From the medical editor

Dr Roger Sexton

Health is a battlefield.

Over the past few years, the health sector has experienced more examples of competitive inter-professional behaviour, such as with pharmacy, nursing and other allied health providers. The discourse has not always been flattering. It erodes trust and appears to our patients as self-interested. It may also contribute to suboptimal health care.

The argument for increased scope and autonomy usually centres on the presence of a clinical service vacuum created by over-burdened medical professionals who ‘need help’ because the community’s expectations for timely, convenient access to a doctor are not being met. Other health professionals sense an opportunity and step in to respond. The public respond positively, in the setting of a cashless society attuned to the Uber-eats model and expectations of immediacy and convenience.

But the public should be concerned about the (possibly) cocky and (probably) naïve health professional who may assume their undergraduate and post-graduate training gives them transferable ‘medical’ skills of a standard approximating that of their medically trained colleagues. But the equivalency of these other health professionals’ examination skills, pattern recognition, differential diagnosis, prescribing, special test ordering and interpretation should not be accepted without question. Trials of extended scope practice may have had a pre-determined outcome and may have been too readily accepted by politicians and the public as evidence of safe practice. The proposed pharmacy prescribing of the oral contraceptive, for example, warrants robust and independent scrutiny.

With patient safety at the heart of this, the statutory obligations of Ahpra and the relevant professional board to protect the public firmly sit in this space.

You will be aware of the trend in clinical product advertising that now proclaims, ‘If pain persists, see your health professional’. The public may have come to believe that diagnostic equivalency with a doctor is indeed true. Home delivery, Amazon, telehealth services, Dr Google, entrepreneurial internet-based ‘medical’ services and self-diagnostic online tools have all altered the health access landscape, too.

Other health professions seeking to increase scope of practice are responding to a need that we have not always been able to meet. We must acknowledge this and that time, case complexity and volume and infrastructure limitations in medical practice have contributed to this.

Meanwhile, the gap in service provision has become the perfect stepping-stone for others to progress their career, scope and business ambitions. The message here must be to tread very carefully’. With scope comes responsibility, accountability and high cost ‘med-mal’ insurance.

We must advocate for our own profession to develop its scope and capacity to meet patients’ needs. General practice has huge potential to do so but has been constrained by chronic bipartisan disinvestment in the sector. The opportunity exists to lead and engage more closely with other health professionals with enhanced scope within general practice. We can ‘grow the pie’ through innovation, solving patient health problems in a timely way and addressing health system problems such as ramping. This will drive a reallocation of resources to where they have the most impact.

Doctors who are life-long learners and work to and within scope are more satisfied professionally. As teachers, doctors can all contribute to improving the scope of practice of the others in our team without competition and work cooperatively with external health professionals for the benefit of patients.

Imagine where IT, remote monitoring, personalised medicine, overnight stay general practices, outreach home care, preventive health care can take us and what expanded roles are needed to achieve this. ‘Growing the pie’ increases everyone’s share through enhanced scope of practice, remuneration, capacity building, status, impact and influence. We solve more problems, improve our service to our patients, and secure the future of our profession.