Decluttering our homes and lives

Accumulating possessions is not always associated with an improvement in wellbeing. It can actually lead to stress and health issues.

On the other hand, giving, donating and getting rid of stuff are usually described as positive experiences. Decluttering homes even has health benefits.

A new Netflix series, Tidying up with Marie Kondo, brings a powerful message across: organising our homes and offices comes with rewards.

Marie Kondo, dubbed the Japanese Mary Poppins, creates happiness by helping people throw away stuff they don’t need and organise their belongings. As a result relationships seem to improve and families live happier together.

The concept is of course not new, as professional organisers, unclutter clinics and clean-up blogs have been around for a while. But there is something appealing about watching this show.

Whether it is a desire for simplicity, a need to create organised spaces to think, work and live, or just guilt reduction, the slowly disappearing clutter towards the end is satisfying.

Marie Kondo makes decluttering homes, and lives, a fun activity. But she does something else. By asking whether objects spark joy she reminds us about our priorities and what life is all about – something we occasionally forget.

Finally some common sense on health reform

Mal Brough MP - Finally some common sense on health reform
Liberal MP Mal Brough last night in the Sunshine Coast, Queensland: “This must be a debate about improving health (…) not on cost cutting or shifting.”

When I arrived last night for a meeting with Federal MP Mal Brough, I had to work my way through TV camera crews to get to my chair.

But Brough didn’t come to challenge the prime-minister. The meeting with local hospital doctors, GPs and staff was about health reform and the Medicare rebate – and what he had to say was remarkable.

I was expecting the usual: Budget crisis, rising Medicare costs, price signals etc. But this was a different message coming from a liberal MP.

Brough first showed some figures comparing (combined commonwealth and state) hospital expenditure versus GP Medicare rebates: $39.9 billion vs $5.9 billion per year. He demonstrated that hospital costs are rapidly rising but GP Medicare rebates remain more or less static.

His 3 core messages made sense to me:

1. This must be a debate on improving the health of the nation, not a debate on cost cutting or cost shifting

2. A co-payment or price point should not be the starting point of this discussion

3. There are tremendous efficiencies to be had in hospital, specialist services and aged care if Primary Health provision is enhanced and is the heart of the nation’s health system.

Health organisations are hammering this message: If you want to keep patients out of our expensive hospitals, strengthen general practice – don’t take money out of the industry.

Brough underlined this by showing AIHW data indicating that already over one-third of emergency department presentations were for potentially avoidable GP-type presentations (see image). A GP co-payment will almost certainly drive more traffic to the hospital EDs.

Mal Brough’s suggestion: Scrap it.

The audience was excited and so was I. Let’s bring on the real health debate.

Social determinants of health: Why I am all tip and no iceberg

Why I am all tip and no iceberg

In the ‘Blogging on Demand’ series you get to choose the topic. If you have a great idea you want the world to know about, send an email, contact me via social media or leave a comment below. Melissa Sweet suggested the topic of this post: ‘Social determinants of health’. She tweeted: “Interested in your take on SDOH & how they play out locally.” Thankfully, to make the task easier, Melissa suggested some background reading: 436 articles from the Croakey archives.

Note: ‘Social determinants of health’ are economic and social conditions that influence the health of people and communities.


“Doc, that’s not going to work.” The health worker was standing behind me. She had overheard my consultation with the elderly man. I thought I was doing a great job, as I had taken the time to explain what diabetes was all about – in layman’s terms – and how he should inject the insulin.

The indigenous health worker continued: “He lives mostly outside and keeps his medications under a tree.” I couldn’t believe what she had just said. When the penny dropped I realised she was, of course, right: the insulin wouldn’t last in the excessive heat of the Kimberley.

It was clear that I had no idea of my patients’ living circumstances. I felt like a fool.

The home visit

Another time, another place. I was doing a home visit in a Cape York indigenous community as part of a team consisting of two nurses, a social worker, a health worker, a police officer and a local government representative.

The verandah was covered with rubbish and furniture. It was hot inside. The room was empty, apart from a few mattresses. The concrete floor and walls were dirty. “How many people live here?” I asked. “Between 8-20, depending on when you visit,” said the social worker.

The patient was lying on a mattress – she clearly only had a short time to live. There was not much I could do apart from some small medication changes. Afterwards, we had a long chat on the verandah about fixing the air-conditioning and the tap, and making her last days as comfortable as possible.

All tip and no iceberg

The contribution of doctors and other health care professionals to our wellbeing is relatively small: Depending on what source you read, healthcare contributes for about 25 percent to our health. On the other hand, an estimated 50 percent of our health is determined by economic and social conditions (see image).

