Divorce dying wife if want stay, rural doctor told.

Philippines-born Dr Cesar Sofocado has been helping out with the doctor shortage in rural Western Australia since 2005. Now, the dad of two young daughters has been told to divorce his dying wife if he wants to stay. Mary has advance breast cancer and says she will only seek palliative care to not burden the state's coffers. Upon learning her condition, immigration told him to apply for a visa type that didn't allow appeals related to health matters. She wishes to spend her last days with her family here. He wishes to show his daughters, Sofia and Kyla, that "we don't leave each other for any reason". (the west australian)

"I married my wife for richer and poorer and in sickness and health - that is the vow I took." (west australian news image)

At least 1800 more doctors are needed for folks in country Australia. When International Medical Graduates (IMGs), who are bound by a ten year Medicare restriction to areas of need, staff more than 41% of rural posts, whilst local doctors are flying in and flying out with no "real solid commitment to the community" (abc), commonsense dictates a review of the good doctor's plight on compassionate grounds.

Amidst of all this, the AMA told a federal parliamentary inquiry earlier this year that "given the nature of rural practice, with its emphasis on resourceful individualism, generalist medical skills, isolation, lack of supervision and small communities, there could not have been a worse place to send IMGs."

AMA: "(IMGs) need better support, and the moratorium guarantees that's really tough to deliver".

Calling for an end to the ten-year restriction, the AMA argued that attracting rather than forcing IMGs to rural areas will better solve the rural doctor shortage. (the australian)

There is no word from the Immigration Department yet. I hope they will make the right decision for the good of the family and us all.

Update (28/4/2011):
Rejoice my fellow earthlings! The Sofocados have been granted permanent visas by intervention of Immigration Minister Chris Bowen. YAY! (the west australian)

And they lived happily ever after. (west australian news image)

Source: Rural Doctors Association of Australia fact sheet (pdf)

Emergency doctor misleads jury to protect colleague

An emergency medicine specialist at the Canberra Hospital admitted he had "slightly misled" the jury to protect a colleague from criticism. The doctor had previously said the patient was medically dead when he asked an emergency registrar to perform an emergency thoracotomy, which is an incision of the chest cavity to allow access to organs like the heart. This is amidst a fatal stabbing trial with the defence lawyer arguing the victim may have died as a result of the surgery and not the stab wounds. (ABC)

Whilst this is most disconcerting and should raise questions of ethics, it is prudent that we recognise this is being played out right now and there maybe more unknowns. I appreciate the fact that the doctor is in a very undesirable position and I hope he can navigate through this with integrity.

Meanwhile, Captain we have visual...on whistleblower Dr Julian Fidge from defence doctor: toxic culture

Yet another meanwhile, more than 200 medical students from Otago Uni have signed a petition urging the government to remove GST from milk and legislate to require Fonterra, which controls 90% of Kiwi's raw milk, to sell milk "at prices considered affordable" back home. They cite a recent study saying high domestic milk prices may be contributing to rising rates of obesity and chronic illness. In Australia, milk is GST free, for which I'm grateful. (Otago Daily Times)

P.S.  Homage to Randy Pausch. Can anyone spot it?

MD? You're a Doctor of Medicine!

Doctor dream at a nightmare $230,000 from The Sunday Age quotes Brigid Wolf saying, "Nearly a quarter of a million dollars for a 21-year-old is a lot of money to think about going into debt for. Who wants to have a mortgage by the time they turn 25 without a house?"

Ms Wolf is one of 55 domestic full-fee paying medico wannabes enrolled in the new Doctor of Medicine (MD) at Melbourne Uni commencing this year. Rebranding its MBBS as a masters degree MD has allowed Melbourne Medical School to sidestep Labor's 2009 ban on accepting full-fee paying domestic undergrads, which was designed to improve access and equity in tertiary education. The controversy caused since the inception of MD has not been obscure.

Accredited by the AMC (Australian Medical Council) to the same level as other MBBS and BMed (see below for subtleties), Melbourne's MD has given birth to a new AMSA policy, adopted this March, which states MD's own birth could create "confusion and unequal treatment" of medico wannabes and medicos, amongst other undesirables.

