Who is the real winner in the latest stoush between pharmacists and doctors?

Last week a state Pharmacy Guild president made a few negative comments about general practice. I thought it was neither here nor there, but what happened next was interesting.

I could not find the original column (admittedly I didn’t look very hard) so I can’t verify his exact words but apparently, he said that increased funding for GPs will only incentivise five-minute ‘turnstile’ medicine.

Most GPs would not have read or been aware of the column until, on the eighth of February, Australian Doctor Magazine, owned by the Australian Doctor Group (ADG), posted an article on their website titled “Pharmacy Guild says GPs working ‘turnstile operations’ filling time-slots with easy patients.”

Then all hell broke loose. There were 170 comments on the article from mostly angry GPs.

A few days later, on the eleventh of February, Pharmacy News published this piece: “Guild takes aim at GPs who favour wealthy, healthy patients”. 

Interestingly, Pharmacy News is also owned by ADG.

Then the response came. On the thirteenth of February a reply penned by the RACGP president was published. And you guessed it, that same day Australian Doctor posted: “Turnstile, cream-skim medicine? RACGP hits back at Pharmacy Guild.”

The ADG publications got hundreds of clicks and views of their website content out of the latest stoush between pharmacists and doctors.

Good on them, one could argue. But hang on, there’s more to it. The ADG website explains how it works:

“We know that GPs are increasingly time-poor and less reliant on [pharmaceutical] sales reps,” says Bryn McGeever, Managing Director of Australian Doctor Group. “They’re looking elsewhere for information.”

“While readership of medical print publications remains strong, digital channels are becoming increasingly popular with almost eight in 10 GPs now reading online medical publications monthly.”

“In recognition of this continuing shift in GP behaviour, Australian Doctor Group last week launched AccessPLUS, a bespoke digital sales channel designed to fill the space left behind as rep engagement continues to fall.”

And the real winner is….

It is sad, but not surprising, that the medical media are fuelling the tensions within primary care. Of course, like other media, ADG is just doing its job. I do wonder how many GPs and pharmacists are aware that they are the product on sale here.

I have had my fair share of altercations with the Pharmacy Guild – but it’s a road to nowhere. I prefer to listen to people like pharmacist Debbie Rigbie, who rightly says, “We must build bridges across our differences to pursue the common good.”

Spin and misrepresentation: the toxic mix of academia and media

A good example of the toxic interaction between academia and the media is the coverage of a recent study that claimed parents did not trust their GP. The research data clearly showed Australian parents have confidence in the family doctor – but that didn’t seem to matter.

The study and the uncritical, sensationalised media reports about its bizarre conclusions received a dishonourable mention in ABC’s Media Watch. In this blog post Professor Moyez Jiwa and I examine a worrisome trend in the reporting of academic research.

With an ageing and increasingly morbid demography, health care costs are rising exponentially and, therefore, health policy is under constant scrutiny. Each previous reform is considered and, in many cases, reversed by every new government. In this context, reports that suggest any cause for public concern about the performance of health practitioners or hospitals are seized upon by the media to promote stories that will draw an audience.

In the new era of plain speaking, it is now possible to level outrageous claims against the beleaguered health industry. It is open season on doctors and their employers who may be perceived as a weakened, divided and defensive target. With each claim and counter claim the media chant “fight” and the protagonists oblige.

At the same time, the tertiary education sector is under similar pressure, having long participated in the competition for “most cited research”. The key performance indicators for academics are to grow academic outputs in peer reviewed journals. More than ever, it is a case of publish or perish, and sometimes this comes at the expense of quality.

Sensational stories

The temptation to frame the performance of health practitioners in less than flattering terms may be hard for the media to resist, and poorly designed academic research provides opportunities for them to harvest dubious results. Data to draft sensational stories are ever more readily available, as algorithms capture everything that can be measured and very little of what really matters.

As Lohr and Singer (The New York Times) state:

“… data science is a technology advance with trade-offs. It can see things as never before, but also can be a blunt instrument, missing context and nuance.

Editors of the burgeoning academic journals now vying for higher citations are also tempted to publish articles that can create a media storm and draw attention to their offering among the plethora of me-too rags, many of which derive income from advertisements targeting health practitioners.

Misrepresentation & spin

Exaggerations, simplifications and misrepresentations of research findings are often fuelled by the wording of abstracts and the use of spin in press releases from universities. This self-sustaining race to the bottom can damage health systems as well as grassroots health practitioners working in it and, worse, it may affect health outcomes.

It is time to pause for reflection. There are several elements in the eye of this perfect storm:

  • a sensitised and dissatisfied public;
  • electronic data that are ever more readily available;
  • a government with an eye on its dwindling coffers;
  • a squeezed and competitive tertiary education sector competing for ‘best’ university status based on research outputs rather than teaching excellence;
  • an academic culture encouraging quantity instead of quality of research;
  • media hungry for market share and advertising income;
  • a tolerance for sensational statements because of the trend to behave as if we all live on the set of a soap opera.

