Over the last half century, the practice of primary care for children has evolved tremendously. Although paediatrics is a relatively young field compared to other specialties, like a child, it has grown to become an integral part of the heath system. The previous international award-winning third edition, Paediatrics and Child Health [1]is succeeded by the latest edition Essential Paediatrics and Child Health [2], which includes twenty-six chapters that are covered in a 520-page textbook. This beautifully presented book combines Prof. Mary Rudolf’s four decades of experience as a consultant paediatrician and Professor of Child Health at Leeds University with that of Prof. Anthony Luder and Dr. Kerry Jeavons who both are experts in the field of paediatric medicine.
A diverse range of scenarios are represented in this textbook with a particular focus on clinical management. This resource also provides perspective on social determinants that impact women’s health, which need to be considered by health professionals for the provision of holistic patient-centred care
A review of Compendium of Histology by Dr Anders Rehfeld, Dr Malin Nylander, and Dr Kirstine Karnov, a succinct and sufficiently detailed compilation of histology.
A review of Dermatology Made Easy by Dr. Amanda Oakley; a concise resource and perfect introductory companion for any medical student with a dermatological disposition.
In a nation often eager to present a whitewashed version of Australian history, Mary Ellen Jordan gives us an uncomfortable, yet refreshingly honest account of her experiences living in a remote Indigenous community for 14 months. Balanda: My Year in Arnhem Land [1] follows her experience, highlighting the stark social and cultural divisions between Indigenous and non-Indigenous Australians. This book recounts Jordan’s time at the Community Art Centre in Maningrida, a 2,300 strong coastal Aboriginal community in the heart of Arnhem Land in the Northern Territory [2]. Having previously lived and worked as an editor in Melbourne, Jordan’s role in Maningrida is to organise the community art centre and work on a bilingual dictionary including English and the local Indigenous language.
One can only learn so much about Aboriginal culture in a medical school lecture theatre. Guest lecturers, workshops in Australia’s history, and explanations of Aboriginal culture as ‘deeply spiritual’ reward us with only a broad, generalised view of what is, in reality, a diverse collection of tribes, languages, and individuals. The impact of these diverse cultures on diagnosis and treatment is often only touched upon, or otherwise described only in general terms.
Despite accounting for 3.7% of total health expenditure, the Close The Gap initiative of 2008 is failing [3,4]. There is an average life expectancy gap of ten years between Indigenous and non-Indigenous Australians, a 2.5 times greater disease burden, and disproportionate incidences of preventable diseases such as rheumatic heart disease and trachoma in Aboriginal and Torres Strait Islander populations [5]. Furthermore, the ultimate goal of Closing the Gap between Aboriginal and non-Aboriginal Australia in terms of culture is not always clear. Is it a covert attempt to achieve Western assimilation? Or an endeavour to preserve a culture already re-shaped by the influences of a dominant white culture?
In remote Maningrida, a sense of cultural alienation results in a type of split community, where “there is very little crossover between the two cultures, although [they] live side-by-side [1].” Balanda aims to investigate the involvement of white Australians in Aboriginal communities as ‘modern day missionaries’, a resonant phrase for medical students considering placements or working in an Aboriginal community. While Jordan’s inability to offer a solution to the social determinants of health may frustrate readers, it reinforces her sense of helplessness regarding the complexity of the current situation for Indigenous people and cross-cultural communication.
Confronting and critical, Jordan’s recount lingers in the reader’s mind long after the covers are closed. Questions regarding what it means to be non-Indigenous in a country built on dispossession are raised and not always answered clearly. For medical students inexperienced with Indigenous cultures, these questions are unsettling. Jordan describes the healthcare system as an imposition of one culture onto another, in which health practices are taught based on the Western model of medicine rather than Aboriginal tradition. To her, the “unspoken…unintentional assimilation [1]” of healthcare delivery is often administered in a paternalistic fashion, in which Aboriginal people are prevented from taking responsibility for themselves and their community.
Integration and success have been noted, however, in the example of Aboriginal Community Controlled Health Services (ACCHS) [6]. These services, offering general practice, allied health, antenatal care, and support programs deliver holistic and culturally appropriate primary healthcare. ACCHS exist as autonomous organisations initiated by Indigenous communities and governed by a locally elected board. These services overcome trends of non-participation and tokenism by engaging the community through partnership, self-determination, and community ownership. For these services to succeed, building community capacity, addressing risk factors, and implementing evidence-based strategies to address social determinants is necessary.