"This is not acceptable", AMA pronounces in its latest e-dit (is this a misfortunate play on edict?). Its president Andrew Pesce argues that the financial burden could distort specialty choices. ''If you graduate with a debt of $250,000, are you likely to take up lower-paid specialties such as general practice or are you going to want to be an orthopaedic surgeon or a plastic surgeon?" I think this line of argument is a bit too novel for some reason. But he topped off with the line "preventing people from lower socioeconomic backgrounds from studying medicine". Wolf's parents had to remortgage their home though I'm sure many wealthy parents out there have no qualms about paying for their medico wannabes. Which is perfectly reasonable.

In Melbourne's defence, its dean of medicine Jim Angus said government funding for HEC places was "insufficient to give us a quality medical education". The AMC also recognises the uni has accounted for "the additional academic expectations of programs at master degree level" in their accreditation report published this year.

Apparently Western Australia med may be considering full-fee places next year as well, as mentioned in the same Sunday Age article.

I must declare I'm not a student at Melbourne but I haven't ruled out med there, which must be quite worthwhile as I do wonder why Wolf didn't just pick another school. "When I got the offer of a full-fee place I was devastated. I thought I was going to have to knock back everything I really wanted to do." The article could well be anything but a nightmare of a read for Melbourne's PR.

Meanwhile, Melbourne Uni dilutes disadvantaged intake reported that Melbourne has raised the entry ATAR of its medicine-leading Biomedicine degree from 88 to 92 for poor and rural students because of high demands. Considering this year's normal CSP cut-off of 98.45, it expects next year's cohort would see 35% of disadvantaged students, compared to this year's 48%. I'm sympathetic to both sides.  It really depends on your vantage point, which may be heavily aligned with self interest.

(thank you nucleophilic addition-elimination (verified human, not michael crichton's) for pointing out the correct 2011 CSP cut-off in comments)

defence doctor: toxic culture

Captain Julian Fidge (pictured) is a defence doctor in the Army Reserve and has faced more than 12 charges of insubordination. This medical officer is also on suspension for exposing that "a toxic culture of denigration of and discrimination against" health professionals in the Australian Defence Force.

"your rank is not a real thing"

"Health support specialists are barely tolerated and often denigrated" by general service officiers and that medicals officers are leaving in droves, with those who stay on "becoming more demoralised and further deskilled". (check bottom for source)

Fidge chilling in East Timor. I didn't know medical officers carry rifles. And he's a smoking doctor. Absolutely no offence. (ABC image)

In Feburary this year, SMH reported that the navy would be investigating allegations of negligence and patient managament ("believed" to include bullying) at the HMAS Albatross medical centre. On this note, Julian Fidge said that most medical officiers in the Regular Army are "junior and inexperienced, often just out of internship".

In November last year, ABC's ADF running short of medics said that the defence force wants to recruit more than 200 medical personnel. Julian Fidge was quoted for saying he and his medics "had significant difficulties" accepting the healthcare provision by civilian contractors, who are not as well trained as seriving medical officers. I think it makes sense that working in a combat enviroment requires different skill sets than those used in the more controlled civilian world.

The past few days have seen reports of a cadet sex scandal, inaction over homophobic haressment, suicides caused by bullying and so on, yes to yesterday's SMH editorial Defence needs a cultural revolution. But as an expert in public sector governance and risk writes in Changing defence culture will take time, changing the culture in an organisation as large as defence needs time and persistence. Each generation of leadership (ministers and top brasses), needs to take the baton and pass it on.

"I am obliged to do by virtue of my profession, to advocate for my patients’ health and well-being, even at personal cost", Julian Fidge

I've always been positively disposed to those who dare to speak out. And Julian seems like an man with intergrity.

You can read Julian Fidge's write up in the MJA's electronic newsletter InSight here. Subscription is needed but it's free. Or just check out this article from The Australian. This is the link of the picture above.

Update:
Julian Fidge talks about this in a video embedded here.

To dissect or not

I have always had a huge interest in anatomy and I would love to get my hands dirty and dissect (former) donors to science. Anatomy of a dissection debate from today's SMH is a good, longish feature that talks about the different opinions on dissection in med schools. I wonder how many schools still offer dissections as opposed to just prosections (viewing anatomy structures dissected by others) (I actually answered this myself below but no names were given though).

