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Preference: Government and politics

Supervisors – powerhouses of the medical workforce

By AMA VICE PRESIDENT DR TONY BARTONE

I recently had the opportunity to reflect momentarily on how our well-oiled training allows us to so confidently and expeditiously care for our patients in a vast array of situations. One of my colleagues in the clinic had to attend to a patient with chest pain in the treatment room, something most of us have had to deal with. Making sure he did not need extra assistance, I observed the calm yet confident manner with how he dealt with the critical situation.

We can do all of those things because of our medical training and education, the clinical and professional skills we learned from working with dedicated supervisors, who in many cases become our mentors and friends.

The standard of medicine practised in Australia is consistently ranked among the best in the developed world. This is because we have a highly trained medical workforce based on the established apprenticeship model, with our Colleges maintaining education and independently determined training standards.

However, this model which has served us so well in the past is now at risk. Insufficient postgraduate positions and increasing numbers of graduates and aspiring trainees are stretching the system.

Continual advocacy by the AMA has ensured that there is a growing awareness that we do not have enough prevocational and specialist training places for the increasing number of new doctors. Whether governments and health policymakers are fully awake to the urgency of these worsening shortages is a topic for another time.

Unfortunately, I think it’s forgotten sometimes that clinical supervisors are the powerhouses of our apprenticeship model of training doctors. For the AMA, it is clear that to meet the challenge of training the expanding medical workforce, more clinical supervisors need to be found, supported and properly recognised and rewarded.

Boosting supervision capacity is a pivotal issue for our doctors in training, and the AMA has developed a significant suite of policy proposals and ideas in recent years.

To assist our ongoing advocacy, the AMA, led by the Medical Workforce Committee, has prepared a position statement that brings together these policies into a stand-alone document.

Building Capacity for Clinical Supervision in the Medical Workforce 2017 affirms our view that training and supervising new doctors is just as important as delivering services in the health system.

The document emphasises that the apprenticeship model of medical training is as relevant as it was as five decades ago, and shows that building supervision capacity across the spectrum of public, private, general practice and rural settings has common and unique sets of challenges and solutions.

Any discussion on this issue should not neglect the importance of ensuring that clinical supervisors have the support they need to train the next generation of doctors, as well as fostering a culture within medicine that encourages teaching and training.

From a personal perspective, many of my colleagues and I have found supervising junior colleagues to be a demanding yet thoroughly rewarding experience, with much gained in return.

Regrettably, I hear from different sources that protected time is not always available for teaching and training and simply added onto other responsibilities. Worse still, I hear many stories of those who have ended their roles because of a lack of support time or resources. I also know of VMOs and staff specialists who are actively discouraged from setting aside time for these activities. This makes no sense at all. Surely, now is the time to be boosting, not diminishing support for our supervisors.

Building Capacity for Clinical Supervision in the Medical Workforce 2017 outlines what the AMA believes has to be done from the industrial, financial, regulatory and cultural perspectives. I encourage you to take a look.

advocacy/position-statements

 

Medical Indemnity

BY ASSOCIATE PROFESSOR JULIAN RAIT

As previously covered in this publication, the profession’s concerns about medical indemnity insurance have re-ignited since the Government announced reviews of all Commonwealth funded medical indemnity schemes and the underpinning legislation.  

At the height of the indemnity crisis in the 2000s, many practitioners faced uncertainty about the future of their practice, with some thinking about leaving the profession all together.

Everyone was vulnerable.

The AMA played a pivotal role in stabilising the industry by bringing the profession together, and working with Government, to design schemes that were more equitable and affordable for practitioners.

However, these protections put in place by then Health Minister Tony Abbott looked to be under attack of late – indeed a saving has already been garnered through the MYEFO in December, along with the announcement of the review.

Since December, we’ve had a new Minister and thankfully, as it appears, a new approach. Following extensive lobbying by the AMA, the Terms of Reference (ToR) for the reviews into the Medical Indemnity Schemes appear to be far more informed.

