In this issue...

Spotlight on doctors in a digital world 

There’s no doubt that medicine no longer looks the way it did 50, 20 or even 10 years ago. The advent of new diagnostic tools, doctors working in partnership with their patients to support their care, telemedicine and new treatments have all brought robust changes for the profession.

In a bid to do what’s best for our patients, many of us make ourselves “always available” and there’s a device nearby at all times, “just in case”. This edition shines a light on how to best navigate common digital dilemmas, from the diagnostic quick pic shared with others, to the Facebook friend request from a patient, and how to ensure we maintain our ethical and professional responsibilities to those to whom we provide care.

On another note, as GPs deal with a horror flu season and measles outbreaks this year, we spoke to Dr Vicky Sheppeard, Director Communicable Diseases with NSW Health, who shared her advice on how to ensure the cold chain storage system at your practice is not compromised and meets national standards.

Similarly, recent complaints to Council regarding pain and scarring associated with OS cryotherapy suggest a need to brush up our knowledge and communication skills in this area. We have included a short article aimed at supporting better clinical practice and patient safety.

I encourage you to share your feedback and suggestions about the Council’s
e-newsletter and future online articles so we can improve this service to you.  You can email the team with your ideas at communications.team@mcnsw.org.au

Kind regards,

Associate Professor Richard Walsh, President, Medical Council of NSW

Stay between 2 and 8 to (safely) vaccinate

While there has been a high demand for flu and measles vaccines of late, these vaccines and others are only effective if they are stored correctly.

Flu season reminds us that vaccination storage is an important issue in general practice. Vaccines are delicate biological products: if we don’t protect them, they don’t protect our community.

Dr Vicky Sheppeard, Director of Communicable Diseases with NSW Health, provides some timely advice on storing vaccines safely and properly.

Friend request or patient at best?

Privacy, confidentiality and trust are at the core of every doctor/patient relationship. With social media providing potential for others to connect and engage with us, how can doctors ensure they maintain professional boundaries with patients when online?

Cryotherapy - are you getting it right?

Cryotherapy is often used in general practice, skin cancer medicine and dermatology to treat a number of common skin lesions. It is an established and inexpensive treatment and one of the most commonly used MBS items in general practice in Australia. A commonly used cryotherapy technique is timed spot freeze open spray (OS) which involves the use of a liquid nitrogen spray gun with a spray tip attachment.

Recently the Medical Council has received a number of serious complaints from patients related to pain and scarring associated with the use of OS cryotherapy by general practitioners.

The Council’s concerns include failure by practitioners to explain to patients the potential outcomes from the technique, alternative treatment options, and not applying safe and appropriate practice regarding the length and number of freeze-thaw cycles.

To avoid unexpected outcomes, distressed patients and potential complaints it is important when using cryotherapy to:

• Be confident in your diagnosis regarding the type of lesion because this is crucial in determining the dose and number of repeat treatments required.
• Clearly communicate with your patient to ensure you have their informed consent. In particular, it is important your patient is aware of:
  • the pain associated with cryotherapy depending on the location of the lesion;
  • the possible outcomes of cryotherapy such as ulceration and scarring; and
  • alternative modes of treatment available for a patient’s lesion such as wart paints, field treatments or excision
• ​Use a well-accepted guide as to the length and number of freezes. A good reference is Optimising Cryosurgery Technique (2017) a peer-reviewed guide published by the Royal Australian College of General Practitioners.

More information: 

• Australian College of Rural and Remote Medicine: a video by dermatologist
  Dr Lynda Spelman. Watch the video.

Test your knowledge

What does Optimising Cryosurgery Technique recommend as the appropriate freeze duration and number of freeze-thaw cycles (FTC) cryotherapy OS treatment of an actinic keratosis?

 A.  5 seconds x 1 FTC?  

   B. 15 seconds x 1 FTC?    

C. 30 seconds x 1 FTC?

Find out the correct answer at the end of our e-newsletter.

Image source: DermNet NZ. Licensed under Creative Commons.

Meet our Council members:
Maria Cosmidis and Dr Geoffrey Brieger

Maria Cosmidis and Dr Geoff Brieger sat down with us to talk about their experience and role as Medical Council members. From their perspective as decision-makers, they share insights about steps doctors can take to avoid a complaint and what to do if they are the subject of a complaint to the Council.

Clinical images – don’t let diagnostic snaps be your downfall

Asking for advice on a diagnostic photo is as simple as snap, click, send. But what is the purpose of taking the photo? Did you seek the patient’s permission? How can you maintain confidentiality once you hit send? Read more to see how to avoid breaching patient privacy

News bites 

What is correct answer to our cryotherapy question?

The answer is B.  Optimising Cryosurgery Technique recommends 15 seconds as the appropriate freeze duration and one freeze-thaw cycle (FTC) cryotherapy OS treatment of an actinic keratosis

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