about Statins, so we’re doing it today. It’s under the auspices of “Expert Insights” as we’ll be drawing almost entirely from Dr. Roberts’ work.
So, what are the risks of statins?
According to Dr. Roberts, one of the biggest risks is not just drug side-effects or anything like that, but rather, what they simply won’t treat. This is because statins will lower LDL (bad) cholesterol levels, without necessarily treating the underlying cause.
Imagine you got Covid, and it’s one of the earlier strains that’s more likely deadly than “merely” debilitating.
You’re coughing and your throat feels like you gargled glass.
Your doctor gives you a miracle cough medicine that stops your coughing and makes your throat feel much better.
(Then a few weeks later, you die, because this did absolutely nothing for the underlying problem)
You see the problem?
Are there problematic side-effects too, though?
There can be. But of course, all drugs can have side effects! So that’s not necessarily news, but what’s relevant here is the kind of track these side-effects can lead one down.
For example, Dr. Roberts cites a case in which a woman’s LDL levels were high and she was prescribed simvastatin (Zocor), 20mg/day. Here’s what happened, in sequence:
- She started getting panic attacks. So, her doctor prescribed her sertraline (Zoloft) (a very common SSRI antidepressant) and when that didn’t fix it, paroxetine (Paxil). This didn’t work either… because the problem was not actually her mental health. The panic attacks got worse…
- Then, while exercising, she started noticing progressive arm and leg weakness. Her doctor finally took her off the simvastatin, and temporarily switched to ezetimibe (Zetia), a less powerful nonstatin drug that blocks cholesterol absorption, which change eased her arm and leg problem.
- As the Zetia was a stopgap measure, the doctor put her on atorvastatin (Lipitor). Now she got episodes of severe chest pressure, and a skyrocketing heart rate. She also got tremors and lost her body temperature regulation.
- So the doctor stopped the atorvastatin and tried rosovastatin (Crestor), on which she now suffered exhaustion (we’re not surprised, by this point) and muscle pains in her arms and chest.
- So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
- So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
- So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
- So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
- She did her own research, and went back to the doctor to ask for cholestyramine (Questran), which is a bile acid sequestrent and nothing to do with statins. She also asked for a long-acting niacin. In high doses, niacin (one of the B-vitamins) raises HDL (good) cholesterol, lowers LDL, and lowers tryglycerides.
- Her own non-statin self-prescription (with her doctor’s signature) worked, and she went back to her life, her work, and took up running.
Quite a treatment journey! Want to know more about the option that actually worked?
Read: Bile Acid Resins or Sequestrants
What are the gender differences you/she mentioned?
Actually mostly sex differences, since this appears to be hormonal (which means that if your hormones change, so will your risk). A lot of this is still pending more research—basically it’s a similar problem in heart disease to one we’ve previously talked about with regard to diabetes. Diabetes disproportionately affects black people, while diabetes research disproportionately focuses on white people.
In this case, most heart disease research has focused on men, with women often not merely going unresearched, but also often undiagnosed and untreated until it’s too late. And the treatments, if prescribed? Assumed to be the same as for men.
Dr. Roberts tells of how medicine is taught:
❝When I was in medical school, my professors took the “bikini approach” to women’s health: women’s health meant breasts and reproductive organs. Otherwise the prototypical patient was presented as a man.❞
There has been some research done with statins and women, though! Just, still not a lot. But we do know for example that some statins can be especially useful for treating women’s atherosclerosis—with a 50% success rate, rather than 31% for men.
For lowering LDL itself, however, it can work but is generally not so hot in women.
Fun fact:
In men:
- High total cholesterol
- High non-HDL cholesterol
- High LDL cholesterol
- Low HDL cholesterol
…are all significantly associated with an increased risk of death from CVD.
In women:
…levels of LDL cholesterol even more than 190 were associated with only a small, statistically insignificant increased risk of dying from CVD.
So…
The fact that women derive less benefit from a medicine that mainly lowers LDL cholesterol, may be because elevated LDL cholesterol is less harmful to women than it is to men.
And also: Treatment and Response to Statins: Gender-related Differences
And for that matter: Women Versus Men: Is There Equal Benefit and Safety from Statins?*
Definitely a case where Betteridge’s Law of Headlines applies!
What should women do to avoid dying of CVD, then?
First, quick reminder of our general disclaimer: we can’t give medical advice and nothing here comprises such. However… One particularly relevant thing we found illuminating in Dr. Roberts’ work was this observation:
The metabolic syndrome is diagnosed if you have three (or more) out of five of the following:
- Abdominal obesity (waist >35″ if a woman or >40″ if a man)
- Fasting blood sugars of 100mg/dl or more
- Fasting triglycerides of 150mg/dl or more
- Blood pressure of 130/85 or higher
- HDL <50 if a woman or <40 if a man
And yet… because these things can be addressed with exercise and a healthy diet, which neither pharmaceutical companies nor insurance companies have a particular stake in, there’s a lot of focus instead on LDL levels (since there are a flock of statins that can be sold be lower them)… Which, Dr. Roberts says, is not nearly as critical for women.
So women end up getting prescribed statins that cause panic attacks and all those things we mentioned earlier… To lower our LDL, which isn’t nearly as big a factor as the other things.
In summary:
Statins do have their place, especially for men. They can, however, mask underlying problems that need treatment—which becomes counterproductive.
When it comes to women, statins are—in broad terms—statistically not as good. They are a little more likely to be helpful specifically in cases of atherosclerosis, whereby they have a 50/50 chance of helping.
For women in particular, it may be worthwhile looking into alternative non-statin drugs, and, for everyone: diet and exercise.
Further reading: How Can I Safely Come Off Statins?
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Coconut vs Avocado – Which is Healthier?
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Our Verdict
When comparing coconut to avocado, we picked the avocado.
Why?
In terms of macros, avocado is lower in carbs and also in net carbs—coconut’s a little higher in fiber, but not enough to make up for the difference in carbs nor, when it comes to glycemic index and insulin index, the impact of coconut’s much higher fat content on insulin responses too. On which note, while coconut’s fats are broadly considered healthy (its impressive saturated fat content is formed of medium-chain triglycerides which, in moderation, are heart-healthy), avocado’s fats are even healthier, being mostly monounsaturated fat with some polyunsaturated (and about 15x less saturated fat). All in all, a fair win for avocado on the macros front, but coconut isn’t bad in moderation.
When it comes to vitamins, avocados are higher in vitamins A, B1, B2, B3, B5, B6, B9, C, E, K, and choline. Most of those differences are by very large margins. Coconuts are not higher in any vitamins. A huge, easy, “perfect score” win for avocados.
In the category of minerals, however, it’s coconut’s turn to sweep with more calcium, copper, iron, magnesium, manganese, phosphorus, zinc, and selenium—though the margins are mostly not nearly as impressive as avocado’s vitamin margins. Speaking of avocados, they do have more potassium than coconuts do, but the margin isn’t very large. A compelling win for coconut’s mineral content.
Adding up the sections, we get to a very credible win for avocados, but coconuts are also very respectable. So, as ever, enjoy both (although we do recommend exercising moderation in the case of coconuts, mainly because of the saturated fat content), and if you’re choosing between them for some purpose, then avocado will generally be the best option.
Want to learn more?
You might like to read:
- Can Saturated Fats Be Healthy? ← defying Betteridge’s Law here!
- Avocado, Coconut & Lime Crumble Pots ← if you do want to enjoy both, here’s a fabulous way to do so in style
Take care!
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