The review has just commenced and the ToR appear to be more focussed on stability, understanding the importance of affordable indemnity insurance and affordable health care, and considering the international experience.

From an AMA perspective the schemes have been a resounding public policy success. They should remain and be strenuously defended.

We’re also aware that Medical Defence Organisations (MDOs) have been discussing what they wish to achieve through the review – including insuring that the outcome continues to promote stability in the industry, and maintains affordable premiums. 

It is also expected that the role of insurers in providing universal cover – that is the requirement to be an ‘insurer of last resort’ in a particular jurisdiction, will come under review.

From an AMA perspective, there is a strong belief in the importance of universal cover, and that all indemnity insurers should be required to provide it, and that the arrangements should be fair and equitable. The last thing we want to see is a situation where an insurer, rather than a regulator, decides who can effectively practise in the medical profession.

From an insurance perspective, there is a desire to be able to charge a premium that reflects the level of risk in providing coverage, and to have a mechanism to encourage a practitioner to engage with the MDO and improve their practice.

One of the issues related to the indemnity review is any legislation changes that may be considered as part of ongoing AHPRA and MBA work. This potentially includes requiring indemnity insurers to disclose civil claims to AHPRA.

As all members know, the AMA does not support poorly performing practitioners. However, in absence of any level of detail about how these proposals will work we remain highly wary. Furthermore, a civil claims settlement, and poor medical practice, are not necessarily one and the same thing.

However, it is clear that there is an appetite in some jurisdictions for looking at mechanisms to reveal potentially poorly performing doctors – this builds on previous attempts via the revalidation agenda.

It is therefore critical that the AMA continue to advocate on behalf of our members on the importance of indemnity insurance; the critical requirement for the insurer and the regulator to be separate; and to address any ill thought out or underdeveloped approaches that unfairly target practitioners.

To that end, the AMA will closely watch the forthcoming proposed legislative changes, and the revalidation work underway by AHPRA.

In the meantime, Federal Council has reaffirmed our support for universal cover arrangements, and work has begun on our submission to the indemnity reviews.

But in the immediate term, this review needs to hear from the whole profession. The AMA has written to the Colleges, Associations and Societies, and in this publication, encouraging contributions to the Government’s indemnity review.

Providing affordable insurance flows directly through to affordable care, which is an issue the profession is focussed on right now. We need to ensure our voices are heard. For those who wish to make a submission, please see:

http://www.health.gov.au/internet/main/publishing.nsf/content/medical_Indemnity_First_Principles_Review

AMA Members are also welcome to directly contact me via my email address as follows:

jrait@eyesurgery.com.au

 

COAG move on mandatory reporting welcomed

The Council of Australian Governments (COAG) Health Council has resolved to develop a nationally consistent approach to mandatory reporting provisions for health practitioners.

The move has been warmly welcomed by the AMA.

Federal and State and Territory Health Ministers have agreed to consult with practitioner and consumer groups, and develop a nationally consistent proposal for consideration at the next COAG Health Council meeting in November 2017.

The agreement follows months of lobbying and advocacy from the Federal and State AMAs, highlighted by discussions in face-to-face meetings between Health Minister Greg Hunt and AMA President Dr Michael Gannon in recent weeks.

Dr Gannon said that the AMA had always advocated for treating practitioners to be exempted from mandatory reporting requirements.

“Mandatory reporting laws deter health practitioners from seeking early treatment for health conditions that could impair their performance,” Dr Gannon said. 

“We have advocated long and hard at both the federal and State level for changes the mandatory reporting provisions.

“It is an issue that the AMA and the whole medical profession feel passionately about. It affects every doctor, their families, their loved ones, and their colleagues.”

Delegates to the AMA National Conference in May were unanimous in seeking amendments to the mandatory reporting requirements under the National Law, so as to not dissuade medical practitioners from seeking necessary medical treatment or assistance. 