Health practitioners and medical students may well feel intimidated by the candid accounts of the communication challenges faced by Jordan, such as differences in verbal and non-verbal language, and social organisation. Jordan’s recognition of her difficulties in cross-cultural communication highlights how bridging two disparate cultures can pose a major impediment to clinical practice.
Practitioners and students, however, should not to be dismayed or dissuaded by Jordan’s cynicism. Rather, this book encourages us to reflect on how our own beliefs and social milieu shape how we act towards others, and in turn, form partnerships that celebrate diversity. The author’s insights and experiences can be used to formulate inventive and novel approaches to addressing health disparities, and help prepare for both the inevitable frustrations and rewards experienced when working with such a unique and ancient culture.
Acknowledgements
Dr Tarun Sen Gupta, the Lynn Kratcha Memorial Bursary selection committee, and the staff of the University of Saskatchewan for making my placement in Canadian rural Indigenous communities a success.
Conflict of interest
None declared.
References
[1] Jordan ME. Balanda: my year in Arnhem Land. Australia: Allen & Unwin; 2005.
[3] Australian Government Department of the Prime Minister and Cabinet. Closing the gap: Prime Minister’s report 2017. In: Department of the Prime Minister and Cabinet, ed: Commonwealth of Australia 2017; 2017.
[6] Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust. 2014;200(11):649-652. doi:10.5694/mja.00005
Figure 1: Home page of Medscape app, displaying a current news story and available sections.
To many medical students, the ability of consultants to recall the pathogenesis of a rare condition or the dosing schedules for a myriad of medications seems unattainable. This feeling is further emphasised when we are confronted with patient questions that can make us feel grossly underqualified. If only there was a way to carry our library of textbooks into the clinic for quick consultation! Enter Medscape: a free app for iPhone, iPad and Android devices. Medscape’s comprehensive features may be an invaluable tool, whether it is in the clinic, writing assignments, or as a study aid for exams.
Table 1: Summary of Medscape features.
The Medscape application has a number of features that make it unique compared to other medical apps (Table 1). Primarily, it is a free application. All information is peer-reviewed, and in an easy to read format that is available both on- and offline. Another advantage is that the Medscape app covers a broad range of topics, providing a range of detailed information for almost every clinical scenario (Figure 1). The categories covered include:
Figure 1: Home page of Medscape app, displaying a current news story and available sections.
Drugs: A comprehensive list of pharmacotherapies, including prescription, over-the-counter, and alternative medications (Figure 2). For every medication listed, the app provides the generic and commercial names, dosage and indications, administration, adverse effects, warnings, pregnancy information, basic pharmacology and pharmacokinetics, images, and formulary.
Conditions: Medscape provides detailed information about a wide range of conditions, from allergic asthma to Zollinger-Ellison syndrome. Each condition is divided into the following sections: overview, clinical presentation, differential diagnosis, work-up, treatment and management, and follow-up (Figure 3). Over 1,000 conditions are included within the application, however it is important to note that this list is not exhaustive, as some rarer conditions are not covered. Overall, however, using this section for any disease is more than sufficient information for a medical student or junior doctor level.
Procedures: A list of many procedures listed by specialty as well as a large atlas of anatomy is included (Figure 4). Articles do however primarily use text to transmit information. Topics such as these may benefit more from greater use of visual adjuncts and illustrations.
Figure 2: Example from “Drugs” section displaying available features.
Drug Interaction Checker: This tool allows the user to add up to 30 medications concurrently and view the subsequent potential interactions that may occur between these medications. This tool will prove useful when assessing older patients, or those with multiple co-morbidities who are often subject to polypharmacy, to check for interactions.
Pill Identifier: A tool that allows the user to input information about a medication’s appearance (shape, colour, etc.), and generate a list of possible medications that match the description. While in theory this could be a useful tool for patients who cannot remember the name of their medication, in practice it is not particularly accurate, and customised towards medications available in the USA. As such, this tool appears to have limited utility in an Australian setting. For example, searching for features of Panadol capsules leads one to a page of 500 possible medications, none of which are the drug in question.
Calculators: Over 150 medical calculators and clinical decision-making scores (e.g. Glasgow Coma Scale, Warfarin Bleeding Risk, Framingham Risk Score, etc.) are provided, arranged by specialty. This section is ideal for quick calculations when a computer is not available: for example, when calculating a patient’s renal function to see if they are contraindicated for a pharmacotherapy.
