Is there a risk in health professions being caught up in reality TV-like public turf wars? And can collaboration happen on everyone’s terms, asks Anthony Tassone
Recently I spent some time at Parliament House in Canberra talking to federal politicians about issues affecting community pharmacy.
But what got me thinking was a comment made by one politician in reference to recent articles by doctors and pharmacists who seem to be constantly battling with one another over any number of real or imagined grievances.
This parliamentarian summed it up by saying: “Gee you docs and pharmacists love giving it to each other through the media. Entertaining it’s not us pollies for a change.” Clearly, they, and possibly their colleagues, enjoy these confrontational pieces and they are something of a ratings winner for this audience.
And if truth be known they are a ratings winner on a wider scale. A recent article by GP Edwin Kruys titled ‘Who is the real winner in the latest stoush between pharmacists and doctors’ highlighted that the medical media go out of their way to promote, encourage and widely distribute anything that may be seen as a stoush between doctors and pharmacists.
He referenced a recent article published in the Australian Journal of Pharmacy by a Guild representative that Dr Kruys said “made a few negative comments about general practice. I thought it was neither here nor there, but what happened next was interesting.”
He pointed out that most GPs would not have read or been aware of the column until Australian Doctor Magazine, owned by the Australian Doctor Group (ADG), posted an article on its website titled Pharmacy Guild says GPs working ‘turnstile operations’ filling time-slots with easy patients.
“Then all hell broke loose. There were 170 comments on the article from mostly angry GPs.”
“It is sad, but not surprising, that the medical media are fuelling the tensions within primary care. Of course, like other media, ADG is just doing its job. I do wonder how many GPs and pharmacists are aware that they are the product on sale here,” Dr Kruys said.
Just like reality TV
His depiction of the exchanges between pharmacists and doctors being reduced to a ratings click bait exercise by a cynical media brought to mind another ratings juggernaut which is featuring on our TVs several nights a week, Married at First Sight.
Now I’m no fan of the show, but it’s fair to say that some of these unions are just not meant to last or at the very least need some major counselling. And often the people featured in the show are clearly pawns in the ratings battle.
So, whilst the recent public spats between pharmacy representatives and doctors’ groups may be entertaining and ‘rate’ for some, are we in danger of having a situation where the viewers grow tired and will soon switch the channel?
Pharmacists and doctors working on the ground, doing their best to treat and meet the needs of their patients, do not want to see this public sparring.
Amongst other things, the reality is that a successful marriage entails both partners being equal and mutually respected.
A recent article by AMA National President, Dr. Tony Bartone that appeared in the Medical Observer: AMA president calls for collaboration over fragmentation in response to the Pharmacy Guild’s latest scope of practice push in response to the recent debate about greater utilization of pharmacists made for interesting reading of the views of peak medical body colleagues of collaboration.
Putting that into the context of doctors and pharmacists, from Dr Bartone’s comments AMA wants collaboration but on conditional terms, and even better if there’s a payment attached through the general practice incentive scheme for recruitment of allied health professionals.
While the general practice pharmacist model is an example of doctor-pharmacist collaboration, there are two thirds of the pharmacist workforce employed by community pharmacies (approximately 20,000 people) out there wanting to collaborate to provide patient benefits and improve care and for the most part do so every day across Australia.
Collaboration already does and will continue to happen beyond the four walls of general practice.
But there’s always the opportunity to have even greater levels of collaboration with many possibilities potentially including improving accessibility to harm minimisation services through collaborative prescribing models particularly in regional areas where patient access to doctors who prescribe opioid replacement therapy may be limited.
We can work together
My recent experience being a member of the expert advisory group for the SafeScript real-time prescription monitoring for the Victorian Department of Health and Human Services – along with colleagues from the medical fraternity, consumers and other stakeholders – is a case in point of the positive things that can be achieved when experts with a common interest and respect come together.
In the health professional team, without mutual respect, patient care risks being compromised.
The Medical Board of Australia’s Good Medical Practice: A Code Of Conduct For Doctors In Australia emphasis the need for health professionals to work together.
The code states: “Good relationships with medical colleagues, nurses and other healthcare professionals strengthen the doctor–patient relationship and enhance patient care.”
