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The Quarterly 2011


Dear Editor

Dr Flett's article in the September 2010 issue of The Quarterly regarding the ageing Australian population has relevance beyond aged care.

Amongst the systematic problems noted, the paper cited our tendency to operate within silos. This is a modern truism. Distinctions based upon the nature of services provided, staffing arrangements or the funding mechanism may permit local flexibility and specialisation. The challenge is to ensure opportunities to align best practice or purchasing power are not lost amongst the inefficiencies and increased administrative costs.

Practical problems including inadequate pay, beds and staffing rates were raised. The impact of such factors upon one's ability to deliver services let alone implement clinical updates cannot be underestimated. For example, there is a national drive towards greater engagement in Advance Care Planning1 but programmes aimed at improved clinical care must pay heed to practicalities such as HR infrastructure and training needs.

As the paper noted, the future is looming. Beyond sheer numbers (and at risk of stereotyping) is the conundrum of balancing the health needs of ageing baby boomers against the social values of Gen Y. Twenty first century medicine's ability to treat and manage disease is extensive - percutaneous repair of aortic and mitral valves is now possible and targeted upon patients previously deemed unsuitable for surgical intervention 2. The efficacy of intravenous immunoglobulin (IVIg) in the treatment of dementias is in phase III trials4. All are costly interventions - in excess of A$100 million was spent in Australia on IVIg in 2006-75. The associated opportunity cost cannot be denied.

A discussion of these issues should not be confined to the health sector. At heart is the ethics of delivering healthcare and the ethics of ill-health. We sit at equipoise between technological advances which increase our ability to treat illness and sustain the parameters of life across the age spectrum and a zeitgeist which values quality over quantity of life and questions the logic of intervention at all costs. As clinicians and health administrators, is engagement with the community and patient to understand their expectations of health and a health service not also our responsibility?

Dr Audrey Koay
RACMA Candidate


1 National Palliative Care Strategy 2010. Supporting Australians to Live Well at the End of Life. Canberra: Commonwealth of Australia; 2010
2 http://www.clinicaltrials.gov/ct2/results?term=transcatheter+aortic+valve+implantation. Accessed March 2011
3 http://clinicaltrials.gov/ct2/show/NCT00818662?term=IVIG+and+dementia&rank=2. Accessed March 2011
4 Mauri L, Garg P, Massaro JM, Foster E, Glower D, Mehoudar P, Powell F, Komtebedde J, McDermott E, Feldman T. The EVEREST II Trial: design and rationale for a randomized study of the evalve mitraclip system compared with mitral valve surgery for mitral regurgitation. Am Heart J. 2010 Jul;160(1):23-9.
5 Jurisdictional Blood Committee, for and on behalf of the Health Minister's Conference. Criteria for the Clinical Use of Intravenous Immunoglobulin in Australia. Canberra: Commonwealth of Australia; 2007.

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