Issue 5 / 16 February 2015

I’LL never forget the first grand rounds I attended as a medical student

It was a review of a patient who had died in hospital. After admission under a medical team, transfer for surgical care and a stay in intensive care, the patient had a sudden and fatal deterioration back on the general ward.

A junior registrar presented the case and, while he seemed nervous, his detailed, objective reporting and the collective reflective capacity in the room that day were mesmerising.

I knew I had joined a profession with the ability to observe and analyse its failures, and use new knowledge to improve processes and outcomes.

Two news stories in this week’s MJA InSight reflect ways in which we do this.

One story follows up an article in the MJA by paediatric respiratory physician Professor Peter Van Asperen, who points out that we have a responsibility to learn from the deaths of 20 children from asthma expounded in the most recent NSW Child Death Review Team annual report.

Another article gives voice to a call for a change in standard practice. As the contribution of antibiotic prescribing to the growing problem of antimicrobial resistance becomes increasingly understood, experts are spreading the word that stopping antibiotics when infections are clinically resolved or prove unlikely to have a bacterial cause is better than staying the course.

While the cycles of continuous improvement in medicine are far from perfect and replete with aberrations, the intent and the effort are genuine, yielding measurable benefits over time.

Three words that might embody this culture were invoked by our Prime Minister a fortnight ago when he delivered a speech at the National Press Club in Canberra “I have listened, I have learned, I have acted”

These are not words that are often played out in politics and, as the responses to two reports released last week revealed, in this case they were ultimately hollow.

In his address to Parliament when tabling the “Closing the Gap: Prime Minister’s report” Mr Abbott acknowledged that 7 years after targets had been set by the Council of Australian Governments, the slow progress on reaching them was “profoundly disappointing”, and reiterated bipartisan determination to work towards improvement.

There followed much hand wringing in the media about wasted expenditure and the need to redirect resources. One respected Aboriginal doctor and academic, Professor Ngaire Brown, articulated the thoughts of many who work in the sector when she pointed out a failure to listen and to learn from what we know, and to act accordingly, is surely the main impediment to progress.

“Successive governments have failed to capitalise on the experience and expertise in this field, they’ve failed to understand the evidence. Rather they’ve used their ideology to inform policy, resourcing and service delivery”, Professor Brown said.

On the same day, a report from the Australian Human Rights Commission, The Forgotten Children was also tabled. The report documented neglect, and hundreds of instances of physical, psychological and sexual abuse of children in immigration detention.

This came as no surprise to concerned health professionals, who have been raising the alarm about children in detention for more than a decade.

Such a report should have provided the government with an opportunity to acknowledge the evidence, reiterate their commitment to releasing the more than 300 children currently in onshore and offshore detention, and indicate it would consider the recommendation for a Royal Commission. Instead, the Prime Minister condemned the report as a “blatantly partisan politicised exercise” and said the Commission “ought to be ashamed of itself”.

Before the report was released, a group of doctors described the "appalling" conditions at the detention centre on Nauru, with one saying he felt compelled to speak out despite the contracts he signed before working on the island.

As a profession, doctors believe in the power of speaking out about processes and policies that are detrimental to health. As an editor I’ve done my bit to facilitate it.

But right now I’m wondering if anyone with the power to make change is prepared to listen, learn and act.


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

One thought on “Ruth Armstrong: Listen, learn, act

  1. Randal Williams says:

    I recall a lecture from a clinical microbiologist back in the 1970’s suggesting that for most conditions antibiotics can be ceased when symptoms have settled, and that prolonging the course ‘encourages bacterial resistance.’

    Interesting how old ideas resurface.

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