Interview Dr Bill Glasson, AMA President with Jon Faine, ABC774 Melbourne - Best practice rostering kit for doctors;hours worked by doctors; need for better rostering of doctors and nurses; future use of health professionals to ease burden on doctors

COMPERE:     This morning, the AMA, the Australian Medical Association, together with the AHA, the Healthcare Association, are launching a campaign to reduce the working hours of doctors in public hospitals. Dr Bill Glasson is the President of the AMA. Dr Glasson, good morning.

GLASSON:      Good morning to you, Jon.

COMPERE:     Are doctors exhausted?

GLASSON:      Well, they are and they have been for a long time, particularly, as you say, in our public hospitals, but also in the private system as well, where doctors tend to work long hours.  And I don't think ... often they don't realise how, if you're tired, how impaired you can become.

So I suppose This is all about better rostering, about safer hospitals, about happier doctors and, more importantly, about healthier patients and healthier hospitals.  

So it's all an initiative to try and identify what fatigue is, what it does to you in your performance and, obviously, we always draw the analogy of being intoxicated, so if you work more than 24 hours in any straight shift, they always talk about you being the equivalent of about .05 to .1 intoxicated with alcohol. So I presume that most patients out there would feel that that is not the appropriate doctor or nurse to be treating them.

COMPERE:     It has ever been thus though, has it not?  As far back as I can remember it's been part of doctor training to put them through this absurd period of time where they work ridiculous hours.

GLASSON:      Exactly, Jon, it's like a rite of passage to be a doctor...

COMPERE:     Yeah.

GLASSON:      ...to sort of work these ridiculous hours.  I remember when I was a resident, we used to ... I used to work all week and then we'd finish sort of late Friday night, we'd start seven o'clock Saturday morning, we'd go to midnight on Saturday night, start again  Sunday morning at seven, go to midnight on Monday morning, to be back at work at seven o'clock on Monday morning. 

So it was just ridiculous.  By the end of the day, you know, you were sort of half ga-ga.

COMPERE:     You were a robot.

GLASSON:      An absolute robot.  And obviously it impacts on your decision making, impacts on your ability to treat patients.  Also, you became inefficient, you know, like anything, if you're tired, you can't see patients as efficiently, you can't think as quickly. And also, it's not only bad for the patient, it's also bad for the doctor's health.

COMPERE:     I would have thought appalling for their personal life, apart from anything else.

GLASSON:      Absolutely.

COMPERE:     But it's pretty easy to fix, isn't it, you've just got to spend more money.

GLASSON:      Exactly.  And also be smarter with the rosters, Jon.  At the end of the day, if they do these rosters appropriately and smarter, it can actually save them money effectively.  You may need a few more extra staff, but in reality, if you can have some flexibility in the workface ... workplace, as far as the hours that they work and the shifts they work, you have a much happier workplace and you have less staff turnover and therefore you've got a much more sustainable service.

COMPERE:     We don't have enough doctors anyway though, do we? Even if you had more money, you'd still have a shortage of practitioners.

GLASSON:      You're absolutely right. The big issue out there, Jon, is we do not have enough doctors and it's going to unfortunately get worse before it gets better.

But I think we can probably ... I keep saying that if they've got enough flexible shifts, a lot of our part-timers, particularly part-time females, as well as the part-time males, can actually slot into the hospital system as hospital officers, medical officers, and actually fill a lot of those shifts and obviously take a lot of the slack, particularly if people are sick, or if they get short of doctors at any particular time of the year. 

So they need to have it attractive for the doctors to work there and have the hours attractive, then you're more likely to keep people there and also to say, bring people back into the system that feel it has been unsustainable in the past.

COMPERE:     At the risk of being shouted down by you, Bill, I'd have thought it's time to rethink our definition of nurse and doctor and to create something in between, so you can get a lot of the work being done and taking up the time of highly qualified doctors being delegated to health professionals who are better trained than your average nurse or paramedic, but is not necessarily a fully trained and qualified doctor.  And you can free up the whole system by redefining the different roles and skills.

GLASSON:      I think you're right, Jon.  I think we're going to have to get smarter now as we have less doctors and less nurses.

COMPERE:     And in remote communities in Australia and overseas, this has happened already, but not in the cities.

GLASSON:      No, that's right.  I think it will happen, because I think we will not be able to deliver the service that we have traditionally delivered and so we've got to get a little bit of measure, to make sure that the doctors that are working are working there effectively at what they should be doing, not filling out a whole lot of forms, which a lot of the junior doctors find themselves doing.

So I do think you're right, we've just got to decide how we need to remodel the whole system so that we can actually deliver the service, or the increase in demand for service, particularly as we all get older, by the community.

COMPERE:     So would you agree there's room then in our major hospitals for a paramedic, or senior highly experienced and better trained nurse, who is delegated the authority to prescribe some particular pharmaceutical products, or say, 'yes, this patient needs a drip', or 'that needs a suture', or 'that needs a dressing', but can also refer more complex diagnoses and treatments to a doctor if there's a need?

GLASSON:      I think that's happening with integrated nurses even these days now, is that the nurses are more highly skilled and highly trained.     

I wouldn't ... my main argument is that they should be integrated as part of the team, they should not be independent.  In other words, whoever is in the team, I don't really care, as long as they're working as a unit and not working independently. And so at the end of the day, the buck's got to stop somewhere and that usually stops at the doctor, who ultimately has got to make the final decision.

And so long as the doctor and the nurse and whoever else is working the team is responsible, I suppose, to that unit, then I think you're right, we've got to get smarter that way and I think that's one of the ways of moving forward.

But I don't believe in having a sort of independent system, or an independent group of practitioners that really are not answerable to the team and I think it's got to be team approach and that's where we get our efficiencies.

COMPERE:     All right.  Just going back then to the announcement that's being made today, what's the actual rostering kit, what is in it?

GLASSON:      What we've done actually is allowed ... it's a sort of software program that the hospitals can take home and look at. But essentially gives them a series of schedules, rosters, that they just put doctors on.

And it demonstrates, you know, what is a smart roster and what is one that is not so smart, in other words, where doctors are working hours that are too long, shifts that are too close together, working too many hours per week and not giving people enough time off, you know, in a weekly cycle, not having any time off at all.

So it tries to identify in a fairly smart way actually some of the current commercial software programs, Jon, that you can actually buy that try to help with rostering. But this, sort of, I suppose ties in with that and says that this is the way to have a healthy workforce, a more effective workforce and, as I say, more importantly, healthier patients in the long term.

COMPERE:     Just finally, in Melbourne, The Age newspaper, Dr Glasson, has been running a pretty insightful series about medical errors in hospitals. It's caused us to sit up and think, well, wow, there's something going on here.  What's the AMA's view?

GLASSON:      I mean, this is all part ... this is all part of our strategy, strategy to identify exactly why these incidents are occurring.

What normally happens there, Jon, is it's not an individual, it's a system failure. And the trouble is the public hospitals are under more and more strain, the doctors and nurses and everybody are expected to do more and more on less and less and yet we're supposed to be sort of, you know, performing at 99.9 per cent.  The jumbo has to get off the ground every time.

Unfortunately, with older patients, sicker patients that are on poly-pharmacy, often on 10 or 15 drugs, it's often the drug interactions that are the ... where a lot of these adverse events arise and so again we've got to have systems in place, we've got to have sufficient funds in place so we can actually address these concerns that have been raised in this report.

COMPERE:     Have a successful launch today and let's hope we all get the benefit of it.

GLASSON:      Okay, Jon, thanks very much.

Ends