Download the Australian Medicine app, free at your favourite app store Budget takes aim at health Universal health care in Government sights, p8 10 Public hospitals under pressure 11 Indigenous health’s temporary lifeline 12 Close 457 loophole: AMA 19 Post-antibiotic world looms 20 Pap smear’s days numbered 34 Plain packaging laws provoke trade storm WHO declares global polio emergency INSIDE 29 ISSUE 26.09 - MAY 13 2014 BOOK NOW! BUY TICKETS NOW AT Join entertainers Vince Sorrenti DISCOUNTED RATE and Keith Scott and celebrity FRIDAY 13 JUNE speakers Graham Richardson and Alan Jones for a night of laughter 2014 whilst reflecting on some of the issues that gave rise to the Dispute. Dr Peter Catts invites you to join him and his colleagues at a This is a must attend event for doctors and friends who believe in GALA CHARITY BLACK TIE DINNER and FUNCTION professional independence and the AT THE BALLROOM OF THE FOUR SEASONS HOTEL importance of the doctor patient relationship. 199 George Street, Sydney at 7 pm on Friday 13 June 2014 Come and celebrate that you are as we recognise the proud to be a doctor as we bring Australia’s medical profession 30 YEAR ANNIVERSARY together. This profession stood up for the of the 1984 Doctors Dispute rights of patients in 1984 and now, 30 years on, this battle continues. Click here to see blog. For more information on the The event supports three worthy medical charities – Neuroscience Research Australia event, please contact SALT (NeuRA), The Shepherd Centre and the Victor Chang Cardiac Research Institute. Events Pty Ltd on (02) 9973 1218 or email [email protected] www.doctorsdispute.com.au In this issue Managing Editor: John Flannery Editor: Adrian Rollins Production Coordinator: Kirsty Waterford News 8-26, 38-39 Contributor: Sanja Novakovic Graphic Design: Streamline Creative, Canberra Regular features Advertising enquiries 5 VICE PRESIDENT’S MESSAGE 32 DOCTORS IN TRAINING Streamline Creative Tel: (02) 6260 5100 7 SECRETARY GENERAL’S MESSAGE 33 HEALTH ON THE HILL Australian Medicine is the na tion al news publication of the 27 PUBLIC HEALTH OPINION 36 LETTERS Australian Medical Association Limited. (ACN 008426793) 28 GENERAL PRACTICE 37 RESEARCH 42 Macquarie St, Barton ACT 2600 Telephone: (02) 6270 5400 29 THERAPEUTICS Facsimile: (02) 6270 5499 Web: www.ama.com.au Email: [email protected] Australian Medicine welcomes diversity of opinion on national health issues. 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President Vice President Chairman of Council Treasurer Executive Officer Executive Officer 3 Dr Steve Hambleton Prof Geoffrey Dobb Dr Iain Dunlop Dr Elizabeth Feeney Dr Brian Owler Dr Stephen Parnis VICE PRESIDENT’S Government project has still to deliver MESSAGE It is governments, not its potential efficiencies. The other great opportunity is in telehealth. doctors, who need to While there has been some take up, particularly for consultative services, telehealth remains greatly under- utilised, especially for a country change archaic practices with such a dispersed population as Australia. In particular, the potential for improved access to general The Better Bang for your Buck issue Nevertheless, the most interesting for 46 per cent of Medicare costs, practitioners for those in rural and of Health Voices, the magazine article comes from Federal Health and potential roles for private health remote communities has still to be BY AMA VICE PRESIDENT of the Consumer Health Forum, Minister Peter Dutton, because it insurance in primary care. realised. PROFESSOR GEOFFREY DOBB includes articles from a range of provides some insight into the current Missing from the article is any commentators on health policy thinking of Government on health More fundamental are the acknowledgment of the world leading as well as contributions from the policy, and there has been little inefficiencies that arise from our health outcomes enjoyed by the Coalition, Labor and Greens. external indication of that since the Federal funding system. Australia is average Australian, or the role that election. “failing to reap The underlying theme is that it is successive Commonwealth and Much was made of the ‘blame game’ possible to reduce waste and improve Given recent media coverage though, State Governments have played in under our previous Government but, the potential efficiency in our health system - and it is not surprising that it is written contributing to current inefficiencies. make no mistake, duplication of it’s hard to argue with that. from the “Growth in spending on Australia is failing to reap the services or worse - service