Medical Tribunals: revenge, ignorance and failing the public

Today, the ‘Australian Doctor’ reported on the sanction of a GP who may or may not have performed substandard medicine. I cannot judge that but I can comment on the tribunal’s attitude to the use of testosterone supplementation. Here is part of the their findings:

‘Although the tribunal described the doctor as an “intelligent, passionate man who cares deeply about his patients”, it said his “narrow view” of medicine caused him to interpret symptoms, signs and pathology reports in a way that was out of step with his peers in general practice.

“The respondent appears to have a powerful and unshakeable belief in his interpretation of the physiology of the human body, and is unable to consider that he may be wrong,” the tribunal said in its ruling.’ And, ‘He interprets, to suit his belief, blood levels that are within the normal range as being abnormal if the results are either towards the low or high end of the normal range.’

I have blogged previously about the abuse of the word ‘normal.’ This Tribunal demonstrated, once again that it. like others before it, has NO idea, what ‘normal’ means. Did the Tribunal ask patients who were treated with so-called normal values if they had improved? Highly unlikely, as the last thing you would want in this context is proof that your all ready ill-conceived ideas were wrong. If you are experts sitting on a Tribunal panel, you will surely think that you are god-like and would have no inclination to see another point of view. That is confrontational to a belief system – you must not challenge beliefs, religiously guarded.

In this instance, the Tribunal showed, by its very own words, that it had no idea what a normal range represents. Normal ranges should be used to identify outliers who may be in extreme trouble but values in the ‘normal’ range tell us very little about the well-being of that person.

Humans CANNOT be considered to be sick or well, based on a single cut-off line. By this I mean that if your testosterone is 6 nmol/L you are considered to be normal (perfectly healthy) but if you are 5 nmol/L you are deficient (sick). Even a 6th grader could understand this concept of a graduated response but not, apparently, experts like Prof David Handelsman, who is an advisor, directly and indirectly, to organisations, like this Tribunal. If he is clueless, what hope do we have trying to treat sub-optimal health, which, for the most part, is what treating patients is all about? He and his ilk inform the panels and boards and if the advice they get is ridiculous, no wonder we cannot get justice in such settings as a ‘peer reviewed.’ investigation. This board invoked the ‘peer’ concept- clearly they know nothing about the disparaging views held by Drs Horton and Angell, editors of the world’s most prestigious medical journals, and Dr Peter C. Gøtzsche, co-founder of the esteemed Cochrane Collaboration, on how corrupt and useless peer review is. These are the real world experts. Too bad Australian authorities don’t listen to them.

The Tribunal cited their observation that the above GP did not perform to the same standards as his GP peers. Interesting. His GP peers would have no idea how to use testosterone and neither would they have any clue about the symptoms of suboptimal testosterone levels, or how to deal with them. Why is that? It is because there is not one week given to male studies in the WHOLE of medical school training.  NONE.
So do GPs treat testosterone deficiency states properly? How could they when they don’t know anything about the topic? So this GP was judged by standards that are deficient because his peers would have no idea what the whole topic of testosterone deficiency states was about!. How terrible is that?

Endocrinologists in Australia have a well-deserved reputation for being aggressive, confrontational and just down-right mean to any who oppose them. A trainee in Internal Medicine who loved the field of Endocrinology, told me the reason he did not go into that specialty in Australia was because of the terrible attitudes of the endocrinologists who taught him. These are the specialists who judge the GPs who prescribe thyroid hormone and testosterone therapies. And they don’t like it! Turf protection?

Australian doctors have no training on male issues including hormones and have no knowledge of nutrition either. How can the Australian male get good care in this country  when ignorance about these vital subjects is the norm?