A wandering mind and seeing the wood for the trees is the journalist’s lot. A residents’ association meeting sparked this one!

With urban sprawl predicted to outstrip available land in Perth, the “in-fill” town planners are on the loose. This means the death of the four-by-two as the oldies sell to developers and move to a more tightly built retirement village and then onto a nursing home (euphemistically called a ‘residential aged care facility’).

The RACFs are short of beds in WA and they are pretty full already with elderly demented patients.

So where does this leave the younger family with elderly parents? While the elderly parents are well, all is good. They perform their baby sitting duties on cue, and look after the grandchildren. But if one of them gets sick or has a fall, they can no longer serve any useful function in the paddy fields of life, which means they become a drain on the ‘system’.

With both younger parents often working these days, the job of looking after the infirmed elderly may fall to Medicare and all its attenders.

Hang on to your local park or greenbelt as “in-fill” progresses. You may no longer see the grandchildren playing with the oldies there (those who are fit enough, that is), or the oldies taking their dog for a walk.

The suburban sprawl is already happening. You have all seen the suburbs – devoid of trees; closed communities without walkways; squeezy single storey developments (because two storey is less profitable) – offering affordable housing for younger families but at what price?

With the Perth population set to outstrip available land along the coast, the rezoning of medium-to-high density and the appearance of accommodation like apartment blocks will mean that ‘down-sizing’ by older citizens will occur. Here’s hoping they stay well too!

Let’s face it. It is hard to stay across all the health effects of these social changes, mainly because there are so many. It was interesting to hear the Health Minister Roger Cook say at the last Doctors Drum that his colleagues in parliament repeatedly put forward brilliant policy for their portfolios but policy that will create more ill health in the community.

He definitely thinks a “public health approach” is required but here’s the rub – he cannot ignore people who have ill health today even though he believes that underlying causes need attention, if the community is to move forward.

And doing the financial report (P25) you have to ask whether the profession is part of the problem or part of the solution. Where the money is the doctors will follow.

Federal and State politicians know this story all too well. When it comes to GPs and Medicare, both the carrot and the stick are used. If our efforts are consumed by chasing compensation for whatever each of us does to help people – be that community medicine, procedural work, specialist care, or research – then the hungry beast of customer care may get in the road of seeing the big picture. This is where system thinkers with a soul are needed!

Looking at the editing of Clinical Updates that Dr Joe Kosterich and I have done, you have to marvel at the rapid pace of developments and how things are becoming more specific. The DG of Health Dr David Russell-Weisz (Russ) feels we are heading towards more personalised medicine where diseases and treatments are predicted and mapped out in our DNA or some other test.

The two big questions are:

  1. Can we do this more cost-effectively and with the current resources we have at present?
  2. Is this good for the art of medicine as a ‘calling’?
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