09 Feb 2015

Nurse Surgical Assistant at Prince of Wales Private Hospital

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As most of you know it is common practice in Australia to have a doctor assist the obstetrician at caesarean sections. Indeed this practice is generally viewed as compulsory (although in the UK and NZ I often found myself performing a Caesar assisted only by the scrub nurse) and there are times when another pair of experienced hands can be very useful.

You will also be aware that surgical assistants at Prince of Wales Private Hospital will send you a bill for their services. Depending upon the time of day (or night) these doctors can charge anywhere from around $600 up to $1,000 (or occasionally more) to assist at your caesarean and you will usually get around $150 back from your Medicare and your Health Fund.

There is now a nursing surgical assistant at Prince of Wales Private Hospital called Cynthia Labi. Cynthia is an extremely capable assistant and I use her frequently. If Cynthia assists at your caesarean she will bill you a flat rate of $300. Because she is a nurse you will not be able to claim for her fee from either Medicare or your Health Fund but please note that you will be financially better off than if we used a doctor assistant – your out of pocket expense will be less than if a doctor assisted.

Rob

18 Jun 2014

A New Test!

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Many of you will be aware that there is a new blood test around for the diagnosis of Down Syndrome and other major chromosomal problems in unborn babies. It is called the Non Invasive Prenatal Test, or NIPT. I have written a new info sheet about this test (and prenatal diagnosis in general) and we have posted it in the INFO section of my website. Take a look.

Rob

25 May 2014

Fees Increase – just kidding!

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I usually increase my fees each year in order to reflect my increasing cost base. However I realise private obstetric services are expensive so this year we will absorb those costs and not alter my basic fee structure.

We will however now have to charge for giving iron infusions and for performing fetal heart beat tracings. While my midwifery colleagues do much of this work I pop the IV in for the iron and I read and report the heart tracings. These episodes will cost $160 although you should get more back from Medicare than for a usual visit because of the complexity of these visits (Rebekah can tell you exactly how much). All other midwifery visits will remain free and I urge you to see the Amanda and Caroline from time to time during your pregnancy and they offer great support after the birth of your baby.

 

I will be renewing my lease with Westfield later next year and I have heard a significant rent increase is on the way so I may need to increase my fees from 1 July 2015 but let’s wait and see.

 

Rob

06 Jan 2014

A Doctors Christmas

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A Doctors Christmas

On the twelve days of Christmas I’d like to be a better doctor.

On the first day of Christmas I want to treat my patients with the utmost respect and spend as much time with them as they need

On the second day of Christmas I want my patients in labour to feel as if they are my only patient in the whole world for the duration of their labour

On the third day of Christmas I would read every medical journal that arrived in my letterbox (and inbox) from cover to cover and be bang up to date with the obstetric scientific literature

On the fourth day of Christmas I’d like to supervise the junior staff more thoroughly and not take over a procedure because it’s late and I want to go back to bed (and not be grumpy over the phone when they ring me late at night)

On the fifth day of Christmas I will never lose my temper when given the Mayo scissors when I asked for the Metzenbaum scissors On the sixth day of Christmas I will treat all of my colleagues – even the hospital’s administrators – with kindness, patience and respect

On the seventh day of Christmas I will take my undergraduate teaching responsibilities more seriously and I will prepare for my lectures and tutorials more thoroughly than in the past

On the eighth day of Christmas I will actually turn up for the above mentioned teaching sessions and not delegate them to my registrar

On the ninth day of Christmas I will become involved in scientific medical research (OK – that one is never going to happen)

On the tenth day of Christmas I will diligently attend all of the academic sessions of every conference I attend and not sneak out early to go to the gym (or the bar)

On the eleventh day of Christmas I will diligently work to improve my procedural skills by operating with colleagues and attending workshops

On the twelfth day of Christmas I’d like to be a lot less tired and grumpy when I get home from work than I have been in the past.

Happy Christmas

Rob

01 Oct 2013

Aqua Mamma is here!

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For some time now I have been thinking about healthy hydration in pregnancy. I have watched as my patients have struggled to have their hydration needs met throughout pregnancy. In the first trimester a lot of my patients find water makes them more nauseated than usual so they struggle to keep their fluid intake up. In the second trimester some women are affected by the low blood pressure (and fainting as a result) that usually goes with a healthy pregnancy.  Then in the third trimester women need to keep their fluid intake up without taking in too much sugar. Finally I see women bring all sorts of – usually sugary – drinks in with them for hydration in labour.

