The Greens oppose the CPRS not because it is too weak, but because it will point Australia in the wrong direction with little prospect of turning it around in the timeframe within which emissions must peak, says Senator Christine Milne.
Nurses say that it’s time the AMA got with the times
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In coming months, the World Health Organisation will launch a series of case studies showing how nurses around the world are leading primary health care projects, as well as innovation and development more broadly in health care. The report, which I’ve helped prepare, also shows that in countries such as the US, Canada, the UK, South Korea and the Cook Islands, nurse practitioners are providing front-line care that is recognised to be as safe and effective as that delivered by doctors. Sometimes patients report being more satisfied with the care provided by nurses. The WHO report also shows that in many countries, midwives deliver the bulk of maternity services and do so safely, appropriately and without the excessive intervention that can occur in Australian obstetric servicing. So it’s extremely heartening that Australia is finally taking steps to modernise its health care practices and to enable nurses and midwives to work to their full potential. The Federal Government’s recent appointment of a Chief Nursing and Midwifery Officer is long overdue. It’s embarrassing, however, that elements of the medical profession seem to wish to take us — not even back to the future, but forward to the past. Rosanna Capolingua’s recent address to the National Press Club and subsequent press statements are more reminiscent of Dr Findlay’s casebook than a modern health care service. The perfect medical world that she paints is far from the reality for the majority of health care consumers. While Dr Capolingua stresses the importance of doctors being the gatekeepers of the health system for ensuring continuity of care, I wonder who looks after her patients on the days outside her Monday surgery? I point this out not to denigrate Dr Capolingua’s commitment to her patients, but to highlight the reality of the modern health care system, in which many doctors work part-time in the clinic, and refuse to see patients out of hours or do home visits. Don’t let’s imagine either that the AMA has a monopoly on safety or quality. There are plenty of other really good health professionals - nurses, midwives, physiotherapists, radiographers, pharmacists and others - who are more than capable (and quite probably more appropriate and less expensive than doctors) of working with people in the community to provide good case management AND to be able to liaise with everyone else who needs to be involved. That’s what nurses in hospital do every day of their lives. The big issue for the AMA is not quality of care, not patient safety — it’s turf, its money. Don’t be fooled, Australia — other countries can demonstrate the safety and efficacy of nursing and midwifery led models. The sky won’t fall in when we formalise similar models here — in fact there will be improved access to health care and better primary health care in homes, schools and work places. While the PM and Health Minister do their best to bring Australia’s health system up to date, it looks like the AMA will continue on its Luddite path. In the meantime the nurses and midwives of Australia are already working collaboratively and successfully with many visionary doctors and allied health professionals who want to be a part of a 20:20 vision for health care. Mary Chiarella is Professor of Clinical Practice Development and Policy Research in the Faculty of Nursing, Midwifery & Health, at the University of Technology, Sydney. |
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7 Comments
I had the displeasure of being at Dr Capolingua’s Press Club address and heartily agree that it sounded “more reminiscent of Dr Findlay’s casebook than a modern health care service”. Her sing song description of bulkbilling a patient over decades and dealing with the familiy members after her death was admirable but hardly reflects the common reality for patients. Over 40 years I’ve never seen the same GP more than two or three times in a row. Its the same for my kids, we pay $70 up front for the six minute service and sometimes wait hours past the alloted appointment time.
An integrated medical centre or superclinic efficiently using a range of professionals including nurses, GPs and administrators to deliver timely care with continuity would be a dream come true.
The premise that there is complete separation of skills between doctors and nurses is clearly false. There must be areas where service (and cost) efficiency can be delivered. I will read with interest Professor Mary Chiarella’s report.
I respect my local GP, but he does not run an efficient business. He is two doors away from a similar surgery. His receptionist sits on her butt most of the day, so does the other one. The vaunted Productivity Commission should look into why (largely) Medicare funded doctors are allowed to operate as sole traders with duplication of premises, equipment and usually a receptionist to greet and apologize.
