When government money comes pouring into the private sector, businesses of dubious character tend to spring up quickly.

The National Disability Insurance Scheme (NDIS) may be one of the biggest facilitators of this at the moment.

As of mid-December, there were 269,432 active NDIS providers across Australia, the vast majority of which (around 94%) are what’s known as unregistered providers. It means they haven’t been audited and approved by the NDIS Quality and Safeguards Commission (NDIS Commission) – one of the main regulators – to make sure they’re delivering quality services and sticking to the rules.

Though there are limits on the types of support they can provide, these businesses have comparatively low start-up costs and can enter the market quickly. In some parts of Australia, unregistered NDIS providers seem to be everywhere, and many are exploiting the sprawling system. Between 2018 and 2024, the number of NDIS participants grew by 452%.

The NDIS currently serves around 761,000 adults and children, and it cost around $49 billion in taxpayer dollars in 2025. Those costs have been predicted by some analysts to rise to $100 billion a year by 2035, overtaking the age pension to become Australia’s most expensive social support program.

The NDIS has been an indispensable life-changer for many, but the scheme remains a work in progress, and it has fallen short of expectations on a number of fronts, especially when it comes to meeting the needs of marginalised groups such as First Nations people and those from culturally and linguistically diverse backgrounds.

A recurring complaint from participants overall is that the NDIS administrative processes are complicated and confusing. The bureaucratic hurdles are many.

It’s also important to point out that nearly half of NDIS providers suffered a financial loss in 2024–25 according to National Disability Services, the peak industry body for non-government disability service organisations.

But there’s a larger overarching issue – that many NDIS providers are more focused on reaping profits from the government-subsidised scheme than on helping people with a disability. This unfortunate fact is contributing heavily to the cost blowouts.

The National Disability Insurance Agency (NDIA) and the NDIS Commission have prime responsibility for regulating the scheme. (The NDIS Commission received 29,054 complaints about providers in 2023–24.)

But NDIS providers are also beholden to the Australian Consumer Law, which is overseen by the Australian Competition and Consumer Commission (ACCC).

The dodgy provider problem is big enough that these three regulators set up a task force in December 2023 to deal with it. In February this year, the ACCC released a report outlining some of the enforcement actions it has taken since then. The transgressions it highlights are standard fare in the broader consumer marketplace – false advertising, overcharging, contracts lopsided in favour of the business, illegal restrictions on returns, and so on.

But when people with a disability are the victims, it gets more concerning.  

Ausnew’s dodgy sales tactics and misleading claims

Shortly after the task force was set up, an NDIS provider called Ausnew Home Care Service came under scrutiny for engaging in tactics reminiscent of the big supermarkets and unscrupulous online retailers. (Ausnew, a registered provider, sells everything from therapeutic pillows to mobility scooters.)

In December 2024 the ACCC took the business to court for allegedly promoting “sales” prices by displaying earlier strikethrough prices complete with “last chance” sales banners and countdown clocks. In fact, the “sales” prices were just the regular prices that were always available, and the strikethrough prices never existed. The ACCC is currently undertaking legal action against both Woolworths and Coles for similar conduct.

Then ACCC Commissioner Liza Carver said that the “artificial urgency” would have misled consumers, “many of whom were elderly or with a disability requiring support”.

Ausnew Home Care Service was also called out for claiming its products were “NDIS approved” on its website and in Google ads, a marketing boast that seems particularly irresistible to certain providers. The problem is that there is no such thing as an NDIS-approved product. The NDIS Commission registers providers, but it doesn’t endorse or approve of particular products.

The way this plays out for NDIS recipients is that they may end up purchasing something – a massage chair for instance – that says or implies it’s NDIS-approved. Then their NDIS claim for reimbursement is rejected because it’s not an eligible support item.

To round out its contraventions of consumer law, Ausnew also made up its own rules about consumer guarantees. Its refund policy imposed various conditions and exclusions on refunds or replacements for faulty goods, including that they had to be returned within seven days of purchase in their original packaging, and that it was up to Ausnew whether to provide a store credit or replacement. According to the law, consumers can demand a repair, replacement or refund in the case of a major fault, with no conditions attached. The Ausnew case is ongoing.

In all of the above, Ausnew is not alone. But the business did manage to tick several non-compliance boxes at once.

False claims of NDIS affiliation

A business claiming a connection with the NDIS when there is none is perhaps the most common form of consumer deception arising from the scheme. Early last year, the retail chain Bedshed paid $39,600 in penalties after the ACCC issued it with two infringement notices for claiming that some of its mattresses, furniture and bedding accessories were “NDIS approved” and “NDIS permitted”.

“Targeting consumers experiencing vulnerability or disadvantage with misleading advertising is particularly concerning, and we are continuing to investigate companies making similar claims,” ACCC chair Gina Cass-Gottlieb said at the time.

Around the same time, Thermomix Australia paid $79,200 in ACCC penalties for claiming its Thermomix TM6 mix and Kobold cordless vacuum and mop were connected with the NDIS.

The misleading promotional language ran the gamut: “NDIS approved”, “NDIS-registered product”, “NDIS-consumables”, “NDIS assistive technology”, and “NDIS equipment”.

“Each NDIS participant has unique needs, and what’s funded under their plan is determined individually, not through a list of approved products. There are no categories of goods or services which are automatically NDIS approved or funded for all NDIS participants,” Cass-Gottlieb said.

The NDIS Commission was recently given new powers to combat fraud, most notably an enforcement tool called Anti-Promotion Orders, which can be imposed on providers who misleadingly promote products as “NDIS approved”.

When the ACCC report was released in February this year, ACCC deputy chair Catriona Lowe sounded a warning to businesses set on putting profits ahead of the needs of people with a disability.

“Harm can range from financial loss and life-limiting impacts, to compromising the safety and physical wellbeing of NDIS participants. Such conduct is completely unacceptable and the ACCC will continue to work with taskforce agencies to protect NDIS participants, educate and hold providers that continue to do the wrong thing accountable.”

How to spot false NDIS advertising

• If it says “NDIS approved” it’s misleading by definition – the NDIS doesn’t approve particular goods or services.
• Don’t trust ads that say NDIS funds will cover “all inclusive” holidays. NDIS funding doesn’t cover costs for participants on holidays. 
• Ads that provide instructions on how to use NDIS funding codes for recreational outings like the movies or theme parks are misleading – the scheme doesn’t cover this.
• Don’t trust businesses that suggest an NDIS affiliation or endorsement in their name, such as “NDIS therapies” and the like.

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But there’s a big problem that has nothing to do with human health: the law currently allows Australian life insurance companies to access genetic test results and take them into account when setting premiums.

Even though a worrisome result generally just means that you’re at a higher risk for a certain disease, life insurance companies will price your premiums as if you’re definitely going to get that disease, or summarily decide not to insure you. And if you pay those inflated premiums for your policy your whole life and end up dying of something else, they won’t be reimbursing the extra premiums to your survivors.

Health professionals have a duty to warn patients about the possible life insurance implications of taking these tests, and the consent forms also carry such warnings.

As a result, many people steer clear of genetic testing, and thereby run the risk of developing a life threatening disease that may have been caught early or prevented.

Use of genetic test results by insurers to be banned

All this is set to change, and it has been a long time coming. In 2018, a Joint Parliamentary Committee Inquiry recommended that Australia immediately ban the use of genetic test results in life insurance, a rule that’s been in effect (with some exceptions) in the UK since 2001.

The practice is also banned in Canada as well as many European countries. In the US, health insurers and employers are prohibited from using genetic information as part of the underwriting or hiring process. 

In November this year, the federal government introduced legislation that would ban the use of genetic test results by life insurers in Australia once and for all. It’s expected to come into effect in mid 2026.

In a statement, Assistant Treasurer Daniel Mulino said the bill “supports medical practitioners to prevent, diagnose, treat and monitor a range of cancers, cancer predisposition syndromes and other heritable conditions”.

He added: “Some people aren’t getting tested because they’re concerned about the impacts of the results of those tests on the affordability and accessibility of life insurance”.

The bill “has broad support across the Parliament”, Mulino said.

Industry self-regulation proved ineffective

The November announcement was the culmination of years of advocacy work by health professionals and other consumer advocates, who faced stiff headwinds from the insurance industry.

There were half-measures along the way. In 2019, the then peak body for the Australian life insurance industry, the Financial Services Council (FSC), forged a compromise, requiring people who applied for life insurance to disclose genetic test results only if the policies had death or permanent disability benefits of more than $500,000. 

But this measure was entirely self-governing. No government agency was checking to see if insurers were following it. (A new peak body, the Council of Australian Life Insurers, was established in 2022.) 

In 2020, the federal government funded a project (called the A-GLIMMER project) to investigate whether this industry self-regulation was working. The final report of the project, published in June 2023, makes clear that the FSC partial ban was far from effective at putting a stop to genetic discrimination in life insurance.

The three-year investigation uncovered several troubling facts, chief among them that some life insurers were ignoring the industry-led partial ban (technically a moratorium) and that the lack of independent oversight meant that no one really knew how widespread the non-compliance was.

The lead investigator on the A-GLIMMER project, Dr Jane Tiller – an ethical, legal and social adviser in public health genomics at Monash University – has long been convinced that a total ban on life insurers’ access to genetic test results is the only answer. 

Health professionals and patients whose views were sought as part of the investigation overwhelmingly agreed.

“Many Australians have been afraid to have genetic testing that could save their lives, because of the potential financial implications of their genetic test results,” Tiller says.

“Life insurers can still legally use genetic test results to deny coverage, increase the cost of premiums or place conditions on cover. This means people are making decisions about genetic testing based on insurance fears, not health needs.”

“Choosing not to have genetic testing means people could miss out on critical health information and access to early intervention or prevention, which can be life-saving.”

Years of industry pushback

Tiller, who has been campaigning against the use of genetic test results by Australian life insurance companies for the past ten years, says the prolonged pushback by insurers in Australia followed a well established pattern.

“Every time a new country embarks on this process, the local industry fights vigorously against it,” Tiller says.

