View from a Doctor’s Desk – Dr Lisa Surman

What is Endometriosis? Endometriosis can cause significant distress, both physically and mentally, in women and is often misunderstood. Our article and links hope to clarify some of these misconceptions. Lena Dunham has written a very personal account of her decision to have a hysterectomy at 31 after years of suffering with endometriosis in the recent issue of Vogue (In Her Own Words). She describes battling endometriosis for ten years and undergoing nine surgical procedures and how she chose the surgery despite knowing that the surgery does not guarantee that the pain will cease and does not cure endometriosis. Endometriosis is estimated to affect 176 million women and their families worldwide. It is not related to lifestyle choices and affects physical, mental and social wellbeing, often affecting a woman’s ability to complete education, maintain a career, interferes with relationships, social activities and can affect fertility. Between 1% and 10% of Australian women have endometriosis. A general lack of awareness by both women and health care professionals, perhaps due to “normalisation” of symptoms, results in significant delay between experiencing symptoms, diagnosis and treatment (the average is seven years). Endometriosis is condition where tissue similar to the lining of the womb (endometrium) grows outside the womb, the hormones that usually trigger a period cause bleeding at the sites of endometrial-like tissue and causes pain. The cause of endometriosis is currently unknown, with several theories such as retrograde flow of endometrial tissue out of the womb through the fallopian tubes implanting in the pelvic cavity, genetic predisposition and other gynaecological factors and environmental exposures (such as dioxin and PCBs) all being investigated as contributing. Although endometriosis is associated with inflammation and immunological dysfunction, it has not been proven itself to be an autoimmune disorder. Some studies have linked the presence of endometriosis to the development of ovarian cancer, but the association is not definitive and the absolute risk for a woman with endometriosis is very low. The complicated nature of pain pathways is also involved, explaining why some women have advanced endometriosis with few symptoms and others very little endometriosis and severe symptoms. It is possible to have surgical treatment for endometriosis and ongoing significant pain due to the pathways mis-firing and not progression of the disease. The symptoms of endometriosis include painful periods, painful ovulation, pain during and after sex, fatigue and infertility. Diagnosis can only be made by laparoscopic (keyhole) surgery. The International Organisation, endomeriosis.org has posted a very useful list of myths and misconceptions surrounding endometriosis:
  1. Endometriosis is difficult to understand. There are many associated myths, taboos, hit-and-miss treatments, lack of awareness, a wide variety of symptoms contributing to a frustrating, painful chronic condition. Health professionals often have poor understanding of the disease and the media present varying understanding of the disease and outcomes, so women receive confusing information
  2. Severe period pain is not normal. If period pain interferes with daily life, such as going to school, work or day-to-day activities it is not normal
  3. No-one is too young to have endometriosis and it is possible to have symptoms after menopause, particularly due to scarring and inflammation effects of the disease
  4. Hormonal treatments do not cure endometriosis. Hormonal treatments temporarily suppress the symptoms while the drugs are being taken. Surgery by an experienced gynaecologist is the only effective medical treatment
  5. Pregnancy does not cure endometriosis. Like hormonal drugs, pregnancy temporarily suppresses the symptoms, but does not eradicate the disease itself.
  6. Endometriosis does not equal infertility. Most women with endometriosis go on to have children. In general, it is believed that the likelihood of fertility problems increases with the severity of the disease and age. There are no statistics available to give a reliable indication of an individual woman’s fertility.
  7. Infertility is not just caused by endometriosis on the tubes, pelvic inflammatory disease damages and blocks fallopian tubes. Tubal endometriosis is much less common and does not always cause infertility. The mechanism by which endometriosis causes infertility remains largely unknown
  8. Hysterectomy does not cure endometriosis
  9. Endometriosis is physical, not emotional. Women with endometriosis may struggle with emotional distress associated and, as a result of, unrelenting pain and infertility
  10. Abortion does not cause endometriosis
  11. Douching does not cause endometriosis
There is no best treatment for endometriosis. Treatments will work differently for individual women with endometriosis. It is important to be aware of the different kinds of treatments and their possible effects, side-effects or complications. Usually a combination of treatments can be used to relieve the symptoms associated with endometriosis. There are now national support organisations worldwide. The Pelvic Pain Foundation of Australia (pelvicpain.org) website has links to the Australian Coalition for Endometriosis, the peak consumer and advocacy body representing the needs of girls and women with endometriosis in Australia. There is also a pelvic pain booklet , advice regarding pelvic muscle relaxation, and links to subscribe to the regular newsletter. Endometriosis Australia has a helpful website (endometriosisaustralia.org) containing a medical Webinar series as an educational reference and possibly has more detailed information regarding the nature of the treatment options. To read the Lena Dunham article, see https://www.vogue.com/article/lena-dunham-hysterectomy-vogue-march-2018-issue   Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

