Sometimes it seems there are two parallel universes when it comes to discussions about health policy.

In the sensible universe, there’s a general agreement that the answers to many of the health system’s problems lie in better collaboration, whether between health professionals, health services or financing systems.

In this universe, the talk — at conferences, in journals, reports and policy meetings — is all about the importance of teams, and how to build them and make them sustainable and effective.

In this universe, the importance of situation and context are also important — the right team for providing care in Canberra might look different to the team that works in Winton.

Meanwhile, in the other universe — and unfortunately this is the one that tends to be more visible because it dominates the airwaves and news pages — much of the talk about health policy is dominated by professional turf wars.

No prizes for guessing who leads the charge here — the Australian Medical Association and its presidential warrior Dr Rosanna Capolingua.

It’s worth checking out her interview with Radio 4BC yesterday, regarding the AMA’s opposition to nurses taking greater responsibility in emergency departments (listen here), which I presume followed this AMA news release appearing to blame nursing care for the deaths of two patients at Sydney’s Westmead Hospital.

The transcript is apparently being widely circulated in Canberra and health circles.

Here’s a brief taste:

ROSANNA CAPOLINGUA: And you are a journalist or a radio announcer, what are you? What would you like to be? And if you wanted to be something else you’d go and train to be it, you wouldn’t assume…

GREG CARY: You see, that’s the elitism I’m talking about. You’re saying that because you’re — it is elitist. You’re saying that because you’re a trained doctor that nurses who aren’t trained to be doctors can’t do some of those things that doctors do. They do them on a daily basis, doctor.

ROSANNA CAPOLINGUA: No, see, you were saying that.

GREG CARY: No. You were saying that. You just said it a minute ago.

ROSANNA CAPOLINGUA: I’m not saying that. I’m saying that nurses are trained to do things and they should go ahead and they do go ahead and do them with great skill and expertise. Just like I would not like someone to supplant the place of a nurse — if a nurse is looking after a patient in a hospital and perhaps they take them… well, they’re there when they go, when they get breakfast or something or other — and the nurse will observe that the patient is perhaps more short of breath than they were yesterday.

Apparently the AMA chief was quite flustered afterwards and is today stressing that her comments were about patient safety, not turf. Of course. And of course anyone can fluff an interview with an aggressive questioner. But the issue here is much broader than just this interview.

The AMA’s ongoing campaign to defend medical turf is starting to make the organisation look defensive, outdated and irrelevant to contemporary policy debates and challenges.

It risks alienating the many doctors (including some AMA members) and other health professionals who are trying to move forward, to improve systems of care and to ensure services are available to those who now often miss out.

It also invites some rather critical analysis of the AMA’s role in supporting a system which is too often driven by professional rather than public needs, is focused on rewarding specialist medicine rather than primary and preventive care, is in desperate need of work practice reform and so often fails to meet the needs of the most disadvantaged.

This morning I happened to be interviewing Dr Ruth Stewart, a rural GP in Victoria and vice president of the Australian College of Rural and Remote Medicine, for a story on rural maternity services. Nearly all of those I’ve interviewed for the story — whether GPs, obstetricians or midwives — have emphasised the importance of developing systems to support better collaboration between health services and professionals.

Asked for her views on the ongoing professional turf wars, Stewart told Crikey, “within rural and remote medicine, we stand in teams or we die alone. We need to be walking together; doctors need to be working with nurses and nurses need to be working with doctors; we only have a good medical service when we’re working collaboratively.”

Capolingua’s term expires mid-year, and she told me this morning that she is giving serious consideration to standing again.

“I am talking to colleagues and seeking their advice … about what is best for the AMA,” she said.

It might be an interesting election to watch.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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