Today is the beginning of my three-week stint in Chinchilla, a town of 3500 people 90 kilometers west of Dalby and 300 kilometers from Brisbane. I will spend all of my time with the local GPs and hopefully get a taste of what being a rural GP is like.
The practice consists of three principal GPs, one junior partner, and one registrar (the equivalent of a hospital-based resident). I will spend one week with each principal GP. With most people that go to these GPs being private patients, I know I won't be able to do too much hands-on stuff as I was able to with public patients in Dalby Hospital. Instead, I'll spend a lot of my time sitting in on consults and mostly watch.
In between consults, the GP I'm following this week enlightens me on the health care set up in Chinchilla. There is a public hospital, but it's entirely run by nurses because it has no doctors. The five of them, all private GPs, are the only doctors in town. So, they have been contracted by Queensland Health to provide public health care at the hospital. Besides running their own practices, they run outpatient clinics at the hospital three afternoons per week, provide public in-patient service, and can also admit their own private patients. Now, if that doesn't raise a giant Conflict-of-Interest flag, I don't know what does - they are competing against themselves!
I'm told that, in order to encourage people to buy private health insurance, the doctors here have to provide different levels of service between their private practices and the hospital, namely an inferior service at the hospital. The main disadvantages for public patients that go to the outpatient clinic at the hospital are: they don't have a choice of doctors, and the length of consults would be shorter. The first one is fair enough - that's how the public system works: you get whichever doctor is available. But the shorter consult would directly translate into inferior service, which would have to be noticeably worse than private care for patients to want to get private insurance, otherwise everyone would just become pubic patients!
It's understandable that private GPs in a small town wouldn't want too many patients to use the public system - it means they would have fewer private patients. So I can see why they do it. I just can't get over how the same doctors can deliberately provide two levels of service. If I were put into the same situation, could I follow suit and do the same thing? What would I do to balance my professional and personal interest against the interest of the public? Regardless of how I feel now, I know that at the end, pragmatism will win the day; my idealism will just have to try not to get snuffed.
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3 comments:
I´ve read the whole story, and it seems a littel bit like a combination of "er" and reality;-interesting ans tempting in the same time...
it's too bad that i don't know the precise meaning of "GP",maybe just a practitioner?
i think in China,people still like to go the public hospital rather than the private hospital ,people think the public hospitals are more efficient with better doctors and advanced equipment.but you can choose the doctor which one you want. The consult time for outpatients is very short too, imagining that a doctor need to serve for 50 patients from 8am to 11:30am^^^^^
GP stands for general practitioner. In Australia, people normally see their GPs first when they get sick (unless it's an emergency, in which case they go to the emergency department of their local hospital). If they need to see specialists, they need GPs to give them a referral.
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