Frank Frizelle, Editor

We continue to practise in interesting times. Sometimes I wonder if things are going from bad to worse. New diseases keep popping up. Last year we thought SARS was bad, yet this year Asian chicken viruses threaten to be worse. Treatments we thought were good, such as HRT, turn out to be bad. The inequalities between different racial groups in regard to access and outcome in medical care are now well described, but there is little evidence that we are able to do much about them. We are increasingly recognising that adverse events are part of the faulty human system of medicine; however, in parallel, we are experiencing the increasing crimination of medical error. New laws affecting doctors, which were designed to make matters better, appear to be making matters worse. To cap all that, our young doctors are said to be leaving New Zealand as fast as they can get their medical degree.

So, should we all be despondent at the beginning of a new year, or is there reason to hope that things will improve? Last year New Zealand was fortunate not to be too affected by the SARS crisis, but this year we are told that officials are braced for a flu pandemic. Besides making the appropriate preparations, there is little we can do to protect ourselves from this threat other than cross our fingers and hope that our remote location will once again work in our favour.

Health access and outcome for different racial groups is perhaps an area over which we should feel able to exert somewhat more control. This issue of the Journal presents further studies that demonstrate the inequalities existing in New Zealand. Over the last year we have published a number of similar studies highlighting these inequalities; the real issue now is what can be done about them. The problems are complex and often relate more to the socioeconomic realities of different ethnicities than anything else, and these are difficult to change. We urgently need more research aimed at providing solutions to these inequalities, not just describing them.

Legal aspects of medical care continue to dominate the media and be of major concern to most doctors. Hard-working medical professionals are repeatedly held up by the media as bad doctors and bad people, when in truth reporters are often relaying unsubstantiated allegations. It appears increasingly likely that doctors will not be able to get name suppression for cases waiting to be heard by the Medical Practitioners Disciplinary Tribunal. The Health and Disability Commission seems to be keen avoid name suppression, as this prevents other cases related to a medical practitioner coming forward.

The Medical Council likewise seems to have forgotten that it needs to be there for both the doctor and the patient, at times withholding doctors’ annual practising certificate when they have yet to appear before a tribunal. Does this mean that if the Director of Proceedings decides to charge us we must be guilty; if so, his/her role becomes increasingly critical. The HPCA Act comes into effect this year, and the influence of this is uncertain. However, it seems likely that it will at the very least increase Ron Paterson’s workload.

The retention of doctors continues to be a problem and is a subject that the media have recently picked up. However, there always have been and always will be plenty of young doctors heading overseas. Many of them do return. New Zealand also continues to attract many quality doctors from overseas. Despite this, there are many concerning aspects about retention of doctors in the public system, with surgical specialists increasingly opting out of the public system into full-time private practice. Another worrying trend is the reduction in the number of medical students coming from families where at least one parent is a medical doctor. It is difficult not to wonder what advice doctors are giving their children about careers in medicine.

The New Zealand Medical Journal will continue to publish articles of interest to New Zealand medical practitioners, covering a broad range of subjects from Asian chicken flu to the HPCA Act and as much in between as best we can. Last year we published more original manuscripts than ever before (35% of submitted papers). We still have an average turnaround time from submission to publication of 3–4 months. The biggest delay relates to the time it takes to find available reviewers (who continue to do an excellent job). The Medical Image and Case Notes sections we launched last year appear to have been well received. We are particularly grateful to our colleagues working behind the scenes to provide material for the Medical Image, 100 Years, Methuselah and Obituaries sections.

No major changes are expected in the structure of the Journal over the next 12 months; however, as can be seen from the medical news we never know what is around the corner. By continuing to showcase research of which New Zealand can be proud, and opening up issues for serious debate, we hope to make a positive contribution in the coming year to the efforts of the medical community in addressing some of the challenges it faces.

Correspondence: Professor Frank A Frizelle, Department of Surgery, Christchurch Hospital, Private Bag 4710, Christchurch. Fax: (03) 364 0352; email: frank.frizelle@cdhb.govt.nz