Huntington's chorea is an autosomal dominant disease that affects patients in their middle to old age with a progressive dementia and writhing movements of their face and limbs. Since 1993, it has been possible to estimate the risk in children of affected patients. However, there is no cure and many individuals at risk have preferred not to know their status and carry on their lives in ignorance, if not bliss. Suicide rates in patients diagnosed as being positive can be up to 9%. Patients testing negative may experience “survival guilt”.
Testing for antenatal chromosomal abnormalities have also become increasingly available in recent years. Once again there are no trivial therapeutic options with termination of pregnancy an unacceptable choice for many people.
In the early 1980s there was no therapy for HIV and performing diagostic tests posed similar ethical challenges for doctor and patient alike.
In medicine we are taught that if the result will not change the therapy, the test should not be performed. However, as we see in end of life care, a better understanding of the disease process and a more accurate prognosis may allow patients to cope with their disease.
This month's GPSpeak reports on a study in melanoma risk assessment by researchers at Sydney University. Genomics has advance significantly in recent years and it is now possible to estimate the genetic as well as the enviromental risk for this disease. Clearly this information can be beneficial to such patients allowing them to address at least their modifiable risks.
Also this month we report on local strategies financed by the government to address crystal methamphetamine use and addiction. As with other drugs, not all users become addicted but for the 25% that do, it can have major ramifications for themselves, their families and the community. The current ICE education campaign needs to clearly spell out the dangers but as a community we need to provide opportunities for addicts to get their lives back in order as is tellingly reported by former ICE addict, Suz, in our ice epidemic article, Getting Clean.
Lastly the Nothern New Sounth Wales Local Health District (NNSW LHD) and the North Coast Primary Health Network (NCPHN) are to be congratulated on their efforts to improve co-ordination between primary and secondary care. The North Coast Integrated Care Wave finished in June 2016 and made important first steps in improving this collaboration. Continuing efforts in electronic communication, awareness of available services and pre-operative management of surgical patients are being made to improve the transfer of care between sectors. Several articles in this issue touch on these broad themes.
The Northern Rivers General Practice Network, as the local representative of the area's general practitices, applauds the statements by the new Chief Executive of the NNSW LHD, Wayne Jones, on the seriousness with which he views improved patient care co-ordination across the whole sector.
As Bogie says to Claude Rains at the end of Casablanca, “I think this is the beginning of a beautiful friendship.”
