Monday, January 26, 2015

What Does Australia Day Commemorate? Not Something To Be Proud About.

The vast majority of nations have a national day that in some way commemorates an event that is directly linked with the formation of a national identity.  What Australia Day commemorates is in stark contrast to comparable nations. Australia marks a commemoration of white settlement of Australia when the First Fleet landed in New South Wales in 1788.  For the indigenous population, it is often referred to as Invasion Day.  For this reason alone, Australia Day will never be a fully inclusive day that will enable all Australians a reason to feel national pride or celebrate as a nation.

It is important to examine comparable nations for the underlying background behind their designated national days. The most relevant comparators are nations that grew out of British colonization and transportation, in particular, Canada and the USA.  Canada celebrates Canada Day on 1 July each year and this represents when its three provinces (Nova Scotia, New Brunswick, and the Canada provinces) united under the Constitution Act to become the nation Canada. Arguably the most famous or recognizable national day in the world is the 4th of July which represents the declaration of independence of The United States of America from Great Britain. 

Culturally, the closest nation to Australia is New Zealand. The signing of the Waitangi Treaty, is regarded as being the founding document of nation of New Zealand. The day of signing is celebrated as Waitangi Day and is also known to a lessor extent as New Zealand Day. Whilst there can be argument over the manner by which the signing of the treaty occurred, its signing did legally define the creation of the ‘colony’ of New Zealand. 

Australia did not become a national entity until Federation on 1 January 1901. It seems ludicrous to reflect back to the landing of the First Fleet in 1788, where the intent for the British was to establish a penal colony rather than having any thought of creating an independent nation. Celebrating a time when white settlers set up camp in a foreign land is at total odds with other nations where there is national pride associated with a key event that defined the creation of a nation or a significant moment in the history as a nation.  It is almost cringe worthy when we have to explain to those from outside Australia when asked about the background behind Australia Day.

If we review the rationale behind the national day for the great majority of nations, we stand out alone as being frankly embarrassing. Other nations have designated national days that provide reason for its citizens to be proud and it is clear that an alternate day should be identified.  If we cannot identify a particular rationale to gazette a specific day, perhaps we should follow the lead of the United Kingdom, which does not have a designated national day.  They do not appear to have been worse for the absence of one.

An alternative Australia Day must be debated and change undertaken to not only allow inclusiveness but a reason to be proud of what it stands for.

Tuesday, January 13, 2015

Surgeons receive no empathy training. This needs to change.

Communication skills are an essential part of clinical practice.  It plays an especially important role in creating patient satisfaction, delivering bad news and conflict resolution.  Unfortunately there is little training in communication skills, particularly in the surgical specialties.  As surgeons, we generally think we are fine with this and quickly acquire the skills with clinical experience.  We do tend to have self confidence in our skills which possibly goes hand in hand as to why we have become surgeons in the first place. But then again, it is probably the very reason we need to be better trained in communication skills.

General practice training in Australia includes hands on training in communications skills. Trainees are observed as they interview and assess patients for full sessions.  Additional to this, they undergo patient interviews that are video recorded and then reviewed with a mentor where self reflection and critique of the interviews are undertaken.  With surgical training, it is uncommon (why don't we make that never) to ever have a single patient interview observed by a mentor.  Certainly, there would not ever be any video recording of a patient interview for training purposes.  The closest we get to supervised patient interview is a mini CEX which in reality has been a tick box exercise for surgical trainees in Australia and even the majority of trainers do not take it seriously. 

So where is all this leading to? I recently attended the Urological Society of Australia and New Zealand NSW Section Meeting held in Hobart.  It was an honour to be there as an invited keynote speaker but an even greater honour to meet Helen Reiss who is a psychiatrist affiliated with the Harvard Medical School and Massachusetts General Hospital in Boston.  Dr Reiss has become prominent in the teaching of communication skills, particularly empathy.  Her address to a urological surgeon audience was warmly received and taught us about empathy and interpersonal skills training.

See her TED talk.

It was quite notable that the talk by Dr Reiss was attended by those who probably least needed to see the presentation.  It was also interesting that the preceding talk by Dr Nader Awad was on the subject Narcissism in Surgery - it was a bit a of joke over lunch where everybody felt that those most in need in seeing these presentations were absent from the meeting.

This week I have taken the opportunity to do the online modules created by Dr Reiss and are available on the Empathetics website.  It takes about three hours to complete the three modules.  Without performing a detailed critique of the modules, I am convinced that every doctor in clinical practice with face to face contact with patients should be doing this type of course or equivalent. I am convinced that empathetic practice can be taught. 

It seems crazy that in spite of the fact that our work as front line clinicians involves communication there is minimal such content throughout our training.  Do the Empathetics course modules and you will change your mind if you do not already have such an opinion.

Tuesday, January 6, 2015

Predatory Journals. Academics Are as Much a Part of the Problem.

Medical doctors in academia are gullible. They are so gullible that they are amongst a number of groups, the perfect target for predatory publishing companies. The definition for a predatory journal or publishing company can be found on this link.  They appear to be growing in numbers at a seemingly exponential rate.  It is obviously worth the effort for the creators of these on line publishing companies who try every tactic to trick academics into paying excessive fees to publish.  In other words, there are always enough gullible individuals to make if worth the effort. This is all well documented and whilst there is growing awareness of these scams, it is disappointing to see how academics are quick to give up their credibility by becoming a part of the problem.  They allow themselves to become the bait to attract other academics to submit their manuscripts to the journal.

I get these emails all the time. These are invitations to join the editorial boards of these junk journals.  This one gives the impression of being US based but when you visit the website, it is obvious that the authors of the website are not native English speakers and most people would be able to work out that it is really based in India.

The emails often butter up the recipient with glorified praise about their eminence in the field. That aside, being invited to be a member of an editorial board is generally considered to be something of value and the more editorial boards one can boast the better. Without much thought, academics respond in the affirmative and their picture and bio soon appears on the ‘journal’ website.  These predatory journals have also been in the habit of placing academics on their editorial boards without permission but from my own investigations, it appears that the vast majority have actually consented to the process without having given a thought to where they have gifted their own good name as well as the good name of their university.

We are all keen to see these journals run out of business. It is not only the gullible academics who support them by submitting manuscripts but also our gullible academics who provide some resemblance of credibility to these journals. We are very much part of the problem.

(Related post:-

Disclosure - Henry Woo is on the editorial boards of Prostate Cancer Prostatic Diseases, Prostate International and World Journal of Men's Health which are all Pubmed/Medline indexed.  He is also the Editor in Chief of BJUI Knowledge, a new CME portal of the reputable BJUI Company.