One of Australia’s leading researchers on the economic and social determinants of health is Professor of Public Health Fran Baum. “Typically,” she writes in this editorial, “responses to diseases and health problems are knee jerk and concerned with ameliorating immediate and visible concerns.”

Professor Baum calls this the ‘all tip and no iceberg’ approach. Instead of focussing on disease and unhealthy behaviours we should improve the conditions of everyday life.

To combat the chronic disease and obesity epidemic for example, we should not just be advising lifestyle changes and initiating medical treatment. These are tip-of-the-iceberg solutions.

Instead, says Baum, let’s look below the surface at things like urban planning, the availability of unhealthy food, our sedentary lifestyles at home and at work, and equal opportunities for all.

Social determinants of health
Image: About 50% of our health is determined by economic and social conditions (green). Source: Adapted from a presentation by Professor Fran Baum

General practice

In my work the influence of economic and social factors is apparent. Some examples:

  • The 26-year old single mother who cannot afford medications for her children
  • The 38-year old machine operator who gained 10 kg of weight since he started a fly-in-fly-out job in a remote mining community
  • The 50-year old chief executive who makes 14-hour days in a high-pressure environment, and develops anxiety symptoms.

My role as a GP in these scenarios is modest. Ok, ‘all tip and no iceberg’ may be too harsh – apart from the fact that it sounds like ‘all icing and no cake’…

But Professor Baum has an important message: We must not close our eyes to what really makes us ill and, more importantly, change it.

Thanks to Melissa Sweet for the topic suggestion.

Follow me on Twitter: @EdwinKruys


Doctors get sick too

Doctors get sick too

I took a sickie the other day. Nothing serious, but when you’re in the line of fire you get burned now and then. Patients always respond the same. They may say, half-surprised half-joking: “I didn’t know doctors could get sick.”

I can kind of see the humour of a sick doctor, but unfortunately finishing medical school doesn’t make us immune. Yes, I had my flu shot this year. No, I didn’t write a doctor’s certificate for myself. I also don’t have a secret cure that prevents me from falling ill.

Have a look at the headlines in the news this week, and you will be forgiven for thinking that medical science can cure anything:

“Implantable device ‘lowers blood pressure’ through electrical brain pulses”

“Duchenne muscular dystrophy may be treated with erectile dysfunction drug”

“DNA used to build tool that may literally shine light on cancer”

“3D-printer hearts ‘in 10 years’”

“Immunotherapy may work in cancers: study”

Hope vs false expectations

Health news is usually positive, which is great as most other news is depressing. News about scientific discoveries and new medical treatments gives us hope. Hope that one day, we may be able to live without suffering. But it also creates false expectations.

I would like to see more headlines that reflect reality, like:

“Doctors often don’t know cause of illness”

“Lifestyle just as important as medical treatment”

“Many diseases still without cure”

“If you eat healthy you probably don’t need supplements”

“Doctors get sick too”

Writer and philosopher Alain de Botton wants the news to take on new roles. I think he’s got a point. He warns about our appetite for the latest news: “We constantly want a new update on things and it’s become very hard to talk to ourselves… the news is from outside and any of that quieter news that bubbles up from within is being squashed by endless stories.”

The news often only tells part of the story and this may cause anxiety. It would be good if the news could educate us a bit more and help us to put things into context.

Medicare Locals, please make it easier for us, not harder

Medicare LocalHealth Minister Tanya Plibersek said on ABC’s Q&A that Medicare Locals had developed as a ‘natural successor’ to divisions of general practice to assist primary care at the local level.

Although this sounds great, it seems that Medicare Locals are wasting tax dollars and are creating red tape. Medicare Locals are funded by the federal government and responsible for funding local health projects such as after hours care.

This week, Medicare Locals have been put on notice by the AMA because they are rolling out onerous contracts for GP after hours services. Although the after hours work is still done by doctors and nurses, the funding is now in the hands of Medicare Locals instead of the state health service.

It also appears that Medicare Locals are sending out new contracts to GP practices for PIP incentive payments (‘PIP’ is a bonus paid out to practices if certain targets are met). The contracts require GPs to produce lots of data e.g. quarterly reports, and contain many clauses that give full control to Medicare Locals but put all the risks, costs and responsibilities on health professionals.

It is expected that many GPs will not sign these contracts. This will have serious consequences for patient care.

If we do not stop Medicare Locals, doctors and practice managers will be wasting valuable time behind their computers generating reports, instead of helping patients. Medicare Locals should be supporting health professionals to improve patient-access to health care facilities.

