The will to will

2 Nov

We had an interesting phone call last week from a patient wanting to know how to ensure his father’s will would be valid. The elderly father (not a patient of our clinic) wanted to update his will. The solicitor insisted he receive approval from his GP regarding his mental competency to draft the will and therefore sent him to his own GP. The GP performed a brief exam of his mental state and declared that he (the GP) would not be able to provide endorsement of mental competence, and that the patient would need to see a specialist.  The patient who rang us wanted to know if that was correct.

By coincidence, a couple of days later one of the leading medical defence companies put out an advisory note for GPs about what to do when asked to assess a patient for competence.  Essentially, the GP needs to be sure that the patient understands the implications of the will that they are drafting and that there be no evidence that they are under any pressure to fashion it or sign it by any particular family member.

To assess competency, the GP will usually perform a mini-mental status exam – a series of questions that demonstrate short term memory, long term memory and interpretation of instructions. The test is not particularly sensitive but is quick, simple to apply and a reasonable first effort to assess someone’s mental capacity.  Neither a pass nor “fail” (there isn’t actually a fail score – just an indication of degrees of impairment) is an absolute guarantee of competence or incompetence but is a reasonable indication.

The GP would also need to be certain that the patient preparing the will understands the implication of the document they are signing; that they have a good understanding of the assets they are willing and that they have thought about the implications for anyone else that may have a claim to the estate but is not included. Note that some patients with early dementia would still be able to satisfy those standards.

Assuming the above criteria are met, the GP would be able to confirm that the patient has competence to prepare their will. The onus on the GP is actually quite high, and many GPs are very nervous about being subsequently dragged into a court dispute over the will which may involve them being grilled on their experience, expertise and the exact details of the assessment they performed. Therefore if your GP does refer you (or a family member) to a neurologist, geriatrician, psychiatrist or neuropsychologist for further assessment, its not being done just to annoy you, but because the GP is simply not in a position to unequivocally sign the paperwork.

And of course one implication of the above is that you should prepare your will (or ensure your parents prepare theirs) BEFORE any question of impaired competency arises.

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Mother and child

28 Oct

We all know:
– that vaccines are very effective (but nothing is perfect) at preventing nasty – even fatal – diseases in childhood;
– that vaccination for kids starts at 2 months of age; and that therefore
– there is a gap in protecting children between birth and their first vaccination at 6-8 weeks of age.

We also know that this is the age group that suffers the most severe disease if they do contract an infection like pertussis (whooping cough).

So how to best prevent newborns from getting infected?

New research from England shows that immunising mothers during pregnancy against whooping cough will decrease the chances of the baby getting whooping cough by around 70%. That’s a great decrease in infection risk, and prevents an incredibly distressing illness. Even if not fatal, whooping cough can make a child very sick (see this video: http://www.youtube.com/watch?v=S3oZrMGDMMw)

If you are planning to get pregnant, come and see us a few months before you start trying. There’s lots to talk about!

Forever young

27 Oct

There is an excellent saying “We don’t stop playing because we get old; we get old because we stop playing.”
Increasingly research seems to show that our mindset can profoundly affect our health. Not just improving our mood by adopting an optimistic attitude – but actually controlling blood pressure, preventing cancer or avoiding infections.
The science is not definite, and the mechanism far from clear -but there are certainly some interesting findings. Most interestingly – it seems that thinking young can actually make you younger!
Read more in this article from the
http://www.nytimes.com/2014/10/26/magazine/what-if-age-is-nothing-but-a-mind-set.html?_r=0

Is perfect too good?

22 Oct

A recent study in the prestigious British Medical Journal raised the question – should there be an acceptable level of mistakes that doctors can make?
Counter-intuitively, striving less hard to always be right may be safer for the patients in the long run. Every test and every treatment has a cost – and not just financially. Tests are unpleasant and time consuming, medications have side effects and surgery often painful and debilitating.
Yet often all these tests and treatments are for no purpose other than “to be sure”. If we accepted that sometimes we will miss conditions in the early stages, it may be possible to significantly decrease the number of tests and treatments we perform.
To be sure that may result in some things being missed. But it will also significantly decrease the number of problems that we cause.
Getting the balance right is the great challenge of modern medicine.

