Topics

Abstract

Objective: To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives.

Study design: We reviewed peer‐reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008–2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed.

Data sources: CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases.

Data synthesis: The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria.

Conclusions: Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community‐based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate.

Protocol registration: PROSPERO CRD42019116228.

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Graduate School of Medicine, University of Wollongong, Wollongong, NSW

Correspondence: rhoffman@uow.edu.au

Acknowledgements:

We thank University of Wollongong librarian Brian Kenady for his guidance and the time taken to developing our search strategy.

Competing interests:

No relevant disclosures.

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Editorial

Sexual misconduct by doctors: a problem that has not gone away

Cherrie Ann Galletly

Med J Aust 2020; 213 (5): . || doi: 10.5694/mja2.50734
Published online: 7 September 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Sexual health

Health services administration

The medical profession has the opportunity to prevent further harm to patients and damage to public trust

Bismark and colleagues1 report the disappointing finding that health practitioners, particularly doctors, continue to be found guilty of sexual misconduct with patients. During 2011–2016, Australian regulators received more than 100 notifications of sexual misconduct by Australian doctors each year. As with other sexual crimes, it is likely that many victims do not make formal complaints; in this study, only 34% of notifications were made by affected patients.

1 Adelaide Medical School, University of Adelaide, Adelaide, SA
2 Ramsay Health Care (SA), The Adelaide Clinic, Adelaide, SA
3 Northern Adelaide Local Health Network, Adelaide, SA

Correspondence: cherrie.galletly@adelaide.edu.au

Competing interests:

No relevant disclosures.

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Perspectives

New Zealand's COVID‐19 elimination strategy

Michael G Baker, Amanda Kvalsvig and Ayesha J Verrall

Med J Aust 2020; 213 (5): . || doi: 10.5694/mja2.50735
Published online: 7 September 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Environment and public health

Compared with the mitigation and suppression approaches of most Western countries, elimination can minimise direct health effects and offer an early return to social and economic activity

On 23 March 2020, New Zealand committed to an elimination strategy in response to the coronavirus disease 2019 (COVID‐19) pandemic. Prime Minister Jacinda Ardern announced that on 26 March, NZ would commence an intense lockdown of the country (the highest level of a four‐level response framework1). At the time, NZ had just over 100 COVID‐19 cases and no deaths, so this “go early, go hard” approach surprised many. However, there were compelling reasons for NZ to pursue elimination.2

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University of Otago, Wellington, NZ

Correspondence: michael.baker@otago.ac.nz

Acknowledgements:

We thank our many colleagues who have contributed to development of the NZ elimination strategy, notably Professor Nick Wilson at the University of Otago, Wellington. We also acknowledge funding support from the Health Research Council of NZ (20/1066), which did not have any role in the planning, writing or publication of the work or the decision to publish.

Competing interests:

No relevant disclosures.

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12. Baker M, Wilson N, Hendy S, et al. The need for a robust scientific definition for the elimination of COVID‐19 from New Zealand. Public Health Expert 2020; 5 May. https://blogs.otago.ac.nz/pubhealthexpert/2020/05/05/the-need-for-a-robust-scientific-definition-for-the-elimination-of-covid-19-from-new-zealand/ (viewed July 2020).
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Perspectives

Navigating the complexities of voluntary assisted dying in palliative care

Eswaran Waran and Leeroy William

Med J Aust 2020; 213 (5): . || doi: 10.5694/mja2.50729
Published online: 24 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Palliative care

Voluntary assisted dying is not part of palliative care

The Voluntary Assisted Dying Act 2017 (Vic)1 came into effect in Victoria on 19 June 2019. We present the case of an inpatient death under the voluntary assisted dying Act in our health service and describe a short case history followed by a discussion examining two relevant topics related to voluntary assisted dying and palliative care: conscientious objection and the complexity of palliative care involvement.

