Volume 200 Issue 1

In the interests of children and families, doctors need to know how to recognise and deal with signs of child abuse

R Kim Oates MD, DSc, FRACP

A patient’s right to privacy must be balanced with the information needs and safety concerns of others

Christopher J Ryan MB BS, MHL, FRANZCP · Sascha Callaghan LLB, MBioeth · Matthew M Large BSc, MB BS, FRANZCP

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

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

Smoking caused a million deaths in Australia in the past 6 decades; we are gradually winning, but the battle is not over

Mike Daube BA(Hons), HonDSci

A focus on overuse of psychotropic drugs in aged care facilities is too narrow and will not help solve overall problems

Jeffrey C L Looi MD, FRANZCP, AFRACMA · Stephen Macfarlane MB BS, MPM, FRANZCP

Even in settings with well developed infrastructure, few potentially eligible prisoners get hepatitis C treatment

Michael M Mina MB ChB(Hons), MRCP, MIPH(Hons) · Paul J Clark MB BS(Hons), PhD, FRACP · Holly M Beasley BSc, PostGradDip (IntHealth) · Lilie Herawati MD, MPH · Tony G Butler MSc, PhD · Andrew R Lloyd MB BS, MD, FRACP

To provide quality health services, we need to collect meaningful data and invest in embedded research and development

Julie A Halton

To the Editor: I would like to commend Penington for his insightful opinion piece regarding the challenges facing the Australian health system over the next decade.1 I, and I am sure many others, share his warranted concern regarding the future of quality and safety in health care in a politically charged, target-based funding system. As highlighted by Penington, the recently published McKeon report provides a suggested ...

Justin M Nazareth

To the Editor: The response of Sievert and colleagues for the Gastroenterological Society of Australia1 to an article on iron deficiency anaemia in a young woman2 missed the point. In the absence of menorrhagia, dietary deficiency of iron is extraordinarily rare unless the individual is a vegan. The young woman presented with a haemoglobin level of 61 g/L and was treated with iron supplements over a ...

Terry D Bolin

To the Editor: The Gastroenterological Society of Australia (GESA) response1 to the anonymous father’s heartfelt account of the suffering and ultimate death of his daughter, misdiagnosed on a number of occasions by general practitioners and medical specialists, was, in my view, inadequate. The young woman certainly warranted a colonoscopy, if not at presentation then certainly after 6 months of unsuccessful iron replacement therapy. Sievert and colleagues should ...

Randolph S Williams

In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states ...

William Sievert · Barbara A Leggett · Finlay A Macrae

To the Editor: We were not surprised by the results of Birden and Underwood’s study of the attitudes of medical students to professionalism programs.1 In the context of similar issues at our university, we have recently implemented a professionalism program (“Ethical Practice–Empathic Practice” [EP2]) in our Doctor of Medicine (MD) course. This program begins in the first full-time clinical year (Year 2) as weekly small-group tutorials ...

Geoffrey J McColl · Barbara D Goss · Eleanor M Flynn · Agnes E Dodds

To the Editor: Personal and professional development (PPD) as part of the medical school curriculum has been the subject of recent interest and debate in the MJA.1,2 The authors highlighted the disjunction between what is intended to be taught, what is learned and what is valued by students, with one of the conclusions being the importance of gaining student feedback on PPD. To promote medical student ...

Paul M McGurgan

To the Editor: Like Birden and Usherwood, we have struggled with the need to facilitate the learning of professionalism for our medical students.1 We also recognise the importance of using authentic, real-world situations and clinical teachers to inspire meaningful reflection and discussion between students1 and to counterbalance the negative impact of poor role models or unsuccessful clinical experiences that contribute to the hidden curriculum. At our ...

Lisa M Parker · Lisa D Watts

To the Editor: Birden and Usherwood’s article regarding medical students’ perceptions of the teaching of professionalism1 would have struck a chord with countless recent graduates from Australian medical schools. Being forced to reflect on one’s clinical experience is artificial; and after some trial and error by students (with respect to writing style and content), they develop an understanding of what will attain good marks, and submit ...

Alexander M Owen

To the Editor: The article by Birden and Usherwood1 presents a very limited view of professionalism, one that is based solely on doctor–patient interactions. Both the focus groups and the authors have failed to discuss the breadth of professionalism that includes a doctor’s relationship with other doctors, allied health, nursing staff and other craft groups. Although made during the focus group interactions the derogatory comment ...

