0716-McEvoy-Rob-Dr-Aug15 3Is ‘convenience’ shaping the way medicine is practised these days?

It’s all about convenience these days – because of the time pressures people find themselves under and because convenience is how new business can gain a foothold.

In medicine, is convenience shaping how and what we do in a way that is good for people’s health?

Patients (or their parents – this is the Child Health edition!) will say that anything that gives us improved access to good advice is a bonus because access is harder to get. Fair enough. But if the patient lobs on the caregiver without all relevant information, how can the caregiver give a considered elective decision or even a snap judgement?

My contention is that convenience is turning some ‘elective decisions’ into ‘snap judgements’ and this may not be healthy. Those patients familiar with using the internet will source information and try to access their doctor 24-48 hours before their script runs out.

A considered opinion about their contraceptive use or diabetes management is not entered into because they could only book six minutes with their doctor. Or they arrive on the specialist’s doorstep with a rushed referral and incomplete information. Costly investigations may be repeated (no pathology coning rules for specialists). In the hands of some doctors and patients, My Health Record (the rebadged PCEHR) and other things may simply patch over the cracks by replacing careful consideration with convenience. It needs to be watched.

201608-Training-junior-doctorsOne lesson we have all learnt in recent years is there is more to health than the time spent with doctors. The health journey involves the patient (more self-help is coming) those around them (the doctor is part of a ‘team’) and advice from family/friends/fellow sufferers (the internet).

One analogy is the convenience of the new Mobile Travel Agents (“we come to you”). Is something of substance being replaced by convenience – such as the conversation travel companions had during their drive to the Travel Agent, the private conversation that no longer occurs? It is a hard one to pick. Doctors are learning they are a small slice of their patient’s health journey – the whole journey needs to be carefully considered changing one slice.

And then you have the innate talents of the doctor. Doctors self-select into different streams in medicine, maybe not for the right reasons. The RACS clearly has a problem with sex discrimination and bullying and is changing its spots. General practice, rural and urban, is incredibly diverse with myriad market forces at play.

Feet-of-clay doctors, both specialists and GPs, can train as underperforming ‘duds’, whether just a square peg in a round hole or poor achievers at most things. Who judges their performance? The profession cannot leave it to the Medical Board or AHPRA or those influenced by commercial interests.

Training of doctors has a low attrition rate, compared to say, pilots. Why? Both must perform well in life or death situations. Yet we hear of university trainers restrained by appeals of various types and living in fear of litigation; the same for specialist colleges. The end result may be that misfits get passed. Money comes into it too. But before we launch into a class war we have to ask, ‘Are these people not fitting in for good reasons?’

It all goes to show how complex medical training is but it is in need of some serious navel gazing. Unless the profession has an open conversation on the issue of ‘dud’ doctors, like child abuse, it will never come into the open. The profession has nothing to hide, just some things it prefers not out in the open!

The September 22 Doctors Drum, “Training and ‘Dud’ Doctors?” we hope, is a good start.

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