Comments for MJA InSight

Comment on Sandra Leggat: Empowering health managers by SL (the author)

SL (the author) — Wed, 01 Feb 2012 06:54:04 +0000

Many thanks for your comments. I wanted to respond to Dr De Leacy. Often management is accused of being an art, with no science. But here is an example of the science. Empowerment is not just a weasel word (although I have to agree that it sometimes gets used as such with little understanding of what it is and how to foster it). Empowerment is a well-defined and validated psychological construct that the evidence suggests we need to pay attention to.

Comment on Jane McCredie: Life in the app lane by Sue Ieraci

Sue Ieraci — Wed, 01 Feb 2012 02:12:28 +0000

Couldn’t agree more, Jane. In an increasingly self-obsessed and risk-averse society, we are being flooded with information but deprived of wisdom.

What an irony that our community has rejected paternalism in medicine, preferring to believe that an individual is the best judge of their own healthcare (examples – the anti-vaccination and anti-obstertics movements). While orthodox medicine is now more open about not having all the answers, people have moved in droves to the “alternative” practitioners, who have something to offer you for all those symptoms and measurements. And it’s usually a “remedy”, or regular “therapy”. So much for taking personal responsibility for your own health.

Comment on Sandra Leggat: Empowering health managers by JD

JD — Mon, 30 Jan 2012 11:28:44 +0000

In my experience, the problem is far worse than merely having untrained managers. As Dr Ieraci points out, while clinicians are subject to clinical governance there is no real administrative governance.
The result is that I’ve seen numerous instances of not just poor performance by administrators, but also, behaviour which breeches Codes of Conduct, and is probably illegal.
The Garling report (remember?) stated that bullying and harassment was rife in NSW. There is still no real avenue to bring administrators who are perpetrators to account.

Comment on Jane McCredie: Life in the app lane by Dr George Margelis

Dr George Margelis — Mon, 30 Jan 2012 11:11:18 +0000

Whilst I am a big fan of technology in healthcare the self quantified self movement seems a bit over the top. Equating physical parameters with health is a sure sign that the engineers have taken hold and tried to simplify healthcare to just managing the numbers. Real clinicians understand that there is much more to healthcare than just managing the numbers, it requires an understanding of the person, their society, and the various other determinants. There is a very real place for monitoring, but let’s not forget that we are deaIing with real people not robots.
Disclaimer: I work in health IT and listen to engineers all day, so I really think it is important that clinicians take control of this now!

Comment on Mental health funding lacks transparency by Anonymous

Anonymous — Mon, 30 Jan 2012 08:18:30 +0000

Why single out mental health for an evaluation? Shouldn’t all health programs and services be subjected to the same level of monitoring and transparency re their outcomes?

Comment on Jane McCredie: Life in the app lane by jo romero

jo romero — Mon, 30 Jan 2012 07:46:06 +0000

Excellent article. I think that the excess of information in the
electronic media confuses patients a lot. They’re not always
correctly advised by doctors, who are busy managing the tangle of
information that exists nowadays. I believe the hour has arrived to
return to the aphorism of knowing a little, but knowing it well.

Comment on Confidence in research shattered by Glenn Rosendahl

Glenn Rosendahl — Mon, 30 Jan 2012 05:59:46 +0000

We vilify industry without acknowledging its nature. A ‘for profit’ organization must make profits, or it ceases to exist. In this competitive world, only those industries that make high profits will continue to exist. Where ethics and existence compete, which is paramount? Governments around the world have continued to slough off onto the private sector tasks they previously understood were properly the role of an independent arbiter. Politicians now obtain power, and use power to achieve partisan and irrational goals. The problem is not simply the ethics of industry (any industry). It is the ethical standard and reasonable expectation of the community as a whole.

Comment on Philippa Ramsay: Beware miscarriage misdiagnosis by Harry Karipis

Harry Karipis — Mon, 30 Jan 2012 04:43:58 +0000

I could not agree more with the comments about diagnosis in early pregnancy on a single ultrasound. The problem is in our society we want an answer now and we want an immediate solution. But even to do nothing is to do something. The conservative (expectant management) approach to failed pregnancies is also an option with most women (some say up to 85%) completing the process without invasive intervention and the associated health care resources. Many well developed European countries take this approach. Serial HCGs are a waste of time except if ectopic is considered. If an early ultrasound is too early or uncertain then repeat ultrasound some time (at least a week later) will either show progress and a live pregnancy or it will show no progress-hence a failed pregnancy. The advantage of this is some will spontaneously miscarry (therefore no intervention) while the others are unlikely to complete the miscarriage in a timely manner and can be offered the surgical approach.

However I do appreciate there are many ways to beat an egg in order to make an omelet.

Comment on Philippa Ramsay: Beware miscarriage misdiagnosis by Sue Ieraci

Sue Ieraci — Mon, 30 Jan 2012 02:36:20 +0000

Like every area of medicine, no single test should be used in isolation. Evidence of foetal viability includes not just ultrasound, but history, examination and quantitative beta hCG. Unless the woman is life-threateningly haemorrhaging or septic, there is no immediate urgency that would delay a thorough evaluation.

Comment on Sue Ieraci: A weak substitute by Sue Ieraci

Sue Ieraci — Mon, 30 Jan 2012 02:32:11 +0000

I think you are likely to be right, Makdabr. The figures relate to the advice given, not to the actual actions of the worried patients. It is inevitable that, in a risk-averse society, an advice line can only act in a conservative way, so it is quite likely that they would refer more people than they divert. Like the data shows on some nurse-run walk-in clinics, the service might actually be duplicated rather than diverted.