Surgery stitch-up: NSW patients stung for thousands

Some surgeons are charging thousands of dollars more than their colleagues for the same orthopaedic operation, leaving patients with up to $5500 in out-of-pocket costs.
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Paying for a return flight to Adelaide for a hip or knee replacement would, in many cases, be cheaper than seeing a Sydney or Melbourne surgeon, an impractical hypothetical revealing the huge variations in surgeon fees across Australia.

A Medibank report detailing the vast disparities sends a clear signal to patients to shop around for their doctor, taking into account out-of-pocket fees, complication rates and expertise.

Private patients could have no out-of-pocket costs for orthopaedic surgery or incur thousands, depending on their surgeon. Photo: shutterstock南京夜网

The average cost of a hip replacement varied by more than $20,000 ($19,439 to $42,007) depending on the surgeon, showed the joint Medibank and Royal Australasian College of Surgeons (RACS) report of all orthopaedic surgeries funded by the health insurer between 2014-2015 and 2015-2016.

For a knee replacement, the average cost ranged from $17,797 to $30,285, and knee anterior cruciate ligament (ACL) repair ranged from $5076 to $13,950.

Out-of-pocket costs fluctuated by thousands of dollars, depending on the choice of surgeon, the review of close to 28,000 surgeries released Tuesday found.

Just over one third of surgeons charged no out-of-pocket fees. Among the surgeons who did, their average out-of-pocket bills were as high as $5567 for a hip replacement, $5137 for a knee replacement and $2907 for a knee ACL repair.

Medibank chief medical officer Dr Linda Swan said the report should encourage patients and referring GPs to do their research before settling on an orthopaedic surgeon.

“There is a lot more to selecting a doctor than taking the first person that is recommended to you,” Dr Swan said.

“[Cost] should be part of the referral process. They should be asking questions like ‘What is the expertise of this doctor?’, ‘How many procedures have they done?’, ‘What costs will I incur?’, ‘What hospitals will this doctor be able to walk right into?’ “

The report should also prompt health authorities to investigate the causes of the vast disparities.

“When we see large amounts of variation, then somewhere along the line something may not be working well … whether it’s waste, or not having the appropriate standards of even errors in the health system.

“It really should cause people to stop and ask questions.”

A state-by-state breakdown of out-of-pocket costs also found wide variations between states and territories.

NSW surgeons charged $2673 on average in out-out-pocket costs for hip replacements, almost five times that of South Australian surgeons. Victorian surgeons charged $1997 on average in out-of-pocket costs.

The out-of-pocket cost for a knee replacement in NSW was $2499 compared to $1609 in VIC and $397 in SA on average. For ACL repair, out-of-pocket costs were $2248 in NSW, $1671 in VIC and $321 in Tasmania.

“What are the reasons surgeons charge higher out-of-pocket costs in NSW than, say, South Australia? It could be overheads are a lot higher. Maybe there is some justification to it, or it could be that people are prepared to pay more in NSW so surgeons charge more,” Dr Swan said.

The report – which does not identify the doctors – also found stark differences in the rate of complications, climbing as high as 400 per 1000 hip replacements, suggesting some surgeons had as many as one complication for every 2.5 hip replacement surgeries they performed.

For knee replacements, the complication rate ranged from zero to 200 per 1000 surgeries, and 30-day readmission rates for ACL repair varied from zero to 20 per cent.

High complication rates could be partly due to some surgeons having small patient numbers or treating a very sick patient group with complex conditions, or they were not performing as well as their peers, Dr Swan said.

The rates of referral for rehabilitation between surgeons also varied widely.

Some surgeons sent none of their hip or knee surgery patients to rehabilitation, while others sent every patient to rehab, suggesting a doctor’s preference rather than a patient’s condition determined their chances of referral.

“You really have to stop and ask ‘Why would this be?’ ” Dr Swan said.

Dr Swan hoped surgeons would use the data to improve their practices, but “other levers could accelerate change”, including introducing regulations and agreed standards about cost and referrals.

RACS president John Batten said “This is about looking at the quality of care in the system and how we can use these reports as an educative process: where there are surgeons that are outliers, how can they improve their practice in line with their peers?

“We are committed to continuous improvement in clinical practice in Australia,” Mr Batten said.

Why we struggle to say, are you OK?

