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Preference: Surgery

1175

For the welfare of the community

Family Doctor Week
Queensland – Dr Colin Owen

Described by those who know him as a hero of the bush, Dr Col Owen has been practising medicine in Inglewood, South-West Queensland for half a century. For three years before that, he was practising in the even more remote Charleville.

A Life member of AMA, a founding President of both the Rural Doctors Association of Queensland and the Rural Doctors Association of Australia, and a founding Fellow of the Australian College of Rural and Remote Medicine, Dr Owen is a well-qualified GP at the Inglewood Medical Centre.

“I have been practising here for 50 years and six months,” he said. “I’m getting the hang of it.”

The town of Inglewood has a population of 1200, but the practice has a catchment of 3000-plus because it serves the region and locations around it as well.

“On a quiet day I might see 30 patients and on a busy day it could get up to 60. It depends on the season,” Dr Owen said.

“I have been involved in treating five generations of patients. That’s really amazing, and for me that is pretty special. You really get to know them. And it is important medically, to be involved in the health care of a community and generations of the same families for so long.

“I once did obstetrics, surgery and anaesthetics here and I have delivered many children. I have delivered the children of children I have delivered.

“My last delivery, the mother said to me ‘do you remember delivering me too?’ and I said ‘yes’, but then her husband said ‘you delivered me too’. I didn’t remember that one, but it turns out that I delivered both the mother and the father of the baby I was delivering then.”

Dr Owen knows only too well that being a family doctor in a small regional community, means you are much more than the local GP.

“You have got to be part of the community when you practise medicine in a small place like this,” he said.

“You know what’s going on and you get involved. But you’re not just a part of the community, you have to be a leader in certain areas.

“You have to be an advocate for the health of the community and lead on a number of issues for the community’s welfare.”

CHRIS JOHNSON

 

 

[Obituary] Ogobara Doumbo

Leading malaria researcher. Born in the Dogon region of Mali, Africa, on Jan 1, 1956, he died after complications from surgery in Marseille, France, on June 9, 2018, aged 62 years.

[Health Policy] Progress in clinical research in surgery and IDEAL

The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement decisions, lead to slow adoption of innovations, and permit widespread adoption of procedures that offer no benefit, or cause harm. Improvement in the quality of surgical evidence would therefore be valuable.

[Department of Error] Department of Error

Devereaux PJ, Duceppe E, Guyatt G, et al. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial. Lancet 2018; 391: 2325–34—In the final sentence of the Interpretation in the Summary, the dose of dabigatran was recorded incorrectly. The sentence should read “Patients with MINS have a poor prognosis; dabigatran 110 mg twice daily has the potential to help many of the 8 million adults globally who have MINS to reduce their risk of a major vascular complication.” This correction has been made to the online version as of July 5, 2018.

[Comment] Personalised recovery after general and gynaecologic surgery

Over the past decade, attention on post-surgical recovery has increased. Enhanced recovery pathways have been developed that focus on improving clinical outcomes such as complications and length of stay after major abdominal surgery. Despite their effectiveness, these pathways do not extend beyond discharge and sometimes fail to incorporate patient-reported outcome measures.1 Recovery periods after intermediate-grade abdominal surgical procedures (eg, laparoscopic cholecystectomy) are excluded from these pathways; thus, patients are left to recover from these uncomplicated day-surgery procedures by themselves.

[Comment] The clinical utility of preoperative functional assessment

Nearly 17% of patients undergoing elective surgery have an in-hospital complication, and 0·5% are estimated to die during the admission for surgery.1 With more than 300 million operations occurring per annum, this equates to 50 million complications and 1·5 million deaths annually.2 Preoperative risk assessment is the cornerstone on which subsequent safe surgical care is provided, and functional capacity is entrenched in preoperative cardiovascular assessment. The subjective assessment of functional capacity is a critical decision node in preoperative cardiovascular algorithms,3,4 yet the evidence supporting this practice is limited.

[Articles] Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study

This dataset has the largest series of patients with rectal cancer treated with a W&W approach, consisting of approximately 50% data from previous cohort series and 50% unpublished data. Local regrowth occurs mostly in the first 2 years and in the bowel wall, emphasising the importance of endoscopic surveillance to ensure the option of deferred curative surgery. Local unsalvageable disease after W&W was rare.

[Comment] Robot-assisted versus open cystectomy

Open radical cystectomy with pelvic lymph node dissection is an integral component of the treatment for high-risk, non-muscle-invasive, and muscle-invasive bladder cancer.1 When the surgery is done by an experienced surgeon, the approach practically guarantees patient outcomes that have remained unchanged since the 1980s.2 New surgical techniques must be compared against this standard with regard to parameters such as morbidity, quality of life, costs, and oncological outcomes. In The Lancet, Dipen J Parekh and colleagues report a multicentre, randomised controlled, phase 3, non-inferiority study3 comparing open cystectomy and robot-assisted cystectomy.