should be 0.4/1000 and 0.2/1000 respectively.' Although they note that higher rates have been reported in single centre studies, they do not point out that these studies were prospective and would be expected to provide more complete data.

The consensus document concerning laparoscopic entry techniquesL states that all patients should be told of the risk of the possibility of injury to bowel, blood vessels, and bladder and that on present evidence the risk of all three may be in the region of 1-4 per 1000 cases. In addition, all patients should be informed of the pos- sibility of conversion to laparotomy and that on very rare occasions a temporary colostomy may be required.

When counselling patients it is important that gynae- cologists are consistent regarding the risks of visceral injury. The authors note that consensus opinions provide guidance and may be seen by the courts as effectively reference points in judicial decision-making.

Therefore, in terms of risk management I believe it is essential that clinicians are aware o f the recommendations concerning counselling contained in the consensus document.

Marsham Moselhi FRCS MRCOG, Specialist Registrar in Obstetrics and Gynaecology, Llandough Hospital, Penarth. South Glamorgan, CP64 2XX: UK. email: mmoselhia aol.com

References 1. KdlU G, Wright J . LdpdrOScopiC Surgery 2nd the law. %-he ObSk'f?kZUYZ

G Gynaecologist 2001;3:141L6. 2 . A consensus document concerning laparoscopic entry techniques:

Middlesbrough, March 19-20 1939. Gynaecological Er~doscopy 1999;8:403-6.

A LE'ITER FROM 'DOWN UNDER'

The sun is shining, the temperature is a balmy-24"C, and the deep blue water of the Harbour stretches out from the Conference Centre reflecting the Sydney skyline, punctu- ated by the superstructure of the Harbour Bridge and the Opera House sails. A typical October day at Darling Harbour where the 5th International Scientific Meeting of the College will be held later this year. It is not surprising that Sydney maintains its reputation as one of the top tourist destinations in the world, by a unique combination of the glorious scenery of the Harbour and its environs, its culinary excellence and Aussie hospitality.

Sydney is also the major stepping-off point to the other icons of Australian natural beauty - the Barrier Keef, Ayers Rock (Uluru), the Gold Coast, the Kimberleys and the winemaking districts of the southern states. Any visitor coming to our side o f the world will have no shortage of outstanding memories to take home. As portrayed by the Olympics in 2000, hospitality for overseas guests is genuinely unique. While the travel to Australia is not

cheap, delegates will be amazed at the buying power with $A3 for every British pound. In my recent visits back to the UK I have felt like a pauper when 1 have tried to use Australian dollars!

When I initiated the Australian bid for the International Meeting some four years ago it was blatantly an excuse for me to return the hospitality that I received over many years in the UK - an opportunity for my friends to come out to Australia. Many have already indicated their desire t o do so and I am excited by the prospect of an extremely enjoyable time at a social as well as academic level. 1 am not alone in this anticipation. There are a number of Australian and New Zealand Fellows that have made contact with their old friends and colleagues from the UK to offer their hospitality when they come to visit. I understand that a group of the Antipodean registrars who trained in Glasgow in the 1970s and the 80s are organis- ing a substantial 'get together' with their mentors and fellow registrars of the time. Such collegiality will make this meeting a unique event. The major travelling societies already have their plans well in hand to attend the meeting. The organising committee is currently anticipat- ing registration numbers of 700 to 800, with 400 to 500 from Australia and the rest from overseas. We are looking forward to making this meeting a successful event and hope to see you here in Sydney 2002.

Having now spent half my professional life in the IJK and the other half in Australia, it is interesting to reflect upon the differences between our two systems as well as see the similarities of practice, which are derived from commun roots. There are positives and negatives in the variations between our . systems. Holding an academic meeting jointly with the Australian and New Zealand College will expand upon these variations and we hope impart benefits for both Colleges.

The inajor difference between our two systems is in the basic health care system. While the National Health Service (NIIS) is a predominantly public based system with care provided free at source, in Australia there is a combination of the public hospital system with free care, a GP and specialist consulting system with a fee for sew- ice, and a significant inpatient private hospital infrastructure. In 2002 over 40% of the Australian population are covered by private health care insurance which Government tax initiatives have fostered. This insurance cover combined with a subsidy through the Government (Medicare) allows a large proportion o f the population to participate in private practice at both an outpatient and inpatient level. There is substantial support for the perceived advantage of having a specified doctor undertaking care and using private hospital facilities, which are significantly 'nicer' than the public hospital system. The positive side of this, in Australia, is that incomes are relatively good for private practitioners. In addition one's remuneration is reflected by the effort that one puts in and therefore personal satisfaction is considerable. Virtually 100% of

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specialists in Australia are involved in sizable private practice - even the academics. On the negative side the demands on the doctor are significant, particularly in obstetrics where the major issue is litigation and Medical Indemnity Insurance which in 2002 will amount to $A98 000, a rise of over 100% in the last three years. The Government, the Defence Unions, and the Australian Medical Association are striving to find solutions for this rise in indemnity but are making little impact at the moment. It is clearly a major disincentive for junior doctors to go into obstetrics. It may be surprising to those not working in Australia that if you do undertake private obstetrics the return per case is relatively small and that practices of between 200-400 deliveries per year are common. Not surprisingly there is a reasonably high induction and caesarean section rate for which we are criticised. Albeit, it is reassuring for an Aussie to watch the caesxean section rates rising in the LJK in response to medico-legal and women’s demands.

The other down side of a significantly private based health system is the loss of association with public hospitals, in particular the teaching hospitals. In addition, with academics having to do private practice to maintain some degree of parity with their private colleagues, academia within Australia and New Zealand is somewhat patchy. Recruitment into academic medicine, as in the UK, is difficult but I would suggest it is more difficult in Australia.

The news w e hear of the British system generally continues to be depressing. From UK registrars now rotating to Australia in increasing numbers, we hear of the current state of the system, which clearly is a step down from the wonderful training that most of us in Australia experienced when we worked in the UK. The NHS continues to he portrayed as in decline and the morale of most specialists decreasing. On the positive side it appears there is still the security of tenure and for those not deeply involved in private obstetrics, there is a lifestyle that is much more manageable than for most obstetricians in Australia.

In addition the UK continues to produce leading edge clinical research, which is applicable across the world. Bringing the latest of that research to a forum such as the 5th International Meeting of the College will be of significant bcnefit lo Australian and New Zealand specialists. Our scientific program also includes experts from Singapore, Hong Kong, US, and the best from Australia and New Zealand. Thus, for British College Members and Fellows, there should be a significant broadening of horizons at an educational level,

I was impressed by the quantity and quality of new work presented at the last British Congress in July 2001 encouraging me to believe academia is not dead in the NHS. The International Meeting is certainly acting as a spur for Australian trainees to show off their research activities. It has always been a major opportunity for the

juniors to travel internationally and present their work. The Australian and New Zealand trainees and research fellows have indicated that they are prepared to take up the challenge and show that we too have a significant research output.

Michael Chapman MBBS MD FRCOG FRACOG CKbl, Chairman, Organising Committee, 5th RCOG International Scientific Meeting, 3rd Annual Scientific Meeting RANZCOG, St George Hospital, Gray Street, Kogarah 2217, New South Wales, Australia. Conference website: www.bestfo~omen.conf.au/

110 The Obstetrician C Gynaecologist April 2002 Vol. 4 No. 2

LETTERS