A recent survey also brought to light that about fifty percent of Medicare Local staff is busy writing reports instead of providing or facilitating services to patients or clinicians.

Whichever party wins the next election, this needs to change. Medicare Locals, please make it easier for us to provide patient care – not harder!

eHealth: The good, bad and ugly

E-health: good, bad, ugly

We’ve come a long way with technology in general practice. Technology should make our lives easier. However, in health-IT a good idea can easily go bad. But the opportunities are mind-boggling and we’ve got exciting years ahead of us.

Let’s have a look at the good, bad and ugly in eHealth, including cyber insurance, liability issues, telehealth, mobile apps, social media and of course the PCEHR.


The PCEHR has gone ugly. Sidelining doctors and clinical leads didn’t do the project any good. A basic requirement of a successful project is effective stakeholder management. Healthcare evolves around GPs, and if the main stakeholders are not on board for 200%, the project will fail. Meanwhile, the government has started data-mining our patient’s eHealth records. A colleague recently said on an IT forum:

I demand legislation that simply states something like: Information stored in the PCEHR can exclusively be accessed by health professionals directly involved in the patient’s treatment and exempt from access by any other third-party including by means of subpoena

I’m not holding my breath here but it’s a clear message, shared by many GPs. By failing to listen to doctors the PCEHR will be added to the already impressive global scrap heap of major health IT fiascos.

But the good news is: there are alternatives. Instead of wasting more tax dollars, we should adopt one of the already fully functioning, cheaper Australian shared record systems, like RecordPoint from Extensia.


Video consultations between rural patients and specialists save time and travel costs. But some patients would benefit more from Telehealth access to their GP. The RACGP budget submission to fund Telehealth for people living with a chronic disease was a great suggestion.

Initiatives like Telederm where GPs can get send a picture of a skin condition to a dermatologist and get advice, are worth their weight in gold. And eventually we really have to agree on a simple, but professional alternative to Skype that cannot be accessed by (foreign) governments or other third parties.

Social media & mobile apps

Whether we like it or not, social media is slowly becoming part of mainstream healthcare. We’ve figured out how to use social media wisely. More and more GP conferences now include workshops and session about how to sign up for Twitter, linkedIn or WordPress.

Registrars use Facebook and Twitter for e-learning. A new launching pad has been created to assist GPs interested in the professional use of social media.

Mobile and sensor-based technologies enable our patients to monitor just about anything, and with a push of a button this data could come our way – from blood pressures to continuous holter monitor results. GPs will have to figure out a way to deal with this data. This will be a challenge, but ignoring it will not make it go away.

Security & legal issues

When we introduced free WIFI for patients in our practice we discovered security risks that had to be mitigated first. The explosion in cyber crime fueled by cloud computing results in more data breaches, and GP practices are not exempt as we’ve seen not long ago in Queensland.

Technology in health care always creates liability. Recent national concerns about e-dispensing alerts and the doctor’s duty of care are a good example. New national privacy legislation will include mandatory breach notification. This means GP practices have to report all data breach events, even the minor ones, and failure to do so will incur high penalties.

AHPRA didn’t want to stay behind and introduced a social media policy, as well as a revised Code of conduct, revised Guidelines for advertising and revised Guidelines for mandatory notifications – which now include social media clauses.

The problem with regulations like this is that it further increases liability for doctors, already operating in a highly regulated industry. We don’t need more regulation. Risks are: less innovation and progress, a defensive attitude by doctors, higher legal and insurance costs, increased AHPRA fees and eventually higher costs for patients.


It’s not surprising that cyber insurance is going to be the next hot topic. Cyber insurance should cover us against threats like cyber extortion, identity theft, crisis management, business interruption and disaster recovery. The PCEHR already has it’s own legal pitfalls. My indemnity insurance now provides cover in case of:

  • PCEHR privacy breaches.
  • Allegations of negligence for failing to detect critical patient information contained within the PCEHR.
  • Loss or corruption of electronic documents or data.
  • Intellectual property disputes.

The insurance policy does not cover fines and civil penalties related to the PCEHR – another reason why our practice will not sign up. IT security upgrades of practice systems as well as connected home and mobile devices will be unavoidable, and GPs and practice managers may have to do some upskilling to get their heads around this.

This article has previously been published in AMA(WA)’s Medicus Magazine, June 2013.

7 amazing health benefits of positive thinking

7 health benefits of positive thinking

“I have not failed. I have just found 10,000 things that do not work.”

This quote from Thomas Edison oozes positive thinking. Optimistic people have a favorable expectancy of their future, and not without reason it seems: studies indicate that optimism leads to a longer, healthier life.

