National Primary Health Care Partnership is a political tool

The official launch of the NPHCP has been met with skepticism from groups such as the RACGP and AMA that have been excluded from the panel.

Exclusion on it’s own should not evoke skepticism. But the exclusion of two major groups previously involved in healthcare policy does smell suspicious.

While this blogger is not in a position to comment on why this has occurred, it does seem counter-productive to exclude such major groups. Buy in from major groups is necessary for any serious change. If however the NPHCP is all about political speak, or is just a body to advertise the governments policy proposals – then by all means exclude distasteful groups.

A reader in Japan

Thankyou to Arifumi, my onetime colleague who is back in Japan and supports my moves to reform our health system. He sent me this photo to show me just how good I’ve got it back here!

Ari was one of the funniest guys I’ve worked with, but also wise. He left me these words: if you want to change the system, be as you believe.

Latest on the Aussie Healthcare shakeup

Columnist Mike Steketee had a wild swing at doctors in this recent article. He points to a Productivity Commission report that says a large part of healthcare’s inefficiency is due to doctors acting as gatekeepers to all government funded healthcare.

Of course the AMA, and most doctors I think, argue that gatekeepers is precisely how it should stay (see this letter to the editor from the ADF). Doctors have been made gatekeepers precisely because healthcare is expensive and drugs are dangerous.

These arguments are nothing new. And I’ve already argued that the debate needs to move beyond this point. 

First, We need to clearly define the roles of various healthcare professionals. Doctor, nurse, physio etc are outdated terms in our world of competency based practice across every industry.

Second, we can’t be distracted by the economic benefits of allowing non-doctors to treat and charge medicare. Quality is an issue, and the culture of healthcare will also be changed with this proposed system. All of this needs to be taken into account.

Our Crystal Ball – Mergers and Acquisitions

It’s not an easy jump from health management to the hard world of M and A’s. But they are happening all the time and will play a major part in determining the products and costs of a variety of drugs and tools we use in the future.

A long-standing but increasing trend is big pharma raiding smaller companies with more potential drugs in the pipeline as their innovation dries up.

Something I find more interesting is the diversification we are beginning to see in pharma and other healthcare companies (see this important example for those in life sciences). While one principle of leadership is to focus on your core strengths, i.e. not spreading yourself too thin, companies are now grasping every part of the big biotech horizon to ensure their future.

In a fascinating recent example, giant J and J just bought a Swiss company that has developed a desktop blood diagnostics tool for GP’s. It can instantly measure a variety of blood markers while the patient chats with their doctor. No more waiting for path results (perhaps no more big path companies if they can add a few more markers!).

Such mergers may seem unusual but have huge potential if their predictions of our medical future are correct.

Read my previous blog on this topic that mentions recent acquisitions of generic manufacturers. 

For some other interesting news on the future of biotech see virtual drug development, and targeting smaller populations.

Surgeons a dying breed

I’ve previously said that the traditional surgeons are a dying breed. This is based on two notions: prevention and medical treatments are improving rapidly, and technology is minimizing the type of surgery we have seen in the recent past. Few people really agree with me.

I was astonished to read that over 800 Da Vinci robotic operating systems exist worldwide. Here’s a list of Australian surgeons that use the Da Vinci. Nowhere near the number of surgeons – but as wealth spreads, so does the demand for the best surgery. 

In 20 years, we have gone from many substandard forms of heart surgery to stenting almost everyone. Why not in twenty years – assuming there is any need for valve replacements after current prevention – will we not have technicians operating with robots? Robots are far better at the delicate, hard to reach stuff. Other semi-robotic systems may remove the need for expert hands and allow less experienced users to do a procedure.

Here’s a great article in the economist on the topic.

Australian EMR’s – Healthelink is failing so what next?

An insider at Westmead Childrens hospital in Sydney said Health-elink has not impressed the staff. Amongst many concerns, they find paper files still better for accessing patient information. This may suggest poor website design.

My suspicion is that the program will not get off the ground. While there have been supposedly positive meetings in Canberra this week, there are many deadlines still to be met and various groups cannot agree about some fairly core aspects such as security and numbering systems. If it does get off the ground it will be inflexible and used only because people have to – as is the case in the few countries that use EMR’s widely.

