Money and the medical game

Our doctors are revolting. But today's medical revolution has nothing to do with technological and scientific advances. Instead we have watched the metamorphosis of health care into 'money care'.

A global 'malpractice crisis' is driving the provision and quality of our health care.

Doctors are choosing to pay more attention to their unions than Hippocrates, and are motivated to action by the declining assets of their insurers and the encouragement of their militant associations.

In Australia we were caught with our pants down when our nurses began to strike. Our doctors, in a ripple-effect strategy, began to refuse to accept new patients; closed their offices; planned nationally co-ordinated leave; and threatened to exit the medical profession altogether unless their demands for indemnity sureties were met.

The Commonwealth Government initially denied any responsibility for medical insurance, and hand-balled the issue to the States. That was before investigations into FAI, HIH, and UMP revealed some significant financial haemorrhages. In the case of UMP, an engorged herniation of alleged projected claims is yet to be notified.

Despite evidence from our legal institutes and law councils that there was no 'surge in medical litigation', the medical insurers and associations persuaded the media that patient litigation was to blame for both the indemnity crisis and havoc in the health system.

The previously civil relationship between doctor and patient became a civil war with doctors on one side of the money grab, and patients on the other. The medical profession developed some partial amnesia to humanitarian service and intensified focus on its fiscal survival.

As doctors closed their offices, the patient-surplus was fed into the hiatus of 'waiting' for medical attention in overcrowded public accident and emergency wards until the government was forced to concede a promise of indemnity guarantee.

This promise was interpreted by many as government tolerance of the poor financial management of the insurers. Meanwhile the associations’ PR machine was manipulating the media. Doctors, fearful of their collective incompetence, demanded financial support from the Australian Government to cover their expected claim. This expectation may say something about the standard of their clinical practice.

How many avoidable and compensable injuries do our doctors expect that they might inflict in the course of their future work?

According to the World Health Organisation's 2002 Report, Australia has the highest percentage of avoidable medical injury in the world.

During a hospital visit, 16 per cent, or almost one patient in six, will suffer a "measurable" adverse outcome that is unrelated to the original medical condition. Given that there were more than five million admissions to Australian hospitals last year, 800,000 patients suffered “avoidable” injuries or sickness.

These are shocking statistics for a developed Western nation that is internationally recognised in medical research and invention. Our doctors are excelling in medical laboratories, but clearly failing in clinical practice.

Earlier this year, a panel conscripted to review the Laws of Negligence, including those of medical negligence, delivered a final report that mentioned the ‘patient’ only in passing in order to define the panel's written intent. Patients, as the pivotal fraction of any health-system equation, were not given any collective recognition by the panel which had been appointed by the Treasury rather than the Health Ministry.

Medicine has shrugged off the mantle of a 'compassionate vocation', and evolved into the 'health industry'; governed by the same 'bottom line – dollar sign' as every other corporate venture.

Doctors can no longer be regarded as white-coated altruists who are moved by the will to heal; they have become shrewd and aggressive shareholders and investors. They view their patients as potential enemies in litigation, and consequently practise lower risk 'defensive medicine'. As a result, patients are not necessarily being offered the full and optimum choice of available medical options.

This is band-aid medicine.

Yet neither the government nor the health-care industry has pointed out that a national reduction in the incidence of avoidable medical errors would naturally lead to a national reduction in the incidence of medical litigation.

Our State and Federal Governments, intimidated by the medical fraternity's recent show of muscle, have scuttled new liability legislation through their parliaments post-haste. This legislation effectively disables the rights of the majority of injured patients to seek fair judicial and financial accountability through the courts. Neither they, nor the Treasurer's Panel to Review the Laws of Negligence have recommended any strategies or financial provision for the implementation of new comprehensive patient safety and risk management initiatives.

Australian medicine bears the shame of demonstrating the worst statistical incidence of avoidable medical injury in the entire world – and yet we are one of the few remaining developed countries that does not have a dedicated national patient safety day, or week.

It seems that the injured patients alone realise that money can' t buy good health. And now they exist within a health care system in dire need of a ' heart ' transplant.

And the future for the "Business of Health Care?"

It's all "in the bank!"