by the Public Health Department. The patient was subsequently discharged with her usual insulin dosage and without addi¬ tional therapy. Comment—The
diabetic
back¬
ground of our patient may have made
her more prone to this type of infec¬ tion. As in the previously reported case, the possibility also exists that this organism was a saprophyte in a chronically inflamed sinus. C. Jack Bark, MD Lawrence J.
Zaino, MD
Kay Rossmiller, MT C. Leroy Cooper, MD Alvarado Community Hospital San Diego
Medical Care and Education in Australia
To the Editor.\p=m-\Iread with interest the comments of Joseph A. Buckwaiter, MD, concerning medical care and education in Australia (239:2491, 1978). I noted that his overall impression of Australian medicine was favorable. I have recently completed a year in Australia where I was associated with university and medical centers in both Melbourne and Sydney. I would heartily agree with Dr Buckwalter in his overall conclusions. However, there are certain points that Dr Buckwalter did not raise in his comments that are perhaps germane to the current discussion for medical planning in the United States. In my role as Senior Lecturer Ophthalmology at the University of Sydney, I was impressed that the general interest of registrars in training exceeded that of the general interest seen in even the best residency programs in this country. This is not due to any difference in quality of personnel. However, there is a very real difference in the practice oppor¬ tunities that an ophthalmologist-intraining can anticipate in Australia. Even in the urban centers such as Adelaide, Melbourne, and Sydney, the concentration of ophthalmologists no¬ where approaches the concentration
relatively sophisticated in dealing with problems that might ordinarily be thought to be those seen only in teaching centers in this country. This»experience in a country where physicians in my specialty can antici¬ pate an active and interesting prac¬ tice has prompted me to examine the situation more carefully here in my own country. At least in the specialty of ophthalmolgy it would appear that the prospects for the young ophthal¬ mologist-in-training are much less
in the major urban centers on the east and west coasts of this coun¬ try. For this reason, ophthalmic
registrars fully expect to see most medical and surgical problems within the realm of eye diseases, including
of the diseases that would be considered rare. Since the tendency for referral to university centers is much less established in Australia, many of these difficult cases will be handled at a local level. Thus, most ophthalmologists in Australia are some
care. Donald A. Hammel, MD Robinson Memorial Hospital
rosy than in Australia. This is not
reflected financial
much in differences in income, but rather in the and interest in the nature of
diversity clinical practices. Thus, many young ophthalmology residents I meet in this country are concerned primarily with where they may find someplace to practice, rather than in acquiring additional information in the residen¬ cy to be as broadly experienced in
ophthalmology as possible.
I am concerned that many special¬ ties in America, and perhaps even general medicine in the near future, are overcrowded. While some forces in our country see this as a threat to the income of physicians, I am much less concerned by this factor than by the general decline in the intellectual excitement to be found in a general clinical practice. I believe we must take a careful look at medical systems like Australia, where the lessons to be learned may be somewhat ego shat¬ tering but nevertheless essential. Creig S. Hoyt, MD San Francisco
Bed-Population Ratios To the Editor.\p=m-\Thearticle "Health Services in the Netherlands" (239:
1558, 1978) quotes hospital
usage
figures of 1.688 inpatient days per 1,000 population and an average length of stay of 16.6 days. Calculation, using an average occupancy of 90%, results in a bed-population ratio of 5.14 beds per 1,000.
85%, care
Ravenna, Ohio
so
of
seen
nizations and Health Systems Agencies are attempting to do), why, then, are the bed-population guidelines issued by the Department of Health, Education, and Welfare (DHEW) more than 20% lower? It strikes me that DHEW figures might just be influenced more by what is consid¬ ered a desirable budget level (ration¬ ing) rather than an accurate assess¬ ment of what is an optimum level of
(At
figure often quoted by health planners as desirable, the figure a
is 5.44.) Since this is the
requirement for a modern, industrialized, progressive, fairly homogenous population, determined by experience and where a
well-established system of government monitoring "directs its attention particularly toward quality of services, sufficient and efficient facilities, and use of these facilities for both inpatient and outpatient services" (much as our developing Professional Standards Review Orga-
Hysterectomy and Normal Menses?
To the Editor.\p=m-\Hasanyone called
attention to the apparent error in the article "Corpus Luteum Hemorrhage" (239:2270, 1978)? In case 3 (middle column of p 2271), Drs Waxman and Baird state that the patient had a hysterectomy, but the last line of the case report says: "Normal menses has returned." Reminds me of that old column filler in the New Yorker magazine entitled "Our Forgetful Authors." Arthur F. Greenwald, MD Palm Springs, Calif
Pseudomonas From Whirlpool.\p=m-\ \p=m-\In the June 2 issue of The Journal (239:2362-2365, 1978), the BRIEF REPORT "Pseudomonas Folliculitis Acquired From a Health Spa Whirlpool" should have referred to the association of Pseudomonas aeruginosa with the green nail syndrome, not the blue nail syndrome, in the first paragraph. In addition, on page 2364, column 3, the last sentence of the second complete paragraph should have reported that Pseudomonas organisms were found in pools that measured 0.3 ppm chlorine or less, not 0.7 ppm chlorine or less.
Upside-down Scintigrams.\p=m-\ In the Aug 4 issue of The Journal, the film for the scintigrams (Fig 1 through 4) was incorrectly turned 180\s=deg\placing Fig 1 in the position of Fig 4 in the CLINICAL NOTE "Discrepancies Between Iodine and Technetium Thyroid Scintigraphy" (240:463-464, 1978). The legends were correctly positioned.
