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AMA Speech - Speech to the AMA Parliamentary Dinner

27 Aug 2014

Speech to the AMA Parliamentary Dinner
Parliament House, Canberra
Wednesday 27 August 2014
AMA President A/Prof Brian Owler

I would like to acknowledge the traditional owners of the land on which we are meeting, and pay my respects to elders past and present.


I thank the Minister for Health Peter Dutton, the Shadow Minister Catherine King, and the Health Spokesperson for the Australian Greens, Senator Dr Richard Di Natale, for accepting the invitation to speak tonight.


I acknowledge the Speaker of the House of Representatives, the Hon Bronwyn Bishop, all of the Members of Parliament, senior staff, health sector leaders, and members of the media, and I thank you all for attending tonight.


Well, it’s been just over three months since I have taken on the role of AMA President.


There is certainly no shortage of topics in health that I could focus on, and that is what you are probably expecting.


But first I want to talk about the AMA as a professional organisation and, more importantly, how those within the AMA see its role.


In actual fact, the motivation of those within the AMA, particularly AMA Councillors, is not too different from the motivation of those in Parliament.


While Parliamentarians differ markedly in their views, I would agree that the motivation of Members of Parliament is to make this country a better place.


You represent your constituents and will promote their interests, but it is in the context of the greater good for this nation.


The AMA is a professional organisation, but it also a membership organisation.


As such, we have a duty to advocate on behalf our members – and this is sometimes a source of criticism for the AMA.


But a membership organisation should and must advocate and advance the interests of its members. It should do so in an ethical and moral framework, and that is our core purpose.


I should also add that advocating for all members within the broad church of the AMA is not always easy.


The GPs say we are too specialist-focused, and no prizes for guessing what the specialists say.


In any case, the ability of the AMA to advocate on behalf of the whole of the profession is, I believe, a strength.


The role of the AMA is so much more, though.


As doctors, our first duty is to our patient.


Many people think that doctors still take the Hippocratic Oath.


We don’t – and, if you have ever read it, you would be quite relieved.


However, in 1948, the World Medical Association agreed on a new ‘oath’. It has been amended a number of times and it starts like this …


I solemnly pledge to consecrate my life to the service of humanity;

I will give to my teachers the respect and gratitude that is their due;

I will practise my profession with conscience and dignity; 

The health of my patient will be my first consideration…


We have a tradition of reciting the Declaration of Geneva at the start of the AMA National Conference each year.


It is useful because it encapsulates what it means for many doctors what it actually means to be a doctor.


It puts our patients as the priority and, as a professional organisation that represents doctors, the AMA has to put the interests of patients and the health of the public as a priority.


The idea that doctors devote their life to the service of humanity is an important one.


Many doctors do go into medicine for that purpose.


It also means that our role extends well beyond the role of direct interaction between doctor and patient in the consultation room.


Advocating for the health of our patients is a key motivation for doctors who choose to actively serve the AMA.


And this is a genuine commitment – a passion for many.


That is why many doctors choose to combine their busy clinical lives with their equally busy and time-consuming advocacy work with the AMA – at both the State and Federal level.


So, in a week when terms like ‘money grab’ and ‘white-coated bandits’ are bandied about, I believe it is important to remind people what drives hardworking doctors to be AMA advocates on behalf of the profession and patients.


Doctors have had a proud tradition of advocating for the safety and health of the public generally.


My predecessors lived this tradition. The doctors in this room tonight continue that tradition – all of them.


It’s a role that I personally believe is important, and it is a key reason for me being in this role.


So, in addition to being the AMA President, I am of course the face of the Don’t Rush road safety campaign in NSW.


The origin of that campaign is a relatively unusual one, but it was a situation that is sadly familiar to doctors.


Essentially, it was a long weekend.


I was on call for both the adults’ hospital at Westmead and the Children’s Hospital at Westmead.


