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Letters to the Editor editor@mforum.com.au
Mandatory rorting? Dear Editor In reply to Dr Sara Bird’s article (The Mental Health of Doctors, May edition), her comments appear reasonable at face value in a perfect world, but there are practical undercurrents not addressed in her article. She is assuming all employees in health services are honest and upright citizens, but research has shown that 1% of individuals in the workplace are sociopaths. Cognitive or unconscious bias is also a disruptive feature in the workplace and most of us, if we care to reflect on our careers, know of at least one individual we would wish to avoid. Framing of Mandatory Reporting legislation does not address the ever present potential for mischievous and vexatious complaints, and it is naive to leave such flaws in the legislation open ended, to the complainants discretion. Complainant fidelity in accusations and allegations made against medical practitioners is a joke, and must never be assumed. There must be stricter procedures incorporated in the regulations to prevent manipulation of the system, because of some initial perceived fault by a medical practitioner, and a backup mechanism that ensures steps in due process are strictly followed in a subsequent investigation. Qualified privilege should be suspended if this does not occur. Deliberate attempts to unjustly accuse a medical practitioner must be treated harshly to discourage this practice. The phrases “in good faith” and “to the best of my knowledge” place the accused medical practitioner in a precarious position, as it will lead to preliminary suspension and possible termination of their employment. I would like to see “the following factual evidence” and “the patient’s clinical outcomes” inserted into the legislation in its place. Anything less than this has the potential to lead to injustice. We all know that the written law can be an ass on occasions. Dr Michael Marsh, Floreat
A stitch in time Dear Editor There is now unquestionable evidence that the first three years of life are vital for healthy brain development for learning, health and behaviour (Kids Miss Crucial Health Checks, May edition). In
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addition to established preventive measures it is clear that when there are concerns about developmental progress, early identification and intervention provides the best opportunity for a favourable outcome. Developmental surveillance in these early years is important and has been available in WA with an excellent service for many decades. However, with population increases not matched by staff increments in community and Child Health nursing, rationalisation has overridden professional priorities and some appropriate ‘health checks’ have been eliminated from the former schedule. In particular, the 18 month developmental screen has been omitted in favour of attention to earlier ages. This is a time when language development, symbolic play and increased problem solving are important to confirm – and if not emerging, an important time for further assessment and early intervention. Another concern is wait lists for appropriate further assessment and therapy, both in the public and private systems, and despite some recent improvements in services to Child Development Centres following some extra funding. However, there has been no significant increase in Child Health nursing – and insufficient ‘marketing’ to encourage young parents to attend for continued developmental surveillance for every child – when what is appropriate cannot be provided. It is known that $1 spent in the early years saves at least $17 spent in remediation subsequently. For the wellbeing of children now and for better outcomes for future society we need governments to adjust their priorities. Dr Trevor Parry, Paediatrician
Racism a two-way street Dear Editor Yes, Prof Stanley, racism is indeed a key issue (Research Explores Aboriginal Health Failures, March edition) – being called a ‘f*** white c*** ‘ is not acceptable especially when someone in Derbarl Yerrigan administration attempts to lightly dismiss it as part of my induction to Aboriginal health. Abuse of staff is rife within Indigenous health services. Having done a poster presentation at the RACGP Conference of 2008 I was stunned by the number of colleagues and ancillary health workers who wished to discuss how deeply traumatised they were by the experience of working in Aboriginal health. These staff were from all over Australia and stated they would never again work in Indigenous health.
Because of infighting within the Indigenous community and the tendency to lash out indiscriminately when a request is not acted upon in the manner the client desires, hundreds of thousands of dollars are being spent on security at our three metropolitan branches of Derbarl Yerrigan Health Service (DYHS) to try and stop staff being abused and attacked and to separate feuding clients. I have been informed that not a single local medical graduate now works in DYHS and they are paying huge sums for locums. If you lack accountability you are doomed to failure – for this reason the ‘merry go round’ continues with eight new CEOs at DYHS over the past few years and an ongoing inability to recruit and maintain staff. Hopefully, the answers as to why the major Metropolitan Indigenous Health Service is such a dysfunctional workplace will be within Prof Stanley’s research outcome report. Dr Julie Copeman, Malaga Ed. Dr Copeman demonstrates how racism impacts on people, whoever the protagonist. We understand she has a long-standing dispute with Derbarl Yerrigan - their spokesperson declined to respond. See p22 for a perspective on cultural competency training.
Indigenous Superclinics? Dear Editor I am fascinated by the intermittent political hype about so-called Superclinics. As far as I can see, these appear to be clinics containing a team of GPs and allied health workers, all under one roof, bulk billing patients for their services. Kind of like a shopping centre. Somehow this is supposed to transmute itself into magical great health for all the patients of such a service. I don’t know why the political movers and shakers think this is such a new idea. The Derbarl Yerrigan Health Service [formerly the Perth Aboriginal Medical Service] has provided exactly this type of one stop health shop since 1973, expanding and modernising its services along the way. Patients can obtain everything from dental care (the first five to arrive in the morning and prepared to wait) to medications dispensed on site, audiology, podiatry and a fantastic little treatment room and acute care facility. Not to mention a recall system that involves support from a team of dedicated Aboriginal Health Workers – all much needed, overstretched like the rest of us, and in constant demand. However, if facilities like this produce the results, surely our Indigenous population should be the healthiest in Australia?
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