AMA’s turf war won’t win the war on pain

 

We didn’t need another demonstration of how out of touch the AMA is with the broader medical profession and the society they serve — but we got one any way.

In response to the proposed $20 million dollar trial for pharmacists to consult on chronic pain following the codeine crackdown, AMA president Michael Gannon angrily tweeted about “another slap in the face for GPs, the real community health experts.”

The AMA has been aggressively pushing an array of ‘progressive’ agendas (including the not so sweet sugar tax). But when it comes to demarcation disputes between GPs and other health professionals — to say nothing of long overdue real reform that could have immediate benefits for thousands of patients navigating an archaic industry — special pleading about injustice is the AMA’s stock standard response.

The real injustice is that the typical Australian over 65 has four chronic diseases to address in a 15-minute GP appointment. They are likely to receive four specialist referrals, a few management plans and then spend their time (and money) catching buses or paying for parking all over the city, visiting each doctor in their siloed practice.

Meanwhile, their chronic pain –— increased by the extra pain inflicted by the system — isn’t getting any better. However, the problem is that both GPs and patients are victims of the Medicare status quo.

GPs find the value of their time diminishing, so that it is more feasible and achievable to spend 15 minutes referring or writing a script than it is to address the myriad of symptoms and complications from chronic disease.

Given the lack of comprehensive assessments and treatment for chronic pain, and the reliance on simply handing out prescriptions, it is hardly  a surprise that the majority of deaths from the alleged opioid crisis actually come from abuse of prescribed medications.

Chronic pain is a ‘heart-sink’ diagnosis for most health professionals. We see it, we feel helpless, we don’t have the training or the time — so we attempt a quick fix and move on.

The mismatch between how medicine operates and the nature of chronic disease is the biggest health challenge of our time.

As every hospital doctor — attending daily multi-disciplinary team meetings knows — pharmacists are invaluable, and chronic diseases need a team approach. Patients in the community could receive care from a similar team of health professionals — doctors, pharmacists, physiotherapists — who could work together to provide value-based care.

In this arrangement, the team is encouraged to be responsible for the health outcomes of an individual over time and provide continuity of care for chronic disease suffers. Costly hospital avoidance and better symptom control for longer is rewarded. As such, ‘fee for service’ medicine that encourages fast episodic disjointed care could be replaced by ‘fee for patient’ medicine where the team is remunerated per person as a whole over time.

This radical concept of a team of health professionals providing value-based care over time and being more accountable for the health outcomes of a patient with chronic disease is constantly opposed by the AMA with scaremongering about the end of ‘free’ bulk-billed GP visits.

If the AMA won’t allow us to address the structural problems in the health system — and cries foul every time a new idea is proposed under the guise of ‘Mediscare’ — then enabling other health professionals to take on some of the burden should be supported.

With automated medications and e-prescribing,  doctors’ handwriting won’t need to be deciphered  and pharmacists should have more time on their hands.

Many pharmacists will surely welcome the opportunity to care for and interact with patients in line with the full scope of their training. Given their expert knowledge and the concerning rise in abuse of prescription medication, they are well placed at the coalface to start the conversation about chronic pain.

The health system is being bombarded with technological advancement at every turn; but at its core is operating the same way it did hundreds of years ago — providing hierarchical, siloed and episodic care epitomised by the GP-centric model of care that Medicare underwrites.

Yet this one small innovate step is being opposed by the so called progressive AMA on antediluvian turf war grounds.

Dr Jessica Borbasi is a medical doctor and a research associate at the Centre for Independent Studies’ Health Innovations Program.