The intention of the legislation was to ensure the protection of the public by requiring doctors and other health practitioners to report colleagues whose health was impaired.

But this created a barrier for health professionals to access health care, particularly in relation to mental illness. The lived experience of doctors’ health advisory services across the country confirms these fears.

“Mandatory reporting undermines the health and wellbeing of doctors,” Dr Gannon said.

“It is a tragic reality that doctors are at greater risk of suicidal ideation and death by suicide. This year we have lost several colleagues to suicide.

“While there are many factors involved in suicide, we know that early intervention is critical to avoiding these tragic losses. 

“The AMA has identified that mandatory reporting is a major barrier to doctors accessing the care they need.

“The real work begins now. We need action from all our governments.

“The medical profession and the public need a sensible system that supports health practitioners who seek treatment for health conditions, while at the same time protecting patients. 

“We urge all Health Ministers to work cooperatively to come up with an achievable agreed proposal at their next meeting.”

CHRIS JOHNSON

New medical school places undermined by bad policy

The AMA has welcomed the Federal Government’s commitment to 50 medical school places at the Sunshine Coast University Hospital, but AMA President Dr Michael Gannon said the policy surrounding the move needed rethinking.

Dr Gannon said he was pleased the impasse over medical school places on the Sunshine Coast had been resolved, with a commitment to 50 Commonwealth Supported Places (CSP) announced at the end of August, but good intention had been undermined by bad policy.

He said the AMA has supported the establishment of the new medical school, provided total national medical student numbers do not increase.

“We welcome the fact that the Government has partly listened to our arguments, with the overall number of CSP medical school places across the country remaining unchanged,” Dr Gannon said.

“The 50 CSP places on the Sunshine Coast have been reallocated from other medical schools.

“However, the AMA understands that, as part of the negotiations with other medical schools, the Commonwealth has been forced to agree to support the recruitment of additional international full fee paying medical students at those universities that have given up places.”

The move comes on top of the decision by Macquarie University to establish a new $250,000 medical degree course – a decision that prices a medical degree out of reach for many of Australia’s best and brightest students.

The AMA insists the policy focus must be on the mal-distribution of doctors and shortages in particular specialty areas, not supporting universities to boost their bottom line.

“We are graduating record numbers of medical students, putting us well above the OECD average,” Dr Gannon said.

“But we are not providing enough prevocational and specialist training places for our medical graduates. Next year, we face a shortage of 569 first year advanced specialist training places.

“We must address community need by supporting extra prevocational and vocational training places, otherwise access to medical care will continue to be a problem in many parts of the country.”

Dr Gannon said the downside of the Sunshine Coast Medical School announcement was that it was unfortunately another example of where horse trading has replaced good medical workforce planning and policy.

“The Government needs to take a much tougher approach to full fee paying medical school places, both for domestic and international students,” he said.

“Working with the AMA and other groups will ensure that policy settings genuinely tackle the medical workforce problems we now face.”

CHRIS JOHNSON

Minister to co-chair Indigenous Suicide Prevention Committee

Indigenous Health Minister Ken Wyatt will co-chair a new steering committee working directly with Aboriginal communities to address Indigenous suicide prevention.

Mr Wyatt made the announcement as the Kimberley Suicide Prevention Trial begins detailed planning and delivery of potentially lifesaving initiatives across the region.

“This is where the rubber hits the road, working very closely at the community level, involving young people, families and elders,” the Minister said when attending a recent suicide prevention roundtable in Broome.

Mr Wyatt said he believed it was important in establishing a strong working partnership between local Aboriginal communities and the Commonwealth, especially through younger people. 

“We now have a strong operational plan based around the communities, to bring promising and proven strategies together in liaison with local people, to make a difference on the ground,” he said.

The Minister praised a presentation by Kimberley Aboriginal Youth Suicide Prevention Forum members Jacob Corpus (aged 20) from Broome and Montana Ahwon (19) from Kununurra, and said young people must be supported to play key roles in reducing suicide.