Figure 3: Example from “Diseases & Conditions” showing available features.
Formulary: The formulary tab on this app is designed to provide clinicians with a reference of which medications are subsidised at their hospital or state. However, as the app is designed to suit the USA market, this feature is not applicable in Australia.
Directory: This section provides a directory that lists nearby hospitals and specialists according to GPS location of the mobile device. However, this is another feature designed for the American market and thus has serious compatibility issues for Australian users.
Conclusion
The Medscape mobile application is not perfect. As of version 5.5 it remains U.S.-centric, rendering features such as the drug formulary, directory, and pill identifier almost useless for Australian medical students and clinicians, which is a major drawback. I have also found that suggested dosing regimes can differ from Australian standards, as per the Australian Therapeutic Guidelines. Finally, by extension, Australian names of commercial medications are not listed. Aside from this, the drug pharmacology section can be very brief, so it may be more suitable for a refresher rather than learning drugs primarily through the app.
Figure 4: Example from “Procedures” section, displaying available features.
Overall, however, I have found that this app can be a fantastic tool for a medical student to have in a clinical setting, or as a reference tool for studying, and acts as far more than just a medical encyclopaedia. It is especially suited to those who wish to brush up on conditions already learned, or to extend their learning. All features other than images and pill identification are available offline, which may be useful in areas where internet access is limited, such as the clinic. The app works smoothly, and is well laid out and easy to navigate. The app manages the delicate balance between not enough information and too much irrelevant information very well when compared to similar medical applications available on smart devices, making it indispensible to any student anticipating some difficult patient or consultant questions.
In the digital age, our patients expect the medical fraternity, and by extension, medical students, to be more knowledgeable than ever. As such, in the author’s opinion, this app is a fantastic way to provide additional information, and may help students and clinicians alike to provide better patient care.
The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age
Robert Wachter
New York: McGraw-Hill Education, 2015
Modern medicine in the 21st century is an evolving enterprise of knowledge and technology. In The Digital Doctor, Dr. Robert Wachter, one of America’s 50 most influential physician- executives, discusses the wiring of the healthcare system in the form of electronic health records and ‘big data’ today. While there is hope digitised healthcare will increase the efficiency of practitioners and improve clinical practice, Wachter reports less than optimal experiences – interrupted work flows in the clinic to attend to electronic databases, decreased opportunities for the practitioner to establish healthy doctor-patient relationships, and occasionally, fatal consequences when the technology we so heavily rely on fails us. Indeed, Wachter succinctly summarises today’s epoch of computerised healthcare in his title – “hope, hype and harm.”
As a medical student, The Digital Doctor has been thought provoking. My generation of medical students are digital natives who, having grown up with technology, are comfortable with it. Yet, as Wachter points out in his book, by being too comfortable with computerised healthcare, we are less critical of its shortcomings. It is hence imperative to reflect on the importance of striking a balance between being technologically-competent and being vigilant in the age of digitised healthcare.
Through interviews with prominent health professionals and vivid anecdotes, the picture Wachter paints is realistic but solemn. When patient history, drug doses, and investigations are electronically recorded, bedside treatment shifts to the computer. Electronic health records and digital monitoring of the patient, which may come in the form of electronically updated investigation results, introduces the concept of the ‘iPatient’. The iPatient is monitored online, and only attended to when the electronic healthcare system sends out reminders. The fundamental concern is that less time is spent taking a history or physically examining the patient. The end result being that we might overlook diagnoses and unnecessarily invest in costly technological interventions. When these amount to hastened patient interactions and increased billing costs, the patient’s experience with the healthcare system will be an unsatisfactory one.
Digitised healthcare may have also fallen short of the areas in which it has sought to improve. Although digitised healthcare was designed for convenience, electronic documentation is burdensome when one must adhere to strict formatting when recording data. Additionally, the availability of patient information at the click of a mouse means that any data stored online is just as easily lost, possibly through software malfunction or accidental deletion. Furthermore, there is the possibility that digitised healthcare undermines the skill of practitioners, where practitioners are too trusting on the computer to speak up when in doubt. The Digital Doctor draws up a real incident whereby a computer error led to a teenager being prescribed an overdose of 38.5 antibiotic tablets. The error, despite raising suspicions amongst the nurses, was not corrected, and resulted in the patient taking the prescribed medication overdose. This raises the concern of the quality of education students receive to prepare them for transitioning to practitioners. Are we adequately trained to confidently apply our knowledge in real life situations where the patient is more than an illness defined by exam buzzwords? Is there the possibility that we give ourselves room for mistakes because we trust that computerised healthcare will always correct us when we are wrong? As current medical students undergoing traditional medical school teaching methods, are we sufficiently prepared to become future doctors competent both in our practice, and in the technology that accompanies it?
