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Newsletter Editorial, March 2005

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• Rescuing Medical Education
• Toward a More Positive Future for Tasmanian Public Hospitals
• A Letter From London
• ADF news in brief
  • The Australian High Court says Lawyers can't be sued
  • Solicitor re-instated by High Court
  • HIC demanding retrospective payments
  • Unfreeing the National Health Service
  • More Bureaucratic Madness in the Land of Hope & Glory
  • The Rain in Spain
• Quotable Quotes

Rescuing Medical Education

Rescuing Medical Education Summit hits the Mark. Letters of praise from the attendees of the ADF summit continue to arrive in our office. Over 160 participants heard 16 presentations outlining major concerns of the direction of medical education and post graduate training.

This conference is now available on www.adf.com.au. See insert this newsletter entitled, "Public Statement Concerning the Future of Australian Medical Education".

Following due consideration of issues raised by medical practitioners, academics and medical students over the direction of medical education in Australian universities, and following the summit conference entitled "Rescuing Medical Education" held in Sydney on Friday 18th February 2005 (available on www.adf.com.au), the Australian Doctors' Fund calls on:

1. The Deans of medical schools and those involved in curriculum development to ensure that:
   1. all medical students receive a comprehensive practical education in anatomy, physiology, microbiology, biochemistry, pharmacology and pathology as an essential requirement and foundation of their medical education and hence reverse the downgrading of these basic medical sciences
   2. the proper balance between medical and social science, theory and practice, didactic teaching and problem based learning is achieved in all curricula.
   3. the Hippocratic tradition of master/mentor and apprentice/student be maintained and enhanced as the preferred model for the teaching of clinical medicine.
   4. the recommendations of recognised medical colleges as to content of curricula be highly regarded and duly considered.
   5. all students be given a grading by examination for completed course work and that grading systems rank all students from zero to high distinction.
   6. the role of post mortem be re-affirmed as an essential element in the teaching of medical science and as a requirement for quality assurance, and that medical students be exposed to dissection as an essential part of their medical education.
   7. all entrants to undergraduate medicine meet the same standards of entry regardless of their financing arrangements.
2. Federal and State Governments to:
   1. Protect the Australian public by requiring that all overseas trained medical practitioners meet the standards required of Australian trained medical practitioners prior to being registered to practise in Australia.
   2. Reverse some of the impact of mature aged entry and increased feminisation on the medical workforce by early identification and where practical the streaming of medical students into the medical workforce including an apprenticeship system as health care workers in hospitals prior to graduation.
   3. Allow for universities to give preference to students who receive their secondary education in the state where the medical faculty is located and for post graduate specialist training to give preference to those candidates who are likely to reside and practise in the state in which they are trained.
   4. consider making it an offence for any academic to direct or act on a direction that a student be passed on any grounds other than academic merit.
3. State Governments to recognise and respect the honorary role of doctors as teachers in the Australian public hospital system and allow for, encourage and recognise but not compel the teaching of medical students as a central part of the operation of public hospitals.
4. University Boards to ensure that university fees paid by students and the taxpayer for their medical education be spent for that purpose and not diverted in the form of cross subsidies to other faculties or programmes.
5. Private hospitals and day surgery centres to facilitate opportunities for the teaching of medical students which protects the status of private patients and simultaneously allows for practical exposure to clinical medicine.
6. Medical colleges and teaching hospitals to recognise the unique role of the rural and remote practitioner and the need to introduce procedural training at the undergraduate, postgraduate and vocational training level for medical students contemplating a career in independent rural and remote medical practice.

Toward a More Positive Future for Tasmanian Public Hospitals

A ground breaking ADF report which recommends that public patients and not hospitals (or state governments) be directly funded, is now available on the ADF website www.adf.com.au. The report entitled, " Towards a more positive future for Tasmanian Public Hospitals" contains substantial ADF research identifying the underlining problems of our Public Hospital system. Its recommendations are universal.

A Letter From London

... When the NHS was established in 1948 we had 480,000 hospital beds. By the year 2000 the number had fallen to 186,000. This represents a fall from 10 beds for every thousand of the population in 1948 to 3.7 in the year 2000. It means that we often now have insufficient hospital capacity for prompt investigation and treatment even of first class emergencies. According to the official statistics we have just under one million patients waiting for hospital admission. There is no margin for handling epidemics and admissions for elective surgery are frequently cancelled owing to lack of beds. In an attempt to deal with this state of constant crisis patients are now being sent to France and Germany for their operations. And still the number of NHS beds is falling. ...

