Publications
Annual Conference Reports
Presidential Address
18th ASMS Annual Conference2-3 November 2006
Dr Jeff Brown
Esteemed visitors – kia ora. Distinguished guests – kia ora. Record number of delegates – welcome each and every one.
Seize power, not for its own sake, but to effect change.
That was my clarion call a year ago. How much have we achieved – as individuals, as departments, as tribes of artisans, as an organisation – in the last twelve mont
A Minister of Health followed the designs of his predecessor and blindly decided to appoint other than the top four polling candidates in elections held by the Medical Council of New Zealand. He claimed he had not been advised otherwise. Your ASMS Executive had strongly advised him in person, and he had received written advice from the Pan Professional Medical Forum, to both appoint the top four, and to regulate for binding elections in the future.
We argued that, comprised of the factotums of political favour, future Medical Councils may be mere mouthpieces for the party of the hour. No matter the quality of appointees, the perception that it may be so influenced is dangerous indeed. Once the confidence of the profession in its own regulatory body is shaken, the safety of the public cannot remain unstirred. How can patients be confident their doctors are confirmed and constrained if the licensing authority and the source of ethical evaluation is open to political favour and fancy?
Confronted with consistent consensus advice (which he labelled a rut) the Minister acquiesced to consider binding elections. The very system his own veterinary fraternity enjoys. His acknowledgement that he was wrong, that he made a mistake, was not a victory for political proselytising, but for a unified message from a unified voice representing almost all medics – the Pan Professional Medical Forum.
Under pressure to cleanse their waiting lists for specialist assessments and interventions some DHBs adopted behaviour that many found abhorrent. Rationing by stealth and subterfuge did not sit well with surgeons. Managers made derisory decisions to avoid balance sheet blowouts at month’s end. In at least one DHB demand managers were appointed to keep GPs from directly talking to hospital specialists about patients dumped from waiting lists, and to prescribe what doctors could say to doctors when espousing the managerial creed. Such appointments were denied until undeniable memos were available to media eager to confront such perverse peregrinations. Available because local SMOs raised alarms and information could be paraded in public when opportunity permitted.
Rationing. Trying to juggle the unmet need with the unfound supply. We trained to see patients, to do something for them, even if “only” to reassure that nothing serious or sharp needs to be done. To work with our colleagues to manage the entire anxious to acute spectrum of sickness. Sometimes we assumed that when a GP referred a patient to a clinic, seeing that patient was our duty. Sometimes we knew that it would take some time for that patient to be seen. Sometimes we realised that there was little chance of helping the patient unless resources changed. Today the Health & Disability Commissioner will lead a debate on the duty of care we may have to these unseen patients.
Perhaps we need to train the minimologist.
This new specialist will be expert not only in “first do no harm” but also in “first do no thing”. They will be incentivised for inaction. They will be rewarded for not seeing patients, for declining referrals, for denying tests and treatment. Therapeutic catatonia will be their measure of success. They will defy demand from the safety of distance. The minimologist will not need clinic rooms, will not need nurses or allied health professionals. Will not need task substituting assistants. They may be the future shape of the medical workforce that George Salmond will be discussing – the sort of doctors should NZ be training. With broadband and a fax they will work from afar, will work across DHB boundaries, will not need car parks or bicycle sheds.
Stop. I submit that when rationing is not acknowledged, the fabric of the health system unravels. Inability to deliver care frustrates and forces the fine and the fantastic away from a public hospital system, to private or overseas practice. We begin to stare at a future funding the refuge of the deranged or the dodgy.
And under such pressure behaviours can go badly wrong. Good doctors, just like good managers, can be the harshest critics of their peers. The worst at supporting ourselves when the mental stretch marks of tiredness threaten to trip us, our teams, and the patients we focus on. With the Cognitive Institute later today we will consider doctors behaving badly, and how they can be helped. Because, of course, it is never us, only someone we know.
We decided to address this issue at Annual Conference because we cannot expect DHBs to naturally take a paramount interest in the welfare of doctors, nor can we ask the patients we serve to consider our wellbeing while we manage theirs. We need to look after ourselves. If the organisations you work for are not supporting and guiding you, ensuring your sustenance and minimising obstacles to your valuable work, your union can fight for you, but only as much as you demand and permit it.
Your national office now has seven full-time staff who have individually and together achieved outstanding service. For over 2760 members they run a lean (but not mean) machinery of advice, advocacy, administration and activism. Please individually acknowledge Ian, Angela, Henry, Yvonne, Jeff, Kathy, and Barbara.
Please also thank your National Executive who have governed your national office, have formed the core of the negotiating team for the MECA, and have led the strengthening of branches through Joint Consultative Committees. And particularly thank the efforts of your Vice President David Jones and National Secretary Brian Craig.
I encourage you to continue to challenge your Executive and national office. To tell us what we are doing well, what we can improve, and how we might improve.
Especially as we deliberate over the next two days on the impasse in our MECA negotiations. These negotiations have confirmed a significant regression towards the culture of managerialism, of bosses telling workers what to do. Of attempts to claw back the advances towards shared governance and clinical leadership we have achieved in many partnerships where regional, sub-regional, hospital and community based initiatives are driven by best outcomes for patients, not balance sheets. For long term outcomes, not short term outputs.
They have also redefined the meaning of words, of “final” and “not budging”, of “bargaining” and even “negotiation” itself. And shown a smoke and mirrors approach to accountancy that defies logic, including costing one segment out to sixteen years as an argument against it. Faced with such intransigence and myopic muddling, your negotiating team has recommended resolutions for your debate. This Conference will determine the form and force of action that ASMS must embark on to preserve a public hospital workforce that is valued by the community, supported by health officials, planned for by educational institutes and paid to the level that attracts and retains the best.
As we contemplate the ambit of possible actions I recall the angst, anger and anxiety generated when resident medical officers went on strike earlier this year. It is hard to recall a more challenging time for ASMS and for me as your President. To represent your diverse views which ranged to all ends of the rainbows of ethical, industrial, financial, collegial and professional behaviour. My media performance may not have satisfied each and every one of you. Your national office may not have expressed your personal persuasions. Together we tried to tread a delicate and deliberated middle ground.
Imagine how much more challenging it will be to achieve consensus with representation when we contemplate our own possible options. Opinions already expressed vary from accepting anything the DHBs offer or claw back (and how dare we do otherwise in a climate of fiscal constraint) through to demanding with every joule of industrial muscle the equivalent of Australian remuneration. Somewhere between these extremes must lie a pragmatic position. You as delegates from your workplaces need to decide our possible paths.
Action and favourable outcome will only be possible if we support ourselves. If we own our own behaviours. And if we hold our resolve when the time turns to implementation. The task of turning the words into action. The task of leadership.
We must, each and every one of us, demand of ourselves and of those around us the leadership of our workplace. In conjunction with the good managers who have the patient at heart, who have earned by their actions the trust of health professionals. Demand leadership by those who know the entanglement with the patient – physical, emotional, ethical – that enriches and enhances the doctor-patient relationship on the shared path to healing. Demand leadership by those who treasure the strands of connectedness with the luminous layers of professional responsibility that keep the system alive at all hours of day and night. Demand leadership by those who see strength in the gossamer threads that link skills, knowledge, apprenticeship, experience, wisdom and respect.
All the doctors who ascend the ladder by the evaluation and elevation of their peers, not by clawing or licking their way up each rung.
And all the well behaved doctors with whom you and I are privileged to share the next two days.
Kia kaha.
Jeff Brown
NATIONAL PRESIDENT