“We certainly faced a lot of opposition in the early days, with the industry very strongly saying that this would have catastrophic implications, that it would impact consumers in bad ways because premiums would rise, that the life insurance industry would be unsustainable. These claims were made in other countries as well. So for the first several years, it was very hard to get any traction.”

The A-GLIMMER investigation put a fine point on what happens when profit motives get mixed up with medicine.

“In our research, we found two things,” Tiller says. “One is that people don’t trust insurance companies, and that’s very clear. People don’t trust them to use their data when that data is of benefit to the life insurer.”

“And we heard reports of multiple insurers not complying with even their own moratorium [on using genetic test results for policies with death benefits of $500,000 or less]. Brokers were telling us that the life insurers they worked with were very happily using whatever mechanism they could to get around that and not comply.”

The effect on patient outcomes

Designing a study to measure the effect of avoiding genetic testing on long-term patient outcomes would be difficult at best, but Tiller says the substantial anecdotal evidence gathered through the A-GLIMMER project suggests people who avoid such tests face higher health risks.

The data on test avoidance itself is clearer.

“We know that there are many people who go to a genetic counselling appointment, are told about the insurance implications, and decide not to have testing. And we know that lots of people say they would never have genetic testing because of the insurance issue,” Tiller says. 

She recounts a story recently told to her by a clinical geneticist of a patient who came in for genetic testing for a BRCA variant (which would indicate a seven-in-ten risk of breast cancer).

“She said, ‘I’m going to go away and think about it. I’m worried about this insurance issue’. When she came back a year later, it was because she’d been diagnosed with breast cancer. These kinds of stories happen all the time, and I’ve heard many of them.”

“I can only imagine the number of stories that I haven’t personally come across. They are discussed incessantly in community groups, in advocacy, organisations, in research. There’s a constant conversation about having to tell people about the life insurance issue and the fact that they go away and don’t come back.”

Tiller is co-leader of a study called DNA Screen at Monash University, which aims to increase the uptake of genetic testing. For one project, 10,000 young people were tested for the risk of preventable cancer and heart disease.

“There is huge community interest in this kind of actionable genetic information,” Tiller says. “But lots of people dropped out along the way. And when we surveyed them, more than half said the reason they decided to drop out was because they learned about the insurance issue.”

“So we know it’s the biggest barrier and the biggest reason people don’t participate. And we know that this will eventually lead to high rates of cancer, of heart disease, and of other conditions that may have been prevented or treated earlier.”

Law won’t be retroactive

The new law – should it pass – will be written into the Insurance Contracts Act, which is enforced by the Australian Securities and Investments Commission. It will also dictate an amendment to the Disability Discrimination Act, giving people the right to file a civil suit if it’s contravened.

Applying it to existing insurance contracts would have been the ideal outcome, but Tiller acknowledges there are tricky legal issues involved in applying new conditions to old contracts. 

“It will only apply going forward to people who take out new insurance policies,” she says. “It won’t apply to people who have current policies that are discriminatory. And that’s something that we’ve always been concerned about. What about that group of people that won’t be helped?”

Some genetic test results mean not just that you’re at higher risk but that you’re certain to develop the disease, such as those that reveal the gene variations linked to Huntington’s Disease.

“But we’re talking here more about tests that show that someone has a future risk of disease,” Tiller says.

“People walking around with these genetic variations have them whether they have the test or not. And so if they go and get insurance without having a test, that’ll actually be underwritten at standard rates. But they would then be at a higher risk that they’re not addressing.”

“If they have the genetic test, they’re able to take preventive steps. But until this law comes into place, they would then be subject to pricing discrimination because they took that proactive step.” 

Tiller is confident that the bill will become law, and that a federal law is a lot better than relying on the industry to monitor itself.

“I think that the legislative framework is robust enough that it will ensure that most insurers change their practices. It is a total ban. And that was something that we weren’t sure we would get in the early days.”

“Will it be able to be enforced is the real question, and that is always a challenge. But I think the more robust the regulation is, the more of a deterrent it creates. This is leaps and bounds better than what existed before.”

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On this page:

• What does Medicare cover?
• How does bulk billing work?
• Knowing how much Medicare will pay
• Medicare safety net explained

So here’s your ����Vlog guide to Medicare – what’s free, what’s not, and how far the safety net really stretches to stop your medical costs spiralling out of control.

What does Medicare cover?

For starters, everything you get in a public hospital as a public patient is free. You’ve already paid for it through your taxes.

That includes surgery, medical appliances, accommodation, tests and medicines. Out-patient services, such as check-ups after a surgery, are also covered at public hospitals. Medicare covers emergency services, chronic illness management, and elective surgeries like joint replacements, cancer treatment and hysterectomies.

For the purposes of this article, we’re going to talk about services outside the public and private hospital systems that are covered by Medicare. These include:

• consult fees for doctors, including GPs and specialists
• tests and scans, such as blood screens, MRIs, X-rays and ultrasounds
• eye tests at an optometrist – one per year for over 65s, one every three years for everyone else
• subsidised prescription medicines through the Pharmaceutical Benefits Scheme (PBS).

What doesn’t Medicare cover?

Although there are exceptions, Medicare generally doesn’t cover:

• dental treatment outside a hospital
• glasses and contact lenses
• allied health services like physiotherapy, chiropractic, podiatry and psychology – although you can access Medicare-subsidised care with a treatment plan from your GP
• ambulance – some state governments provide it but most people need to purchase private health insurance or an ambulance subscription from the ambulance service
• hearing aids and other devices.

How does bulk billing work?

Bulk billing is when your doctor sends your bill directly to Medicare, making the service free for you. The name comes from the practice of sending multiple patients’ accounts to Medicare at the same time, hence ‘bulk’.

While many GPs, optometrists and pathologists do offer bulk billing, not all do. Your doctor might want to charge more than Medicare pays for a service. In this case, Medicare will still pay for some of the bill, but you’ll have to pay the rest.

You’ll have to make a claim to Medicare to receive your rebate. Your doctor’s office might be able to submit the claim electronically, otherwise you can .

Either way, you should take your Medicare card to your appointment, and check beforehand if and how much you’ll be out of pocket.

What about private health insurance?

Private health insurance can cover you for treatment and accommodation you receive as an admitted patient in a hospital. However, it is illegal for it to cover out-of-hospital services that are already covered by Medicare, such as GP visits and specialist appointments. Many of the things not covered by Medicare, such as dental care or glasses, are covered by extras health insurance policies.

Knowing how much Medicare will pay

There’s a document called the (MBS), where the government publishes what it thinks is a fair baseline price for the medical services it subsidises, called MBS fees (or sometimes schedule fees – it’s the same thing). MBS fees play a big role in everything that’s coming up.

On your doctor’s bill you should be able to find an item number, which you can use to look up the MBS fee for each service. When your GP bulk bills, they’re billing Medicare the MBS fee amount for a consultation. If they don’t bulk bill, you can claim 100% of the MBS fee on Medicare.

For non-GP services, Medicare will cover 85% of the MBS fee and you pay the rest. This is the case whether the provider charges the MBS fee or more.

There’s a cap on how much you pay in gaps

The Greatest Permissible Gap (GPG) is a rule that keeps expensive specialist services within reach of people on modest incomes. It does this by capping the value of individual gap fees, which in 2024 is $98.70. The GPG means you’ll pay either $98.70 or 15% of the MBS fee, whichever is lower. It applies to services with an MBS fee over $658, and increases annually in line with inflation.

For example, let’s say you have an out-of-hospital procedure. Your doctor charges you $1200, but it has an MBS fee of $1000. Medicare won’t cover the extra $200 on the bill unless you qualify for a safety net, but because it’s an expensive service, Medicare will cover a bigger percentage than usual.

Medicare will cover 85% of the $1000 MBS fee, leaving a $150 gap. That’s more than the GPG, so Medicare pays another $51.30. That means your total out of pocket expenses will be the $98.70 GPG cap, plus the $200 the doctor charged you above the MBS.

Medicare safety net explained

Original Medicare Safety Net

Even with the GPG, your out-of-pocket costs can add up if you need numerous services.

The Original Medicare Safety Net (OMSN) limits the total amount you have to pay in gap fees each year to $560.40. Once you cross that threshold, the Medicare rebate for all out-of-hospital services jumps to 100% of the MBS fee.

Not all your out-of-pocket expenses are counted towards meeting this threshold. Any cost you incur because your doctor charges above the MBS fee is not counted. Only the part of the MBS fee that Medicare doesn’t cover is counted. In the example above, $98.70 will contribute to meeting the threshold.

If you’ve qualified for the OMSN, for that $1200 procedure Medicare will pay the full $1000 MBS fee. Because in that example the doctor charged above the schedule fee amount, you’ll still be $200 out of pocket. 

Extended Medicare Safety Net 

The Extended Medicare Safety Net (EMSN) comes into effect when your total out-of-pocket expenses for a year reach a certain threshold. For this threshold your whole gap payment is counted – that is, the difference between what your doctor charges and what Medicare pays.

In 2024 the threshold is $2254.20 ($811.80 if you have a Commonwealth Concession Card or receive Family Tax Benefit Part A). Once your expenses reach this threshold, Medicare covers up to 80% of your out-of-pocket expenses for the remainder of the calendar year. Some services in areas like obstetrics and IVF are also capped at a dollar amount.

Remember, this is on top of the standard Medicare rebate and any part of the bill the OMSN has covered. If you receive that $1200 treatment after qualifying for the EMSN, Medicare would cover the full $1000 MBS fee (under the OMSN), plus $160 of the remaining $200 bill.

Safety net for families, couples and concession cardholders

The higher benefits in the Medicare Safety Nets are automatically paid once you reach the threshold. Individuals don’t need to register. If you’re a couple or have dependants, you can . (This is different to getting a family Medicare card.)

Registering as a family lets you count everyone’s medical expenses towards reaching a single threshold. Once the threshold is reached, the safety net applies to all family members, not just those who had a prior expense.

If you qualify for Family Tax Benefit Part A, your family qualifies for the lower EMSN threshold. There are around when you can claim the safety net, based on how you receive the FTB Part A payment.

