STRAWS IN THE WIND: by Max TeichmannNews Weekly
Physician heal thyself
, December 14, 2002
Physician heal thyself
We can all make a list of books about Australian society which never seem to appear; whereas, the equivalents can be found regularly turning up; selling well, and, quite often, sparking important debates, in Europe, Britain and most especially the United States. All we seem to get are pamphlets and slim monographs, coming out of some Institute or think tank, sparsely reported, finding limited distribution, and soon forgotten.
The descriptions of many important public policies, and changes in our society are being left to the tender mercies of politicians, pressure group advocates and a handful of journalists.
The public - who are the ultimate objects, and the suffering objects, of powerful lobbies which end up setting the agenda - are kept very much in the dark as to the whys, the whos and the wherefores, of the group activities which control so much of their existences.
We have seen some virtually heroic attempts to bring some light into the enormous multicultural and aboriginal industries by a handful of authors such as Kathy Betts and Mark Lopez, in looking at the origins and development of multiculturalism; and a few authors such as Keith Windschuttle, Ron Brunton, Noel Pearson, in challenging the towering piles of nonsense; the slanted and sometimes specious histories of our indigenous people, and the bureaucratic monstrosities which have arisen to impede hopeful and meaningful progress in the condition of the aborigines.
I am sure that there would be a lively market for books and studies putting the non-Establishment views on these matters of vital concern. For one thing, most of the public are on the side of the critics, and the frustrated investigators - and almost instinctively reject the politically correct dogmas, and cover-ups.
Two extremely powerful groups who are escaping virtually all our analyses and reportage are our doctors, and our lawyers and jurists. We have seen quite striking changes in the activities, in the professional attitudes, and what is taught in our legal academies, since Whitlam's time, but little about the whys and wherefores.
Has anyone tried to do a book on the origins and the ongoing influence of the Labor Lawyers, starting as they did as a humble - well....small - group of radicals, also around the time of Whitlam? People will give you a serve on Opus Dei, or the early Economic Rationalists - but, on our Labor Lawyers? Nyet.
Nor just how far the Labor doctors and their more recent allies have come since their humble beginnings. I'll just say that some of them wore many hats. So, where are the in-depth studies - the chronologies, the pressure group analyses, examinations? I could add the extraordinary development of Social Work, the rise of 'psychology' and allied therapies...and the latest rising star in the firmament of power, pelf, and political pressure - Counselling. Where are the books - the studies?
But I want to look at what is happening in medicine, and what the doctors are doing.
Starting with a piece by Mary Papadakis, headlined, "GPs baulk at treating the aged". from a recent Melbourne Herald Sun
. According to the AMA, only 16% of the nation's doctors are treating nursing home patients, GPs "increasingly refusing to attend Aged Care facilities, blaming inadequate rebates and out of pocket costs, for the trend".
Of course, sick and frail pensioners aren't out of pocket - 'tis well known. The CEO of the Aged Care Association of Victoria said: elderly frail people are being transferred to acute care hospitals for things that could be dealt with at home, and some doctors had charged $10 surcharge per patient and a $2 prescription fee.
Werribee's Glendale Hostel manager said that a shortage of nurses and GPs and the growing reluctance of the latter to visit nursing homes, amounted to a crisis in Aged Care. "I would hate to get to a point when an elderly person's life is at stake because we can't get hold of a doctor," he said. But the AMA Victorian president has identified a class of new poor, whose plight must be salved, before the nursing home situation can be remedied.
"GPs could not afford to continue treating nursing home patients under the current Medicare rebate," said doctor Nukesh Haikerwal. GPs received $42.55 on a 19 minute visit, less than half the $86 rate recommended by the AMA; doctors are paying for the privilege of visiting people in Aged Care facilities and losing in their practice when they are not there. It's a bad business decision,' said the Victorian. AMA president.
Kay Patterson's spokesman said that the Medicare increases which the AMA are demanding would effectively double the current rate and were unsustainable.
Did I hear the AMA say 'Stiff Cheese?' And the ALP the same - only sotto voce
Another increasingly financially beleaguered group are the specialists, and GPs who are refusing to accept the Gold Card, granted to pensioners, including war pensioners, by government and parliament. They can't afford it they say. The government won't fill the gap between what it and parliament have determined, and what this group of doctors reckon they need.
Ex-servicemen are waiting for what the new leaders of the RSL have to say about this. I hope we don't have to wait too long.
Yet another co-ordinated attack on bulk billing is under way, as a means of forcing up the Medicare levy. Current leaders of the push are saying that doctors who still bulk bill are the inferior doctors, who can only attract patients this way. It couldn't be that these doctors still possess some public spirit, some concern for the capacity of poorer patients to pay, could it? Why not ask the patients?
The game of ideological musical chairs that has been going on over the Medicare levy, and bulk billing is just extraordinary. Labor brought in Medibank, to the great dissatisfaction of the conservatives, and the greedier, or more affluent doctors.
A similar confrontation occurred over bulk billing, and the Liberals were accused, over many years, of wishing to destroy this most important of Labor's achievements. And to return patients to the old fee for service system - which discriminates most heavily against the poor, workers with young families, and the old, who are obliged to use the services, most frequently and in depth.
The reforms pushed through by Hayden have been of inestimable value. And the Liberals eventually came to see this.
Now, we see New Labor wishing to subvert this system while appearing not to do so. How to force the Liberals to water it down or abandon it - and they be blamed? The answer appears to be to make common cause with those who hope to profit by Medicare dilution. The Labor doctors, and the normal common or garden greedy doctors, could be the answer. They also help further undermine the conservatives' medical and health systems by sabotaging the latest ways of protecting the poor and the pensioners. That is the Gold Card, which has been extended to many more people by Howard.
Meantime, Labor are still planning for their time in Canberra - and one of its plans is to consider cutting back private insurance, and private medicine, and force patients back into the State hospital system, overcrowded, top heavy and malfunctioning as it already is. So as to get something like the British NHS. For purely ideological reasons, I think.
Enter the Labor Doctors. And to strengthen the hospital unions.
So, the proposal is to cut out the 30% private hospital insurance levy, now paid to those wishing to access private medicine, and hospitalisation.
Finally, there is the enormous difficulty in getting doctors to work in the country areas, or in the poor, off-limits ghetto suburbs of Melbourne. Like getting teachers to work there, let alone live there.
We all remember stories by people like D.H. Lawrence, about Jesus returning to earth in an incognito capacity, and how he would be treated, and with what hostility the reiteration of his original views would be greeted. Most of all by people calling themselves Christians.
Well, what kind of hospitality would Hippocrates encounter, if he left the company of the august Dead, returned here, and began to lecture his colleagues, his students on the duties and responsibilities of the doctor to his patients, his colleagues and students, and to the Greater Society?
I fear he would be greeted with incomprehension, or guffaws, from many contemporary doctors, especially younger, politically conscious ones.
"This is the real world, old man; we don't have much use for archaic words like duty or obligation. We are more at home with words like tax and insurance and fee schedules. We prefer to talk about cars, and overseas conferences, and the generosity of drug companies so, don't try to get on the Register. Go back to your Dead White Ancient Greeks in the sky. You' ll never make a dollar down here."