Speak out!

I like North Stradbroke Island. Under the smoke of Brisbane lies this beautiful island with a lovely rural feel to it. At Straddie you can also swim with dolphins. My kids love it.

During our last camping trip, just as the children had come out of the water after a beautiful close-encounter with a dolphin, four women marched on to the beach, the leader of the pack carrying a bucket full of fish. They walked straight past the please-do-not-feed-the-dolphins sign, into the water, and began to draw the attention of the dolphins.

My children were watching, initially surprised. “Dad, what are they doing?”

“It looks like they’re hoping the dolphins will come.”

“But dad, they are not allowed to feed the dolphins!” My son became angry and suggested to kick the bucket over which was standing on the beach behind the women. Then the dolphins came. Followed by the spectators.

“Dad, tell them to stop!” This was the point where the situation became tricky.

While I was thinking of the social psychology experiments by Latane and Darley about the innocent bystander effect (the probability of help is inversely related to the number of bystanders) and Milgram (participants administered electric shocks without protesting), I realised that I needed to act soon to save the dolphins and my reputation as responsible parent.

But instead I said: “Ok kids, let’s go.” I started to pack our gear and walked back to the car, feeling really bad and trying to find excuses; it wasn’t my job after all to look after these dolphins and besides, feeding them a few fish more or less wouldn’t matter anyway.

In the meantime a crowd of about thirty people had gathered around.

While I opened the trunk of the car, I noticed the sign. It wasn’t one of those ‘Don’t feed the animals’ warning signs you see in the zoo; this was a friendly educational post with pictures and background information. It said that feeding dolphins changes their normal wild behaviour and turns them into beggars – which puts them at risk. This made a lot of sense of course, but it also triggered something inside of me.

“Maybe I should say something,” I said. This was received with a cheerful “Yes daddy!” by my kids, who suddenly saw a glimmer of hope: maybe dad wasn’t a typical scared grownup person after all!

Fuelled by a sense of righteousness I walked towards the group. But, as I passed the bucket, I noticed it was empty. A little voice in my head said: “You see, what’s the point? The damage is already done. You’re too late,” but as I looked over my shoulder I saw my children watching in the distance, jumping up and down with excitement. There was no way back.

With a loud voice I informed the group that their actions were illegal and that they could be fined, pointing out the big sign. The responses were quite interesting: some people immediately walked out of the water, a few in the direction of the sign. Others – with the bait still in their hands – looked at each other, unsure what to do next. Some chose to ignore my clearly unwelcome message.

On the way back to the camp my action was abundantly celebrated on the back seat. I realised that it had been a close call. A quote from Pam Brown crossed my mind: “Dads are most ordinary men turned by love into heroes, adventurers, story-tellers, and singers of songs.”

Why doctors should work closer with patient organisations

Historically, campaigns against bad government health policies have been predominantly doctor-centric. And the usual government response is to divide doctors and patient organisations.

Many politicians have mastered playing the ‘greedy doctor’ card, which is an effective way of making doctors’ objections seem less trustworthy.

A while back, I interviewed the influential patient advocate Jen Morris for my blog. Ms Morris is a researcher in healthcare quality and safety at the University of Melbourne.

Patient–doctor alliance

We spoke about the untapped power of the patient–doctor alliance. She strongly feels that we can achieve so much more in Canberra if patients and doctors joined forces more often.

“At a strategic level, it’s a numbers game,” she said. “There are approximately 26,000 GPs in Australia, and about 82,000 registered medical practitioners. But there are over 23 million patients. That is an enormous bloc of voters and lobbyists to leave untapped.”

The RACGP’s ‘You’ve been targeted’ campaign earlier this year against the co-pay plan was an example of what happens if patients stand united with GPs to protect primary care. The Consumers Health Forum of Australia (CHF) issued a joint press release with the RACGP and the Australasian College for Emergency Medicine to reject the co-payment scheme. The RACGP’s change.org online petition had obtained 44,800 signatures within a week.

Other organisations including the AMA followed suit. The broad approach seemed to have an impact, first in the media and eventually in the corridors of power, and GP co-payment and extended level A consultations were dropped.

More recently, the RACGP, the Royal Australasian College of Physicians, and the CHF partnered in a joint submission to the Federal Health Minister regarding the deregulation of pharmacy locations and ownership.

