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In times of strain, the quiet work of care — for patients, colleagues, and ourselves — becomes both more difficult and more essential. The March issue of the Medical Journal of Australia arrives against a backdrop of mounting global and local pressures. Rising living costs, increasing fuel prices, and geopolitical instability are not abstract concerns; they are felt in clinic rooms, emergency departments, and households across the country. These pressures shape how patients present, how clinicians practise, and how health systems cope.
Periods like this tend to expose the fragility of the systems and people that sustain care. They also remind us of something more fundamental: medicine is not only a technical enterprise, but a deeply human one, reliant on relationships, trust, and resilience. The papers highlighted in this issue speak to these themes in different ways — from system-level challenges to the lived realities of clinicians and patients — and collectively underscore the need to look after one another, as well as ourselves.
In this issue, Rees and Silove provide an overview of the Adaptation and Development After Persecution and Trauma (ADAPT) model as an overarching framework that can guide psychosocial interventions and promote adaptive coping, recovery and resilience especially in light of the recent Bondi beach terrorist event. The ADAPT model identifies five interrelated psychosocial pillars on which stable societies are grounded, and which are disrupted by intentional acts of mass violence such as that which occurred at Bondi: (i) safety and security, (ii) attachment and bonds, (iii) justice, (iv) identities and roles, and (v) existential meaning. Coordinated care, involving a range of psychosocial and specialist mental health services, is therefore required to meet the diversity of needs. Recovery should aim not only to restore well-being but also to identify and strengthen individual and community resilience to respond to future trauma.
Gray et al acknowledge that child health inequity continues to be an ongoing problem and explore how linked administrative data support timely, precise, agile and coordinated policy responses and monitor their impact. They argue that linked administrative data offer a powerful, low-cost tool to generate scalable insights to inform timely and equitable policies. Their perspective article notes that addressing child health inequities requires stacking complementary interventions across sectors, particularly during the critical early years. For priority populations, including First Nations children, children with disabilities, those in out-of-home care, children experiencing socio-economic disadvantage and those from ethnically minoritised or refugee communities, the authors recommend integrated cross-sector data, disaggregated for priority populations, are essential to identify who is most affected, monitor reach and ensure responses do not inadvertently widen gaps. They make recommendations regarding investment in key enablers to turn data into evidence and impact.
In this issue Digenis et al conducted qualitative research to explore primary care providers’ perspectives on (i) healthcare needs and barriers to care for Aboriginal and Torres Strait Islander children and adolescents; and (ii) enablers and opportunities to strengthen care. Participants identified mental health as a central health need for children and young people, noting that presenting complaints often masked deeper issues and highlighted the importance of trauma-informed, collaborative care. Barriers to access included lack of cultural safety, social and financial challenges, limited awareness of services, and concerns around privacy and confidentiality. Improvements were suggested through youth-tailored services, enhanced provider training (particularly in mental health and communication), safer and more engaging care environments, greater support for staff wellbeing, and increased resourcing.
Taken together, some of the studies in this issue provide a view of the current healthcare landscape. They quantify the extent of workforce strain, identify gaps between evidence and practice, and analyse the structural factors influencing system performance. While each focus on a different aspect of care, a consistent message emerges: external pressures — economic, social, and systemic — are having tangible effects across the health system.
In periods of uncertainty, there can be a tendency to focus narrowly on immediate demands. However, the findings presented here suggest that broader contextual factors must also be considered. Delayed care, clinician burnout, variation in practice, and policy constraints are interconnected challenges, each influencing the others. Addressing them requires both targeted interventions and a recognition of the wider environment in which healthcare operates.
Looking after ourselves and each other remains central to this effort. The evidence presented in this issue underscores that clinician wellbeing is not separate from patient care, but integral to it. Similarly, understanding the barriers patients face — including financial pressures — is essential to delivering effective care. While systemic solutions are critical, the everyday actions of clinicians also play a role in mitigating these challenges.
In a time of rising pressures, that commitment — grounded in evidence and sustained by care for one another — matters more than ever.
Dr Aajuli Shukla is a Sydney GP and a Deputy Medical Editor at the Medical Journal of Australia.
Read the latest issue of the Medical Journal of Australia here.