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Danish register of life-wills
Settlement for NSW visiting medical officers
human rights, and to take specific actions needed. The next meeting is scheduled for March 5-8, 1994, in Oslo. Among the topics for discussion will be issues directly related to humanitarian actions aimed at women and children, a special’interest of the Norwegian Ministry of Foreign Affairs, which is sponsoring the meeting, as it did that in September.
medical officers (VMOs) in New South Wales public hospitals have won their nine-month battle against the restrictive provisions of the Hungerford decision handed down in 1993. Hungerford had, among other things, recommended that the pay rates for VMOs be substantially reduced, which caused the Australian Medical Association (AMA) to threaten industrial action if Hungerford held sway. In March, 1993, the Arbitration Commission agreed to stay Hungerford, pending AMA arguments, put mainly on behalf of
Visiting
Otto W Steenfeldt-Foss, Bjørn Oscar Hoftvedt
Changes to German medical education
:
surgeons.
handed down . in December, but except for senior surHealth Minister Horst Seehofer has proposed yet another medical education geons, it makes no definite decision about reform. It has long been accepted that hourly pay rates. However, it is expected medical students in Germany receive that present (pre-Hungerford) rates will insufficient clinical training and that the not be reduced and that specific adjusttraining period is too long. The changes ments will improve them.: introduced in recent years have been : Moscow’s minor, such as more oral examinations. mountain Seehofer is not proposing too drastic a remedy. He intends to reduce the number of medical students by 20%. This The shortage of drugs and pharmaceutical proposal is widely welcomed, and even products in Russia has become, over the criticised as being too cautious by Dr past few years, a matter of much intemaKarsten Vilmar, head of the Federal tional concern. But not all drugs are in Medical Council, who is arguing for a short supply. Moscow, it seems, has man50% cut. Seehofer wants to reduce the aged to accumulate an "aspirin mounnumber of examinations from four to tain". In 1992, Moscow’s Main Medical three. Oral examinations should carry Board spent one-sixteenth of the city’s more weight than the multiple-choice tests total budget on aspirin from the German which will, despite severe criticism, not be Bayer company. Bayer’s products, The latest
judgment
was
aspirin
abandoned. : Under the new proposals students will receive clinical teaching in their first two years. The aim is to combine preclinical with clinical thinking. There will be more tutorials and bedside teaching with a smaller number of students. Problemoriented learning, as already practised in a few universities in Germany (see Lancet May 8, 1993, p 1206), is taken: as a model. Seehofer further suggests
though
On Feb 1, senior surgeons’ hourly rates will rise from$136 to$142 with upward adjustment for leave, superannuation, and ongoing practice costs (those costs of a surgeon’s practice that continue while they treat public patients), which are presently being negotiated. New rates for other senior specialists (anaesthetists and physicians) also have not yet been decided. Hourly rates for other classifications of VMOs are: specialists (less senior surgeons, anaesthetists, and physicians) $128; general practitioners with ten years or more of experience$109; GPs with between five and ten years’ experience $91; and GPs with less than five years’ experience,$83. All these rates are expected to be augmented by adjustments for annual leave, sick leave, superannuation, and practice costs, following AMA representation with the Department of Health.
Peter
Harrigan
ber, which is officially in charge of the
city’s supplies of drugs, not consulted? Why were the details of the deal entrusted by the Board to a commercial firm that had no experience or competence in the pharmaceutical industry? The Main Medical Board claims that 70% of the aspirins purchased from Bayer have already been used. But Vladimir Gurvich, the medical affairs correspondent of Nezavisimaya Gazeta maintains that a random spot check of Moscow hospitals indicates that the opposite is true.
Meanwhile, according to Healthprom, undoubtedly considerably superior to the the newsletter of the London-based AssoRussian aspirins, cost ten times more.