Concessional families

If you have a Commonwealth concession card, your individual EMSN threshold is lower. Even if you’re registered as a family, the EMSN comes into effect for you when your personal expenses hit that lower threshold. Your expenses also contribute to meeting the family’s general threshold.

If some, but not all, family members have a concession card, those that have one form a “concessional family”. At least one parent must have a concession. Medical costs for these family members are counted together towards meeting the lower concessional threshold. Once this is reached, the safety net applies to all concession cardholders. 

As with individuals, medical expenses for concessional family members also contribute to reaching the general threshold for the rest of the family.

The post How does Medicare work? appeared first on ����Vlog.

On this page:

• What is telehealth? 
• What are the costs?
• Finding online consultation services
• Other online health assistance
• Home visits
• Just need a doctor's certificate?

But since the onset of COVID-19, phone and video consultations have become commonplace for many Australians. So how does telehealth work and what’s the best way to access these services?

Cold, flu and COVID-19: It’s very difficult to distinguish between the symptoms of COVID-19, influenza and a cold. If you have symptoms such as a sore throat, headache, fever, shortness of breath, muscle aches, cough or runny nose, you may need to self-isolate and to be assessed by a medical professional. You should also get tested for COVID-19. 

What is telehealth? 

‘Telehealth’ or ‘e-health’ refers to a medical consultation that takes place by video conferencing or audio over the internet. Telehealth services can include diagnosis, treatment and preventative healthcare. 

Before the COVID-19 pandemic, telehealth services were mainly used by people living in rural or remote areas who needed to access specialists not available in their area. A Medicare rebate was available for eligible patients, but it didn’t extend to the general population, and didn’t cover non-specialist services such as GP visits.

But since the onset of the pandemic, the government has increased funding for telehealth, which means all Australians with a Medicare card can access rebatable telehealth services. The government has also extended the number of services covered by Medicare to include videoconference or telephone consultations between patients and GPs, specialists, allied health and nurse practitioners.

All this means that any Australian can choose to have a video or phone consultation with their GP rather than a face-to-face consultation at no extra cost (provided their GP offers this service).

How does it work? 

The process for booking a telehealth appointment is more or less the same as for booking an in-person appointment. You call to make the appointment, ask for it to be done over the phone or by video conference (depending on what the clinic  offers) and then in most cases the doctor will call you when it’s time for your appointment. 

Be aware that your doctor may be running late, as with in-person appointments, so set aside plenty of time.

How widespread is telehealth?

Some telehealth services are provided by online-only clinics. In this case, they will probably process bookings and conduct appointments online, and some may even have their own apps.

But more and more traditional bricks-and-mortar clinics now offer telehealth services, alongside their usual face-to-face appointments. For example, many GPs, health clinics and psychologists now give patients the option of booking phone or video appointments, as well as face-to-face ones. 

Telehealth not always suitable

Not all doctor/patient consults lend themselves to a virtual experience, particularly those where an examination or test is needed on the spot. 

But one e-health provider we spoke to claims that up to four in every five (80%) GP presentations can be managed online – particularly for common health issues such as coughs and colds, weight loss, sexual health and emotional wellbeing. It’s also possible to ask for specialist referrals, prescription repeats and medical certificates by email or fax after an online (or real-life) consultation. 

If you’re booking a telehealth appointment with your GP, you must have had a face-to-face consultation in the previous 12 months with the same doctor, or another doctor at the same practice, to be eligible for a Medicare rebate.

All the e-health websites we looked at state clearly that they aren’t for medical emergencies.

You’ll also need decent internet coverage to be able to use these services. Be sure to check the provider’s policies on refunds when it comes to technology failures and problems with connections.

What are the costs?

All Australians with a Medicare card can now use telehealth services from GPs, psychologists, midwives/obstetricians, specialists, dental practitioners in the practice of oral and maxillofacial surgery, and other covered health professionals – without paying any more out-of-pocket costs than they usually would for a face-to-face appointment. 

If you’re usually bulk-billed at your GP clinic, your telehealth appointment with your GP will be bulk-billed too. If you usually pay a gap, you’ll have to pay the same gap for your telehealth appointment.

Claiming on insurance

If you have extras insurance, you may also be able to claim on your telehealth appointment. Many health insurers are now offering increased coverage for telehealth services, letting you claim on a telehealth appointment in the same way you would for a face-to-face visit. Check with your insurance provider to see whether they cover telehealth services and, if so, which ones.

How long will the new telehealth rebates continue?

Medicare-subsidised telehealth services were introduced in direct response to the COVID-19 pandemic. Like many other forms of economic support introduced for the same reason, the new telehealth inclusions on the Medicare Benefits Scheme are described as ‘temporary’. 

The Australian government recently announced that, as part of the 2021–22 Budget, it will invest more than $114 million into extending telehealth until the end of the year. But, as yet, there’s no guarantee it will be extended into 2022.

Finding online consultation services

For most people, the best way to access telehealth is simply to ask your GP or other healthcare provider whether they offer it. If they don’t, you may want to use one of the online-only companies that offer consultations to all Australians. 

Remember, to be eligible for a Medicare rebate for a telehealth session with a GP you’ll need to have had a face-to-face appointment with the GP (or another GP in that practice) in the past year. This means you won’t get a Medicare rebate for sessions booked through these online-only services.

GP2U

offers online consultations (they also have an app for iOS and Android) with GPs for diagnosis, specialist referrals, prescriptions and medical certificates. The service also offers prescriptions faxed to the nearest chemist or a delivery service.

Cost: Registration is free and requires a Medicare card, contact number and email address. Consultation prices are set by individual GPs and are based on the length of the appointment. An average consultation lasts 15 minutes and typically costs $50­–69.

Health Now

offers video and phone consultations (it also has an app for iOS and Android) with Australian-based GPs 24/7, as well as psychologists and specialists practising endocrinology, cardiology, psychiatry, paediatrics, neurology, rheumatology, respiratory, haematology, immunology and geriatrics. 

The 24/7 doctor service provides medical consultations and advice, medical certificates and prescriptions, if needed. The psychologists provide stress, anxiety and depression management, long- and short-term therapy and counselling, assessments, life coaching and treatments for various mental-health issues. Specialists are available with a referral from your GP.

Cost: These range from $79 for a doctor’s consultation to $180 for a 50-minute session with a psychologist. Specialist prices vary.

Doctors on Demand

provides video conferencing 24/7 for medical consultations, prescriptions and medical certificates from a GP, as well as sessions with a psychologist or dietician. An app is available for iOS and Android.

Cost: Doctors’ consultations cost $60 during business hours and $90 out of hours. Psychology sessions start from $168 for 60 mins (these are eligible for a Medicare rebate). Dietician appointments cost $195 for 60 mins during business hours.

Instant Consult

offers a range of GP services including consultations, medical certificates, prescriptions, specialist referrals and more. An app is available for iOS and Android. 

Cost: Consultations cost from $35 (less than 10 minutes) to $105 for a longer consultation of more than 40 minutes. 

Other online health assistance

If you’re not quite ready for a virtual doctor’s appointment, there are still plenty of apps and websites to help you get ahead before you get into the waiting-room queue.

Symptom checker and service search

The government-supported website contains a wealth of information on health topics from pregnancy and ageing right through to general health. It also gives in-depth information on medicines and services.

If you’re feeling off-colour, the site has a symptom checker that virtually triages users according to their symptoms. The program collects basic data such as your age and sex, before asking a series of detailed questions about your symptoms. It will then recommend whether you should see a GP, call an ambulance or go to a hospital. 

The site lets you search for GPs, hospitals, dentists, pharmacists, emergency departments, COVID-19 services and allied health practitioners according to the postcode you’ve entered.

Health Direct also has a 24-hour phone service (1800 022 222) staffed by registered nurses who can connect you to an after-hours GP helpline if you need. There’s also a separate phone line for pregnancy, birth and baby advice (1800 882 436).

Cost: Free.

How to find out emergency-room waiting times

Waiting times at the doctor’s surgery or hospital can sometimes stretch to hours. But these handy sites and apps can help you dodge the worst of the waits.

ACT

can give you up-to-date information on the average waiting time over the previous two hours and the number of patients currently waiting in emergency departments.

NSW

Visit to see the number of patients being assessed by a triage nurse and waiting for treatment for all major hospitals.

NT, Queensland and Tasmania

You’ll be relying on good fortune rather than data to dodge the long wait, as there’s little live information available. But you can check with the relevant health department in that state for more information.

SA

Get updates every 30 minutes on the number of patients in the emergency and inpatient areas at . The site also gives the average waiting time over the previous two hours for the state’s major public hospitals.

Victoria

You can’t access live data but gives you estimated waiting times for major hospitals.

WA

Real-time information is available at for each of the metropolitan hospitals in the state that has an emergency department.

Home visits

The National Home Doctor Service (13SICK)

provides urgent after-hours medical care to patients at home in most capital cities. The service offers bulk-billing for all Medicare users and Gold DVA cardholders.

You can book by phone (13 74 25) or using the app (iOS/Android).

How to find a GP near you

Most of us have a preferred GP and, when it’s not an emergency, are happy to wait a few days until they have an available slot. But what if you can’t wait a day or two? Online booking services let you view the available appointments in your chosen area in real time and make a booking ASAP.

Although these sorts of booking services can be convenient, it pays to be wary about sharing your information. In 2018, it emerged that one of these providers, Health Engine, had shared users’ information with personal-injury law firms and other third parties. So it’s best to take care with what you reveal when you book your appointment, and only share what is strictly necessary to make the booking. And, of course, always read the terms and conditions before you agree to them.

Health Engine

The website and app (iOS/Android) lets you view in real time the available appointments with participating GPs, dentists, physios and more, then make a booking.

Cost: The service is free, but it does send direct marketing communications including post, telephone calls, SMS or email to customers who register for the service (although you can choose to opt out).

Ozdocsonline

lets patients ask participating GPs for online appointment bookings, prescriptions, pathology results, referrals and consultations.

Cost: The service isn’t covered by Medicare, but the site claims the average cost of requests is $20.

