Like most GPs I have a sizeable number of grossly obese patients. None of my 140 kilogram-plus patients are in the workforce or have private medical insurance, and they cannot afford the services of the private bariatric surgery facilities in the ACT. There is no publicly funded bariatric facility in the ACT, and the facilities in NSW that used to accept referrals are now restricting their services to NSW residents.
Given the above scenario, what are ACT GPs supposed to do when the legal system now tells us (''Obese man awarded $350,000'', February 8, p8) that we are liable if we do not refer and, in fact, actively assist these patients in getting bariatric surgery? Will we be held equally liable in the near future when our smoking patients get lung cancer, the alcoholics destroy their livers, etc? Am I supposed to stand in front of shops and stop my patients from buying the wrong food or smokes?
I also do not expect ACT Health to develop access to bariatric services as a priority - we have a system where we have no paediatric cardiology services in the ACT and when we as GPs send patients to specialist clinics at the Canberra Hospital they are often not seen by the medical specialists but end up seeing only allied health workers who, at some clinics, turn away as many as 40 per cent of the referrals the GP has sent to the specialist.
Given the lack of access to some core specialities I would therefore not be demanding that limited resources be spent on gastric banding.
As mentioned in your article, this fiasco will result in GPs being more and more defensive in their management of patients - with these obese patients it will mean that their already long and complicated consultations will be even longer. These patients are usually not in the workforce and we usually bulk bill them. The maximum rebate that a GP clinic can get (for any consultation longer than 40 minutes) is just over $100. We can't charge for the time we spend chasing down people at various hospitals and clinics, arranging transport, blood tests, etc - often spend several hours per obese patient while bulk billing them $100 or less. This may seem a huge sum to a public servant or academic commentator, but any small businessman would appreciate that a gross income of $100 for a couple of hours' work does not pay the overheads.
This legal decision is yet another nail in the coffin of small GP clinics and very soon all that will be left will be the large corporate and super clinics.
Dr Thinus van Rensburg, Charnwood
Senate seat at risk
Noel Towell's article (''Sidelined Senator's fate rests in own hands'', February 8, p6) misses the point, and sadly so do the Canberra Liberals.
It's not Gary, but the party who will be toast on September 14. For two consecutive elections the Liberals have come within a whisker of losing the Senate seat. The reason they haven't is because of the respect Humphries commands with the sensible centre of Canberra politics. These are people who don't agree with many Liberal policies but believe that Humphries is a worthwhile voice of moderation in defence of Canberra. Zed Seselja does not command this respect, and the centralists will move their support away from the Liberal ticket.
Couple this with the feeling of betrayal felt in Tuggeranong in Brindabella, and the serious questions raised about his character and competence by the allegations of misuse of overtime by his staff and the role of the party president in his office. Surely this would and should be a central element of the Greens' campaign.
My prediction is that the seat will be lost if Zed is the candidate, and then the party will utter once again the ignorant words of Peter Costello. How did it come to this?
Nicholas Jarosz, Stirling
Some remember Zed Seselja as the Assembly leader who repeatedly showed scant regard for the legal requirements of his elected office. Party machinations may well see a Senate seat lost rather than gained by the Liberals.
Gary J. Wilson, MacGregor