It is crucial to note that this narrative is set in America. While there are differences between the American and Australian healthcare system, we too practice digitised healthcare, and there are lessons to learn. We should accept that this technology is inevitable alongside advancements in diagnostic and therapeutic equipment. We need to understand that technology is an aid to improve our practice. It is not an alternative or a distraction. We must remember that it is still our patients we are treating, not digital data presented to us.
The Digital Doctor is a cautionary narrative that is highly relevant, albeit critical. We need to accept that the interface of medicine, as The Digital Doctor rightfully highlighted, is changing. The future of technology in healthcare is dynamic and promising – it can be our Mecca if we are adaptive practitioners in using this technology. While we are never fully prepared for what lies ahead of us in our medical careers, we are at the very least, enlightened by the age of computerised medicine and what it has in store for us, both good and bad.
Conflict of Interest
None declared.
References
[1] Wachter R. The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. United States of America: McGraw- Hill Education; 2015.
As medical students, we are experts in rare syndromes and exotic illnesses. However cancer, the second most common cause of death in the developed world, is still a total mystery. How do we explain to patients what so many of us don’t understand? Where do we begin?
Dr. Siddhartha Mukherjee is an Indian-born American oncologist, researcher and Pulitzer Prize winner. In this captivating narrative, Mukherjee explores cancer, its complexities, changing personalities, nuances, pet-peeves and habits. Indeed, Mukherjee himself states that, ‘it felt, inescapably as if I were writing not about something but someone.’ The language, therefore, unlike the mere spouting out of facts like a medical textbook, draws one in, such that the reader feels that Mukherjee has blasted open a door and allowed us to enter a landscape of discovery.
Mukherjee describes cancer’s existence thousands of years ago in Egyptian scripts, details the origins of the ongoing battle between cancer and physicians, and depicts his own clinical experiences with cancer patients, thus pouring insight, appreciation and a deeper understanding of this dreadful disease into the reader’s mind. One cannot hope to pursue a discussion about the history of cancer without first explaining what it is. His brief explanation is easy to understand and strikes a happy medium between layman’s terms and medical jargon, hence resonating perfectly with the mind of the medical student.
Cancer’s story begins in Sidney Farber’s lab in 1947, where leukemic cells were being studied. The utilisation of folate antagonists to treat leukemia can be credited to Farber’s genius: ‘If folic acid accelerated the leukemia cells in children, what if he could cut off its supply with some other drug – an antifolate?’. Thus, the idea of molecular targets and chemotherapy was born.
As chemotherapy grew in popularity, opportunities for combination therapy were explored. The author investigates the consequences of various clinical trials such as the catastrophic dips in white cell counts, the death toll rising with every turn of the page. He then leads us through the challenges of specific cancers, such as prostate and breast cancer.
Finally, Dr. Mukherjee arrives at the present day, detailing our new interests in gene therapy. Despite advancements, the true nature of cancer continues to elude us and with it, the cure consistently slips through our fingers. Dr. Mukherjee encapsulates this perfectly by advising us to, ‘focus on prolonging life rather than eliminating death’. With cancer rates increasing, its presence is approaching a level of normality and this guidebook warns us not to underestimate ‘the emperor of all maladies’, an important lesson for all future doctors.
As a medical student, The Emperor of All Maladies is a great introduction into the world of oncology. It is an easy and fun read that is a refreshing break from the traditional textbooks we pore over daily. The reader is not only educated about the intricacies of cancer but also walks away with a great deal of empathy for the patients and families whose experiences are vividly narrated. Furthermore, in the journey from historical events to present day, Mukherjee’s exciting and thrilling perspective of cancer is a useful timeline of the events of the past and what we, as medical students, can expect in the future of Oncology.