DocBook

is another website that lets patients browse practices, search by location and make an appointment with a GP. The service is available Australia-wide (excluding the Northern Territory), although the choice of participating surgeries is fairly limited.

Cost: Free.

Just need a doctor’s certificate?

You’ve woken up on a workday feeling dreadful and call in sick, but you’ll need a medical certificate. The last thing you feel like doing is leaving your bed in search of a doctor to write you a certificate. Thankfully, there are sites that can help you with that too.

Qoctor

will set you up with a video consultation with a GP to discuss the issuing of a medical certificate, prescription or a referral to a specialist. If you need a medical certificate, you can download it immediately after your consultation..

Cost: $22.99 and there’s no Medicare rebate. 

Prime Medic

offers video consultations with a GP to discuss the issuing of a medical certificate, prescription or a referral to a specialist. If you need a medical certificate, you can download it immediately after your consultation.

Cost: $19.99. Some doctors are able to bulk-bill patients, but the number of appointments with these doctors may be limited. 

Pharmacies

Some pharmacies such as and various also offer advice and absence-from-work certificates, which may be a cheaper option than using a telehealth service. 

The post Telehealth and other online e-health services appeared first on ����Vlog.

In early 2019, the federal government will set up an electronic health record for all your health data – including sensitive issues like mental health treatments and other conditions you may wish to remain private – unless you opt out by 31 January 2019.

Doctors will be able to access your record to assist in their treatment of you, which could be essential in emergency situations. But security experts warn privacy breaches are only a matter of time.

There’s been a lot of public discussion since the opt-out period started. So we’ve looked into the pros and cons to help you decide if you want in or out.

What is My Health Record?

My Health Record is a digital collection of reports relating to your health, such as prescriptions, doctors records, imaging and other test results. What it means is that instead of having files with every doctor you’ve seen, test results at a pathology lab, prescription records at various pharmacies and so on, all this information will be in one central online location accessible by authorised health professionals.

Relaunch of existing program

Technically what we’re seeing now is the My Health Record Expansion Program. The original Personally Controlled Electronic Health Record (PCEHR) program was launched in 2012 as an opt-in system, with low uptake by the public.

The current push is to expand the system by making it opt-out so that by default, everyone has a record made for them unless they specifically request not to have one.

How My Health Record works

The data that will be added isn’t new, but it’s currently stored by Medicare, your doctor, hospital or other health professionals, sometimes in a paper-based system. What’s new is that electronic records will be stored in one central place.

Information can be added to your health record by various health professionals and businesses, government agencies and yourself. It can be accessed by authorised health professionals, such as doctors, pharmacists, hospital staff and allied health professionals (for example nurses or physiotherapists).

The sorts of things that might go in there include doctor’s reports, such as hospital discharge summaries, and results from tests and scans. It also includes all your Medicare claims and you can add your allergies and even an advanced care plan.

You can access and manage your record. You can set a PIN and restrict access to some or all documents stored on the record. You can even connect any health apps you’re using to your record.

In an emergency, health care professionals will be able to override the safeguards to make sure they get all the information needed to provide you with appropriate care.

You may already have a record

Some people may already have a record, having set one up – perhaps without even realising – under the original system (the PCEHR). Almost 6 million people currently have a record. Check if you’re one of them.

If you miss the deadline to opt-out or you already have a record, you can cancel it but your doctor and other healthcare providers may keep copies of any records they have uploaded to your record and store them in their own record-keeping systems.

Benefits and concerns

The main benefit of My Health Record is that all of your and your children’s healthcare professionals will know the medication you’re taking and the conditions you’re treated for.

People who are most likely to benefit are those who:

• have complex health conditions
• take multiple prescription medicines
• get treatment from various doctors and other health professionals
• live in remote and rural areas
• are elderly
• don’t speak English very well
• have difficulty remembering and/or communicating all the details of their medical story.

My Health Record should lead to better and well-coordinated treatment, while preventing unnecessary tests, harmful side effects caused by medication mix-ups, or even avoidable hospital admissions.

There are safeguards in place, so you can manage your My Health Record by installing a PIN and limiting the access to some or all documents to make sure that your emergency contact, carer and healthcare professional only have access to appropriate information.

But security experts warn that centrally stored information always brings the risk that in the event of a data breach there could be serious implications for you. And it would not be the first time healthcare data has been accessed by hackers.

If you can’t decide whether you want to stay in or opt out, you can always opt out now, then rejoin at a later stage.

How to opt out or manage your record

You can use the step-by-step guides on the website, and if you run into trouble call the helpline on 1800 723 471.

Further details are below for different situations.

What the experts say

Medical experts such as the Australian Medical Association, the National Rural Health Alliance and the Consumers Health Forum have welcomed the new system and asked consumers to use the opt-out period to inform themselves about the benefits or otherwise of taking part.

Security experts, while acknowledging the potential benefits of having a centralised record system, warn that the safeguards could be breached which could expose sensitive information.

Medical experts stress the benefits

• Australian Medical Association
• Consumers Health Forum
• National Rural Health Alliance

“My Health Record can save lives”

Australian Medical Association

“The current system of medical records means that we may have incomplete information on a patient – especially if the patient has recently seen another specialist or has been discharged from a hospital. The My Health Record will result in doctors having access to better information, in a more timely fashion, via secure means. Less time chasing up paperwork means more time can be spent treating our patients,” says Australian Medical Association president Dr Michael Gannon.

Consumers Health Forum

“My Health Record is a key step in the shift from health consumers as passive patients, to consumers as active partners in their own care,” says Consumers Health Forum CEO Leanne Wells.

“For too long, healthcare has lagged behind in exploiting the clear benefits of information technology to provide prompt, secure, and precise patient information. For these benefits to be realised and a consumer-centred and digitally enabled healthcare system to become a reality, consumers will need to be involved in using and improving innovations such as My Health Record,” Wells says.

National Rural Health Alliance

“Australians living in rural and remote areas are more likely to end up in an emergency department from a heart attack, car accident or diabetic coma,” says National Rural Health Alliance CEO Mark Diamond.

“If they’re unconscious, and the medical team doesn’t have access to their health history, the team may not be able to provide life saving care,” Diamond says.

“A My Health Record means that all your important health information is at the fingertips of your doctor, nurse or surgeon,” he says. “Simply put, My Health Record can save lives.”

Security experts warn of potential data breaches

• Professor Vijay Varadharajan – Global Innovation Chair in Cyber Security, University of Newcastle
• Professor Katina Michael – School of Computing and Information Technology, University of Wollongong
• Dr Cassandra Cross – Faculty of Law, The Queensland University of Technology

“A honeypot of health data, waiting to be hacked”

Professor Vijay Varadharajan – Global Innovation Chair in Cyber Security, University of Newcastle

“Having access to patient records can be highly useful, especially when it comes to requiring them in the case of emergency or even with old age patients. However data security and patient privacy are critical when it comes to healthcare information.

“From a technical point of view, there are access controls in place. However, the data itself, at this stage, is in plain format, it is not encrypted. Hence there is a potential for leakage if a breach occurs. With the growth in malware and security attacks, we cannot rule this possibility out.”

Professor Katina Michael – School of Computing and Information Technology, University of Wollongong

“The type of confidential information stored on an electronic health record is unlike having merely your identity credentials stolen – it is like having your whole personhood exposed in terms of your condition, medication, past acts and more. There are massive implications for those working in pressured workplaces who may have their health record used against them – e.g. pilots, doctors, surgeons, healthcare workers.

“We need to make people aware of the pros and cons of opting-out, but we also need better, more honest reporting by government about some of the potential risks, in essence, to better inform the public. What we have now is a major honeypot of health data, waiting to be hacked for the taking and be available on the dark web.”

Dr Cassandra Cross – Faculty of Law, The Queensland University of Technology

“The current My Health Record places a strong onus on individual consumers themselves to regulate the privacy and security settings of their record. In requiring an ‘opt-in’ model on the privacy settings of the record, this means that many people are unlikely to modify these settings. This may be through a lack of knowledge that the settings exist, uncertainty on how to do this, or an inability to successfully navigate the system.

“There are also genuine concerns over the likelihood of data being compromised in some way. While it is argued that there are strong security measures in place, it is naïve to assert that these are 100% foolproof (as demonstrated through data breach incidents with many previous organisations). Health data is an increasingly common and attractive source of data for criminals, and their ability to use personal information to gain reward is a reality.”

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On this page:

• Are home DNA kits reliable?
• Home DNA kits don't have all the answers
• Will DNA testing affect your life insurance?
• Privacy and your DNA
• Can you handle the truth?
• Skeletons in the closet (like, literally)
• Upselling your genes

Once you’ve bought the kit, you simply send in a sample of your saliva and then wait for the results.

Ancestry.com promises to give you “sense of identity”, while MyDNA claims to help “people make better health, wellness and lifestyle decisions using your DNA results”.

We take a look at what you need to consider before you spit in that tube and send it away to a lab, and what the experts think about home DNA testing.

Are home DNA kits reliable?

This is what the experts say:

Genetics counsellor and academic says:

“If people are doing it with the appropriate support it may have some value, but only if it’s done with a GP or a doctor who can reassure you and can point you in the right direction. But these tests are being rolled out too soon – they are commercial decisions being done by private companies with financial interests.”

Dietitian says:

“While genetic testing can provide some information, in many cases it doesn’t provide the full picture. While more education and understanding in this area is great for patients, it doesn’t necessarily have to mean direct-to-consumer testing, and not straight off the bat.”

GP says:

“Gene tests promise the world, but deliver very little. Uninterpretable results muddy the waters and can even have a negative impact on patient care.”

Home DNA kits don’t have all the answers

Associate professor Kristine Barlow-Stewart specialises in genetic counselling and genetic medicine at The University of Sydney. She says it’s important that people understand the limitations of consumer commercial DNA testing.

“While there’s no doubt an organisation like Ancestry and others use good science, you will get different results from different companies because of the reference DNA that they are comparing you to,” she says. “You are being compared to the data population they have, which isn’t everyone. This is why you can send your DNA to different companies and get different results.”

