Transcript of Question and Answers at the Ama's National Press Club Address With AMA President, Dr Mukesh Haikerwal, 20 July 2005

COMPERE: Thank you very much Dr Haikerwal, we have a period of questions which begin today with Jason Frankel.

QUESTION: Thanks very much Dr Haikerwal. Jason Frankel from the Herald Sun. Two questions if I could. One, just historically has the AMA ever been as close to the Commonwealth Government as it is right now, and do you see that relationship continuing in it's current course?

Just secondly, you touched briefly upon Health Connect and ID cards and Medicare cards, can you envisage a day when we will have one catch-all card that's covers identity and health records and medications and all those things? And do you think it will rile the public?

DR HAIKERWAL: Jason thank you. Very essential questions as usual. The closest to government, we're really a lobby group. We have two real functions I believe. One is to look after the interests of our profession, to make sure that the working conditions for doctors and health related workers are good and acceptable.

The other point for the AMA is to look after the welfare of patients and being honest through the arbiter. The person that can cut through some of the hype that you get from all political parties. We do have a good relationship with the present government, and we do have a good relationship with the opposition, and we do have a good relationship with other members of parliament too. So I would like to maintain good relationships with all the people in the political sphere because it's important for us, it's important for our members, and obviously important for the public.

Regarding the ID card, the debate really is - will actually get blown out of the water if we're not careful. We've just got into a system where electronic health information in this country is being thought about in a very thoughtful, careful manner. We've got the national electronic transaction authority working on this in a systematic way, and it's important that they continue to do that, and bring confidence into the system. Make sure people are happy with the security, make sure they understand that if there is going to be data that's kept, it's very, very personal and it's got to be secure.

If we don't suddenly bring into this debate, all this question about leaking data and databases for spurious reasons, we undo all that good work. We've got to do the work, do it well, make sure they're confident with the processes and the sanctity of that data.

QUESTION: Sue Dunleavy at the Daily Telegraph. Dr Haikerwal, a few weeks ago, the Health Minister, Tony Abbott accused doctors groups of being more interested in their incomes than their ethics. And he said that if you didn't start doing something about your ethics then the government might have to do it for you.

Today you've issued a press release and you've done a survey which shows that Australians are not happy about doctors who sell their de-identified medical records. There are doctors in Sydney who set up a group, they're getting paid every time they refer patients to physiotherapists or other allied health services.

There's another group which is looking at setting up a system where they get paid every time they order a blood test, and currently there are several hundred doctors who are getting shopping vouchers when they do pass on the de-identified patient data to a computer company.

What does the AMA think about this practice? You've done a survey but what are we going to do about reigning in these practices?

Do you think they're ethical, and are you going to take a stand on this as president?

HAIKERWAL: There are a variety of points in your question. I think the important thing is the ethical basis has to be maintained. The AMA has a code of ethics and there's some that we've pursued, so we've certainly got a variety of ways in which we deal with pharmaceutical industries and other industries as part of that process.

Remember that our members are members by choice, and that we can provide a code of practice, a code of ethics. That we can advise people is the right way to do it and we can discuss that within our own processes. There is no real way in which that can be imposed. The medical board has had a way that if they think someone's unethical, or something isn't proper, and those things get reproached.

Yes, I think that the way in which data is used, collected, the purpose which is collected has to be done in a very careful way and it has to be informed patient consent about this and anything else. Then if at the time the data is collected, the reasons in which that data is collected, and before that data can then be used for that purpose. If it does get to wrong purpose or another, that is actually something that we would have issue about.

QUESTION: Glen Milne from News Limited, Sunday publications and the Australian. I'm not sure why I was singled out by our beloved CEO in his off air introduction, but I just want to assure the members of the national press club committee that when I wrote last week that there was a leak inside the club, I was referring only to the roof.

Dr Haikerwal, if I could ask you about the question of portability of private health insurance funds. We all know that Medibank Private is stripping itself down for possible privatisation and that involves reducing the number of contracts it has with hospitals including I'm told, St Vincent's. I've met with two of the biggest hospitals in Australia. That raises the issue of portability or the lack thereof between private health insurance funds.

I wondered what you thought was the implications for both doctors and patients of that lack of portability and what you'd like to see the government do about it. And if I could ask one second question, you raised serious issues of privacy today. What would be the AMA's position on the question of the national identity card?

HAIKERWAL: Thank you. The question about portability of health funds of course is very important. The government puts in 30% towards private health premiums, and it's an important product that health funds actually provide, is a good product and is a product that people actually won't haggle it to buy. And part of that's buying a product. Those who get services when they need them.

If the services provided by health funds are being curtailed for one reason or another, that can certainly put a lot of pressure on that process, and therefore you need to have portability so that you can get a health fund that meets your needs.

We need to make sure that there is a good process to ensure quality of safety with hospitals that are being used. But if two of the biggest hospitals in the country, and it's said of two of the biggest hospitals in Victoria are going to be removed from the provider's list from a large fund, it's got serious implications on the fund to deliver services to its members.

One thing that will exist when you first think about it is, if somebody does transfer from one fund to another because they want to get these services from that newer fund, there may be some obligation that pertains to the fund from which they came from to maintain some of that obligation to pay for those services because they weren't in the fund if you like.

On the second point, privacy. It's a very important issue and it's central to medicine and we're developing some good protocols and some good ways of dealing with that very important medical information. And people don't mind if some on the web, they get a bit hacked off, but I don't think they'd particularly - but if they saw their medical records went on it they'd be very upset.

Let's use that process and see if it's worth taking it any further. We've had a great concern about linking of different databases and datasets, and that linkage of data can be very insidious, and it can be very destructive when an individual person's privacy and independence. I think that's something that you've got to pay attention to.

The ID card, good, why are we doing it? What's the purpose of it? If it's about terrorism, will it work? Did it work in Spain where they have ID cards? I don't know.

It's a debate that we have to have within our own Council as well. But we've got to understand what we want to do and why are we doing it before we set up a system by immediate reaction. And what is the fantastic work that's been done to make things really safe.

QUESTION: Melissa Polimini from Australian Associated Press. In terms of Australia's mental health system, do you think there needs to be a re-think on Australia's policy of moving mentally ill people into the community and that's in light of comments by the Police Federation of Australia, that they're bearing the burden of an under-funded system?

HAIKERWAL: Thank you. I think that mental health is a very significant issue within our community. We have 20% to 30% of our population who will have a mental illness at some time during their life. It's a significant illness. You have no choice when you get mentally ill, but it's treated as though we do. If we had a heart attack, we would expect to have a right to ambulance and expect to go to a proper care unit. We'd expect to have arteries opened up and all sorts of whiz bang treatment.

When you say a psychiatric care patient with clear acuity in the level of your illness, if you're lucky to get somebody out, you're lucky. If you get into a casualty department you can get chained in there for days while you get someone from the right area to come and look after you, and the care that you get is pretty poor when it happens.

We need to approach mental health with a much bigger picture, a much better look. The senate committees were one start in this process, but we have got to be real about it. We've got to have an approach that is going to be an area or nationwide approach and provide proper funding and proper facilities for people.

Now we had an

COMPERE: Thank you very much for our first appearance here for the National Australia Bank addressing your new role as Head of the AMA. I hope that Family Doctor Week is a great success - you've certainly done your bit for it, and we thank you for it.

DR HAIKERWAL: Thank you very much.

Ends