Two things caught my eye this week – first was a link emailed from a colleague “I was just browsing the internet and read this about you” – pretty sure it was a phishing link, but turned out to be a link to ‘rate your MD’ an online bulletin board where patients can rate their doctors.
Call me a sceptic, but usually this sort of thing attracts the disaffected. You know the old adage – do good for one person and they’ll tell another; do bad by another and the’ll ten ten. Rather than anonymous postings on the interweb, I’d rather honest feedback from patients, happy or disgruntled. Anyway I was somewhat surprised with the feedback – clearly an unrepresentative sample!
There are other rating sites out there – I remember the angst of the medical profession int he UK when Dr Neil Bacon (founder of the www.doctors.net.uk & www.ausdoctors.net websites used by almost 200,000 doctors) used the database to establish www.iwantgreatcare.org to allow feedback on NHS doctors and hospitals.
So that begs the question – is such feedback useful? The dangers of course are biased opinions from the disaffected. I think feedback is to be encouraged (we use it for hotels eg: tripadvisor.com) but one needs to balance reviews and separate system- from individual failings. In my case, the name is spelled incorrectly – and whilst my report (so far) is favourable, it could be problematic if one name were confused with another.
Ultimately, are these sites there to offer genuine choice in ‘who to see’? Or to allow patients to have a whinge online? Or worse still to libel their doctor. One could argue that patients will vote with their feet if their doctor is crap – thankfully my lists are full most days and a perennial complaint from patient is difficulty accessing ‘their doctor’. Matching demand and supply ain’t easy, especially in rural areas – some rural practices in SA have wait lists of over 6 weeks!
But that leads nicely to the second point of interest I received in the mail today – a link (presumably a spoof) where doctors can rate their patients. Not my cup of tea, but some of the (alleged) feedback was telling :
“Patients will not be permitted to contest any ratings nor will discovery of names of physicians who submitted ratings be possible.
Not surprisingly, patient advocacy groups are up in arms about the plan claiming it may unfair characterize certain patients. On hearing of the new service, the executive director of Patients for Justice, Leighton Baines said, “We are concerned that a single doctor who did not get along with a certain patient might unfairly portray her as difficult.” He felt that this might hinder that patient’s ability to receive care.
Dr. van Bronckhorst countered that no one seems particularly concerned that a single negative rating from a patient or even a competing doctor with malicious intent might unfairly harm his practice.”
Why is this relevant? Well it relates to the notion of ensuring quality in medicine.
First is the move to introduce revalidation in Australia. Australian doctors engage in regular continuing professional development. In primary care this is every triennium (3 years) and points are awarded for attendance at courses, conferneces, online study, papers published and attendance at upskillign events. In my areana of rural medicine, I have to stay currnet in not just primary care, but also emergency medicien and anaesthesia. The tools of #FOAMed, particularly sites like BroomeDocs.com, Prehospitalmed.com and Resus.me are fantastic, as are all the downloadable podcasts and videos – see the collation relevant for rural docs at ruraldoctors.net
But some are not happy. Dr Jo Flynn, head of the Medical Board of Australia has called for the introduction of revalidation in Australia.
The (unproven) premise is that CPD is insufficient and that an additional system is needed. The UK has gone down this path, int he wake of the Shipman episode (Harold Shipman was the UKs worst serial killer). But revalidation in the UK has been beset with problems – not least no evidence-base to show it works (ironically murderers like Shipman would probably end up as appraisers for revalidating other doctors, not flagged up as underperforming). The system has also become an exercise in red tape, with doctor spending 60 hours or more (that’s over a week of non-patient time) in preparation fro their appraisal. Recent moves by some health authorities to allow non-doctors to undertake appraisal have further raised concern that this is a tick-box bureaucratic mentality, not a proper assessment by one’s peers.
I am all for quality – but not mindless bureaucracy which is what revalidation in the UK has become. Rather worrying to hear senior health bureaucrats mutter that ‘half of all doctors are below average’ – betraying a worrying understanding of statistics and what the term ‘average’ means (50% above, 50% below).
Regardless of whether the current CPD program continues or is replaced by a monstrosity like revalidation, such measures are time consuming and expensive. Even a basic life support course catering for entry -level costs over $2500 – with associated costs for travel, accommodation and meals which are borne by the rural doctor who has to travel to the city for such events.
So the Government proposal to cap work-related self-education expenses at $2000 per annum will hit hard – particularly rural doctors who have to travel some distance & who need to keep abreast of a variety of fields.
The ATO’s reasoning on this is not unreasonable – to reduce ‘tax dodges’ whereby people claim first class travel and overseas holidays as a self-education expense. But again there is no evidence-base; for many professionals, the ongoing self-education expenses come at the cost of time doing their income-generating work, impose time away from family and involve economy-class travel, staying in cheapest hotel and eating crappy airport food. Not lazing by the pool drinking cocktails or kite-surfing in Guam!
You can see my submission on this here. Keeping up to date does not come cheap, and these costs are made from income as a sole trader – not met by an employer or the health service.
It’s not too late to make your submission – and share this with anyone affected – not just doctors – nurses, paramedics, midwives, architects, pilots, teachers, tradies etc. This bill will affect many people.
Can you imagine a long-haulage trucking company, who incurred a legitimate business expense on fuel, had their fuel allowance capped at $2K per annum? Neither can I. Yet for those for whom ongoing education is mandatory (see CPD and revalidation above), then a cap on allowances will hit hard. Alternatively doctors will drastically downsize their ongoing education or pass costs on to their patients.
It is not too late to fight the cap – visit www.scrapthecap.com.au and tell your colleagues…