Volume 198 Issue 1

Medical education offers diverse and meaningful work, but this diversity creates difficulties for defining it as a specialist discipline with a standard career pathway.

Wendy C Y Hu MB BS, PhD, FRACGP · Geoffrey J McColl MB BS, MEd, PhD · Jill E Thistlethwaite MB BS, PhD, FRACGP · Lambert W T Schuwirth MD, PhD · Tim Wilkinson MD, PhD, FRACP

The 2007–2010 outbreak of Q fever in the Netherlands was the largest ever identified, with 4000 people affected. Although further research is needed on best practice to control transmission and detect and treat infection, lessons have already emerged for Australian medical and public health practitioners.

Heather F Gidding BAppSc, MAppEpid, PhD · Stephen R Graves BSc, MB BS, PhD

Recognition for individuals, and highlighting important causes in healthMost of us who work in health and medicine don’t expect a prize for what we do, but neither are we averse to a bit of competition. From the MJA’s perspective, the output of competitions — often comprising the most innovative and creative of submissions — makes for enriching content. Thus, in concert with a number of ...

Ruth M Armstrong BMed

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

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

Complex reforms and increasing financial strains on the UK National Health Service make it almost inevitable that patient care will suffer.

Tony Kirby BSc(Biological Chemistry)

Greater emphasis is needed on behavioural and psychosocial aspects in research and clinical practiceWednesday 14 November marks World Diabetes Day, the birthday of Sir Frederick Banting, whose research led to the discovery of insulin in 1922. In the 90 years since, there have been other significant landmarks. The Diabetes Control and Complications Trial (DCCT)1 and United Kingdom Prospective Diabetes Study (UKPDS)2 showed that the devastating complications of ...

Jane Speight PhD, CPsychol, AFBPsS

A draft revision of Australia’s dietary guidelines is comprehensive with respect to nutrition but contains minimal reference to the environmental impact of the food supply, and the choices consumers can make to minimise this impact.

Linda A Selvey MB BS(Hons), PhD, FAFPHM · Marion G Carey MB BS(Hons), MPH, FAFPHM

Never let the truth get in the way of a tidy timesheet.

Rosalind J McDougall

To the Editor: Weisbrot and Breen’s proposal1 for a no-fault compensation system for medical injuries should extend to all injuries in Australia, including those from motor vehicle accidents and in the workplace. It should also apply to recreational injuries that may lead to common law compensation cases. After 40 years of clinical experience in the rehabilitation of patients with severe neurological injury, I argue that such ...

David C Burke

To the Editor: We read with great interest the article by Burns and Belton regarding the deficiencies in knowledge and attitudes of health professionals towards understanding legal considerations of photographic ownership, storage and disposal.1 This article is timely, given the escalation of smartphone use among clinicians in daily practice. However, we feel that no practical advice was offered to clinicians. The advent of smartphones capable of ...

Rahul Chakrabarti · Chandrashan M Perera

To the Editor: Burns and Belton1 are to be commended for their reminder that informed consent is required before taking patient photographs. They warn that many clinicians are unaware of copyright issues, fail to meet required hospital standards for clinical photographs and/or store images in unacceptable ways. These are important messages. Interestingly, their article did not mention the core reason for medical photography. They state that ...

Rod Phillips

To the Editor: Burns and Belton’s negative, alarmist approach to clinical photography1 is at odds with our clinical experiences and the attitudes of our patients. Camera phone use in Australian hand trauma assessment was first described in 2004.2 Smartphones are now ubiquitous and young doctors commonly send images via smartphones as an adjunct to diagnosis and management. Our patients are increasingly taking smartphone photographs of their ...

Jillian K Tomlinson · Andrew J Myers · Bryce M Meads

In reply: We are grateful for the interest in our article on medical photography. We plan to publish a more comprehensive article on our research results shortly, to provide a better understanding of the issue in one Australian tertiary hospital. Medical photographs aid diagnosis by becoming part of the patient file, providing a highly useful visual record for case management. Among 167 clinicians surveyed in our research, ...

Kara Burns · Suzanne Belton

To the Editor: Scott and colleagues address the vexed issue of using highly sensitive (hs) cardiac troponin (cTn) assays to detect myocardial infarction (MI) and likely increases in hospitalisations.1 Greater numbers of MIs detected by hs-cTn assays also confound population surveillance of MI trends and our understanding of disease prevention. The initial introduction of cTn assays resulted in predictions of marked increases in MI rates, based ...

Lee J Nedkoff · Michael S T Hobbs · Tom G Briffa

To the Editor: We comment on practical aspects of the approach to maternal Indigenous smoking raised in the study by Eades and colleagues.1 Pregnant smokers face barriers to quitting; however, we believe some additional barriers are systemic,2 including excessive caution in prescribing nicotine replacement therapy (NRT). Guidelines for maternal smoking cessation recommend an unassisted attempt before considering NRT.3 There is no agreed definition of a “failed ...