 

So in my spare time (Ha Ha) I have come up with Aqua Mamma.

 

Currently there are very few healthy hydration options available to pregnant women (and middle aged obstetricians, for that matter). Purists will argue that our hydration and electrolyte needs are best met by drinking one to two litres of water per day and eating a banana. However some people – and pregnant women in particular – struggle to drink lots of plain water. Indeed I find it hard to drink lots of plain water after I have been for a run.

 

The problem is all of the other drinks out there are inappropriate for pregnancy , contain artificial sweeteners, caffeine, or – worst of all – FAR too much sugar. Some examples of sugar contents are:

  • ·         Cola drinks – 10.6 grams sugar per 100 ml
  • ·         Apple Juice – 10.9 grams sugar per 100 ml
  • ·         Orange juice – 7.8 grams per 100 ml
  • ·         Sports drinks – 5.7 grams per 100 ml
  • ·         Coconut Water – 5 grams per 100 ml
  • ·         Low Calorie Vitamin Water – 4.3 grams per 100 ml.

 

Aqua Mamma contains 2.5 grams of sugar per 100 ml along with an appropriate amount of electrolytes.

 

The product in the above list that upsets me the most is apple juice. Apple juice (along with many other fruit juices) is marketed as being healthy because it is pure and natural yet such marketing overlooks the high sugar content 13 grams of sugar per 100 ml! There is less sugar in most soft drinks!

 

Remember also that many juice bars use apple juice as the basis of many of their drinks and smoothies. Take a look at the energy and sugar contents of drinks that are marketed as being healthy and natural – you may be in for a surprise.

 

Coconut water is marketed as being very healthy hydration yet it contains twice as much sugar as Aqua Mamma. When it comes to coconut water as with most things, due to its popularity – an increase in quantity leads to a decrease in quality. The stuff right out of the coconut might be great for you, but the stuff on store shelves is a far cry. In fact, there’s a lot not to love about coconut water. Here are a few not-so-fun facts about “nature’s sports drink”:

  • To prevent Thai coconuts from spoiling on their way to the U.S., they’re coated with formaldehyde.
  • Several independent studies reveal that most processed coconut water does not have the level of electrolytes they claim. Big manufacturers O.N.E and Vitacoco are currently involved in class action lawsuits because of this false advertising.
  • Fresh, raw coconut water has enzymes that detoxify and repair the body, helping it to easily absorb all its electrolytes. But the stuff you find in stores has been pasteurized, which kills those healthful enzymes.
  • If natural is your priority, raw, organic coconut water is still a better choice than sports drinks after a heavy sweat session (and by heavy, I mean hot yoga-heavy, or outdoor-run-in-95-degree-heat-with-100-percent-humidity-heavy) or to rehydrate during a stomach bug, but in general the sugar content (11-14 grams per serving) makes it a poor choice in large quantities.

Anyway with all of these concerns in my mind I went into partnership with Rob Bates (my website guy – Tasman Multimedia – who is the healthiest person on the planet) and Victor Manauzzi (my wonderful accountant and Principal of Platinum Associates) to start making a healthy uncomplicated drink that is appropriate for pregnant women (and everyone else for that matter). Aqua Mamma is the result.

 

Aqua Mamma is pale pink (of course!) and it has a pleasant mild Cranberry / Raspberry flavour.

 

Aqua Mamma is low sugar, low calorie and it contains no artificial colours or flavours. We have added some sodium (not too much) and potassium in order to assist with your electrolyte needs. We have made certain the drink contains nothing genetically modified and our recyclable PET bottle is BPA free (I recently read a study in which BPA – commonly found in many plastic containers – can be found in the urine of some pregnant women). We tried to add folic acid, iodine and many other goodies to our drink but we found that these adversely affected the taste and texture of the drink and we simply could not add therapeutic amounts of these substances to the drink so we have stuck to a purely hydration and electrolyte product (and all the pregnant women I know are taking an appropriate pregnancy multivitamin anyway).

 

While we are promoting Aqua Mamma for pregnant women it is just as good for women planning to become pregnant and those who have given birth. In fact it is better and healthier than most hydration options for everyone which is why I drink a bottle after going for a run and always keep one in my car.

