Letters

To the Editor: Until recently, Australian medical workforce planning has seemed a rather ad-hoc affair. We have self-induced an undersupply of doctors (having actually reduced student numbers in the mid 1990s,1 taken a decade to increase production, and now have crashed into entirely foreseeable undersupply of intern placements). The establishment of Health Workforce Australia has promulgated some much needed detailed, future-focused planning, although the fragmented ...

Dev A Kevat · Shanti Raman

To the Editor: The perspective of the Doctors for Voluntary Euthanasia Choice needs to be challenged.1 Firstly, irrespective of one’s views on the matter, it does not seem reasonable for euthanasia to be legalised so that doctors can avoid the scrutiny of the law. Secondly, the authors point out that “pain may not be a prominent symptom, making death by morphine legally unjustifiable”, therefore implying ...

Paul F Dunne

To the Editor: The Doctors for Voluntary Euthanasia Choice want Australia to have enlightened euthanasia laws similar to those of the Netherlands.1 But a recent review of Dutch physician-assisted death (PAD) suggests that such practices are extremely difficult to control.2 They state that there has been some improvement in the rate of reporting of cases of euthanasia (a legal requirement), although only 2% of deaths classifiable ...

Roger K Woodruff

In reply: We thank Dunne and Woodruff for comments on our Perspectives article.1 Both colleagues firmly expressed their opinions. However, we find it telling that neither mentioned consideration of their patients’ opinions and both referred to euthanasia, not voluntary euthanasia (VE), which was the subject of our article. We agree with Dunne that “it does not seem reasonable for euthanasia to be legalised so that doctors ...

John O Willoughby · Robert G Marr · Colin P Wendell-Smith

The problem of excessive psychotropic drug use in Australian nursing homes is well known, but where are the solutions?

Juanita L Westbury · Gregory M Peterson

To the Editor: The article by Hilmer and Gnjidic1 raises issues about the management of behavioural and psychological symptoms of dementia (BPSD)2 in residential aged care facilities (RACFs). It is important to remember the context in which RACF residents’ care is provided. The federally managed aged care system is politically and organisationally perceived as supported accommodation, which is geared toward supporting or substituting for residents’ performance ...

Ludomyr J Mykyta

In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1 While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses ...

Sarah N Hilmer · Danijela Gnjidic

Data from a tertiary paediatric refugee health clinic show that instances of post-traumatic stress disorder are on the rise in this population, particularly in children who have been held in detention.

Joshua R Francis · Sarah Cherian · David Forbes

When considering this controversial procedure, how do we weigh the results of patient satisfaction surveys with those of clinical trials?

Wayne Adams

In reply: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient’s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery ...

Rachelle Buchbinder · Ian A Harris

To the Editor: This letter encourages timely preoperative recognition of restless legs syndrome (RLS), for patient wellbeing, as well as for practical management of incidental procedures. RLS is a neurological disorder found in many older patients of either sex and in those with a variety of conditions including iron deficiency, pregnancy, uraemia, diabetes and rheumatoid arthritis. It may also affect patients with other neurological disorders ...

Ivan Cher

To the Editor: We read with interest the viewpoint offered by Mitchell and colleagues, highlighting the need for improved integration of global health training in postgraduate medical education in Australia.1 This subject has garnered interest in Australia and overseas with reference to ophthalmology. In the United Kingdom, the case for structured global health training has been advocated in ophthalmology postgraduate education, where financial and bureaucratic ...

Jan Kokavec · Lauren Hodgson · Justin C Sherwin

To the Editor: Mitchell and colleagues have done medical education a service by outlining all the potential benefits and harms associated with global health training.1 They are right to state that sustainability is key — however, all too often in the past, it has been sustainability that has been lacking. According to Yikona, writing in 2003: “Case by case analysis of medical schools in sub-Saharan ...

Kieran Walsh