The problem with blackening the field’s image – again – based on some fundamental misunderstandings is that patients will be the ones who suffer in the end.
On balance, I believe most ABC investigative journalism is good for us. Good independent public interest journalism is vital to a functioning democracy (and our democracy is fraying at the edges pretty badly these days).
But when the ABC gets things wrong, which it does at times, its work can result in extremely serious adverse consequences for the public.
A big problem for the ABC is that it will never admit it is wrong. That’s arrogant and stupid. It’s an organisation whose culture is too often blind even to constructive criticism (good grief I’m sounding like Andrew Bolt), which is what I’m about to attempt.
The ABCs latest “most doctors are rorters” exposé on Monday night had many of the hallmarks of the “GPs are rorting Medicare for $8 billion” exposé 18 months ago:
- Extrapolated figures with no hard evidence or logic for the extrapolation. When we asked Nine and the ABC during the $8bn rort episode to provide us exactly where the figure came from and how it was calculated, we were ignored. No one ever provided any evidence for the figure, or indeed an algorithm that might remotely get you there. An independent review found there was probably $1-3 billion “leaking” from the system and that most of the leakage was likely errors created by an overly complex MBS. In this week’s exposé, the only data was billing and procedures. Without medical records there is no possibility that anything being implied or said could be proven. The people doing it must have realised this.
- Single high-impact examples of obviously terrible practice by doctors, connected to the extrapolation for impact. The effect is that an audience thinks such terrible things are common, when the data clearly indicates that they are not.
- Unrelated incidents. In this case, anaesthetists’ billing practices connected somehow to some horrific device malfunctions and incidents.
- A superficial ratings-grab approach. In both exposés the ABC focuses on the problems of money and process, and does not articulate any of the underlying issues that result in overt money and process problems. They don’t understand what is going on. They, like a tabloid newspaper, are going for the “gotcha” headline and eyeballs, not for underlying issues and solutions. Good journalism has purpose: what was the purpose of this program if they didn’t get to the real issues underlying the odd horror story they were amplifying for effect? The purpose of this program seemed to be to let everyone know that you can’t trust any doctor in the country. And the mid to long-term effect of trying to get everyone to swallow this line is very bad for everyone. It’s also way way off the mark. Even if doctors were broadly corrupt, creating widespread distrust of doctors across the country without addressing any of the fundamental issues underlying why it was happening does not seem a justifiable purpose for anything other than ratings.
- The technique of “where there’s some smoke in terms of evidence of bad behaviour and practice” you can infer a “wildfire” no one sees yet. Where there is a little truth you can infer there is a lot in your story if you add a lot of emotion and colour.
- Very poorly qualified notice of conflicts of interest. The data in this week’s story came from the private health insurance sector, which clearly has an agenda. The ABC admitted it was in bed with the PHA in obtaining and analysing the data. No one clarified the issue of privacy and consent on the data. But they also failed to properly notify just how much they were potentially being led up the garden path by a powerful profit-driven organisation with a barrow to push.
Most readers will know the ABC gets things wildly wrong from time time. But in case you don’t, my favourite example (you can still see this episode in the archives) was a Four Corners exposé on the horrendous effects of electromagnetic radiation (EMR) from high-voltage powerlines circa 1992. The enduring (staged) image of this show was a mother walking her newborn baby in a pram beneath some high-voltage powerlines adjacent to her house in the western suburbs of Sydney. The message of that image and that show was that EMR from high-voltage powerlines, which run close to housing all around the country, was likely going to cause a cancer epidemic in the near future, especially for babies in prams which whose foolish mums walked them under power lines.
That cancer epidemic never happened. The evidence over time (and a lot at the time) was that the effect of EMR just wasn’t what the ABC scared every viewer into thinking it was. The ABC never said sorry or corrected the record on the episode.
The ABC has never said sorry or corrected the record on its claims of $8bn in rorting, even after a formal independent review found the claims to be outlandish. That series of exposés did irreparable and unfair damage to the reputation of GPs across Australia, and has likely affected the relationship between GPs and patients for some time to come, to the ultimate detriment of patients.
A big irony in Monday’s show is that one of the targets – anaesthetists – is clearly a group that the government needs to get its head around much better. The report said its “expert” data analysts found that a vast proportion of anaesthetists were “rorting” illegally – in one case it said up to 87% were doing the wrong thing.
But there were two big problems with what the ABC said:
- It looks a lot like it did the analysis wrong, particularly around timing of items. The Australian Society of Anaesthetists responded that “the quote of 87% of anaesthetists overstating time appears to be based on a gross misinterpretation of the Medicare items claimed for anaesthesia. The vast majority of the anaesthesia time claims are likely to be correct.” More informal responses could be found on Twitter, largely along the lines of: “Tell me you don’t understand anaesthetist billing without telling me you don’t understand anaesthetist billing.” If the ABC has got it wrong, will it follow up and say sorry? Judging by form, no. TMR asked certain parties if they had gone back to the data with the anaesthetists’ feedback about their analysis but we, as usual, have been ignored.