Annalise Braakensiek: On the road with the RUOK? Conversation Convoy. Photo: Supplied”Are you OK?”In a country where the cultural psyche is to downplaypain, these three little words can have monumental power.
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But, new RUOK? statistics reveal that one in three people don’t feel comfortable asking the question.

“When we drilled down to the reasons people are holding back, it was things like ‘I don’t know what to say, I don’t want to make it worse, I don’t want to pry’,” explains clinical psychologistRachel Clements.

“To have a conversation with someone whom you suspect is not travelling so well, you don’t have to know exactly what to say … you can give a tremendous amount of support by asking the question and listening.”

It was the lack of questionsand lack oflistening that struckRUOK? ambassador, actorand vegan caterer, Annalise Braakensiek when she was “immobilised” by the “dark cloud” of depression.

Annalise Braakensiek: Not always OK, and that’s OK. Photo: Supplied

“Very few people asked me ‘was I OK?’ And when I did say [I wasn’t], they ran,” the 44-year-old says.”I was so shocked by the reaction of so-called friends –the aggression, the lack of support. That’s when I really realised the negative stigma with mental illness is rampant. People have that real ‘what have you got to be depressed about?’ [attitude]”

In reality of course, as Braakensiek says: “Suicide and feeling you’re on the edge;success doesn’t come into it.”

Our culture of downplaying or dismissing pain has “got us into trouble”, Clements says.

“We have an incredibly high suicide rate in Australia – there are eight deaths a day by suicide.”

While not everyone is willing to open up when they are struggling, even when they have a strong support network, we cannot underestimate the potency of letting others know that we’re there and we care.

The first time Braakensiek fell into depression was about 15 years ago. She had met her biological father only three years before he died from cancer.

“Seeing him pass away was the most hideously painful thing because I’d just found him,” she recalls. Her grief was compounded by the unexpected death of her best friend three days later.

“I didn’t know what depression was,” Braakensiek says, but she found herself overwhelmed and unable to get out of bed.

After a friendreached out and suggested she might be suffering from depression, she started cognitive behavioural therapy (CBT), a meditation practice and prioritised rest and exercise.

“I got out of it quickly, all things considered, and was super well for many, many years until two years ago,” she recalls.

Then, in the space of four months she lost three family members as well as two friends who died of suicide.

“It was an incredible amount of grief in a short space of time which left me incapacitated again,” Braakensiek says.

Although she “immediately” recognised the feelings, they once again overpowered her.

“I couldn’t get out of bed,” she says. “I think I spent about six weeks in bed. I couldn’t do anything but cry my heart out – it was a very frightening feeling.”

The reaction of those around her didn’t help.

“What surprised me and really disappointed me was I had people actually being aggressive ‘what have you got to be depressed about? You live this charmed life, you’re famous, you’re beautiful’,” Braakensiek says.

“People seem to run away from it like ‘how can you be like that’? I’m usually this innately positive person and very energetic… for me to be bedridden and immobilised, they didn’t know how to deal with it … One person literally said ‘ugh, here she goes again’.”

Just as a negative response can exacerbate the way someone is feeling, a positive, empathetic response can be instrumental in that person feeling supported.

“Talking to my grandfather was so wonderful, he made everything make sense and took away me feeling like I was being indulgent for feeling this way,” Braakensiek says. “When you hear ‘what have you got to worry about’ or ‘get on with it’ you feel guilty … he helped me to get on the right track.”

She began CBT again and now sees a kinesiologist, meditates, does yoga and exercise and focuses on eating well and sleeping.

“I’ve lost more people than I can count on two hands. I would be a robot if I wasn’t brought down by this,” says Braakensiek who is touring Australia with other ambassadors for theRUOK? Conversation Convoy.

“You need people to care and be there but self-care is imperative as well … I tackle it every single way I can, but I also honour the fact that I loved these people so so much and they’ve left and it’s OK to not be OK.”

How to ask ‘Are you OK?’ALEC:Ask, Listen, Encourage action (which may simply mean assisting someone towards support), Check in (stay in touch and be there for them)

Trust your gut:”Expect people to minimise and say they’re OKwhen they’re not,” Clements says. “Our psyche is to minimise, deny and avoid in the space of mental health. Trust your gut reaction – if you know someone well, be gently persistent.”

Don’t assume:”We see someone in a high-performing role or doing well at work or they might have a great family and we do make assumptions,” Clements says. “It doesn’t discriminate and it can affect anyone. How someone is presenting on the outside is often very different to how they’re presenting on the inside.”