Concerns

Although these are great developments, there are also concerns. What if our goals are in opposition?

Take for example the PCEHR. Patient organisations want full control of the data, which makes it less useful as a clinical tool for doctors.

Understandably, there is scepticism from both sides. Patient organisations may be wary of working with powerful medical organisations setting the agenda. Patients may feel that doctors are not genuinely interested in their opinions. Doctors on the other hand may be concerned about increasing demands and consumerism.

Morris: “It is important to remember that disagreement doesn’t only pose an obstacle in ‘patients and providers’ scenarios. Neither patients nor providers are homogeneous groups, and we do well to remember that. It is worth asking how providers approach the problem when they disagree on an issue or project, and source lessons from that.”

So, the answer lies in building trusting relationships. GPs are good at this on an individual level. It is one of the strengths of general practice. We should be doing the same at an organisational level. Working closely with patient organisations will improve the mutual understanding of our values and beliefs.

According to Ms Morris, we should be looking for common ground. More often than we acknowledge, patients and doctors are really advocating for the same outcomes. But too often, she added, we don’t take the time to really analyse where the crux of disagreement actually lies. Morris: “(…) if we find that the aims of doctors and patient organisations are so distinct as to be deemed incompatible, we should be re-evaluating those aims urgently.”

‘Them and us’

Of course, the ‘them and us’ thinking also occurs between providers. This can be confusing for patients and third parties including government organisations. For that reason, I’m a great believer in the power of United General Practice Australia. It is made up of the main GP groups, including the colleges, the rural groups, the AMA, registrars and supervisors and the divisions network. These organisations have shown a desire to collaborate and put aside their differences.

A similar structural working relationship should be developed between doctors and patient organisations. This alliance should exist not just to respond to new developments, but also to proactively set out a future course and lobby governments accordingly. It would make primary care less vulnerable to the rapidly changing preferences and priorities of the government of the day.

It is good to see the willingness from both sides to work together, and I hope it is the beginning of a fruitful collaboration in years to come. We must harness the potential power of the patient–doctor alliance to protect what’s good and, where needed, improve the care for our patients.

This article was originally published in Australian Doctor Magazine.

Why the ‘You’ve been targeted’ campaign against the co-payment was so successful

“We don’t have to engage in grand, heroic actions to participate in the process of change. Small acts, when multiplied by millions of people, can transform the world.” ~ Howard Zinn

Not many people know that the main message of one of the most successful campaigns of the Royal Australian College of General Practitioners (RACGP) against government policy was largely inspired by one patient.

At the height of all the commotion about the co-payments, patient advocate Ms Jen Morris posted a message on Twitter suggesting a different response to the government proposals: Instead of focusing the campaign on doctors, she said, we should be focusing on the consequences of the policy for patients.

We’re sorry

I used her simple but powerful message in a leaflet (see image). It said:

We’re sorry to hear your rebate will be slashed. (…) It’s not that we haven’t tried, but the Government doesn’t seem to listen to GPs. They may listen to you.”

We are sorry
The original design inspired by Ms Jen Morris.

Not long after I posted it on my blog and social media channels, the RACGP President contacted me. He wanted to include the message in a national campaign. I thought it was great that the RACGP was using social media and that they took notice of what was being said. Not long after, the You’ve been targeted campaign was unleashed by the college. The message was similar to the original, inspired by Jen Morris:

“Your rebate from Medicare will be CUT (…). We have been vocal with Government but it’s falling on deaf ears. They haven’t listened to us but they will listen to you.”

The RACGP had listened to patients and many of their members who wanted a patient-focused campaign. The You’ve been targeted approach showed that every GP surgery in Australia can be turned into a grassroots campaign office if necessary. After other groups, including the Consumers Health Forum and the AMA, increased pressure on the government, the co-payment plan was dropped.

I spoke to Ms Jen Morris and RACGP President Dr Frank Jones about the role of patient input, the use of social media and what we can learn from the remarkable campaign – as there is still a lot of work to do (for example to reverse the freeze on indexation of Medicare rebates)

A pay cut for wealthy doctors?

Morris: “I opposed the co-payment, but was concerned that the original approach adopted by doctors’ organisations misjudged the public’s values, as well as public perceptions of doctors’ wealth and social position. In the initial stages of the campaign against the proposed co-payment, doctors’ organisations, and thus media coverage, were framing it as a pay cut for doctors.”