I was sitting at home in my study doing my dictation on a Friday night. The sort of exciting life that you lead as a neurosurgeon. It was raining.


The phone rang and it was my registrar at the Children’s Hospital.


There had been an accident and there was a child that had just had a scan. They had arrested and were having CPR. They sent through some pictures.


The skull had been shattered and there was not a survivable injury, and I suggested they stop. She died.


About five minutes later, the phone rang again and this time it was the adults’ hospital.


A young lady with severe head and facial injuries was in the scanner. She needed surgery that night.


When I arrived, I learnt that she had been the driver in that accident that had not only killed the child from the Children’s Hospital but also had killed another adult and another child.


All because she decided to overtake in the wet. A split second decision with fatal consequences, but also a life with a brain injury and, no doubt, a lifetime of guilt.


The next day I had another call.


This time from the Children’s Hospital, and this time there were two children. So I went in to find a situation of what seemed to be chaos.


They were brothers, aged 6 and 8. One had a CT scan. He had a bleed on the brain, and we were about to take him to theatres. The other was in the scanner when I arrived.


The child was having CPR. There were about 20 people in the room, working frantically. The mother and the father were in the room. The current wisdom is that, in these circumstances, parents cope better with loss if they are present. I am not sure that is true. They knew what was happening.


I looked at the scan and I could see the reason why. The spine had separated from the skull. In medical terms, an atlanto occipital dislocation. In lay terms, an internal decapitation.


The child was not going to survive, and I suggested they stop. The team took the child back to the ED so that the parents could be with him in his final moments.


I have, unfortunately, witnessed a lot of grief, but perhaps never seen quite the same anguish from parents as this.


I suspect one of the reasons was that the driver that caused the accident was the father. A split second decision, again fatal consequences for some, lifelong disability and anguish for others. He was no doubt a good person. A good person making a bad decision.


I can clearly remember driving home that weekend – exhausted – but thinking – there has to be something that I could do.


For me, that was the moment that it became not just about the patient in front of me, but those patients that would come after and, of course, preventing people, particularly children, from becoming patients at all.


The AMA in NSW was working with the State Government on health reform at the time, and I was invited to a meeting with the NSW Minister for Roads, along with the chief of the RTA, their marketing team, and others.


I realised that, okay, this just might be something. They wanted to hear the story, and pretty soon the Don’t Rush campaign was born.


It was my AMA role that allowed this to happen. It’s an example of the credibility that practising doctors bring in the eyes of the public.


I made public health a priority in my State Presidency, and will do so with my Federal Presidency.


The AMA already has a proud reputation of leadership in public health advocacy.


The list is long, but highlights include:


·         the AMA Indigenous Health Report Card;

·         support for tobacco plain packaging;

·         support for clear food labelling to help combat obesity;

·         our ongoing campaign to raise vaccination rates;

·         advocating for proper health care for asylum seekers and refugees;

·         highlighting the health effects of climate change;

·         raising concerns such as domestic violence and alcohol-related violence;

·         talking about possible negatives from the Trans-Pacific Partnership (TPP) free trade agreement;

·         our annual Dirty Ashtray Awards highlighting legislative deficiencies in tobacco control and stopping people smoking;

·         and the National Alcohol Summit we have planned for October.


This only scratches the surface of our public health agenda.


As I mentioned before, I believe passionately that we have an obligation to do more than care for the patient in front of us.  


Some would argue that this is a ‘nanny state’. But that is a concept foreign to me and to many doctors.


Governments do have a responsibility to keep people safe and to keep people healthy.


It is at the core of responsible health policy.


Economically speaking, the costs of caring for people with disabilities and injuries suffered through road trauma and other accidents is very high. It’s a burden that has to be shouldered by the rest of the community.


Many of you are seated next to AMA Federal Councillors or Board members tonight.


It might be worthwhile asking them over dessert why they are AMA Councillors. What motivates them?


They almost all have stories such as mine.


