Brett Montgomery

In which direction does causation go here? Does TikTok ruin attention, or do people with poor attention choose TikTok?

A few hours later they sent me another email with a link that actually worked! bsky.app/profile/bret...

Hopefully you, like me, will have got a follow-up email with a corrected link that works as it should. bsky.app/profile/bret...

Hopefully you, like me, will have got a follow-up email with a corrected link that works as it should. bsky.app/profile/bret...

Update: Microsoft has sent me another email with a corrected link that indeed leads to the option to move to a Family Classic plan. Problem resolved.

Why? I value OneDrive storage, the option of the web-based Office apps, and being able to collaborate with others on shared documents online. I don’t get those things from LibreOffice (which I agree is good — I prefer Calc to Excel for some tasks). I just don’t want to use or pay for Copilot.

The bad news: when I follow the link to downgrade to Family Classic, I am offered instead only my current expensive Copilot-containing Family plan or a single person Classic plan. Where is the promised Family Classic plan? Microsoft still appears to be making this unreasonably difficult.

The good news: this legal action appears to have precipitated an apology and and offer to convert to “Microsoft 365 Family Classic” with a refund, according to this email I received today.

Greener and Sustainable Respiratory Care: Reducing Carbon Footprint in Healthcare - The Good GP In this episode of The Good GP, host Dr Sean Stevens discusses environmentally sustainable respiratory care with Dr Brett Montgomery, a GP and Senior Le...

Can GPs improve asthma care and decrease environmental impact, all at the same time? Yes, we can. It was good to talk about this on “The Good GP” podcast. thegoodgp.com.au/episode/gree...

Should we aim to bulk-bill everyone for GP visits? We asked 5 experts Health care is universal in Australia, but this doesn’t mean seeing a doctor is always free.

Should we aim to bulk bill everyone for GP visits? I said yes, at least in principle. But under current policy settings, I don’t blame GPs for sometimes charging gaps. Good to see a near-consensus in support of the ideal of accessible healthcare. theconversation.com/should-we-ai...

Is this writer available for graduation ceremony speeches? Nailed it.

I don’t think there’s anything wrong with learning from quality web-based sources. But I think there’s a lot wrong with not doing the learning in the first place, and hoping you’ll fill every gap with a Google search in future years. We need solid foundations as well as ongoing learning.

I suppose it fixes your LUTS while (often) simultaneously causing you new urinary symptoms. Problematic in a different way.

Also, I think if your disease comes back after prostatectomy, you can still have EBRT. I think it doesn’t work the other way around. So by choosing prostatectomy first, people may feel they are saving more options for later. How important this is may depend on life expectancy and patient values.

So why do prostatectomy? I’m a GP, not a urologist/oncologist, but I think part of the answer may be a perception that prostatectomy is slightly superior (lower mortality estimate in that trial, albeit the difference was not statistically significant and the absolute difference was small).

Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer | NEJM Between 1999 and 2009 in the United Kingdom, 82,429 men between 50 and 69 years of age received a prostate-specific antigen (PSA) test. Localized prostate cancer was diagnosed in 2664 men. Of these...

Also relevant: similar survival rates (as you say) were found in this large RCT: www.nejm.org/doi/full/10.... — arguably more robust than your paper as it was a trial (not observational) and follows people as long as 15 years.

newsGP - Surge in working-age people avoiding GP care due to cost More than one in every seven patients aged 25–34 is now holding off on a visit to their GP, reflecting the cohort’s absence from recent bulk-billing incentives.

In today’s episode of “Easily foreseeable effects of policies”, we look at what happens when you withhold bulk billing incentives from working age adults during a cost of living crisis. www1.racgp.org.au/newsgp/profe...

Your asthma puffer is probably contributing to climate change, but there’s a better alternative As if having asthma wasn’t bad enough news, your health condition is probably contributing to climate change.

Also I wrote this a few years ago for a general readership: theconversation.com/your-asthma-... I would write it a bit differently today though. Since that was written, the role of antiinflammatory relievers (ICS-formoterol) has become a lot more clear.

newsGP - How GPs can improve asthma outcomes and protect the environment New guidelines show switching to greener dry powder inhalers could reduce the carbon impact of asthma therapy by more than 90%, while also leading to better asthma control.

Here’s a NewsGP article: www1.racgp.org.au/newsgp/clini...

We also slipped a green inhalers case into this edition of Check (again for GPs): www1.racgp.org.au/getmedia/f90...

At a policy level, this roadmap report is really useful: asthma.org.au/wp-content/u...

Respiratory inhalers and the environment Respiratory inhalers contribute significantly to climate change, principally because the propellant gases in pressurised metered-dose inhalers are potent global warming gases.

And this article in AJGP aimed specifically at a GP audience: www1.racgp.org.au/ajgp/2022/de...

There are a few other resources. Like this recent statement from the National Asthma Council: files.nationalasthma.org.au/resources/NA...

Do you mean prescribing more broadly, rather than inhalers specifically?

Traditional respiratory inhalers (pMDIs) can have surprisingly large climate impacts. How can we limit this impact while ensuring good respiratory health care? After many drafts, we have finally published a position statement: onlinelibrary.wiley.com/doi/10.1111/...

I enjoyed this article otherwise!

So among pharmacists following the protocol, I think "nearly 50% misdiagnosed" is probably far too high an estimate.

Does this woman have an acute uncomplicated urinary tract infection? - PubMed In women who present with 1 or more symptoms of UTI, the probability of infection is approximately 50%. Specific combinations of symptoms (eg, dysuria and frequency without vaginal discharge or irrita...

This (slightly old but relevant) review in JAMA finds: "Specific combinations of symptoms (eg, dysuria and frequency without vaginal discharge or irritation) raise the probability of UTI to more than 90%, effectively ruling in the diagnosis based on history alone." pubmed.ncbi.nlm.nih.gov/12020306/

The trial protocol would only lead to pharmacist antibiotic prescribing if two or more typical UTI symptoms are present and vaginal symptoms are absent. (Screenshot from: eprints.qut.edu.au/232923/8/UTI...)

Louise writes: "In the North Queensland pharmacy trials, almost 50% of the women who presented were misdiagnosed. We know this because, on average, around 50% of women presenting with UTI symptoms do not, in fact, have a UTI." I don't know if that's quite fair.