Perspectives

United States Surgeons-General wield very little actual power, but the late “Chick” Koop nevertheless drove surprising progress in public health.

Mike Daube BA(Hons), HonDSci

Media reporting about suicide may lead to increased suicidal behaviour in at-risk people, or it may operate positively and reduce the risk of suicide. But media representations of suicide are distinct from community discussions. It is time to have a much richer, more honest and more open public discussion about suicide.

Scott J Fitzpatrick BA(Hons) · Ian H Kerridge BA, MPhil, BMed

What are the potential health benefits and risks of population social–emotional screening of children as young as 3 years of age, and are there other options for ensuring kids’ social and emotional development?

Michael F Daubney MB BS, FRANZCP · Cate M Cameron PhD, MPH, BSocWork(Hons) · Paul A Scuffham PhD, BA

Recent changes in perioperative patient management — including well integrated pre-admission clinics, the “bundle of care” initiative and clinical handover using electronic medical records — mean that surgical patients should have a smooth perioperative journey.

Bruce P Waxman FRACS, FRCS, FACS

One tool that decisionmakers could use to assess whether such interventions are fit for purpose is a comprehensive checklist of evaluative criteria, starting with questions about how well the problem to be addressed by the intervention has been defined.

Ian A Scott FRACP, MHA, MEd · John B Wakefield MPH, FRACMA, FRACGP

Guiding principles in the Australian Open Disclosure Framework consultation draft highlight the important roles that health service organisations can play in closing the “disclosure gap” between expected practice regarding disclosure of medical errors and what is actually being done.

Stuart R McLennan MBHL · Robert D Truog MD

Patients with drug-resistant tuberculosis will inevitably reach the Torres Strait or Australia’s mainland. To defend against this threat, all those who present to health services in Australia should have free and equal access to tuberculosis care.

Tony Kirby BSc(Biological Chemistry)

When critically appraising trials of new drugs, clinicians need to keep in mind generalisability, patient selection, and the politics of drug marketing.

John R Attia MD, PhD, FRACP · Robert Pearce BPharm

We have a continued responsibility to ensure that the benefits of new drugs demonstrated in randomised controlled trials are translated into clinical practice.

John W Eikelboom MB BS, MSc · Graeme J Hankey MD, FRACP, FRCP

Learning from past experience to improve paediatric vaccine safety.

Paul V Effler MD, MPH, FAFPHM · Heath A Kelly MB BS, MPH

Experiencing the sights, sounds and smells of childbirth can’t be replaced by plastic models or videos

Caroline M de Costa PhD, FRANZCOG, FRCOG · Ajay Rane PhD, MD, FRANZCOG

An intensive care unit is only as good as the care and decision making provided at 2 am. What is needed is an environment that promotes optimal decision making 24 hours a day.

Sean L Kelly BMed, FACEM · Roger D Harris MB BS, FACEM, FCICM · Anthony R Burrell MB BS, FANZCA, FCICM

Unless future well designed studies show an actual benefit for patients, hospitals and health care, policymakers should resist any attempts to enforce this potentially expensive and ineffective practice.

Adam M Deane MB BS, PhD, FCICM · Mary G White MB BCh, BAO, FFARCSI

To change practice, we should move beyond trial-based efficacy to real-world effectivenessMeaningful health care reform requires robust evidence about which interventions work best for whom and under what circumstances. The Institute of Medicine in the United States has estimated that less than 50% of current treatments are supported by evidence and 30% of health care expenditure reflects care that is of uncertain value.1 In studies ...

Ian A Scott FRACP, MHA, MEd

Public reporting of hospital performance is welcome, but we need to understand the limitations of the data and report the most meaningful outcomes.

Leon J Worth MB BS, FRACP, PhD · Ann L Bull PhD · Michael J Richards MB BS, FRACP, MD

Researchers need an umbrella group to advocate on their behalf, identify the research gaps and provide a way to share ideas and infrustructure.

Ian N Olver AM, MD, PhD · Anthony C Keech FRACP, MSc(Epid)

Today, sex-based inequalities and inequities shape how individuals are disproportionately exposed to adverse determinants of health. Our sex can determine how well or ill we become, and if or how our health care needs are acknowledged and met.1 The underlying reasons for this disparity are complex and diverse, shaped by how sex and sexual customs interact within varying political and social contexts. Discriminatory values, norms ...

Izzeldin M M Abuelaish MD, MPH

How can the current health care system accommodate, integrate and implement the strategies required for quality end-of-life care for people on a longer-term trajectory of disease?

Teresa A Burgess GradDipNursing Management, MPHC · Annette J Braunack Mayer BMSc(Hons), PhD · Gregory B Crawford MB BS, MD, FAChPM · Justin J Beilby MB BS, MD, FRACGP

Tasmania is the only Australian jurisdiction to operate a state-funded registry and to require registration of completed enduring guardianship forms, but uptake is low.

Michael A Ashby MD, FRACP, FAChPM · Robert N Thornton BEd, MHPEd, PhD · Robyn L Thomas MB BS, FRACGP, FAChPM