Sunday, 17 July 2011

The GP Story

Doctor Visit

Doctor's visit for the toddler: paid $72, got $36 back from Medicare. So much for public health.
I tweeted the above on Thursday. It was picked up by Leslie Cannold (aka the best person on Twitter); after she retweeted it I received many replies asking me in one way or another why I did not go to a bulk billing doctor. One particular reply noted that GPs cannot be expected to survive on government Medicare rates.
Given the subject’s popularity, I thought I’d use this post to explain my position on the matter. Writing here allows for more breadth and depth than Twitter does, even if this post won’t be read by a tenth of the people who follow Leslie Cannold’s tweets.

First and foremost, I think bulk billing – that is, the ability to go and see a doctor without paying them anything – is important. It’s important for financial reasons because many of us can’t afford seeing a doctor. It’s important for social reasons because we usually need to see a doctor in times of trouble, and being hit a financial blow aside of the health problem only makes things worse. And it’s important for pure health reasons, because the child whose sick but her parents can’t afford to take her to the doctor would pass her disease over to my son (and make me lose productive days at work while at it).
A healthy society needs free and easily available health services, amongst which a visit to the GP is probably the most commonly used service.

This ideal scenario doesn’t manifest itself in contemporary Australia. As someone who calls Australia home for less than a decade I can actually see things deteriorating not very gradually over the years. It starts with the obvious fact that bulk billing doctors are becoming an extinct species rather rapidly.
Have you tried seeing a bulk billing doctor lately? There are exceptions, but in general I have found the contemporary bulk billed visit rather scary. It does not feel like you're visiting a doctor; it's more like a production line at an abattoir. The doctors cannot afford to spend too much time on you, so it all starts and ends in two minutes; during those two minutes the doctor will hardly examine the subject, not to mention paying too much attention to trivial matters such as patient history or visit documentation for the sake of future visits. Thank you very much, but given this reality I prefer to pay and see a proper doctor.
I mentioned exception. Those tend to come in the shape of clinics that only bulk bill children, which is great by me given that the toddler of our household is the frequent flier when it comes to doctor services. We even have such a clinic near us, but here's the rub: in our experience, we were able to have a doctor of theirs see us on the same day only on 1 of 5 attempts. On the other four we go to a non bulk billing doctor.
The issue of not being able to see a bulk billing doctor on the same day is not something that troubles us on emergencies only. The reality of the common Australian workplace dictates that a parent staying home to look after a sick child has to provide a carer's note signed by a doctor (unlike normal sick leave, which does not always require a doctor's certificate). Doctors are pretty reluctant to provide retrospective certificates, therefore putting the parent between a rock and a hard place: either pay for the doctor that same day or risk issues with work. I choose the former.
The point of my personal doctor story is simple. The problem with bulk billing is not only the result of a government that doesn't want to spend money on personal health. There are social problems all around, from the shortage of doctors that comes with the high cost of studying and the sheer hardship of qualifying to become a doctor, to issues at the very core of the Australian work culture. In the mean time, we spend thousands a year so our toddler can see a doctor all the while politicians act as if Australia has a public health system.

Image by Laura4Smith, Creative Commons license

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