View from a Doctor’s Desk – Dr Lisa Surman

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites. Valentine’s Day comes with a timely reminder for Women about heart disease Heart disease is the leading cause of death for women, with three to four times more women dying from heart disease than breast cancer in Australia. Women having a heart attack can have severe chest pain, but many experience more subtle symptoms such as dizziness, fatigue, nausea, burning sensations similar to heartburn, discomfort in their arms, neck and jaw, shortness of breath, sweating or nausea. The difference in the nature of heart attack symptoms between men and women often means that women present later to Hospital and, upon arrival at Hospital, recent studies in the US, UK and Australia have demonstrated that women’s symptoms can result in missed diagnoses. Women are referred less for in-hospital treatments such as angioplasty and also are referred less and attend fewer cardiac rehabilitation programmes, with poorer outcomes as a result. Prior to a heart attack, some diagnostic tests for heart disease indicators are less accurate in women than men, women are less likely to seek help quickly for nonspecific symptoms and some health professionals are less likely to check for heart disease for so-called recent onset nonspecific symptoms. The National Heart Foundation of Australia has developed several videos and documented personal stories to raise awareness for women of the signs and symptoms of heart disease at inviisiblevisible.org.au Previously each risk factor was individually measured and treated. It is now recommended that your overall risk be assessed using several measures to determine your personal risk score. Men statistically are at higher risk than women for developing heart disease in middle age, but hormonal changes after menopause and possibly increases in other lifestyle-related risk factors cause a woman’s risk of heart disease to increase over time to probably equal men. There is no single cause of coronary heart disease. Several risk factors cannot be changed, including family history, racial factors and increasing age. The good news is that others can be managed. Heart disease risk factors that you can change include: – smoking – high cholesterol – high blood pressure – diabetes – physical inactivity – overweight – depression, social isolation and poor social support It is important for women, particularly at menopausal age, to have their individual risk markers assessed and their overall heart disease risk calculated. Your GP is in an ideal position to arrange the measures, review the risk factors and assist with changes that are recommended to reduce overall scores. The website heartresearch.com.au provides overviews regarding many factors linked to heart disease and more details about definitions and diagnoses   Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee

View from a Doctor’s Desk – Dr Lisa Surman

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

Many people will be spending some time watching the Winter Olympics and may wonder what they could do to improve their own fitness, endurance and muscle power? An ideal time to get accurate information on supplements.

Many people use sports supplements (available over the counter and online) for varied and complex reasons – to gain muscle mass, lose weight, improve health or performance. Almost 3% of Australian adults reported using a special dietary product in an Australian survey from 2012, with 70% of the supplements being sports and protein beverages or powder. The rate of use in young men aged 19-30 years was 7.8%. The claims are very tempting – better recovery, improved endurance, increased strength. loss of body fat and enhanced immune systems.

Most people believe that government laws prevent companies from making false claims, particularly in writing, and would prevent unsafe products from being available. In Australia, supplements fall under the control of the Therapeutic Goods Administration, the most lightly regulated category of the TGA. There is no requirement that a product must have proof of its benefits to be accepted at this level and supplements can be heavily marketed in Sports Magazines, brochures and other communications with very little control over the claims made. The testimonials of successful athletes are part of sponsorship or paid advertising by the manufacturers or simply by word of mouth, which are persuasive arguments to others. Performance is the result of many factors such as talent, training, equipment, diet and mental attitude. In real life an athlete finds in difficult to pinpoint how much each factor contributes to a success.

