Technology advancement – not always the panacea for making your life easier
BY DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS
I hope all have had a splendid and refreshing break with family and friends. 2018 is set to be a busy year around the nation related to industrial relations. Victoria has just settled its Enterprise Bargaining Agreement under extenuating circumstances, but which has exacted an unbelievable cost which will soon be widely discussed, akin to what transpired some years ago in the upper echelons of Victoria Police. For those continuing with their jurisdictional discussions, my strong advice is to develop a strategy and adhere to it.
Beyond pure, old-fashioned industrial relations, there is to be a Senate inquiry related to the emergence of new technologies in Australia, and their impact on the future of both work and on workers (it reports in June). The AMA is making a submission and your CPHD will be working to consider how we can minimise perverse outcomes arising from rapid change.
You may recall the early prediction that the introduction of a computer-based, ‘paperless’, office would cause a conundrum for society: how would it manage a consequent huge increase in a workers’ available leisure time. I observe that this was staggeringly inaccurate. Instead, an explosion of intra/inter-organisational communication occurred, along with profoundly new work methods, which then created significant additional workload and response pressures, not to mention more paper.
Medical practice is not immune from such implications, but we can prepare to ensure both quality patient care and professional sustainability. To preserve our well-established (and evidence-based) norms, we must establish significant ownership over such mooted technological change. This will enable us to guarantee that patients, and thus the community, will benefit from effective and efficient implementation / integration of technologies, and will ensure medicine remains a safe, attractive and useful career. Like all workers, we too seek job satisfaction and security; reasonable work time commitment; observing good effects arising from our work; having clear purpose when at work; having opportunity for professional growth; having a family and recreation time and receiving a fair day’s work for a fair day’s pay.
So, what might be the effect of revolutionary technology, including artificial intelligence, for us in the public hospital setting? We are already observing a US model of care outsourcing radiology/medical imaging reporting and analysis all the way to India (teleradiologists). That’s perhaps all very well superficially, but what about: the de-skilling impacts locally; quality assurance; uncertain medico-legal liabilities where there is further intervention underpinned by reporting error; and consideration of the patient being properly served when off-shore analysis might not have access to all pertinent records and information?
There is also another more sinister side to this. In our domestic public hospital context, AMA has already had some industrial experience of representing radiologists who, while rostered On-Call but in fact basically through incremental hospital request over time, have ended up working from home as if on duty, all thanks to current IT capabilities. Home computers (and employer installed equipment) have made activity possible that was previously only ‘in the hospital’. This makes it easy for many of us to fall into the trap of never being away from our work. There is incentive for an employer to increase their expectations on us while we are left with our vocational challenge of being unable to stop serving our patients.
Concerns about exploitation and fatigue management are very real, but also our existing payment compensation entitlement framework about On-Call, Recall or overtime have not been design to accommodate such new ways of “doing things” now enabled through use of new technology. This is an indication that we need to stay on our toes to prevent unfair and unpaid (over)work direction. Remuneration and rostering methods for our enlarged workforce will need modernisation to account for our anticipated expanded work value contributions and requirements.
Medicine and medical practice has always evolved with the expansion of scientific knowledge, and its translation to medical care. In the modern environment of rapid advancement and transformation, the frequency, pace and unpredictability of the consequences of change will likely increase, yet be of a different character to previously experienced adjustment processes. Managing the integration of new technology/artificial intelligence is a new challenge. Technology necessarily changes behaviour, which brings with it a new set of requirements to coordinate new systems of work. We want to guarantee effective communication between us, apply the new technology, and manage the implications for our teams and hospital administration. Employers will need to work with us with early respectful dialogue to ensure there is careful introduction of the new ways of doing things; this so that patient care is not undermined and we are appropriately rewarded.
For CPHD, the challenges we face in response appear to be about ensuring employment rules keep pace and useful new technology/artificial intelligence are effectively implemented/integrated. Both of these fundamentally relate to us being enabled to maintain the high standards of presently enjoyed patient care.