Monday, 22 June 2009

Says who?

My silence on this blog should not be read as a sign of acceptance of the status quo nor one of contrition.

Recently, the office of the Director General of Health sent to all Q health employees an email message about medical outpatient clinics.

“The activities of general medical outpatient clinics are to be revised so that only core activities are undertaken. A greater clinical load will be shifted from public hospitals to general practitioners.”

Adult internal medicine is a ‘specialty’ but its alternative title, ‘general medicine’, suggests inclusivity. If a person’s condition is simple, it is usually easy to sort; if it is complex, then it needs to be sorted.

General physicians don’t define “core activity”. That is for bean counters and director generals.

In Australia, the state governments fund public hospital medicine. The federal government funds most other health care. There is an obvious duplication of bureaucracy, but also, there is between the two sectors a constant battle of costs. Moving clinical load to general practitioners is ‘cost shifting’; something, which we workers have always been told, is illegal.

Shifting of clinical load from one sector to another also means that lines are drawn, in this case, between general practitioners on one side and hospital doctors on the other. The result: patients falling between the cracks (um...quacks).

If someone is turned away from a medical outpatient clinic with a condition that is not strictly “core business”, it is dangerous to assume that general practice will provide the needed care.

As much as the Director General would like to think so, the interface between patients and their GPs is not always reliable. The opportunity to give good care should be captured whenever and wherever it happens.

Unless this impractical, dangerous DG wants to sit in on every consultation I do, my clinic’s core activity will remain exactly as it is: “general”. Bring it on.