And the size of the order outstripped all . reasonable demand. Moscow’s Hospital Number 7, for example, which uses about 500 packs of aspirins a year, now has over 2500 in its pharmacy, and is unlikely to get through half of them by the time their shelf-life runs out in 1995. : The pro-reform daily Nezavisimaya : Gazeta is asking pertinent questions about the "mountain". Why, it wants to know, : did the Main Medical Board, which is not supposed to involve itself in commercial transactions, do so much to foster the deal? Why was the Pharmaceutical Cham-
ciation for the Promotion of Healthcare in the Former Soviet Union, Bayer has signed an agreement to supply machinery, equipment, and know-how for the production of aspirin and other non-prescription drugs in Russia as part of a joint venture with Suromed (Switzerland) and a Russian hospital and pharmaceuticals association. The first aspirins to be produced under this deal will go on the market in the next few months. With Bayermade aspirin available in Russia, such lavish over-ordering should be avoidable.
National Board of Health, Michael von Magnus, said that the board expects every : doctor to do his duty. He admitted that it : The register, started 15 months ago (see is virtually impossible for the board to Lancet 1992; 340: 901), has more than ensure compliance with the law. : 62000 entries. When in doubt about a Several doctors claim the register is : patient’s wishes on whether or not to be unnecessary, but not so the chairman of subjected to prolonged life-saving efforts the Danish Medical Association, Torben when the prognosis is hopeless, doctors Pedersen, who agreed that in most cases have a legal obligation to contact the regknowledge of the patient’s wish is obtainister by telephone. : able from the patient or from relatives, "so . Very few doctors, however, consult the situations where it might be relevant to register. During the first year only 65 contact the life-will register very seldom
should be kept, even if it is both troublesome and expensive". Euthanasia is forbidden in Denmark. But it is common practice among doctors to avoid unnecessary, life-prolonging efforts. No authority would take action if, for example, morphine given to keep a
emphasis on certain topicsgeriatrics, pharmacotherapy, quality assurincreased
ance, and health economics.
Annette Tuffs
Danish
inquiries
register of
were
made. In
life-wills
commenting on
this very small number the chief of
occur.
But
as
thethe security
long of
a
as
people
life-will,
seem to
the
Vera Rich
dying
nearly-dying patient pain-free patient’s life. According to von Magnus, the law on life-wills and the register were introduced primarily to bring legislation in line with practice. or
were to
shorten the
want
register
Kaare Skovmand
167
human rights, and to take specific actions needed. The next meeting is scheduled for March 5-8, 1994, in Oslo. Among the topics for discussion will be issues directly related to humanitarian actions aimed at women and children, a special’interest of the Norwegian Ministry of Foreign Affairs, which is sponsoring the meeting, as it did that in September.
medical officers (VMOs) in New South Wales public hospitals have won their nine-month battle against the restrictive provisions of the Hungerford decision handed down in 1993. Hungerford had, among other things, recommended that the pay rates for VMOs be substantially reduced, which caused the Australian Medical Association (AMA) to threaten industrial action if Hungerford held sway. In March, 1993, the Arbitration Commission agreed to stay Hungerford, pending AMA arguments, put mainly on behalf of
Visiting
Otto W Steenfeldt-Foss, Bjørn Oscar Hoftvedt
Changes to German medical education
:
surgeons.
handed down . in December, but except for senior surHealth Minister Horst Seehofer has proposed yet another medical education geons, it makes no definite decision about reform. It has long been accepted that hourly pay rates. However, it is expected medical students in Germany receive that present (pre-Hungerford) rates will insufficient clinical training and that the not be reduced and that specific adjusttraining period is too long. The changes ments will improve them.: introduced in recent years have been : Moscow’s minor, such as more oral examinations. mountain Seehofer is not proposing too drastic a remedy. He intends to reduce the number of medical students by 20%. This The shortage of drugs and pharmaceutical proposal is widely welcomed, and even products in Russia has become, over the criticised as being too cautious by Dr past few years, a matter of much intemaKarsten Vilmar, head of the Federal tional concern. But not all drugs are in Medical Council, who is arguing for a short supply. Moscow, it seems, has man50% cut. Seehofer wants to reduce the aged to accumulate an "aspirin mounnumber of examinations from four to tain". In 1992, Moscow’s Main Medical three. Oral examinations should carry Board spent one-sixteenth of the city’s more weight than the multiple-choice tests total budget on aspirin from the German which will, despite severe criticism, not be Bayer company. Bayer’s products, The latest
judgment
was
aspirin
abandoned. : Under the new proposals students will receive clinical teaching in their first two years. The aim is to combine preclinical with clinical thinking. There will be more tutorials and bedside teaching with a smaller number of students. Problemoriented learning, as already practised in a few universities in Germany (see Lancet May 8, 1993, p 1206), is taken: as a model. Seehofer further suggests
though
On Feb 1, senior surgeons’ hourly rates will rise from$136 to$142 with upward adjustment for leave, superannuation, and ongoing practice costs (those costs of a surgeon’s practice that continue while they treat public patients), which are presently being negotiated. New rates for other senior specialists (anaesthetists and physicians) also have not yet been decided. Hourly rates for other classifications of VMOs are: specialists (less senior surgeons, anaesthetists, and physicians) $128; general practitioners with ten years or more of experience$109; GPs with between five and ten years’ experience $91; and GPs with less than five years’ experience,$83. All these rates are expected to be augmented by adjustments for annual leave, sick leave, superannuation, and practice costs, following AMA representation with the Department of Health.