Just prior to the last Olympics, ASADA released results that found one in five of 67 common Australian supplements analysed contained banned substances such as anabolic drugs or stimulants and, importantly, none of these substances were listed on the ingredient list on the labels.

According to the Australian Anti-Doping Authority as many as one in five products contain banned substances including stimulants and anabolic drugs and warned that any supplement may not be safe to use as a result of these findings. Some contain large amounts of protein or creatine, which may alter blood results in an otherwise healthy person, and long term effects are not known. Taurine is promoted for its ability to improve exercise capacity and performance, but most products do not contain enough for therapeutic benefit and little is known about the long term effects of regular, nor heavy use. Androgenic steroids are often not listed on the ingredient label and can cause androgen deficiency with symptoms such as fatigue, lethargy, low mood, irritability, poor concentration, hair loss, acne, liver damage, breast development in males and reduced sexual desire or performance.

Designer anabolic hormones, also referred to as pro-hormones, natural steroids, testosterone boosters have been available in the legal marketplace for the past ten years. The pro-hormones have also been identified in tests of supplements and not declared on the labels. Despite attempts to improve regulatory efforts, many remain easily available. These products have potential significant side-effects, now seen increasingly in General Practice. Liver damage, hypertension, renal failure, hypogonadism, gynaecomastia and infertility are increasingly being reported, most are reversible on ceasing the supplement, more permanent damage is possible from chronic use, including heart attack and stroke Some products contain “liver protectors” such as milk thistle extract or herbs, none have been demonstrated to have any protective value against oral androgen liver damage.

The Australian pharmacy business is controlled by a number of regulatory and licensing requirements. A prescription is required for some products and importations of controlled substances is prohibited. Online pharmacies generally supply products without prescriptions and may or may not employ pharmacists. All studies and warnings from regulatory agencies emphasise the caution ” buyer beware” many websites operate outside legal requirements and there is no way to check the authenticity of the product and how it will affect you. The TGA does not conduct any regulatory review of internet sites. The TGA’s position assists consumers in having greater confidence in Australian online pharmacy sires rather than those overseas.

The advice given by the Australian Sports Anti-Doping Authority to competitive athletes in relation to the various supplements available is to assess whether the specific supplement is safe, effective or necessary and the same advice is relevant to the general public. The advice to athletes is to completely avoid the combined products and “enhancers”. Improvements to health and performance are possible with changes to nutrition, sleep or training and there are professional sports dieticians, exercise scientists and even medical practitioners who can provide useful guides about benefit and harms of various products and chemicals. There remains significant concern about the unlisted and potentially dangerous substances in the supplements that are not listed on the labels.

For the current Supplement In Sport Fact Sheet from the AIS see ausport.gov.au for a list of products and the current evidence for benefit or not for individual products such as creatine and simple dietary guides re nutrition and protein intake when training.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software?s Clinical Leadership Advisory Committee

Best Practice launches “Be In The Know” Bp Learning modules

Best Practice Software is making medical software training even more relevant this year, with a new series of webinars inspired by calls to Bp’s Support Team. Manager of Sales & Customer Management Jessica White said it was an exciting new initiative. Our Support Team receive hundreds of calls a day, so it’s an ideal barometer of what is important to our Bp Premier customers said Mrs White. Every few months, as demand dictates, we’ll be focusing on what our customers have told us they want to learn. February marks the start of Bp’s Be In The Know Bp Learning sessions, where experienced Training Specialists will take users through free online one hour tutorials. The first tutorial will kick off on Wednesday 21st of February, with 2 sessions on offer: 11:00am to 12:00pm or 3:00pm to 4:00pm (AEST). Bp Product Training and Knowledge Leader Suzi Eley says this opportunity will be a fantastic chance for Bp Premier users to upskill their efficiency when using the software. The first module is of great interest to all of us doing business in the digital world and will be of particular relevance to practices using Bp Premier, covering important topics such as data maintenance and disaster recovery. Ms Eley said. In this free one hour session attendees will also learn some new tips on Backups and Permissions that can be specifically tailored in the software. Bp Training Specialist Mark Hodgkinson who has over 4years’ experience in teaching Bp will be leading these first sessions, that can be accessed from computers or mobile devices. For more information on Be In The Know training sessions or to book in, Bp Premier users can visit the website. or phone 1300 40 1111 (Australia) or 0800 40 1111 (New Zealand).

