Letters

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

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

To the Editor: It is truly difficult to understand by what standard the University of Melbourne defines its MD degree, which it commenced in 2011 to replace its previous MB BS degree. Several things are abundantly clear, however. The educational standard is distinctly short of the traditional British and Australasian higher doctorate degree. The University of Melbourne clearly recognises this itself, as it has renamed its own ...

Richard M Hanney

In reply: The Melbourne Medical School is celebrating its 150th anniversary this year. However, the University of Melbourne awarded medical degrees as early as 1856, including the award of the MD degree ad eundem gradum to the acknowledged founder of the Medical School, Anthony Colling Brownless, on the basis of his MD from St Andrews University, Scotland, obtained by examination in 1847. The MD is ...

James D Best · Geoffrey J McColl

To the Editor: In their recent article on emergency department (ED) waiting time performance data, Greene and Hall1 proposed that “assigning patients to a less urgent triage category than is appropriate” is a possible explanation for observed variations in waiting time performance. In Australia, triage decisions are made on the basis of clinical urgency. The Australasian Triage Scale is underpinned by a robust body of research ...

Julie Considine · Ramon Z Shaban · Marie F Gerdtz · Dianne Crellin

In reply: We thank Considine and colleagues for their interest in our recent article. Our research documented a relationship between the reported urgency mix of patients in emergency departments and waiting time performance, and we discussed possible explanations for the relationship, including “undertriaging”.1 We were explicit that the study did not provide evidence of undertriaging, but argued that it was a possibility worthy of consideration, ...

Jessica Greene · Jane Hall

To the Editor: The recent Australian Institute of Health and Welfare (AIHW) statistics on emergency department (ED) care show that 38% of attendances from 1 July 2011 to 30 June 2012 were potential general practice presentations.1 This indicator is reported under the National Healthcare Agreement. Both the AIHW and Council of Australian Governments acknowledge that this method is flawed and have agreed to review this indicator.2 To date, this ...

Yusuf Nagree · Andrew D Gosbell · Daniel M Fatovich · Peter A Cameron · Sally M McCarthy · David Mountain

To the Editor: Harrison and colleagues present data which confirm that inequitable distribution of mental health care is increasing under the Better Access program.1 They discount our promotion of the central role of general practitioners in the more restricted Better Outcomes program2 and our advocacy for GPs to resume those key activities despite lack of support under the Better Access program.3 The fatal decision that accompanied ...

Sebastian P Rosenberg · Ian B Hickie

In reply: We share Rosenberg and Hickie’s belief that general practitioners should play a central role in mental health care. We showed with Bettering the Evaluation and Care of Health (BEACH) data that GPs have played this role in both Better Outcomes and Better Access.1 Rosenberg and Hickie rely on administrative data to make inferences about clinical practice. They assume that GPs not claiming review items ...

Christopher M Harrison · Graeme C Miller · Helena C Britt

To the Editor: Beatson and Rao’s article1 appeared in the MJA Open supplement subtitled “A guide to management in primary care”. Despite acknowledging that it “can be difficult to distinguish between [borderline personality disorder] and [major depressive disorder]”, the authors offer no specific guidance for general practitioners on how to do this. Beatson and Rao cite no primary care research, although admittedly there is a dearth ...

Darryl L Lacey

In reply: Lacey suggests that the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP-BQ)1 can be a useful tool for the assessment of personality problems by academic general practitioners. We agree. Significant elevations on the DAPP-BQ’s affective lability, identity problems, insecure attachment, and self-harm scores would alert the practitioner to the probable — if not certain — presence of borderline personality disorder (BPD). However, the ...

Josephine A Beatson · Sathya Rao

To the Editor: We congratulate Kwan and colleagues on their evaluation of an online chlamydia testing program (OLC) in Western Australia. However, their study does not demonstrate OLC to be a “highly effective means of increasing access to testing among young people at risk of STIs [sexually transmitted infections]”.1 Adolescents account for 30% of chlamydia notifications in WA,2 yet only 37 of the 377 people (10%) who were ...

Peter S Azzopardi · Elissa C Kennedy · Alex D Brown

In reply: Azzopardi and colleagues seem to equate “young” with “adolescent”. We defined “young” as less than 30 years of age; 84% of chlamydia notifications in Western Australia occur in this age group,1 and they comprised 71% of online chlamydia testing program (OLC) users.2 This group accesses the internet frequently, with about 90% of Australians under 35 years of age using the internet at least once a ...

Lewis J Marshall · Edwina A Jachimowicz · Lisa Bastian · Donna B Mak

As the debate about older drivers continues, an observant reader notes another danger for car occupants lurking in an MJA illustration.

Paul Gerber

Deaths from hypothermia are not limited to colder climates or to the winter months. Older people who live alone without adequate heating are especially vulnerable.

Fiona Bright · Calle Winskog · Roger W Byard