Tom R Sutherland

Finding missed cases of possible child abuse is a positive outcome from fortnightly review of ED case files for children

Amanda Gwee · Benjamin Coghlan · Cate Rayner · Anne Smith · David Krieser

A screening checklist has proved successful in Queensland

Jennifer K Broom · Mark D Kelly · Alex F Broom

To the Editor: Large administrative datasets are increasingly being used for health research; validation studies are critical to understanding data quality, in particular that coding accurately reflects the clinical condition under study. We compared heart failure coding and the associated comorbidity burden using the New South Wales Admitted Patient Data Collection (APDC) with the clinical data in patient medical records (the “gold standard”). The APDC ...

Jane Robertson · Sallie-Anne Pearson · John R Attia

Data linking multiple disease notifications from the same individuals show patterns of infection in Sydney men

Kelly-Anne Ressler · Mark J Ferson · Elizabeth J Smedley

To the Editor: The article by Segard and Macdonald is interesting but has significant methodological weaknesses and reports data that do not support all of their conclusions.1 Methodologically, retrospective dataset reviews with little demographic or morbidity data to avoid confounding (it is unclear why these were not available) are problematic. Additionally, death certificates were used as a surrogate for improved outcomes from additional diagnosis. Segard and Macdonald ...

David Mountain

In reply: We thank Mountain for his comments. As he points out, it is only possible to infer cause and effect from observational data. The fact that referrals for D-dimer levels and computed tomography pulmonary angiography increased during the same period does not prove that one “drove” the other, although we believe this is a reasonable inference. Importantly, D-dimer testing was introduced as a “rule-out” ...

William B G Macdonald · Tatiana Segard

Tobacco plain packaging had a more sustained effect on increasing calls to Quitline than graphic health warnings

Jane M Young MPH, PhD, FAFPHM · Ingrid Stacey BSc(Hons) · Timothy A Dobbins BMath, PhD · Sally Dunlop PhD · Anita L Dessaix MPH · David C Currow BMed, MPH, FRACP

A firmer hand on elective caesarean section policy could reduce costs and morbidity

Himanshu P Popat MB BS, FRACP, MMed(ClinEpi) · Margaret Wall BA, MSS · Kathryn A Browning Carmo BMED, FRACP, CCPU · Andrew Berry FRACP

Maladministrations occur infrequently, with low patient risk, and most commonly due to incorrect preparation and dispensation of radiopharmaceuticals

George S Larcos FRACP, DDU, MPH · Lee T Collins MSc · Andrew Georgiou PhD · Johanna I Westbrook BAppSc, MHA, PhD

Weighing up the worth of a local program recommended for national rollout

Balakrishnan (Kichu) R Nair AM, MD, FRACP, FRCP · Andrew M Searles BEc, MMedStats, PhD · Rod I Ling PhD, MA, BCom · Julie Wein DipBus(Man) · Kathy Ingham DipTraining

Outlier patients may be at risk if their therapeutic and monitoring needs are only met on their home ward

John D Santamaria MD BS, FRACP, FCICM · Antony E Tobin MB BS, FRACP, FCICM · Matthew H Anstey MB BS, FCICM, FACEM · Roger J Smith BN, MPH · David A Reid

An off-label treatment and an outstanding outcome

Melissa N Manahan BPharm, MB BS(Hons) · Peter Peters BSc(Hons), MB BS · Salvatore Scuderi BSc, BMedSci, MB BS(Hons) · Devita Surjana BSc, MB BS · Graeme L Beardmore OAM, MB BS, DDM, FACD

Ancient Egyptian surgeons employed skill, magic and superstition to perform an impressive array of procedures

Peter R Mayall MA, MB BS, FRANZCOG

What does it mean to be a leader in global health today?

Kylie Ngu MB BS, BMedSci

Where do cystic fibrosis and chlamydia intersect with autism and alcohol misuse? In adolescent medicine, which is the focus of one of the first texts on this topic to be published in Australia. While adolescent health was addressed in this Journal in 1959, considerable time elapsed before clinical units became formally established. These are now centres of excellence in an expanding field in Sydney, Melbourne ...

Murray G Williams

Taking time out to practise medicine in a different location is a rite of passage for many, but recent regulation and workforce changes are altering the locum landscape

Annabel McGilvray

Dr Will Milford has been advocating for junior doctors in his role as outgoing chair of the AMA’s Council of Doctors-in-Training. It’s been a busy and contentious 18 months

Cate Swannell