Doctor and activist
02/04/2020
2 April 2020 This is now a current question because of a French trial. When a new disease comes there is a rush to test existing substances to see if they work. When AIDS arrived, many drugs were tested. One drug, acyclovir was found to help. Acyclovir had been developed as an anti-leukaemia drug but […]
07/11/2019
7 November 2019
I have some experience in this area, though I would not seek to overstate it.
In 1985 I won a public service fellowship to look at workplace absence and I looked at the evidence of whether drug testing in the workplace worked. The main place it was suggested was at pre-employment medicals. The idea was that if you tested them and they were OK, they could have the job. It was a pretty silly idea as only a really serious addict would come to job medical interview with drugs on board so the pick up rate was low, the costs high, and the impression on the workers quite negative.
Later in my OHS job a worker was sent in for a medical as he was said to be using hard drugs in the portable toilet (thunderbox). He was taunting and arrogant, saying that I could not prove anything, and could not do anything as he would not give permission for the test. He was right of course, but he soon proved his accusers right as well by falling out the door of the thunderbox with a needle stuck in his arm.
When I worked in private OHS, the NSW State government saved money by sending people on parole to be drug urine tested on Medicare by local GPs. I was stuck with it in our practice which was one of the few that still agreed to do the testing. A man came in, angry and abusive, demanding immediate service, which he was granted to stop him terrorising the waiting room. He brought in a jar of very cold urine for testing. I said that I wanted a fresh specimen, gave him a jar and pointed to the toilet, ten paces away. He left to ‘get a new specimen’ and came back some time later. I said that I wanted to see him pass it, so he pulled his undies down saying, ‘There it is, are you happy now?’ No I wasn’t, as he had another small vial of urine in his hand as he held his undies. ‘You are a hard bastard’, he said as he eventually passed the urine, which unsurprisingly showed he was still using narcotics. The Parole people were pleased. They said, ‘We knew he was using but could not get a GP to get us a specimen’. I was not surprised that GPs were reluctant. At $15.20 for a Medicare visit that involved a terrified waiting room, half an hour of time, a threat to have your head punched in and the disruption of a whole afternoon for a whole medial practice, I told them that we were not going to continue testing either. Presumably he went back to gaol, and one might wonder how much good that did.
My next encounter was a female friend who had been very traumatised by a previous serious rape attempt that she had fought off. She was going through Central Station on her way to work, when a sniffer dog made the Police insist on searching her bag and ‘patting her down’. She had an empty plastic bag in her handbag that she had had a small amount of marijuana in some weeks before. But she was very traumatised by the experience because of the memories that were stirred and by the idea that she could not even walk around without people assuming that they had the right to touch her body.
The NSW Government will not allow pill testing at concerts, but wants to try to stop the drugs entering. Presumably there is a risk that younger people will bring them in if they are exempt from searches. Where will this end? Body cavity searches? MRIs outside concerts?
Prohibition will generally not work in the workplace, let alone the rock concerts. We need harm minimisation policies. This is not easy and it is not perfect, but it is better than prohibition.
Here is the NSW story in the NY Times, presumably with the unstated subheading, ‘Look what these mad Australians are doing now.’
www.nytimes.com/2019/11/06/world/australia/strip-search-children-drugs.html
20/10/2019
20 October 2019 When I was in Parliament, 4 things happened in quite rapid succession. I was part of an inquiry into prisons and a Dept of Corrections psychiatrist who attended court to question accused people told the committee that it was much easier to get into Prison than the mental health system and that […]
03/10/2019
3 October 2019 Governments say that they want to fund research, but think that they are very clever if they can do it ‘in cooperation with the private sector’. They think that they will save money and get some inside running to a share of profits. Mostly they are played for mugs. The private sector […]
25/07/2018
25 July 2017 It is good to have a health record available for a complicated case. It saves doctors a lot of time. When Records started to be computerised in the early 1980s the people at North Shore Hospital where I worked had a working party. I offered to help, but they said that they […]
11/10/2017
11 October 2017 It is getting harder to trust people. Once we trusted our teachers, our doctors, our bank managers and our politicians to lead us. And people trusted that people could do their jobs. But we became obsessed with competition instead of cooperation. Everything had to make money. Everything was a commodity. It was […]
28/09/2017
28 September 2017 People who see the world from a very narrow perspective generally get it wrong, however clever they are in their own specialty. If the only problem in health were smoking, perhaps vaping could be justified. But the realities of money and marketing is that a whole industry will try to get the […]
01/07/2017
1 July 2017 I have grave fears for this system. I am unsure even of the goodwill of some of its advocates. I was on the Social Issues Committee of the NSW Parliament and we looked at Disability services and the way that these were delivered. Basically if you ask how big the disability problem […]
26/11/2016
26 November 2016 Power, Injury and Awards. I work in medicine, treating mostly third party motor vehicle injuries and workers compensation injuries. There are much fewer of the latter because there are less employees. Many people working as couriers are ‘self employed’ contractors. One man had to pay $75,000 for the right to deliver parcels […]
11/09/2016
CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.
The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).
The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.
All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.
Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.
I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.
For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.
www.smh.com.au/business/workplace/green-slip-reforms-will-leave-most-motorists-to-fend-for-themselves-20160905-gr8zca.html