When it comes to health DNA testing, Barlow-Stewart says genes don’t hold all the answers or responsibility when it comes to health issues. “Take breast cancer for example, genes contribute just five to ten percent. The rest is from something else we don’t know.”

The same goes for nutrition. “With nutrigenetic variations, the environment, such as diet, still plays a large role in overall health outcomes,” says Melissa Adamski, who works in private practice as an accredited practising dietitian and also at Monash University’s Department of Nutrition and Dietetics. “And with weight loss, it’s so difficult to get the full picture from genetics alone, so while genes play a part, weight is multifactorial and other factors should also be considered.”

It’s all in the interpretation

While the experts we spoke to agreed that there’s plenty our genes can tell us, they all agree that the findings often beget more questions than answers.

Adamski says that when it comes to DNA and nutrition, genes are important but testing doesn’t necessarily provide the entire picture.”In some cases genetics can play a role in guiding nutrition requirements, and going forward it may mean we have different dietary requirements based on information from our genes,” she says. “[So] the current one-size-fits-all government recommendations may need to be tailored to each individual. But the other side of this is that a lot of the time with DNA, the more we dig the more complex it gets and we end up with more questions than answers.”

Adamski says a major challenge is finding a health professional best suited to interpreting gene tests. “There’s no perfect medical professional to deal with it at the moment.”

She says that while dietitians now understand how genes are playing a role in diet and weight management, they’re not geneticists, while a geneticist can interpret the results but can’t guide you in what to do. “You need a multidisciplinary team. Not all health professionals have the training yet – it’s still so new.”

Will DNA testing affect your life insurance?

One of the biggest issues to consider before embarking on any health, fitness or diet-related DNA tests in Australia is that the results may affect your ability to secure or claim life insurance.

Currently if you have genetic test results, even if they were done online and where the scientific evidence might be a bit wobbly, you must disclose that information if it’s requested. And any results that could indicate a risk of disease can be used against you by the life insurers in a variety of ways, from increasing premiums to denying claims.

In April 2018, a which looked at the life insurance industry made a recommendation regarding the use of predictive genetic information. They recommended that, in consultation with the Australian Genetic Non-Discrimination Working Group, the Financial Services Council – the peak lobby group for life insurers – assess the consumer impact of imposing a moratorium on life insurers using this kind of information except where it was provided by the consumer to demonstrate they’re not at risk of developing a disease.

This recommendation, and the report overall didn’t really focus on good consumer protection. Instead, the onus is on the industry to self-regulate wherever possible.

����Vlog policy and campaigns advisor Xavier O’Halloran says it’s concerning that people don’t know the impact of getting these tests done. “For people who don’t know this, it can affect their ability to get life insurance. For those who do know, there is a huge health risk that they may not want to get genetic tests done for fear it will impact their access to life insurance.”

Privacy and your DNA

While some companies offer the option to destroy your data or de-identify it by removing your name, address and other details, others may require you to plough through complicated terms and conditions to find out exactly what you’ve agreed to.

Barlow-Stewart says sending your DNA to a commercial facility is like joining Facebook. “Many of these online testing companies retain the information indefinitely. You can request that the data is destroyed, but if the company is overseas it can be hard to do. You need to read the fine print.”

Ancestry recently updated it’s privacy policy and states that it doesn’t claim any ownership rights in the DNA that is submitted for testing. Yet critics of the update have pointed out another clause that makes it clear that despite this, the organisation still owns the ‘rights’ to it. Confused? That’s probably the point.

And while some companies make assurances about de-identifying your data, Barlow-Stewart says that may not be enough to protect your privacy.

“Even though they say that they are de-identifying your data, there are concerns about whether you can truly be totally de-identified because there is a lot of capacity to know hair colour, eye colour and face shape from your DNA. And if you have a rare genetic condition you are in an even smaller pool. You may be easily identified despite having your name removed.”

Can you handle the truth?

When it comes to the results of your DNA tests, what may seem like a bit of harmless fun has the potential to be a real headache, particularly when it’s any kind of DNA health testing.

Sydney GP Dr Brad McKay says he’s had a few patients come in with DNA tests relating to health or medication that have caused them stress, even if the results didn’t indicate a specific health issue.

In a recent article for the Royal Australian College of General Practitioners, associate professor Grant Blashki (who sat on an advisory committee looking at genomics in General Practice) was quoted as saying GPs could play a vital role helping patients understand the evidence base, including developing a ‘healthy scepticism’ about extravagant claims. “It is important in advance that patients consider who is going to be assisting with interpretation once the tests are done,” he says.

But genomics veteran Barlow-Stewart says this is easier said than done. “This is a new field and many GPs are not trained to interpret the data. Many companies are saying they can put you in touch with a genetic counsellor but they are overseas, or it’s on the phone and there might be charges.”

She says GPs often refer patients to a genetic counsellor, but that there can be long waiting times. “They are going to be sitting waiting and getting very stressed out about the results. We are seeing a big upswing in people wanting to see genetic counsellors – and in many cases we are dealing with the ‘worried well’.”

Skeletons in the closet (like, literally)

Police investigators in the US recently arrested a serial rapist and murderer who had evaded detection for almost 40 years. And it was all thanks to a DNA test done by an unsuspecting relative who was interested in their ancestry.

When a relative of the alleged “Golden State killer” Joseph James DeAngelo posted their DNA on an open-source genealogical site used by people wanting to know more about their family heritage, little did they know that police were painstakingly trying to match DNA collected from crime scenes with DNA profiles that have been posted in the public domain. Unbelievably they made a match between the two, and as a result DeAngelo has been charged with 12 murders.

While most of us probably won’t encounter this situation, it’s a timely reminder that if you’re considering DNA testing of any kind you need to be prepared for the results. From unknown siblings and dubious paternity rights to the knowledge that you might develop serious health issues, these are all possibilities once you sign up for a $99 test.

Upselling your genes

As more genetic tests become available, some online DNA testing companies offer the option of holding on to your data and letting you know when there are more opportunities for new tests and refined results.

Both MyDNA and Ancestry state in their terms and conditions that you’ll be sporadically contacted with updates when more information becomes available, on anything from newly discovered relatives to new results on health issues. While this sounds helpful, some users may get more than they wished for.

With organisations like 23andme in the US now offering ancestry testing as well as health testing, it’s easy to see how customers can be upsold in the future. At the time of writing you can order a combined ancestry and health kit for $139 USD (plus another 30% off and free gift wrapping for Fathers Day) which offers a massive 75+ health reports that range from genetic health risks to “Carrier status” for inherited diseases. Finding out you’re the genetic carrier for cystic fibrosis is a long way from wondering which part of Europe your dad’s family came from.

And even without the genetic upselling, engaging with these companies is a gateway to good old-fashioned upselling too. Since we sent a DNA test from ����Vlog to Ancestry we’ve received a number of emails offering discounted tests for family and friends with the tagline “the more you test, the more you can discover. Each additional family member you test can reveal new details about your family story”.

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On this page:

• DIY genetic testing
• Screen for Life
• DEXA body composition scan scan
• Full-body CT scans
• The tests you should have

Here, ����Vlog explains the issues with the following screening services, which are being offered directly to consumers without a medical referral.

Government-funded vs direct-to-consumer screening

The government funds various screens and tests recommended for people at various ages and life stages, as well as general health indicators such as blood pressure, blood sugar and blood cholesterol levels. The government funds these tests because the health benefits for Australians and health system cost savings are calculated to outweigh the costs of supplying the tests. But advances in medical technology and lower costs of equipment have seen many common diagnostic procedures and technologies being used to screen for diseases and conditions in people without any symptoms.

No referral needed

By offering these services directly to consumers, patients and service providers can bypass patients’ regular doctors and other health professionals. However, while applauding this proactive approach to looking after health, many medical professionals have concerns.

The main problem with such screening is that it may provide false reassurance that there are no problems, with implied permission to carry on as normal, even if that includes risky lifestyle and behaviours (diet, alcohol consumption, inactivity and so on). Or, it may find something suspicious, which will be followed up by invasive testing, accompanied by stress and anxiety that turns out to be unfounded.

On the other hand, a small percentage of people will benefit from the early detection of a disease or condition they were completely unaware of, potentially saving lives. This small payoff against a huge cost isn’t enough to make the government bean-counters recommend the screens to everyone, but individuals who can afford it may feel the potential benefits outweigh the risks.

DIY genetic testing

There are many legitimate reasons for genetic testing, which traditionally has been carried out through a private doctor or the public hospital system.

Medical genetic testing usually requires referral from a medical practitioner as well as pre- and post-test counselling, and a majority of tests occur through the public hospital system with geneticists and counsellors on hand. The purpose of the test and the implications for the patient (and their family) must be explained to them, and the patient must provide informed consent. Medicare covers the cost of some genetic tests.

Genetic testing can be used to predict an individual’s risk of disease when there is a family history of it. An example is the BRCA1 or BRCA2 gene mutations that indicate increased risk of breast and ovarian cancer, which may prompt more frequent screening (mammograms) or risk reduction surgery (such as a preventative double mastectomy).

Genetic testing can also be used to predict treatment response – for example, certain gene mutations in forms of cancer (breast, colon and melanoma) indicate susceptibility to particular treatment drugs. These drugs may be expensive or have undesirable side effects and shouldn’t be used when patients are not likely to benefit.

Now consumers can undertake their own testing by buying kits online, providing a DNA sample from the comfort of their own home, posting it off to a lab and finding out all manner of genetic information, such as:

• ancestry (for establishing paternity, for example)
• genetic quirks (sneezing when you look at a bright light)
• talents (athletic proclivities)
• health information (susceptibility to diseases and conditions).

It’s this direct-to-consumer genetic testing, which bypasses the normal checks and balances of the health system testing, that’s raising concerns.

Should I get a DNA test?

