In the forest of possible consequences when medical error leads to patient harm, what's
the best path? McNeill and Walton appraise the ethical issues using four authentic cases presented in increasing order of concern. They demonstrate that apparently distinct paths — one allowing disclosure of mistakes
and the other advocating the need
for accountability — can actually converge.
→ See Medical harm and the consequences of error for doctors
Over the past decade or so prescriptions for indapamide have been on the increase, while thiazide diuretics have waned in popularity.
Is indapamide as likely as thiazides to cause electrolyte imbalances? Chapman et al studied prescription data and reports to the Adverse Drug Reactions Advisory Committee to find out.
→ See Hyponatraemia and hypokalaemia due to indapamide
The Australian Council for Safety
and Quality in Health Care intends
to collect data on issues such as hospital-acquired infections and the safe use of medications and blood products in healthcare facilities.
In the future some of this information may be available for public scrutiny. Other countries have led the way
in this "warts-and-all" approach. Marshall (from the UK) and Brook (from the US) discuss the pros
and cons of such openness.
→ See Public reporting of comparative information about quality of healthcare
How many Australian patients with coronary heart disease achieve the recommended target levels for reducing cardiovascular risk factors? A comparison by Vale and colleagues of patients from 1996 to 1998 with those from 1999 to 2000 gave encouraging results. We didn't do too badly in overseas comparisons either.
→ See How many patients with coronary heart disease are not achieving their risk-factor targets? Experience in Victoria 1996–1998 versus 1999–2000
Doctors bring to their craft many different belief systems and ethical frameworks. According to Griffiths and Dunlop, however, this laudable diversity may not be to the benefit of the institutions in which they practise. The time has come for Australian hospitals to adopt formal codes of ethics — and to be seen
to have adopted them. The authors describe the development of such a code in a large Melbourne hospital.
→ See Ethics, medicine and economics: integration in a hospital environment
Yes, it's about time we had one. But would Australian men actually use it? Weston et al surveyed a captive population — men visiting their female partners on the postnatal ward — to find out. → See Will Australian men use male hormonal contraception?
Male hormonal contraception is
not yet available, but Handelsman's editorial comments on
the need for a male contraceptive that is not only reversible but reliable. Surprisingly, such a product was shown to be feasible a decade ago, but its further development awaits
an entrepreneurial kickstart.
→ See A hormonal male contraceptive: from wish to reality
In the 1980s, HIV/AIDS made infectious diseases a hot topic.
These days, the prospect of bioterrorism has led to another resurgence of interest in the subject. However, the intent of the latest
MJA Practice Essentials series — Infectious Diseases — is broader: infections still cause a quarter of
all deaths globally, and the CIA considered them a security threat well before September 11 last year. There's never been more need for clinicians to be primed on infectious diseases.Why did we choose some topics
for the series and not others? Series editors Grayson and Wesselingh explain the choices in their introductory editorial, Management of infectious diseases. At the frontline, there's been an outbreak of chickenpox at the local school; a teacher there is pregnant and is seeing you tomorrow for advice. Just as well this issue
of the MJA arrived today! You turn immediately to Gilbert's article on infections in pregnancy, part of our new Infectious Diseases series, for how to assess the risks
for her baby.
→ See 1: Infections in pregnant women
Healthcare facilities and the surgical procedures carried out within them are definitely not without health risks. Bellomo and colleagues assessed the incidence and nature
of serious adverse events after surgery in a Melbourne teaching hospital. Their findings raise issues such as what constitutes optimal perioperative management.
→ See Postoperative serious adverse events in a teaching hospital: a prospective study
The number of patients dying or incurring permanent disability each year in Australian hospitals as a result of adverse events (AEs) is estimated to be: 18 000 deaths; 17 000 cases with more than 50% permanent disability; and 33 000 cases with less than 50% permanent disability. There are estimated to be 280 000 AEs resulting in temporary disability.
Excerpted from QAHC Study, MJA 1995; 163: 458-471
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.