Monthly Archives: May 2014

Does the End Justify the Meanness?

Proposed changes to health funding in Australia’s 2014 Commonwealth Budget include direct costs (“co-payments”) to patients every time they see their GP or have pathology done, and an increase in the cost of prescribed medications. This extra revenue will be put towards medical research. Does the end justify the means meanness?

For some people with schizophrenia the only medication that keeps them well enough to stay out of hospital is clozapine. Clozapine was initially introduced in the early 1970s but was withdrawn within a few years because some people died while taking it. Although clozapine is the only effective antipsychotic for some people with schizophrenia, about 1% of those who take clozapine will develop agranulocytosis (a dangerous drop in white blood cells, especially neutrophils – the most abundant type of white blood cells). Left unrecognised and unmanaged agranulocytosis leaves people very susceptible to serious infections and, as happened back in the 1970s, can even lead to death.

Schizophrenia is a bugger of an illness. Onset of symptoms is nearly always in teenage years or early twenties. Schizophrenia is often misrepresented as split personality – that’s wrong – it infers that a person can choose or control their symptoms. The word schizophrenia has it’s roots in the Greek language, translated it means split mind – people do not choose to have a split mind. Symptoms vary between individuals, but very often people with schizophrenia will experience thought disorder (non-sequential, disorganised, confused thinking), delusions (beliefs, often unsettling and difficult to understand, that are not shared by others) and auditory hallucinations (sounds or voices that nobody else can hear, but which sound and feel very real to the individual experiencing them). If these symptoms are intense or frequent they can really make a mess of the individual’s ability to function successfully in school, university or the workplace. Consequently people with schizophrenia are over-represented amongst the unemployed and homeless.


Because schizophrenia is such a bugger of an illness and clozapine can be so effective at dampening-down the symptoms, in the early 1990s clozapine was made available again with some very strict protocols in place to keep the people taking it safer from serious side effects. When starting on clozapine blood tests are taken every week to check that the neutrophils/white blood cell counts don’t drop. It is built-in to the infrastucture of clozapine management – you can’t get a prescription until you’ve had a blood test and the doctor checks it against previous blood tests. If there are any problems with the blood tests the doctor will stop prescribing clozapine – no ifs, ands or buts. For about 1% of people the risk of agranulocytosis will outweigh the benefits of staying on clozapine.

For the person with schizophrenia taking clozapine this regular regime of blood tests, visiting the GP and getting a short-term prescription (there are no repeat prescriptions for clozapine) might be the difference between being in hospital and being at home, or (sometimes) being homeless and being at home. Once initial treatment is established, safe management of clozapine requires frequent blood tests, a new prescription every 4 weeks and regular visits to the GP.

The proposed budget changes include a $7 payment to see the GP, $7 fee for out-of-hospital pathology, and an additional $5 for each prescription medication. What are the benefits of making schizophrenia treatment more expensive? Are there any foreseeable problems?


We are being told by our government that Australia’s universal health coverage is not under threat. $7 to visit a GP costs the same as two beers says our treasurer. What a sneering, mean thing to say.

People with schizophrenia, like people with diabetes, chronic obstructive pulmonary disease (COPD) and other enduring illnesses, are already at a social and financial disadvantage. For the individual with schizophrenia whenever there is an increased intensity or frequency of delusions, auditory hallucinations and disordered thoughts they suffer terrible distress. The people who love and care for them share in this distress. Often an expensive hospital admission for a few weeks is required to bring the symptoms back under control and sort-out the social problems that a period of being out of touch with reality can cause: unpaid bills and rent may lead to loss of accommodation; neighbours, friends and family may be feeling uncomfortable having you home again; your self care and physical health may have deteriorated; your tobacco, alcohol and drug use may have increased; you may have come to the attention of the police.

Do the benefits of co-payments really outweigh the risks?


Final Notes

On Monday 19th May 2014 Joe Hockey, Australia’s Treasurer, will be appearing on Q&A. I have submitted this two-part question:

For some people with schizophrenia the only medication that keeps them well enough to stay out of hospital is clozapine. 
Safe management of clozapine requires frequent blood tests, a new prescription every 4 weeks and regular visits to the GP. 
What are the benefits of making schizophrenia treatment more expensive? 
Are there any foreseeable problems?

You may have a question of your own for Mr Hockey, if so go to

CoPayLogo2CoPayStories provides an avenue for patients and health professionals to share their perspective on the proposed GP co-payment – visit the website and/or follow @CoPayStories on Twitter.

For the purpose of this argument I’ve cited only one side-effect of one medication for one illness. I am aware that clozapine has more than one side-effect, and there are illnesses other than schizophrenia that require regular pathology, GP visits and prescriptions.

Thanks for visiting meta4RN: as always, you are welcome to leave feedback in the comments section below.

Paul McNamara, 17th May 2014

Short URL:

List of Australian Nurse Colleges

Australia-map-wall-art-sticker-62Professional associations in health often (not always) define themselves as colleges. That is, a formal group of colleagues who abide by the same set of standards or laws.

I could not find a single list of Australian colleges of nursing and midwifery, so have created one here, and have added a couple of college-like speciality nursing associations. Inclusive, not exclusive.

