Month: May 2018

A letter to the AMA: Mandatory sentencing

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By Seamus Horan

In 2014 the Victorian Liberal government instituted six-month mandatory minimum jail sentences for people who assault emergency service workers, except where there are “special reasons” not to impose it. In December last year two women were found guilty in the Magistrates Court of assaulting a paramedic and, as per the mandatory laws, were sentenced to prison. On appeal this month, the County Court overturned this decision on the basis of the “special reasons” exemption.  Those reasons related to difficult backgrounds, mental health and dependent children. This prompted an outcry from Ambulance Victoria paramedics, who have called for the mandatory minimum sentencing laws to be tightened, with “It’s not OK to assault paramedics” painted onto ambulances across the state. In response, the Victorian Premier Daniel Andrews has promised to tighten mandatory sentencing laws.

In a newsletter from 17 May 2018, the AMA conveyed their “profound disappointment” in the removed jail sentence for the two women, and called upon the government to send a “strong message” that “such acts [should] be met with the mandated penalty”. In response, Seamus Horan wrote the following letter exploring the effect of mandatory sentencing.

I refer to your email newsletter from 17 May 2018 regarding penalties for attacking healthcare workers, specifically discussing the recent assaults against paramedics. I was surprised to read that the AMA is supportive of mandatory sentencing.

Healthcare workers have a right to be safe at work, and often this right is not met. Tragedies in the last year alone have shown us the devastation that attacks on healthcare workers can have. As the peak body representing medical practitioners and students in Australia, the AMA has a responsibility to advocate for change that will make us safer. Advocating for mandatory sentencing does not achieve this.

The AMA supports evidence-based medicine, however it appears this outlook does not extend to the legal system. The evidence indicates that mandatory sentencing fails to produce the desired result of deterring crime, and comes at high social and economic costs. The Law Council of Australia found that mandatory sentencing results in unjust sentences where the punishment does not fit the crime, and that by their very design they disproportionately impact particular groups within society. These groups include Indigenous peoples, juveniles, people with mental illnesses and cognitive impairment, and those who are impoverished. Indeed, in 2000 the United Nations condemned mandatory imprisonment legislation in Western Australia and the Northern Territory for its disproportionate effect on Indigenous Australians, acknowledging the negative health consequences, as well as the social and legal impacts.

If we were to compare the legal system to the medical system for a moment, imagine the medical equivalent of mandatory sentencing. Mandatory clinical guidelines would be unthinkable in medicine. There would be an outcry if they were imposed, particularly if they were imposed by politicians spurred by popular demand. Clinicians would rightly say that the specific circumstances of individual patients should influence which treatment is recommended. This is the job of doctors – if we follow mandatory clinical guidelines, what is the point of having doctors?

Mandatory sentences are unjust because by their design they similarly ignore the circumstances of individuals and lead to unjust results. If we have mandatory sentences, what is the point of judges? Why allow discretionary judgement in any profession? By weakening public confidence in our justice system in this way, we only weaken ourselves.

For further detail of the substantial evidence that mandatory sentencing leads to unjust outcomes and fails to deter crime, I refer you to the article below.

In the era of Fake News and political scepticism, our institutions are under intense pressure. The AMA has the potential to play a moderating role, to champion evidence-based policy and confront populist politics. By supporting mandatory sentencing, the AMA has done the opposite.

Regards,
Seamus Horan

Articles:

Sentencing Matters: Mandatory Sentencing, 2008, Sentencing Advisory Council, Victoria
AMA Media Release

Featured image from WorkSafe Victoria 

A Letter to my Year A Self

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Anonymous Author

To My Year A Self,

You’ve just arrived in Churchill and it is not what you expected it to be. When you thought “rural” you pictured rolling hills and gumtrees. You did not picture a somewhat post-apocalyptic landscape marred by a coal mine, and fields bathed in the glow of the power stations. When you thought “country town” you thought of a tight-knit, friendly community. You will be shocked to realise that several med houses have already been robbed.

You’ll walk to the main shopping area, which will take approximately 3 minutes to explore. The dining options are limited, but you’ll comfort yourself with the fact that you’ll spend less energy thinking about what to eat and therefore have more energy to study. It’s kind of like how Obama only had blue or grey suits, so he’d spend less time choosing what to wear and more time making other important decisions. Kind of.

You’ll meet everyone, make some friends and go to your first lecture, only to be told it will be your last. You’ll be hit with the “flipped classroom model” and “lectorials” and be asked far too many times if you’re #medready. The flipped classroom in year A means that you’ll be watching lectures online and coming to tutorials ready to discuss what you’ve learnt- so basically what you did in undergrad when you didn’t feel like physically turning up to lectures. The first few weeks will be spent conducting a complete overhaul of your learning style, resigning yourself to the fact that flashcards are the only way you’re going to be able to memorise all the content they’ve thrown at you.