Peter
Harrigan
ber, which is officially in charge of the
city’s supplies of drugs, not consulted? Why were the details of the deal entrusted by the Board to a commercial firm that had no experience or competence in the pharmaceutical industry? The Main Medical Board claims that 70% of the aspirins purchased from Bayer have already been used. But Vladimir Gurvich, the medical affairs correspondent of Nezavisimaya Gazeta maintains that a random spot check of Moscow hospitals indicates that the opposite is true.
Meanwhile, according to Healthprom, undoubtedly considerably superior to the the newsletter of the London-based AssoRussian aspirins, cost ten times more.
And the size of the order outstripped all . reasonable demand. Moscow’s Hospital Number 7, for example, which uses about 500 packs of aspirins a year, now has over 2500 in its pharmacy, and is unlikely to get through half of them by the time their shelf-life runs out in 1995. : The pro-reform daily Nezavisimaya : Gazeta is asking pertinent questions about the "mountain". Why, it wants to know, : did the Main Medical Board, which is not supposed to involve itself in commercial transactions, do so much to foster the deal? Why was the Pharmaceutical Cham-
ciation for the Promotion of Healthcare in the Former Soviet Union, Bayer has signed an agreement to supply machinery, equipment, and know-how for the production of aspirin and other non-prescription drugs in Russia as part of a joint venture with Suromed (Switzerland) and a Russian hospital and pharmaceuticals association. The first aspirins to be produced under this deal will go on the market in the next few months. With Bayermade aspirin available in Russia, such lavish over-ordering should be avoidable.
National Board of Health, Michael von Magnus, said that the board expects every : doctor to do his duty. He admitted that it : The register, started 15 months ago (see is virtually impossible for the board to Lancet 1992; 340: 901), has more than ensure compliance with the law. : 62000 entries. When in doubt about a Several doctors claim the register is : patient’s wishes on whether or not to be unnecessary, but not so the chairman of subjected to prolonged life-saving efforts the Danish Medical Association, Torben when the prognosis is hopeless, doctors Pedersen, who agreed that in most cases have a legal obligation to contact the regknowledge of the patient’s wish is obtainister by telephone. : able from the patient or from relatives, "so . Very few doctors, however, consult the situations where it might be relevant to register. During the first year only 65 contact the life-will register very seldom
should be kept, even if it is both troublesome and expensive". Euthanasia is forbidden in Denmark. But it is common practice among doctors to avoid unnecessary, life-prolonging efforts. No authority would take action if, for example, morphine given to keep a
emphasis on certain topicsgeriatrics, pharmacotherapy, quality assurincreased
ance, and health economics.
Annette Tuffs
Danish
inquiries
register of
were
made. In
life-wills
commenting on
this very small number the chief of
occur.
But
as
thethe security
long of
a
as
people
life-will,
seem to
the
Vera Rich
dying
nearly-dying patient pain-free patient’s life. According to von Magnus, the law on life-wills and the register were introduced primarily to bring legislation in line with practice. or
were to
shorten the
want
register
Kaare Skovmand
167