She Still Won’t be Right, Mate
edited and published by the Psychiatrists Working Group
Rec. price: $34.95
The Bulletin’s Editor-in-chief, Max Walsh was recently asked what he thought of the possibility of a big communications corporation taking over the Fairfax media group. Walsh said that, if they did, he would give the corporate executives two weeks before they would be wishing to heaven that they were rid of it. They don’t have any idea of what it’s like to try to manage journalists, he said.
Doctors may not like being compared with journalists – or visa versa – but much the same applies to managing them.
When non-professionals tell the doctor to change his treatment or the journo to change his story in order to raise profits or cut costs, eruptions are only to be expected. Both can be dogged fighters. Both pack a punch when it comes to public relations and the capacity to articulate. Journos have their self-esteem to worry about, and the merciless response of their fellows if they are caught out.
Doctors have not only sworn the Hippocratic Oath to put patients first and give them the best treatment available, but also face possible medical negligence suits and professional deregistration.
It is well to keep such professional characteristics in mind when attempting to understand the current battles over Australia’s health care system and its nagging problems.
Government has attempted to maintain collective funding of the health system while still keeping total expenditure below nine per cent of GDP.
To pull this off, it has resorted to privatising and corporatising public hospitals, promoting private health insurance, and introducting a cost-cutting, financial management system known as Managed Care.
If you want to find out how the new US-style managerialism is affecting the health system and doctors’ capacity to treat you, then you couldn’t make a better start than by reading She Still Won’t Be Right, Mate. The book’s subtitle is ‘Will managerialism destroy values-based medicine? Your health care at risk!’
The book is the second in a series that commenced with a 1997 publication She Won’t Be Right, Mate. The series is the result of efforts by a number of leading Australian psychiatrists to raise public and professional consciousness of what is being done to Australia’s health system, and how this is affecting the quality and availability of healthcare.
The 25 contributors include prominent local and some overseas psychiatrists, but also business, law, sociology, medicine and philosophy academics – Elizabeth Adeney, Danuta Mendelson, Alec Pemberton, Paul Komesaroff, and Max Charlesworth. They also include a consultant ethicist, Nicholas Tonti-Filippini, a leading medical specialist, Dana Wainright, an investigative journalist, Bob Browning, and even a part-time comic artist and psychotherapist, Yvette Wroby.
Among the particularly telling contributions is an analysis by child psychiatrist George Halasz. Every parent would do well to note it. Halasz tackles the alarming trend to over-prescribe anti-depressants and psycho-stimulants for children.
He relates the dramatic increase in diagnoses of attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) to the new market-driven health care managerialism. He considers the extent to which these ‘epidemics’ are manufactured.
He argues that drug treatments often suppress rather than assist normal psychological development of children, sometimes with tragic results. The cheap, quick and easy way out often ends up the most expensive, especially for the child, and in ways more important than money.
Gil Anaf, a psychiatrist and Adelaide University lecturer, uses clinical case studies to bring home to readers ‘the awful reality that our community faces as the social changes herald increasing stress, decreased productivity, increased alienation and community fragmentation’.
Richard Prytula, another leading psychiatrist and Monash University lecturer, does something of a George Orwell by prising apart the Newspeak of US-style Managed Care. MC is the system that economic rationalist policy makers are forcing, by one means or another, and under one name or another, on to the Australian health system – a system people used to regard as one of the best in the world.
Prytula takes a scalpel to such new weasel words as ‘quality gateways’, ‘clinical pathways’, ‘evidence-based medicine’, ‘relative value study’, ‘value-free methodology’ and so on.
Shirley Prager is also an honorary Monash University lecturer and a child and family consulting psychiatrist. She attempts to analyse such inscrutable financial management concepts as ‘Casemix’ and ‘DRGs’ (‘Diagnostic Related Groups’). She also deconstructs the import of health insurance terms like ‘capitation’, ‘products’ and ‘contracts’.
Well-known Melbourne psychiatrist John Buchanan exposes the threat to the best-interest-of-the-patient standard of care to which traditional professionalism committed doctors.
He evaluates the implication for ethical standards of the so-called Integrated Mental Health Services Project, aka the Mental Health Demonstration Project.
All the contributions are meaty, serious and informed.
This is not just a good read, it is a necessary read for those who want to know what is being done to their health system and how they or theirs may fare in the future when they get sick.