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In This Issue

Med J Aust 2003; 179 (5): 227.
Published online: 1 September 2003

Medical Journal caught napping with health experts

Don't be fooled by the title of this special issue or the mellow cover image. Chronic illness is (or should be) the hot topic of the early 21st century! Many contributors to this "chronicle" have confronted the challenge of the growing burden of chronic illness and dared to dream.

Chew and Van Der Weyden set the tone, with their vision of what could happen if we follow the "C's" of quality care (→ Chronic illness: the burden and the dream), while Gross et al draw inspiration from Australia's past successes in public health, to assert that we have the resources (but need the political and policy resolve) to tackle the coming onslaught (→ Australia confronts the challenge of chronic disease).

For a sensational view from the hospital bed of the 21st century, turn to Zajac, who has a particularly vivid dream for the hospital of the future (→ The public hospital of the future). For a reality check on who was, is and always will be the most important person in any health-related interaction, read Bauman et al (→ Getting it right: why bother with patient-centred care?).

We are at war

You've all seen the graphs which show our population getting older and sicker, with a widening gulf between health service demand and supply. How have we equipped ourselves to fight against this axis of evil? Nair and Finucane explore the shifts occurring in medical education, to produce doctors who can provide holistic continuous, rather than acute episodic, care (→ Reforming medical education to enhance the management of chronic disease).

The federal government has introduced several initiatives to enhance general practitioners' management of common chronic conditions, but are they attuned to the real world? Veale asks this and other searching questions (→ Meeting the challenge of chronic illness in general practice).

Far from the scenario predicted by Orwell, Huxley and other prophets of doom, many modern technologies have the capacity to bring people closer together. Celler et al show how information technology will strengthen the all-important partnership between doctors and people with chronic illnesses (→ Using information technology to improve the management of chronic disease). And speaking of partnerships, the growing burden and complexity of chronic disease means that some new alliances between health professionals are in order. Brooks explains how such collaborations might work (→ The impact of chronic illness: partnerships with other healthcare professionals).

Sex and drugs and . . .

. . . relationships are explored by McInnes (aka sex therapist Dr Rosie King) (→ Chronic illness and sexuality). Chronic illness and drug therapy can profoundly affect sexual satisfaction (for both sufferer and partner). Yet doctors often feel uncomfortable about broaching the subject. Here's a practical guide on how to discuss sex according to your own level of expertise and comfort. Need we say more?

Mystery illness strikes entire family

With the current focus on the ageing population, it is easy to forget that chronic illness can occur at any time of life. We asked five experts to consider the particular issues surrounding common chronic diseases at each life stage. While the contributions on childhood (Isaacs and Sewell, (→ Children with chronic conditions)), adolescence (Sawyer et al, → Chronic illness in adolescents), young adulthood (Dick, → Chronic illness in young Australian adults), middle age (Usherwood, → Chronic illness in the middle years) and old age (Gray and Scott, → Chronic illness in older people) present diverse perspectives, the need for prevention, collaboration and patient centredness is a given at any age.

If you add Indigenous status, poverty, mental illness or even rural residence into the equation, some groups of Australians fare worse than others in the illness stakes. Wilson et al consider how to even up the score (→ Targeted approaches for reducing inequities in chronic disease).

Ex-Czar, eminent editor reveal all

Allan Fels (ex-chairman of consumer watchdog, the Australian Competition and Consumer Commission) was our best regulator, according to the independent news web site, Crikey. The AMA, oil companies and others with whom he clashed may beg to differ. His high profile led to the accusation that he was a "media tart" but, love him or hate him, his is a powerful story as father and carer of a person with schizophrenia (→ Chronic illness: a carer's perspective).

Editor of the BMJ's Career Focus section, MacDonald, first "came out" as having scleroderma two years ago in an editorial. As a (typical) junior doctor on the wards, she had ignored her initial symptoms — black fingers. Later, working as a doctor while undergoing treatment, colleagues refused to work with her. While her path may not be strewn with roses, neither is it all thorns. Her Personal Perspective is a celebration of life lived to the full (→ Chronic illness in doctors: a personal view).



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