“Misframing the situation like this made it harder for those of us opposing the changes to explain the various proposals, including Medicare rebate freezes, in a way which the public could understand. It also made it easier for the public to write the problem off as not their concern, but rather a pseudo ‘workplace relations’ issue between doctors and Medicare.”

“At the time, the public were reeling from a budget widely touted as disproportionately impacting the most vulnerable and disadvantaged people. In a social context of widespread public perception that doctors of all stripes are wealthy. So there was little public sympathy when the doctors’ lobby cried foul because the government was trying to ‘cut their pay’. There was a sense that as well-off professionals, GPs should take their fair share of the fiscal blows and ‘cop it on the chin’.”

“The government played perfectly into the combination of these two problems. By later touting the co-payment as ‘optional’, they painted GPs who chose to charge it as opting to squeeze patients rather than take a pay cut.”

‘Extremely poor policy’

Jones: “The RACGP repeatedly raised its concerns with government over many months regarding the impact of a co-payment on the general practice profession and its patients. As GPs we have an obligation to speak up and oppose any policy that will impact on our patient’s access to quality healthcare. We know that poor health policy drastically affects the ability of GPs to deliver quality patient healthcare, and this was extremely poor health policy.”

“When it became apparent the RACGP’s concerns were not gaining the traction required to influence change, we decided it was time to increase pressure. While advocacy has always been a major component of the RACGP’s work, it has recently taken a more public, contemporary approach to these efforts.”

“In the case of You’ve been targeted, this meant ensuring patients were also included in the conversation and encouraged to stand united with GPs to protect primary healthcare in Australia. We collectively see hundreds of thousands of patients a day and knew that a campaign bringing GPs and patients together would present a strong united voice.”

You've been targeted
The succesful RACGP You’ve been targeted campaign

The strength of the campaign

Morris: “Like most public policy debates, successful campaigning against the co-payment was contingent on securing public support in a political PR contest, which means getting the public on side. I believed that re-framing the issue around patient interests was the key to changing public perceptions, and winning the PR battle.”

Jones: “The RACGP took notice of what patients were saying about the co-payment and listened to our members who were telling us they wanted a campaign that focused on how their patients would be impacted. This is what led to the creation of You’ve been targeted.”

“The response to the RACGP’s change.org online petition was a big step for the campaign, with more than 44,800 signatures obtained in less than one week. While the campaign gained momentum through protest posters, use of the social media hashtag and sending letters to MPs and this allowed for concerns to be heard, the online petition was a collective demonstration of the sheer extent of those concerns.”

“A campaign’s strength is intrinsically connected to how powerfully it resonates with its audience and You’ve been targeted hit all the right buttons in this respect campaigning on an issue that affected every single Australian, young and old.”

Novel approaches

Morris: “If doctors and patients can capitalise on common ground and present a united front from the outset, the weight of political force will rest with us.”

Jones: “In terms of closer collaboration on advocacy campaigns, the RACGP feels there will be significant opportunity to work with health consumer organisations, given the mutual priorities of better supporting patient care.”

“The RACGP has already partnered with consumer organisations including the Consumers Health Forum (CHF) with whom it produced a number of joint statements. Most recently, the RACGP and CHF partnered in a joint submission regarding the deregulation of pharmacy locations and ownership.”

“The RACGP has consumer representatives on its key committees and boards. We have a history of working with consumer groups on important issues, and will continue to do so moving forward.”

“In light of the RACGP’s recent campaign successes, we will increasingly use social media as a platform to act as a voice for Australian GPs and their patients. Social media is new age media and the RACGP is committed to keeping pace with technological advances to ensure its members are effectively represented.”

The untapped power of the patient-doctor alliance

Traditionally campaigns against poorly thought-out Government policies have predominantly been doctor-centric, and the usual Government response is to divide consumer and medical organisations.

Jen Morris is a patient advocate and researcher in healthcare quality and safety at the University of Melbourne. She feels strongly that cooperation is required if we want to make more impact in Canberra.

This makes sense. It looks like the time is right for a novel approach – and it is much needed too, as the discussion about healthcare so far has been about dollars instead of quality. What are the benefits of a patient-doctor alliance and how do we overcome our differences?

Jen Morris
Jen Morris: “If doctors and patients can capitalise on common ground and present a united front from the outset, the weight of political force will rest with us.”

