The penance for an extended holiday is returning to more than a metre of reading of the latest medical news. And what a depressing read it is.
On one hand, there are the usual stories of outrage from various medical leaders and organisations: how dare anyone presume to step onto our professional turf? On the other hand, there are the usual depressing stories of how doctors can’t be found to work in areas of need, whether it’s the bush, the disadvantaged ‘burbs, mental health, Indigenous health…and the list continues.
On the one hand, the general media is full of stories about the dire straits of public hospitals while, on the other hand, much of the informed health debate is about the pressing need to strengthen primary care and prevention.
What to do? A good start – for health ministers, treasurers, premiers and the PM, not to mention their helpers – would be to read John Menadue’s recent suggestions in the Medical Journal of Australia.
Unlike the discussion papers over at the National Health and Hospitals Reform Commission (and what a nightmare these must be for policy makers trying to make sense of them), Menadue offers some straightforward political strategies for achieving change. The question is whether the Government, struggling to juggle economic and environmental meltdown, will have the heart to pick a fight with the powerful vested interests identified by Menadue?
5 Comments
Welcome Croakeys!
I find these columns on Crikey a depressing, as a doctor I feel we are being painted as the source of the health systems problems. Please give us a bit of encouragement for going into underserved areas (mental health in my own case) instead of finding every excuse to replace us.
Hi Ian, Blaming individual doctors for the health system’s woes is a little like blaming young people for binge drinking or individuals for eating junk food. When societal structures encourage and promote this sort of behaviour, it seems more than a little unfair to heap all the blame on people who are responding to environmental and societal cues. Similarly the health system (if there is such a ‘thing’) often encourages doctors to work in areas and ways that may not be for the greater public good. So I’m not trying to put the blame on individual doctors acrss the board. I know many individuals who work very well with other health professionals or choose to work in relatively under-rewarded and difficult areas such as mental health or rural health. On the other hand, the AMA and other professional organisations (and not just in the medical sphere) are too often major barriers to us progressing towards a system that is truely based around the community and patient needs.
The reforms being discussed carry a real risk of making the problem you are talking about worse. Consider a medical student choosing between psychiatry and plastic surgery. If government policy is that the psychiatrist can be substituted with a nurse-practitioner or a psychologist, but surgeons can’t, which are they going to choose?
There is clearly a need for very broad scrutiny of professional roles and how best to fund and deliver the services the community needs. The incentives and disincentives for health professionals to work in areas of need also need scrutiny. As an aside, at least some of the physician assistant roles now being tested in Australia are in the surgical area. I know of at least one surgeon in Adelaide who has been pushing to have physician assistants working alongside surgeons.