more_vertInsufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs).
Preference: Pathology
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[Series] Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action
Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health.
[Series] Access to pathology and laboratory medicine services: a crucial gap
As global efforts accelerate to implement the Sustainable Development Goals and, in particular, universal health coverage, access to high-quality and timely pathology and laboratory medicine (PALM) services will be needed to support health-care systems that are tasked with achieving these goals. This access will be most challenging to achieve in low-income and middle-income countries (LMICs), which have a disproportionately large share of the global burden of disease but a disproportionately low share of global health-care resources, particularly PALM services.
Your AMA Federal Council at work
| Dr Chris Moy | Federal Council Area representative for South Australia & Northern Territory | Australian Digital Health Agency My Health Record Expansion Program Steering Group | 8/8/217 & 7/12/17 | ||
| Prof Mark Khangure | Member of AMA Federal Council and AMA Health Financing & Economics Commttee | ADHA My Health Record Diagnostic Imaging Programme Steering Group | 5/11/17 | ||
| Dr Richard Kidd | Chair – Council of General Practice | My Aged Care Gateway Advisory Group | 05/03/18 | ||
| Dr Richard Kidd | Chair – Council of General Practice | PIP Advisory Group | 09/03/18 | ||
| Dr Richard Kidd | Chair – Council of General Practice | DVA Health Provider Forum | 12/04/18 | ||
| Dr Richard Kidd | Chair – Council of General Practice | PIP Advisory Group | 13/4/2018 | ||
| Dr Tony Bartone | AMA Vice President | TGA Consultative Committee | 10/04/18 | ||
| Dr Gino Pecoraro | Federal Council Member – obstetrician/gynaecologist | National Strategic Approach to Maternity Services Advisory Group | 06/03/18 | ||
| Dr Beverly Rowbotham | Chair of Federal Council | ADHA My Health Record Pathology Steering Group | 23/04/18 |
[Perspectives] Kenneth Fleming: making the global case for pathology
Some years ago, and while still occupying a senior post in the administration of medical training and research at the UK’s University of Oxford, pathologist Kenneth Fleming was at a meeting in Bangkok. He got talking to a fellow Oxford academic who was living and working in Thailand. On enquiring if he could help locally in any way, Fleming learned that the country had a pressing need for more staff and resources in pathology. This was the first time he realised that the provision of pathology services was a major but neglected problem not only in that part of Asia but also over much of the globe.
[Comment] Pathology and laboratory medicine: the Cinderella of health systems
High-quality pathology and laboratory medicine (PALM) services are an integral part of health systems in high-income countries. New molecular diagnostic techniques, advances in precision cancer treatments, and population-based screening programmes for disease prevention or early detection have made PALM an even more important part of modern medicine and health care. And yet, even in high-income countries, the role of PALM is not well understood by the general public, and pathology remains a somewhat unpopular specialty in medicine.
[Comment] Laboratory medicine in low-income and middle-income countries: progress and challenges
Laboratory medicine is essential for disease detection, surveillance, control, and management.1 However, access to quality-assured laboratory diagnosis has been a challenge in low-income and middle-income countries (LMICs) resulting in delayed or inaccurate diagnosis and ineffective treatment with consequences for patient safety.1 In the new Lancet Series2–4 on pathology and laboratory medicine (PALM) in LMICs, Michael Wilson and colleagues2 provide a comprehensive analysis of the challenges and gaps that limit access to PALM services.
Candidate profile – Dr Jill Tomlinson MBBS(Hons), PG Dip Surg Anat, FRACS(Plast), GAICD
Nominating for the position of AMA Vice President
We are at a critical period of change in health. We are asked by Government and the community to do more with less. Healthcare costs are rising. Technology is changing how we practise, offering opportunities but also challenges. Our profession faces significant cultural change.
The AMA must remain relevant and engaged in this time of change. It needs a strong leadership team who will deliver advocacy, political representation and passion to do better for our patients and for the profession.
If elected, I will make digital strategy a key priority. Within the AMA, this means improving communication and engagement with members by expanding digital services and addressing barriers at State and Federal levels. The AMA must be where doctors are, and must support a strong AMA in every State.
Within the health system, a focus on digital strategy means strong advocacy for systems and programs that work for doctors, not create work for doctors. This is not just about My Health Record, it’s about real time prescription monitoring, secure messaging, data use and security, accessibility, interoperability, care co-ordination, the digital determinants of health and the regulatory and administrative burden on doctors. We must get digital systems right, or else – as we’ve seen with hospital constructions across the country – billions are spent but the final product doesn’t address the needs of patients or doctors.
