Cough Syncope and Fatal Motor Vehicle Accidents: Two Australian Cases.

Cough syncope is an uncommon but well-recognised medical condition diagnosed primarily on the history provided by the sufferer. In situations where the sufferer is in control of a motor vehicle, syncope can lead to accidents involving death and injury. In the medico-legal setting, cough syncope can be a contested cause of such accidents.

National registration scheme at 5 years: not what it promised.

A national registration scheme for health professionals was introduced in Australia 5 years ago, replacing the long-standing state-based schemes. This review examines whether the scheme has delivered what it promised and makes recommendations for change. The available evidence indicates that the scheme's design and its implementation were rushed and that the legislation has serious flaws.

Revalidation - what is the problem and what are the possible solutions?

The proposed introduction of a revalidation process as part of renewal of medical registration in Australia needs wide debate. The revalidation process that began in the United Kingdom in 2012 is premised on a need to regain the trust of the community and to promote participation in continuing professional development. These alone are not justifiable grounds for introducing a similar process in Australia.

A no-fault compensation system for medical injury is long overdue.

The 2011 report of the Productivity Commission (PC) recommended the establishment of a no-fault national injury insurance scheme limited to "catastrophic" injury, including medical injury. The report is welcome, but represents a missed opportunity to establish simultaneously a much-needed no-fault scheme for all medical injuries. The existing indemnity scheme based on negligence remains a slow, costly, inefficient, ill targeted and stress-creating system.

Doctors' health: can we do better under national registration?

The move to national registration of doctors presents both threats and opportunities for the manner in which doctors seek health care and for providing assistance to doctors who may be impaired by illness. The most striking threat is the regressive nature of the provisions for mandatory reporting of ill doctors. The new system should be grasped as an opportunity to achieve national agreement on resourcing adequate services to help distressed doctors and to foster education and research into the health of doctors and medical students.

National registration legislative proposals need more work and more time.

The release for public consultation of the draft Health Practitioner Regulation National Law 2009 represents a once-in-a-generation opportunity to ensure best practice in medical regulation. The draft law fails to build on the best aspects of existing state and territory legislation, particularly in regard to how allegations of misconduct, poor performance or impairment are to be handled. If adopted, this legislation has the potential to set back important improvements to professional regulation that have been implemented in Australia in the past 20 years.

Medical professionalism: is it really under threat?

Recent publications on medical professionalism have created an impression of a medical profession under siege in several countries. These publications recommend a new approach to medical professionalism to assist the profession to respond to new challenges. I suggest that the issue is not one of failed professionalism, but a shift in the balance of the ethical responsibilities brought about by major changes in health care systems.

Gastroesophageal reflux and related pathology in adults who were born with esophageal atresia: a long-term follow-up study.

Background & Aims: Esophageal atresia (EA) is the most common congenital anomaly of the esophagus. There are few long-term follow-up data on adults who had surgery for EA as infants. The primary aims were to evaluate the prevalence of esophageal symptoms and pathology and second to develop recommendations for follow-up.

Strengthening Australia's framework for research oversight.

All stakeholders should contribute to enhancing Australia's guidelines for ethical research.

Improving the governance of health research.

Australia has so far been spared serious mishaps in health research, but rising pressures on researchers, deemed to have contributed to two deaths of research participants in the United States, clearly also exist in Australia. Health research investment in our institutions is large and represents an often overlooked area of risk by boards of management. Research governance (the framework through which institutions are ultimately accountable for the scientific quality, ethical acceptability and safety of research conducted in the institutions) has not received sufficient attention.

Improving Australia's ethical review processes--slow and steady wins the race.

In this response, the Australian Health Ethics Committee (AHEC) indicates that it shares, and has strategies in place to address, the majority of the concerns identified by Susan Dodds. AHEC believes it is too early to assess the full impact of the National Statement on Ethical Conduct in Research Involving Humans (1999) or to call for a major review of the ethics committee process. While some Human Research Ethics Committees (HRECs) are overstretched, the system is not on the verge of collapse.

The medical profession and the pharmaceutical industry: when will we open our eyes?

There is evidence that drug-marketing techniques affect doctors' prescribing practices. This has ethical implications for doctors, as it affects the trust required in the doctor-patient relationship. Doctors need to recognise they are affected by drug marketing, and take steps to maintain their independence from the pharmaceutical industry.