Issue 25 / 14 July 2014

IF you’re reading this on Monday morning, there’s a chance you’re a bit bleary-eyed from getting up early to watch the final of a major sporting event.

My limited interest in several codes of football stems from a male-dominated household but I do enjoy the singing of national anthems at international sporting events. After that, I take a dutiful interest in the preferred team and brace myself to witness the inevitable injuries.

It’s hard to understand why we care so much about sport but often fail to take care of those who play it. Although soccer is far from the worst of the contact sports, this World Cup has dealt its fair share of devastating blows. Most controversial is the footage of players returning to the field after apparently sustaining concussions, sparking much needed criticism and debate.

Closer to home, a young professional player has just announced his retirement from rugby league due to the effects of repeated bouts of concussion.

The timely publication last week of a position statement from the American Academy of Neurology underscores doctors’ ethical obligation to undergo training in concussion management if they are involved in caring for players, and also emphasises their duty to protect concussed players from returning to competition before they are medically ready.

For our first news story we asked sports injury experts what can be done to care for the neurological status of athletes at every level of sporting endeavour in Australia.

Extending the duty of care for patients with cancer is a theme of two articles in MJA InSight this week. Our second news story is based on a study published online in the MJA, which reveals that people who have had cancer are more likely than those who have not to be diagnosed with chronic conditions such as cardiovascular disease, hypertension, hypercholesterolaemia and diabetes. The study points to a need to engage cancer survivors in preventive lifestyle measures and carefully monitor them for a range of chronic illnesses.

Caring for the mental health of children who have a parent with cancer is the subject of another article in InSight this week. There has recently been a call to screen all families in this situation for vulnerability to psychological distress, and provide specific therapy to those identified.

Psychiatrist Jane Turner asks whether, in the long run, this is necessary, realistic and a good use of resources. Turner makes the point that screening can only be effective when it points the way to effective care, and that the care is safe and available.

This well known principle of screening partially underlies the recent reaffirmation of the advice from the US Preventive Services Task Force that population-based ultrasound screening for carotid artery stenosis (CAS) is not warranted.

The evidence review underpinning the recommendation found population screening would lead to risky investigation of false-positive results, and that there was little to recommend invasive treatment of screen-diagnosed CAS over current best medical therapy.

We sought comment from stroke and screening experts, as well as proponents of vascular screening for our third news story.

A sometimes overlooked duty of care for health care professionals is to ourselves and our colleagues. The Reverend Helen Dick highlights the need to look after those who are caring for the dying, particularly in the emotionally taxing and underappreciated aged care sector.

Good medical care includes a duty to fully disclose the limitations and possible side effects of any treatments but, in her column this week, Jane McCredie explores the potential for these conversations to exacerbate the nocebo effect (whereby the expectation of a negative outcome makes that outcome more likely) if not handled sensitively.

The discussion of how we choose our words could be extended to the current debate about sport-related concussion. Maybe the time has come for doctors to call concussion what it is — a brain injury.

Who knows, if we extend our duty of care to change society’s cavalier attitude to the neurological health of our best and fairest, future international footy players might remember and sing the national anthem.


Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight

3 thoughts on “Ruth Armstrong: Duties of care

  1. john Carlyle says:

    Duty of care either exists  or does not  exist – it cannot be extended.

    Extending a duty of care becomes interference with the rights of  the individual.

    This intereference is a type of medical stalking – population education is the alternative that is acceptable. But as the research shows society is becoming dumber this seems unlikely.

  2. Sue Ieraci says:

    “Medical stalking” – what a strange concept! Would the anonymous “Barrister” consider all injury prevention strategies to be ”medical stalking” – or only those used in sport? What about seatbelts and helmets?

  3. Ian Cormack says:

    I was born into a world where you did silly stuff at your own risk. If you took a chance and the trick came off, congratulations hero. If not, the cost was yours. Now, in my seventh shakespearean stage of man, I find a duty of care has crept in. There was a duty to warn in advance, then to prevent, then to rescue if the first were ignored.

    Seatbelts and helmets have been mentioned. Add to this riding in the back of trucks, a trick I enjoyed. The main arguments for laws governing these were economic. Taxpayers were expected to fund repairs, so taxpayers wanted to put a stop before the disaster.

    Otherwise does a duty of care exist? I believe a perception exists and I suspect even “Barrister” may be convinced that the right argument presented in the right forum can extend such a perception.

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