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Change: do the sums, stop the guesswork
Dr David Rivett
Australian Medicine 14 December 2009
To me, as the proud owner of about 70 Poll Hereford cows with calves at foot, the months of October to December are a great joy as the worrisome calving period is over and one can sit back and enjoy watching the cows nurturing their rapidly growing young.
Likewise it has been great to see the AMA engage productively with government on the future of medical care.
Change is inevitable. But it must be focused not on change for change’s sake, but on achieving better patient outcomes. For such to occur, government much engage with the profession at the coalface, and give short shrift to starry-eyed academics in ivory towers who wish to stamp their ideologically-driven theorems on the workplace. Big wins have been made for patients, by the AMA’s lobbying both for GPs to lead primary care provision and for regulations to ensure collaboration of independent nurse practitioners with a doctor.
What can best be achieved for our patients, given constraints on both funding and manpower is best decided by clinicians actively involved in patient care. Grand changes to the order of the day, should not be made by bureaucrats distant from care provision and removed of responsibility for clinical outcomes.
Any suggested sweeping changes they wish to pursue must be progressed by engaging clinicians and, with clinician support, then trialing their solutions in a limited population group. Solid evidence must then be secured that the trialled change is both cost effective and benefits patient outcomes before it is rolled out en masse. Change for change’s sake is merely disruptive, and distorts the focus from patient care to coping with the rewired system.
Does sound methodology and solid evidence direct change now in our health system?
Sadly, it does not. Enhanced Primary Care items in the MBS have no robust evidence that they are of benefit to clinical outcomes, and no meaningful attempt under way to determine such. Certainly they are welcomed by the general practice workforce as a source of funding, enabling them to keep their small businesses afloat.
But has a trial been even envisaged of, say, paying fair patient MBS rebates for longer GP consultations in one state and EPC items in another? No, it is all too hard, and the results might be a major embarrassment to those who have given us such grandly titled schemes.
Well, it’s time that government put in place actual trials of new directions agreed with clinicians, and then did the sums on costs and outcomes and stopped guessing.
Bureaucrats in the Department of Health and Ageing need to find what actually works, not just what can be sold to their political masters as electorally attractive. All too often overseas evidence is quoted as directing change. It seems not to matter if the evidence is out of date or more recently discredited if it helps sell an ideologically-driven solution.
Before government goes reforming medicine as we know it in Australia, let us agree on an evidence-based protocol for change, to ensure that no babies are cast aside with the bathwater or, failing that, that they are quickly spotted and revived.
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