Wednesday, 18 November 2009

What value a medical degree?

It seems that the Australians have more balls than the British, down under the Australian government is trying to force through various destructive dumbing down reforms that empower those without medical degrees to jobs that previously required much higher levels of education and training. The Chairman of the Australian Doctor's Fund is clear with his message:

"Who would subject themselves to the rigours of a medical degree when it is so much easier to obtain a nursing degree and be jumped into a medical role?

In other words Ms Roxon has to decide whether she wants doctors or nurses to be the ultimate decision maker on the care of patients. Sadly our leaders seem to be unaware of the problem or seem to think that simply by announcing it, their job is done. Sadly those driven by ideology rarely succumb to reasoned argument; backed by million dollar budgets and armies of public servants they play with their half-baked ideas and impose them on those who know better.

It is our duty and our intent to prevent these destroyers of the culture of medicine from achieving their goals. It is our duty to assert and intervene in all possible ways to make sure that a medical degree, and all the discipline required to achieve it, is given its rightful place, namely signifying leadership in medical care.

This is the model that has delivered Australians world-class medical treatment. There is no reason or compelling case to dismantle it.

When I worked in England many years ago I was appalled that there seemed no one who took personal responsibility for a patient. Let us not go down the same road here."

Ms Roxon is the Health Minister who is coming up with the half-baked ideas, the parallels to the UK are obvious, and these half-baked ideas are very much a threat to world-class medical treatment, once the dumbing down starts it is hard to stop. The Australian Government is also trying to replace GPs as the cornerstone of Australian medical practice, in a way that draws striking parallels to what the Labour government has done here in order to usher through the privatisation of the NHS. A former Australian Medical Association chief has this to say:

" If nurses want to be doctors, trained to take a history, examine, investigate, diagnose and
formulate a management plan with the depth of knowledge required for the possibility of
differential diagnoses, then they should apply to medical school…."

This quote from another big cheese shows how the Australians are trying to push through exactly the same dumbing down agenda as has been done in the UK, it matters not what education, skill or training anyone has, you can all be 'doctors'! But then what will the word doctor come to mean?

"And, interestingly, there is a push for another change – namely, that all practitioners
working in primary care, irrespective of their qualifications and expertise, be now called
“doctor”. Such a collaborative model readily brings to mind the sovietisation of health

There is a problem with bananas, this half-baked philosophy of cutting the number of properly trained staff won't even save money; it is expensive, bad for patient care but it does allow the government to push through it's privatisation schemes more easily. The NHS Skills Escalator looks like it were drawn up by a braindead slug on crack, but sadly this is a creation of our retarded overlords in government and it is being pushed through regardless of its utter stupidity.

Good luck to the Australians in resisting this destruction of their excellent health care system, it will be hard as the government have buddied up with the Australian Nursing Federation and seem determined to repeat the damage that has been done in the UK. They have established a 'National Health Workforce Agency' which may well be another prong in their attack on medical professionalism and standards.

It is sad that there are so many people out there who are too stupid to see the wood for the trees. It matters not whether people are called doctors, nurses, paramedics or monkeys. The labels to things do not matter, relabelling a useless product does not make it better. It is as simple an argument as less education and training makes for a lower quality of care. After all if the government announced plans to train doctors in about three months then I am sure everyone would be up in arms, so why do some idiots find it acceptable to convert nurses into doctors with an even shorter period of training? There isn't even any decent evidence to show that it is safe. In life you get what you pay for, less investment in training people properly will get you a poorer service, it won't magically save you money and provide as good a service.

"The Cochrane Collaboration summary on the equivalence of GP-led and nurse-led care has more disclaimers than a set of K-Tel steak knives. Most damning is the statement that these findings “should be viewed with caution given that only one study was powered to assess equivalence of care, and many studies had methodological limitations”. So, Australian policy-makers, reformers and governments beware – 50 years of general practice hard slog has resulted in international benchmarking for key health outcomes, and unsurpassed general practice patient satisfaction."
(Prof Claire Jackson, The ‘little sick/big sick’ myth of general practice, Australian Doctor, 19/10/09)


Jobbing Doctor said...

Can't fault what you say, Garth.

GrumpyRN said...

I was going to comment and then I thought f**k it, life is too short to continually go over the same ground and argue the same things over and over. I am glad I work in an area where the doctors are supportive and encouraging towards the nurse practitioner role - but then they understand it.

Garth Marenghi said...

again Grumpy RN,

this is a general point and it is not aimed at all nurse practitioners,

it is aimed at those who are empowered and who practice out of their depth in trying to a job they are not adequately educated and trained for,

the walk in centre NP who practises general practice in an unsupervised manner is the prime example of this substandard dumbing down

Nikita said...

Totally agree with all you've said.

Worrying times for doctors, nurses and especially patients who will be at the receiving end of all cost cutting exercises.

Nurse Anne said...

It's kind of silly because it is NOT the standard nursing degree that gets one into the nurse practitioner program.

The standard nursing degree is a BSc. You have to go onto get a masters if you want to be a practitioner. Is that right or am I still stuck on the Yank way of doing things?

Going for the masters and onto a practitioner role is definitely not something most nurses want to do. I am working on my masters (non healthcare). It is my ticket out of nursing not into doctorland.

Dumbing down does not save money anyway. It costs way more money in the long run because of all the fuck ups. Why isn't that the powers that be do not understand this?

Nurse Anne said...

If you are on about BSc or less Nurses going into practitioner roles I agree with you. I have a huge problem with someone of my level of education prescribing.
That should be illegal. It should be a masters program etc.

AZ said...

Hey I normally support what you have to say but -
?where are the sources for any of this
?who is saying nurses will be called "doctor"
?When did the ADF say what you quoted (and while I respect the chairman immensely, international readers should be aware that they are not exactly a major grass-roots organisation
Could you perhaps expand a little as I am seriously confused by your post.

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