Doctors In Australia Research Articles

Skin procedures in general practice.

Most skin cancers diagnosed in Australia, including melanomas, are identified and managed in a primary care setting. Most skin cancers have the diagnosis confirmed by histopathology, and surgical excision is the most common form of treatment. Therefore, it is important that all primary care doctors in Australia are competent and confident in the diagnostic sampling and surgical management of skin cancers. This article considers the process of performing biopsies and excisions from the skin to diagnose or treat skin cancers. Primary care is the appropriate setting for the management of most skin cancers in Australia. Small simple lesions can be sampled for diagnosis and excised as definitive treatment of the tumour. This can be simpler, cheaper and more efficient for the patient compared to the hospital setting, allows the resources of speciality care to be used for more difficult scenarios and be quite a satisfying part of providing primary care.

Individuals' perceptions and expectations of nutrition care provided by doctors in Australia: A focus group study.

Doctors are well placed to facilitate nutrition care to support dietary improvements due, in part, to their regular contact with their patients. Limited literature exists which explores the perspective of patients regarding thenutrition care provided by medical professionals across the continuum of care. This article explores the perspective of patients regarding perceptions of nutrition advice and care received from doctors and expectations of this care, including key skills and attributes the patients perceive as important. Six online focus groups were conducted with Australian service users (n=32). Framework analysis identified four key themes: perceptions of doctors' role in nutrition care, expectations and experiences; the importance of individualised care; barriers and enablers to nutrition care; and topics, skills and attributes perceived as important in nutrition care. Patients have a desire for individualised and collaborative nutrition care but experienced systemic barriers in practice.

Struggling to Satisfy the Board: Historical Difficulties Faced by Japanese Doctors in Australia

Abstract: The aim of this paper is to review the difficulties faced by overseas-born applicants, particularly Japanese, in seeking to practise medicine in Queensland and Western Australia before and during the period of the Immigration Restriction Act. It limits itself to those two colonies/states as they were the only ones to have a sufficient number and concentration of resident Japanese to attract a Japanese doctor. After tracing the history of the development of relevant medical legislation and examples of its early application in respect of various foreigners, the paper reviews the experiences of a number of Japanese who managed to practise, both with and without registration. Its principal focus is on the behaviour of medical boards and their sometimes dubious use of the subjective powers given to them.

Beri-beri and Japanese doctors in Australia

There has been a range of lengthy examinations of the history of the discovery of the cause of beri- beri and particularly its relationship with western or ‘scientific medicine’ in Japan, and the failure of that country’s medical elite to adopt clearly prophylactic measures. However, there has been negligible consideration of the history of beri-beri in Australia, despite it having been a regulated ‘contagious disease’ over many decades. There has also been very little consideration given to the work of the small number of Japanese doctors who came to Australia more than a century ago when beri-beri was a major affliction in Asia and the Indian sub-continent. The basic contention of this paper is that, even though, or perhaps because, it was largely confined to persons of Asian background, beri-beri was, and remained for a long period, a far more significant affliction in Australia than is generally acknowledged. Moreover, its local history is inevitably interwoven with what occurred in Japan, and the way it was dealt with in Australia reflects a similar intransigence among those who had or perceived a vested interest, or who simply could not escape the attitudes of their own upbringing and education.

“I’m Really Glad that You’re Doing this Research”. Qualitative Research Involving Doctors With Lived Experience of Mental Health or Substance Use Challenges in Australia and Aotearoa New Zealand

Background Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants’ motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of under-represented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors’ health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma.

Does doctors’ personality differ from those of patients, the highly educated and other caring professions? An observational study using two nationally representative Australian surveys

ObjectivesPersonality differences between doctors and patients can affect treatment outcomes. We examine these trait disparities, as well as differences across medical specialities.DesignRetrospective, observational statistical analysis of secondary data.SettingData from two...

Management of paediatric acute severe behavioural disturbance in emergency departments across Australia: A PREDICT survey of senior medical staff.

Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in EDs. It poses a significant risk to the patient and those around them. Little is known about the epidemiology or most effective management in the paediatric population. The aim of the present study is to clarify the practice of senior emergency doctors in Australia when managing paediatric ASBD. The present study was a voluntary electronic questionnaire distributed to and undertaken by senior medical staff in EDs affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. Respondents reported on exposure to and confidence in managing paediatric ASBD and their current practices. A total of 227 (33%) clinicians completed the survey between February and May 2020. Most clinicians were caring for at least two young people with ASBD each week (72%), felt confident regarding the majority of components of management and referred to local clinical practice guidelines (69%). Agitation/sedation rating scales were seldom used (19%). There was a significant variation in self-reported management practices. The choice of whether to use medication at all, the medication chosen and route of administration all varied greatly. Respondents were more willing to provide parenteral medication to young people reported as having recreational drug intoxication (84%) than those with neurodevelopment disorders (65%) when the same degree of agitation was reported. Within Australia, there is considerable variation in paediatric ASBD practice, in particular regarding medication provision. Further prospective research is required to inform best clinical practice.

