Issue 14 / 28 April 2014

ALTHOUGH he only had praise for his predecessor, the new NSW Premier Mike Baird began his unexpected tenure with a promise to do some cleaning up — particularly in relation to restoring public confidence that lobbyists, fundraisers and other “influence peddlers” were not the ones pulling the strings of government.

This week’s MJA InSight also begins with a call to clean up, after an MJA study revealed that the overall improvement in hand hygiene in Australian hospitals masks pockets of both exemplary and sub-par practice. In our lead news story, one infection control expert dubbed the finding that doctors are still less compliant than nurses as “the elephant in the room” that requires some clear thinking on how to motivate medical personnel.

Still on the topic of hospitals, if your idea of a clean-up involves a big chuck-out, you will enjoy this week’s contribution from Dr Aniello Iannuzzi, on the importance of keeping patients’ bedside charts to their minimalist best. As a rural GP with hospital admitting rights, he wonders whether it will be eye-strain, information overload or a slipped disc that becomes his career-ending injury.

With the federal Budget looming ever-closer, another MJA online article, which suggests one way of clawing back some health dollars is to clean up a discrepancy in the way drug therapies are funded, is the subject of our second news story.

In the past few years, Australian prescribers have embraced combination drug therapies, where two pharmaceutical agents are combined in a single tablet or capsule. This might save patients money, but the price government pays for the combination drugs often ends up being much more than for the sum of the individual components.

Given the ingenuity of online fraudsters and scammers it should not be surprising that bogus open access academic journals, with sham peer review and no editorial processes, have been sinking their tendrils into researchers to extract their papers and their money. It creates a market for these journals and a loophole for unethical authors. Yet the extent of this practice, when revealed by an investigative journalist in Science last year, sent shockwaves through the scientific publishing community.

Our final news story looks at the clean-up that is underway to help authors decide where to publish, and the inevitable reality that “a bit of due diligence by the researcher about the journal” is now more important than ever.

Reading our reader comments on an InSight news story on chiropractic last year, and summarising the response a few weeks later, I was struck by the fact that a profession that fails to clean up the instances of poor practice and questionable ethics in its ranks will suffer a rightful loss of legitimacy.

In her column this week, Jane McCredie takes aim at the outrageous claims of some chiropractors who treat children, and the practice of “persuading people they have a medical problem so that they can be sold the solution”.

The reputation of the pharmaceutical industry has also been damaged by unchecked instances of disease mongering and “indication creep” but the medical profession is also not exempt from the need to clean up some problem areas of our own.

Last week’s controversy about a promotion linking cosmetic breast surgery to ANZAC Day via a competition led to a rapid apology by the practice involved. The apology was directed at the RSL, and veterans and defence organisations but made no mention of whether it was appropriate for a doctor to tout for business by asking women questions including “How would you celebrate with your bestie after getting the breasts you truly desire?” or to offer, as part of a prize, a free consultation with a surgeon.

These activities are not isolated and not confined to cosmetic surgeons, and are not a good look for the medical profession as a whole. We, too, must do some cleaning up if we wish to retain the public’s confidence that our primary concern is for our patients, and not our commercial interests.

Dr Ruth Armstrong is the medical editor of MJA InSight.

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