Real-time conversations and connections matter:”A text doesn’t cut it if someone is really struggling. It’s effectiveness versus efficiency: it might be more efficient to send a text message but is it more effective?”

Take initiative:Don’t wait for someone to come to you before you ask how they are. “We’re not relying on the person who’s not travelling so well to come to us,” Clements explains. “We’re taking the burden off them to invite them into that conversation and that’s whatmakes a tremendous difference in connecting people when they feel disconnected.”

The RUOK?Conversation Convoy is currently in WAand will be in Sydney on 1 September before heading north to Cairns. To donate or track the Conversation Convoy they can head to梧桐夜网ruok.org419论坛

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Tony Windsor weighs into Barnaby Joyce NZ citizenship scandal

Former New England MP Tony Windsor.FORMER New England MP Tony Windsor hasn’t ruled out running to try and regain his former rural NSW seat, if a by-election is triggered by current holder and Nationals leader Barnaby Joyce being disqualified from parliament due to dual citizenship.
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Mr Windsor spoke up today after news broke of Mr Joyce’s latest challenge – to retain his position in parliament and seat of New England, due to being the latest federal politician embroiled in the citizenship scandal.

In a brief statement to the House of Representatives, Mr Joyce said he was contacted last Thursday afternoon by the NZ High Commission to advise that on the basis of preliminary advice from the department of internal affairs, which had received inquiries from the NZ Labour Party, it considered he could be a citizen of NZ by descent.

“Needless to say I was shocked to receive this information,” Mr Joyce said.

Asked if he would run in a by-election if Mr Joyce was disqualified, if it was proven he held dual NZ citizenship, Mr Windsor said “I would not rule anything out”.

“Would see what the lay of the land was but would not think there would be one (by-election) however you never know,” he said.

Mr Windsor said he didn’t know the technicalities of Mr Joyce’s citizenship issue but with other Senators recently resigning from parliament – Greens Larissa Waters and Scott Ludlum – he believed Labor leader Bill Shorten and Prime Minister Malcolm Turnbull needed to take a good look at the rules.

“The current law needs to be looked at,” he said in reference to section 44 of the constitution.

“Not sure who but someone has said Barnaby Joyce is definitely a dual citizen of NZ so under the current arrangements he’d be ruled out.”

Mr Windsor resigned from parliament in 2013 after holding the seat for 11 years but unsuccessfully challenged Mr Joyce at least year’s election.

Mr Windsor said it was also up to the government and Mr Turnbull to decide, if Mr Joycestayed in the ministry, rather then stepped aside, like Queensland Nationals Senator Matt Canavan has done, while the High Court decides his fate, after it was revealed he held dual Italian citizenship.

In his statement today, Mr Joyce said the government had taken legal advice from the solicitor general.

“On the basis of the solicitor general’s advice, the government is of the firm view that I would not be found to be disqualified by the operation of section 44.1 of the constitution for serving as the member for New England,” he said.

“However to provide clarification to this very important area of the law, for this and future parliaments, I have asked the government to refer the matter, in accordance with section 376 of the Commonwealth Electoral Act, to the High Court, sitting as the Court of Disputed Returns.

“Given the strength of the legal advice the government has received, the Prime Minister has asked that I remain Deputy Prime Minister and continue my ministerial duties.”

ABC political expert Antony Green said if Mr Joyce sorted out his citizenship issuein time, if ruled to be ineligible, he could also run at any potentialby-election.

Speaking in parliament, senior Labor power-broker Tony Burke questioned the broader impacts of Mr Joyce’s eligibility to sit in parliament.

Mr Burke said it was unknown if parliament had an eligible member for New England, Deputy Prime Minister, or even a majority government.

Mr Joyce assumed Senator Canavan’s ministerial responsibilities for Northern Australia and Resources, while the Court of Disputed Returns deals with his eligibility issue.

At the time, National Farmers’ Federation CEO Tony Mahar backed in the Deputy Prime Minister saying Mr Joyce had an understanding “better than most”, of the issues in the Resource and Northern Australia portfolios.

“I have every confidence that Minister Joyce, with the help of assistance ministers, will capably manage the extra responsibilities, until which time a more permanent solution is in place,” he said.