I think we should go for privately built web2.0 medical software/EMR system.

So I was happy to hear about Google’s new program for allowing online entrepreneurs to build applications that run alongside it’s other web2.0 offerings. There has been huge interest in Australia, mostly from people interested in social networking, but perhaps there is someone out there interested in health aplications. If so – please get in touch with me!

The data is increasingly supportive. In this NEJM paper, a majority of physicians felt EMR’s improved the quality of care, though few had sustained experience with them.

In some parts of the US, EMR’s are being made compulsory. 

Which nation visits the doctor most?

It’s not as simple as asking who are the sickest, or best funded.

Healthcare is enormously complex. In this article, the Economist makes the mistake of suggesting that Japanese are the most frequent consulters of doctors because of their aging population. In fact, Japan has a system whereby visits to doctors are completely free, no referrals are needed, and the average visit time is about 3 minutes.

Japanese visit doctors 13.8 times a year on average according to the OECD. Australia, in comparison, only go 6 times. But if you consider our average consultation time is more like 10 minutes – we aren’t that different.

If the Japanese are more healthy,  it is probably because of numerous other factors including lifestyle – not because they go to the doctor 14 times a year!

FDA to post warnings online

No longer will doctors have to wait 3 weeks for a letter to warn them that they are prescribing a dodgy drug.

Over 100, 000 doctors in the USA have already signed up to receive email warning so that any changes in FDA recommendations are received immediately. 

Hopefully that means less law suits for the FDA as well!

Ethics and malpractice reporting

Greed comes in many forms. In finance the object of greed is obvious. In medicine, greed is perhaps only one of the many vices that may lead to unethical conduct. Nevertheless, we can learn from the finance industry how to promote good ethics and catch malpractice before it really hurts.

In my previous post I suggested individuals reporting online might do a better job than government bodies. On this newsletter from the Aspen business institute, we read that Ernst and Young has instituted far greater systems for promoting ethical conduct than I’ve ever seen in a hospital. As well as the usual teaching programs and oversight committee’s, they have a hotline for asking ethical questions (great idea!) and constant communication about the shared nature of the responsibility to be ethical.

In business, people are finally realizing that ethics makes a difference. The social impact of poor business practice is ultimately measurable in some way and influences, if nothing else, their corporate image. Many companies now have environmental accountants.

In medicine there is a closer link between poor ethical practice and a social impact – but not in all cases. For example – when doctors routinely overcharge or mistreat patients, it reflects negatively on the profession as a whole. When one doctor goes particularly off the rocker, the impact is felt everywhere.

I would also argue that some ‘medical’ practices of debatable ethical (moral) validity, may have a social impact beyond what is measurable to doctors. Some of these things only became apparent in the late 1900’s and their impact may not be felt for some time. In most cases they are areas of medicine not pursued for the sake of curing health, so much as for making money.

Yes greed and other vices are an issue for doctors. I think we have much to learn about how to teach and reinforce the importance of ethics in our profession.

Rate your Doctor – on your own

In the mad free world of American health, insurance companies have long been pushing patients to ‘rate’ doctors with a view discouraging their clients from using bad ones. What this really means is that companies use the cheapest doctors to cut costs.

Now we all know low cost is no indicator of quality – and quality matters.

We briefly had a ‘rating’ debate in Australia when, after the Dr. Death expose, the call came for a somewhat different rating system – a new register to avoid malpractice on a grand scal as displayed by Patel and others. Our government is now pushing for a National Registry to replace the state registries and AMC. It has been backed by a former Patel patient.

A little web search shows that some websites already allow us to rate doctors. This rating site has a few doctors I know – all well rated, thankfully. But the site isn’t popular and probably never will be.

It tells me, however, that we may not need several layers of registers if health systems move more towards the digital domain. In terms of responsiveness, a government inquiry is likely to take months to respond to malpractice, while an internet posting can change someone’s mind immediately. As we saw in the Patel and Bega cases, months makes all the difference. An average doctor sees hundreds of patients in that time.

Just as cost doesn’t equal quality, nor does government intervention ensure quality.