The following is a comment I made in MJA Insight on July 8th 2019 as part of a discussion about Rural General Practice:
‘Describing the Australian Healthcare System as a system is an oxymoron. What passes for a system, structures, the processes, and the hierarchies have never evolved beyond its 19th-century origins.
In the present day, the most important level is Primary Care, and the most important practitioner is the Primary Care Physician/General Practitioner.
In the early 1970s, when I first arrived in England to learn Geriatric Medicine I had to work as a locum in London so that my family and I could survive before I found my first hospital appointment. In the course of that time as a locum I did stints in General Practice, Hospital A&E Departments, and even as a Consultant in Outpatient Departments of some of the great hospitals.
Having spent a year in general practice in Australia, I found London Metropolitan general practice an nightmare. 10 minutes were allocated for a “consultation”. It took me some time to learn that I was not expected to take histories, examine people, and reach medical diagnoses. I was there to provide sickness certificates, write prescriptions, and refer anything else to A&E at the nearest hospital.
When I was the locum RMO or registrar in said hospital, I was extremely busy dealing with referrals consisting of only a few words: “abdominal pain… Headache” et cetera. When I became the registrar at the Nunnery Fields Hospital in Canterbury, I met real general practitioners for the first time.
What reminds me of this experience from the past, is that this is where Primary Care is heading in Australia.
We have better models and examples to follow. I find that the best quality General Practice, and the best Aged Care is to be found in one-practice country towns. This is a credit to those general practitioners and not the system, which fails to recognise the value that we are getting for a pittance, while we pay proceduralists and super specialists generously for only being very good at one thing.
I must hasten to add, that I would not be alive today without the quality care that I have received from super-specialists and proceduralists. The workman is worthy of his hire, and we heap great responsibility and unreasonable expectations on general practitioners in many areas while failing to value their input equitably.
In discussing the quality of the healthcare provided in residential facilities with some of the NGOs, they have been offended by my remarks and have pointed out that they provide high-quality healthcare. None of them have been able to show me where the general practitioner appears on the organisational chart.’
I recently met a young man who had just been appointed to a senior administrative position with a Management Company that runs many General Practices across Australia.
The business model is now the dominant and unquestionable favourite in running the Health Industry and the Aged Care Industry. It justifies and rationalises managerialism, and the leadership of human services by lay administrators in heading Health and Welfare Services and other human services. The flowery rhetoric about Mission Statements does not hide the reality that the Budget determines what services will be provided.
Look around. In rural South Australia, where I practice, services will only be introduced and supported if they attract a fee.
When I drive towards the airport, I can’t help noticing the flashy new buildings going up on very expensive land, housing the administrations of several NGOs that deliver the trickle-down services of My Aged Care to desperate elderly people.
There used to be an alternative in South Australia. The Regional Domiciliary Care and Rehabilitation Services emanating from regional hospitals provided very comprehensive home-based support and rehabilitation services for thousands of people in a timely manner, urgently where needed, for a pittance. We were salaried Public servants. All the necessary infra-structures were already in place and did not need to be duplicated. We were regularly audited and subject to the same accreditation standards as our parent hospitals.
It is very North American and neo-Conservatist (USA, not Canada) to ignore the contribution that Public Services (“Western European Socialism”) can make. USA’s poor ranking in the delivery of Health and Welfare Services among the OECD nations should make our political leaders use their brains.
Dr Mykyta was appointed as a Member of the Order of Australia for services to Geriatric Medicine and medical education in 2012. He has practised medicine for over 50 years and still travels all over South Australia seeing patients. He has treated close to 10,000 patients with Dementia.