1 Eastern Health, Melbourne, VIC
2 Monash University, Melbourne, VIC
3 La Trobe University, Melbourne, VIC

Correspondence: Eswaran.waran@easternhealth.org.au

Competing interests:

No relevant disclosures.

1. Voluntary Assisted Dying Act 2017. http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/f932b66241ecf1b7ca256e92000e23be/B320E209775D253CCA2581ED00114C60/$FILE/17-061aaauthorised.pdf (viewed March 2020).
2. Royal Australasian College of Physicians. Statement on voluntary assisted dying. Sydney: RACP, 2018. https://www.racp.edu.au/docs/default-source/advocacy-library/racp-voluntary-assisted-dying-statement-november-2018.pdf?sfvrsn=761d121a_4 (viewed March 2020).
3. State of Victoria, Department of Health and Human Services. Voluntary assisted dying: guidance for health practitioners. 2019. https://www2.health.vic.gov.au/about/publications/policiesandguidelines/voluntary-assisted-dying-guidance-for-health-practitioners (viewed March 2020).
4. Litz BT, Stein N, Delaney E, et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev 2009; 29: 695–706.
5. Talbot SG, Dean W. Physicians aren't “burning out”. They're suffering from moral injury. STAT 2018, 26 July. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/ (viewed March 2020).
6. State of Victoria, Department of Health and Human Services. Voluntary assisted dying: health practitioner information [website]. https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/end-of-life-care/voluntary-assisted-dying/health-practitioner-information (viewed July 2020).
7. Catholic Health Australia. Catholic Health and Aged Care Services response to the “Voluntary Assisted Dying Act” [media release]. CHA, 2019. https://www.cha.org.au/images/Media_Releases/2019/20190610%20CHA%20Joint%20Media%20Statement%20-VAD%20Implementation%20with%20Quotes%20endorsed.pdf (viewed March 2020).
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9. Shalev A, Phongtankuel V, Kozlov E, et al. Awareness and misperceptions of hospice and palliative care: a population‐based survey study. Am J Hosp Palliat Care 2018; 35: 431–439.
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11. Palliative Care Australia. Palliative care and voluntary assisted dying — position statement. Canberra: Palliative Care Australia, 2019. https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2019/09/2019-VAD-position-statement-Final.pdf (viewed Mar 2020).
12. Australia and New Zealand Society of Palliative Medicine. ANZSPM positions statement: the practice of euthanasia and physician assisted suicide. 2019. http://www.anzspm.org.au/c/anzspm?a=da&did=1005077 (viewed March 2020).

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Perspectives

“Now we say Black Lives Matter but … the fact of the matter is, we just Black matter to them”1

Chelsea J Bond, Lisa J Whop, David Singh and Helena Kajlich

Med J Aust 2020; 213 (6): . || doi: 10.5694/mja2.50727
Published online: 17 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Social determinants of health

Environment and public health

Health services administration

If Black lives matter we need to be prepared to examine and address racial violence within the Australian health system

My name is Kevin Yow Yeh and today I march for every Black death in custody but I especially march for my grandfather Kevin Yow Yeh Sr. At the age of 34 this man apparently had a heart attack at a Mackay watch house … This last month we've seen plenty of stats, 430 plus Black deaths in custody … and that's only since the Royal Commission, but what about all those deaths that led to that. My grandfather was one of them. Let's humanise these stories. When this man had a heart attack, he left his wife and he left five young children. My grandmother was still having his children when she had to put this man in the ground. That's why we march! Of course we stand in solidarity with our brothers in America. And, of course we stand in solidarity with our sisters in West Papua … but today we stand for our lives here, on stolen land.2

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1 University of Queensland, Brisbane, QLD
2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT

Correspondence: c.bond3@uq.edu.au

Acknowledgements:

We would like to acknowledge the work of the National Justice Project, which provides a targeted health law service for First Nations peoples and communities who have experienced discrimination in health care or medical negligence.