- You can argue that anaesthetists are rorting. But unfortunately for now, they are doing it for the most part legally. In the last MBS review the two people at the top tried to point out that lots of item numbers were either unnecessary or way too expensive, but within days of saying this, the anaesthetists had nearly got both of them sacked. The problem with anaesthetists is that they are literally more powerful than the Teamsters union in the US in the 1950s and 60s. If they down tools the health system stops. They have more power than any other component in the system and any union in the history of Australia. They also know where all the bodies are buried in terms of doctors who screw up operating, they are rich and mix in the right political circles. No, you don’t f&*k with the anaesthetists.
The ABC missed this latter point entirely because the reporting team does not understand really what is going on beneath the waterline in health – and apparently didn’t ask anyone who could have told them. There are some ABC excellent specialist health journalists who really do understand a lot. But for some reason, the journos who do these exposés don’t seem to talk to the ones who know their stuff.
Stuff like what the issues really are in the system and how government might better address them. Four Corners just delivered their now stock “doctors are bad” narrative. Even if doctors were all bad instead of a few outliers, which exist in most professions, the ABC did not ask or address the underlying problems leading to that bad behaviour.
That the ABC missed the mark unfortunately gives anaesthetists ammunition to defend their lucrative position on the MBS, which feels a little indefensible at a time when it’s tough balance our healthcare budgets across all specialisations in a manner that is best for patients.
By implying that anaesthetists are acting fraudulently, when what they’re mostly doing is perfectly legal, the ABC has just muddied the waters on the fairness of specialist group remuneration.
The whole result is a banal South Parkian “Hmmrrr, Australian public … doctors are bad, mkay?”
Really? Are they? Or is something else going on, Aunty? Could we not get a just a little more sophisticated in our analysis of what is wrong here, because there is a lot at stake in terms of patient wellbeing?
Of course, I’m talking to doctors mostly here, so who cares?
The ABC doesn’t, which is pretty disappointing from a mostly good and vital institution.
A quick note on tax bears in the woods
It wouldn’t be a Saturday if we didn’t do something on payroll tax. Try your hardest to read on.
If you haven’t read Holly Payne’s piece Between a tax amnesty and a hard place, I urge you to read it. It’s much easier and more fun to read (and a lot shorter) than anything I’ve done.
Who doesn’t love a good bear story?
And this is a pretty good one. Holly may have done more in her analogy here to advance the cause of understanding for practices of the payroll tax situation than three years of long-winded rants about the topic from certain other commentators.
But she didn’t quite get to the end of her analogy, which I’ll do for you now.
To catch you up, she likened State Revenue Offices to hungry GP-eating bears which you could either run and hide from in a cave or offer your hand as a survivable but costly sacrifice.
If you are a runner then what you want to keep in mind is that once you find yourself a cosy cave somewhere, you need to then work on your bear protection protocols.
I’m not talking about getting some big guns here so you can shoot the thing if it turns up again – no gun big or small can kill this bear. You need to build a big fence, have some cameras up, and don’t do stupid things like leave the equivalent of jars of peanut butter and honey outside your cave accidentally.
A good example of a jar of honey is your practice accreditation contract … but that’s another story.
All this is to say that just running away and hiding won’t do it. These are pretty adaptive and smart bears we are dealing with. You need to build some good fencing and early warning systems and every year you need to be inspecting the fence and camera network and upgrading it to appropriate standards.
In this way, you’ll be able to live with the bears in some sort of harmony. Translation: get someone to look at your current structure and advise on upgrades to your fencing and camera network, etc.
Lots of practices have done this and they aren’t having any problems with bears, at least for now.
Some bears have even tested the new fencing and got a bit of a rude shock and run away, presumably understanding that there is no way in for now, so they should go and try someone else’s cave because they know a lot have not got themselves good fencing yet.
Some interesting new aspects to the bear story emerged this week.
Turns out some bear defence system advisors (accountants and lawyers) don’t seem to have given their people very good advice on fencing and alert systems.
In South Australia, about 60% of practices offered up body parts to the bear.
The advisors maintain that they didn’t advise their clients one way or the other, just pointed out the pros and cons of body part sacrifice vs hiding to fight another day. But given how many practices decided on the path of body part sacrifice, most people are going to wonder what exactly that pro and con advice was.
Feels like it must have been heavily weighted to body part sacrifice, which feels like it was the wrong advice.
But it probably gets worse than that.
Why were so many practices out in the open and vulnerable in the first place? Why were advisors not saying, hey we know a good fencing contractor and that’s a pretty good option here?
It was more than three years ago that we got reports of wild hungry bears suddenly starting to roam our local forest.
Why were so many practices so exposed to bear attack after three years or so of understanding the new danger around them?
One last thing.
The Queensland amnesty has so far panned out differently from the SA one. There’s been no en masse “strike three, you’re all out” … so far.
In this situation, apparently a lot of practices that put in for an amnesty are having second thoughts via getting a second opinion.
Apparently some don’t have such bad fencing after all.
With a bit of work and maybe a new camera system, its looks like they might be able to repel the bear.
That’s going to be interesting.
