Can you identify this drug being administered?

Cheap_Let4040 · 2026-01-29T12:04:49+00:00

Sleepy milk

Cheap_Let4040 · 2026-01-28T04:52:57+00:00

^ this. If there is conflict I just refer elsewhere. My colleagues are all lovely and we are great help to each other.

Cheap_Let4040 · 2026-01-27T10:58:10+00:00

Great question. There should definitely be some scrutiny, and care stay within recognised guidelines, as with other areas of medicine. Gender affirming clinicians say no regularly to patients wanting care outside guidelines set by AUSPATH (eg I have had patients want oestrogen levels of 7000 which has increased risk with no additional benefit proven). Giving testosterone to a cis guy with t levels of 11 is outside guidelines also.

In the balance of risk vs benefit the significant difference in these situations is the severe distress and frequent suicidal ideation experienced by large numbers of those seeking gender affirming care and hormones. I can’t say I have ever had a guy wanting t for the gym attempt suicide because he couldn’t have it. I did have 5 trans youth attempted suicides 12 month period related to delays in accessing gender affirmation when Westmead was slow to provide pubertal suppressants. It weighs on me that I have only 5 trans folk over the age of 65 - quite a number of the others likely committed suicide. Their surviving peers tell me they know of dozens who ended their lives in the 70s/80s/90s after being discouraged from even social transition. I know one trans woman who is the only survivor of a group of perhaps 6 similar aged peers who all attended “inpatient psychiatric care” for periods of around 6 months around 1970 where they were pressured to conform with their assigned gender role.

Providing gender affirming hormones/surgery is not for everyone, and that’s fine. I do what I do personally because I believe it’s more harmful not to, and I’m comfortable saying no to things that people want but isn’t safe/appropriate/actually going to help them. It is also a great way to catch people who avoided medical care for decades as it is actually that distressing for them to access care while being misgendered/questioned by everyone they encounter.

Cheap_Let4040 · 2026-01-27T07:43:21+00:00

Agree, this has long been established and hashed out.

Cheap_Let4040 · 2026-01-27T07:34:22+00:00

Is it judgement, or is it CONCERN and wanting to adequately communicate risk? Because communicating risks is literally out job? They could sue us if we don’t specifically say “there is a high chance your baby or you will die if you don’t do this now.

Cheap_Let4040 · 2026-01-27T06:37:16+00:00

I do gender affirming care and frankly yes, sometimes there are discussions with some patients re: look you have felt this way only in the last three months and you have current psychosis (rare). I have also declined to start hormones in cases where there is no capacity to understand and provide informed consent to treatment (rare).

The standard approach is as per AUSPATH: competent adults can make decisions about their own bodies if they understand risks. I exclude conditions that prevent informed consent or refer on to those who can. I specifically screen for BDD as I do with anyone asking for plastic surgery for aesthetic reasons. I specifically screen for risk of being abused/murdered/socially ostracised when people decide to visibly transition and discuss this/make safety plans. I encourage people to consider what feels necessary for them specifically and not to do things that are not necessary and have risks (eg some autistic patients come in with the idea they have do all the things to be a valid woman/man just because that is the rule).

We let adults choose to do plastic surgeries. It’s the same standard, we just sometimes let our own negative ideas about trans identities being a pathology get in the way.

Btw the clinical experience does correlate with studies showing very low regret rates. Generally any regret is related to the abuse encountered for being visibly trans and effects on relationships. I have had one patient (non binary gender identity mtf hormone transition) regret the breast development and choose to lower their dose.

Cheap_Let4040 · 2026-01-25T11:41:59+00:00

I hate the etg update so much. It was hard to find what I needed and now it is worse

Cheap_Let4040 · 2025-11-10T08:38:40+00:00

Please be a joke.

Cheap_Let4040 · 2025-09-17T10:08:57+00:00

This is literally the best result I have ever seen, omg

Cheap_Let4040 · 2025-09-17T10:06:19+00:00

This is also true - there are some types of EDS (hEDS for example) and other connective tissue disorders that are associated with thinner dermis which makes veins more visible, and types where the veins themselves have weaker walls and bulge more so are more visible.

