HERE’S an exercise for the weekend.
How much do you know about your doctor – general practitioner or specialist – before you hand over your well-being, and sometimes your life, to him or her? And where do you go to check?
The likely answers are “Not much” and “Not sure”. And that’s a problem.
After more than three years writing about the pelvic mesh device catastrophe I’ve learnt the following - when things go wrong a lot turns on the notion of a patient’s “informed consent”; our whole concept of the “trust” relationship between doctor and patient needed to change with corporatised health, when patients stopped being patients and became health ‘consumers’; and there’s vast sums of money sloshing around our health system where vast sums have no business sloshing.
And another thing. Right across the health sphere there are many pretty words said and written about people and patients being at the centre of everyone’s thinking – “Building a regulatory system for the 21st century aimed squarely at protecting the public”, and “We’re committed to the establishment and maintenance of the highest possible standards of practice in women’s health”, being a couple of examples. But they’re just words.
Money is at the centre of our health system. When things go wrong you discover by just how much.
But let’s not get dispirited. It’s time for a little health consumer activism.
It tells you very little that you really need to know to distinguish quacks from the rest. I write that based on direct evidence of the complaint histories of some Australian doctors associated with pelvic mesh devices, whose public records are almost virginal in their purity.
In about 2010 the Australian Health Practitioner Regulation Agency was established to administer a national registration and accreditation scheme, working with the national boards of professions including the Medical Board, Dental Board, Nursing and Midwifery Board and Chiropractic and Chinese Medicine Boards.
It runs on a model of registrations meeting costs. In 2015/16 AHPRA collected $171 million in income to meet its $169 million in costs. Australia’s drug and medical device watchdog, the Therapeutic Goods Administration (TGA), runs on a similar model. The regulated fund the regulator, in other words.
AHPRA will tell you if your doctor/health professional is registered, date of first registration, his or her specialty area and practice address. If he or she has been the subject of a complaint process leading to conditions placed over his or her practice, those conditions will appear.
It won’t tell you why conditions were imposed, the health practitioner’s complaint history, how many matters might have been pursued in court – leading almost invariably to settlements with confidentiality clauses to keep matters out of the public realm – and once the terms of those conditions are deemed to have been met, they disappear from the register.
In other words, it tells you very little that you really need to know to distinguish quacks from the rest. I write that based on direct evidence of the complaint histories of some Australian doctors associated with pelvic mesh devices, whose public records are almost virginal in their purity. Complaints and decisions might be recorded elsewhere, but you have to know where to find them. That’s fine if you’re a journalist whose business it is to know about these things, not so fine if you’re a trusting member of the public.
Here’s why this lack of information and transparency matters.
For the past few years since the penny dropped that many pelvic mesh devices on the Australian market – particularly for women’s prolapse after childbirth – were approved with little or no evidence of safety and efficacy, the health system has responded by emphasising the need for doctors to have very specific skills and significant experience in mesh device surgery.
Then it dumped responsibility for determining which doctors were particularly mesh-skilled and experienced on women. This in a system where too many doctors have direct financial relationships with mesh manufacturers or have invented pelvic mesh devices themselves, and where it’s virtually impossible to discover a doctor’s complaint and litigation history, apart from asking the person who’s soon to be inserting a foreign object through your vagina while you’re out cold on an operating table.
Sure. You want to get your doctor offside under those circumstances, by questioning his or her expertise or litigation record. But it’s up to patients to give “informed consent”.
AHPRA and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists can’t and won’t help with information on a doctor’s complaint and litigation history. Individual hospitals credential doctors and procedures – or don’t if there are concerns – and I’ve spoken directly with former senior hospital representatives who’ve acknowledged doctors don’t tend to complain about other doctors. They just ensure they can’t do surgery at their hospitals. Not in my backyard, in other words.
Doctors’ insurance companies know everything about doctors’ complaint and litigation histories. But they’re not compelled to do anything with that information. And as an insurance company representative told a Senate inquiry in 2005, if a doctor has “many claims” against him or her, the insurer charges the doctor more in premiums. I contacted the insurer to see if it had changed its policy in the interests of protecting the public. No response.
The current Senate inquiry into the pelvic mesh catastrophe - called because women victims formed a group, the Australian Pelvic Mesh Support Group, campaigned through the Newcastle Herald and showed Senator Derryn Hinch why an inquiry was desperately needed – has confirmed how blinkered the health industry is to the influence of money. And how vulnerable the public remains without substantial reforms.
It’s time to demand them.