Don’t let the genie out of the bottle!
The Back to Future series appears to be back on TV again. In the recent replay, Marty McFly went back in time to try to match their parents up but unfortunately, end up doing the opposite, resulting in the gradual disappearance of his siblings from the photo. Often, in the practice of medicine, with all good intentions at the time, unintended effects occur down the track. If we don't take extreme care and agree to various "innocent changes" to our practice without great analysis and consultations with grassroots doctors, the way we practise our craft can be significantly affected.
We have already seen what happened with electronic prescribing recently and the whole process is now back to the drawing board as medicolegal issues has "just" arisen (see last month's Echo).
We have seen the PCEHR slowly being rolled out and the more informed amongst us are sitting on the sidelines waiting till we are dragged in kicking and screaming if we have to. The powers to be predictably do this every single time:
Suggest an unpopular or untested measure and despite protestations from all stake holders, rolls it out anyway and fund it via divisions (and now ML) or the colleges. Suddenly, all the objections to the scheme or measure is muted because someone was been paid to roll it out. It makes it all OK because some big organisation rolls it out. No questions asked of the original objections!
Take the PCEHR as example. Over the last three years, just about everyone objected to the scheme because of issues of privacy, confidentiality, reliability and accountability, to name a few.. I don't recall that any of these issues have been addressed by NEHTA. But, it is being rolled out and with funds to the college and ML, suddenly workshops across the country is mushrooming and GPs are invited to help us implement the system and how wonderful this technology is. Many GPs are photographed, absolutely proud that they were the first adopters, just like the first to get new Samsung Galaxy 4 or iPhone 5 or 6. But we forget that the issues raised has not been addressed. We fall for it all the time. Once the genie is out of the bottle, it is awfully difficult to put it back in.
In addition to the PCEHR disaster waiting to happen, there are 2 other time bombs coming up in the not distant future which will impact upon our work flow and workload:
Diabetes Care Project
Most of you will remember the abortive attempt to fund diabetes care in primary care by paying GPs a one off $1200 per year (inclusive of all consults). Amidst protests from many quarters, it was called off at the last minute pending a "pilot study" which is currently underway in many states but not in NSW. I have been trying to dig up some information about the pilot. There is supposed to be two models of care they are trialling: 1) Usual GP care 2) Usual care with help of a non-medical "coordinator" which will assist and direct care when needed. We all know what happens when there are layers of bureaucracy on top of clinical care! I am also suspicious of the parameters used to determine "ideal care". It is well known that politicians never conduct any inquiry unless they know the outcome. You can guess which model will get better results. Once the pilot is completed within the next year, the recommendations will start as guidelines and then become standard. The genie will be out of the bottle by then.
I get very annoyed when governments sit on reports for years and then decide at the eve of an election that we need to fund this NOW and we have to hurriedly get money from somewhere to fund this. There is no arguments from anyone that we need a National Disability Insurance Scheme. In fact, we need it 3-5 years ago. What I fear most is the tsunami of paper work coming our way when the scheme gets going - what is the definition of disability (and the forms to certify that!), who gets what and when and treating doctors' report, proof of diagnosis, specialist referrals etc etc. You see my drift.
How do we stop all these from happening. We need to work together as a network. Come to meetings. We will need to be informed, be engaged and be active. Talk to your chapter reps. You can email me. Be suspicious. While we recognised that the college has its roles in setting certain standards and the AMA on occasions speak out against government meddling, SSWGPL represents the grassroots.
Woody Allen once said: “Just because you are paranoic, doesn't mean they are not out to get you”.
Workcover Forms needs some serious rehabilitation!
Have you tried using the new NSW Workcover Authority’s Capacity to Work online form recently?It is filled with very annoying bugs:
- The boxes to fill in are not in sequence - First name appear first but pressing the tab key after that does not take you to the surname but Telephone Number next
- The Dates fields are mostly not in sequence - the years do not come after the day and the month as you tab along. And there are lots of Dates to fill in!
- Page 1 & 3 requires you to enter First Name and Surname separately but Page 2 requires Name in one box
- The forms are now in three pages (actually if you include a “propaganda” page on Page 4) but does not contain any more information than the previous one page document. Because there are 3 pages now, we have to fill in Names and Claim Number three times!
Oh, have you noticed that the new three page document really doesn’t contain anymore information than the previous one page document. Shift a few boxes around, call it something else and the whole system has been “re-invented”. I wonder how much it cost to redesign the form?
I have contacted Workcover Authority which has palmed me off to some department. I am still waiting for a response after three weeks.