Preventable illnesses associated with obesity are literally killing our patients. We need a radical, whole of community approach to the problem – one that drives meaningful change. We must advocate for public health improvements and make real investment in general practice, which is the most efficient part of the health system and has been neglected for too long. We must improve mental health care, aged care and veterans’ services. We must reduce inequality, and Close the Gap. We must be inclusive, and support equity and diversity. It’s the fair thing to do but it’s also in the best interests of our patients and the profession.
We must address workforce issues, including doctor and training position maldistribution. We must support medical students and doctors-in-training who are increasingly struggling to manage the overwhelming demands of training and service delivery. We must improve access to flexible training and end discrimination on the grounds of pregnancy, mental illness, disability, parental leave and return to work. We must advocate for marginalised individuals and groups that cannot speak for themselves.
We must fight for an independent profession. Patient care suffers when health funds control access to care or make decisions for patients; corporatisation increasingly affects general practice, radiology and pathology.
I seek your support and your vote at National Conference. I seek your advice and insights into how we can improve health in Australia as, while I have a vision for the AMA, I do not claim to have all the answers. And most importantly, I seek your enthusiasm, passion and engagement – only by working together will we achieve the best outcomes for our patients and the profession.
* See other candidate profiles on thios site.
Candidate profile – Dr Janice Fletcher MBBS (Hons 1), MD, BSc, FRACP, FRCPA
Nominating for the position of AMA Vice President
My decision to nominate for Vice President came about after careful consideration about what I could offer the role, and, importantly, if I had the time to commit to the requirements of the position.
After a recent (second) knee replacement I also had to make sure I was fit to run. I, only half jokingly, credit my orthopaedic surgeon for this decision.
Having served as President of the AMA SA I have been exposed to the rigours of such a role.
I believe strongly in the role of the AMA, recognising the issues both at Federal and State level, having worked in South Australia, New South Wales, and Victoria. Coming from a small state, I bring geographic diversity to the executive table.
My professional background is diverse; paediatrics, genetics, pathology and medical administration. I was proud to be the fourth female President of the AMA SA.
As a strongly influential organisation, the AMA must be at the forefront of setting the health agenda for Australia. As experts in evidence-based medicine, we need an evidence-based approach to our profession.
We need to advocate for, and evaluate, research which will give us a true picture of the health needs of the Australian community and the workforce requirements in the next five, ten, twenty years and beyond. And we need to know who is currently being trained, and in what areas.
This will give our next generation of doctors a much better insight into where the jobs will be in the coming years.
In taking this proactive role the AMA will be re-established as the key decision maker, ensuring that the right policies are in place to steer the right course.
I have extensive experience in the public domain, with the media and have worked with all sides of politics.
I have been given a ‘sensible’ tag, which I wear proudly. This role is not about me, but more about the decisions the AMA makes. I bring to the table a considered approach, objectively looking at all sides of an issue. I know when to ‘keep my powder dry’ and when to go in, guns blazing.
Also of benefit to the AMA leadership team is my expertise in the field of genetics. As evidenced by the 2018 Federal Budget, this area of medicine is a key driver of our future and the impact it will have across all fields of medicine is significant. I am an Emeritus Member of the Human Genetics Society of Australasia, with professional respect across the country and internationally.
I am passionate about improving nutrition in our community, particularly in childhood. We must improve nutritional literacy for all Australians. We must also improve genomic literacy for the community, patients and all healthcare professionals.
A focus on the future is what is driving me to nominate for Vice President. As a teacher and researcher, I continue to work with many young doctors and students. If we don’t advocate strongly for them, they will not have a profession, but a mere job.
I am not running on a ‘ticket’ as I know I can represent the interests of all States and Territories and work alongside all President nominees.
If you would like further information or to contact me, please visit my website:
https://janicefletcher0.wixsite.com/aboutjanicefletcher I would love to hear from you.
* See other candidate profiles on this site.
[Comment] Clinical Pictures in The Lancet: a good eye for detail
A key part of medical training is developing the ability to recognise physical signs of illness in a patient and associate them with the causative pathology. The acquisition of this skill, through training and experience, marks the transition of student to clinician. In recent years, the required repertoire has changed, expanding to include recognition of pathological and radiological signs. But the passing of this diagnostic expertise from one generation to the next remains remarkably unchanged across the globe.