Dr Neela Janakiramanan
@NeelaJan
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👋 Surgery, words, health equity, refugee health 👜 Reconstructive & hand surgeon ❤️ Columns + novels 📖 Bestselling author of ‘The Registrar’ (Rep @mjostell )
Naarm (Melbourne), Australia
Joined February 2018
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Happy publication day to my book baby 🥳
I hope you’ll enjoy this deliberately realistic and fast-paced glimpse into modern Australian hospitals and medical training, and how patients, and healthcare workers might live, love and survive.
Available at all bookstores, today!
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Kids folding laundry and chatting:
13 year old: why are the pyramids in Egypt
10 year old: because they are too big for the British to steal
All three cackle loudly.
My parenting work is done.
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I hope everyone in Australia’s takes notice of the ease with which the Aboriginal flag was added to the podium at Parliament.
I could have been at any time - its omission was the deliberate decision of those in charge, just as placing it there today was a deliberate choice.
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Notable that after about twenty seconds of whinging, Melbournians have emerged in public today sporting their boutique, fair trade or home made vintage single origin perfectly colour coordinated and stylish face masks as if we have always worn them.
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To everyone comparing Vic and NSW testing centres/capacity, please remember that Victorian testing staff tested 20K people plus for months on end, got sick, came back, kept working, and are now being recalled from well deserved holidays. Please be kind, and patient.
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“If people come to our house, Jenny and I always greet them with a smile,” says the man who wouldn’t come out and meet tens of thousands of women marching for action.
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There’s a well dressed middle aged guy sitting on a bench in Fitzroy, swinging his legs and eating an entire tub of ice cream at 11 am and this is the sort of energy I want more of in 2022.
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Are powerful men in this country really reading and publishing the diaries of a young woman, now dead, to try and discredit her, in defence of their powerful mate?
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To every little girl who believes that women are not important I would say: watch the world mourn a woman who was the linchpin of a failing democracy.
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Melbourne/Victorian outbreak. My phone is running hot with people asking “should we panic”?
My take? Be vigilant, restrained and careful. Not panicked.
Keep your distance, wash your hands, avoid gatherings, keep social contact to the min req for mental health.
Why?👇🏽
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A general observation: when two boxes of BBQ Shapes are same price as a head of broccoli, it is not the time to be shaming anyone for their food choices.
When you are or have been poor, calories and a full tummy will beat nutrition every time.
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Please know that it’s not Covid that’s broken our health system.
It’s decades of a broken health system, run by overworked, exhausted and often underpaid people - with two years of ‘it’s Covid, please flex/be resilient/work harder/feel unsafe/help for free��� thrown on top.
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I won’t be watching Q&A tonight, for the same reason I don’t watch debates with climate change skeptics. Not everything has an opposing view. Airing the opposing view in the hope it gets shot down just gives it breath and life.
Herd immunity can’t be conferred by mass infection
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So apparently my patients in Melbourne can go out to dinner in a poorly ventilated room with 49 strangers and have their nails done, but can’t have already delayed surgery in a theatre full of vaccinated staff to ease their pain and restore their function. 👇🏽
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“Flabbergasted” that a sick doctor would keep working?
Um, sick doctors working is the backbone of our health system. The entire underfunded, understaffed, and underresourced system relies on people coming in every day, despite ANY personal challenge.
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Why isn’t there a parenting technique called ‘chaotic mix of unconditional love and mad screeching’ or does that not sell books
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All female surgical team here for International Women’s Day. Someone send us cupcakes.
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Public health message from a hand surgeon: self-isolation is not a good opportunity for non-essential DIY.
Watch TV, read a book, play a board game. Step away from the power tools in a pandemic.
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When you live in an isolated provincial capital and have the poor people of an entire rest of a country shouldering the epidemic to unload your freight and drive you food across the desert while you seal yourself off, it’s very easy to be smug.
I recently went to two Christmas parties. Not a single person was wearing a mask.
And it was okay, because there’s no epidemic where I live. Western Australia has managed to sustain zero COVID for nearly 2 years.
Eliminating COVID-19 was always possible. The world chose not to.
