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15 Aug 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA  

I’ve been attending many meetings recently and listening to government, professional and consumer group representatives talk a great deal about what reform they desire from the health system. It has been sobering and unsettling. There is a great danger of enthusiastic but facile discussion with a perfunctory and thin veneer of consultation with doctors, in the inexorable pursuit of pre-determined actions.

There are three main drivers for change that I hear repeated by consumer representatives (we hope they represent the broader view) in numerous forums:

  1. Accessibility.
  2. Convenience.
  3. Affordability.

You would likely check these off your own list too. But did you notice the glaring omission? Do consumers/patients ever worry about quality? One of the refuges in AMA policy is that much can be defended on the basis that doctors provided a high-quality service. For example, a reasonable, known gap commensurate with the service provided is not inappropriate to see a highly trained doctor of your choice.

Some patients obviously do worry about the quality of health care – but others definitely do not and their criteria stops at the above three items. Dial-a-doctor is fine for them. I suspect some take for granted that the huge majority of doctors in this country are fantastic and they do not have to worry about quality in our system. Some possibly rate the perceived severity of their problem and accept a lower quality of care for that which is thought to be a minor ailment (very fraught strategy as we know). Some maybe just have a fixed idea of what they want and do not care who gives it to them. My secretary thinks patients only worry about quality after something goes awry. Distressingly possible.

The paucity of discussion around valuing and investing in high-quality care is very worrying. This is one of the reasons a doctors' fees website is potentially so dangerous – encouraging comparison and provision of care based on cost alone.  To be clear, I am very much in favour of increased health literacy and enhancing the ability for patients to make informed choices about their own health care (such as via the Informed Financial Consent document we launched recently). But price is a terrible arbiter/comparator alone and the unintended consequences will be profound and unimagined of the website. More on the Government’s doctors’ fees website another time.

Our failure to realise that a meaningful portion of our patients would sacrifice quality for accessibility, convenience and affordability has fostered recalcitrance in embracing new models of care. This has allowed an opening for general practice usurpers to gain traction (we all know who they are) on the basis they are more accessible, convenient and/or affordable. Patients also want to be more engaged and have feedback regarding progress e.g. the free electronic health check machines being rolled out around the country.

It would not be fair or appropriate for GPs to be left only treating more complex and difficult disease because usurpers have hived away the ‘simpler’ work. But if we want to better protect the critical, central importance of general practice (which by extension protects specialist referrals) we must beat the usurpers at their own game. I know there are spare GP consultation slots every day all over the country, GPs are progressively expanding opening hours and that much work is bulk-billed (e.g. in aged care facilities) – but this message is not cutting through. Patients seem to want more or at least something a bit different. We cannot lament patients receiving vaccines in a pharmacy if the cost of the vaccine is less than the cost of seeing the GP.

In this online age, I suspect they want greater online access to services and MUCH greater use of digital strategies for them to stay in contact with their general practice. Can I give a nod to Dr Kean-Seng Lim, the AMA NSW President, who has developed an App for his general practice? Patients can have contact with their GP, input healthcare data and have it graphed, book appointments, and so on. Fantastic! I strongly suspect this is what patients are increasingly demanding. We need to offer it if we are to curtail the usurpers and anneal general practice. Clearly, the AMA has a pivotal role in developing this strategy and assisting us all to harness the full potential of our worth.

Our President, Dr Bartone, has achieved the start of significant new investment in general practice by the Commonwealth, but this advocacy effort of the AMA needs to occur concurrently with us making ourselves more appealing in the marketplace. Patients should never waver in desire and comfort to see their doctor regarding a personal health issue, as opposed to seeing anyone else with inferior training, just because they are perceived to be more accessible or convenient.

Quality clearly cannot be lost, but we also need to define it in our own way before someone else does this in a disagreeable, alternate fashion. As we develop new models of care, we will also need to work collaboratively with computer boffins and other progressive minds to develop a profession-led methodology to measure quality and have appropriate data made available to consumers that reinforces the good work of Australian doctors.

The AMA has an important role to ensure quality is not diminished in importance when discussing cost and access. To emphasise its importance, however, we need to be prepared to make quality measures available. In doing this, we hopefully gain a powerful weapon against the usurpers, especially when combined with innovative models of care which give patients what they want. Only doctors can offer quality health care together with convenience, accessibility and affordability. To come out on top, though, in the primary care battleground, we need to watch, listen, learn and act.


Published: 15 Aug 2019