“Both Montana and Jacob are incredible and inspiring young leaders who have helped identify key factors that impact on Kimberley youth, which the steering committee will now consider,” Mr Wyatt said.

He also recognised the importance of including young Aboriginal people on advisory groups, to help empower them to take up future leadership roles.

Youth forum recommendations included: support for emerging young leaders, positive role models and mentoring; teaching in school of local culture and country traditions; the dangers of drugs and alcohol, and the importance of resilience; and strong youth engagement and networking through sports, arts and local cultural activities.

The steering committee will be co-chaired by Kimberley Aboriginal Medical Service Deputy CEO Rob McPhee and will report to the Kimberley Suicide Prevention Working Group.

The Government has committed funding of up to $1 million per year over three years to June 2019 to the Kimberley Suicide Prevention Trial, to support suicide prevention activities developed by the working group. 

The Minister for Indigenous Affairs, Senator Nigel Scullion, has also announced the Government will commit $10 million to expand nationally the suicide prevention trials conducted in WA over the past year.

The Critical Response Team (CRT) model involves trained crisis team visits to families affected by suicide and other traumatic events to co-ordinate support services to help them deal with loss and to build resilience by communities for communities.

Suicide rates among Indigenous people in the Kimberley region of Western Australia are among the highest in the world, according to the World Health Organization. During the period 2001–2010, age-adjusted suicide rates among Indigenous and non-Indigenous Australians were respectively 21.4 and 10.3 per 100 000 population per year.

The AMA remains committed to working in partnership with Aboriginal and Torres Strait Islander groups to advocate for government investment and cohesive and coordinated strategies to improve health outcomes for Indigenous people. The AMA recognises Aboriginal and Torres Strait Islander peoples are among the most disadvantaged groups in Australia, and experience high levels of mental ill health and low levels of social and emotional wellbeing.

To read more on the AMA’s position go to position-statement/aboriginal-and-torres-strait-islan….

MEREDITH HORNE

Fast food plans to slow down antibiotic use

Fast food giant McDonald’s has recently announced that it aims to serve up more antibiotic-free meat at its restaurants around the world.

McDonald’s has said that from 2018 it will begin implementing a new chicken antibiotics policy in markets around the world, which will require the elimination of antibiotics defined by the WHO as Highest Priority Critically Important (“HPCIA”) to human medicine. 

This plan includes Australia. McDonald’s estimate that each year it purchases 21.4 million kilos of Australian chicken.

The world’s largest burger chain will also work toward limiting the use in cattle and pigs of antibiotics important to human medicine, a significant move because McDonald’s is such a significant purchaser of beef and pork.

Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses and parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it.

As a result, standard medical treatments become ineffective, infections persist and may spread to others. Resistance to current antimicrobials is increasing faster than the development of new drugs, and so effective treatments cannot keep pace. The World Health Organization (WHO) describes AMR as a looming crisis in which common and treatable infections will become life threatening.

More than 1,000 cases of almost-untreatable superbugs were reported in Australia in the 12 months to March this year.

For the first time, the Australian Commission on Safety and Quality in Health Care has tracked dangerous bacteria resistant to the last line of antibiotics.

Speaking to SKY News earlier this year, AMA Vice President Dr Tony Bartone said: “The over-prescription of antibiotics is a problem because, world-wide, we’ve seen the emergence of what we call anti-microbial resistance – that is, resistance by bacteria to antibiotics, life-saving antibiotics in the past.

“Now with this emerging resistance, it’s becoming more and more difficult to treat these resistant bacteria, and we’ve all got a role to play in trying to reduce that incidence and that spread.”

In April 2014, WHO released its new global report, Antimicrobial resistance: global report on surveillance, which states ‘… this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect everyone.’

The Australian Government and other international governments have already identified antimicrobial resistance (AMR) as a high-priority issue.