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Of the many things that happen in a hospital when the power goes out, one haunts my memory, a story I have also heard over and over from other doctors who also worked in a hospital when it suddenly went dark
A thread about mothers and their children👇🏽
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When women get older they don’t get aggressive/passive-aggressive; they just stop taking the disrespect and discrimination we used to put up with.
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Tim Smith is also responsible for this catastrophic second wave by aggressively undermining all the public health messaging that would have stopped this from spreading through the community for months. If hotel quarantine is the spark,
@TimSmithMP
is a wind fanning the fire.
Daniel Andrews and ministers;
@MartinPakulaMP
,
@LisanevilleMP
,
@JennyMikakos
, are responsible for this catastrophic failure that has resulted in the 2nd wave.
Security guards for hotel quarantine were hired via WhatsApp and then given no training.
You couldn’t make this up.
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Australia finding out that healthcare workers are ordered to work when sick, exhausted, traumatised, injured, infectious, vulnerable, in pain.
That’s our health system, always.
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Please note: It has been much much MUCH harder to teach them how to fold laundry than to teach them history.
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I’ve been thinking about the ‘doctors defraud Medicare’ piece for hours.
It’s my considered view that it’s a shitty piece of investigation.
Not because doctors don’t defraud Medicare - a minority do; this is abhorrent.
But because most of what’s in the piece isn’t fraud.👇🏽
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Three years of climate change, fires, pandemic, job losses, deaths in institutional care and THIS is what Parliament stay up all night for?
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Why were the poor people so contagious that 3000 of them had to be locked into their houses immediately, but the rich people weren’t so they got a day to flee to their second homes in the Peninsula, boats and surfboards in tow?
Does the virus know your bank balance?
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Final comments because this has run away.
I don’t hate the British. But they did steal a lot of stuff. Teaching history doesn’t equate to teaching hate.
Also acknowledging history doesn’t make one racist. I promise no British people were harmed in the making of this joke.
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Really feeling for all the nurses who will be having their leave cancelled as Victoria declares a code brown. As ever, as in every previous wave, it will predominantly be nurses who bear the brunt of this.
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Please share
#MedTwitter
. Last week we lost one of our own. Not to our broken medical systems, but to the Australian policy of indefinite collective punishment for seeking refuge by sea. He asked to leave to join his parents in the UK, and we refused even that. Vale Dr Rohani.
He BRAVELY crossed the sea by boat, to ask for asylum of Australia. Aged 32, Doctor Mirwais’s Rouhani took his own life. Made ill after years of mistreatment & medical neglect on Manus & dept mess ups here. He tried so hard to get well but his heart broke
@JacquiLambie
#Medevac
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The more I think, the more it doesn’t make sense that a government that’s paid $100/test for 55 million PCR tests won’t fund a $10 test, esp with limits.
So, is it REALLY that they can’t get them, or they think the states should fund or something else? What’s really going on?
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Morrison’s election platform: you only get free stuff if you’re already rich.
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For everyone suggesting this didn’t happen, I can completely understand. Who ever heard of 10 and 13 year old boys folding laundry? Please know it has taken years of alternating shouting and bribery m, and they still went to play basketball in the back yard without finishing.
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The women of the Liberal party trying to discredit
@juliahbanks
is actually proof of the point Julia is making. Women are forced to make patriarchal bargains to survive in sexist, misogynistic industries. Where genuine equity exists, there is open discussion and acknowledgment 👇🏽
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Someone buy Victorian public health/contact tracing a pile of pizzas and a couple slabs. What stars.
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Disappointing when a doctor doesn’t remember rule number one of internship - if you order a test, you wait for the result.
Premier Andrews made it clear that when the results of all the random tests done, decisions will be made. Seems fair to those who had their brains tickled.
Why is Premier Andrews deferring the baby step of Step 1 when the National Cabinet has built a strong health safety net to trace, track and trap covid. Less deaths in Victoria from covid than annually from the flu. What evidence is he using to inform his policy?
#COVID
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If women didn’t go to everything also attended by someone they have disdain for (because that person has behaved unethically, abused their power or deliberately hurt others or us), we’d never leave the house.
