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Inspirational Olympics
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By Linda Calabresi
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I love the Olympics.
I love seeing the best in the world compete against each other.
Not being particularly sporty myself, I'm in awe of people at the pinnacle of fitness, who have honed their skills through years of dedicated training and practice.
What’s more, it’s such a great leveller.
Looking at the competitors out there on the starting blocks there’s really no indication of the often very different lives they live back in their own country.
And even though they may all look in peak physical condition, you can guess they haven’t all had equal access to dedicated sports’ institutes, special diets and the latest sports medicine support.
I got some insight into this back in 2000, working as a volunteer doctor for the Sydney Olympics. By some incredible stroke of good fortune I was rostered to look after sick spectators (of which there were very few - strangely enough! Would you give up your $300 seat at the swimming for anything short of life-threatening illness?), but I got to speak to those health professionals working in the ‘polyclinic’ for the athletes.
They were completely swamped.
Scores of athletes and officials from the poorer African nations especially had never before had such ready access to high quality medical and, particularly, dental care.
And the health workers told stories of horrendous long-standing, untreated conditions the likes of which they had never seen before. And this was in the best of the best.
It does make you wonder, doesn’t it?
Imagine what it must be like for some of these athletes, coaches and officials.
I read recently that a Sierra Leone soccer team were lauded as heroes after returning from an overseas competition. The praise was not because they won but, because the entire team returned to this poverty-stricken country that was their home.
The Olympics should be seen as inspirational, not only in terms of athletic prowess but because it can create such a common sense of purpose across so many diverse countries.
If only the world could manage to get its act together with health as well as it does with sport.
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Now they want your records
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By Linda Calabresi
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So now we can all rest easy. The government isn't going to take us to task if we charge a Level C when we spend more than 20 minutes treating Mrs Bloggs’ indigestion, plantar fasciitis, and BP along with her Pap smear.
This descriptor at least has been clarified – in a fashion. But the spectre of increased audits still looms before us. As of January next year Medicare Australia plans to conduct audits on 4% of the medical profession annually, up from the current 0.7 per cent.
According to the government’s media release (link) back in May it’s a move to ‘further protect the integrity of Medicare’. Makes us sound like a shifty lot doesn’t it? Are there so many rotten apples in our barrel?
Looking back on those glossy little name-and-shame publications put out by the Professional Services Review over the last few years, doesn’t really shed any light on where the impetus for such a ‘stick’ approach is coming from.
In 2004-2005 Medicare Australia (then called the HIC) referred nine doctors to the PSR to be reviewed for suspected dodgy dealings and in 2005-2006 there were seven referrals. Admittedly last year they had a bumper crop, 27 referrals! Even with that ‘blow-out’ (and remember all these referrals are yet to be proven) – that’s 42 doctors in three years – out of 50,000. Hardly a groundswell of graft and corruption.
The PSR also managed to recoup $1,155,980.84 for Medicare last year, but compared to the $7.5 million the organisation costs the government each year, for the 15 full-time staff and the 133 committee panel members, it obviously isn’t a revenue-generating exercise.
So perhaps the audits are a way of giving the PSR something to do. And this is where I think it gets really scary. At the moment Medicare Australia just looks at stats and can talk with the doctor about their practice. If further investigation is deemed necessary they refer to the PSR, who are doctors who can then look at the evidence to support the referred doctor’s claims.
However, with this new initiative, Medicare Australia is going to be given new authority to examine the evidence to support the claim. Along with being able to check receipts, referrals, requests and appointment books this will also mean the power to check patient files.
Some bloody bureaucrat will have the power to look at a doctor’s file to check whether they really did treat four conditions in 20 minutes! I didn’t believe it either but I have it in writing from the Minister of Human Services’ office.
But don’t worry, the minister assures us that these changes (due to start next January remember) won’t happen without significant consultation with the medical profession. Hmm ...
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No friends like old friends
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By Linda Calabresi
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Last weekend saw me disappear off for my annual weekend away with the 'girls.'
For over 20 years, six of my school friends and I have written off a couple of days every year to devote ourselves to the heady combination of wine, laughter and conversation.
Over the years we’ve shared stories of careers, relationships, children, parents, health, happiness and heartache. It’s an old but true saying, there are no friends like old friends.
There is something inherently valuable about a long-term friendship. And it’s the same with general practice. In general practice however it’s not known as long-term friendship it’s called ‘continuity of care’ but, in reality, it’s the same thing. It is that ability to pick up where you left off when they walk through the door rather than having to start from scratch each time.
Many GPs I know have far more experience with this phenomenon than me, but even in my 10 year tenure at my current practice I have a number of patients whose life as well as their medical history I can recite without prompts.
While familiarity might be said to breed contempt it surely has to also breed a better standard of care. Any diagnosis I make or any treatment I prescribe in these patients is made with a background knowledge that is so much deeper than just reading the front-page health summary.
Do you think the powers that be recognise the value of continuity of care?
There’s no denying that patients with complex medical problems benefit from access from a wide variety of health professionals, but patients also appreciate and want a single health advocate, someone who knows their entire history rather than just their current problem.
With all the recent talk about extending prescribing rights to other health professions, and GPs not necessarily having the ‘gatekeeper’ role, you do get the feeling there is a lack of appreciation for the value of continuity of care, at least among bureaucrats.
Fortunately, however I feel people like me, value long-term friendships. Human nature being what it is, there is always going to be demand by many patients to have their own GP.
And for us GPs, there are no patients like old patients.
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