Volume 197 Issue 2

Despite its limitations, this important study highlights a genuine need for systematised performance monitoring[It] is like a dog’s walking on his hinder legs. It is not done well; but you are surprised to find it done at all. Samuel Johnson1 The results of the CareTrack study, reported by Runciman and colleagues in this issue of the Journal,2 and the accompanying commentary by the study authors3 represent an ...

Ian A Scott MB BS, MHA, FRACP · Christopher B Del Mar MD, MB BChir, FRACGP

All health professions aim to provide the best care they can for their patient. However, achieving this is easier said than done. In this issue of the Journal, Horey and colleagues document the implementation of a care pathway aimed at facilitating care at the end of life (EOL) in 14 residential aged care facilities (RACFs) ...

Geoffrey K Mitchell FRACGP, PhD

Standing up for common senseScience sets out to rigorously eliminate bias, not to assert it. The arguments mounted for the closure of complementary medicine courses in Australian universities by the Friends of Science in Medicine in a recent editorial in the Journal1 are highly emotive and, while having a gloss of superficial reasonableness, they do not stand up to critical review. In a letter sent ...

Stephen P Myers BMed, ND, PhD · Charlie C Xue BMed, PhD · Marc M Cohen BMedSc(Hons), MB BS(Hons), PhD · Kerryn L Phelps MB BS, FRACGP · George T Lewith MD, FRCP, MRCGP

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

One of the centrepieces of this week’s Primary Health Care Research Conference in Canberra will be a presentation, billed as “best paper” at the conference, on how general practitioners respond to women who fear violence at the hands of their partners. Despite a long history of concern and policy action to reduce domestic violence, it remains ...

Ray N Moynihan BA

Clinical practice guidelines are useful, but there is much more to delivering optimal care in the primary care settingThe CareTrack study reported by Runciman and colleagues in this issue of the Journal raises serious concerns about the delivery of appropriate health care in Australia.1 Yet we have some of the strongest benchmarks internationally,2 and Australia is one of the world’s healthiest countries.3 How can this ...

Evan Ackermann MB BS, FRACGP

For decades, there have been concerns about the extent to which the health system provides the right care to those who need it in a cost-effective, timely manner. In Australia, there has been much discussion and marked improvements in some areas, but the provision of highly ...

William B Runciman MB BCh, FANZCA, PhD · Enrico W Coiera MB BS, PhD, FACMI · Richard O Day MD, FRACP, MB BS · Natalie A Hannaford DipAppSc(Nursing), MPH · Peter D Hibbert BAppSc(Physio), GradDipComp, GradDipEcon · Tamara D Hunt BAppSc(Nursing), CritCareCert · Johanna I Westbrook PhD, GradDipAppEpid, MHA · Jeffrey Braithwaite PhD, MBA, FCHSM

Friends of Science in Medicine should avoid threatening their own valuesScience has always been — and should be — a battleground for contending views on what is true. Because of the close connection between knowledge and power, however, the risk is always present that those who command the dominant theories or ideologies will rely on their positions of influence to overcome those who oppose them. ...

Paul A Komesaroff MB BS, PhD, FRACP · Amber Moore BChineseMed(Hons), BA(Hons) · Ian H Kerridge MPhil, FRACP, FRCPA

The postwar arrival of refugee doctors heralded changes to the Australian health workforce that we are still adjusting to todayInternational medical graduates (IMGs) are an important part of Australia’s health workforce, accounting for about 23.5% (n = 16 186) of all doctors in Australia today.1 The recruitment and placement of IMGs in rural areas is particularly vital to the provision of health services in rural Australia, where there ...

Daniel R Terry BNurs, MInternatHlth · Jessica J Woodroffe BA(Hons), PhD · Quynh Le PhD, MAppComp, MEdStud · Kathryn J Ogden MB BS(Hons), MPH, FRACGP

Action is required now for future older Australians to receive adequate mental health careOver the next 20 years, the number of Australians aged 65 years and over is projected to nearly double from around 3.2 million to about 6.2 million people.1 Individuals with lifelong mental illness will be joined by those with new mental disorders, such as mood disorders, late-life psychoses and anxiety disorders that are often associated with ...