In summary, The Emperor of All Maladies is a roadmap of the places we have been, what we have done and where we still need to go. Cancer was, is, and will be the most challenging ailment that we, as future doctors will have to face. Hence, all medical students should take a note from cancer’s biography and its master storyteller.
Conflict of Interest
None declared.
Correspondence
M Ong: michelle.ong@my.jcu.edu.au
References
Mukherjee S. The Emperor of All Maladies: A biography of cancer. London: Fourth Estate; 2011.
Jayasinghe, S. Rohan. ECG Workbook, Australia: Elsevier; 2012.
RRP: $59.95
This is an Elsevier supported book review
Like tools are to a plumber, correct ECG interpretations are to a doctor. ECGs are the basis of diagnosis for many of the patients that walk through our hospital doors. Consider this: how many patients do you see that don’t have an ECG tucked into their notes? And how often have you looked at an ECG and quietly thought to yourself, “what on earth is going on?” before sheepishly praying that the consultant doesn’t ask you to interpret it? Mastering an ECG is the foundation of being a doctor, an essential skill that you will not be able to shy away from. So in a quest to find a tool that would ease my ECG fears, I stumbled across this clever little book.
Jayasinghe takes both a logical and systematic approach in this text as he emphasizes the “importance of treating a patient and not an ECG”. Readers are provided with real life case studies and guided through a stepwise process to interpret an ECG. This provides an opportunity to not only practice this new skill set but also to formulate a clinical diagnosis and decide on appropriate and optimal management.
The workbook is divided into three convenient user-friendly sections.
Section 1 takes readers on a journey through the fundamentals of ECGs. Essential knowledge on cardiac conduction physiology is revisited, before explaining the derivation of the modern electrocardiogram by the Nobel prize-winning Dutch physician William Eithoven. Difficult concepts (for example, the accurate determination of the cardiac axis) are explained using both the two and three lead method. This is discussed before using a difficult yet more accurate methodical explanation of its relation to a hexa-axial reference system. The importance of correct limb placement is clarified before the author dives into providing the reader with six practical rules that should be applied when ‘eyeballing’ any ECG. This framework then provides an organized line of attack when attempting to read an ECG. Overall Section 1 studies the ‘normal’ ECG and highlights life-threatening ECG changes that require urgent therapeutic intervention.
Section 2 explores ECG based diagnosis through interpreting pathological ECGs, highlighting areas of study such as abnormalities in the P wave, PR segment, QRS complex, Q wave, R wave, S wave and ST segments. This section then focuses on STEMI associated ECG changes. The author should be commended for including pathologies with mixed ECG changes which are commonly seen in clinical settings such as pulmonary embolism, subarachnoid haemorrhage, takotsubo cardiomyopathy, hypokalaemia and hyperkalaemia before drawing the reader’s attention to drug induced ECG changes.
Everyone knows that practice makes perfect and that the key to mastering any new skill set is practice. The final section of this innovative book is clearly set out in workbook format containing a series of ECG tracings linked to a clinical scenario. A fill in worksheet guides the reader to interpret the ECG using the strategic framework taught in Section 1.
Many texts that attempt to help the reader master the art of ECG interpretation lack this crucial worksheet approach, which facilitates repetitive learning and ultimately allows the student to master the ability to interpret ECGs in the clinical context. Each case is followed by the answer, which has been carefully set out in the same systematic framework taught throughout the text. The author has clearly placed much effort into ensuring that the reader understands the importance of using a stepwise approach when faced with this somewhat daunting task. Additionally, the author endeavours to engage readers to teach them to stratify the significance of the ECG findings based on clinical relevance and urgency. This is a refreshing approach from a medical textbook.
Self assessment enables the reader to build confidence and precision, to gauge their competence and to hone weaknesses. Key concepts can be revisited and mastered as they work their way through this glorious all-in-one paperback.
This short but sweet text provides a comprehensive and systematic approach to learning ECG interpretation whilst ensuring relevancy to real life scenarios. The only criticism I have of this clever little lifesaver, which is small enough to effortlessly carry around hospital, is that it should be available in hard-back! All things considered, the author, an interventional cardiologist, should be applauded as he has succeeded in providing readers with the perfect balance of mastering the art of ECG interpretation whilst being able to apply it to diagnostic situations without getting lost in the detail.
White T. Starlight: An Australian Army doctor in Vietnam. Brisbane: CopyRight Publishing; 2011.