The numbers game

“At a strategic level, it’s a numbers game,” says Jen Morris. “There are approximately 26,000 GPs in Australia, and about 82,000 registered medical practitioners. But there are over 23 million patients. That is an enormous bloc of voters and lobbyists to leave untapped.”

“When campaigns are too doctor-centric, that leaves this bloc ‘in play’ – sparking a spin and PR war between doctors and the government, vying for public support. But if doctors and patients can capitalise on common ground and present a united front from the outset, the weight of political force will rest with us.”

“More importantly, putting patients and their care at the centre of pro-healthcare campaigning recognises healthcare exists wholly for, and because of, patients. Sometimes, public debates amplify some of the worst features of traditional hierarchies in clinical healthcare. Authority figures argue over who knows what’s better for patients, and best represents their interests.”

“All the while, patients pushed to the sidelines quietly await a chance to speak for themselves. If we’re serious about changing the culture of paternalism in healthcare, and empowering patients, that change in approach needs to permeate right through from the consulting room to the campaign platform. ”

What if we disagree?

There may be topics where patients and health providers don’t agree, such as certain aspects about the PCEHR. This can really paralyse a project. How should we approach this?

Morris: “It is important to remember that disagreement doesn’t only pose an obstacle in ‘patients and providers’ scenarios. Neither patients nor providers are homogeneous groups, and we do well to remember that. It is worth asking how providers approach the problem when they disagree on an issue or project, and source lessons from that.”

“It’s worthwhile looking for points of common ground, and building upon those

“The possibility that some parties may disagree is not, for example, a reason to exclude likely dissenting practitioners from a committee of doctors. In the same way, it is not a reason to exclude patients from healthcare policy discussions. Moreover, the fact that patients and providers may not always agree is not a reason to close our minds to collaborating when we do.”

“We should approach such disagreement on policy and projects the way we should in any sector. That is, give relevant stakeholders of all perspectives a fair opportunity to be heard. And, where possible, try not to speak for others in lieu of them speaking for themselves first.”

“It’s worthwhile looking for points of common ground, and building upon those. More often than we acknowledge, patients and doctors are really advocating for the same outcomes. But too often we don’t take the time to really analyse where the crux of disagreement actually lies.”

“So it’s worth trying to identify when disagreement is about what the end goal should be, and when it’s about how we should best get there. That helps to clarify how the points of difference, and points to potential solutions.”

“In cases where viewpoints really do differ substantially, all parties should have the opportunity to make a case for their proposal, then let the policy and law makers evaluate those on their merits.”

Is there a will to cooperate?

Morris: “Because I don’t work for or represent a consumer organisation, I can’t speak for them with any authority. However, I will say that in my experience, there is reflexive and entrenched suspicion on both sides.”

“If we find that the aims of doctors’ and patients’ organisations are so distinct as to be deemed incompatible, we should be re-evaluating those aims urgently

“Patient organisations are concerned about being seen to endorse a situation in which doctors’ organisations dominate and speak ‘on behalf of’ patients. Because such situations hark back to unhelpful, dictatorial hierarchies which have traditionally silenced the patient voice.”

“On the other hand, doctors’ organisations have expressed concern that patients do not understand the complexities of health policy and systems, the challenges faced by practitioners, and the broader potential consequences of proposals.”

“But in my experience, if and where these issues exist, it is in working together that parties learn from each about about how they can all do better. And the result is stronger organisations, and a more robust campaign.”

“It is healthy for organisations to remain vigilant about being faithful to their purpose and mandates. However, if we find that the aims of doctors and patient organisations are so distinct as to be deemed incompatible, we should be re-evaluating those aims urgently.”

“As a patient advocate, I would be delighted to have the opportunity to campaign alongside doctors and their organisations when appropriate. And indeed, on several issues I have done just that.”

“I have the privilege of working alongside many doctors in my role, who have taught me a great deal about the everyday realities of being a doctor. And I am a better advocate as a result. I hope that working with patients and advocate affords doctors similar insights.”

How social media is changing the healthcare landscape

How social media is changing the healthcare landscape
Image: Pixabay.com

There seems to be a significant growth of social media usage in the Australian healthcare industry.

