Dr Capolingua's farewell Presidential Address
As a member association we must truly represent not simply the medical profession, but also the values and principles on which our great profession is based.
Too often today the AMA is characterised as a right wing doctor’s union.
While we will never apologise for fighting for doctors and the medical profession, the AMA’s activities extend far beyond the pecuniary interests of doctors.
Of course our detractors rely on this false perception of our function.
It is vastly easier to dismiss the “mercenary intentions of a greedy doctors union” than it is to dismiss those of the most powerful and independent voice of health in this country.
Government and the media see mileage in vilifying the profession.
Ours is the only profession where a $2 rise in the recommended fee for a GP consultation – from $60 to $62 – rates a front page tabloid splash as happened in the Daily Telegraph in October last year.
Government fuels this by continuously feeding the media gross figures of Medicare payments to doctors.
The Daily Tele story quoted the figure handed to the media as three hundred thousand dollars for every GP. And other exaggerated figures across specialties are routinely trotted out to an unquestioning media.
I cannot think of another example of a government deliberately misinforming the community about an entire profession.
We do devote our lives to helping patients, only to be actively attacked and cast as the black hats, the villains in the health debate, by our own elected government representatives.
These elected representatives presented a major challenge early in this Presidency - we were faced with a popular, energetic, and confident new government that was hell bent on fundamental health reform – but reform that is based on breaking the important role of the doctor in patient care in order, perhaps to appease political promises to other groups.
The Minister’s “Light on the Hill” speech was a direct challenge, not just to our proud profession, but to our organisation.
The speech was startling in its honesty – doing nothing to hide the Minister’s ideological zeal and this government’s intentions.
It was also unambiguous in its attack on the medical profession’s leading role in today’s health system, demanding of us that we need to ‘let go of’ work that others can safely do.
I quote...
“Or if doctors don’t want to let go of it, to accept being paid less for devoting their highly skilled and heavily trained selves to less complex tasks than they might.”These “less complex” tasks apparently include diagnosing and treating patients.
As one member put it to us in an email, “if the Minister wants to break doctors’ monopoly on healthcare, does she also want to break the pilots’ monopoly on flying aircraft or the engineers’ monopoly on building dams? “
The pilot’s analogy is a good one. Modern avionics means that a passenger aircraft will virtually fly itself for ninety five percent of the time. But I don’t think that this means we are happy to have a flight attendant at the controls.
The Minister’s speech goes on to outline what I believe is a “Kumbaya” approach to Medicine. We all hold hands together and herald the advent of proper preventative Medicine, newly discovered by the Rudd Government, which means there’s scant further need of hospitals or chronic care.
If you haven’t read “the light on the hill” speech – I recommend it to you.
It shows with crystal clarity the ideological battleground we now occupy.
In the face of this major challenge; certainly the starkest faced by the Medical profession in a generation; there are some who counsel a softly-softly approach. The idea being that we shouldn’t criticise Government for fear of losing our place at the negotiating table.
Some believe we should stand mute in the face of a highly aggressive Government reform agenda that contradicts all of our training – all of our instincts about what is right for our patients.
Should we stand mute as government takes over medical training, and makes health standards subject to the workforce and political vagaries of the time?
Do we say nothing as government administrative officers gain open access to the private patient records of every person in this country?
Must we turn a blind eye to policy that makes our aged, or our sickest, or our rural Australians, second class citizens who don’t deserve the services of a doctor?
Do we ignore the fact that doctors and nurses are trained to do different things and stand back while KPI focussed policy sends emergency patients home without seeing a doctor?
Must we surrender all of this just to ensure that we get an invitation from the Government in the mail?
I think not.
I think this strong stance was reflected in the Minister’s speech today.
There’s no point to a watchdog that doesn’t bark.
A watchdog can’t do the job if he keeps rolling over to get his tummy tickled. This is the time to bark long and loud and warn Australians of what is coming and maybe even stop some of it arriving. And certainly influence and change it to protect patients.
That is not to say we shouldn’t cooperate with Government when it is useful and appropriate to do so. I have met and stood with the Minister on many occasions during my Presidency (She has had afternoon tea in my practice and she has shared her wedding photos with me).
The relationship really is a good one. A relationship of mutual respect.
On Indigenous health and most recently on Swine Flu – where the AMA took responsibility for early commentary as well as working directly with the Chief Medical Officer and the Minister to ensure both the flow of information to doctors and the community. This included the AMA launching a public appeal for people not to stockpile anti-viral drugs.
The clarity and strength of our message has also born fruit in a broad range of positive outcomes over this Presidency; from dramatic increases in training positions for doctors, to the Prime Minister even quoting our figures on public hospital bed requirements.
From a complete back-down on the Code of Conduct to major wins on C and D consultations.
From substantial shifts on national registration and accreditation to winning a Senate investigation into the Medicare Audit legislation and ensuring the minister was very sensitive in making his claims in the face of wide spread concerns about patient privacy. And again we respect the Minister for joining us today.
These are major wins for the profession and the patients we serve. In each of these instances we achieved our ends through a combination of steady pressure, high quality analysis, quiet negotiation and, where necessary, strident protest.
As well as delivering specific wins, this approach has also helped to modify some of the broader rhetoric. As the government has become more mature, the desire for reform for reform’s sake has lessened. There is now a growing acceptance that the medical profession has a role to play in helping to build a better, more sustainable health system. The attention given to the AMA’s submissions to various inquiries is evidence of this progress.
So, we work with government on the things that benefit patients. And we work against government on the things that harm patients.
We don’t, I don’t, I won’t, apologise for this.
Without our clear resonant and independent voice healthcare in this country would be far less than it is today.
At the end of my Presidency, and with the amazing work of all of those around me, I’m happy to say the shop is in good order.
The policy delivered by the President is policy worked up from the grass roots, through committees, medical students, doctors in training, GPs, salaried doctors and others through Federal Council and Executive.
My thanks go to you all.
Australia remains one of the best places in the world to be sick or injured. We live longer, happier, healthier lives and a big part of that is thanks to you the doctors and thanks to the AMA – members of the Australian Medical Association.
Firstly - for the dedicated, compassionate, expert care we give our patients in our practices, surgeries and hospitals.
And secondly for the voice that we have raised for many years, not just from me, as the AMA, against health policy, cost cutting and sometimes bureaucratic madness that harms our patients.
This is both a legacy and a challenge. It is a legacy for me, at the end of my Presidency, but it is also a challenge to us all. Our challenge is to deliver to the next generation of Australians the same health benefits we have today.
And the same opportunities for our junior doctors.
Based on this Government’s ambitions for health, this is a mighty challenge.
But it is one that we are equal to. It is also one in which we must not fail.