Competing interests:

Chelsea Bond is a recipient of an Australian Research Council Discovery Early Career Award (180100090). Lisa Whop is a recipient of a National Health and Medical Research Council Early Career Fellowship (1142035), and a member of the Aboriginal and Torres Strait Islander Health Strategy Group of the Australian Health Practitioner Regulation Agency.

1. Bird NC, Ma J. Black Lives Matter [lyrics]. Sony/atv Music Publishing Allegro Pty Ltd, Mushroom Music Pty Ltd, 2016.
2. Bond C. Black Lives Matter – a Brisbane Blacks manifesto. @IndigenousX 2020; 15 July. https://indigenousx.com.au/black-lives-matter-a-brisbane-blacks-manifesto/ (viewed Jul 2020).
3. Bond CJ, Singh D. More than a refresh required for closing the gap of Indigenous health inequality. Med J Aust 2020; 212: 198–199. https://www.mja.com.au/journal/2020/212/5/more-refresh-required-closing-gap-indigenous-health-inequality#:~:text=After%20over%20a%20decade%20of,rethink%20of%20the%20policy%20approach
4. Baker N. Greg Hunt says Black Lives Matter protests contributed to Melbourne coronavirus spike. SBS News 2020; 24 Jun. https://www.sbs.com.au/news/greg-hunt-says-black-lives-matter-protests-contributed-to-melbourne-coronavirus-spike (viewed Jul 2020).
5. Federal Health Minister Greg Hunt has announced $35 million is being invested in 42 Indigenous health project. SBS News 2020; 14 June. https://www.sbs.com.au/news/australia-won-t-be-whole-until-indigenous-gap-is-closed-says-greg-hunt (viewed Jul 2020).
6. National Aboriginal Community Controlled Health Organisation. Coalition of Peaks release landmark report on community engagements shaping new National Agreement on Closing the Gap. NACCHO News 2020; 24 June. https://www.naccho.org.au/coalition-of-peaks-release-landmark-report-on-community-engagements-shaping-new-national-agreement-on-closing-the-gap/ (viewed Jul 2020).
7. Taylor P. Ambitious new deal to close Indigenous gap. The Australian 2020; 2 July. https://www.theaustralian.com.au/nation/new-power-deal-to-close-indigenous-gap/news-story/ade8ce165d97ff623fb576b7871b1ef8 (viewed Jul 2020).
8. McQuire A. Aboriginal community health's success with Covid‐19. Saturday Paper 2020; 25 Apr. https://www.thesaturdaypaper.com.au/news/health/2020/04/25/aboriginal-community-healths-success-with-covid-19/15877368009740 (viewed Jul 2020).
9. Crooks K, Casey D, Ward JS. First Nations people leading the way in COVID‐19 pandemic planning, response and management. Med J Aust 2020; 213: 151–152.
10. Sweet M. Calling out some of the silences in Australia on Black Lives Matter. Croakey 2020; 24 Jul. https://croakey.org/calling-out-some-of-the-silences-in-australia-on-black-lives-matter/ (viewed July 2020).
11. Whittaker A. ‘Dragged like a dead kangaroo’: why language matters for deaths in custody. The Guardian 2018; 8 Sept. https://www.theguardian.com/commentisfree/2018/sep/07/dragged-like-a-dead-kangaroo-why-language-matters-for-deaths-in-custody (viewed July 2020).
12. Allam L. Family of David Dungay, who died in custody, express solidarity with family of George Floyd. The Guardian 2020; 1 Jun. https://www.theguardian.com/australia-news/2020/jun/01/family-of-david-dungay-who-died-in-custody-express-solidarity-with-family-of-george-floyd (viewed July 2020).
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15. Australian Health Practitioner Regulation Agency and National Boards. The National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020‐2025. Melbourne: AHPRA, 2020. https://www.ahpra.gov.au/About-AHPRA/Aboriginal-and-Torres-Strait-Islander-Health-Strategy/health-and-cultural-safety-strategy.aspx (viewed July 2020).
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Consensus statement