Doctors sometimes get things wrong. However, it is also very hard to draw conclusions from “data” without a great deal of the context in which the information was gathered. Data can be manipulated; it can be misleading, if not aberrant. Scientific methods can be flawed and the peer review process can be, and often is, faulty.

Journals publish what sells and the media report bad news because that’s what the public seems to buy. Finally, sound bites and 140-character sentences are now accepted as the way to communicate about complex issues. That includes issues that defy simple explanation.

Stop the rot

What is at stake, however, is our health. Every outrageous comment from an academic with a barrow to push and job to protect heaps more pressure on the very professionals who must prevent, diagnose and manage our illnesses. The results of poor research — badly designed, widely publicised, seemingly endorsed by peer review and poorly understood by a manipulated public — reduce trust.

Many academic institutions, researchers, journals and journalists work to high and ethical standards. However, our hope against the tsunami of chronic and complex conditions is the men and women who commit to the care of people, and we need to stop the rot before it sets in. The responsibility for reversing this state of affairs rests on many, but especially on the shoulders of the tertiary care sector, which needs to call out bad behaviour.

Professor Moyez Jiwa is Associate Dean of the Melbourne Clinical School at the University of Notre Dame. Dr Edwin Kruys is vice-president of the Royal Australian College of General Practitioners. This article originally appeared in MJA Insight.

Promising breakthrough: dramatic miracle cure offers hope to victims

The problem with headlines about medical breakthroughs and miracle cures is that they never live up to the expectations. On the other hand, the breakthroughs happening every day in primary care do not attract much media attention.

Seventeen years ago medical journalist professor Schwitzer published the seven words you shouldn’t use in medical news: ‘promise’, ‘breakthrough’, ‘dramatic’, ‘miracle’, ‘cure’, ‘hope’ and ‘victim’. Has Schwitzer’s taboo list made an impact?

Words you shouldn't use in medical news
Source: Twitter

Not really. A quick Google search shows that the same words are still used to celebrate ‘heroic medicine’ – often surgical interventions, new drugs or medical technologies. Scientific progress and developments are important but not always easily translated to every day care for every day Australians. They are never ‘miracle cures’.

At the same time we are seeing an increase in spending on hospital treatments but little investment in keeping Australians healthy and out of hospital. Although the breakthroughs in primary care are not regarded as newsworthy, they are often life-changing.

Dramatic & miraculous examples

Here are some of the amazing health ‘breakthroughs’ that are happening every day in Australian communities:

The patient who, supported by her general practice team, feels so much better after getting control of her diabetes. The person with a mental health condition who, after many months of hard work, and treatment by his psychologist and GP, is able to do the groceries again without a panic attack.

The woman who died peacefully at home, according to her wishes with close family around and supported by her GP and the palliative care team. The obese man who has been able to lose weight as a result of determination and regular contact with his GP and allied health team.

The patients who were glad they came in for a blood pressure check or immunisation because the general practice team picked up a heart murmur or melanoma. The highly anxious child who returned to school with help from the multidisciplinary team – much to the relief of the parents.

Medical news: wrong headlines
News headlines: room for improvement?

 

The courageous person who opened up and told his GP or practice nurse what he has never shared with anyone else before – and made a start to change his life. The worried parents demanding antibiotics for their feverish baby, but eventually leaving the GP practice relieved and without a script because they know the infection is self-limiting.

The hospital admissions avoided through a phone call by the GP – with a concerned patient, allied health professional, aged care facility nurse or hospital doctor. The elderly, isolated and malnourished patient who improved and continued to live independently with support from community nurses and the general practice team.

The consultation around the plastic bag of medication boxes brought in by a patient after a visit to the hospital – an essential chat about which tablets to take and when, to make sure she gets better.

Promising breakthroughs

Professor Lesley Russell Wolpe wrote in Inside Story about the value of incremental care. She said: “Heroic medicine has its place, but treating it as the core of medicine means that the majority of government funding goes to hospitals, acute care and elective surgery, a situation that is reinforced by the political imperative to deliver visible returns in a short election cycle.”

She said: “Treating general practice as a speciality in its own right — along the lines of the current advertising campaign ‘I’m not just a GP. I’m your specialist in life’ run by the Royal Australian College of General Practitioners — would help. Ensuring that primary care has the resources to keep up with its central role in the healthcare system is also vital.”

In the years ahead more ‘dramatic breakthroughs’ will continue to come from primary care teams who, day in and day out, assist people with important health decisions and adjustments in their lives. It is time to change the headlines. It is time for decision-makers to increase their support for primary care.

As RACGP president Dr Bastian Seidel said in The Australian: “Our patients want health, they don’t necessarily want treatment”.