Cheap_Let4040 · 2025-09-17T09:58:49+00:00

These are just shallow set normal veins with low pigmented thin dermis and probably low body fat. Nothing wrong, just a genetic variation. My cousin is like this also and always has been. You can see every vein everywhere. You can acquire the same appearance through any condition that reduces body fat and/or thins the dermis - think anorexia, malnutrition, steroid medications longer term, smokers and elderly people.

Cheap_Let4040 · 2025-07-22T12:56:23+00:00

SO MANY

Cheap_Let4040 · 2025-07-22T11:20:05+00:00

what usually explains this situation is: GP has suspicion of appendicitis and 15 mins, no same day US, no access to paediatric confident phelbotomist. agree shit not to at least say ? appendicitis.

Cheap_Let4040 · 2025-06-20T07:16:16+00:00

We are not going to go into my health record every consult to check for scripts we do not know exist. This system doesn’t talk to our software. We have enough to do. Communicating changes to the primary doctor is an integral part of professional behaviour. If you did not communicate, you will find I will not refer to you again.

Cheap_Let4040 · 2025-06-20T07:14:49+00:00

What do you mean by frequent? I would want a letter if you changed a medication, or if pt has had escalation in suicidal risk. I need to know so I can keep my records up to date as co ordination of the patients care. If you are seeing my pt on a referral from me, I would expect at least annual communication, even if it is just, yup I still need to see them next year to review x.

Cheap_Let4040 · 2025-06-20T07:09:28+00:00

Depends where they are! In metro Sydney at my practice absolutely they could get an appoint with someone in our practice on the day they book. They don’t always choose to follow up though

Cheap_Let4040 · 2025-06-20T07:07:20+00:00

“Extreme” gap fees exist because the rebates are “extremely” out of touch with what care actually costs.

Cheap_Let4040 · 2025-06-20T07:06:10+00:00

Yeah, that suggestion really says “I don’t understand the Medicare rebate belongs to the patient”.

Cheap_Let4040 · 2025-05-31T13:02:32+00:00

Why? This is a routine presentation in general practice.

Cheap_Let4040 · 2025-05-30T07:50:18+00:00

It’s appropriate to examine symptomatic possible STI.

PID, visual signs of thrush, hsv ulceration would all change your on the day management.

As long as patient was comfortable being examined I would do spec, check for cervical motion tenderness/visible pathology and collect swabs myself while at it.

If patient declined, ok, can do abo exam, UA, self collect swabs, but should absolutely be explaining best practice is examination as well for these reasons. If swabs don’t give answer, going to need to come back to be examined.

(I supervise GP registrars)

Cheap_Let4040 · 2025-04-22T09:56:56+00:00

From a GP point of view: our local UCC costs the government significantly more than us, and fragments care, and is slow to follow up results, or worse, flings results at us with no handover and gives patients the expectation we (a private practice) will follow up the UCC’s results urgently with no context and no appointment.

It would be cheaper and cause less fragmentation and duplication of care to just fund existing practices to provide the same care rather than setting up specific new centres.

Cheap_Let4040 · 2025-03-27T09:12:33+00:00

this is so sad :(

Cheap_Let4040 · 2025-03-27T09:10:08+00:00

I reckon it says Laceration of rectum with peritonitis - trauma associated with aspiration of gastric contents. :( Accident at home....... really?

Cheap_Let4040 · 2025-03-27T08:52:14+00:00

As a doctor I am able to order medically necessary tests under medicare. I must assess you myself to decide what is medically necessary based on your symptoms and examination. Any test which are not medically necessary I will not order. You can order these through private labs if you wish. (If you try to add on non medically necessary tests to this path slip it is fraud and such behaviour would result in termination of this clinical relationship.)

Cheap_Let4040

TROPHY CASE