Gillian S Gould · Andy McEwen

In reply: Although our trial1 did not decrease quit rates with an intensive intervention, health professionals should continue to deliver appropriate intensive smoking interventions to pregnant Indigenous women.2 Guidelines advise the exercise of caution with the use of nicotine replacement therapy (NRT) in pregnancy,3 given the lack of trial data supporting its use.4 A recent trial of NRT in pregnancy found similar rates of adverse ...

Sandra J Eades · Rob W Sanson-Fisher · Katie Panaretto

To the Editor: We refer to the article by Leslie and colleagues1 and seek to clarify some comments regarding emergency medicine in New South Wales. The Australasian College for Emergency Medicine (ACEM) unreservedly supports the spread of specialist emergency medical services across all hospitals and does not limit vocational trainee numbers. In 2011, 286 Fellows of the ACEM and 191 advanced trainees were working across at least 472 ...

Alana M Killen · Sally M McCarthy · Anthony P Joseph · Andrew D Gosbell

In reply: The Hospital Skills Program (HSP) is a lifelong self-directed education process, across three levels of expertise. It aims to support the individual learning needs of all non-specialist doctors, wherever and however they practise. This includes facilitating access to quality local, college and university programs when relevant to need. The HSP thus applauds and is appreciative of all Australasian learned colleges in the provision of ...

Simon D Leslie · Mary Webber · Michael Boyd

A survey of students and parents shows that bedside teaching is viewed positively in paediatric wards.

Kathryn L Connelly · Michael S Gordon

To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk. Although the ...

Patrick Coleman

In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately. We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context ...

Geoffrey A Head · Barry P McGrath · Mark R Nelson · Michael Stowasser

To the Editor: Scott and Glasziou’s recent article about the challenges of integrating best research evidence into practice had excellent examples of the 20%–30% of treatments that remain widely used despite being shown to be ineffective or harmful.1 We also note the National Health and Medical Research Council initiative in creating a Research Translation Faculty to improve research relevance and its uptake into practice. A recent ...

Robert G Fassett · Bill Lancashire · Anne Rasmussen

Primary catheter ablation is an increasingly used therapeutic strategy for the management of atrial fibrillation. In this consensus statement, the National Heart Foundation of Australia presents general recommendations to health care providers to assist them in the care of these patients.

Jonathan M Kalman MB BS, PhD, FRACP · Prashanthan Sanders MB BS, PhD, FRACP · David B Brieger MB BS, PhD, FRACP · Anu Aggarwal MB BS, FRACP, PhD · Nick A Zwar MB BS, PhD, FRACGP · James Tatoulis MB BS, MD, FRACS · Andre E Tay RN, CCDS, MN · Alison Wilson MBA · Maree G Branagan MPH

In a cohort of 65 boys aged 12–16 years at recruitment, treatment for more than 3 years with stimulant medication was associated with a slower rate of physical development during puberty, compared with boys not taking stimulants.

Alison S Poulton MA, MB BChir, MD · Elaine Melzer RN, RM, OAM · Paul R Tait MB BS, FRACP · Sarah P Garnett BSc, MNutrDiet, PhD · Chris T Cowell MB BS, FRACP · Louise A Baur MB BS, PhD, FRACP · Simon Clarke MB BS, FRACP, FCP

A study of help-seeking behaviours, reproductive disorders and rates of testing for prostate problems in Aboriginal and Torres Strait Islander men from urban, rural and remote communities in the Northern Territory and Queensland.

Michael J Adams BSW, MA, PhD · Veronica R Collins BSc, MSc(Epidemiol), PhD · Michael P Dunne BA(Hons), PhD · David M de Kretser MB BS, MD, FRACP · Carol A Holden BSc(Hons), PhD, MPH

Objectives: To report on the prevalence and implications of overweight and obesity in a rural maternity cohort.Design, setting and participants: A retrospective 6-year cohort of 6138 pregnancies managed in a rural Victorian maternity service from 1 January 2005 to 31 December 2010.Main outcome measures: Maternal body mass index (BMI), prevalence of overweight and obesity, prevalence of pregnancy complications and their association with BMI ...

Chris E Cunningham MSc, BLit, BA · Glyn R Teale MRCP, MRCOG, FRANZCOG

A review of clinical records of patients treated in Canberra and Sydney identified 10 patients who were likely to have suffered “deathcap” mushroom poisoning between 1999 and 2012. Despite treatment according to current standards, including use of the purported antidote silibinin, eight developed significant hepatotoxicity and four died.

Darren M Roberts PhD, FRACP · Michael J Hall FACEM · Morna M Falkland BPharm · Simone I Strasser MD, FRACP · Nick A Buckley MD, FRACP

At a time when increasing use of electronic health records and communication methods has led to increasing use of clinical photography — particularly in visually oriented specialties — this is timely guidance on proper procedure and permissible uses of photographs.

