Issue 20 / 10 June 2014

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

3 thoughts on “Ruth Armstrong: A word of advice

  1. Dr Gael Phillips says:

    It is extremely important that medical diagnosis and treatment is based on the best scientific evidence. There needs to be a more concerted campaign to educate the public about the necessity for immunisation for tetanus, diphtheria, whooping cough, measles etc, to counteract the negative effect on vaccination rates caused by the ill-informed anti-vaccination lobby. The dangers of interactions between prescription medicines (prescribed by our excellent Australian medical practitioners, trained in University teaching hospitals) and alternative medicines, often perhaps self-prescribed, also needs to be more widely known by the general public. Into this catergory I would also place fad diets. We need a public education process to better inform the general public.

  2. Philip Dawson says:

    Medical journals are supposed to be evidence based, so what they should do (to follow your theme), is to stop talking about things that have been dosproved. Racism is one of those things. There is only one human race. The idea of more than one started with darwin (the tilte to his book on evolution icludes “favoured races”), perpetuated by Sigmund Freuds 1900 book on the unfavoured race of Australian Aborigines who were doomed to die out in favour of the “favoured white race”. Before Darwin it was accepted there was only one human race (St Paul writes tha all people are of “one blood”), and since the human genome project was completed over a decade ago it is confirmed Darwin was wrong, there is only one human race. Time to stop using this pejorative word, call a spade a spade. If one group or other of people is getting a raw deal well discuss that.  Australians of Aboriginal descent are only different to the rest of us if they differ in culture and remote location. many no longer have links to their “culture” and live in urban areas,  or them it may just be their skin colour results in “scrimination”. That too is a furphy, we all have the same skin colour, melalin, just different shades of the two melalin pigments! 

  3. Dr Yaacov (John B.) Myers says:

    Taxonomic classification distinguishes species, genus and in the species Homo Sapiens, also race. Melanin is a colouring, a pigment, not a colour. Shades differ. Colours differ and even emit a different wave length of light or sound depending on how one perceives it. Differences are healthy. Bureaucracy and subjectivity, which are the same, are not. We are composed of similar molecules but respecting rights unites Mankind. Even the same pigment may look a different colour in another light. My point is that context needs to be taken into account. We are at the same time different and the same. What really needs to be evaluated is the concept of a “virgin birth”. That must be the ultimate con, a duplicity that ranks over all others, which is why every other duplicity, such as “acting in the public interest”, is a duplicity those on Boards and Tribunals can get away with and why some groups and individuals are “bullied” and harassed by the bureaucrats, who also “bully” and abuse us. In this too there is no difference, only the context differs. We are all Aborigines in that sense and, called “racism” or not, something has to be done about it. A System of Evaluated Decisions to ensure accountability and ethics prevail over the self serving agenda of Boards, courts and tribunals, needs to be instituted, in order to promote a healthy transparent and accountable society; in order to have evidence based evaluation tools to determine “what is rightfully” in the public interest; and to replace subjectivity that anecdotal case law, not subjected to prospective evaluation and objective scrutiny, represents.

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