 

And so we have manufactured our first 5,000 bottles of Aqua Mamma (or AM, as we call it). We have a little more work to do on the labels but we are 100 percent happy with the drink and all of our early feedback from pregnant women has been favourable.

 

At the moment we are giving bottles of Aqua Mamma away for free from my office and from Women in Focus Physiotherapy (www.womeninfocusphysio.com.au) on level 17 of my building (OK, its Frank Lowy’s building but you know what I mean) so please come in and try it (it doesn’t matter if you aren’t one of my patients). Rebekah in my office will sell you  a six pack for $20 if you wish – and one of our first three paying customers was the health conscious husband of one of my patients.

 

We are very excited about having three paying customers.

 

A couple of intrepid outlets – Windscreens Café at The Royal Hospital for Women and Clodeli Café in Clovelly Rd – are also stocking Aqua Mamma. I don’t think they have sold any bottles yet but hope springs eternal.

 

And in the meantime we are working on a healthy hydration drink for everyone.

 

Then we are going to take over the whole world…

 

Enjoy

Rob

30 Apr 2013

Hydration for Pregnancy, Labour and Birth

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I have been thinking about drinks and hydration in pregnancy lately. There don’t seem to be many healthy options out there for pregnant women so in my spare time (ha ha) I have been working on a healthy hydration drink for pregnant women. It is called Aqua Mamma and its coming very soon – watch this space!

30 Apr 2013

Assistance

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I’m well aware that having a baby in the private system is an expensive exercise, even with Medicare and Health Insurance. As I have explained previously neither organisation contributes a great deal to doctors’ fees in maternity (and given the prospective size of the Federal Budget Deficit I wouldn’t hold out any hope of an improvement).

A few patients have been surprised and disappointed to receive an invoice from a surgical assistant if they have a caesarean at Prince of Wales Private Hospital. Unfortunately it is compulsory for me to contract a surgical assistant when you have a Caesar at Prince of Wales and unfortunately they do send you a bill and your Health Fund doesn’t cover a great deal  of it.  You can avoid this expense by having your baby at The royal Hospital for Women. If you have a Caesar there I press gang one of the junior doctors to assist and they cannot bill you (I bought a plasma TV and a couch for the junior doctors lounge at The Royal in recognition of their ongoing support).

30 Apr 2013

I know it’s only Rock and Roll…

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I know it’s only Rock and Roll…

But I really like it.

Almost by mistake I discovered that my favourite superannuitants, The Rolling Stones, are embarking on a tour of North America. As the long rumoured tour dates in Australia have not been announced (and may not be announced) I’m off to see them in LA on May 18th (a weekend off for me anyway). Can’t wait.

11 Feb 2013

Fifty Shades of Obstetrics

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I have been looking at my bookings for the year and can’t help but notice I have a mini baby boom going on in March and April. Despite our best efforts my numbers are higher in those two months than in any other time in the history of my practice.

I have been racking my brain trying to think what could have initiated such a baby boom. Of course it wasn’t the Olympic Games (for some reason seeing Aussies win gold leads to some – er – celebratory bonking) as they took place in August last year. However baby due dates in March and April mean conception dates in June and July. This was the time when sales of the erotic thriller (well it was hardly Pride and PrejudiceFifty Shades of Grey were at their peak.

In order to keep up to date with current trends in Obstetrics and Gynaecology I of course – being such a dedicated soul – began to read Fifty Shades of Grey last June especially as for some reason a copy had made it’s way onto my ipad. However I gave up after about fifty pages when I was overwhelmed with terrible feelings of inadequacy. And these feeling were not just because I don’t fly my own helicopter.

Seriously though the next couple of months will be a bit busy for the practice. I may be called away to labours and births a bit more frequently than usual so we may “bump” your appointments from time to time (I always prefer rescheduling to making people wait for hours). It is probably smart to ring Rebekah just before you leave for your appointments with me just to check I haven’t rushed out the door because someone has gone into labour. 

31 Jan 2013

Your Baby’s movements

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I have had a couple of women ring the office asking Rebekah to move their appointments forward because of a reduction in their baby’s movements.

I cannot emphasise strongly enough that a reduction in your baby’s movements is a potential emergency and that you must call or text me on my mobile phone if you are concerned – and that you must not go to bed worried about your baby’s movements.

Please read Your Baby’s Movements on my website. This information is also found in the booklet I gave you at your booking visits.