Tuesday, June 28, 2016

What do you do when a patient asks to speak to another patient who has undergone cancer surgery?

Not infrequently, I am asked by my patients if they could speak with any other of my patients about their experience of having undergone radical prostatectomy surgery for prostate cancer.  In the past, I have done my best to assist with this request but in more recent years I have moved away from supporting this.  I have a couple of reasons for doing this.

Firstly, it could be argued that selecting patients for such a discussion is like cherry picking. It is arguably little different from a patient testimonial on a website where the most favourable outcomes are provided although unlike the latter, it does not breach AHPRA regulations for advertising.  

Secondly, patients under long term care for cancer treatment are potentially vulnerable.  As doctors, we should never underestimate the desire of patients to please us and the potential for some patients to fear displeasing us by refusal to submit to any request we make of them. 

In writing this, I do not mean to suggest that I am critical of those who provide their own patients as a resource for other patients seeking support or real life experiences. I know that this is done by the vast majority of clinicians with the very best intentions. There may be a time a place for this, particularly with uncommon diseases or unusual clinical circumstances.  

My approach is to now to keep an arms length. I now place my patients in contact with a choice of the local prostate cancer support group or the Prostate Foundation of Australia who are able to provide such a service in addition to their excellent information resources.  From time to time, my patient will be placed in touch with somebody who just happens to also be a patient of mine and that is absolutely fine with me.  I feel comfortable with this transparency and I am also gratified by the positive feedback from my patients who have undertaken this suggested approach.

Sunday, May 1, 2016

How I Almost Did Not Become a Urological Surgeon.

If anybody had suggested that I would become a urologist when I was a medical student or even as an intern, I would have told them that they were dreaming. My exposure to the field was fairly minimal during my time as a medical student and the thought of operating amidst urine just did not spark the slightest interest.  If anything at all, I was interested in becoming a plastic surgeon or a general surgeon. 

At the commencement of internship, we were all allocated to do at least one surgical term out of the 5 terms for the year. I was allocated urology for my surgical rotation. It was known to be horrendously busy and quite ironically, the two interns allocated to that rotation were probably lucky to ever have time to empty their bladders. I was horrified at the thought of doing the surgical specialty that was of least interest to me.  I quickly got in touch with a friend whose career interest was in psychiatry and he was completely unfazed about which surgical term he would do.  The swap was made and I got out of urology and did a plastic surgery rotation instead.  I just loved my time doing Plastics and by the end of the term, I was virtually unmovable in my desire to be in that specialty.  

For the second post graduate year (or resident medical officer year), it was again a fairly general year and to my horror, I was again allocated urology. I thought ‘hang on a sec, isn’t urology meant to be an intern rotation?’  Given that the term was so stressful for two interns, it was thought that it would be better to replace one of the interns with an RMO. Having that extra year of experience was going to make a huge difference.  I again hit the phones and on this occasion could not find anybody who was willing to do a swap. Begrudgingly, I accepted the fact that I would have to do this rotation. In spite of the adversity, I threw myself into the job and to my great surprise found the specialty extraordinarily interesting.  Urologists were both physicians and surgeons of the genitourinary tract and were not beholden to masters in any other specialty group in order to have a practice livelihood. On top of this, the urologists to whom I was to be exposed to, took great interest in my work ethic and general interest in surgery.  Their kindness and support for me had a profound impact on me although I was still steadfastly obsessed with having a career in Plastic Surgery.  

My primary career focus during my RMO year was to pass my surgical primary examination which at that time has a pass rate of around 25%. It was at that time, a clear barrier to restrict entry into the surgical profession. Fortunately I passed the examination on my first attempt which was pretty good going since my undergraduate academic record at university was fairly ordinary (after I discovered the medical revue, I never saw another credit or distinction grade for the remainder of my medical degree).  I now had to think carefully about where my next career move would be.  Something that I had noticed about the plastic surgery trainees at the time was the fact that they were all relatively old compared to other trainees.  At that time, those entering into plastic surgery training would first complete their general surgical training and then spend a year or more in non-accredited plastic surgery positions before commencing core training.  I came to realisation that the majority of those who were undertaking plastic surgery training were going to nudging 40 years of age by the time they were ready to commence independent surgical practice.  I thought that this was crazy and that I did have a life to live and made the tough decision to abandon the idea of training in plastic surgery.  My mind kept me returning to my time in urology and I soon became convinced that this was where my future lay.  