‘Just don’t go’ fails to understand the magnitude of the problem.
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As a doctor, I don’t think being a doctor gives us the right to comment on whether an app is safe to use.
As a doctor I believe in contact tracing and quarantine.
Whether the app is safe to do this is a question for cryptographers and cybersecurity experts.
As a doctor, I’ll be downloading the contact tracing app, and I’ll be encouraging my patients, colleagues, family, and friends to do the same
#COVIDsafe
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It’ll be interesting to see how long until powerful men in the USA start advocating for safe, accessible abortion given, for the first time in history, there’s safe, accessible DNA tests.
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To be clear the joke is not original. It’s been around for years, and was read somewhere before it was retold today. I just like that they understood it and found it blackly amusing.
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I actually didn’t think Australia would impose pre-departure testing from China.
Hard to see this as anything other than xenophobic, as if disease control were the aim, a whole suite of measures directed at, essentially, the whole world, would be more appropriate.
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While the federal government use Novax Djocovid as a huge distraction, don’t forget that they failed to plan and communicate for this phase of the pandemic adequately, and that generally speaking, Australian border policies are inhumane.
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Hey
@GregHuntMP
, I’m a surgeon in the Mornington Peninsula. Why is it still so hard for HCWs down here to access the covid vaccine, especially those under 50? It’s either a comms or access issue - suggest you look into it!
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In every wave globally the uncontrolled spread of COVID has been due to inequity.
I just paid $90 for six RATs to cover my family of five, just in case we need them. If you make it a massive privilege to act a good citizen, you’ll get a whole lot of people who can’t be.
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I have disagreed with public statements by our Health Minister, but
1. Her staff are exceptional and have done more than the people of Victoria will ever know. Thank you.
2. Failures are always systemic, and rarely caused by (or fixable by) one person. We should remember this.
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In Victoria, the response has been very impressive. Rapid upscaling of manpower, communications, testing, and resources to support people being tested and isolated. What we are seeing is a world-standard response. We should be proud, not panicked.
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(Sorry, last point. Enough with the racism, ok? As the rich skiers in Mornington/Toorak showed, ANYONE can unwittingly get and transmit the virus. It’s a global pandemic. And if anything, this is proof of why we have to work together rather than be divisive. We’re all connected)
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I’ve spent years worrying about Peter Dutton as party leader, but to see him as the leader of a party so shattered and withered, so lacking in insight as to what went wrong, I’m suddenly not worried at all.
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Anyone seen the Minister fir Women this week?
(This month? This year? Since the last election?)
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Boarded a plane in extra time. Half the plane groaned as we lined up to take off just as penalties started and all the phones had to turn off. ATC advised the final score which the pilot announced as we flew, to an eruption of cheers. Absolute scenes. Go Matildas!
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It turns out that wearing a mask that stops 99% of airborne viruses stops 99% of infections in those working on COVID wards in the UK.
More astounding findings to follow 👇🏽
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Have spent the evening thinking about all the problems uniquely faced by Australian women that would be solved if Jenny Morrison just turned her mind to pointing out that ‘their girls’ might face them one day.
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Victorian schools haven’t done an undisrupted term since term 4 2019.
Today, lockdown announced late afternoon and online learning plans and schedules for tomorrow in our inbox already from our public school.
I hope teacher salaries will be going up.
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I will end with this comment from Dr Ghassan, a plastic surgeon like me.
Think of this, please, when you consider whether it is ok to for the power to go out in hospitals, anywhere in the world.
There no lonier place in this universe than around the bed of a wounded child who has no more family to look aftervthem
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If we learn anything from the Victorian crisis it should be this: in the corridors of power, in medicine and government, we should be looking around and asking ‘who is not in this room, who should be’.
It’s not enough to care about diversity. Diversity needs to be at the table.
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Every dinner party in Australia just became 3 hours and 59 minutes long.
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Georgie Crozier saying that frontline hotel quarantine workers (who risk themselves for our safety) shouldn’t have ‘getting mandatory COVID tests’ count as work for which they are paid is pretty much all you need to know about how the Liberal Party (don’t) value ordinary workers.