The Doctor’s Union seems mighty precious when pushed on such issues.
After my husband’s prostate surgery went horribly wrong I found the Nursing Consultants attached to the Community Heatlh Service far more informative and caring than the specialists encountered.
The Nurse answered all our questions no matter how inane she may have felt they were. She was able to suggest different therapies - physio, etc. The Drs, in contrast, were interested in only doing more surgery as we are privately insured.
In the end the Nurse turned out to be correct - less surgery has resulted in less trauma and a return to full health.
Super Clinics and allied health professionals will suit us admirably.
Totally agree! It’s such a waste of time, money (mine and the taxpayers’) and resources (that could be going towards sick people) that I have to go and see a GP - who knows far less about my health than I do - for a few minutes for him or her to write out the prescriptions that I tell them to write. I’ve never seen such easy money in my life - litlle wonder the AMA is trying to protect the status quo.
On a radio training assignment in PNG’s remote highlands last October it was instructive to find that PNG nurse practitioners were frontline staff in delivering primary health care, according to the Australian head of the local hospital. It was great to work with these women, and other health workers, in delivering a range of health education messages via news, community service announcements and radio plays.
How did we, the colonial power, manage to enable this in PNG but not in Australia? I’ve worked in a few health institutions over the years and the rejection of NPs is always by the same medical staff and for the same reaons. Meanwhile back in PNG …
I have no doubt that some patients report being more satisfied by the treatment they receive from nurse practitioners than they would from doctors. Equally, I have no doubt some patients would report being more satisfied with receiving treatment from a doctor. However having experienced the nurse practitioner model the NHS operates in the UK, I can say my experiences have been entirely negative. When it comes to receiving medical treatment, I now do one of two things – pay exorbitant fees for private treatment (despite paying for top private health insurance), or postpone treatment until my next trip back to Australia.
Nurse practitioners might be fine for countries with less advanced health systems, but Australians deserve, and must demand, better. Perhaps a first-hand experience as a patient in the UK would make Prof Chiarella think twice about commending it as an example of success.
Nurses are the backbone of our hospitals and are undoubtedly among the best in the world. We rely on them to play a vital role as nurses, not doctors. As for the nurse practitioner model in the UK, all I can do is make a heartfelt plea to our health ministers – please don’t go there.
If the roles of nurses and doctors are completely interchangeable then why not just call the nurses “doctors”? The proposition that they are interchangeable is an absurd argument! The training of the 2 professions, while overlapping in some ways, is quite different and that the leading spokespeople for the Nursing profession deny this makes me wonder about the soundness of the nursing curriculum.
The postings are also quite revealing. PNG is a ‘basketcase’ economically and socially so any health care delivery is better that none . Chris says he has never seen the same GP more than 2-3 times. I assume he is suggesting that is because he cannot get access.How does being able to see a physiotherapist, nurse, chiropractor, etc in place of the doctor solve that problem? In any case, the ideal IS to see the same doctor regularly. Continuity of care is crucial to good preventive medicine and the management of chronic disease. That is why you need a well trained generalist doctor providing the care. Good medicine is not just writing scripts.
Tim’s posting about the Gp ” who knows far less about my health than I do ” makes me want some reassurance that I’m not practicing in his area. Patients with that attitude remind me of that Mr Bean skit where he inadvertently anaethetises the dentist attending him then procedes to do his own filling. I think they’re known as the patients from hell!
Finally, surely opening Medicare to the allied health professions in the manner foreshadowed by Nicola Roxon has some cost implications for consolidated revenue. Was not the reason that Michael Woolridge restricted provider number access, when he was Health Minister, to try and contain costs to Medicare by containing the SUPPLY side of the cost equation?
No governement will countenance any restricition on the DEMAND side of Medicare with a price signal so I’m puzzled by this opening up of Medicare to all and sundry.