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What we don't offer:

• False reports: All reports provided from this practice are honest and ethical. Please do not ask for anything else as you will still be charged, yet not obtain what you want.

• Unproven methods: There are more than enough "alternative" practitioners offering unproven or even disproven therapies for a variety of motivations. This GP offers evidence based, proven methods as the "default". If there is no proven help or you have exhausted orthodox methods taken appropriately, unproven methods can be discussed and a logical, scientific approach formulated - (see "Trial of One"). Unproven methods will be clearly explained as such, with no false claims for effectiveness or safety.

• Procedures where the harm may outweigh benefit: -including neonatal circumcision, Achilles tendon steroid injections, cosmetic body piercing, cosmetic collagen and Botox injections, surgical removal of keloids and prescription of anabolic steroids.

• Procedures where I lack experience: -including circumcision where a foreskin problem exists, split skin grafts, tendon repairs, varicose vein injections and anything else I don't feel competent performing. However, I will refer to an appropriate surgeon who manages them often enough to maintain competence.

• Procedures which I didn't or don't recommend: This includes procedures recommended by telemedicine doctors, alternative practitioners, Google, friends, neighbours and relatives (even if they are doctors or nurses). I am however willing to look at all options. Please note that I will normally need to examin any abnormal skin condition before any biopsy or excision, rather than assuming I have the time or ability to do this in a normal consultation.

• Unethical treatments: -including prescribing drugs in addictive quantities or assisted suicide.

  Assisted Dying Service I am not able or prepared to provide an Assisted Dying Service, however, appropriate terminal care may involve withholding inappropriate life-prolonging therapy and providing pain control irrespective of risk to life. These issues are best discussed before, or early in a terminal illness. It is still possible for my patients to be referred to the Support and Consultation for End of Life in New Zealand (SCENZ) service. See SCENZ.

  Termination of Pregnancy (TOP) is an ethical issue for the patient where my personal beliefs are not relevant to a woman's choice of action. My service will be to ensure the woman has thoroughly considered all options and makes a decision that protects her current and future health. I will refer a woman on for consideration of TOP if she has made a considered decision to explore that option, or even to discuss it further. However I like to place an emphasis on realistic Family Planning for all sexually active patients in the practice to ensure unwanted pregnancies are less common.

 

Trial of One"
Where a treatment is unproven or only helpful in some cases, it is often appropriate to undertake a "Trial of One", particularly when a significant cost is involved. This concept can establish the appropriateness of this therapy for an individual and help justify on-going costs, or more often may help demonstrate the ineffectiveness of the treatment and save money and false hope.

Essentially, one asks a willing helper to obtain the proposed treatment (eg bee venom capsules) from the source, and also to obtain a safe "placebo" that has a similar appearance (say a vitamin capsule) from your pharmacist. It is important for the patient not to know what the "active" treatment looks like, and to avoid trying to find out until after the trial. Either the pharmacist or the helper then transfers each "active" or "placebo" capsules into identical containers labelled "heads" or "tails", recording which product is in which bottle. It is also a good idea to make a list of symptom scores, or have a third party (spouse, GP etc) make independent observations. If the helper is to make the observations, they shouldn't know which is the "active" capsule (get the pharmacist to pack them).

One then flips a coin, takes whichever turns up at the recommended dose for an appropriate time (if the product claims improvement within "x" weeks, take it for "x" weeks, then repeat the symptom scores & observations. Take a week or so off (a "wash-out" period), then take the other bottle at the same dose and for the same time before repeating the scores and observations.

Only after reviewing the scores and observations, and a decision made about which treatment ("heads" or "tails") is better, or there is no difference, should the "code" be broken. Sometimes, if one cannot be sure, it might be worth repeating the process, perhaps for a longer period before breaking the code. Sometimes one actually feels better on the placebo, indicating the "active" agent has side effects, or makes the condition worse! After a scientific "double-blind trial of one", it should be possible to make a more informed decision about the place of the "alternative" therapy for the person in the trial.