Research competency and specialist registration: Quo vadis ?

The requirement of 'research completion' as necessary for specialist registration with the Health Professions Council of South Africa (HPCSA) has recently been subject to legal action, with a court order potentially shifting requirements beyond those envisaged by the HPCSA. The research requirement is congruent with National Department of Health strategy in this regard, i.e. the strengthening of research as a stated priority. While the expectation of research competency is not in itself contentious, the capacity of institutions and the ability of registrars to facilitate and complete, respectively, have brought the issue into focus. Specifically, the apparent discrepancy between a court order and a regulation needs to be resolved to ensure that specialist registration is not unduly hampered, while ensuring that a potentially important contributor to a national priority is not prejudiced.

Chronic pancreatitis, depression and substance use disorders: A not uncommon combination.

Chronic pancreatitis (CP) is a progressive and debilitating disease. A potentially important consideration is the relationship between CP, depression and substance use disorders, which seems to be circular and multiplicative. Pain management is a critical component of intervention, and it would seem that in the context of chronic illness this requires a biopsychosocial approach aiming for a tailored intervention that strikes an appropriate therapeutic balance.

Defining and Measuring Spirituality in South African Specialist Psychiatry.

To define the meaning of "spirituality" in a South African phenomenological, theory-generating qualitative inquiry, theory construction methodology was used. This refers to the tradition of nursing theory development, where a central core concept identified from the integrated data-in this case, interviews and the literature content-had to be defined. A major focus of the study was to distinguish spirituality from religion. The denotative and connotative meanings of "spirituality" were explored to establish the components for a definition. The attributes of this definition included that spirituality constitutes a "quality", a "journey", a "relationship" as well as a "capacity". While these items derived from this local definition of spirituality can be proposed for inclusion in a questionnaire for measuring spirituality in a South African context, the limits of the scope of the explorative qualitative inquiry from which it was derived must be considered.

The role of spirituality in specialist psychiatry: a review of the medical literature.

A review of the international medical literature was undertaken on the role of spirituality in the discipline of psychiatry, within the context that a perceived change is taking place in the health care environment in South Africa. Revitalized interest in spirituality was evident from the literature partly because Western societies have, through the migration of people, become more heterogeneous in recent years. The literature concurred that spirituality must be incorporated into the current approach to the practice and training of psychiatry, but within the professional scope of the discipline, while all faith traditions and belief systems should be regarded equally. Beyond South Africa, it is envisaged that the review has implications for the practice of psychiatry in Africa.

Meanings of thinness and dysfunctional eating in black South African females: a qualitative study.

OBJECTIVE: This study qualitatively explored local meanings of thinness and dysfunctional eating in black adolescent females in the rapidly westernizing socio-cultural context of post-apartheid South Africa. METHODS: Four (n=4) urban state highschools in KwaZulu-Natal were selected from which 40 subjects were sampled from Grades 9-12. Focus groups were conducted following a semi-structured interview and analysed using Constant Comparative Analysis. RESULTS: Subjects reported a wide range of different meanings for thinness, which included traditional idioms of distress and typically western pressures towards thinness, which was particularly evident in the multicultural schools. Subjects also reported a wide range of dysfunctional eating practices (such as purging) which were underscored by a wide range of motivations, including traditional practices and western body image concern; and which did not tend to follow patterns of 'dieting' that are typical in affluent, western societies. CONCLUSION: Western pressures towards thinness may be blending with traditional idioms of distress and culturally sanctioned rituals of remedial purging and social over-eating, thereby placing this group at particular risk for a range of dysfunctional eating patterns that may not follow typically western paradigms or diagnostic systems.

Surgeons and HIV: South African attitudes.

OBJECTIVES: The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. DESIGN: A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding their attitudes to the preceding issues. RESULTS: The salient findings included the view that a patient-centered approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. CONCLUSION: Patient-centered approaches and restrictive policies, related to this issue, do not accord with clinician sentiment. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines.

Surgeons and HIV: South African Attitudes

Objectives. The HIV status of surgeons; in the context of the informed consent obtained from their patients; is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. Design. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa; regarding their attitudes to the preceding issues. Results. The salient findings included the view that a patientcentred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients; and that HIV-positive surgeons should determine their own scope of practice. Conclu- sion. Patient-centred approaches and restrictive policies; related to this issue; do not accord with clinician sentiment. In the absence of comparable local or international data; this study provides clinicians' views with implications for the development of locally relevant policies and guidelines

The impaired practitioner - scope of the problem and ethical challenges.

Practitioner impairment occurs when a physical, mental or substance-related disorder interferes with his or her ability to engage in professional activities competently and safely. The Health Professions Council of South Africa makes reporting of impaired colleagues and students mandatory. The ethical dilemma faced by many colleagues on the issue of reporting an impaired practitioner is that of having to choose between protecting the privacy of the practitioner and the safety of patients. However, medicine as a profession with an acknowledged fiduciary relationship has a clear responsibility to assure the public, and all patients, that its practitioners and institutions are trustworthy. An awareness of and sensitivity to physician vulnerability and early detection and prevention of impairment is important.

HIV-positive status among surgeons - an ethical dilemma.

HIV/AIDS is a manageable disease with a reasonable expectation that affected individuals might be able to experience both reduced mortality and morbidity. Within the socio-political context of the illness there has been a very strong emphasis on human rights issues, especially in relation to discrimination, which has seemingly been influenced more by emotion than science. This article explores and addresses the potential risk of an HIV-positive surgeon transmitting the virus to a patient. We argue that the Centers for Disease Control (CDC) and Health Professions Council of South Africa (HPCSA) guidelines are too restrictive, especially against a background of limited transmission risk, and hence that these guidelines could be more harmful than beneficial to our health systems.