Some interesting responses to my Crikey story today about the AMA and turf wars:

John Menadue, Centre for Policy Development:

For years, it has been clear to me that there is widespread agreement in the ‘health industry’ about the need for reform. That widespread agreement covers such issues as the priority for primary care, the fragmentation of Commonwealth and State health programs, widespread and inexplicable variations in clinical practice, appalling workforce practices and demarcations.

Yet when it comes to implementing reform, as recommended in numerous reports, including the recent Garling Report, we get a ‘dig in’ by established vested interests who want to defend their turf.

Those vested interests include doctors and particularly specialists who resist workforce change in the name of safety, subsidised private health insurance companies who defend their inefficiency and high cost in the name of ‘choice’ and  pharmaceutical companies who defend their high margins on the basis of promoting lifesaving research.
But probably the most powerful vested interests are the health bureaucracies both State and Federal, who are much too close to the vested interests. The health bureaucracies reflect in their very own organisations, those powerful interests.

But nowhere is there a well-resourced and informed group that represents the public interest and the community. Theoretically we would hope that ministers would do this, but many are captives of their departments and the vested interests they promote.

In the short term there are two possible ways to address the power of the vested interests who will concede incremental reform but not the structural reform that we need. Unless we have that structural reform, health costs will continue to escalate.

The first possible way is for health ministers to establish an independent professional and community commission that can provide informed countervailing advice that reflects the public interest and not that of the vested interests.

The second possible way and it follows from the first is that this new commission should have as an important part of its role the education of the community so that the powerful vested interests with their lobbying capabilities can be contested.

Unless the community better understands the issues at stake, it is extraordinarily difficult for them to provide articulate support to ministers who want to see structural change.  Under-resourced journalists are really no match for the well-resourced vested interests.

I remember years ago the former Liberal Party  minister and later ANU Chancellor, Dr Peter Baume, said to me ‘you will get  no-where in health reform unless you address the abuse of power within the health sector’.
It is disappointing to see that the AMA and others continue to blatantly project their self interests which in so many instances is contrary to the public interest.


Justine Caines gives the consumer perspective, and responds to Victorian rural GP Dr Ruth Stewart’s comments about the importance of collaborative care:
The Corangamite Managed Clinical Network in Victoria does not utilise midwives to their full capacity, it is still a GP controlled model.  It does not give women the choice of having a midwife care for them throughout. Essentially it keeps midwives in a handmaiden role with only slight improvement to traditional care.

There are so few ‘team’ models anywhere in rural Australia that I find Ruth’s comment quite odd.  The only models that exist do so if GPs sanction them.  Consumers have worked hard in Young for 4 years to develop a community midwifery model and have been told quite clearly it will never happen without GP approval.

Where I am in the Upper Hunter in NSW, our AHS refuses to challenge the control of our ‘medically led model’, this is despite a large (could be 20%) of local women receiving little if any antenatal care (yes primary health) as there is no free service and GPs do not bulk bill.  At the same time we have midwives sitting at the maternity unit working way under their registered and educated capacity.  This is not collaboration or team work.

I have done this for a long time now and have particular expertise in rural areas, until there is a level playing field that allows all health professionals to work to their capacity we cannot talk team work or collaboration, at the moment it is medical domination.
Mary Chiarella, Professor of Nursing, University of Sydney, and Chair, Australian Nursing and Midwifery Council:

Doctors don’t have a monopoly on safety any more than nurses have a monopoly on caring – highly skilled nurses are equally as concerned about competence and safety to practise as are their medical counterparts and wouldn’t dream of taking on work that they were unqualified to perform.

Similarly I have seen many a good doctor provide the surveillance and nurturing work (you know giving someone their breakfast, noticing someone is short of breath – Oh reaaallly Rosanna) that Rosanna associates with nursing.

We are always delighted when doctors assist us in the name of improved patient care – most forward thinking (non-Luddite?) doctors that I have the pleasure to mix with express the same views about sharing the workload – as if there weren’t enough work to go around!


Associate Professor Merrilyn Walton, Director Patient Safety, Office of Postgraduate Medical Education, University of Sydney:

Melissa Sweet hits the nail on the head about turf wars dominating the policy agenda around both access and patient safety.

Most people knowledgeable about patient safety know that a patient centred approach to health care requires one to put themself in the shoes of the patient and then reflect on their needs-not those of the doctor or nurse.

From a patient perspective all members of the treating team are important. Educating patients about their conditions, managing acute episodes,varying management plans can be done safely and in a timely manner by a range of health professionals; not just doctors.

Adopting a patient centred approach takes the turf out of the debate; if the AMA were truly interested in patients they would adopt a patient centred approach and welcome the inclusion of the rest of the team.

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