View from a Doctor’s Desk – Dr Lisa Surman

Often patients spend time talking about medical and social issues currently in the media, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites. These are usually written weekly by a doctor in our practice. We all know that patients often don’t recall some of what is said in a consultation and these articles allow them to revisit the issue at their leisure and share the information with others, without detracting from consultation time. As we start the new school year parents are concerned about how their children will cope with potential bullying incidents and our latest article addresses this. The Children’s Commissioner has released the data of a survey of 1800 Western Australian children finding one in five high school students and one in ten primary school students were afraid of being bullied or being hurt in some way. Relationships with peers and friends and teachers were key issues as were relationships with parents and health issues. Commissioner Pettit said this did not mean those students were in chronic fear, rather that they did not feel safe all the time. YouthbeyondBlue has launched some resources to guide young people when supporting their friends and has a wide choice of advice about how to open conversations with young people if you are concerned about their behaviour and well being or if you are worried they may be being bullied. Melbourne App developers and Youthbeyondblue have created The Check-in App for anyone who wants to check in with a friend but is concerned about saying the wrong thing or making the situation worse. The app suggests ways to think about where you might check in, what you might say and how you might support your friend. There is also a section showing you things to consider if your friend denies there is a problem. The app also gives advice on the next steps after you have had your conversation and where to get support and additional links or tips. The website also suggests ways to start a conversation when someone you know is not acting the way they usually do (such as stressing out or withdrawing), there is a written guide and video examples. It is hard to know what to say to someone you care about who needs some help or support. The four key things that Youthbeyondblue suggests are:
  1. Look out for signs such as not hanging out with usual friends as much, always being down or tired, being more snappy or looking a mess
  2. Listen to your friend’s experiences, don’t rush in with advice. they may not want to talk about it, let them know you are worried and that you are happy to listen when they want to talk or suggest someone else.
  3. Talk about what is going on, simply saying that you have noticed they are not themselves and showing that you are prepared to listen can be very supportive to a friend
  4. Seek help together by encouraging your friend to get some support. It can be family or a local GP or Health Professional. You may even offer to attend the first appointment
If you think your child’s worry is affecting their life, there are many evidence based programs and services effective in reducing anxiety and worry, like Centre for Emotional Health or Brave Online. The Triple P Parenting programme offers a range of ways to get your positive parenting, either choosing single visit consultations to public seminars, group or private sessions and an online course offering strategies and ideas at triplep-parenting.net.au Help for young people is also available at Kidshelpline If urgent advice is needed,call the beyondblue support service on 1300 224636 or visit beyondblue.org.au   Dr Lisa Surman, CBD West Medical Centre, Perth, WA Member of Best Practice Software’s Clinical Leadership Advisory Committee

View from a Doctor’s desk – Dr Greg Wyatt

Today is 31st January and while I am looking forward to tonight’s blue moon lunar eclipse, weather permitting, I am not sure I am looking forward to tomorrow, the day that all codeine containing medications will require a prescription. I am sure that we have all been wondering what the impact of this policy will be on our practices.

So far, I have not had one more request than usual for a codeine prescription. Like most GPs, I discourage the use of codeine. However, I am sure that it still has a use in the short-term management of mild to moderate acute pain. Again, like most GPs, I probably don’t have a clear idea of the full use of over the counter (OTC) medications by my patients; I don’t always ask and they don’t always tell. Only a few have mentioned the declining pharmacy stocks of OTC paracetamol-codeine and ibuprofen-codeine preparations.

The various medical media outlets have already been discussing this issue and most commentators are far more knowledgeable on this topic than this normal GP.

