Doctors Speak Out!


A few weeks ago I discussed the crisis at Sydney’s Royal North Shore Hospital (RNSH) with a health reporter from the local broadsheet. She made some telling observations of what had been an exhausting week in the media. Having been inundated with comment from every quarter it was becoming difficult to find a cogent line to report on, she said.

In the context of a health system that has been in ‘crisis’ for as long as I’ve been a doctor, the reporter’s comments are telling.

When incidents like those reported at RNHS occur in public hospitals, everybody has something to say. Members of the public flood drive-time radio claiming similar experiences, the Opposition uses a grieving family as puppets to attack the Government, health professionals attack bureaucrats for being ignorant of patients’ needs.

Amid all this noise, one of the most consistent complaints from the medical profession is that no one seems to be listening to them. Their concerns range from ‘other people keep telling me how I should practice’ to ‘bureaucrats can’t run a health system’ and even ‘my patients are unrealistic about the care I can provide.’ An entire generation of doctors is coming through the system feeling disenfranchised and isolated as a result of perceived lack of voice.

In fact, this frustration has little to do with under-representation of doctors’ opinions. Doctors have plenty of voice, and loud ones at that. The problem is that these voices are poorly organised, inconsistent and occasionally frankly unhelpful.

In the aftermath of the latest Royal North Shore crisis, doctors’ groups put a number of positions forward. The President of the Australasian College of Emergency Medicine, Dr Tony Joseph, has cited poor recruitment of junior staff and insufficient supervision amongst the key problems in emergency departments.

Image thanks to Bill Leak.

Professor Stephen Leeder, director of the Australian Health Policy Institute, linked a drop in the overall funding and number of public hospital beds to emergency department overcrowding.

The opinions of respected commentators such as Joseph and Leeder always deserve attention. The problem is that the common thread in their arguments is increased health care funding rather than widespread reform of a dysfunctional system.

Although there is no doubt that some sectors in the public system have suffered from a funding shortfall, the tendency of every doctors’ group to demand more funding is unsustainable in the context of a burgeoning health budget.

The President of the Australian College of Radiologists, Liz Kenny, blamed insufficient radiology training positions as a cause of the national x-ray reporting backlog. Far from training more radiologists, the medical profession should look at limiting its use of expensive diagnostic tests as a means of curbing health expenditure. (It is also questionable whether increased funding of radiology training positions will be of any help to the public health system, given the significant proportion of time spent by radiologists around Australia in private practice.)

Comments like Kenny’s demonstrate a failure of our medical leaders to see their own practice in the context of the wider health system.

Of all health professionals, doctors should understand that with an ageing population there will be a glass ceiling on health funding in Australia. Our shrinking tax base will be unable to cope with already spiralling health costs. The plight of RNSH, which treats a region with the highest proportion of elderly Australians in the country, is a window to the future of Australia’s health.

It’s almost as though in playing politics doctors have forgotten their medical training. We are taught to practise holistic medicine, taking into account a whole host of factors in our diagnosis and management. And yet, when it comes to giving their political opinion, doctors fragment, contradict each other, and focus on their own specialties.

The body that is supposed to unite the medical profession, the Australian Medical Association (AMA), must shoulder a large portion of the blame for poor cohesion.

The current leadership has offered some bizarre commentary on recent events. Dr Andrew Keegan, President of the NSW AMA, commented that ’10 per cent of the income and 90 per cent of the hassle come from public hospital work.’ This will do nothing to assuage a community already suspicious that doctors are overpaid professionals more interested in their private than public work.

On a Federal level, the AMA has demonstrated unswerving support of the Coalition and knee-jerk rejection of ALP health policy. In an election that will be dominated by health, the AMA has struggled to gain media coverage of its own policy platform, a wordy 16-page wish-list with few clearly defined policy objectives.

It is also the responsibility of the AMA to educate its own members about the rational use of the public purse. Doctors are the custodians of the health dollar but rarely admit their own role in increasing health costs. It is disingenuous for a profession to blame the Government for insufficient funding without regulating its own use of public funds.

For a body with so much potential influence over health, the AMA has effectively sidelined itself by showing partisan support to a political Party and by reacting to rather than developing its own health policy. As the peak representative body for doctors, it must lead and educate the public about healthcare reform in Australia, rather than being simply a protector of the status quo for specialists.

Ultimately, the frustration doctors have in not being heard arises from the media and public not really knowing who to listen to. We can complain all we like about being ignored by politicians and bureaucrats but until we come up with a coherent message that goes beyond simply asking for funding increases we will remain part of the disease rather than the cure.

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Launched in 2004, New Matilda is one of Australia's oldest online independent publications. It's focus is on investigative journalism and analysis, with occasional smart arsery thrown in for reasons of sanity. New Matilda is owned and edited by Walkley Award and Human Rights Award winning journalist Chris Graham.