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/09/2015
diabetic
back¬
ground of our patient may have made
her more prone to this type of infec¬ tion. As in the previously reported case, the possibility also exists that this organism was a saprophyte in a chronically inflamed sinus. C. Jack Bark, MD Lawrence J.
Zaino, MD
Kay Rossmiller, MT C. Leroy Cooper, MD Alvarado Community Hospital San Diego
Medical Care and Education in Australia
To the Editor.\p=m-\Iread with interest the comments of Joseph A. Buckwaiter, MD, concerning medical care and education in Australia (239:2491, 1978). I noted that his overall impression of Australian medicine was favorable. I have recently completed a year in Australia where I was associated with university and medical centers in both Melbourne and Sydney. I would heartily agree with Dr Buckwalter in his overall conclusions. However, there are certain points that Dr Buckwalter did not raise in his comments that are perhaps germane to the current discussion for medical planning in the United States. In my role as Senior Lecturer Ophthalmology at the University of Sydney, I was impressed that the general interest of registrars in training exceeded that of the general interest seen in even the best residency programs in this country. This is not due to any difference in quality of personnel. However, there is a very real difference in the practice oppor¬ tunities that an ophthalmologist-intraining can anticipate in Australia. Even in the urban centers such as Adelaide, Melbourne, and Sydney, the concentration of ophthalmologists no¬ where approaches the concentration
relatively sophisticated in dealing with problems that might ordinarily be thought to be those seen only in teaching centers in this country. This»experience in a country where physicians in my specialty can antici¬ pate an active and interesting prac¬ tice has prompted me to examine the situation more carefully here in my own country. At least in the specialty of ophthalmolgy it would appear that the prospects for the young ophthal¬ mologist-in-training are much less
in the major urban centers on the east and west coasts of this coun¬ try. For this reason, ophthalmic
registrars fully expect to see most medical and surgical problems within the realm of eye diseases, including
of the diseases that would be considered rare. Since the tendency for referral to university centers is much less established in Australia, many of these difficult cases will be handled at a local level. Thus, most ophthalmologists in Australia are some
care. Donald A. Hammel, MD Robinson Memorial Hospital
rosy than in Australia. This is not
reflected financial
much in differences in income, but rather in the and interest in the nature of
diversity clinical practices. Thus, many young ophthalmology residents I meet in this country are concerned primarily with where they may find someplace to practice, rather than in acquiring additional information in the residen¬ cy to be as broadly experienced in
ophthalmology as possible.
I am concerned that many special¬ ties in America, and perhaps even general medicine in the near future, are overcrowded. While some forces in our country see this as a threat to the income of physicians, I am much less concerned by this factor than by the general decline in the intellectual excitement to be found in a general clinical practice. I believe we must take a careful look at medical systems like Australia, where the lessons to be learned may be somewhat ego shat¬ tering but nevertheless essential. Creig S. Hoyt, MD San Francisco
Bed-Population Ratios To the Editor.\p=m-\Thearticle "Health Services in the Netherlands" (239:
1558, 1978) quotes hospital
usage
figures of 1.688 inpatient days per 1,000 population and an average length of stay of 16.6 days. Calculation, using an average occupancy of 90%, results in a bed-population ratio of 5.14 beds per 1,000.
85%, care
Ravenna, Ohio
so
of
seen
nizations and Health Systems Agencies are attempting to do), why, then, are the bed-population guidelines issued by the Department of Health, Education, and Welfare (DHEW) more than 20% lower? It strikes me that DHEW figures might just be influenced more by what is consid¬ ered a desirable budget level (ration¬ ing) rather than an accurate assess¬ ment of what is an optimum level of
(At
figure often quoted by health planners as desirable, the figure a
is 5.44.) Since this is the
requirement for a modern, industrialized, progressive, fairly homogenous population, determined by experience and where a
well-established system of government monitoring "directs its attention particularly toward quality of services, sufficient and efficient facilities, and use of these facilities for both inpatient and outpatient services" (much as our developing Professional Standards Review Orga-
Hysterectomy and Normal Menses?
To the Editor.\p=m-\Hasanyone called
attention to the apparent error in the article "Corpus Luteum Hemorrhage" (239:2270, 1978)? In case 3 (middle column of p 2271), Drs Waxman and Baird state that the patient had a hysterectomy, but the last line of the case report says: "Normal menses has returned." Reminds me of that old column filler in the New Yorker magazine entitled "Our Forgetful Authors." Arthur F. Greenwald, MD Palm Springs, Calif
Pseudomonas From Whirlpool.\p=m-\ \p=m-\In the June 2 issue of The Journal (239:2362-2365, 1978), the BRIEF REPORT "Pseudomonas Folliculitis Acquired From a Health Spa Whirlpool" should have referred to the association of Pseudomonas aeruginosa with the green nail syndrome, not the blue nail syndrome, in the first paragraph. In addition, on page 2364, column 3, the last sentence of the second complete paragraph should have reported that Pseudomonas organisms were found in pools that measured 0.3 ppm chlorine or less, not 0.7 ppm chlorine or less.
Upside-down Scintigrams.\p=m-\ In the Aug 4 issue of The Journal, the film for the scintigrams (Fig 1 through 4) was incorrectly turned 180\s=deg\placing Fig 1 in the position of Fig 4 in the CLINICAL NOTE "Discrepancies Between Iodine and Technetium Thyroid Scintigraphy" (240:463-464, 1978). The legends were correctly positioned.
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/09/2015