Doctors and other health professionals have raised a number of concerns about DIY DNA testing:

• Companies doing testing may be located offshore and not follow the same stringent test procedures and interpretation or analysis as Australian laboratories. This may mean inaccurate, unclear or misleading results.
• GPs are under no obligation to interpret, accept or act upon results of these genetic tests. If they results are inaccurate, unclear or misleading, the GP would be held liable for any issues arising from information or advice they gave you on the basis of the results.
• There may also be privacy issues, where privacy laws in other countries are different to our own. Some people get around this by providing a false name.
• Any information you discover may also affect family members, so consider the implications and how you share information.
• Genes don’t tell the whole story. Even if you have a genetic predisposition to certain health problems, such as type 2 diabetes or obesity, your lifestyle can determine whether genes get a chance to act.
• For now only a small fraction of the genetic contribution to common diseases has been identified, so a genetic profile won’t give you the big picture.
• If you have a predictive genetic test or a test for a condition or disease for which you have no symptoms, you have a duty to inform life insurers if applying for a new policy or changing an existing one.
• Some clinics are offering less well-established tests for commercial benefit. For example, some natural medicine clinics will conduct DNA testing to determine special nutritional needs you may have, then helpfully sell you the supplements to meet these needs, which may or may not be real.

The (HGSA) encourages consumers considering DNA testing to discuss this with their healthcare provider, consider the potential negatives, and, should they decide to go ahead, choose a test provider that abides by practical and ethical principles based on best practice.

Screen for Life

A private company called Screen for Life sends letters to people in their fifties, offering cardiovascular ultrasound screening. With its tagline, “prevention for peace of mind”, the company claims they can detect potential risk factors for stroke, heart attack and aneurysm, allowing you to take preventative action – or else give you the all-clear and peace of mind.

The letter itself is quite alarming, pointing out that stroke “is the second leading cause of death in Australia”, and that even if it doesn’t kill you, it “can leave you unable to walk, talk, or take care of your most basic bodily needs”. A package of four screenings costs $199 (not covered by Medicare or private health insurance), but “the reassurance of a health screening can be priceless”.

The screenings have undoubtedly helped some people who were able to take action to prevent a serious health event. However, critics point out that while there’s no harm (apart from the cost), it can provide false reassurance or cause unnecessary alarm.

And there’s little evidence such screening reduces the risk of stroke. For example, one test is a scan of the carotid arteries in the neck, where plaque deposits can stiffen and clog arteries, leading to stroke. But health experts point out that many people have evidence of hardening arteries without an increased risk of stroke. It could also provide false reassurance, leading people to think they have no risk factors and continue their unhealthy lifestyle habits.

Screen for Life says the service is conducted by appropriate health professionals, although it has been criticised for taking place in settings such as church halls and RSL clubs that aren’t under control of a registered health organisation. The stresses it has no links with Screen for Life, saying it doesn’t recommend unnecessary tests and that if you have concerns to see your GP.

DEXA body composition scan scan

The newish kid on the screening block is the DEXA (dual energy X-ray absorptiometry) body scan. A DEXA scanner produces two X-ray beams, one with high and one with low energy, which pass through bone to different degrees to measure bone density.

DEXA scanning has been used for a long time to measure bone density and risk of osteoporosis, but clinics are now offering it to measure body composition (muscle and body fat). In particular, they’re targeting bodybuilders and people trying to improve their health and fitness by measuring actual changes in body composition, which can help people determine whether their particular exercise program is having the desired effect. Some offer the services of an exercise physiologist as well.

You don’t need a doctor’s referral for a DEXA body composition scan, and it’s not covered by Medicare, although your private health insurer may cover a consultation with an exercise physiologist.

Full-body CT scans

Popular in the early 2000s, full-body CT scans were promoted to people without any symptoms of illness or disease risk factors. Thanks to increased regulation they’re less common now, but are still around and also available overseas to medical tourists. Depending on the country, providers may be less well-regulated than their Australian counterparts, so Australian government and health authorities continue to warn against them.

Said to be able to detect early signs of diseases such as cancer and cardiovascular disease, full-body CT scan advocates claim the diseases can be treated more effectively if discovered early. And studies have found that rate of cancers among apparently healthy people who request full-body scans is around two to five per cent – so that small percentage of people is theoretically better off having had the scan.

However:

• for someone lacking signs or symptoms of disease, it is unlikely to detect a serious disease early enough to treat it and alter the outcome significantly
• CT scans can return suspicious findings that turn out to be harmless – for example, scar tissue from an old infection, calcifications, cysts and nodules. Doctors have even coined the term “incidentalomas” for benign lesions found incidentally through scanning when there are no symptoms or other suspicions. Meanwhile, the patient undergoes more invasive and expensive testing, suffering the fear and anxiety that accompanies the threat of a potentially serious problem
• exposure to CT radiation during a full-body scan is about 500 times that of a chest X-ray. This is associated with a small increase in risk of cancer
• full-body scans may also miss hidden cancers, wrongly leading the patient to think everything is fine and that they don’t need to see their doctor or have other specific screening tests (mammograms, bowel and prostate cancer screening, for example)
• they’re expensive, and aren’t covered by Medicare or private health insurance.

CT scans are a useful diagnostic tool for cancers, and when used in targeted areas, the radiation risks are outweighed by the potential benefits of treatment. But for screening the “worried well”, the risks outweigh the benefits.

The tests you should have

These mainstream screening tests are recommended for the relevant people:

• Mammogram for breast cancer. Recommended every two years for women aged 50-74.
• Faecal occult blood test for bowel cancer. Provided by the government for people aged 50, 55, 60 and 65.
• Bone mineral density (BMD) scan for osteoporosis. Recommended for women at the start of menopause, for women after menopause and for men according to medical advice (based on risk).
• Pap smear for cervical cancer. Recommended every two years for women over 18 who’ve ever had sex.

Other useful screening tests include:

• blood pressure test for hypertension
• blood lipid screening for cholesterol and triglycerides
• blood glucose test for type 2 diabetes
• vision and eye health, including cataracts (a clouding of the lens), macular degeneration (the macular is the very central area of the retina) and glaucoma (a group of diseases where the optic nerve is gradually destroyed).

A test to consider:

• PSA and rectal examination. Some recommend once a year for men aged 50-70 to detect prostate cancer, but this is controversial, and health professionals recommend you speak to your doctor about the risks and benefits of screening.

The post Direct-to-consumer health screening appeared first on ����Vlog.

On this page:

• Psychiatrists
• Psychologists
• Counsellors
• Psychotherapists
• What to look for in a therapist
• Other options
• More information

If you’re feeling anxious, stressed or depressed, having relationship problems or struggling with addiction, there are many professionals who can help.

For problems such as anxiety, depression, stress, grief or difficulties with coping, your first port of call could be your GP, who in turn may choose to refer you to a psychiatrist, psychologist or another mental health practitioner.

The alternative is to seek the help of a psychologist or counsellor yourself – but when you’re feeling under siege or overwhelmed already, researching to find the right person to help can be almost too much to bear. So we’re here to do the hard work for you, to guide you toward the best mental health professional for your needs, and let you know what you should look for in an individual practitioner.

Psychiatrists

A psychiatrist is a qualified medical doctor with additional training and qualifications to become a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems.

In addition to talking therapies, psychiatrists are able to prescribe medication to treat people, and have specialised knowledge of mental health disorders caused by biological changes in the brain, such as schizophrenia, Alzheimer’s, dementia and delirium.

To see a psychiatrist you’ll need a referral from your GP. Ask your doctor if they think talking to a psychiatrist would be appropriate and useful – they might suggest a psychologist or counsellor is a better option. If your doctor feels you could benefit from talking to a psychiatrist, they may well bring it up with you first.

Training

Becoming a doctor requires five or six years of university study followed by 12 months as an intern in a general hospital. This is followed by at least another year in a hospital as a Resident Medical Officer.

Postgraduate training in psychiatry, conducted by the , takes at least another five years, during which time they work under supervision in hospitals and community clinics with children, families, adults and the elderly on a full range of psychiatric problems.

Experience and competence are tested throughout the training process.

Cost

Costs vary greatly depending upon whether you see a psychiatrist through a public health service, such as a community health centre, or privately.

Medicare rebates are available, though out-of-pocket expenses may apply if the doctor doesn’t bulk-bill. Make sure you ask about costs and billing when you make your first appointment.

Psychologists

Psychologists deal with everything from depression, stress, anxiety, eating disorders and suicidal thoughts, to improving relationships and personal growth. The professional title is restricted to psychologists who are registered with the via the (PsyBA).

Psychologists aim to change the behaviour and thought processes of their patients, teaching them skills to function better and improve their quality of life without the use of medication. A typical patient undergoes short-term treatment in a series of four to 10 sessions.

Sometimes a single session will suffice, while other patients will need long-term treatment and support. The psychologist should give you an indication of how many sessions will be required at your first meeting.

Training

Psychologists undergo an accredited four-year university degree, and after two years of supervised postgraduate practice they can be registered with the PsyBA.

Clinical psychologists have an additional two-year postgraduate Masters degree (which also entails supervision), and while they may charge more, they can offer a higher Medicare rebate (where applicable).

Costs

The Australian Psychological Society recommends fees of $119 for up to half an hour or $218 for one hour, although it’s up to the individual practitioner.

Medicare rebates under the Better Access initiative are available if you are referred to a psychiatrist or psychologist.

There’s no Medicare rebate if you see a psychologist without a referral, though your private health insurance extras cover may offer a rebate. Check with your fund, as benefits are sometimes very limited. Your private health insurance may also cover any extra sessions you require above and beyond those allowed under the Better Access scheme.

Counsellors

Unlike psychiatrists and psychologists, counsellors have a wide and varied level of training. Unfortunately anyone can call themselves a counsellor, whether they’ve done a correspondence course that teaches the basics, a two-year diploma or the six years of training and supervision required for the Masters of Counselling Psychology – or no training whatsoever.

Training

Membership of one of the professional associations for counsellors means the counsellor has undergone an accredited training program of at least two years, undergoes continuing professional development and meets agreed ethical and professional practice standards.

The (ACA) is a national peak association for counsellors and psychotherapists with more than 3000 members.

The (PACFA) is an umbrella organisation for 37 member organisations, and individual counsellors and psychotherapists join one of these organisations – they may advertise membership of either PACFA, the member organisation or both. Counselling psychologists may or may not be members of the Australian Psychological Society, PACFA or ACA, but they are registered with PsyBA.

