Diary of a GP: The double standards are ridiculous

5 minute read

We are held more and more tightly to medicolegal account while the health cowboys run rampant.

It’s just before 8am and I’m driving to work – prime time for radio advertising.

On comes an ad for some fantastic Australian-made herbal supplement for men who have urinary frequency. No diagnosis necessary. A simple case of “you have an annoying symptom – take this and it will help”.

The ad doesn’t actually say what’s in the supplement, and you can’t guess from the name (Pee Less isn’t on the periodic table) and there were definitely no caveats – I guess it is not a marketing winner to say check first that your urinary frequency isn’t due to chlamydia or gonorrhoea?

But it would seem this is all perfectly legit – commendable even – given that the ad makes a big deal of the fact these formulations are Australian-made.

So on I go to work. Log on to the computer and start checking results and messages.

And there it is. Among the notifications of a new receptionist and the upcoming visit of the “Bone Bus” is a friendly reminder that we are supposed to list – in the notes – the risks and benefits of any new medication we prescribe to patients! 

Not that we’ve discussed risks. No. We are being asked to actually write the specific risks (and benefits – but chiefly risks) of any new medication prescribed. Apparently, that was the directive from the accreditation mob who had recently assessed our practice.

Why? Of course, discussion about any new medication is important and good practice but why the need to record it? Can’t it just be assumed? I would assume that had been done if I read another doctor’s notes who had initiated a new treatment. What would the details of the risks and benefits of a medication add to a handover to another doctor – which is one of the sensible reasons for good notetaking?

The only explanation is medicolegal. “Notes or it didn’t happen,” as I was told. Nothing to do with good patient care – everything to do with liability.

I know I’m not exactly comparing apples with apples but these two events, coming within an hour of each other, did seem to highlight the inconsistency across what is broadly known as the health “industry”.

Is it just me or do you feel that while we, as fully qualified, accredited, professionally developed GPs are being increasingly regulated and being asked to justify (in triplicate) every decision we make, every medication we prescribe, every investigation we order and every therapy we recommend, those who have “alternative” medical products to market to this same vulnerable population are increasingly allowed to make whatever health claims they like via whatever channel they choose?

It’s not a new argument. The issue has been around for decades – it is just that the discrepancy between the sets of rules seems to be widening.

It is right that we should be accountable for what we prescribe. But the fact that there is an industry making millions of dollars from unvalidated claims of health benefit without any sort of accountability just seems so contradictory.

Take this urinary frequency formulation, for instance. The manufacturers are allowed to say as part of their advertising that this “unique formula for men … relieves the annoyance and inconvenience of frequent trips to the bathroom”. Not “may help” … no, it’s definitive – no “evidence-based”, no “scientifically proven”, not even an expert consensus of opinion … it will relieve urinary frequency!

At best it is misleading. At worst it is fraud.

When GPs prescribe, we are expected to take full responsibility for providing all the information about the risks and benefits of any treatment we recommend. When these pseudo-health advisors recommend treatments, patients are expected to discern the limitations of the claims made, with little, if any, recourse when they find these therapies are ineffective, or even harmful.

But that’s the key, isn’t it? These herbal formulations, be they for male urinary frequency, liver health or libido, are rarely harmful.

No one in authority really cares if they don’t work as long as they don’t hurt anyone. I guess it’s the same principle that governs advertising for face creams, shampoos and energy drinks. It is simply a case of buyer beware. But health is a bit different, don’t you think?

All I’m really saying is that, when it comes to medicine and medical conditions there should be a more level playing field in terms of accountability.

There is a high level of health anxiety out there, and these products and the marketing campaigns associated with them feed off this anxiety.

To Australia’s credit, it was determined long ago that prescription medication should not be advertised to consumers directly in this country. Manufacturers should not be able to create consumer demand for prescription medicines on the basis of clever advertising.

Why does this “protection of the vulnerable” not hold true for these off-the-shelf formulations?

Instead of making us GPs jump through ever more bureaucratic hoops, why don’t the authorities focus on this out-of-control industry that seems to be able to say whatever it likes wherever it likes?

At the very least could they please get these outrageous ads off prime-time radio?

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