Roderick G McKay BSc, MB BS, FRANZCP · Brian M Draper MB BS, MD, FRANZCP

To the Editor: The United States medical education system is not a valid comparator in arguing for the shortening of training times for specialist doctors in Australia,1 whose training experience is already less than desirable. I was recently a medical observer at a major US training hospital, and there are significant differences in specialist training between the two countries. The Australian Medical Association Safe Hours campaign ...

David Ku

To the Editor: There are challenging ethical, legal and clinical issues associated with resuscitation and end-of-life care for older people. When an elderly patient with comorbidities and limited independence deteriorates, and is unable to participate in decision making, is it good medical practice to subject that person to invasive and traumatic resuscitation when the survival rate is less than 3.4%?1 Currently, many older patients will be ...

Campbell H Thompson · Margaret Brown

To the Editor: A rising awareness of the prevalence of 25-hydroxyvitamin D (25OHD) deficiency over the past decade is likely to have led to a surge in the number of individuals who undergo 25OHD testing.1 United States data indicate that testing for 25OHD has increased by 80%–90% annually,2 yet there are no reports that investigate the cost of 25OHD testing in Australia. We analysed the ...

Kellie L Bilinski · Steven C Boyages

To the Editor: The South Australian Institute of Medical Education and Training (SA IMET) recently conducted a review of internships in South Australia and proposed three potential changes.1 First, new prevocational training networks would rotate individual interns between more than one major teaching hospital. Under the existing system, most interns remain exclusively at one location, although there is an established southern network incorporating the Flinders ...

Thomas D Crowhurst · John Floridis · Lisa M Raven

To the Editor: A 23-year-old woman presented to the emergency department with bilateral pain, swelling and loss of power in her upper arms, which had started that morning. She had no history of significant trauma. Her medical history was significant for Wolff–Parkinson–White syndrome, diagnosed 3 weeks earlier at the same institution, and mild depression, diagnosed 8 months earlier, for which she had been taking desvenlafaxine (50 mg daily ...

Maximilian Stephens · Jeffrey T J Rowland · Anis Zand Irani

To the Editor: A 38-year-old HIV-positive Somalian refugee with a past history of pulmonary tuberculosis (TB) and poor compliance with antiretroviral therapy (ART) presented with fever, lethargy and mediastinal lymphadenopathy. He was diagnosed with fully drug-sensitive lymph node TB. The CD4 lymphocyte count at TB diagnosis was 20/µL (reference interval, 350–2630/µL), and the HIV RNA viral load was 99 000 copies/µL. Standard anti-TB treatment was commenced, and ART ...

Sarah L McGuinness · Joseph S Doyle · Alan C Street

To the Editor: Monshat and Castle have summarised the current state of play of mindfulness as an important component of the integrated management of chronic disease. So too medical students experience significant acute and chronic psychological disturbance, which impacts on their professional performance and personal life, as well as increasing their risk of substance misuse and suicidality.2 Strangely, in this respect, students and doctors have much ...

Jonathan P Page

Comment: In the 4 June issue of the Journal, I responded1 to an enquiry from McBryde2 as to why the Medical Journal of Australia decided not to publish an article by Haines and Lowenthal regarding the importance of a histological diagnosis when managing advanced cancer. I would like to clarify that the prime reason for rejecting the manuscript was that the patient in the case it reported ...

Annette G Katelaris

An adolescent female patient presents with acute lower back pain of recent onset and no history of trauma. Is it warranted to order a computed tomography (CT) scan of her lumbar spine? The justification for a CT scan at the individual level is complex and the risk–benefit ratio must be considered; the risks associated with radiation are often not well understood and, similarly, the benefit for an individual may be difficult to determine.

