Issue 3 / 3 February 2014

“WHAT have I missed?”

It’s a common thought for doctors, which can range in intensity from a calm re-examination of a clinical presentation, to a jolt from sleep with pounding heart in the middle of the night.

But blind spots are not confined to clinical practice: they can affect us all — as individuals, as a profession and as a wider society.

Making the MJA InSight news this week is an article about a common group of disorders that, according to the authors of a review in the MJA, fail to get the research attention (and dollars!) they deserve. Musculoskeletal conditions are the leading cause of disability burden for Australians and account for more than 17% of all problems managed in general practice, a pattern the authors say is not reflected in the allocation of NHMRC funding.

The authors of an MJA Perspectives article, also reported in InSight news, point to what they term is an “ethical blind spot” that allows clinical practice to proceed without formal oversight from an ethics committee but requires strict adherence to ethical standards for those undertaking medical research.

Whether this is something that should or can be changed led to some debate from the experts we approached for the story, but the authors’ point is well made that, once treatments become established (often without the benefit of formal research), they can be difficult, expensive and controversial to shift.

How best to select students for medical school is on oft discussed topic in the MJA but could it be that, in our endless quest for the most discriminating criteria, we have lost sight of the main game? InSight got some interesting responses to a study published in the MJA ADD LINK, which looked at what happened to the intake at the University of Queensland after removal of the interview from their medical student selection process.

History is replete with collective blind spots that have allowed wrong doing to flourish unchecked, a fact chillingly recalled by Dr Michael Glicksman’s use of a quote from anti-Nazi activist, Dietrich Bonhoeffer, to open his InSight comment calling for doctors to speak up about Australia’s treatment of asylum seekers in immigration detention.

Late last year, Human Rights Commissioner, Gillian Triggs, detailed in the MJA the “mounting evidence” that mandatory and indefinite detention of asylum seekers who have entered Australia unlawfully was harming detainees’ health. Mental illness and self-harm are rife in detention centres, and the Human Rights Committee of the United Nations has twice warned that Australia is in breach of its obligations not to subject people to cruel, inhuman or degrading treatment, and to treat them with dignity.

These observations have not come out of the blue. In 2001 the MJA published a landmark article from a young Iraqi doctor in immigration detention in Australia, detailing his deteriorating mental health and that of his fellow detainees. Subsequent studies and reports, including a 2012 federal joint select committee report have confirmed his findings.

We have thus known for more than a decade that, despite the fact that most  “illegal boat arrivals” are eventually found to be genuine refugees, the time they spend in detention is eroding their mental health. There are also serious concerns about the quality of detainees’ health care, yet the medical profession has allowed politicisation of the immigration debate to divide us and distract us.

With the recent disbandment of the Immigration Health Advisory Group, the AMA has reiterated its offer to be involved in a “truly independent medical panel to oversee and report on health services for asylum seekers being held in both on- and off-shore immigration detention centres.”.

Surely this is something we can all support.

A quote from Søren Aabye Kierkegaard, Danish philosopher and theologian, provides some insight into the dangers of nurturing a blind spot: “There are two ways to be fooled. One is to believe what isn't true; the other is to refuse to believe what is true.”

If we don’t force ourselves to look at this issue now, in decades to come the Australian medical profession might well need to ask itself: “What have we missed?”

Dr Ruth Armstrong is the medical editor of MJA InSight.

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