27 September 2021

No jab, no see patients

Comment covid vaccine

GPs are a fairly disparate group. (That’s disparate not desperate – desperate is a whole other editorial).  

It’s very hard to really define your stereotypical GP, despite us all doing, more or less, the same thing. I’m not saying that’s a bad thing – not at all – there is often strength in diversity.

However, this variety in everything from cultural backgrounds to attitudes to private billing, coupled with the fact we have the responsibility to deliver government-subsidised primary health services to all Australians, underlines the necessity of having in place some basic standards of care.

That’s not punitive, that’s just common sense. When a patient consults an Australian registered general practitioner they can expect that doctor has met and continues to meet all the standards as determined by the colleges and the Medical Board that have been set to ensure that patient is getting quality healthcare. That’s the deal.

Which brings us to the issue of mandatory vaccination of all health care workers, in particular GPs.

Earlier this month the RACGP issued a position statement supporting the mandate. The statement claims mandatory vaccination has benefits for the doctors themselves, their patients and staff and the delivery of healthcare services as a whole.

“The RACGP considers that vaccination of healthcare workers supports the medical profession’s duty of care and builds vaccine confidence in the community,” the statement read.

I am known to have been very critical of the college in the past, but on this issue I believe it is absolutely correct and I admire its commitment to the profession in issuing this statement. As the keeper of the standards of general practice I believe it had little choice.

Just as patients who consult us can be certain we have met standards in terms of education and training, so too they should be able to be certain we have taken every precaution to protect them against catching this pandemic-causing virus. It’s a duty of care and it should be a standard of care.

Of course the issue isn’t really the vaccination (though, frighteningly, some of the comments on the newsGP story following the statement suggest that for some it might be). It is the issue of it being mandatory that is the real sticking point.

It is totally understandable. Nobody likes being told they “have” to do something. There are cries of coercion and the death of our autonomy. There are even threats of a backlash from members of the rank and file.

But this is not about being forced to take your medicine because someone else has determined it is good for you (despite the fact the effectiveness of covid vaccination has been proven over and over again). In reality you can absolutely refuse to get vaccinated if that is your desire – you just can’t treat patients face to face. It’s about ensuring every practising GP is fit for purpose, and that purpose is to look after the health of our patients.

Patients have a right to expect this as a minimum.

Some of the arguments against mandatory vaccination have pointed to the fact that people can still contract the infection and infect others even if they are fully vaccinated. True, but a moot point really. After surgery you can still get a wound infection but nobody would advocate that surgeons do away with scrubbing, gowning and gloving, would they?

It’s about doing everything we can to achieve the best outcome.

The other big catchcry among those GPs opposed to mandatory vaccination is lack of autonomy. Basically they’re objecting to the college deciding that the rights of the community have precedence over a health professional’s right as an individual. There is no doubt this is a big call. And to doctors who have previously lived in countries where oppression and dictatorship were daily realities I can only imagine such directives might feel threatening.

General practitioners in Australia have always exercised autonomy but only within the confines of our standards of care, Medicare eligibility, medicolegal considerations, MBS and PBS regulations, mandatory reporting, CPD requirements etc, etc. It is ridiculous to say we have complete freedom on how we practise,  what we prescribe, what we manage and even how we interact with patients. Along with guidelines there are also rules.

Vaccination of all healthcare workers should be mandatory. Even if all healthcare workers voluntarily went and got vaccinated it should still be mandatory. We should be able to say to anyone – GP, practice nurse or receptionist – it is a requirement of this job that you be vaccinated against covid or you are unable to do this job. No one thinks twice about it being mandatory to wear a hard hat on a building site, and that just protects the individual!

It will be interesting to see how the RACGP weathers this storm, especially as it is facing the very real prospect of ever-dwindling membership as GPs realise they no longer need to be member of it or any college to stay registered.

But if Dr Karen Price’s letter, published two days after the position statement, is anything to go by, it’s going to hold fast on this one.

“It is an evidence-based science-led decision with ethical considerations on patient safety,” she said. And really, that should be the last word.

COVID-19 live update