Life in the Emergency Lane


This talk was brought to you as part of the biannual When I Grew Up series hosted by the Australian National University Medical Student Society. Our guest speaker is Professor Caldicott, who is an Emergency Department Consultant at the Calvary Hospital ACT. It is one of the most heartfelt and genuine talks that we believe all medical students and junior doctors should hear. There are so many pearls of wisdom about living and surviving as a doctor that we can all learn from. This is a raw, honest and entertaining reflection from a senior clinician practicing in one of the most challenging and exciting fields in medicine.

Our Guest Speakers Bio

Professor David Caldicott who is an Emergency Consultant at the Calvary Hospital and a Clinical Senior Lecturer in the Faculty of Medicine at the ANU. He is a spokesperson for the Australian Science Media Centre on issues of illicit drug use and the medical response to terrorism and disasters.

Professor Caldicott designed and piloted the Welsh Emergency Department Investigation of Novel Substances (WEDINOS) project in the UK, a unique program using regional emergency departments as sentinel monitoring hubs for the emergence and spread of novel illicit products. He is currently replicating this work in Australia with the ACT Investigation of Novel Substances (ACTINOS) Group.

MSK 22 – What is Osteoarthritis?

Osteoarthritis of the hip joint. Right side worse than the left with a loss of joint space + subchondral sclerosis and geodes. Remodelling is also present in the hip joint.

Osteoarthritis of the hip joint. Right side worse than the left with a loss of joint space + subchondral sclerosis and geodes.
Remodelling is also present in the hip joint.

Case courtesy of Dr Frank Gaillard, From the case rID: 35875

so, What is osteoarthritis?

OA is characterised by the loss of cartilage in synovial joints leading to changes in the periarticular bone.¹ Interestingly there’s more evidence of an inflammatory component to it’s pathology rather than just purely wear-and-tear.

Interesting and important fact:

Only advanced damaged from OA show up on X-rays.¹ Other investigations such as arthroscopy and MRI may be able to show damage in earlier stages.

For more information Listen to the episode:




  1. Kumar P, Clark M (eds.) Clinical medicine. 7th ed. Edinburgh: Elsevier Saunders; 2009. p.518-521.

Additional Reading:

Professor Stephen Leeder


Image Courtesy of

Prof. Leeder’s address to ANU medical students

Interview with Prof. Leeder

There’s this parable about an accountant to an affluent family that had recently lost their stereotypically shrewd businessman father. Because the rest of the family didn’t know anything about the business or finances, the generous soul volunteered to help manage their inherited wealth for them. Of course, he remained the biggest benefactor to the wealth, sparing just enough for the family to get by and not burden themselves into investigating why their lifestyle took a bigger blow than the father did from the oncoming train.

Earlier this year, Prof. Stephen Leeder was let go from the Medical Journal of Australia; for raising objections about the decision to outsource production of the magazine to the academic publishing company, Elsevier. In summary, the company has been implicated in practices that threaten academic integrity. Fears are that the Dutch company will threaten the autonomy in the quality of papers submitted; a result of the increased role that the company will have over the production of the journal.

Continue reading

MSK14-Systemic Lupus Erythematosus

Typical 'malar' or butterfly rash in SLE showing across the nasal and cheeks

Typical ‘malar’ or butterfly rash in SLE showing across the nasal and cheeks

Systemic Lupus Erythematosus is an autoimmune disease involving multiple organs. Antibody testing include Antinuclear antibodies (ANA), antiphospholipid antibodies, antibodies to double stranded DNA (dsDNA) and anti-Smith (Sm) antibodies.  

Note: ANA is highly sensitive, but not specific. A positive anti-dsDNA and anti-Sm are highly specific antibodies for Lupus.

Find out the pathophysiology and the diagnostic criteria from this episode!

Rural and Indigenous Healthcare

As a young health professional, I have practiced and worked in a diverse range of settings and have had the opportunity to experience a variety of roles prior to entering medical school. I’ve come to ponder upon the future of healthcare in Australia and the current trajectory and circumstances. Whilst, I acknowledge that my view is not conclusive and am not attempting reprimand or critique rather to highlight the issues that are explicitly evident in the healthcare system.

My first concern relates to the state of rural and indigenous healthcare. I have worked within the hospital setting both in Central Australia and rural South Australia. Indigenous health is a passion of mine and we are all well aware of the challenges faced by practitioners intent on closing the gap. Rural healthcare, of which indigenous health is an integral component is faced with enormous obstacles. There is an evident lack of resources and facilities that creates difficulties in delivering optimal care to patients.

Furthermore, it is a challenge to recruit and retain health professionals to stay long-term and to help address these health disparities, thereby creating long waiting periods that progress and complicate health status of patients. Moreover, the vastness of this magnificent continent generates logistical challenges in delivering care. Patients often travel long distances or may not have access to transport to seek help.

Of indigenous health so much requires attention. Most obviously the communication and cultural barriers that impede and disconnect the patients from their health professionals. In addition the social factors that create a revolving door approach to healthcare. Factors such as inadequate accommodation, nutrition, employment and education are essential to maintaining good health. What of the cultural unpreparedness of health professionals dealing with indigenous patients? How can we integrate contemporary medicine with indigenous health concepts and spirituality? Hope is not lost, mainstream Australia is awaken to the ever widening health disparities…

Another major issue is the ageing population of Australia. This dilemma is confronted by many other countries and is not unique to Australia. Advances in medicine have led to improvements in quality of life and increased life expectancy of patients. The ageing population will be placing enormous demands on resources, trained staff and healthcare accessibility. The issues are complicated by an ever-growing list of new and costly therapeutics that place further pressure on finite resources. Is the current healthcare system prepared for the future? Are patients and health professionals positioned to accept the limitations of the current model and finite resources?