NFF however declined to comment on the latest development and whether the NZ citizenship issue would distract Mr Joyce from adequately addressing his ministerial duties.

Mr Burke – a former Agriculture Minister – said Mr Joyce should step aside due to doubt over his constitutional eligibility.

“This is the first time in history of this Parliament a government has asked the High Court to determine whether in fact they have a majority,” he said.

“This is a government reliant on a majority of one.

“What the House is doing right now is saying to the High Court ‘we’re not actually sure if the government does have a majority of one’.

“But we have been here for 12 months making laws with a government that may or may not be legitimate.

“With a Parliament that may or may not be voting according to the Constitution of this country.

“And if the Minister for Resources was able to stand aside even though he had the Attorney General beside him claiming that he had a strong case then why on earth is strong case the defense for the Deputy Prime Minister?

“How on earth does that work?

“It cannot be the case that the words of the Attorney General in defending Senator Canavan and why he wouldn’t resign from Parliament were correct, because they apparently had a strong case, yet stood aside.

“But if it’s the Deputy Prime Minister the person who’s the architect of the Coalition agreement with the Prime Minister on which the fate of this Government hangs that secret deal, then in that situation, the rules all change.”

During question time, Mr Burke argued Mr Joyce should not be permitted to answer questions while the citizenship issue was being dealt with by the High Court – but the speaker ruled he was eligible.

After a vote, Mr Joyce was also allowed to answer a question where he said agricultural production had grown by 19 percent and attacked the opposition’s record.

He said Labor was only after Green votes and had delivered “nothing” for central Queensland, including for cattle producers.

Fitzgibbon blast

Shadow Agriculture Minister Joel Fitzgibbon asked Mr Turnbull what the difference was between the legal advice given to Senator Cananvan who stepped aside from the ministry, and that given in reference to Mr Joyce’s situation.

“How can our farmers and other agribusiness stakeholders have confidence that a Minister whose legitimacy is under question can adequately represent their interests?” he said in a statement.

“For example, Barnaby Joyce is currently responsible for Australia’s biosecurity.

Shadow Agriculture Minister Joel Fitzgibbon.

“If there is a serious biosecurity breach such as the recent White Spot outbreak, how can we be confident the Minister is capable of adequately responding in the eyes of the law?

“How can producers and growers have confidence Barnaby Joyce is capable of representing their interests when trading partners suspend our exports?

“How can they be confident our international partners will take Barnaby Joyce seriously?

“Barnaby Joyce should put the national interest ahead of his own interest and stand aside.”


London’s Big Ben to go silent for four years

Scaffolding is erected around the Elizabeth Tower, which includes the landmark ‘Big Ben’ clock. Photo: APLondon:So it has come to pass that the keeper of the Great Clock announced on Monday that London’s “Big Ben” hour bell will be silenced for four long years as desperately needed repairs are carried out on the 158-year-old timepiece.
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Londoners were not happy to hear the news, and there was lament on Twitter, with many recalling how the hourly bongs of Big Ben serve as a kind of base note for their lives.

“A silent Big Ben will be super eerie,” tweeted Rob, a history student at King’s College. “I could hear the chimes from my room in Euston, they’re the sound of London!”

“It will be very sad, but it needs to be done,” said Kirsten Hurrell, 71, a news agent who runs a busy stall that faces the clock tower.

Hurrell said the gong of Big Ben might be one of those things in life you don’t miss until they are gone. “Quite honestly, we live with it and half the time we don’t hear it,” she said. “But we will miss it when we will suddenly find it’s not there anymore.”

Tourism officials were glum but hoping for the best.

A selfie with the Great Clock atop Elizabeth Tower along the Thames River is almost mandatory. The Palace of Westminster, home to the houses of Parliament, is one of the top five visited sites in London, and Big Ben is the star of the show.

The tower will soon be fully swaddled in metal scaffolding and three of the four clock dials covered. The last gongs of Big Ben, before its long rest, rang out at noon Monday, August 21, London time. Large crowds witnessed the event. The repairs should be complete sometime in 2021, authorities promised.

“Big Ben has marked the hour with almost unbroken service for the past 157 years,” said Steve Jaggs, keeper of the Great Clock, noting that the complex renovation – budgeted at about $US40 million – is designed to safeguard clock and tower for future generations.

“Big Ben falling silent is a significant milestone in this crucial conservation project,” the clock keeper said.