Knowledge of Musculoskeletal Medicine in Junior Doctors in Australia: Is It Adequate?

PurposeThe incidence of musculoskeletal disease is increasing in Australia and around the world. However, medical student education does not necessarily reflect current and projected trends in musculoskeletal medicine. The aim of this study was to assess junior doctors’ competency in musculoskeletal medicine using the Freedman and Bernstein Basic Competency Examination in Musculoskeletal Medicine questionnaire.MethodsWe conducted a cohort study of interns (first year post medical school) across four teaching hospitals in Australia. Interns were asked to take the Freedman and Bernstein examination during organised intern teaching sessions, and results were analysed using the original Freedman and Bernstein marking criteria and validated pass mark.ResultsThe mean score for the 92 interns was 13.9 out of 25 (55%) with scores ranging from 8 to 20.8 (29–83%). Only 8 of the 92 interns (8.7%) achieved a score of greater than 73%, the pre-specified pass mark.ConclusionOur study identifies inadequacies in musculoskeletal medical knowledge in Australian interns. Review of undergraduate medical education may be required to reflect current and predicted trends in the prevalence of musculoskeletal disease and adequately prepare junior doctors.

Transforming the journey together: Baseline findings from a longitudinal, co-designed study on psychiatry trainee experiences of training and wellbeing.

Junior doctors have high rates of burnout resulting in downstream impacts on patient care. The aim of this study is to capture cross-sectional data on a cohort of psychiatry trainees. These data will be used to inform a wider project investigating psychiatry trainee mental health and wellbeing. This paper reports on the 2019 baseline data of psychiatry trainees enrolled in a formal education course at the University of Sydney, Australia. The data were collected with an online survey using a range of validated mental health and wellbeing scales. This descriptive study involved psychiatry trainees as co-designers. Our research findings are in keeping with the existing literature on the poor mental health and wellbeing of doctors with significantly higher levels of anxiety and exhaustion found in female trainees and carers. Despite this, the cohort had high scores on the flourishing scale. Concern around the wellbeing of junior doctors in Australia appears justified. We need to move beyond focussing on individual action to systems-based approaches to improving wellbeing and ongoing sustainability of the psychiatry trainee workforce in NSW.

Medical negligence claims and the health and life satisfaction of Australian doctors: a prospective cohort analysis of the MABEL survey

ObjectiveTo assess the association between medical negligence claims and doctors’ self-rated health and life satisfaction.DesignProspective cohort study.ParticipantsRegistered doctors practising in Australia who participated in waves 4 to 11 of the...

Vocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey

ObjectiveTo understand the association between medical negligence claims and doctors’ sex, age, specialty, working hours, work location, personality, social supports, family circumstances, self-rated health, self-rated life satisfaction and presence of...

Merging motherhood and medicine: A qualitative study exploring barriers and enablers to motherhood among female doctors in Australia.

Objectives:To identify barriers and enablers to motherhood experienced by female doctors in Australia.Methods:Semi-structured telephone interviews were conducted with 18 female physician-mothers in Australia, during March and May 2020. Interview data were examined using thematic analysis to extract key themes.Results:Six key barriers and seven key enablers were identified. Barriers (B1–6) largely reflected structural and cultural issues operating within health services and the wider medical profession. Barriers were the experience of working in medicine (B1); demands of postgraduate specialty training (B2); attitudes towards mothers in medicine (B3); gender inequality (B4); insufficient entitlements and support (B5); and competing priorities, conflicting roles (B6). Enablers were supportive partnerships (E1); break from traditional gender roles (E2); capacity to delegate/outsource (E3); doctors supporting doctors (E4); flexible work arrangements (E5); increasing acceptance and support (E6); and capacity to combine career and family (E7).Conclusion:This was the first qualitative study to explore motherhood experiences among female doctors in Australia. Participants reported structural and cultural barriers during all stages of motherhood. The mismatch between identified barriers and available supports reveals opportunities for improving the experience of physician-mothers.

Mobility as Rhizome and Becoming: Experiences of Vietnamese Women in Crossing Borders to do Doctorates

The purpose of this paper is to unpack the meanings and implications of mobility through the experiences of a group of Vietnamese women who decided to do doctorates in Australia. Drawing on the Deleuzian concepts of rhizome and becoming, our analysis of interview data suggests that mobility is made of multiple connections and is in constant movement, extending often reductive “push-pull” discussions of academic mobility. Each aspect shaping mobility connects to another that is multiscalar and multitemporal, where family, education ideologies, gender norms, economic globalization, neoliberalization within higher education, and the histories and biographies of mobile people come together. Power relations are immanent within structures associated with these connections and the women and mobility come together to create aspirations for educational, professional, and personal becoming. The paper offers a more nuanced understanding of international academic mobility rather than relying on economic perspectives and invites innovative approaches in supporting international doctoral students.

Barriers to getting into postgraduate specialty training for junior Australian doctors: An interview-based study.

