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Members’ Forum


From November next year the Government will prevent doctors from being able to claim a standard consultation and a chronic disease management item for a single patient on the same day, denying them what Chair of the AMA Council of General Practice Dr Brian Morton said was a legitimate form of billing for an all-too-common occurrence in general practice. AMA members share their view.
We have a reminder system and, as a free service, include any pathology or imaging requests with our reminder letters. Inevitably the patient, after spending half an hour with our nurse and then coming to me to complete the care plan or health assessment, presents another problem, such as a chest infection or, often, a driver’s medical that the patient presents me with. It is hard to undo a care plan appointment of one hour, combined nurse and doctor, and then deal with the problem that needs to be sorted out in a timely manner. The patient would have to wait another three weeks for their care plan appointment and we would have wasted appointment spaces. This is unfair on busy, thorough doctors, and is aimed at those bulk billing, over-doctored centres where a doctor might seize the opportunity to value add with a CDM item as well. In the most part, preventing doctors from charging CDM items the first time they see a patient would reduce a lot of these issues, and avoid patients unwittingly have services provided away from their regular practice. Who judges what is clinically necessary? I would like the definition to be that leaving the consultation longer than two weeks would have adverse consequences for the patient as well, including urgent problems such as an infections.
Submitted by Jennifer Loxton (not verified)

“The Department says that it has evidence of inappropriate billing” – Medicare’s evidence in the past has been coming from an extremely low level. How would Medicare have any idea whether it’s appropriate or inappropriate? That line is just code for ‘GPS are bunnies, we need to cut the budget, we will attack GP rebates again’.
Submitted by Scott Masters (not verified)

What other profession would accept the sort of work-related distress suffered by junior doctors? Junior doctors share their reasons for work-related stress.
I think a significant stressor in the workplace is the worry that there are not enough jobs as trainees, advanced trainees and specialists. We see many of our colleagues that are in significant stress due to this.
Submitted by SA (not verified)

I’m a post-graduate medical student in my final year. Thanks for the article. I totally agree – the biggest stress for myself and a number of my colleagues is performing up to registrars’, but particularly consultants’ expectations. Sometimes I feel that we are expected to know just as much about their field as they do – and then, when we can’t answer a question at the bedside, we are berated or dismissed for not knowing. Of course, this is not my experience with all senior doctors. In fact, it occurs less [often] than my good experiences. However, these experiences are what linger in my mind, and it creates a scenario where I am actually fearful to attend some ward rounds due to the pending embarrassment I will experience. I’m an average student (by which I mean my grades are literally sitting on the average), but I think that some senior doctors have forgotten what it was like to be a medical student or junior doctor. My greatest clinical learning has come from understanding, non-threatening senior doctors who have made me feel welcome and have inspired me to work hard, rather than others who tend to inspire through fear and belittlement.
Submitted by Anonymous (not verified) 

General practitioners can now directly refer adult patients for magnetic resonant imaging of the head, neck and knee after the Federal Government signed off on recommendations from a group of medical experts. But GPs are still being denied the ability to order scans for those with lower back pain. One member shares his opinion on MRI.
“The area where it would be of greatest benefit would be in the diagnosis of lower back complaints” – This is not at all correct. In fact, MRI in low back pain is frequently misused and, not uncommonly, leads to more specialist referral, patient anxiety or further investigations due to ‘abnormal’ findings which are purely incidental.
Submitted by Peter Van Winden (not verified) 

The AMA has been given a central role in overhauling the troubled shared electronic health record scheme after President Dr Steve Hambleton was appointed by the Abbott Government to a three-member review panel. One AMA member shares his concerns about the e-health record system.
A fundamental weakness (and possibly one of the main reasons it has failed) is the ‘patient controlled’ requirement. The records are for the benefit of patients but are health records, mostly medical records, created and maintained by doctors. Medical professionals need a system of sharing information electronically that is accurate and meaningful and, where practical, approved and agreed by individual patients, but not “patient controlled”.
Submitted by Professor Ian Gough (not verified)

The health of patients will be put at risk unless the nation’s Health Ministers reverse a controversial decision to allow optometrists, nurse practitioners, midwives and other non-medical health professionals to prescribe drugs, the AMA has warned.  Several readers  voice their opinion.
An expected response, and one that is not supported by the majority of health professionals. With all due respect, Mr Hambleton, allied health professionals are professionals, just like GPs, and are quite capable of prescribing within their scope of practice, as the evidence supports. It is time for reform, and the primary goal is to benefit the general public, not the retention of a privileged position.

Submitted by John Sealy (not verified)

John Sealy, you are quite wrong. There is no point in reform for the sake of reform. Change should only occur if it will result in improved patient outcomes. Not only is evidence for this lacking, but patient outcomes will deteriorate because of the lack of detailed clinical and pharmacological expertise of allied health professionals if this change is implemented.
Congratulations to Dr Hambleton and the AMA for continuing to take a strong stand on this issue. And, by the way Mr Sealy, it is Dr Hambleton, not Mr Hambleton; he has earned that title through many years of hard work and study.
Submitted by Greg the Physician (not verified)