''You need to pick up and follow the structures to identify them,'' Ramsey-Stewart says. ''You need the tactile gnosis.''

I'm excited that ANU has an Anatomy Dissection Prize (hopefully it'll be around for a while). USYD, where the above article draws inspiration, seems to offer envious dissection opportunities, apparently "another 90 donated corpses are downstairs in the university's mortuary".

Back to the future: teaching anatomy by whole-body dissection, published in the MJA last December, found that the anatomical knowledge of students increased dramatically after a 34-day optional dissection course, whose coordinator is also the journal article's lead investigator. The students also gave favourable feedbacks (obviously, from my shoes).

Last April, Review of anatomy education in Australian and New Zealand medical schools from the ANZJS reported that the amount of time spent on teaching anatomy varied widely among the 19 med schools (21 were approached). The average 4 year course offered 180 hours of anatomy teaching but it ranged from 75 to 300 hours. One 5 year course had only 56 hours on anatomy. What a privilege! Compulsory whole body dissection experience was only available in 3 med schools, 4 had no human dissection at all, neither optional nor part.  Cheekily, the investigators identified somewhat indirectly the Aussie (and, by deduction, Kiwi) med school that didn't respond to the questionnaire.

In August 2009, it was reported that two dognapped pet dogs were found by their owners in a dissection room at a university teaching hospital. One was even "sedated, splayed, and strapped to a stainless steel table moments away from the knife"(abc). The University of San Marcos in Peru doesn't have access to enough human cadavers. I'm grateful for the opportunities we have in Australia.

Sydney Uni to ditch ACER application consortium

Sydney med school will only be accepting applications directly starting this year for 2012 commencement. This means they will be conducting their own interviews and not be part of the three-preferences ACER application. This doesn't mean they will be ditching GAMSAT for the test results. Why? The school's dean Professor Robinson says ACER doesn't give them enough information to choose the most suitable students. But James Angus from Medical Deans says others may follow suit and it is tough on families (smh).

The good thing is you get an extra chance since you don't have to worry about putting USYD (known for its competitiveness) as first preference and possibly lose out on other med schools. The bad thing is you have to pay $100 for the interview in Sydney on top of another $100 for ACER application to be considered by other schools.

Money is tight for many but I think the pros have it since you will probably be travelling to other schools for interviews anyhow if you don't get your first preference. For a range of reasons I haven't considered med school at USYD.

With all this fuss, how to get into USYD?

(1) To apply, you must have a miminum GPA of 5.5 and a miminum Overall GAMSAT score of 50. (2) You will then be selected for interview depending on your Overall GAMSAT score until the number of interviews offered is about 1.4 times the number of offers available. (3) They will offer spots to applicants working from top to bottom off a ranked list based equally (50/50) on your Overall GAMSAT score and your interview score (usyd med).

For international students, the process is similar but MCAT can be used instead of GAMSAT and you will only be competing with other int'l students as will me domestics.

Cuts to medical research?

Today thousands turned out to rally against the speculated cuts of up to $400m to medical research. Well you know where I stand. Often what doctors can do is limited by advances on the bench. Think penicillin.

For all we know, breaththroughs that can change millions of lives are just around the corner. Professor Sharon Lewin reckons a cure for AIDS will be found by 2020 (smh).

More funding is actually needed. In 2010, NHMRC could only fund around 34% of projects judged worthy of funding. Whilst 1488 worthy projects went unfunded. It is especially alarming to note that 204 worthy projects by "new investigators" were unfunded in 2009 and 2010 (source).

Beyond the news reports, Cuts and Bruises by Jo Chandler from The Age gave me a heartening account of the lives of medical researchers. I swear they don't get nearly as much credit as they derserve.

Update:
Get real, medical researchers: nobody deserves a bottomless pit of money is a piece of dissenting voice written by Ryan Meyer, an American visiting fellow at Melbourne Uni who looks at "the relationship between social problems and scientific research".  His two points of argument were "profit = health?" and "medical research = better health?" Now, hold your horses because he was quite rational in his questioning the framework in which the rumoured cuts are being debated.