The sorts of questions we have been asking ourselves include:

  • Will there be a big impact of codeine prescriptions on practices; how will we manage and increased admin and GP workload?
  • What will be the cost to patients, for both the visit and pharmacy?
  • How will I respond to a codeine prescription request?
  • How will I manage renewals ” face to face visit, telephone request, on-line request? Will this be any different to my practice’s usual policies?
  • How will Bp Premier help me?

As yet, I don’t have any answers. I guess I am waiting to see what happens. Maybe the impact will be minimal on my practice; maybe I am burying my head in the sand. Still, I am happy to wait and see.

Dr Greg Wyatt, GP, Shalimar House, Dandenong North, Vic

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Best Practice Software supports Scouts Australia

Scouts are known for always being prepared and that has extended to being prepared for any medical eventuality at the Australian Venture, from 2nd January at Camp Warrawee, north of Brisbane.

Best Practice Software have been supplying Scouts Australia with their GP medical software Bp Premier for over a decade.

Dr Michael Rice, a Scouts member in Beaudesert Queensland, says using Bp Premier makes healthcare for kids and adults so much simpler.

Best Practice Software has been generous in allowing Scouts to use their software at events for over a decade, where we can have 1000 to 10,000 youth and adults attending.

We are able to load up our attendance database for each event, saving time and improving accuracy. Dr Rice said.

Scout events can run up to a fortnight, with the attendees and most leader volunteers arriving within the space of a few hours prior to the event and with little time to familiarise with software systems.

Clinical Nurse at the PA Hospital Emergency Department and Venturer Scout Leader at Wishart-Chester Scout Group in Toohey Forest District Kelly Jenkins says Best Practice is very intuitive and easy to learn.
We have a range of volunteers including doctors, nurses, various health science students and administrators, and if they have used electronic clinical records in the past, they learn Best Practice’s Bp Premier so quickly that we are productive from day one. Jenkins said.
CEO and founder of Best Practice Software Dr Frank Pyefinch says he is pleased to see Bp support Scouts Australia over many years.

We have been a very proud supporter of Scouts Australia and we are delighted that our medical software has assisted them at many of their major events. Dr Pyefinch said.

Best Practice launches Bp Premier Lava SP3

Best Practice Software today launches the latest release of its popular GP software Bp Premier ” Lava SP3.

Bp Premier Lava Service Pack 3 includes some significant additional changes to support the National Cervical Screening Program which came into effect this month.

Bp Premier Lava Service Pack 3 also includes some extra enhancements, including support for the Healthcare Homes trial, allowing participating sites to record and report on patient tiers; and support for the uploading of Pathology and Radiology results to the My Health Record.

The National Cervical Screening Program replaces the former state-based screening registers. As part of the new program, the Pap smear has been replaced by a combination of cervical HPV testing and Liquid Based Cytology. Screening has changed from two yearly starting at age 18 to five yearly starting at age 25.

To accommodate this national initiative and other national changes, Bp Premier Lava Service Pack 3 includes key enhancements, including a Pathology Request Screen: Removal of the Pap smear and Cervical cytology test names from the test list, the addition of new test names and additional cervical screening details. The Patient Record has also been updated, with the Cervical screening page in the patient record now split into two sections displaying the old Pap smear results in the top half of the page and the new CST results in the lower half. Recording a Screening Result has also been enhanced. The data entry window for entering screening results has also been modified to allow entry of both older pap smear results as well as the new data elements that are included in the new reports.

Best Practice Software has developed a Quick Reference Guide and FAQ document to support customers through these important changes. This information is also available on the Bp Premier Knowledge Base.

Sites using a pre-Lava version of Bp Premier are encouraged to check out the Bp Premier Knowledge Base to access videos and other reference material to assist with the upgrade process.

For more information visit www.bpsoftware.net or phone the Best Practice Support Team on 1300 40 1111.

Bp’s new Clinical Leadership Advisory Committee meets

Best Practice Software’s new Clinical Leadership Advisory Committee for 2017 ” 2019 have met at Bp’s Brisbane Business Centre today.