MEREDITH HORNE

Communiqué from Federal Council meeting 17-18 August 2017

BY DR BEVERLEY ROWBOTHAM, CHAIR OF FEDERAL COUNCIL

Welcome to the inaugural communiqué from Federal Council highlighting the debates had, and decisions taken, at its meeting in Canberra in the depths of winter on 17-18 August.

In giving his report, AMA President Dr Michael Gannon made mention of the many recent advocacy wins of the AMA. He reported that the working relationship with the Federal Government has evolved following the compact agreed at the time of the Federal Budget in March, enabling frank and effective engagement with Health Minister Greg Hunt.

Dr Gannon reported that benefits of this engagement can be seen in recent successes with the Minister moving to scrap the draft national maternity services framework which was opposed by the AMA for lack of obstetrician and GP involvement; and support by Minister Hunt to work with State and Territory colleagues to remove mandatory reporting from the National Law. Advocacy on this latter issue has been strongly supported by Federal, State and Territory AMAs, which uniformly endorse the WA approach to mandatory reporting.

The Secretary General’s report provided a comprehensive overview of the AMA’s medico-political advocacy. The Secretary General Anne Trimmer noted that the Governance Institute’s 2016 Ethics Index, with research undertaken by IPSOS, ranked the AMA as the most ethical of the national membership and industry associations.

She reported that the secretariat is working with the Minister’s advisers and the Department of Health to shape appropriately targeted after hours GP services, arising from the draft MBS Review report into these services. The secretariat is working with the NBN to finalise criteria for improved access to broadband in rural areas with a proposal to grant Public Interest Premises status to medical practices under the satellite footprint.

Two of Federal Council’s committees are working with the secretariat to develop a new advocacy strategy for aged care with funding and technology identified as priority areas. Federal Council also agreed to campaign for additional funding for the incoming Practice Incentive Program Quality Incentive and strongly opposed recently flagged proposals to increase the return of service periods for future bonded medical places program participants.

The Federal Council noted updates on the two major government reviews currently underway, the MBS Review and the Private Health Ministerial Advisory Committee review of private health insurance arrangements. An informal grouping of approximately 30 members is working with the AMA to inform its response to the draft reports. Work on the PHMAC review has slowed over the winter period although a new working group on risk equalisation has been established. The AMA will be advocating for changes to the risk equalisation pool to facilitate coverage OF pregnancy under all levels of PHI cover.

Federal Council discussed the Government’s review of the medical indemnity schemes. The AMA has worked closely with the Department of Health to shape the terms of reference and remains strongly committed to the schemes as an effective mechanism to moderate the cost impact on practices and patients. The AMA has been communicating to the profession the need for active engagement in the review by Colleges, Associations and Societies.

The AMA is represented on a small working group to review the Health Professional Online Services (HPOS) system, which emerged as vulnerable to fraud. The Minister for Human Services, Alan Tudge, kept the President informed of the steps taken to ensure integrity of the system prior to the establishment of the review of health provider access to Medicare numbers.

With a Senate inquiry underway into the value of private health insurance and medical out of pocket costs, the Federal Council set aside a policy session to consider the issues in depth. The AMA lodged its submission at the end of July (the submission can be read at submission/submissions-out-pocket-costs-australian-he…).

The submission included data on billing practices collected from a poll of members.

Federal Council, noting the growing public commentary calling on limits on out of pocket medical expenses, agreed that the priority was to correct misleading statements about the role of doctors’ fees in the debate about affordability of health care. An animated debate ensued with Councillors contributing a range of views based on their personal experience.

The issue has been largely driven by private health insurance and the growth in gaps in coverage and exclusions. Federal Council noted that there had been limited complaints to the Private Health Insurance Ombudsman about out of pocket expenses. Federal Council also noted that many medical services had always had an element of out of pocket contribution, not to be confused with the charging of an excessive fee which the AMA strongly opposes. Federal Council agreed that there needs to be greater clarity on what constitutes an excessive fee and that this needs to be clearly communicated to the public.