In the past years we have seen surprisingly influential social media campaigns, like AHPRAaction, ScrapTheCap, InternCrisis, and very recently NoAdsPlease. These campaigns not only rally for better health care policies; they also signal a shift towards more transparency and accountability.

Characteristics of the social media campaigns are:

  • They spread quickly and generate a lot of media attention
  • The participants are very passionate about their cause
  • They are often supported by different groups including consumers
  • They may or may not be supported by professional organisations
  • They are very effective.

At the same time other social media movements, like FOAM (free open access medical education) are gaining momentum. Again, these grassroots initiatives are driven by passion – a powerful force. It won’t take long before health care professionals can do their continuing professional education via free social media sources.

I don’t think many professional and health care organisations are ready for these changes – yet they are coming whether we like it or not.

Psychiatrist and blogger Dr Helen Schultz is a social media enthusiast. Helen was involved in the successful AHPRAaction campaign. She believes social media skills are important for doctors: “I feel in the next 6-12 months there will be even more awareness of the need for doctors to know how to use social media professionally, but also how to use it to your advantage, building your brand, your platform and your voice.”

“The time has passed where we can be complacent and think patients will listen to us just because we are doctors,” she says. “We are largely absent from health debates currently, and others educate about health which may not always be necessarily evidenced based. In addition, we must claim our social media real estate, ie own our domain names and twitter handles to prevent others pretending to be us.”

Helen has taken it upon herself to organise a social media workshop for doctors and managers, and she has invited me to speak about blogging. Helen: “On the back of the success of the AHPRAaction campaign – and because I was so inspired by my colleagues around Australia, I thought we had to meet and put our heads together about how doctors can use social media in Australia to join health debates and run really successful campaigns.”

Some excellent speakers presenting at the workshop: Ms Dionne Kasian-Lew, Dr Brad McKay, Ms Jen Morris, Dr Jill Tomlinson, Dr Amit Vohra, Ms Mary Freer, and Dr Marie Bismark. Dr Mukesh Haikerwal is guest of honour.

Social Media by the Sea is a full day interactive workshop with practical tips and insights from the experts about their successful use of social media, whether it be as a blogger, advocate or part of campaign building. Time: Saturday, 15 November 2014. Place: Peppers “The Sands Resort”, Torquay, Victoria. Send email.

Blogging: What do you write when you have nothing to say?

The SoMeGP team was presenting about social media and blogging at the recent GP Education & Training conference (GPET13) in Perth, when this great question came from the audience: “What do you write when you have nothing to say?”

It is a common problem and the fear of every writer and blogger: not knowing where to start. Yet, the medical profession is full of topics to write about. In fact, most doctors, especially GP supervisors, have enough experience to explain a range of topics to patients, registrars, students and staff. It’s just a matter of putting these words in writing.

If you can email, you can blog. But the great thing of online media is that there are many ways to present information: traditional blogs, videos, podcasts, slide shows etc.

Take time to figure out what you want to do with your blog before you begin. Here are some tips to get started:

#1: Write for patients

Debunking myths is always a hit, and (de-identified) questions from our patients are a great place to start: Does hypertension always cause a headache? Is tonsillitis contagious? Can the flu shot cause influenza? Are antibiotics effective against sinusitis? Can Alzheimer’s disease be prevented? Should I have an annual cancer test? Blog about smoking cessation, healthy foods tips, how to perform CPR, etc

#2: Write for colleagues

Most doctors have a passion or field of interest, and sharing this knowledge or skills is fun and much appreciated by many colleagues. GP supervisors could help registrars by blogging about exam preparation, study tips, or asking & answering questions in blogs and online forums, like FOAM4GP.

#3: Write about the profession

Never a dull moment in health care. We have got a wonderful profession, but the ever-changing rules, ‘good ideas’ and intentions by policy makers and the flood of bureaucracy and red tape need to be reviewed and discussed, and blogging is a very effective way to do this. Work-life balance is another ongoing challenge. If you are passionate about a topic, do your research and share it with the world – we want to hear from you!

It sometimes helps to write things down during the day or use one of the many free apps, like Evernote, to collect and organise your thoughts and ideas. The advantage of Evernote is that it captures anything, can be accessed from mobile devices and computers and syncs between them.

And remember, a good blog post doesn’t have to be long: 300-500 words fine. Still in need of inspiration? Have a look at my number 1 blogging tip you should always keep in mind.