gaps - rewards health is unsustainable” perspective, Some of the articles just say what potential rewards of modern continue. even though Australia is in the middle you expect them to say. information and communication of modern of OECD countries in the percentage Whether it is under-provision of aged technology. The Personally Controlled For example, Terry Barnes pushing of gross domestic product we spend care services (a Commonwealth information and Electronic Health Record languishes his $6 co-payment plan again, David on health, with predictions it will responsibility), leaving elderly people as we wait on the outcome of the Baker highlighting the potential increase by only about 1 per cent in in our public hospitals while they communication Government initiated review. savings from greater use of generic the next decade. wait for a place to be available, or technology medicines, and Jeremy Sammut After spending more than $1 billion, the interface between Local Hospital Key points made by the Minister resurrecting personal Health Savings there is little evidence at the point of Networks and Medicare Locals, include suggestions of change to ” Accounts. Others, including the health care delivery of its existence. many areas of clear responsibility for Medicare now that it is 30 years old. Shadow Health Minister Catherine funding and health service delivery He uses a comparison between the Health care is information rich, King and Greens health spokesman still need to be resolved. Richard Di Natale, point to the Kingswood and the cars of today and the benefits from the secure potential savings from investments as a way to mount his argument for sharing of information are clear, from Peter Dutton’s article is titled, in general practice and preventative change, as well as a focus on the increased patient safety to reduced “Change imperative to end archaic health. 10 per cent of patients who account duplication of investigations. This practices”. MORE P6 5 VICE It is governments, not doctors, who PRESIDENT’S MESSAGE need to change archaic practices ... FROM P5 Here he must be referring to the ‘inefficiency’ relates to the role our public hospital sector because public hospitals play in the teaching general practice has changed and training of future generations of drastically over the last three health professions, not just medical, decades - as small to medium size but also nurses and allied health. businesses, there has been no other Public hospital culture comes from option. the top, and there is still too much Any archaic practices - such as old fashioned bureaucracy here. making a telephone call to confirm Endless forms and documentation in a prescription under the Authority a largely information technology poor system - are those forced upon environment are a familiar overhead general practice by the bureaucracy. for those working in our public But even the public hospital system hospitals. Forms needing up to six has made great improvements in signatures for an approval are still a efficiency over the three decades of reality. Medicare. Well done to the Consumer Health This is reflected by much shorter Forum for bringing a broad range of hospital lengths of stay, increased views on health reform together. It’s used of day case admissions, a shame the AMA was not included. implementation of hospital-in-the The AMA has a lot to contribute to home and rehabilitation-in-the- the debate. home systems and, more recently, Certainly, we would always wish reductions in the time patients spend to contribute to Government policy in our emergency departments. positively and proactively rather Almost every clinical process than having to respond to ill- has been subject to clinical conceived policies after their public service redesign, from waiting list announcement. management to the admission But we reserve the right to defend pathway for our unplanned both doctors and patients against admissions. poor public policy when quiet It is often forgotten that some of the advocacy is not enough. 6 COMMENT SECRETARY GENERAL’S REPORT Federal Budget a dramatic prelude to AMA National Conference May is the time of year in the life cycle of the the Treasurer hands down a challenging Federal contribution made by members added to AMA when many different activities come to a Budget. Health Minister Peter Dutton has said the AMA Roll of Fellows. The AMA’s flagship peak. on many occasions that he wants to start “a research publication, the Medical Journal of Australia will provide an award recognising May brings the National Conference and new conversation about health”.