Zoe Brady BSc(Hons) · Timothy M Cain MB BS, FRANZCR, MBA · Peter N Johnston BSc(Hons), PhD

How appropriate is the health care delivered to Australians? A seminal study in the United States showed that American adults received “recommended care” only 55% of the time in the years 1999–2000. Estimates of “appropriate care” — defined here as care in line with evidence-based or consensus-based guidelines — are limited in most countries, including Australia, to small groups of conditions ...

William B Runciman MB BCh, FANZCA, PhD · Tamara D Hunt BAppSc(Nursing), CritCareCert · Natalie A Hannaford DipAppSc(Nursing), MPH · Peter D Hibbert BAppSc(Physio), GradDipComp, GradDipEcon · Johanna I Westbrook PhD, GradDipAppEpid, MHA · Enrico W Coiera MB BS, PhD, FACMI · Richard O Day MD, FRACP, MB BS · Diane M Hindmarsh MScAgr, MBiostats · Elizabeth A McGlynn PhD · Jeffrey Braithwaite PhD, MBA, FCHSM

Objectives: To investigate the acceptability and feasibility of using end-of-life (EOL) care pathways in residential aged care facilities (RACFs).Design, setting and participants: Multistage action research approach involving interviews, surveys and prospective audits of deaths and EOL care pathway use among residents and staff of RACFs and associated general practitioners from 14 RACFs in Victoria and South Australia between April 2009 and July 2010.Intervention: ...

Dell E Horey BAppSc, MMedSc(ClinEpi), PhD · Annette F Street BEd(Hons), PhD · Alison F Sands MB BS(Hons), FRACGP

Despite nearly 70% of Australian women of reproductive age using a contraceptive method, estimates are that over 50% of Australian women have had an unplanned pregnancy. This rate, similar to that in the United Kingdom (30%) and United States (49%), may in part be explained by the fact that the combined oral contraceptive pill (COCP) remains the preferred method of contraception in Australia as it is in the UK ...

Danielle Mazza MD, FRACGP · Christopher Harrison BPsych(Hons), MSocHlth · Angela Taft BA, MPH, PhD · Bianca Brijnath BA(Hons), PhD · Helena Britt BA, PhD · Melissa Hobbs RN, MPH · Kay Stewart BPharm(Hons), PhD · Safeera Hussainy BPharm(Hons), PhD

Emily Dickinson

Arjun von Caemmerer MB BS(Hons), FRACGP

When we watch reports of disasters that strike human populations, whether due to forces of nature or other human beings, we feel special compassion for our journal editor colleagues who face the catastrophe with their fellow citizens. They surely feel like we did in 1991 when the war started in Croatia and also a ...

Ana Marušić MD, PhD · Matko Marušić MD, PhD

THE COMPLEXITY of neurology is both alluring and intimidating — rather like learning Ancient Greek or a Bach five-part fugue. Attempts at popularisation often fail because of either persistent obscurity or oversimplification. In this book, Professor Roy Beran, from the School of Medicine, Griffith University, Queensland, has produced a practical overview which aims to be approachable without dumbing down.To this task he is eminently suited, ...

Timothy J Kleinig

IT WAS always going to be a difficult task to summarise all possible paediatric presentations into a single book to help junior medical staff “on call”, so the authors of this effort are to be commended.This is an Australian adaptation of the popular American handbook, and all three Australian authors — Browne, McCaskill and Cheng — are senior staff in the emergency department at the ...

Julian J Kelly

Academic GPs combine clinical work with research and teaching

Sophie McNamara

Dr Edward Vergara is chair of General Practice Registrars Australia

Sophie McNamara

Professor Mark Nelson is chair of the Discipline of General Practice and senior research fellow at the Menzies Research Institute, both at the University of Tasmania. He is part of a team that recently secured US$50 million in research funding from the US National Institutes of Health. Professor Nelson is also an honorary associate at Monash University and a GP in Lindisfarne, Tasmania

Sophie McNamara

Beyond textbooks ... taking medical education online

Cate Swannell

Three steps to avoiding a lawsuit

Amanda Bryan