Medical training is a long process that is not complete until doctors finish specialty training. Getting into specialty training is challenging because of strong competition for limited places, depending on doctors' chosen field. This may have a negative impact on doctor well-being and reduce the efficiency of the medical training system. This study explored the barriers of pre-registrar (junior) doctors getting into specialty training programs to inform tailored support and re-design of speciality entry systems. From March to October 2019, we conducted 32 semi-structured interviews with early-career doctors in Australia, who had chosen their specialty field, and were either seeking entry, currently undertaking or had recently completed various fields of specialty training. We sought reflections about barriers and major influences to getting into specialty training. In comparing and contrasting generated themes, different patterns emerged from doctors targeting traditionally non-competitive specialty fields like General Practice (GP) and other specialties (typically more competitive fields). As a result we explored the data in this dichotomy. Doctors targeting entry to GP specialties had relatively seamless training entry and few specific barriers. In contrast, those pursuing other specialties, regardless of which ones, relayed multiple barriers of: Navigating an unpredictable and complex system with informal support/guidance; Connecting to the right people/networks for relevant experience; Pro-actively planning and differentiating skills with recurrent failure of applications. Our exploratory study suggests that doctors wanting to get into non-GP specialty training may experience strong barriers, potentially over multiple years, with the capacity to threaten their morale and resilience. These could be addressed by a clearinghouse of information about different speciality programs, broader selection criteria, feedback on applications and more formal guidance and professional supports. The absence of challenges identified for doctors seeking entry to GP could be used to promote increased uptake of GP careers.

Work-life balance: a comparison of women in cardiology and other specialties

ObjectiveSignificant gender disparities exist in some medical specialties, particularly cardiology. We assessed work, personal life and work-life balance in women in cardiology in Australia and New Zealand (NZ), compared with...

Australian doctors are more engaged than UK doctors: why is this the case?

BackgroundDespite reports highlighting the need for greater medical engagement and the benefits of being widely understood, very little information is available on the status of medical engagement in Australia, and...

How the organisation of medical work shapes the everyday work experiences underpinning doctor migration trends: The case of Irish-trained emigrant doctors in Australia

Medical migration is a global phenomenon. In Ireland, hospital doctor emigration has increased significantly in recent years, with Australia a destination of choice. With work and employment conditions cited as a driver of these trends, this article explores how health system differences in the organisation of medical work shape the everyday experiences of hospital doctors which underpin migration decisions. Drawing on 51 semi-structured interviews conducted in July-August 2018 with Irish-trained hospital doctors who had emigrated to work in Australia, the findings highlight doctors’ contrasting experiences of medical work in the Irish and Australian health systems. Key system differences in the organisation of medical work manifested at hospital level and related to medical hierarchy; staffing, support and supervision; and governance and task coordination. Findings indicate that retention of hospital doctors is as much about the quality of the work experience, as it is about the quantity and composition of the workforce. At a time of international competition for medical staff, effective policy for the retention of hospital doctors requires an understanding of the organisation of work within health systems. Crucially, this can create working contexts in which doctors flourish or from which they seek an escape.

Pilot study of the effectiveness of a Mindful Self-Care and Resiliency program for rural doctors in Australia.

Rural doctors are difficult to recruit and retain. Burnout and stress in the medical workforce fluctuates according to location. Overall, doctors have an elevated risk of depression and suicide compared to the general population and other professionals. Higher levels of occupational stress also effect patient care, levels of work satisfaction and relationships with others. This study evaluated the effectiveness, acceptability, feasibility and sustainability of the Mindful Self-Care and Resiliency Program. This was a sequential mixed-method study involving the collection of both quantitative and qualitative data. The study was conducted in Emerald, Queensland. Thirteen doctors took part in the program with seven providing pre and post survey responses. Qualitative data were collected via semi-structured telephone interviews with an additional four rural doctors. Intervention The Mindful Self-Care and Resiliency program consisted of a 4-hour face-to-face session and three 1-hour video-conference follow up sessions. Main outcome measures Burnout, negative affect, well-being and psychological strain were assessed using self-report measures before and after taking part in the program. Results The majority (six out of seven) of the doctors showed reductions in burnout, psychological strain and negative affect following participation in the program. The qualitative data indicated that all doctors gained new skills: self-awareness, reflection and self-care. They also reported improved interaction with colleagues and patients, to whom they passed on their new learning. Conclusion This preliminary investigation of the effectiveness and feasibility of Mindful Self-Care and Resiliency for rural doctors indicates that the program has promise in improving the emotional well-being of this occupational group. Although this study captured approximately one-third of the Emerald workforce, further research with a larger sample is required to confirm these findings.

Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey

ObjectiveDespite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors’ mental health remains unclear. This study examines the relationship...

\u2018Everything was just getting worse and worse\u2019: deteriorating job quality as a driver of doctor emigration from Ireland

BackgroundMedicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job—high pay, high job control, challenging demands, with those of a low-quality job—long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return.MethodsSemi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July–August 2018.ResultsRespondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman’s work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland.DiscussionThe deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.