Related to the previous paragraph is the growth of chronic and lifestyle diseases that are becoming more prevalent in younger adults and children. We are faced with a growing epidemic of obesity, diabetes and Cardiovascular disease. These iIllnesses were absent in or less prevalent in previous generations of similar age group. This places further pressure on resources and management of complications associated with these conditions. Nevertheless, hope is not lost and positive steps in the right direction are being taken….More on that in my next update.

Interview Techniques

I mentioned before preparing for medical school interviews is really important. Don’t listen to people who advise otherwise. Leading up to the interviews I was practising on a nightly basis with whoever was willing to put up with me!

When you practice you need to develop techniques to ensure that you tackle interview questions efficiently and comprehensively, whilst avoiding the risk of sounding rehearsed. Sounding rehearsed is less likely to occur for MMI style universities but can be a major issue with traditional panel interviews. However, with the following strategy I found it reduced the risk of sounding rehearsed for any interview style.  

  • Situation – describe the situation or the context that you had found yourself.
  • Task – What were your tasks  that you had to tackle in the scenario that you have outlined
  • Activity – How did you go about achieving the tasks that you set out for yourself
  • Result – What were the outcomes of your activities. Did you adequately resolve the scenario if not why? What did you learn from the experience.

As you can see using this approach enables much greater focus and structure whilst reducing the risk sounding rehearsed. I’ve found that I was able to address many questions that were asked during the interview. The structure also ensure that your answers are clear and succinct (so you don’t waste time babbling on).

There is also an approach that you can employ the tackle the ethical scenarios that may be asked. The approaches is inspired by the Hippocratic Oath.

Consider these scenarios with the following ethical frameworks:

  • Justice: any approach you propose to tackle the ethical scenarios must be ensure that it fits within the law (so long as the law is within reason e.g killing a population because it is enshrined in the law is not an adequate excuse for the action – refer to the Nuremberg Trials and Nazi experimentation)
  • Autonomy: refers to respecting the patient’s right to choose the course of their life without external interference, e.g you can’t normally a force a treatment onto a patient.
  • Beneficence: you’re actions should be of benefit to the patient and or the individuals involved in the scenario
  • Non-Maleficence: do no harm (pretty self explanatory)  

If you get issues relating to consent or a scenario trying to explore your understanding consent you can approach this by considering the following points:

  • Informed: does the patient or person understand the information you are providing them?
  • Capacity: does the patient or person have the capacity to comprehend the information you are providing them? For example is a child able to provide informed consent (read more about Gallick Competency).
  • Free from duress: did the patient/person consent under their own volition or were they influenced by family/friends.

What are Objective Structured Clinical Exams?

Before entering medical school, I had heard the term OSCE mentioned/referred to a number of times. I read a little about OSCEs but I had very little appreciation about what this type of examination is and how it is applied throughout the medical school examination process. Having now worked my through OSCE-like assessments, I would like to take this opportunity to discuss this examination technique for premed students who are curious about it. My impression is based on the ANU medical school assessments but I think the overall principles apply to most medical schools.

Throughout medical school you are being taught a wide range of clinicals skills, which are highly practical in nature. They are the fundamental skills that are used for examining/interacting with patients. These practical skills are different to the what is taught within practical classes (refer to practicals in medical school guide for an overview). Just like other aspects of the curricula it is important to assess students in the knowledge and application of these practical skills. The clinical skills can encompass discussing patient blood and biochemistry results to perform procedures/physical exams.

At the ANU medical school, a day is set aside to examine all students in the year level on these clinical skills. Students are divided into groups who are assessed over an hour. We have no idea what clinical skills will be examined on the day. However, throughout the semester you develop an appreciation for the key skills that are likely to be assessed in these exams (but you can always be surprised!). The exams start with students being taken to the clinical skills rooms. You are provided with a scenario outside (e.g a patient presents with chest pain, patient has noticed a lump, patient is complaining of a sore tummy in ED etc…). You read the scenario(s) that are provided with a minute or two to think about how to tackle the case.

You are then called into the room but before you can proceed with the clinical examination you will need to introduce yourself to the camera, which records your entire exam. The purpose of this is to ensure that you are in fact who you say you are and also the camera recording can help resolve any disputes about the marking of the examination. After completing this formal step the examiner may ask of you to perform the clinical skills (e.g cardioresp assessment) on the actor (or patient). You then introduce yourself to the patient, obtain consent for the procedure and begin the clinical examination. You have to be very efficient as you are under time pressure to perform the clinical exams. In each room you will be required to perform up to two exams or an exam and a viva (where you discuss a particular investigation or clinical scenario). Once your time is up you may need to sit down with the examiner to discuss your findings.

Otherwise you will be asked to leave the examination room in preparation for your next station. Usually in the adjacent room. You will be then asked to come into the next examination room to continue with the next set of clinical exams. So as you can see OSCEs are an efficient means of assessing a number of clinical skills within a relatively short period of time. These skills are important for your competency in the clinical years and beyond. Moreover, it is a tool by which the university can ensure that you are remaining up to date with the extensive range of clinical skills taught. I hope this article sheds a bit more clarity about OSCEs. Feel free to leave a comment or get in contact with us for further clarification.