It’s incumbent on all of the health professional team to uphold the principles of this code for patient benefit.
Dr Bartone’s most recent column calls for “Collaboration, not fragmentation, is the key” – but is care already fragmented based on patient accessibility to general practice? Delays in making appointments and general practices not taking new patients are a frustration for some patients.
This is not a criticism of GP’s themselves whom I am sure make the best efforts possible within the environment they are practising possibly in a busy corporately owned practice, or where new patients aren’t accepted a local general practice left to deal with more complex patients that other clinics may not necessarily attract or care for.
But the reality is that all is not rosy in GP land and this was highlighted in July 2018 in a Fairfax article titled “Bulk billing clinics turning patients away” when RACGP president Dr Bastian Siedel claimed:
“They are saying, ‘it’s 10 minutes and the patient goes out’. And people are being told ‘if you have a mental health condition you probably have to go elsewhere’,”
“[It] allows some GPs to cream the system by seeing 10 patients an hour and earning $380, while good GPs see four patients an hour and can only bill $152 an hour,”
“I’m concerned that some places are refusing to see children for the same reason.
“So, all of a sudden, you don’t have the comprehensive care that patients deserve. If it’s more complicated, you have to go elsewhere.”
Nobody wants a health system where patients are being turned away – especially those who are vulnerable. But there is a greater risk of this occurring without mutual respect and recognising each other’s important role and potential future role in practising to a practitioner’s full scope.
A true team relies on the collective effort and can’t rely on individuals no matter how talented.
From the turnstiles
While recently used phrases such as ‘turnstile medicine’ sparked a strong reaction, the former RACGP president’s own comments of complex patients being turned away and ‘creaming (of) the system’ can’t be ignored if this is occurring in some potentially corporate owned bulk-billing clinics. This is going to the heart of patient care.
Like general practice, pharmacy has experienced significant reform and changes to its remuneration model over the past decade that has made sustainability a far greater challenge and pharmacy has been forced to adapt. Additional funding will help address some of the issues for the respective industries and while throwing money at the problem would be welcomed, alone isn’t the sole answer.
In Dr Bartone’s column he states: “If Australians have to spend money on their health, the AMA wants them to spend it on medicines and therapies that are supported by evidence, and that work.
On face value the statement makes some sense, but I question whether the AMA has engaged with patients and consumers on what they want to spend their money on, what their burden of proof is for evidence and how their care is delivered?
Despite the best of intentions with these statements, in the eyes of our patients, is this patient centred care?
I couldn’t say the number of times in conducting a Home Medicines Review for a patient in their home or a MedsCheck in the pharmacy that the patient reveals they are taking complementary medicines that they gain a benefit from, but have reservations disclosing it to their GP for fear of being judged and lectured to cease it.
Then following the receipt of the report and the prescriber developing an agreed medication management plan with the patient, the doctor was grateful to be made aware of complementary medicines being used by the patient and did not necessarily suggest they be discontinued depending on the product and overall therapy goals.
As the old saying goes, it is dangerous to assume as it makes an ar*e out of you and me.
Collaboration and patient-centred care at work.
Further in the column Dr Bartone states that patients have a right to see an appropriately qualified practitioner in a GP. But it must be said that they also have the right of choice in the type of care, how they access such care and that it meets their preferences and needs. That is what patient-centred care is all about.
He goes on to cite that medicines affordability and patients delaying having prescriptions dispensed as pharmacy having “problems of its own”. Patients not taking medicine due to affordability issues is not just a problem for pharmacy, it’s a problem for the entire health system and threatens to undermine a key tenet of the National Medicines Policy commitment to equity of access.
Again, encouraging adherence and overcoming barriers is a shared responsibility and not a problem of just pharmacy’s alone.
Pharmacy and medical peak bodies don’t need to walk down the aisle together to collaborate; we can just be friends, but true friendship isn’t conditional on “we respect you but just don’t sell complementary medicines” or “we have a good working relationship but know your place”. Anything else is disingenuous to say the least.
The most important viewer in the latest re-run of a familiar reality drama is the patient, and they want to see a different storyline centred on them from their health professional team or they really will switch off.
Anthony Tassone is president of the Victorian branch of the Pharmacy Guild of Australia