The Clinical Leadership Advisory Committee is made up of six key members of the Australasian medical community ” doctors, practice managers, nurses and diagnostic professionals ” to steer the clinical appropriateness of Bp software into the future.

Chief Executive Officer Dr Frank Pyefinch will continue to lead the way as Chairman, with Chief Operating Officer Mr Craig Hodges as Deputy Chair. Best Practice Software Director Mrs Lorraine Pyefinch will also continue on the Committee.

Mr Hodges says the new Clinical Leadership Advisory Committee reflects Bp’s guiding philosophy of being the medical software provider most connected with its users and one that remains developed by doctors for doctors.

Our first Clinical Leadership Advisory Committee, formed in 2015, was a great success and I’m looking forward to the opportunity of engaging with this Committee, which will guide and advise us until 2019 said Mr Hodges. We look forward to hearing their feedback on our clinical connections and the key user functions and features that will keep our software evolving into the future, Mr Hodges said.

Other members include current General Practitioner Dr Greg Wyatt, who has been an active user and beta tester of Bp software since its establishment. Dr Wyatt has been closely involved in the Divisions of GP for over 20 years in a number of roles including a board member and chair.

Alongside will be Dr Cedric Meyerowitz, who is a General Practitioner with an extensive knowledge in GP computing. Dr Meyerowitz is passionate about electronic communications between healthcare workers and hospitals, has had a long history with beta testing and is well known for doing his own IT support.

Mr Peter Wallis continues on the committee as a business Practice Manager with 10 years’ experience. Mr Wallis has been proactive in the development of technology in general practice, has a background in the NSW court system, not for profit and business sectors.

Ms Charlotte Hurn also continues on the Clinical Leadership Advisory Committee. Ms Hurn is a registered nurse who is currently the National Nursing & Clinical Governance Manager for IPN Medical Centres. Ms Hurn possesses an in-depth knowledge of general practice nursing, monitoring nursing practice and software use support for both doctors and nurses.

New members are Dr Lisa Surman and Mr Rushan Hewawasam. Dr Surman is a General Practitioner in Perth. She has been in fulltime practice since 1985, including 6 years in Brunei. Dr Surman’s interests include shared antenatal care, obstetrics, gynaecology, diving medicine, travel and skin cancer medicine. She has a special interest in the early adoption of new technology and relishes the challenge of beta testing.

Mr Hewawasam, whose background is in Accountancy, has extensive experience in Practice Management, guest lectures at Victoria University in Practice Management, is an Accreditor with GPA and visits other Clinics in Victoria to assist with and assess their accreditations.

We are delighted to have a mix of old and new members who will help guide Best Practice Software for the next 2 years Mr Hodges said.

Team Bp set to deliver LAVA SP1 training in Melbourne

Bp Premier users in and around Melbourne will have the chance to maximise the effectiveness of the new LAVA release with face-to-face training in November.

Team Bp will travel to St Kilda in Melbourne to deliver their final stint of 2017 training for the newly released LAVA Service Pack 1 from the 13th -15th of November.

Jessica White, Best Practice Manager, Sales & Customer Management said the classroom type training would give a wide range of Bp Premier users the chance to speak directly with a member of Best Practice, along with the ability to network within their state and the industry.

“Face to Face training is an ideal way for Bp Premier users to gain experience with the software, without affecting their own practice data” Jessica said. “Another advantage is they can have their questions answered on the spot from our expert trainer Mark Hodgkinson.”

“New Bp Premier users will find it extremely useful, as they get to experience all aspects of the software away from their busy practice” Jessica said. “Even longer-term users of Bp Premier have found the face-to-face sessions very useful in advancing their skills, so we could encourage them to come along as well.” Jessica said.

With 4 different topics to choose from over the three day period, registrations are currently open for Bp Premier Clinical Essentials, Bp Premier Management Essentials, Bp Premier Advanced Management and Bp Premier Dollars & Sense.

Interested Bp Premier users can Register online or call to express their interest on 1300 40 1111. To learn more about Best Practice Software training visit the dedicated website www.bpsoftware.net/learning