26 September 2016

The stakes are high, so let’s actually consult

Accreditation TheHill

 

When my children were in kindergarten, somehow I ended up chairman of their small, independent school.

The challenge was to find a new home, as the buildings we were renting were scheduled for other use.

A university was selling one of its campuses and part of its brief was to provide some community space. Thus the school principal hoped that some of this land might be set-aside for us.

And so we became “stakeholders” in the process of selling the land and were “consulted”.

The chairman of the advisory panel came to the school pretty much telling us what was going to happen. Yes, there was time for questions but clearly the “stakeholder” consultation was about ticking a box that said they had been in the same room with us at the same time.

I was reminded of this experience when I saw that revalidation was currently open to stakeholder consultation. The question arises whether there will be genuine consultation with those who will be affected? Will the views of doctors at the coalface be taken into account, or is this simply AHPRA being able to tick a box and say that they have been in the same room (or on the same internet page) as those being consulted?

The UK has gone down the path of revalidation – maybe it found a few rogue doctors. But it’s been hugely expensive, and there’s no evidence anywhere that shows health outcomes in the UK have improved.

Despite this, we have set down the same path. Initially there was to be a process to examine revalidation. Not surprisingly, this was never to examine whether it was worthwhile or not, but simply to give a cover for its introduction.

Which takes us to the current situation where an expert advisory group is about to advise how it will be done rather than whether it should be done. The motherhood argument usually trotted out is that some doctors are below par.

We can all agree with that. But in this regard we are no worse than any other profession.

The real question is will a cumbersome bureaucratic process inflicted on all doctors find the bad apples? More importantly, will health outcomes improve?

We now have risk factors for being a bad doctor, including being male and being over 35 years of age. Given the average age of doctors in Australia is close to 50, I’m not sure if this narrows it down much. These days, especially with mature student intake, most will not actually start their actual unsupervised career until age 30.

This means you have five years at best till you are in the cross hairs.

Medicine is becoming more feminised, but the majority of doctors are still male (this will change in the next 10 years) and they account for a greater number of hours worked. So in simple terms, being a doctor is a risk factor for below par performance.

And here is the critical point. Can doctors have any confidence in how such a system will be run?

I am aware of one doctor who was subject of a complaint to AHPRA, which was of mistaken identity. The doctor was not in Australia when the alleged event occurred. Yet it took a year for the matter to be dropped and the onus was on the doctor to prove he was wrongly identified.

Through one of my consultancy roles, I visited an AHPRA office to meet a board member. Security swipe cards control the offices and you chat in a meeting room.

I am yet to see any medical practice with swipe card security.

Yet doctors deal with the general public in all it shapes forms and levels of aggression.

And who accredits those sitting on regulatory boards? Are they subject to revalidation to ensure that they are regulating safely? Somehow I doubt it.

Double standards? You can form your own view.

When flying, we are told that if oxygen is required, to fit our own masks before helping others. If you are struggling you can’t assist others.

Adding to the stress levels of good doctors is not going to assist them in helping patients.

And as for steaks, we might do better eating them, not holding them. Make mine medium rare, thanks.

Dr Joe Kosterich is a general practitioner in Perth. For more articles go to www.drjoetoday.com