The President acknowledged the comments of Federal Council and noted that he had an opportunity to address these issues in his upcoming address to the National Press Club (the transcript of the President’s address can be read at media/dr-gannon-national-press-club-address-0).

The AMA’s work on public health initiatives continues, ranging from road safety to obesity and physical activity. Federal Council heard progress reports from working groups led by Councillors and debated draft position statements on road safety, obesity and physical inactivity. Other working groups are considering nutrition, mental health and the social determinants of health. A revised position statement on mental health is in development in conjunction with the AMA psychiatrists’ group.

Federal Council received reports from each of its practice group councils, and from its committees. The State and Territory AMAs and Australian Medical Students’ Association provided reports on current areas of advocacy.

 

[Series] Germany’s expanding role in global health

Germany has become a visible actor in global health in the past 10 years. In this Series paper, we describe how this development complements a broad change in perspective in German foreign policy. Catalysts for this shift have been strong governmental leadership, opportunities through G7 and G20 presidencies, and Germany’s involvement in managing the Ebola virus disease outbreak. German global health engagement has four main characteristics that are congruent with the health agenda of the Sustainable Development Goals; it is rooted in human rights, multilateralism, the Bismarck model of social protection, and a link between development and investment on the basis of its own development trajectory after World War 2.

Questions asked and answered during Press Club appearance

 In addition to delivering a wide-ranging 30-minute speech at the National Press Club, AMA President Dr Michael Gannon spent another half hour at the podium fielding questions from the Canberra Press Gallery.

The issues raised by the inquiring reporters ranged from doctors’ fees, to refugee health, to codeine prescriptions, to marriage equality – and a whole lot in between.

On the subject of cost-shifting by the States to patients covered by private insurance who are attending public hospitals, Dr Gannon said he had made the point directly to Health Minister Greg Hunt, that flexibility must be maintained.

“We don’t want a situation where insured patients are prohibited from care in public hospitals,” Dr Gannon said.

“They might live in a rural area where there’s no alternative; no fancy, shiny, private hospital there in the region. It might be the case that a doctor with sub-specialist expertise only works in a public hospital. It may be that they need the intensive care unit that only exists in a public hospital. It may simply be the patient’s choice. So, wherever we land, we must end up with flexibility.

“One of the things that’s led to this problem is the fact that the States and the Territories and the Commonwealth have underinvested in public hospitals. So, the public hospitals are looking for new revenue streams, and sometimes they’re a bit too tricky and clever trying to get hold of insured patients when they’re not actually providing any greater level of care.

“But I also think this is an area where the private health insurers need to step up to their part of the responsibility.”

In his speech, Dr Gannon described the push by insurers for doctors to publish their fees and customer referrals as “dangerous territory”.

In response to questioning about that, he said informed financial consent was very important.

“But I don’t trust a website owned by the insurers to produce un-vetted information about the quality of the magazines in the waiting room, whether or not the receptionist was rude, and I have great concerns about people not being able to obviously interpret quality data,” he said.

“It’s a lot more complicated than a cheesy website might appear.”

Drug testing welfare recipients

The AMA President was highly critical, when he was asked about it, of the Government’s plan to drug test welfare recipients.

“If I had to put a nasty star on the Government’s last Budget, it was this mean and non-evidence-based measure. It simply won’t work,” Dr Gannon said.

“This is not an evidence-based measure (and) will not help. We don’t expect people in most industries to have drug testing before they turn up to work.

“It’s simply unfair and it already picks on an impaired and marginalised group. It’s not evidence-based. It’s not fair. And we stand against it.”

NDIS

On the question of the NDIS eligibility of people with mental health conditions, Dr Gannon said the scheme needed certainty of funding to ensure proper access and eligibility.

“This is going to be a very difficult and vexed issue for Governments now going forward,” he said.

“Talk to the experts. Talk to the GPs, the psychiatrists, the psychologists, the carers who are there providing that care every day. Look at the evidence. Look at what works, and fund it according to what might be expected to work from international evidence, or from talking to home-grown experts here in Australia.”

