MY family once banned me from watching the news for a month after I verbally abused the television.
At the end of a long day in general practice, I arrived home in time for yet another segment on one of the many things “GPs should” (and had failed to) do. Having heard such advice too many times, I vented my frustration on an innocent household appliance.
Now, many years and another career later, I still try to avoid the “doctors should” approach because I know that most of the things that harm people’s health happen outside of the consulting room, and many of the solutions are also broader. To some extent, practising medicine is about choosing your battles in this broad and overwhelmingly complex context.
This week’s MJA InSight starts with a societal problem that spills over into health care. There is ample evidence linking the experience of racism to poor health outcomes, but a study from Victoria published online by the MJA looks at the context. In what settings are Indigenous Australians most likely to experience racism, and does this affect the potential for harm?
Not surprisingly, retail spaces, public places and educational institutions all out-rank health care settings as places to experience racism, but the study reveals a particular association between racism in health care and psychological distress.
Given the ongoing work towards, and goodwill for, culturally safe health care, we sought advice for our first news story on why racism is still being felt in health care settings, and what else we should do.
Doctors know that malnutrition is important as a cause of disease, and an impediment to recovery. We also know that up to a third of patients admitted to Australian acute care hospitals are malnourished, yet the problem is all but invisible in day-to-day care. Prompted by a Canadian study that found that hospital doctors thought their patients’ nutritional status was important but were also fairly sure it was not being attended to, we sought comment for another news story on whether nutrition needs to be higher on the agenda of medical teams treating hospitalised patients.
Encouraging people to participate in bowel cancer screening is uncontroversially something doctors should (and do) do, but an economic modelling study from the US has thrown the cat among the pigeons in our third news story. The study and an accompanying editorial provide a strong argument for screening people well into their 80s, especially if they have not been screened in the past. With screening rates still well below par in the target group of 50–65-year-olds in Australia, is this a distraction or something to seriously consider?
Pharmacists rather than doctors are in the firing line in a Comment this week. Pharmacist Ian Carr makes a strong argument for what his colleagues should and should not be selling if they want to be part of the team that delivers science-based medicine, rather than self-serving quackery, to a mostly trusting public.
Every now and then, someone gives editors a taste of our own medicine and writes about what medical journals should be doing. In a recent article, Professor Paul Glasziou wrote: “Open-access medical journals must maintain particularly high standards … in order to avoid merely increasing access to a biased selection of (often flawed) research. At the same time, improving research quality but keeping access restricted would mean continued waste in the use and uptake of good science.”
This is good advice for the MJA (an open-access journal when it comes to research) in the lead-up to our centenary on 4 July. In a Comment for InSight this week, our Editor in Chief, Professor Stephen Leeder, reflects on how the Journal’s role has changed and what it should do in order to continue to be relevant.
Leeder admits it “would be a brave soul who claimed to know what the future holds” for medical publishing or, indeed, almost anything.
However, one thing is fairly certain — in the broader context of health care we will continue to choose our battles, and there won’t be any shortage of advice along the way.
Dr Ruth Armstrong is the medical editor of MJA InSight. On Twitter @DrRuthInSight