As is so often the case, it can be the mentors that you meet in the field rather than the field itself that can initially draw you towards it. 

To this day, I have no regrets.

Sunday, April 3, 2016

Payment for Citation Offer Withdrawn - but should never have been offered in the first place.

This Blog post needs to read in conjunction with the earlier entry on the same subject matter.

"Payment for Journal Citation? Possibly Academic Publishing at its Worst."

I wrote to the Editor in Chief to express my concern over his recent email about offering financial reward for citing papers from his journal.  I received a prompt response to the effect that the offer was to be withdrawn.  My plan is to now write to the President of the professional organisation to which this periodical is their official journal.  Whilst the offer is stated to have been withdrawn, it still represented poor judgement and raises a real question about integrity.

You might ask as to why I have not yet resigned from it's editorial board?  Whilst I still have a seat there, my voice can still be heard or at least I would hope more likely to be heard.  There are many reputable individuals on their editorial board and I sincerely hope that they have aired their concerns as well.

I plan to push for this matter to be heard by the Executive of the professional organisation to which the journal is attached and if the organisation is to have any integrity, there needs to be some strong action to demonstrate that even the thought of this misconduct is not to be tolerated.

I will update readers as more information comes to hand.

Payment for Journal Citation? Possibly Academic Publishing at its Worst.

Many of you who have read my blog or are following me on Twitter, would be well aware of my thoughts about academic publishing.  I have always done my best to be careful about which journals I would consent to have my name associated with in any way. 

As a general rule, I will be more receptive to invitations to review manuscripts or even invitations to join an Editorial Board if the journal is associated with a bona fide professional organisation or if the journal is indexed on Pubmed (increasingly being referred to as the ‘white list’).  Whether the journal had an impact factor was of lessor importance but if the journal were to quote any of the bogus impact factors such as the Index Copernicus, Journal Impact Factor, Global Impact Factor or Universal Impact Factor, this would also lead to rejection of any approach. There is no purpose of these bogus impact factors other than to mislead and to fool academics into believing that it was something to do with the established Thomson ISI Impact Factor.  Additionally, any journal currently listed on the Beall’s list of predatory journals was also a definite NO. 

About two years ago, I was invited to join the editorial board of a journal that was the official organ of a professional society that was known to me and the journal was indexed in Pubmed.  I was pleased to receive the invitation and gratefully accepted the invitation.  Whilst the journal has been indexed in Pubmed, it was still going through the process of being assessed for journal citation indexing and therefore receiving a Thomson ISI impact factor.  It seems that this journal’s time has come and I received an email asking me to make a special effort to cite papers from the journal, particularly from the years 2014 and 2015.  The Editor in Chief announced that for each cite, I would receive a fee of US$50 with a maximum of US$500 annually.  

I was shocked.  My immediate thought was to send in my resignation straight away.  Given that this journal is associated with a professional society, I wondered if it was better to attempt to make change from within by writing to the editor and expressing my concern.  Should I write to the EIC and give him the opportunity to have a rethink on this strategy?  Should I simply tender my resignation immediately?  I certainly am not dependent on having membership to this journal's editorial board as an indication of my professional standing. Have a look at the attached email.  

I am also absolutely and utterly appalled by the poor spelling in the email.  

What are your thoughts?  

I can reassure readers that I will certainly not accept any fees for citing papers.  I only cite papers if I consider they are relevant to a given manuscript. Nothing more and nothing less.

As a disclosure, I list my current Editorial Board memberships, minus the one in question.  I also make mention that I am an Associate Editor of the Prostate Cancer and Prostatic Diseases journal.

Additional note 2 April 2016

Please take a look at this update to see the response of the EIC to my email of concern

Payment for Citation Offer withdrawn.