Dr Kerryn Phelps, AMA President - Radio 6PR - Corporatisation of general medical practices

This is not a commercial. This is not a TV show. This is according to a US Supreme Court ruling.

CO-COMPERE: And that's all because of corporate takeovers of medical practices and things like that, I guess, is it?

COMPERE: Mm. And according to The Australian this morning, the ruling threatens the centuries old 'patient first' tradition, and has heightened fears among Australian doctors that the corporate takeover of general practice will put pressure on doctors to ration treatment and meet care.

Dr Kerryn Phelps is Federal AMA President.

Dr Phelps, good morning.

KERRYN PHELPS: Good morning.

COMPERE: Well, we're pretty alarmed. Are you?

KERRYN PHELPS: I'm a bit alarmed myself.

COMPERE: Yeah. It's amazing, isn't it?

KERRYN PHELPS: It's certainly what we've been saying about the potential for a collision course between corporate profits and patient welfare. And it's quite, as you said, alarming. And I had to agree with you on your description - that a Supreme Court judge should see fit to declare the corporate profits as being more important than the welfare of the patient.

COMPERE: Well, what chance of this sort of thing happening in Australia, though?

KERRYN PHELPS: Well, the potential is certainly there. I mean, if you look at company law, the directors of a company are obliged to maximise profits for shareholders. That's what the reason for being as a company is. And, you know, hopefully there will be some ethics that come into the whole equation before too much longer. But at the moment we don't really have an ethical legislative framework in which these corporations operate.

COMPERE: So, how would you feel about this story then in the Medical Journal of Australia where an American doctor failed to order a test for eight days for a patient with stomach pains (and the guy turned out to have a ruptured appendix) because of the rationing guidelines set down by his employer?

KERRYN PHELPS: Well, these are the sorts of concerns that we're having. And when we talk about the loss of clinical independence, that's exactly what we mean - where the doctor who is seeing the patient hands-on does not have control over what tests can be ordered, because they have to call up a clerk in the medical organisation or the HMO and ask if they can have a test done or refer to a specialist.

Now, if that clerk is following protocols and the protocols don't actually match what the problem is for the patient, then you start to run into serious problems. And that's where you get problems when you're looking at rationing of care.

COMPERE: Is it fair to say it comes at an awkward time for doctors here in Australia, Dr Phelps?

I know, by and large, I think, most patients would be satisfied with the service their doctors provide. But obviously with some of the stories around, particularly recently, that services and other incentives are being offered by pharmaceutical companies to offer those particular brands, it is, if you like, a dicey time for doctors at the moment. They really need to prove to us again that our interests are what they are most concerned about.

KERRYN PHELPS: Well, there's been a massive shift in the landscape. And I have to say that it did actually arrive from Western Australia, and Perth particularly, that corporatisation began there and then headed east.

COMPERE: Mm.

KERRYN PHELPS: And it really has, I think, taken governments by surprise. And the AMA has been monitoring this situation and keeping government briefed on it over the last 18 months.

But, as yet, there's virtually been no attention paid to it. And the ALP actually put out a document last week trying to address some of the concerns. I think it's got a lot of work to be done on it still, but at least it's a beginning to start looking at some of the concerns and to actually enshrine patients' rights and the clinical independence of doctors, because doctors don't want to be told what to do when that runs contrary to what they believe is best for the patient. I mean, our ethics are so ingrained in us from the very moment we step into medical school.

What concerns me is if a lot of the training for these young doctors actually starts to occur in the corporate environment, and that becomes normal for them, that's where I think sort of half a generation down the track, that's where I'd really start to be concerned.

COMPERE: All right, darl. Well, keep up the good work. It sounds like you're on top of it.

I've got to ask you about this story, though. This is one that really grabbed me:

"Forget the degree, their bedside manner, or operating experience, what patients first want in their hospital doctor is for him or her to be wearing a white coat."

It's got to be a white coat, Kerryn!

CO-COMPERE: And extra points for a stethoscope around the neck!

KERRYN PHELPS: Well, I think one of the best advantages of a white coat is you don't get yukky stuff all over your good clothes.

CO-COMPERE: Are they still around, though? I mean, every doc I see now is wearing green or blue or

KERRYN PHELPS: Yeah. Well, I think, in the operating theatres the doctors will wear green or blue operating gear. But the white coats seem to have disappeared from the junior residents' staff. Some of the older clinicians still wear them around the wards. But I think most people have pretty much given them up now. I think if the patients want them, I think it's an issue that should be re-visited.

CO-COMPERE: Yeah, I reckon. Sixty per cent of patients want them back.

KERRYN PHELPS: It's a confusing time in hospital. And if you've got people wandering around in civvies, I mean, you're not sure if, you know, if it's the administration clerk who's come along and, you know, is asking your personal details.

COMPERE: Yeah. You don't want to be talking about acute appendicitis to the guy that works on the front counter.

CO-COMPERE: Well, the guy who operated on me recently, it looked like he was the janitor or something. Honestly. He came in. I said 'what are you doing, mate?' He goes, 'I'm the bloke who's operating on you.' 'What!'

COMPERE: Dr Kerryn Phelps, thanks for your time this morning.

Federal AMA President, Dr Phelps.

End.