RRP: $33.00
Not many of us dream of serving as a medical doctor in the frontlines of war. War is after all the antithesis of everything the medical profession stands for. [1] In Starlight, Dr Tony White AM vividly recounts his tour of duty in South Vietnam between 1966 and 1967 through correspondence exchanged with his family. STARLIGHT was the radio call sign for the medical officer and it bore the essence of what was expected of young White as a Regimental Medical Officer (RMO) in the 5th Battalion of the Royal Australian Regiment (5 RAR).
White was born in Perth, grew up in Kenya and read medicine in Clare College, Cambridge University. After completing the first half of the six-year degree, he moved back with his family to Sydney where the pivotal decision to join military service was made. White accepted a scholarship from the Australian government to continue at the University of Sydney in exchange for four years of service in the Australian Defence Force after a year of residency.
In May 1966, White’s wartime duties commenced with 5 RAR in Vung Tau, southeast of Saigon, dubbed “Sufferer’s Paradise”. After a brief settling-in, the battalion moved to Nui Dat, their operational base for the year. The initial excitement of the 25-year-old’s first visit to Asia quickly faded as the realities of war – the mud, the sweat and the blood – set in. Footnotes and explanation of military jargon and organisation were immensely helpful in acquainting the reader to the battalion’s environment. As an RMO, White worked round-the-clock performing General Practice duties such as sick parades and preventive medicine, emergency duties attending to acute trauma, and public health duties monitoring for disease outbreaks and maintaining hygiene. The stark difference from being a civilian doctor is candidly described, “You live, eat, dig, and [defecate] with your patients and, like them, get every bit as uncomfortable and frightened. There is no retreat or privacy.”
From the early “friendly fires” and booby traps to the horror of landmines, White’s affecting letters offer a very raw view of war’s savagery. It was a war fought against guerrillas, much like the present war in Afghanistan, where the enemy is unknown and threat may erupt into danger at any time. During the numerous operations 5 RAR conducted, White attended to and comforted many wounded. With every digger killed in action, a palpable sense of loss accompanies the narration. White clearly laments the “senseless killing of war” as he explained, “You spend all that time – 20 years or so – making a man, preserving his health, educating and training him, to have him shot to death.” White himself had close brushes with death. He was pinned down by sniper fire on one occasion and even found himself in the middle of a minefield in the worst of tragedies encountered. The chapter “Going troppo” ruminates on the enduring psychological effects of these events as the year unfolded.
The insanity of war is balanced by many heartening acts. First and foremost is the remarkable resilience of the diggers whose tireless disposition to work inspired White profoundly. White also voluntarily set up regular clinics in surrounding villages to provide care for civilians despite the threat of enemy contact. In an encouraging twist, both friendly and enemy (Viet Cong) casualties were rendered the same standards of care. Even more ironic was the congenial interactions between the two factions within the confines of the hospital. Perhaps the most moving of all was White’s heartfelt words of appreciation to his family who supported his spirits through sending letters and homemade goodies like fruitcakes, biscuits and smoked oysters.
So why should you read this book? Textbooks do not teach us empathy. White shares in these 184 pages experiences that we all hope never to encounter ourselves. Yet countless veterans, refugees, abuse victims, etcetera have faced such terror and our understanding of their narratives is essential in providing care and comfort. In the final chapters of this book White gives a rare physician perspective on post-traumatic stress disorder and how he reconciled with the profound impact of war to achieve success in the field of dermatology. These invaluable lessons shine through this book.
Conflicts of Interest
None declared.
References
[1] DeMaria AN. The physician and war. Journal of the American College of Cardiology. 2003;41(5):889-90.
technology. In The Digital Doctor, Dr. Robert Wachter, one of America’s 50 most influential physician- executives, discusses the wiring of the healthcare system in the form of electronic health records and ‘big data’ today. While there is hope digitised healthcare will increase the efficiency of practitioners and improve clinical practice, Wachter reports less than optimal experiences – interrupted work flows in the clinic to attend to electronic databases, decreased opportunities for the practitioner to establish healthy doctor-patient relationships, and occasionally, fatal consequences when the technology we so heavily rely on fails us. Indeed, Wachter succinctly summarises today’s epoch of computerised healthcare in his title – “hope, hype and harm.”
As medical students, we are experts in rare syndromes and exotic illnesses. However cancer, the second most common cause of death in the developed world, is still a total mystery. How do we explain to patients what so many of us don’t understand? Where do we begin?