ADF news in brief

The Australian High Court says Lawyers can't be sued

The Australian High Court says Lawyers can't be sued Shortly after ruling that a council was negligent when a surfer became a paraplegic in a tragic surfing accident, the High Court has ruled 6:1 that lawyers can’t be sued for negligence. The court said no to a plaintiff who wanted to sue his lawyer, because he was advised to plead guilty to a rape in 1996. He was eventually acquitted on a re-trial. The High Court stressed that its main concern in protecting lawyers from immunity was " injury to the public interest" because finalised matters could be reopened. Mr Ray Ross QC of the Law Council of Australia is reported as saying that without immunity " litigation would become lengthy, very complex and even more costly than it already is"
SMH Friday March 11, 2005

Solicitor re-instated by High Court

A NSW solicitor who was convicted under Section 61M of the Crimes Act of 4 counts of indecent assault on the 10 and 12 year old daughters of his partner has won a High Court case not to be struck off for professional misconduct. The NSW Court of Appeal had found him guilty of professional misconduct. " the solicitor submitted that convictions of a sexual nature have not generally been thought to mount to professional misconduct, nor, in all the circumstances, did his conduct demonstrate that he was not a fit and proper person to be a legal practitioner."

" The High Court highlighted the need to consider fitness at the time of the hearing, not when the conduct in question took place"
Law Society Journal, April 2004.

HIC demanding retrospective payments

Doctors who place item numbers on accounts run the risk of being asked to pay the full value of the rebate of the item number if at some future time it is decided retrospectively that the definition of the professional service against which the item number has been detailed does not fit with the judgement of an officer of the HIC. There is no requirement in the legislation for a doctor to place an item number on the account. Under the Health Insurance Act 1973, the regulations of that act set out the particulars that are required to be recorded on a patient account to make it possible to claim Medicare benefits. These include:1. the date the service was given, and2. the item number of the item that relates to the professional service, followed by an asterisk (or, alternatively, a description of the professional service sufficient to identify the item that relates to the professional service, preceded by the word 'patient')

Unfreeing the National Health Service

Patient co-payments in the UK NHS have increase across the board in an effort to generate almost A$1 billion in extra revenue to fund the system. So much for the free system!
International Express, Tuesday March 15, 2005

More Bureaucratic Madness in the Land of Hope & Glory

A local area UK NHS plan to deter patients from seeking and receiving after hours care has backfired following the death of an elderly patient who was turned away from a hospital 200 yards from her home and forced to travel by ambulance 30 miles to another hospital. The doctor at the first hospital couldn’t treat the elderly lady because " it was not in his contract". The bizarre contracts also banned GPs from giving injections, dressing wounds and writing prescriptions after hours. Despite a damning report, the NHS "remained fully committed to ensuring that patients had access to high quality health care" .

Meanwhile German locums are being flown to Britain, accommodated in hotels @A$244 per night and being paid A$488 per hour to provide cover at some hospitals over the weekend. Meanwhile Britain’s famous hospital, Ormond Street Hospital is in trouble for treating too many sick children. Some surgeons have responded by bringing forward important operations before operating theatre cuts are imposed i.e. cut before you’re cut.
International Express, Tuesday March 15, 2005

The Rain in Spain

The 6th International Congress for Ambulatory Surgery will be held in Seville, Spain on April 24th-27th 2005. See www.iaascongress2005.org

Quotable Quotes

Let it be remembered that hospitals exist for sick people to receive complex treatments which are, with very few exceptions, medical in nature and are carried out under the direction of clinical medical practitioners. All other activities in a hospital are supportive of this primary function of a hospital.
Dr Barry Dowty, Mildura, VIC

Ironically, the community demanded control in the hope of clinging on to what free enterprise has made available through the abolition of former controls.
Mark Christensen – Letters, The Australian Financial Review, 11 May 2004

The costs of government regulation fall ultimately on the same people who are benefitted by regulation.
Henry Ford

Part of the feeling that the air is freer today stems from the fact that we have already grown accustomed to some of the intrusions which formally we viewed with distaste
Gov General Sir Zelman Cowan Boyer Lectures 1969

The only coercion should be that of argument, the only obligation that of honest reasoning.
A C Grayling, philosopher & writer

Order + counter order = disorder
Old army aphorism

the major defect of the bureaucratic approach is the inability to separate the vital from the trivial
Professor Abraham Zalesnic, US Management & Leadership guru

Liberty lies in the hearts of men and women; when it dies there, no constitution, no law, no court can save it; no constitution, no law, no court can even do much to help it
US Justice (Billings) Learned Hand 1872-1961

Doctors lacking in anatomy are like moles: they toil in the dark and the fruits of their handiwork are mounds of earth
Friedrich Tiedemann 1781-1861