If you’d like to see a counsellor who’s not a registered psychologist, look for someone who belongs to either ACA or a PACFA member organisation so you can be confident they have adequate training and ethical standards.

Both peak bodies have searchable lists of members on their websites so you can find one that suits your specific needs and location. They’re also collaborating to provide a single master list of all counsellors and therapists in Australia.

Costs

As a ball-park figure, counsellors charge between $60-$150 per session. Some charge more or less than this, or may charge according to a client’s financial circumstances. At present there are limited benefits available for members insured with Medibank Private (extras cover), providing the counsellor is accredited with ACA or PACFA.

The peak bodies are looking to extend private health coverage of counselling. And remember, counsellors who are registered psychologists may charge more, but you may be eligible for Medicare or private health rebates.

Psychotherapists

Psychotherapy is any kind of psychological talking therapy that aims to restructure the personality or self. Many trained mental health professionals practice psychotherapy, including psychiatrists, psychologists, general practitioners, counsellors, art/music/drama therapists, and social workers. It’s also possible to train as a psychotherapist at postgraduate level without having a therapeutic background.

As with the term “counsellor”, anyone from a correspondence course enthusiast to a psychiatrist can call themselves a psychotherapist, so if they’re not a registered psychiatrist or psychologist, look for qualifications (such as a Master of Medicine in Psychotherapy for medical doctors) and/or membership of an appropriate professional association (ACA or a PACFA member organisation) to ensure they’ve undergone accredited training and meet ethical and work practice standards.

What to look for in a therapist

Qualifications

There are many different diplomas and degrees on offer. Be warned, though, that some impressive-sounding qualifications may not have accreditation with relevant peak bodies, and may not be government-accredited either. Your best bet is to look for membership of an industry association.

Strengths and interests

Some therapists specialise in particular areas such as drug and alcohol management, family therapy, eating disorders, sports psychology or relationships. Keep this in mind when searching or seeking referral for a therapist or counsellor.

Approach

Therapists and counsellors use different approaches, from cognitive-behavioural therapy, expressive arts and psychoanalytic therapy to somatic psychotherapy, hypnotherapy and transactional analysis and many more in between. You may find a particular approach more appealing to you – see below for useful resources.

Interpersonal compatibility.

The relationship between you and your therapist is an extremely important one. If you don’t click with them, move on as quickly as you can.

Better Access scheme

While some people may prefer to find a therapist on their own, others may choose to go through their GP which may give you access to subsidised care with a psychiatrist or psychologist.

Under the Better Access scheme, patients can receive Medicare rebates for 10 individual and/or 10 group sessions per calendar year with a psychologist or occupational therapist or social worker who’s had appropriate training in mental health services.

The treatment is an integral part of the General Practitioner Mental Health Treatment Plan and encourages a team-based, multidisciplinary approach to mental health care in the community.

The initiative was designed to provide treatment for common mental disorders such as depression and anxiety, where short-term interventions are likely to be useful in cases of mild to moderate severity.

It isn’t designed to provide intensive, ongoing therapy for people with severe, chronic illness or with more complex or intensive care needs. In such cases, referral to Medicare-subsidised consultant psychiatrist services or state/territory specialised mental health services may be more appropriate, especially if affordability is an issue.

Other options

Telephone and web-based counselling

There are several free telephone and online counselling services on offer, the main ones being , and .

These services are often staffed by volunteers who are professional counsellors, psychologists and social workers, and training at Certificate IV level may be offered to people who aren’t otherwise qualified. While best known for crisis support (the big ones are open 24 hours a day, 7 days a week), they also offer assistance with relationship issues, loss and grief, drug, alcohol and gambling problems and mental health and wellbeing.

Online therapy

(for depression) and (depression, generalised anxiety and worry, social anxiety, relationship breakdown, and loss and grief) are free online programs designed and developed by staff at the at the Australian National University, in collaboration with other experts. They provide evidence-based information and teach strategies drawn from cognitive, behavioural and interpersonal therapies, as well as relaxation and physical activity.

Books as therapy

There are many self-help therapy books offering information, insight and therapeutic strategies (usually based on cognitive-behavioural therapy). Though some are undoubtedly better than others, studies on the effectiveness of bibliotherapy for depression have found that it’s almost always better than no treatment, and sometimes as good as professional therapy. The Black Dog Institute website has a that can help with depression.

More information

For more information about the types of treatment available, various industry associations and mental health in general, visit the following:

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On this page:

• Thermography for breast cancer
• Live blood analysis
• Electro-dermal testing
• Bio-impedance analysis (BIA)
• Electro-interstitial scanning (EIS)
• VEGA testing
• Applied kinesiology
• Hair analysis
• Iridology
• ����Vlog verdict

They may offer a test – or a battery of tests – to find out everything that’s wrong with you, from using whizz-bang machines and prodding different body parts, to hair and finger-prick blood tests.

After the test, they’ll likely identify certain herbs, “remedies” or supplements that can help you with your newly discovered syndrome/s, and helpfully sell them to you while you’re booking in an extensive series of therapy sessions.

Having sat down for an hour with someone prepared to listen to the minute details of your health concerns, you’ll already be feeling better, confident your practitioner understands what’s really wrong with you – because there’s always something, and you’ll rarely hear an “I don’t know”.

The question is; do these tests actually work? We look at some of the more common ones here to help uncover the truth.

Thermography for breast cancer

Women over 40 are entitled to free mammograms, and they’re recommended every two years for women 50-69, to screen for breast cancer. They’re sometimes uncomfortable or even excruciating, and there are some wild assertions they actually cause breast cancer. So when a natural therapist offers a “safe, accurate and comfortable” alternative screening for women of all ages, it’s not surprising that some women, particularly younger ones – for whom the traditional process is considerably more painful – are interested.

Thermography, also known as thermal breast imaging, measures the temperature of skin on the breast to produce “heat pictures”. Its use is based on the premise that the skin overlying a malignant breast lesion can be warmer than that of surrounding areas. However, studies have shown that the tumour has to be several centimetres in diameter before it can be detected (mammograms can pick them up at around 0.5cm).

As points out, “There is no current scientific evidence to support the use of thermography in the early detection of breast cancer and in the reduction of mortality”.

Oh, and mammograms don’t cause breast cancer.

Live blood analysis

Live blood analysis (also called dark field microscopy, or Hemaview, after a popular make of machine) involves a drop of your blood being placed under a microscope with the image transferred to video screen. By looking at the shape, size and proportions of blood cells and other components, proponents claim they can detect all sorts of diseases and health problems, such as digestive, eliminative and immune issues, “liver sluggishness”, the presence of bacteria, fungus and yeast, vitamin deficiencies, “amount of toxicity”, pH and mineral imbalances – just to name a few.

A lack of evidence has led the (TGA) advertising complaints resolution panel to demand the withdrawal of ads suggesting live blood analysis can be used for diagnosing health problems related to immunity, nutritional deficiencies, stress and free-radical damage, among other things. Or, as haematologist Professor Hatem Salem says, “The notion that one can diagnose all sorts of ailments by examining a drop of blood on a video screen is both ridiculous and plain stupid.”

Electro-dermal testing

There are a number of measurement techniques that fall into this category, including bio-impedance analysis (BIA), electro-interstitial scanning (EIS), bioresonance and VEGA machines.

All of them claim they can somehow determine your internal physiological status by placing electrodes on your skin and measuring electrical resistance. These devices are widely used by naturopaths, chiropractors and other natural therapists, who claim that their machines are able to diagnose both serious and self-limiting health conditions.

Some say they’re “TGA approved”, which actually means that the device is (or was) listed with the TGA on the basis that it’s reasonably safe – not that it lives up to the grandiose claims that the accompany advertises. Reputable scientific research consistently disputes any therapeutic claims made for these devices, and this is backed up by expert opinion from physicists and specialists in immunology and allergies.

Bio-impedance analysis (BIA)

This is often and correctly used to measure body composition in terms of fat, water and lean body mass, and can be a useful tool for weight management and physical fitness programs – think body fat scales. However, some practitioners claim it can also measure cell toxicity, inflammation and energy levels, as well as determine your cellular age. But endocrinologist Professor Lesley Campbell tells us, “The claim that BIA can assist in monitoring toxicity, inflammation, malnutrition and poor cellular function is unscientific and unfounded.”

Electro-interstitial scanning (EIS)

This is based on measuring and interpreting resistance to the flow of electric current through interstitial fluid (the fluid between the cells) via six electrodes placed on the body. It’s claimed the data can be used to assess the health status of all of the major organs of your body, as well as diagnose ADHD and monitor hyperthyroidism, hypertension, atherosclerosis and depression. Dr Stephen Barrett of (a US-based organisation which applies scientific methods and principles to establish the validity of alternative health products and services), consulted scientific and medical literature and spoke with biochemistry experts to conclude, “Electro interstitial scans have no proven practical value and could cause large amounts of time and money to be wasted by people who believe the speculations”.

VEGA testing

This is often used to detect allergies and food intolerances by having one electrode placed on your finger, another on an acupuncture point on your hand or foot, and introducing a sealed container of food into the circuit. Reduced electrical current means a sensitivity. However, as physicist Professor John Storey points out, “The device simply measures the electrical resistance of the patient’s skin. There is nothing in the device’s operation worth discussing, unless one has a particular fascination with the electrical resistance of a person’s skin.”

Applied kinesiology

Kinesiology is the science of human movement. Applied kinesiology (AK) applies nonsense theory to this science. Practised by some chiropractors and other natural therapists, the premise is that every gland and organ dysfunction is accompanied by a weakness in a corresponding muscle, and by testing the strength of various muscles, the therapist can diagnose stresses, imbalances and sub-optimal functioning.

Similarly, nutrient deficiencies and allergies can be diagnosed by having the patient hold a test substance while the practitioner tests their muscular strength. According to allergy expert Professor Chris Corrigan, “This is all completely bizarre and, I am afraid, utter nonsense. There is no scientific evidence or mechanistic base to suggest that these tests could be remotely effective.”