Patrick D Mahar MB BS(Hons), LLB(Hons), MACLM · Peter A Foley MB BS, MD, FACD · Alexander Sheed-Finck BA, LLB(Hons) · Christopher S Baker MB BS, FACD

“A boss who despairs — or is too cynical, burnt out, bitterly pessimistic or angry — and exudes hopelessness is like concrete cancer which eventually causes a structure to crumble and collapse.”

Simon Wein MB BS

Botanical taxonomy is a repository of medical biographical information. Such botanical memorials include the names of some indigenous orchids of Australia. By searching reference texts and journals relating to Australian botany and Australian orchidology, as well as Australian and international medical and botanical biographical texts, I identified 30 orchids indigenous to Australia whose names commemorate doctors and other medical professionals. Of these, 24 have names ...

John H Pearn MD, PhD, DSc

A Fellow of the Royal Australasian College of Physicians commemorated in TanzaniaAlexander MacKenzie (Sandy) Rankin left an indelible legacy in Tanzania. Born in Perth in 1929, he graduated from the University of Adelaide in 1952, and developed a lifelong interest in medicine in the developing world early in his career. In the main, his commitment was in Africa. Starting in 1959 as a registrar at University ...

Krishna Somers FRCP, FRCPE, FRACP

Adolf Saweri was born on 28 July 1941 in Sarmi, West Papua. He was known to most Australian medical graduates who have worked in Papua New Guinea (PNG) since the 1960s. In 1960, after completing his schooling in Kotaraja in the West Papua region (at the time, a Dutch territory, Netherlands New Guinea), he was one of seven students from the region chosen for medical training in Port ...

Ian Maddocks

David Healy was born in Melbourne on 30 September 1948. He studied at Monash University, graduating in medicine in 1973 and completing a PhD on human prolactin physiology in 1979. After commencing training in obstetrics and gynaecology at the Royal Women’s Hospital, Melbourne, David completed his training at the National Institutes of Health in the United States and the Simpson Memorial Maternity Pavilion in Edinburgh, Scotland. In 1985, ...

Luk J F Rombauts

General practice: the integrative approach. Kerryn Phelps, Craig Hassed. Sydney: Churchill Livingstone, 2011 (xxiii + 993 pp, $150.00). ISBN 9780729538046. COMPLEMENTARY MEDICINES and practices are widely available to, and used by, the Australian public. Until now, there has not been a framework to integrate this into safe, evidence-based medical practice. We needed a book of this calibre.Both authors are leaders in the field of ...

Patrizia Boetto

Smartphones and their apps are adding a new dimension to medical care, bringing information to doctors’ fingertips and connecting them to the world at the bedside

Karen Burge

The Australian and New Zealand College of Anaesthetists (ANZCA) will kick off 2013 with a revised curriculum designed to reflect the expanding role of anaesthetists in practice. ANZCA president Dr Lindy Roberts said the college wanted to ensure its program was contemporary, in terms of clinical content as well as its teaching, learning and assessment methods. “ANZCA’s revised curriculum will be the first in the world to break the nexus between anaesthesia training and surgical procedures”, she said. “Where other countries’ training programs are linked to surgical subspecialties — for example, anaesthesia for burns, cardiac surgery or neurosurgery — our curriculum will be based on anaesthesia clinical fundamentals, which define an anaesthetist’s scope of practice.” The seven clinical fundamentals are airway management; general anaesthesia and sedation; pain medicine; perioperative medicine; regional and local anaesthesia; resuscitation, trauma and crisis management; and safety and quality in anaesthesia practice. Dr Roberts said these reflected the growing role of anaesthetists and ensured the college produced specialists with broad experience across all areas of anaesthesia practice. “This revision is also part of our ongoing commitment to ensure we produce anaesthetists who provide high-quality, safe care to patients.”

Cate Swannell

Professor Flavia Cicuttini is head of both the Rheumatology Unit at The Alfred hospital and the Musculoskeletal Unit in the School of Public Health and Preventive Medicine at Monash University. Much of her work focuses on using magnetic resonance imaging (MRI) to understand factors that affect joint cartilage. Here, she shares some of highlights of her fulfilling career.

Interview by Karen

Sanduni Fernando is a recent medical graduate of Monash University, where she studied at Gippsland Medical School. She has worked at the Musculoskeletal Unit at The Alfred hospital under the tutelage of Professor Flavia Cicuttini.

Cate Swannell

It began as a fun way to keep fit and unwind, but it seems the annual Westmead Hospital Triathlon has a way of bringing out the competitive streak in its athletes. Anaesthetist Dr Greg Downey shares why this health challenge is so addictive.

Linda Drake

Could your financial health be in need of a lifestyle prescription? While doctors traditionally carry a high level of debt, it’s often the personal, not business, decisions that block the way to a debt-free future. Here, experts explain how to overcome your debt hurdles.

Linda Drake