YGBEHR: Conclusion - adhere to the same standards you set for others

Your Great Big Expensive Healthcare Reform: What measurable benefits will you deliver?

Part 4 of 4
Conclusions

[800 wds]

Free Speech is enshrined in Black-letter or Common Law in every Western Democracy, even in the Bill of Rights where extant.: one of our most precious Freedoms. But you don’t have the freedom to shout "Fire!" in a crowded place nor abuse anyone at anytime.

All Democracies have a tension between allowing robust conversations between citizens and silencing those whose agenda is anti-Democratic: mendacious, destructive, abusive or outright cranks and nutters. In the law, they are vexatious litigants.

 On the Internet, they’re called “Trolls”. [1] People whose sole purpose is to create mischief, turmoil and upset, not furthering debate or arriving at a consensus.

From my research for this piece, I can only conclude that FSM and their American parent, ISM, are Medical Trolls.
They mean no well, exist only to criticise, destroy and  intentional create mischief and spread dissension.

The test is quite simple: What are the positive elements of their Demands or Proposals?
None that I can make out in their published statements.

A hundred years of Flexner

Many sources describe the state of Medicine and Medical Education in the USA around the turn of the 20th Century as overcrowded, extremely poor and variable, driven by profits and dreams of riches with practitioner licenses handed out by poorly run Registration Boards via easily scammed exams. [1] [2] [3]

The US AMA was looking to properly regulate the profession and. while doing so, increase their power and influence and drive out of business competing “medical sects”.

This “cleaning of the Augean Stables” started well before 1904 and the AMA’s Council on Medical Education (CME) first proposals, pitched to, and taken up by, the Carnegie Foundation for their first report on “The Professions” in 1910.

YGBEHR: The Flexner Report – its background and relevance

Your Great Big Expensive Healthcare Reform: What measurable benefits will you deliver?

Part 3 of 4
The Flexner Report – its background and relevance

[850 wds]

Many sources describe the state of Medicine and Medical Education in the USA around the turn of the 20th Century as overcrowded, extremely poor and variable, driven by profits and dreams of riches with practitioner licenses handed out by poorly run Registration Boards via easily scammed exams. [1] [2] [3]

The US AMA was looking to properly regulate the profession and. while doing so, increase their power and influence and drive out of business competing “medical sects”.

YGBEHR: What measurable benefits will you deliver?

Your Great Big Expensive Healthcare Reform: What measurable benefits will you deliver?

Part 1 of 4
Introduction - Background and questions

[625 wds]

Government reform in healthcare is predicated on patients moving into a space that involves taking responsibility for their own treatment.

For this to properly occur, all health professionals have to engage with their patients and begin to mentor them to assist in understanding their health problems.
They must provide education and resources so that this process can occur.

To an extent this has successfully occurred, but only in the complementary and alternate medicine field, which is rapidly expanding compared to the mainstream medical model, albeit off a very low base so absolute numbers are still small.

YGBEHR: Models of real & successful healthcare improvement

Your Great Big Expensive Healthcare Reform: What measurable benefits will you deliver?

Part 2 of 4
Models of real & successful healthcare improvement

[695 wds]

After 5 years, if the ISM had a real and useful message from strong, credible people, it would be appearing everywhere. The US AMA’s site has just two references to ISM, both author affiliations in the same article. There are just 27  references to "science in medicine" on the site. Hardly noteworthy or impacting.

The US AMA has a dozen current “Advocacy topics” [1], none of which comes comes near the ISM/FSM position. They do have very clear strategies to address the most pressing healthcare problems:

Arrogance, Ignorance and Incompetence: The State of Practice in Medical Care?

A 2010 Stanford piece on "How Teaching Hospitals could lead Medicine's Metamorphosis" details their processes for improving Patient Safety, Quality Improvement and reducing costs/improving Productivity.

I was struck by a simple question about the Stanford protocols, especially in the ICU:

If they aren't the minimum standard for non-teaching hospitals everywhere, then what do they know that Stanford doesn't?

I think that, especially in ICU, there is now no excuse for hospitals anywhere not to be following, albeit with a delay, the Best Practices researched and adopted by leading teaching hospitals. Reasonable practice would be: pick just one, or two, major teaching hospitals and mirror exactly what they adopt, but delayed by 12-18 months. You get the benefit of pick others' brains and having them iron out the bugs in the protocols for you...

For any management, including the CEO, responsible for hospitals' Quality of Care and Patient Safety, isn't ignoring known, documented Best Practice either Ignorance, Negligence, or Indolence? Any of which you'd hope in an ideal world, would be cause for instant dismissal.

Ethics of End-of-Life treatment on "Lateline"

On the day I wrote about needing a public debate on Affordability and The Rights to Basic Healthcare and the Limits of End-of-Life care, ABC's Lateline news program ran a story and interview on the ethics and implications of End-of-Life care:

• National laws needed for Living Wills
• Need for review of law on 'end of life' treatment

The Ugly Truth underpinning New Age Medical Care: What price a Life?

Update: Lateline ran a story on the ethics of End-of-Life care. They stopped short of examining Affordability and Rights to Basic Healthcare.

I was reminded on the radio yesterday of the simple question, "What price a life?"

This is the fundamental underpinning of Aged Care and End-of-Life Medical Care where a huge fraction, heading to 50%, of our total taxes gets spent.

As we Baby Boomers move to retirement and needing increasing levels of Healthcare and Residential Care, this is a question that must be answered, we can't adopt a Policy of "Head in Sand", "just do the Max".

If we don't have a nation-wide debate on this, consider it explicitly, we will have bureaucrats and politicians decide it for us, implicitly. The decisions they make and inherent resulting bias and who is selected as "privileged" won't please anyone, and probably not even the favoured few.

This is real, this is near, this is important, this affects every one of us.

State of the Art is the Oregon Healthcare Plan, formed with the explicit intention of more accessible, equitable care ("effective and efficient use of public money") and rationing benefits.

I2P: The Internet Changes Everything: No more Dispensing Community Pharmacies

How many Community Pharmacies and Pharmacists will be needed for Australia in 2020?

I suspect, "Not as many as you think" because prescription sales will move on-line with lower prices and higher competition.
Australia Post will be leading a part of the Internet Shopping Revolution: physical delivery. They are providing secure "parcel lockers" accessible at any time. [1][2]

The Internet, as "bits and clicks", does browsing, shopping, payment and central fulfilment well, but the last link in the logistics chain, customer delivery, is weak. Secure, convenient, fast parcel delivery addresses this weakness. Can we assume that their courier service can access the lockers as well? [3]

I2P: Caretrack and Beyond

July saw a landmark report published on the state of Primary Care by GP's in Australia: Caretrack [1][2][3]. The Caretrack project site notes:

The editor of the MJA, Dr Annette Katelaris, has described it as the most important study published in the MJA in the last 10 years.

The reasons for the study were twofold: an earlier American study suggested only 50-60% of GP's followed known Best Practice and with the explosion in Medical technology, drugs, treatment and published research, and GP's are finding it increasingly hard to stay abreast of all current research.