Issue 8 / 10 March 2014

I FIRST heard about the KISS principle in my intern year and it wasn’t a moment too soon.

My surgical supervisor was a wonderful, generous extrovert of a man who, just a few years out from retirement, enjoyed sharing a lifetime of clinical and personal wisdom with his comparatively clueless charges.

“Keep it simple, stupid” was one of his mottos in discussing everything from differential diagnoses to wound closure and, by and large, it’s been good advice.

If you’re looking to keep it simple this week, however, you’d best take a deep breath before diving into MJA InSight.

Our lead news story sets the tone by reporting on one of medicine’s most contested issues — the management of prostate cancer. The latest data, from the Scandinavian Prostate Cancer Group Study Number 4 with up to 23 years of follow up, confirm an overall survival advantage for radical prostatectomy compared with watchful waiting but the devil is in the subgroup detail. We asked some experts where the study fits in our current efforts to improve prostate cancer management.

Most doctors would perceive a clear and simple distinction between withdrawing futile treatment and taking active steps to end a life. The AMA’s position on this issue, for instance, is that “not continuing life-prolonging measures” does not constitute euthanasia or assisted suicide. Apparently not everyone agrees. This week Jane McCredie dissects some recent thinking on the topic from the academic legal and philosophical literature.

Another expert commenting in an InSight news story has highlighted that keeping the message simple is not a guaranteed way to change the entrenched opinions and behaviours of our patients. Professor Jonathan Carapetis was commenting on a US study that compared the effectiveness of four different web-based messages for parents, designed to increase the uptake of measles–mumps–rubella vaccination. His observation that “human behaviour is a very complex thing” is borne out by the study’s findings.

The recalcitrant remnant aside, childhood immunisation is a public health success story in Australia, with coverage in excess of 90%. However, new challenges are always on the horizon.

Our third news story concerns Australian bat lyssavirus infection which, although very rare, requires a public health response of its own.

One reason often cited for our inability to deliver clear and simple health messages about topics like vaccination is the cacophony of conflicting information vying to be heard and believed, and often put forward by skilled or manipulative communicators. In a comment, anaesthetist Simon Hendel asks what chance he and his colleagues have of providing accurate information about safety when their first opportunity to communicate with the patient is often in the anaesthetic bay.

For many years, health communication provided the simple options of face-to-face conversations or the static delivery of promotional messages via the media. Social media has added another dimension and doctors are slowly beginning to appreciate its transformative influence on public health and patient care.

Our online behaviour should sit within established ethical frameworks but some areas, such as the fine line between interacting and advertising, have become complex, prompting the Medical Board of Australia to develop a new social media policy, which, along with revised guidelines for advertising regulated health services, are set to come into effect next week.

The guidelines’ interpretation of the Health Practitioner Regulation National Law, which specifically prohibits the use of patient testimonials, has caused a stir among doctors who use social media and are concerned they will risk fines if patients post unsolicited positive comments about them.

Late last week the board’s chair Dr Joanna Flynn clarified that the guidelines would only apply to testimonials in the context of advertising but her initial response to the outcry did raise a question: “Our legislators shaped the National Law, including the ban on testimonials, based on history, traditional forms of media and past trends in complaints. Whether it is still appropriate in the 21st century, when there are a whole series of conversations taking place online, with different levels of control over who says what about who, is another question altogether.”

And a very good question it is — in a week when we’re struggling to keep it simple.


Dr Ruth Armstrong is the medical editor of MJA InSight.

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