GPs are performing most circumcisions in Australia but aren’t offering adequate anaesthesia, a medical ethicist and paediatric registrar says.
Dr Melanie Jansen, from the Centre for Children’s Health Ethics and Law at the Lady Cilento Children’s Hospital in Brisbane, suggests discussion is needed on whether GPs are the best practitioners for the job.
In a provocative commentary in a Royal Australasian College of Physicians (RACP) journal, Dr Jansen says dorsal penile nerve block (DPNB) plus topical anaesthetic cream has been identified as the ideal anaesthetic and should be “urgently mandated”.
Information provided on websites of GP practices offering circumcision suggests topical anaesthetic alone is the usual pain management technique, she says.
“If a competent practitioner is defined [by the RACP] as a person who can both perform circumcision and manage any complications arising from it, then the vast majority of Australian infant boys are not receiving this standard of care,” she writes.
Dr Jansen says if legislation explicitly reflected RACP recommendations, circumcision would be only performed by a paediatric surgeon plus an anaesthetist using dorsal penile nerve blocks in newborns or a general anaesthesic in older children.
“If legislation as restrictive as this were proposed there would no doubt be outrage from some groups, particularly sections of the general practice community and some religious groups,” she writes.
Dr Jansen says an estimated 10-20% of newborn Australian boys are circumcised.
Most circumcisions are done by GPs in their rooms. Medicare data for 2013-14 show that 16,827 circumcisions were performed on males younger than 6 months of age and 7300 on males of other ages.
Dr Jansen says it may be necessary to disrupt the status quo “unless we are comfortable prioritising adult convenience or financial gain over serving a fundamental interest of children (to not be caused avoidable pain).”
She calls for standardised information on circumcision to be provided routinely to parents during antenatal care.
“It is notable … that the Royal Australian College of General Practitioners has no position statement on this issue and no practice guidelines,” she says.