Same-sex Marriage

On marriage equality, the President said he wouldn’t lecture parliamentarians on legislative approaches, but a risk existed that the wider discussion on the issue will have mental health impacts on people directly affected.

“Equally, we live in a democracy where people are entitled to have their say. I faced criticism of our Position Statement from within the membership, and I have made it very clear that we, as an organisation, are a broad enough church that we can accommodate different views on this topic,” he said.

“And I am not uncomfortable with the Australian people being given their say. We believe that this is an area of discrimination and therefore does have health impacts. We would like to see it resolved. We would like to see the Government, the Parliament, getting on in other crucial areas of public policy, but we are silent on the exact details about how we get there.”

Codeine prescriptions

On codeine, and the AMA’s agreement with the decision to make it available only by prescription, Dr Gannon said the AMA’s position was not a unilateral statement.

“This is very much the AMA supporting the Therapeutic Goods Administration, the TGA, in their independent science-based analysis of the issues,” he said.

“Now, many people might not know that there’s already 25 countries where codeine requires a prescription. Many people might not know that the science tells us that we all metabolise codeine very differently. So for a significant minority of us, we metabolise it in a way that is extremely potent, every bit as powerful as morphine, and is a common cause of death from opioid overdose.

“Not only have we told the Minister we support the TGA’s decision, we are also telling the State and Territory Health Ministers that we do not want to see exemptions from this. That’s wading into very, very dangerous territory, when the independent regulator looking at scientific evidence is overrun by an industry that has a different view.”

Euthanasia

On palliative care and support of doctors who may wish to assist patients to die, he was very clear.

“We have inadequate legislation in most parts of Australia to protect doctors acting ethically and lawfully with inadequate doctrine of double effect legislation,” Dr Gannon said.

“Ninety-nine per cent of end-of-life decisions do not involve requests to die. That is a very, very, very small part of the system.

“And surely the aspiration of all people, whether they favour voluntary euthanasia or not, is to improve palliative care services.

“The AMA Position Statement makes it extremely clear that we understand this is a decision for society: it’s Parliament’s, it’s legislators’. The AMA’s position is that doctors should not participate in these arrangements.”

Refugee health care

Regarding the level of health care provided to asylum seekers in offshore detention, Dr Gannon said the ethical principles were very clear.

People seeking the protection of the Australian Government are entitled to healthcare standards the same as Australian citizens.

“So, that’s a matter of ethics and that’s a matter of law. What we’ve developed over the past 12 months or so is a relationship with the Chief Medical Officer of the Department of Immigration and Border Protection, so that when we receive discussions on individual healthcare episodes we are able to talk about them,” he said.

“… a difficult and vexed issue where a form of medical care, namely termination of pregnancy – which could relatively easily be provided on Nauru – can’t legally be provided because it’s illegal on the island.

“That means that if that cannot be provided, that those patients must be transferred to the mainland. This is a hotly contested political issue. I am not an immigration expert. But I like to think I’m an expert in medical ethics, and I’ve stated our position very clearly as to the health standards that we would expect.”

Private health insurance

On private health insurance, Dr Gannon said agreement must be reached on basic level of cover, or at least better transparency, so people know what they’re covered for.

“The policies that are nothing more than to dodge the tax penalty, they’re junk,” he said.

“The policies that limit you to care in a public hospital, I need to be convinced why they’re any better than being a public patient in our excellent public hospitals.

“Now I don’t want to spend my entire life arguing with the insurers. They have a right to make a profit. In fact they’ve got a corporate responsibility to deliver a profit. But they cannot deliver that profit on the back of diminished services to private patients. And if they don’t get it and they don’t get it soon, they will drive their industry off the cliff.”

CHRIS JOHNSON

The full transcript of Dr Gannon’s Q&A session at the National Press Club can be found here:

media/dr-michael-gannon-national-press-club-q-and