Researchers at the Mayo Clinic identified seven potential health benefits of positive thinking:

  1. Increased life span
  2. Lower rates of depression
  3. Lower levels of distress
  4. Greater resistance to the common cold
  5. Better psychological and physical well-being
  6. Reduced risk of death from cardiovascular disease
  7. Better coping skills during hardships and times of stress.

We can train ourselves to turn a half-empty glass into a half-full one. Positive thinking is not about ignoring problems. It’s about changing your perception of negative experiences.

Here is a simple exercise to practice positive thinking:

  • Look at what you have achieved on a daily basis. Don’t look at what you could’ve done better
  • Every night write down 3 achievements
  • Try to analyse why they went well
  • Give yourself a compliment for your achievements.

We don’t always control the events in our lives, but we can train ourselves to be more optimistic. And it appears to be healthy too.


The secret of happiness

The secret of happiness

Is the grass always greener on the other side of the fence? Most people will answer ‘no’ to this question. Yet we often want what we don’t have. And against better judgement, we sometimes hope that happiness lives on the other side of the fence too.

The commercial world thrives on selling happiness: it’s not the new phone, car or dress, but the dream of a better life that’s on offer. And we all fall for it, thinking that somehow we will be happier after the purchase.

The reason for this is that we’re not good at predicting what makes us happy. Unfortunately, happiness as a result of a treat, purchase, or even winning the lottery, is short-lived – probably less than three months. Spending money on others makes us happier than spending it on ourselves, according to a study published in Science magazine.

Interestingly, happy people enjoy themselves without expensive treats. One happiness study showed that it’s the simple, cost-free things in life that matter, like listening to music, reading a book, going swimming, or enjoying a hobby.

We can spend a lifetime searching for happiness, not knowing that it’s right on our doorstep – because we’re too busy looking at the grass on the other side of the fence.

What makes you happy? There’s a good chance that it’s an inexpensive, relaxing activity, or an act of kindness.

The secret sauce of health care

The secret sauce of health care

The previous Christmas parties at work were nice. We sat down and were served a nice dinner. There was nice live music. We were fed and entertained – what more can you ask for?

Last year our management team took a different approach. We were not fed. We had to prepare our own food: Select the toppings for our pizza and bake it in the wood fired pizza oven. We waited patiently in line. We were the chefs.

There was no band. We had to sing ourselves – on stage. We were the entertainment. There were sumo suits; there was a gladiator ring. It was the best Christmas party ever.

Participation is fun. It creates a sense of ownership, responsibility and improves team spirit. That’s why social media are so popular. Social media empower us: We have become participants instead of spectators.

This is how it should be in health care. I love it how some of my patients take ownership of their health. They are actively engaged, do research, ask questions and understand their treatment. As a doctor I’m not telling them what to do, but I’m part of the team. It’s also called shared decision making.

Participation is the secret sauce. As health care professionals we must do everything we can to encourage participation.

5 things to remember before a doctor’s visit

Questions to ask your doctorIt happens regularly: people visit a doctor but have difficulty providing essential details about their health. The most common reason is probably that people don’t realise what information we need to help them. Example: it is difficult to write out a script if I don’t know what allergies someone has.

Sometimes people incorrectly assume that all information is always at my fingertips. I don’t blame them; the health care sector is complicated and going to the doctor is understandably not everybody’s cup of tea. Therefore I hope the following five tips will help to make the most of your doctor’s visit.

Be prepared and make the most out of your doctor’s visit

1. Gather as much information as you can about your problem. Write it down, together with your questions. The doctor may ask a few things such as: when you first noticed the problem, what made it better or worse, and what your main concerns are. Make sure you know what your questions and expectations are.

  • Tip: You can do some research on the Internet – but always check your findings with the doctor, as online health information may not be applicable to you.

2. When you make the appointment, allow enough time. For example, if you want to discuss a complicated issue or a few problems, consider booking a long appointment to avoid running out of time.

3. You may want to ask a friend or family member to join you. Having someone with you is helpful in many ways: to ask questions, to remember what has been discussed, for support and to give you a lift to and from the clinic if you are unwell.

4. This is important: Keep a record of all your past and present health problems. Doctors always need background information about your health. Don’t automatically assume the doctor always has all the required information.

  • Tip: Your own record could include a chronological list of your medical problems, diagnoses, hospital admissions, operations, medications, vaccinations, allergies and side effects from certain medications, products or food. Outcomes of important tests are always helpful. Keep a paper record, or better, save it on your computer or phone.

5. Never leave things to the last moment. A doctor’s visit just before a holiday trip, or on a Friday afternoon may cause problems – for example if the doctor needs more tests.