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I want to acknowledge all the new interns starting work as doctors for the first time this month in the midst of a massive wave - after two years of being excluded from on site learning as senior medical students.
The whole system’s under strain but I hope everyone will be kind
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Please do not let the power go out in hospitals.
Because anyone who has worked in a hospital where the power has gone out will know and remember that scream of anguish. That the systems failed and one mother had to hold her child’s whole life in her hand, an impossible task.
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After three days in bed I have some recurrent thoughts:
1. Those poor essential workers and families who stayed home in rolling iso for 6 weeks in 2020 - how did they cope?
2. We made nurses work while sick with this?
3. Thank goodness for vaccines.
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Look I know I’ve been making forklift jokes all day, but I’m still really surprised that this is a thing that was actually talked about in the highest levels of government and wasn’t just a joke.
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True story. The first time I met
@ellenmfanning
on The Drum she said to me: “if I don’t get your name right, you can call me Helen”
She did get my name right. And it made me feel so respected, as so few even try.
And I’ve struggled to not call her Helen ever since 😂
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It’s possible wealthy countries will live to regret not doing more for global vaccine equity - if we have to rewind, shut down + revaccinate with a new vaccine.
If not omicron then it might be pi, rho, sigma etc.
The time to act is now. Viruses don’t respect political borders
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Is everyone in Victoria down and disaffected because of this weather, or just me?
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There’s many people distressed that our efforts with lockdowns now means nothing.
The lockdowns were critical. This is what epidemic spread in an unvaccinated population with a more lethal variant would have looked like.
Collective effort saved countless lives.
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One day, when this is all over, I’m going to take a couple weeks of leave just to go sit at the airport and watch families be reunited after years apart.
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I must confess that the reopening of offshore immigration detention in Nauru was not on my 2022 bingo card.
After the clear evidence of the medical harms arising from offshore detention, I did not see any government, much less a Labor government, going there again.
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Took a patient back to theatre on Friday afternoon, even though it was my scheduled afternoon off. Promises made to family and friends were cancelled.
That’s the deal when you choose certain occupations. No one forced SmoKo to be PM. Do your job, or resign dude.
Friday afternoon is often a time where people come in to see the GP with a mental health crisis or chest pain.
Sometimes you've just got to do your job, Scott.
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In the last day, really sensible public health people who have not peddled fear at any point have called for a slightly more cautious approach in the face of omicron - moderate interventions like masks indoors, limits on huge crowds. We should be listening.
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I’m very tired of the expectation that women be happy and respectful, just because.
It’s time that respect and grace be earned, not bestowed.
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Also:
Despite being a professional mask wearer, I do NOT have a mask that is cool enough.
Goshdammit, Melbourne.
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Is now when we give nurses and aged care workers the pay rise they’ve always deserved?
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Dr Chris Higgins is an excellent clinician, and a thoughtful, kind, generous and exemplary doctor.
@JennyMikakos
should be ashamed. I am furious on his behalf. The medical community needs more selfless and caring doctors like him.
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The problem with making a budget blind to gender and other demographic features is that it fails to correct inequities arising because of gender and other demographic features. Equality and blindness IS discrimination, according to all the
#CredibleWomen
.
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I’m a vegetarian Indian.
I was not offended that the Prime Minister cooked meat on a day that was not Diwali/Deepavali and said ‘Happy Diwali’.
I do take issue with most of the PMs actions/inactions/policies. We don’t need to essentialise Indian culture to criticise that man.
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A shout out today to Dr Kerry Chant and everyone within NSW Health, from public health teams to the acute medical teams to community health providers and all the vax clinics who will still be at work today and not enjoying the fruits of their labor.
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Love to see women in medicine living their best life, but there’s a narrow line between celebrating your own life and holding it up as a standard for others.
I was failed by women who did this.
And the older I get, I’m certain the most badass move is boundaries.
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Doctors care about fraud, because it’s our profession AND our tax dollars.
But.
Needing to see multiple issues over multiple consultations because Medicare rebates haven’t risen in 20 years isn’t fraud.
Ordering screening tests isn’t fraud.
