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Dr Kerryn Phelps, AMA President - Radio 3AK, with Nick Papas

PAPAS: And joining me on the line now is Dr Kerryn Phelps, indeed, the Federal President of the Australian Medical Association. Thanks very much for talking to us this afternoon, Doctor.

PHELPS: Good afternoon, Nick.

PAPAS: Oh, you've had a busy day. One of the things I was going to talk to you about is the role of the President of the AMA and how difficult it must be, and we'll get to that in a minute, but lots of news. There's always something going on the health market and the health environment, should I say, rather than market, even though sometimes it is treated a bit like a market, isn't it?

PHELPS: Well, it is indeed, but I think the bottom line for the AMA and for doctors is quality of patient care and, while we have to consider economics and the marketplace, if you like, the most important thing for us is that our patients are getting the care they need in a timely way.

PAPAS: Now, we'll go backwards in time. The relationship between the Federal President and the Minister was not good there for a while, until there was a well publicised meeting where you sat down and had lunch at some restaurant somewhere, and each paid for each other's … for your own lunch and had a debate about how to manage the relationship between the AMA and the Federal Minister. That was about two or three weeks ago. Since then, Dr Wooldridge has been a bit unkind again in the sense of his verbal assault on the Victorian President of the AMA, Dr Mukesh Haikerwal. Is this some sort of political game that the Minister's playing, trying to put the AMA into a sort of political corner?

PHELPS: Well, if it's a game it's not working. I think that the Minister has been quite sensitive to criticism of policy, and the AMA has never been backwards in coming forwards about saying what we believe is right in the interests of our patients. And, Dr Haikerwal's comments and mine regarding the specific issue in question, which was cholesterol-lowering medications were based on international guidelines and what we considered was in the best interests of patients. And the basic underlying philosophy that doctors should be using their best efforts and best clinical information from around the world to be making decisions on behalf of our patients and in partnership with our patients, and that any guidelines, if they're used on an economic basis, should be recognised as such and not said to be best practice guidelines.

PAPAS: And, interestingly enough, I don't think there's much of a debate now. The guidelines pretty well reflect practice in any event.

PHELPS: Well, that's right.

PAPAS: So all fighting about nothing, in a sense, and that's a pity because … the other thing that Dr Wooldridge is very keen to point out is the AMA has to represent doctors and he, Dr Wooldridge, is looking after the interests of the patients of the country. You're not just a trade union head, are you, Doctor, you're there having said you're interested in the patients' best … in the best … what's best for the patients. Of course, your doctor constituency also has an interest in income, etcetera, though, doesn't it?

PHELPS: Well, of course. I mean, the AMA is an advocacy group for the medical profession, but quite parallel to that is our role as an advocate for public health. If you consider individuals in their day to day lives, they very rarely, if they're lucky, come in contact with the health system and usually it's at a time when they're very vulnerable, either they are sick or needing an operation or somebody very close to them is, and it's only then that they see where the problems lie. On the other hand, doctors who are advocates for their patients as well as working in the field - it's what we do every day - we try and get patients into hospitals, we try and get them appointments with specialists in clinics, and if we're running into roadblocks all the time, then we're in a very good position to be able to identify where those problems are and to be able to bring those problems to Government, hopefully, for solutions.

PAPAS: Can I just raise the question of hospitals? There's been a report recently issued to suggest that waiting lists around the country in the years 1998 to 1999 had increased significantly. You're quoted in today's press as saying, well, that report shows what we all know, in a sense - Government needs to put more money into hospitals.

PHELPS: I know. I'm wondering how many times I'll have to say it before it's broadly acknowledged, but the Senate Community Affairs Reference Committee, last year, reiterated our calls for increased money to go into the public hospital system, and it was to the tune of about $900 million over two years, half to be shared by the Commonwealth and half by the States. And, really, when you look at the size of the health budget, it's not a big ask, and the public hospitals are really struggling. And the AMA recently conducted a survey of about a thousand doctors working within the hospital system and asked them a number of questions, and some of the important advice that came back to us was that the hospital system is much worse off than it was 10 years ago, that many of the doctors working in the hospital system fear that it's not going to sustain itself for the next 10 years. In 10 years time, they really believe that they're not going to be able to do the work that they need to be able to do if things keep going the same way, that there's much lower morale, there's workforce shortages, particularly in nursing, and that there are problem areas related to the relationship between the Commonwealth and the States with, you know, fights over who's responsible for the funding. And so, we do need to have a clarification of just who's responsible for the public hospitals, an acknowledgment that it needs more money, and … but having said all that, the increase in the people going into private health insurance over the last 12 months may well start to have something of an impact, but it will take a while to filter through because of the level of unmet need.

PAPAS: Now, of course, medicine changes, like all other professions change. Medicine particularly is amenable to technology, to new medications and new procedures. It's always developing. And a lot of the new procedures, of course, are very intensive and very expensive. We all want to prolong life, of course. Who says, okay, I'll take second best and die tomorrow? The fact is we want the best for ourselves, our children, our relatives. It seems, though, that it's just a never-ending spiral of increasing cost. Is that too simplistic?

PHELPS: I think it's reality. I mean, costs of everything go up all the time, but if we're wanting better technology, if we're wanting the best for ourselves and for our loved ones, then we have to make a decision about whether we ration that care or whether we say, well, okay, we need to spend a bit more in order to maintain the quality of life that we believe we're entitled to in the year 2001 in a developed country like Australia. And let's say, for example, it was a few years ago, and there was this new technique called coronary bypass grafting for heart surgery, which is so very common now, and let's just say that we said to people, well, you know, we've got this fantastic technique but you can't have it because we're not prepared for the Government to put any money into it. Now, people today, because it's such a common operation, would say don't be ridiculous, it just can't … that can't be true.

PAPAS: Yes.

PHELPS: And the new technologies that we're seeing today, in 10 years time, people will be saying what do you mean, we didn't introduce that technology when it's available in countries like the United States and France and Germany.

PAPAS: I'm talking to Dr Kerryn Phelps, Federal President of the AMA. And just to wind up, if we can go back in time a little bit to your past role, you've been involved over many years now in explaining medicine to the people in a broad platform, if I can put it that way. Are people well educated or sufficiently educated in what medicine is and what medicine does and what to expect? I worry that there's still a very strong emphasis from the doctor, just trust me, I'll look after you.

PHELPS: I started working in the media 17 years ago.

PAPAS: Sorry, I wasn't suggesting…

PHELPS: Yes, and the reason that I started out was because I really perceived that there was a lack of general knowledge about health, and I actually set out to make sure that there was more information of a reliable nature getting out to the public, and so I think that there has been over that period of time quite an interesting explosion of not only interest in health, but in expertise in the…

PAPAS: Explaining it, yes.

PHELPS: … in health information. But what we have seen just over recent years is, yes, another explosion in information and misinformation, and that's with the Internet. And, I think that we need to make sure that people have a way of double checking information, that they are sure that the Internet site that they're logging on to is a reliable one, and if they're not sure about that, I think that they still need to go back to their doctors to sort through the information and say how much of this is relevant to me, how much of this is true or not true, what should I believe, what shouldn't I believe, and I think that, you know, whatever advances there are in medicine it still gets back to that essential relationship between patient and GP.

PAPAS: I've been talking to Dr Kerryn Phelps - thank you for joining us today - Federal President of the AMA.

PHELPS: Thank you, Nick.

Ends

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