Despite publication in the Lancet (1988), the initial impact of the Edinburgh Declaration was probably not apparent to many outside the world of academic medical education when it was first published in 1988. In particular the implication for psychiatrists involved with teaching was hardly recognised by the profession at that time. Thus, this review by Professor Walton is a timely reminder of the Declaration's importance.

At the turn of the century, opera was leaderless after the heady days of Verdi and Wagner. Puccini emerged as the new voice of Italian opera, where realism, or verismo, was the way forward. But verismo could never be the answer to the operatic dilemma that faced the latest composers, since it only gave a musical dimension to a stage painting of ‘life as it is’, without reference to underlying psychodynamics — I personally have never thought Puccini much of an intellectual. Beautiful his music may be, but as thinking pieces of theatre they are devoid of real challenges. Their appeal and potency lies, to a great extent, in Puccini's obsession with needless suffering.

In 1987 there were 1,428 psychiatrists in Australia, 8.8 per 100,000 population (Burvill, 1988), 55% identified as in private practice and 45% in public sector practice. Let us be clear about terms. Public sector practice means that each week you receive a salary from the public purse whether you have seen one or a hundred patients. Private practice means that you are paid on a piece-work basis, also largely from the public purse (national health insurance or Medicare), but the income (at about $100 per hour) depends exactly on the number of hours spent with patients. On average, private psychiatrists in Australia gross about $150,000 per year, out of which they must pay practice expenses. The pay for public sector psychiatrists probably averages $70,000 to which, for the purposes of our calculation, we will add the cost of rooms, telephone and secretary provided by the hospital which at $30,000 brings the cost of a public sector psychiatrist to about $100,000 per year. If 45% of psychiatrists are in public practice then the averaged cost of a psychiatrist in Australia can be calculated as $127,500 per annum, and as there are 8.8 psychiatrists per 100,000 the cost, calculated on this simple basis, is $1.12 million per 100,000 population (Andrews, 1989).