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The Venn diagram of people who don’t think people fleeing actual war and persecution deserve safe refuge, and those having a tantrum about living through a pandemic response is pretty close to a circle.
Literally every person I know in Vic is looking to relocate to a different state as soon as borders reopen. They’re terrified they’ll be in lockdown again if there’s another wave - which is in no way out of the question. A mass exodus would have huge ramifications on other states
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#medtwitter
, I did something I am proud of today. I saw a former boss who had once made me feel awful, and I just nodded and then turned my back.
This might seem like nothing, but it felt like huge resistance.
If you are a traumatised trainee, this will be you one day 💪🏽 👊🏽
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The pandemic has made me realise that when the political class take all the berths on the spaceships that fly humanity away from a burning planet, they’ll have no idea of the essential invisible labour they’re leaving behind and wont’t make it past the edge of the solar system.
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If tens of thousands can work out how to work remotely with toddlers and babies underfoot and all sorts of restrictions, it is not unreasonable to expect that both Federal and State parliaments should be able to work out how to do their job as well.
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Undertaking procedures later shown to be low value because at the time they were thought to be high value isn’t fraud (that’s science).
Trying to keep practices viable by optimising rebates isn’t fraud.
Optimising the rebate so patients are less out of pocket isn’t fraud.
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When the power goes out in the hospital, the ICU is dark. There are not lights but a rationed torch. No candles near what oxygen is left behind. The ward is still, no one talking, just mother squeezing bags of oxygen for their babies.
Except mother are not infallible 👇🏽
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A reminder that if you test positive for Covid on a rapid antigen test, you do NOT need to keep testing. Save your $ and extra precious tests for a friend or family member
If vaxed you can exit isolation after 7 days or when you’re symptom free, whichever longer, no test needed
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Dan Andrews makes the top 20 of the triple J hottest 100 and that there is everything we need to know about 2020 in Australia. 😂😂😂
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My father was told by a surgeon that as he was almost seventy, he didn’t need his left hand anymore, and therefore his distal radius fracture didn’t need surgery. “You wouldn’t be using it much anyway” to a man who was on a ladder when he fell.
That’s when I revealed MY day job
MIL asked the surgeon if there were other options for her back pain and he said 'yes- you could leave here in a rectangular box known as a coffin'.
That was the moment I decided to mention what my day job is. 🤨 It was totally not
#OperateWithRespect
.
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The decision made today was correct. You don’t order a test and not wait for the results.
But Victorians have an absolute right to be sad and upset, and ask why this outbreak wasn’t reported early, why known communication issues weren’t fixed months ago, and many other ???s.
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If the Victorian government wants to actually know why day on day more than a third of infections are in health care workers, they could actually ask... any of us? We’ll tell you exactly where all the holes are.
17 round tables this week... how many with the front line?
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Having used the medical stockpile of P2 masks on the bushfire smoke, I wondered where the additional million masks was coming from.
Turns out the government is handing out ineffective surgical masks, which are not adequate PPE for health care providers.
#ScottyFromMarketting
Delivery of masks for GPs as we support our health professionals in managing the coronavirus
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The power is out and it is dark and quiet. Her hand weakens, her eyes fatigue. And then for a few minutes, she is asleep.
Perhaps she will waken in horror. Perhaps the nurse will find her still asleep.
But the effect cannot be undone.
👇🏽
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Restrictions easing faster than expected in Vic (and ACT and NSW) might seem like a sudden about-face - but they are possible because people - so many of you - have turned out in previously unimaginable almost globally unprecedented numbers and speed to get vaccinated.
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When the night sets in and the power in still out, it is the mother who offer to stay by her child. The aunts, uncles, grandparents, father, siblings - if they exist - go home, and the mother stays by her child’s head, in the dark. Squeezing that bag like a nurse taught her 👇🏽
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Effective herd immunity requires a vaccine.
‘Natural’ herd immunity has not stopped any infectious disease in the history of time.
I really wish our leadership would stop suggesting that letting everyone get infected for ‘herd immunity’ was a good strategy.
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Speaking to healthcare workers who are hoping they catch covid to get a week off work is a 2022 mood.
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