Cardiovascular disease and COVID‐19: Australian and New Zealand consensus statement

Sarah Zaman, Andrew I MacIsaac, Garry LR Jennings, Markus P Schlaich, Sally C Inglis, Ruth Arnold, Saurabh Kumar, Liza Thomas, Sudhir Wahi, Sidney Lo, Carolyn Naismith, Stephen J Duffy, Stephen J Nicholls, Andrew Newcomb, Aubrey A Almeida, Selwyn Wong, Mayanna Lund, Derek P Chew, Leonard Kritharides, Clara K Chow and Ravinay Bhindi

Med J Aust 2020; 213 (4): . || doi: 10.5694/mja2.50714
Published online: 17 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Infectious diseases

Health services administration

Abstract

Introduction: The coronavirus 2019 disease (COVID‐19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Pre‐existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID‐19, and COVID‐19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders.

Main recommendations: Common acute cardiac manifestations of COVID‐19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five‐ to tenfold higher case fatality rate with COVID‐19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need.

Changes in management as a result of this statement: Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID‐19 among CVD patients, upskill in the management of COVID‐19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS‐CoV‐2 infection.

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1 MonashHeart, Monash Health, Melbourne, VIC
2 Monash Cardiovascular Research Centre, Monash University, Melbourne, VIC
3 St Vincent's Hospital, Melbourne, VIC
4 University of Sydney, Sydney, NSW
5 Baker Heart and Diabetes Institute, Melbourne, VIC
6 Dobney Hypertension Centre, University of Western Australia, Perth, WA
7 University of Technology, Sydney, NSW
8 Orange Health Service, Orange, NSW
9 Westmead Hospital, Sydney, NSW
10 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
11 Princess Alexandra Hospital, Brisbane, QLD
12 Liverpool Hospital, Sydney, NSW
13 Austin Hospital, Melbourne, VIC
14 Alfred Hospital, Melbourne, VIC
15 Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC
16 St Vincent's Clinical School, Melbourne, VIC
17 Cardiac Sciences Clinical Institute, Epworth Richmond Hospital, Melbourne, VIC
18 Monash Health, Melbourne, VIC
19 Middlemore Hospital, Auckland, New Zealand
20 Flinders University, Adelaide, SA
21 Concord Hospital, Sydney, NSW
22 ANZAC Research Institute, Sydney, NSW
23 Royal North Shore Hospital, Sydney, NSW

Correspondence: sarah.zaman@monash.edu

Acknowledgements:

Sarah Zaman and Ravinay Bhindi have been supported by fellowships from the National Heart Foundation of Australia. The funding body had no role in the consensus statement itself.

Competing interests:

Sarah Zaman reports research grants from Abbott Australia and speaking honorarium from AstraZeneca outside the submitted work. Stephen Nicholls received research support from AstraZeneca, Amgen, Anthera, CSL Behring, Cerenis, Eli Lilly, Esperion, Resverlogix, Novartis, InfraReDx and Sanofi‐Regeneron, and is a consultant for Amgen, Akcea, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Kowa, Merck, Takeda, Pfizer, Sanofi‐Regeneron and Novo Nordisk; these interests are all outside the submitted work.

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Editorial

Are we behind the times on cardiovascular risk assessment in Australia?

Harry Klimis and Clara K Chow

Med J Aust 2020; 213 (4): . || doi: 10.5694/mja2.50711
Published online: 17 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Cardiovascular diseases

Diagnostic techniques and procedures

Our approach to estimating risk in some patients should be updated and the role of coronary artery calcium scoring evaluated

While about one in five Australians aged 45–74 years are at high absolute cardiovascular risk, fewer than half of these people are taking lipid‐ and blood pressure‐lowering medications.1,2 New Medicare Benefits Schedule items for heart health checks (items 699 and 177) were introduced to reduce this gap,3 but the problem remains that recommended risk calculators are inaccurate and misclassification rates are high.4

1 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
2 Westmead Hospital, Sydney, NSW
3 Westmead Clinical School, University of Sydney, Sydney, NSW

Correspondence: clara.chow@sydney.edu.au

Acknowledgements:

Harry Klimis is supported by a Royal Australian College of Physicians Fellows Research Entry Scholarship and a Research Training Program Scholarship. Clara Chow is supported by a National Health and Medical Research Council Career Development Award (APP1105447) co‐funded by a Future Leader Fellowship from the National Heart Foundation.