Going hand-in-hand with AK is Nambudripad’s Allergy Elimination Technique (NAET), which is based on the notion that allergies, caused by energy blockages diagnosed with AK, can be permanently cured with acupressure and/or acupuncture treatments. Suffice to say, if you have a previously unknown allergy diagnosed with AK and miraculously cured with NAET, it probably never existed in the first place.

Hair analysis

Hair analysis is used legitimately to detect certain chemicals and metals, which indicate their presence in the body. Troubled footballer Ben Cousins agreed to regular hair analysis for illicit drugs – then shaved his head and waxed his body before fronting up for a test! Meanwhile, people in high-exposure environmental or occupational situations may use this form of testing if they’re concerned about overexposure to heavy metals such as mercury, lead or arsenic, which can all show up in hair.

But is it useful for the average Joe to get an analysis from their naturopath? Probably not – they’ll almost certainly find some metals, but whether it’s of any clinical significance is dubious. The reliability of hair testing for mineral deficiencies is questionable, and claims that it can detect allergies are completely unfounded.

Iridology

Iridology is the study of the iris (the coloured part of the eye) to diagnose disease, based on the notion that every organ in the human body has a corresponding location within the iris. By examining the markings and patterns of the iris, the practitioner can determine whether a particular organ is healthy or diseased.

It’s true that there are signs of certain diseases in the eye – for example, a whitish ring around the iris indicates high cholesterol. But the claims of iridologists go way beyond these broad signs.

Clinical trials that put iridologists’ skills to the test variously find there’s little consistency between practitioners, that seriously ill people may be diagnosed as healthy (and vice versa) and a practitioner presented with the same iris more than once will diagnose it differently each time.

Patterning of the iris is often used for bio-identification because it’s so consistent and unchangeable over time: this wouldn’t be the case if it changed to reflect new illnesses, such as cancer, and surgery, such as hysterectomy. This may be why the claims of some iridologists have tempered in recent years to suggest that the iris simply shows underlying health weaknesses, which may or may not be activated according to your lifestyle.

According to the , “The practice of iridology has no basis in science and is considered to be disproved alternative health care.”

����Vlog verdict

As Quackwatch observed, “These [electrodiagnostic devices] and similar tests are used to diagnose non-existent health problems, select inappropriate treatment, and defraud health insurance companies. The practitioners who use them are either delusional, dishonest, or both.”

If you consult a natural therapist, take their advice with a grain of salt, and certainly avoid paying for any tests or therapies similar to those above. A nice massage, a chakra realignment and some sound dietary advice (that doesn’t exclude major food groups) could do some good, even if only to your mental state.

Any suggestion of allergy, food intolerance, genuine nutrient deficiency or serious illness should be verified by a medical specialist or allied health professional. If you have a real health problem, visit a qualified doctor for a correct diagnosis.

Are you paying for dodgy diagnostics?

Most health insurance funds offer extras cover rebates for services such as naturopathy, homeopathy, chiropractic and iridology and other alternative therapies whose scientific and medical validity has been questioned. Even if you don’t use them yourself, you’re likely to be subsidising someone else who is! Some policies offer more of these than others, so choose accordingly.

More information

• Visit for information about the national breast cancer screening program.
• The is a non-profit association which focuses on health misinformation, fraud, and quackery as public health problems.
• The regularly run articles about non-proven medicines and therapies.
• covers unproven and scientifically questionable claims of alternative health therapies, vitamin peddlers, and other health frauds.

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On this page:

• Shopping around
• Things to keep in mind
• Medical records and eHealth
• Bulk-billing
• Useful contacts

The best doctors do more than just diagnose – they co-ordinate your complete healthcare, sending you for the right tests and to the right specialists. They’ll help you stay healthier and limit unnecessary hospital visits.

Shopping around

If your current doctor isn’t up to scratch, or you’re moving house, now’s the time to shop around.

To find a new GP you can:

• ask your current doctor for advice
• ask your family, friends and neighbours for recommendations
• ask a local pharmacist or other medical professionals who have dealings with doctors in the area.

Ring your local Division of General Practice or contact the (AGPG) and ask for a list of the doctors practising in your area. Some divisions can even provide additional information about the doctors – like interests and expertise, or languages spoken.

Professional associations such as the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP) may also be able to help.

See useful contacts below for details.

Things to keep in mind

Once you’ve narrowed down a list of possible doctors, visit their practices and consider the following:

Location

Can you get there easily? You might find it more convenient to see a GP closer to your workplace, rather than one near home.

Opening hours

Extended hours are an advantage if you have a chronic condition that tends to flare up at odd times, or if it’s hard to get away from work during business hours.

Medical centres tend to be open longer hours than traditional surgeries, but you won’t always get to see the same doctor every time unless you book in advance.

If you need a prescription or some other medical attention outside your regular doctor’s surgery hours, you might find it convenient to drop into a 24-hour medical centre and see a different GP. If you do this, you should tell your regular doctor about the visit and any medication that was prescribed. Continuity of care is important for good health, particularly if you have a chronic condition.

Home visits

Does the practice offer this service?

Languages spoken

If English isn’t your first language, it’s worth looking for a practice with professionals that speak your language.

Male or female GPs

If you’d prefer a male or female doctor, check that the practice offers the choice. A 2005 study found older GPs (aged 65 plus) and female GPs generally provide longer consultations.

Premises

Are the rooms clean and tidy? If you’re the family type, are there toys and an area where your kids can play while they wait?

Information

Posters and brochures in the waiting room are a plus – they show the practice is aware of the importance of public health education. Look out for a practice information sheet that provides information on thing like fees, appointments, home visits, and repeat prescriptions.

Specialities

Do any of the doctors have extra qualifications or areas of expertise that might be of benefit to you? A doctor with a diploma in obstetrics or paediatrics can be useful if you have or are planning to have kids, for example.

Accreditation

There are agencies (Australian General Practice Accreditation – AGPAL – and General Practice Australia – GPA, for example) that independently rate the quality of general practices and award accreditation to practices that meet a benchmark quality standard. Ask the practice if it’s accredited, or look for an accreditation certificate or logo on display.

Billing

Ask how you’ll be billed when you make an appointment:

• you may be able to get a discount if you pay upfront;
• it may cost more to have an appointment on a Sunday; or
• the practice may bulk-bill.

Decision time

Once you’ve made a choice, take the plunge and go in for a consultation. There’s no obligation to go back to that doctor if you’re not satisfied. Your final choice should be a GP that makes you feel comfortable, and one whose knowledge and judgment you trust.

Medical records and eHealth

Keeping track of your records

When you move practice your medical records should follow you. You can either authorise your old practice to provide a copy or summary of your health information to your new GP, or ask your new GP to request the information for you.

If the practice you usually go to closes down, or if your GP leaves the practice or dies, things aren’t so simple.

In general, there’s very little regulation about what happens to your medical records in these situations, and it varies in each state and territory. In Victoria, for example, the law stipulates that patients must be provided with written notice about what’s going to happen to their records, where practical, and a notice must also be placed in a local newspaper. Similar laws exist in the ACT, but in other states you may not be given that consideration.

Storage of records

Any medical records that aren’t transferred or claimed may have been stored securely under a third party’s supervision. 

Several states have laws that specify how long records must be kept before they can be destroyed. So if you don’t get a chance to claim your records before the practice closes, you might be able to track them down after the fact. But if you’re not informed of their whereabouts or you happen to miss the notice in the paper, there’s not a lot you can do. And it’s not just an issue of privacy. At best it’s also an inconvenience; at worst, a health risk.

There are professional guidelines for the management of health information, including the retention of medical records in GP practices, but we think they should be made into laws.

eHealth

The Federal Government’s vision is a national, cradle-to-grave, electronic health record for all Australians. Your eHealth record should ideally hold your complete medical history – from diagnosis details and treatments, to all contacts you’ve had with the health system.

In theory, this appears to be a sensible move. eHealth records can help prevent unnecessary or inappropriate treatment, and provide protection against potential adverse drug interactions and allergies. They also mean you won’t have to explain complex medical histories whenever you see a new medico.

In practice, though, there are several unresolved privacy issues. It’s currently unclear where and how your information will be stored, and who’ll have access to the records.

And things are complicated more by the current complex plan for state and territory to implement and manage eHealth independently.

We want all consumer concerns to be addressed before this eHealth vision becomes a reality.

Bulk-billing

Consultation costs

If you’re a budget-conscious patient, bulk-billing is great. You pay nothing upfront, and you don’t have to go to the trouble of claiming fees back from Medicare. The problem is that it’s not always available.

Medicare says around 75 per cent of all GP services are bulk-billed. But although practices often bulk-bill concession cardholders, many charge other patients privately.

The says many GPs can no longer afford to bulk-bill all their patients because of the gap between Medicare’s rebate and the cost of the scheduled fee. The estimated cost of providing a standard (Level B) consultation is $55 but the rebate is just $31.45.

Length of consultation

GPS say higher fees help them spend more time with each patient. Longer consultations are usually associated with benefits like higher patient satisfaction and an increased likelihood of preventive care.

And there’s a concern that where practices do mainly bulk-bill, GPs may find themselves under pressure to see more patients more quickly to remain viable. However, in reality there’s no published evidence suggesting you’ll receive a shorter consultation if you’re bulk-billed than if you’re privately billed.

A 2003 report to the Federal Government proposed a change to this MBS structure, but there’s been no action on this to date. Apart from some additional incentives to bulk-bill specific groups, including Commonwealth concession cardholders and children under 16, the situation remains the same.

Useful contacts

Finding a GP

To find contact details for your local Division of General Practice, or the AMA or RACGP in your state or territory, visit:

Making a complaint

If you have a complaint about some aspect of your healthcare (the clinical treatment you’ve received or your doctor’s conduct, for example), it’s a good idea to first discuss your concerns with your doctor or another doctor in the practice. But if this doesn’t resolve your problem, you have several options.

You can complain to:

• the independent health services commission/ombudsman in your state or territory,
• the relevant Medical Board in your state or territory, or
• your local branch of the AMA or other professional association of which your doctor is a member, where applicable.

For contact details for these bodies in each state and territory, visit .

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