Some are motivated by their experiences of public health issues, some by personal industrial experiences, and others by frustrations of the hospital system and a desire to make it a better system for their patients.


It is often the case that the AMA is seen as a doctors’ union whose only motivation is to increase doctors’ incomes.


Well that could not be further from the truth. It is a mistake that many people have made.


The truth is that the AMA is constantly vigilant, on the lookout for actions and policies that could undermine our health system.


A current example is the growing movement of private health insurers seeking greater and more interventionist roles in the health system.


Recently, the Federal AMA held a dinner and the guest speaker was the CEO of a large private health insurer.


Among a number of other topics, he tried to tell us that they wanted patients with private insurance in a public hospital emergency department to receive priority.


His question was if your son breaks his arm and goes to the emergency department, and you have private health insurance, why shouldn’t little Johnny get priority?


Well, to his surprise, that was not well received.


As doctors, we think that the most appropriate prioritisation, especially in an emergency department, is clinical prioritisation.


Our ED doctors are not going to make a more deserving patient wait because little Johnny’s parents have private insurance.


Now, our speaker was a little taken aback by the rejection, but also by the strength of the rejection.


For me, that moment demonstrated that while we might be seen as a very conservative organisation, it underscored that, first and foremost, the AMA is an organisation of medical professions.


Doctors have a strong social conscience.


The AMA has a strong social conscience.


So much of our efforts are actually about the system in which we work.


We do not support the concept of managed care run by the private health insurers.


That concept is borrowed from the United States. The United States does not have a good health system. It is a terrible system. It is bad for patients. That is why they are trying to change it.


We do not need to go down that path.


We lobby and advocate not only for a better system in which our members work, but a system that delivers the best outcomes for the Australian public.


That is why we have spent so much time and effort on the recent co-payment proposal.


I am afraid to say that neither side of politics is focused on what is important for our health system - sustainable general practice in which quality general practice is rewarded.


The Government’s $7 co-payment takes money out of health care, including general practice, almost $4 billion in fact, and asks patients to contribute those funds.


It goes against conventional health policy of prevention and chronic disease management.


It disadvantages those that are already disadvantaged.


It adversely affects Indigenous Australians, the poor, the sick, those in aged care, and children.


It is also impractical in many cases. That is why the AMA wanted protection for vulnerable patients.


On the other hand, the Opposition’s unwillingness to accept any co-payment, while not unexpected, ignores the fact that co-payments exist for 20% of GP services already.


It also ignores the fact that continuation of high bulk billing rates with a Medicare rebate that lags further and further behind the cost of providing quality general practice means that the time that GPs can spend with patients shrinks and shrinks.


That is why we support, for those patients who can afford to contribute, a modest co-payment.


Now, while the Government’s co-payment plan has a $480 million windfall for GPs, Minister, I note that the AMA’s plan has a $580 million cash grab.


This is not about getting more money for GPs - and many of you will take that how you like.


It is not a pay rise. It is an investment in general practice – more staff, new equipment, technology, better premises – to serve the growing and more complex health needs of the community.


It is about ensuring that we reward quality general practice with models that do allow GPs to spend more time on prevention and chronic disease management, rather than being subject to a competitive drive towards 6 minute medicine.


I do hope that all sides of politics will have a serious look at the details of the AMA’s alternative plan.


I also hope that tonight you have a better understanding of what the AMA is about.


Yes, we represent the interests of our members but we will also lobby for better policies and systems, and, on the basis of our experiences as doctors, we will advocate for our patients and for the public.


The AMA sees all of these roles as essential. They are roles that I am proud to have as President of the AMA.


Thank you for your attendance tonight.


My AMA colleagues and I look forward to continuing to work with you on health policy to make Australia’s society both healthier and safer.


27 August 2014


CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                            Odette Visser                      02 6270 5464 / 0427 209 753


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Published: 27 Aug 2014