Competing interests:

No relevant disclosures.

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Perspectives

First Nations peoples leading the way in COVID‐19 pandemic planning, response and management

Kristy Crooks, Dawn Casey and James S Ward

Med J Aust 2020; 213 (4): . || doi: 10.5694/mja2.50704
Published online: 17 August 2020

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Infectious diseases

Environment and public health

Engaging First Nations peoples in public health emergencies is critical to reducing health inequities

Aboriginal and Torres Strait Islander (respectfully hereafter First Nations) peoples of Australia have experienced poorer health outcomes than the rest of the Australian population during recent pandemics.1,2 In 2009, during the H1N1 influenza pandemic, diagnosis rates, hospitalisations and intensive care unit admissions occurred at five, eight and three times, respectively, the rates recorded among non‐Indigenous people.1,2,3

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1 Menzies School of Health Research, Charles Darwin University, Darwin, NT
2 National Aboriginal Community Controlled Health Organisation, Canberra, ACT
3 University of Queensland, Brisbane, QLD

Correspondence: kristy.crooks@students.cdu.edu.au

Acknowledgements:

We acknowledge the traditional custodians of the land and waters on which we live and work as the First Peoples of Australia. We are members of the Aboriginal and Torres Strait Islander Advisory Group on COVID‐19 and we acknowledge and thank all members of the Advisory Group for their continued work and commitment in advocating for cultural inclusion and providing space for First Nations peoples to have a voice in pandemic planning, response and management.

Competing interests:

No relevant disclosures.

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Motherhood and medicine: systematic review of the experiences of mothers who are doctors

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Sexual misconduct by doctors: a problem that has not gone away

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New Zealand's COVID‐19 elimination strategy

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Author

Navigating the complexities of voluntary assisted dying in palliative care

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Author

“Now we say Black Lives Matter but … the fact of the matter is, we just Black matter to them”1

Topics

Author

Cardiovascular disease and COVID‐19: Australian and New Zealand consensus statement

Topics

Abstract

Author

Are we behind the times on cardiovascular risk assessment in Australia?

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First Nations peoples leading the way in COVID‐19 pandemic planning, response and management

Topics

Author

Unemployment, suicide and COVID‐19: using the evidence to plan for prevention

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Author

Recruiting and retaining general practitioners in rural practice: systematic review and meta‐analysis of rural pipeline effects

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Motherhood and medicine: systematic review of the experiences of mothers who are doctors

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Do you have any competing interests to declare? *

Sexual misconduct by doctors: a problem that has not gone away

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New Zealand's COVID‐19 elimination strategy

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Navigating the complexities of voluntary assisted dying in palliative care

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Comment

Do you have any competing interests to declare? *

“Now we say Black Lives Matter but … the fact of the matter is, we just Black matter to them”1

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Author

Comment

Do you have any competing interests to declare? *

Cardiovascular disease and COVID‐19: Australian and New Zealand consensus statement

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Abstract

Author

Comment

Do you have any competing interests to declare? *

Are we behind the times on cardiovascular risk assessment in Australia?

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Author

Comment

Do you have any competing interests to declare? *

First Nations peoples leading the way in COVID‐19 pandemic planning, response and management

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Author

Comment

Do you have any competing interests to declare? *

Unemployment, suicide and COVID‐19: using the evidence to plan for prevention

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Author

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Do you have any competing interests to declare? *

Recruiting and retaining general practitioners in rural practice: systematic review and meta‐analysis of rural pipeline effects

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Pagination