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Mislead and manipulated (Australian Doctor, opinion)
By Dr Harry Hemley. 15 May 2009.
Inconsistent and hidden data does no one any favours, least of all patients...
At the height of the data manipulation scandal that hit Victoria in March, the state’s Auditor-General released a damning report which found that hospital performance data was inconsistent or inaccurate at all four public hospitals audited - one of which, it was found, had been deliberately manipulating its reports.
While data being manipulated by our hospitals is bad enough, at the moment hospitals can only manipulate a part of the story about how long patients wait for health care. The Victorian Government is still hiding vital information – the time patients wait for a hospital outpatient clinic appointment.
Hidden information and data manipulation in Victoria’s hospital system is hurting patients. Bad data means we do not get an accurate picture of the health care needs of the community. It is becoming clearer that we are being misled about how much pressure we have on our system, and it the most disadvantaged in our community that suffer the most.
General practitioners are seeing an evolution in Australian health care to a system where rich and poor get very different care. If a GP sees a patient who needs specialist health care, there are two options. There’s a private, community system where I can refer a patient to a local specialist. There may be a short wait, and there is likely to be a small out of pocket cost. These out of pocket costs can escalate the more care is required.
For my patients who cannot afford private specialist care, I will refer them to the local hospital’s outpatient clinic. Then we wait.
The patient may be in pain, or discomfort, or I may need the specialist diagnosis skills to work out what’s wrong. I have no idea how long my patient will wait, as the Victorian Government still refuses to publish outpatient clinic waiting times.
I see patients referred for hip replacements wait 12 months to be seen in an outpatient clinic, then wait a further 6 months on the “official” surgical waiting list. Most people would see that as an 18 month wait, not a 6 month wait, as officially reported.
The Auditor General last month recommended that the Victorian Government publish the data, but the government said no. The Auditor General said, “Reported performance of access does not represent the actual waiting experience of many patients.”
The government’s decision to hide the data is wrong on several grounds. It’s bad for patients, bad for doctors, and bad for the community as a whole.
First, if the government discloses how long my patient will wait, I can properly assess the alternatives. If I know that it will be twelve months until my patient can get an outpatient clinic appointment, I will look at other options.
There might be another hospital with shorter waiting times, and my patient could travel to another service. I suspect that many outpatient clinic lists are longer in the western suburbs than in the eastern suburbs – but I don’t know.
Access to our public hospitals should not be dependent on where you live. Knowing the data allows me to help the Victorian Government even out the demand.
If my patients are going to be waiting months for specialist care rather than weeks, I might be able to better manage their pain. Several pain medications lose effectiveness over time, and there is the threat of addiction from unplanned, prolonged use. Pain management for patients facing an uncertain wait is much more difficult, leading to poorer outcomes.
Like many Victorians, I am angry and disappointed that hospitals have been caught rorting the figures. But it is worth noting that the hospitals only manipulate part of the story, time to surgery from the time the patient gets to outpatient clinics. The clock needs to start when a GP determines that the patient needs specialist care.
Whatever the short term gains for the hospital, there is a long term deleterious effect on the community. Hospitals that manipulate data to make the figures look good mean that the real need is hidden - less money and less care.
The data manipulation is difficult to swallow, but the failure of the Brumby Government to accept the Auditor General’s recommendation to report hidden outpatient clinic waiting lists is worse.
Hopefully other states will learn from Victoria’s mistakes and pressure will be on all states to guarantee the integrity of their performance data and reveal the true extent of surgery waits.
The clock for waiting lists must start when patients are assessed as needing care – not weeks, months or years later.
We need the truth, and the whole truth. Only then can we have a sensible discussion about providing health care to the disadvantaged.
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