To keep this alphabetical list simple but useful, links to each college’s website, Twitter and Facebook page have been added.


Australasian Cardiovascular Nursing College Web Twitter Facebook

Australasian Neuroscience Nurse’ Association Web Twitter Facebook

Australian Association of Stomal Therapy Nurses Web Twitter Facebook

Australian College of Children & Young People’s Nurses Web Twitter Facebook

Australian College of Critical Care Nurses Web Twitter Facebook

Australian College of Mental Health Nurses Web Twitter Facebook 

Australian College of Midwives Web Twitter Facebook

Australian College of Neonatal Nurses Web Twitter Facebook

Australian College of Nurse Practitioners Web Twitter Facebook

Australian College of Nursing Web Twitter Facebook

Australian College of Operating Room Nurses Web Twitter Facebook

Australian Nurse Teachers’ Society Web Twitter Facebook

Australian Primary Health Care Nurses Association Web Twitter Facebook

Australian Society of Post Anaesthesia and Anaesthesia Nurses Web Twitter Facebook

College of Emergency Nursing Australasia Web Twitter Facebook

College of Remote Area Nurses of Australia (CRANA is now a multidisciplinary organisation for all remote health professionals; to reflect this they have re-badged as CRANAplus) Web Twitter Facebook

Drug and Alcohol Nurses of Australasia Web Twitter Facebook

Renal Society of Australasia (mostly, not exclusively, nurses) Web Twitter Facebook


Thanks to RoxaneStefan CampbellCaleb Ferguson, Jess and  Clinical Educators for their suggested additions to the list. Part of the Twitter consultation process revealed that there are existing lists here: (thanks Roxane) and here (thanks Colleen). Nevertheless, please let me know of the colleges/links I’ve missed in the comments section below.

Paul McNamara, 11th May 2014

You are welcome to link to/share this page. Short URL:



Luddites I Have Known

In the never-ending quest to enthuse midwives and nurses about professional use of social media I’ve talked to people about it, given inservice education sessions, demonstrated is use as an adjunct to education, facilitated workshops, submitted conference posters, contributed to journal articles and have been invited to speak at conferences. To spread the word I’ve taken the risk of being called geek wanker narcissist, and even had cards printed:


When I talk to people about health care social media, I always mention how it lets information be shared quickly and easily,  and network with people from a range of professions/walks-of-life from all around the world. However, the thing I value the most and try to emphasise the most, is the participative, interactive nature of social media. Social media is where the debates are held; those of us who want to influence and participate in decisions gather and test our ideas on social media. Twitter is especially good for this: it lets anyone join in and contribute to- and be enlightened by- the contest of ideas.

To see how Twitter works to share information and the contest of ideas, see these two recent examples (click on the pics to see the complete conversations unfurl):

In health and education roles I encounter many people who give dumb blanket statements like, “I will never use Twitter – I don’t care what Justin Bieber had for breakfast”. Much to my embarrassment, this is the sort of thing I hear nurses (especially those in positions of influence and power) say all the time. These people are so stubborn that they won’t even look, listen or learn about professional use of social media.

A few months ago two Australian nurse lecturers forthrightly and very confidently told me that Twitter and facts are (somehow) mutually exclusive, and they do not and never will use it. I tried being zen about the whole thing (water flows around resistance, rocks in the stream shift or erode), and celebrated some of the nurse academics who are more enlightned about health care social media (see

However, the same thing keeps happening: people in positions of power and influence in the health care and higher education systems are still using silly, uninformed, blanket statements to decry the use of social media and warn people off from using it.

No more Mr Nice Guy – I’m calling these people what they are: Luddites.

People being resistive to new technologies and innovations is not new, and in my lifetime I have seen that change is inevitable – the luddites and laggards will catch-up eventually.

In the 1970s I knew people who refused to play video-games like Space Invaders – “No it’s too confusing, I’m sticking with the pinball machine” said my friend when we went into the pinball parlour.

In the 1980s I knew people who refused to use ATMs (automatic teller machines) – “No, you can’t trust a little card and machine. I’ll wait until the bank opens on Monday.” said my relative.

In the 1990s I knew people who refused to use computers. Every now and then I still hear people say, “I don’t believe in computers” as if computers are akin to the tooth fairy or religion.

In the 2000s I knew people who refused to use a mobile phone, “Why would I ever need one?”, people would say. Now, in Australia, there are more mobile phones than people (for more info:

In the 2010s I know people who refuse to use social media. As evidenced by the “I don’t need to know what Justin Bieber had for breakfast” type of statements, the reason they don’t use it is twofold: [1] they do not understand it, and [2] they decline the opportunities to learn.

I guess I should be patient with my resistive colleagues – history shows that they’ll come around eventually. However, for those nurses and midwives in positions of power and influence, I’m hoping people will print and fax you a copy of this picture below. If  you can’t summon the willingness to learn about professional health care social media, please summon the dignity and sense to stop critiquing something you do not understand.


PDF version (suitable to print and fax to a social media denier of your choosing): Luddites

As always, your comments/feedback is welcome.

Paul McNamara, 3rd May 2014