Ebola fear and facts

20 Oct

In a world where the media seems incapable of reporting fact without adding hype, it’s hard to tell the difference between issues which should cause panic and those which are just a curiosity. Where then does Ebola fit?
It’s certainly true that Ebola is a horrific disease. About three weeks after exposure, patients develop headache, fever, abdominal pain, vomiting and diarrhoea and then internal bleeding and shock. There is no specific treatment – just what the medical profession calls supportive care, which means fluids and drugs to keep up blood pressure and circulation.
In Africa, with less advanced medical support, over 70% of patients die. In Western countries, the death rate is still about 50%. By any standard, Ebola is a serious condition.
But currently the risk of Ebola is still pretty remote. There hasn’t yet been a confirmed case in Australia and only a handful in the Western world. Travellers from West Africa are now being screened; understanding of the need for case management and isolation has grown and awareness of the condition is high. The chances of Australia’s first case arising in Rowville or Lysterfield isn’t just low….it’s tiny.
Our advice is stay calm! Have a long talk to us if you are planning a trip to Africa. If you are in close contact with someone who has been to West Africa and you have concerns, please call us to discuss over the phone. In almost all cases, we will be happy to see you. If there is any significant reason for concern, we will arrange for the appropriate hospital to assess you.

When a cancer’s not a cancer

12 Dec

A fascinating article on the website The Conversation discusses whether we should abandon the word “cancer”. Why? Because so many cancers these days are so minor that they won’t ever cause any harm to the patient. But the very act of using the word cancer can frighten people well out of proportion to the danger they face.

This is particularly so for cancers which are found by screening tests. The theory is that finding a cancer in the early stages improves the odds of survival. The best known examples are prostate and breast cancer.

Yet interestingly, after 30 years of screening for breast cancer in the USA, the number of minor cancers detected has doubled … but the number of advanced cancers detected has dropped by less than 10%. In other words, lots of new cancers are being found, but they were unlikely to ever cause any problems even if not discovered. The same applies – perhaps more so – to prostate cancer.

These extra “cancers” also make the figures for treatment look much better. If you “treat” all cancers – including those that aren’t nasty – your survival figures will dramatically improve.

The discussion around renaming these early or minor cancers is part of a movement in medicine against over-diagnosis and over-treatment. Doctors and patients both have a role to play – doctors need to think more clearly about the implications of conditions, and patients need to understand that medicine is not perfect, that we are always learning and re-evaluating our knowledge; and that doing more can be worse than doing less.

The best investment

30 Nov

Best reason to quit smoking #1
Because it’s the single best thing you can do for your health. The life expectancy of a smoker in the year 2000 is the same as the life expectancy of a non-smoker in the year 1900. That is – smoking eliminates all the benefits of antibiotics, anaesthetics, surgery, ambulances, Intensive Care Units etc. There is NOTHING you can do for your health – exercise, lose weight, take cholesterol tablets – that is as effective as stopping smoking.

Best reason to quit smoking #2
Cigarette prices are going up by 12.5% on December 1st due to increased tax and that will continue each year till 2016 (at least).
Assuming a pack costs about $20, a pack-a-day smoker is spending $7300 a year on cigarettes. (How many weeks work does that equate to in your job?)
A 40 year old will spend $182,500 on cigarettes by the time s/he retires. (Of course with the increased tax rises in coming years, that will rise significantly). An 18 year old smoker will spend over $343,000.

Actually both figures are wrong. If a 40 year old were to take their cigarette money and invest in their retirement savings (assuming 9% compound per year), they will retire better off by over $600,000.

And an 18 year old who invests their 30/day cigarette money will retire with an extra …. $4.3million!! (That’s the benefit of compound interest!)

If you want help to stop, we would be delighted to spend time with you talking about the addiction, the habit and the many ways we can help you quit.