You took anatomy for a whole semester a couple of years ago, but as you look at the cadaver in the anatomy lab you will question where all the knowledge from your Biomedicine degree has gone. You will mistake a nerve for a tendon and feel your head start to throb, partially from stress and partially because of the formaldehyde.

On some days you will drink your weight in coffee to make up for your lack of sleep. For some godforsaken reason Federation University’s student society has decided to host parties in the building behind your room on Wednesday nights- the night before clinical skills days and hospital placements. Invest in some earplugs and try to go to bed at a reasonable hour. It is your only hope of getting a good night’s sleep and curbing your caffeine addiction.

When you meet your first patient in the hospital your ability to talk to another human being will promptly disappear. It will take a few more clinical encounters for you to realise that you can just talk to patients in the same way you would talk to another adult. You’ll learn how to build rapport and feel like you’re helping them, even though you have no formal role in their care. You’ll feel like you’re helping because they’ll tell you how happy they are to be contributing to your education, and at this point you’ll be taking all the encouragement you can get.

Although this year is going to be tough, I assure you that there will be time to laugh and enjoy this crazy journey. You’ll join a mixed netball team and realise that you are probably the worst netball player in history, but you’ll love playing all the same. You’re going to make some great friends, who will be there to support you when you’re struggling- academically or otherwise- because they’re all going through the same thing. You’ll motivate each other to study and run marathon OSCE sessions at each other’s houses. After exams are done you’ll play Cards Against Humanity, which will make you laugh until you can hardly breathe and will help you forget the horrendous history you took in station 3.

You’ll realise you must take care of yourself if you want to stay afloat this year, and you’ll realise this somewhere between polishing off a Woolies chocolate mud cake and opening another bottle of wine. Eating breakfast will become part of your morning ritual and will give you enough energy to get through lectorials. Going to the gym will become a daily habit as well, and it will be a welcome break between finishing class and going home to study. You’ll discover the life-changing concept of cooking in bulk and will be thankful for all the time you have saved, especially during exam time.

Although this isn’t what you thought medical school would be like, you’ll be grateful for the people you have met and the knowledge you have gained. As you move into your clinical years you’ll still feel a strange affinity for Churchill, and whenever someone mentions they also did year A there, you’ll exchange a knowing look and swap some funny stories. This year will be one of the most challenging, stressful and rewarding years of your university life. So, unpack your things, call your mum to let her know you’re safe, and take a deep breath. You’re going to be just fine.

 

Rainbow Doctors: The experience of one queer med student

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By Chris Hardy

Content warning: harsh language, distressing scenarios

“Oh, look at that cute little baby!” I said, walking through the halls of the hospital. No sooner had the words left my mouth when the guttural cry of a complete stranger snaps me back to reality, with words that I have heard all too often: “Fucking faggot.”

How lovely. Exactly what I wanted to hear on that Wednesday morning, right between ward rounds and my regular morning coffee.

The shock of being called such a name never wears off, no matter how often you have it thrown at you. Whether it is out of a car window, in a club, or just walking down the street holding your partner’s hand, it still leaves a hollow, cold sensation running through you and a fear of what will happen next. Will they just move on? Will they spit on me, throw their drink on me, hit me? In that moment, all possibilities are considered and feared over.

Don’t get me wrong though. We all develop a thick skin, especially as medical students. We are constantly being yelled at, abused, and underappreciated by both patients and colleagues alike. Falling to pieces every time someone is mean to you is just not practical. But to have such an integral part of your identity, a part that you may still be coming to terms with, be attacked is devastating. Some attacks are not as openly hostile, like the double take of people when you walk down the street and the deliberate lack of questions regarding relationships at the dinner table, but are still just as damaging.

I am in the GP clinic, talking with a patient about a mundane issue that was quickly resolved in the first 5 minutes leaving the next 25 for small talk. Same sex marriage comes up, and I cringe internally. The patient’s face crumples into a grimace and the familiar arguments brought forward; what will it lead to, gays are diseased, God doesn’t agree with these choices. The once quite pleasant patient is now a hatred-spewing entity who disagrees with a core part of my being. I look impartial and listen like we are told to do, until the onslaught is over and the patient returns to their normal state. “Now then, what about you? Have you got a special girl?”

People are often shocked when I tell them about what has happened to me just because I am gay. Some don’t believe me and think I am overdramatising things: “Surely that is a thing of the past? No one thinks like that anymore!”

Wouldn’t it be nice if that were true? Wouldn’t it be a much happier world if we just didn’t care about this stuff and let people live? Such a cliché and I legit feel like a dick writing it, but we can all have a dream. I would really just be happy with some more queer representation in the curriculum or a focus on the unique issues surrounding queer health to be honest. It is impossible to change people’s minds, but it is possible for us as future doctors to help make the world just a little bit less shit for those who are different.

Don’t assume someone’s sexuality or gender identity, don’t assume they aren’t struggling, and don’t assume that you will never encounter queer people. We exist, we are your friends and patients and colleagues. Don’t forget about us.

Featured image from Pixabay