In South Africa (SA) it is widely accepted that subspecialties such as gastroenterology (GE) are not functioning adequately, as was highlighted in the SAMJ in 2004. Fewer trainees are able to choose to subspecialise in GE. Indeed, all specialties are faced with a lack of training facilities.
I would like to comment on an article about South Africa's future National Health Insurance, written by Dr Stephen Craven and published in the Cape Doctor of April 2013. Dr Craven states, 'The expense of the National Health Service [in the UK] is colossal. There is no cost control. The total budget for 2010-11 was Â£107 billion which, divided by 63.1 million (the 2011 population), comes to the more comprehensible Â£1.7 million per head.'
We read with interest David McQuoid-Mason's article concerning the legality of circumcision in South Africa in terms of the Constitution and the Children's Act. Unfortunately, his statement that circumcision could lead to 'reversal in the gains made against HIV infection' shows that his piece is one of proselytism, not scholarship. Like the AIDS deniers before him, McQuoid-Mason repudiates strong scientific evidence, global public health authorities and the World Health Organization, which has endorsed circumcision as a priority preventive intervention in the struggle against HIV.
South Africa has an unacceptably high rate of interpersonal violence. Recent well-publicised incidents have prompted South Africans to re-examine the massive problem of violence against women in the country. As healthcare practitioners, many South African doctors are regularly exposed to victims of violent crime and are responsible for their care. For those victims who wish to make a case, the J88 form serves as a crucial piece of medical evidence.
The Academy of Science of South Africa (ASSAf) has announced a research initiative to assess life science activity in South Africa (SA). One aspect of the study being undertaken by the ASSAf Panel on Biosafety and Biosecurity is an online survey whereby ASSAf aims to identify and map research and diagnostic facilities engaged in life science activities in the country.
Medical records may be considered to be any information and documents kept in a systematic, scientific and easy way that help clinicians retrieve the required data on a patient at the time it is needed. They can cover a wide range of material including handwritten notes, computerised records, correspondence between health professionals, laboratory reports, imaging reports, videos and printouts from monitoring equipment.
An Italian study showing that diabetic patients of physicians with high empathy had a significantly lower rate of acute metabolic complications than those of physicians with moderate and low empathy scores, is one of several recent scientific reports supporting the use of 'mindfulness' in clinical practice.
Generalists daily make poor evidence-based decisions because regulatory and ethics committees fail them and drug companies habitually misrepresent products. The pervasiveness of this perversion - at least overseas - is best illustrated by the equivalent of R131.4 billion in healthcare fraud settlements made by pharmaceutical corporates in the USA over the last 10 years, with the most recent individual company fines breaking all records.
The lack of proper peer-reviewed medico-judicial processes, which render healthcare workers vulnerable in foreign countries, the ethics of boycott politics, and the real political clout of top private business emerged as major themes in the 9-month saga of Professor Cyril Karabus.
Government regulators need to grant more licences to high-volume surgical centres where doctors can finely hone their skills to give more people better and quicker outcomes at a lower cost, contributing significantly to lowering healthcare inflation, says Discovery Health CEO, Dr Jonny Broomberg.
Op Oujaarsnamidddag 2012, sterf Frans skielik aan 'n ruptuurde aorta aneurisme, en ontstaan daar 'n groot leemte in sy gesin en in dermatologiese kringe in Namibia waar hy die enigste voltydse dermatoloog was.
Edward Joseph Stewart (1926 - 2013) was born in 1926 in Swaziland. He travelled to Cape Town for further education, first at Zonnebloem College, then Trafalgar High School. He graduated MB ChB at UCT in 1951, the first Swaziland-born medical graduate. After considering community practice in Kenya, he met his wife, Dulcima Maurice, and they settled in Cape Town. He established a private general practice, first in Vasco and then in Elsies River - his home for almost fifty years.
Evidence-based medicine has been defined as 'The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.' There are two major assumptions in this statement. First, it is assumed that the evidence is in fact the best. Unfortunately this is not necessarily so, and published evidence is affected by bias, sponsorship, and blind faith in mathematical probability which may not be clinically relevant. Second, the evidence is population based and may not be applicable to the individual, and blind adherence to this concept may cause harm. We must not abandon clinical experience and judgement in favour of a series of inanimate data points. Medicine is an uncertain science.
Screening for diabetic retinopathy (DR) not only allows for detection of microvascular complications, but for detection of other comorbidities. Recent advances in digital camera technology have improved screening for DR and many countries have established systems that screen all diabetics for DR annually. However, South Africa has lagged behind due to pressures at the primary care level, with the result that many diabetics are not screened. In response, the Ophthalmology Society of Southern Africa has developed a low-cost 'scorecard' system for a national DR screening programme.
Recent increases in pathology costs per scheme member are a concern to medical schemes and pathologists alike. To better understand the observed increasing costs, the National Pathology Group commissioned Prognosys to analyse the trends affecting these increases. We found that these increases are driven by inflation, increases in utilisation, and redistribution of the burden of cost. The identification of utilisation as a cost driver for pathology services is noteworthy as almost all pathology services are by referral from another doctor.
Doctors today have to practise medicine in an increasingly hostile, pressurised and uncertain healthcare environment. The cost of clinical negligence continues to rise in South Africa (SA) with increases in both the number and value of claims; increases so significant that some specialties have been left questioning whether they should even continue to practise. Others have adopted a more defensive approach to try to safeguard themselves against the risk of claims.
'It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us ... '. These famous words penned by Charles Dickens in 1859 captured the spirit of the Age of Revolution in Europe in the late 18th century. However, they could also be used to describe the disparate provision of diabetes care in present-day South Africa. Some of our patients have access to most of the new therapeutic agents, are provided with home blood glucose testing apparatus, and have access to multidisciplinary diabetes care teams. Many others are less fortunate. As will be discussed, the 'where' of diabetes care has a powerful influence on outcomes.