The actual bell is not the problem. It is the clock that rings the bell that needs repairs.

Cast by the Whitechapel Bell Foundry, the 13-ton hour bell was the largest of its day, its first performance celebrated by Parliament in 1859.

In all these years, Big Ben bonged through good times and bad, including the Blitz, Germany’s eight-month aerial bombardment of London during World War II.

The hour bell has been silenced for long periods a few times before. Just weeks into its service, Big Ben cracked. Apparently the striking hammer was too heavy. A lighter hammer was installed, the bell was turned, and Big Ben was back in service after three years. The experts say the crack gives the bell its unique but imperfect tone.

In more recent times, Big Ben stopped pealing for six weeks in 2007 and for repairs in 1983 and 1976. The bell was silent during the funerals of prime ministers Winston Churchill and Margaret Thatcher.

The keeper of the Great Clock explained that Big Ben must be silenced as the clock itself must be “dismantled piece by piece with each cog examined and restored.”

The four opal glass faces of the dials will also be cleaned and repaired, the rusting cast iron framework renewed, and the hour and minute hands refurbished. In addition, some modern conveniences – like an elevator and washroom – will be built for the timekeepers.

While the refurbishment in ongoing, the conservationists will allow one dial of the four faces of the clock to be visible, so Londoners can still set their watches. A modern electric motor will turn the clock hands until “the prince of timekeepers” is repaired.

Washington Post

Hammerhead shark spotted in Lake Macquarie

Another shark has been caught on camera cruising the waters of Lake Macquarie.Thehammerhead shark was spotted nearMannering Park on Monday.
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Shane Lee from Toukley captured the footage which he uploaded to Facebook. He had unknowingly set the video to public, instead of privatelysharing it with his friends, and was shocked when he saw it had gone viral online.

It has beenwatched more than 75,000 times and shared by hundreds of people.

“It just went mad,” Mr Lee said.

He has enjoyed thefascination with the video, despite it being ‘just a hammerhead shark’.

“I am on the lake a lot and you don’t see sharks all that often,” the keen boater said.

“I have probably seen three sharks in 15 years.

“Usually you would expect it to be a white pointer or a bull shark. That’s the funny thing, it’sthe only shark I have been able to identify and it was a hammerhead.

“I was actually disappointed.”

He said the shark was about two metres in length and was just ‘cruising around’. With a bit of careful steering, aphone handy and a bit of luck, he managed to get close enough to hit record.

“Everybody has always been fascinated with the sharks in the lake,” he said.

“I wouldn’t worry about getting bit by one though.

“You would have to be pretty unlucky.”

SHARK: A screen shot from the video, which clearly shows the hammerhead shark.

SHARKS IN THE LAKEThis is not the first time a shark has been spotted in the lake.Some believe the end of commercial fishing in 2002 is the reason for increased shark sightings.Others say improved management of the lake is a big factor.

Shark sightings in Lake Macquarie go back a long way, take a look.

Hooked: A hammerhead shark caught off Swansea in the 1970s. Picture: David Wicks

RECENT SIGHTINGSBull sharks were sighted in Swansea Channel in February. Local man Daniel Poka couldn’t wait to dip his feet in therefreshing waters offBlacksmiths when his fiancee Samantha drew his attention to the three sharks swimming towards the rocks. Take a look.

Bull shark in the Swansea Channel. Picture: Daniel Poka video

The previous February was also a busy time for shark activity in the lake. Alarge shark roiling in the water was caught on camera as unsuspecting boaters passthe creature. Watch the video here.

SHARK: A still from uploader 1cut808’s footage, February 2016.

But its it always great white shark sightings that are of the most interest to Lake Macquarie locals. A Rathminesfisherman captured close-up footage of a great white shark he estimatedwas more than three metres long as it swam around his boat off Wangi Wangi in December. Watch the video here.

Hammerhead shark spotted in Lake Macquarie CLOSE ENCOUNTER: A white shark close to the side of Dean Grant’s boat. Pictures: Dean Grant.

A CURIOUS EYE: Dean Grant says the shark approached his boat a number of times over more than half an hour.

I WON’T GET BITTEN: Dean Grant says he won’t be back in the water after filming a big white shark in Lake Macquarie.

TweetFacebook Great white shark in Lake MacquarieHave you got video of shark activity in the lake? Let us know. Email [email protected]南京夜网419论坛