30 September 2013

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Health Report 28 min 2 speakers 7 chapters transcribed 3 days ago

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Should parents consider experimental gene therapy to help a growth‑restricted baby?

Dr. Norman Swan 0:00

Hello and welcome to the Health Report with me, Norman Swan. Today, would you accept gene therapy if it would help your baby grow? Would you accept a new way of testing your unborn baby for genetic abnormalities if you knew the doctors aren't sure of whether what they find means anything? And if you're obese and thinking of becoming pregnant, maybe today's Health Report might motivate you further to get your weight down before conceiving disturbing news about nutrition, iron and the immune system. and the crisis in the supply of general practitioners in rural and remote Australia and possible solutions. They come in a report from the Grattan Institute in Melbourne, co-written by Dr Stephen Duckett, who's director of the Grattan's health program.

Stephen Duckett 0:40

If you look at the shortage in the areas like the Kimberley and the Pilbara, for example, in Western Australia, there's only about 57 doctors per 100,000 population. If you contrast that with suburban Sydney, for example, there are 122 doctors per 100,000 population. So there's only half the number of doctors in these rural and remote areas as there are in the cities. And of course, health needs are somewhat greater in rural and remote than there are in the cities.

Dr. Norman Swan 1:05

Fair

Stephen Duckett 1:05

enough.

Dr. Norman Swan 1:06

But I hear these stories about when doctors go on strike, the population gets more healthy. And while people like to have their doctor nearby, does it actually make an impact on their health?

Stephen Duckett 1:16

I think there are a couple of issues here. The doctor strike stuff looks at overall averages. And so maybe at the high end, at the 122, if the doctors go on strike, there is no impact. But at that lower end, there is a serious impact. We did a study, for example, which looked at the cost to the hospital system of poor access. And what we found was that per patient, after you standardise for everything else, that an additional doctor in a community actually reduces the cost of hospital care for people in that community. So there is an impact on the budget as a result of this low access, not counting the impact on individuals. So what you're saying is that if you don't have a GP, you use hospital services more than you need to.

Stephen Duckett 1:57

Well, you end up going to hospital late and so your condition becomes somewhat more complex. Which is a huge issue for Aboriginal communities. A huge issue for Aboriginal communities.

Dr. Norman Swan 2:07

And you only looked at seven rural and remote areas in this study. Why is that?

Stephen Duckett 2:11

Well, we decided to tackle the worst first. We said, let's concentrate our initiatives on the places with the worst access in the country and see what we can do to change that very, very quickly. Over a five-year period. Now, you said Northwest Western Australia being one area. Where are the other areas, just briefly? Northern Queensland, for example, around Mount Isa, also northern New South Wales. Basically, all of Western Australia is the area we're looking at. Apart from the western suburbs of Perth. Other than Perth. So we're looking at a number of places across the country. All of Northern Territory, for example, is in dire straits.

Dr. Norman Swan 2:45

Now, why look for a solution when we've got this tsunami of medical graduates? We are, some would argue, overproducing medical graduates over the next few years.

How severe is the shortage of general practitioners in rural and remote Australia?

Dr. Norman Swan 2:56

It's starting now. Some of them aren't actually going to have any jobs when they come out. Some people are saying there's going to be 1,200 unemployed doctors within the lifespan of this government if it goes to two terms. Why are we bothering talking about alternatives when, in fact, you're going to have medical graduates coming out of your ears?

Stephen Duckett 3:11

Well, the trickle-down approach, which is what you're suggesting, just pump hundreds, extra thousand graduates into the system and hope that they'll go to the places where needed, hasn't worked in the past. Sure, there's been, over the last five years, an improvement in access, but it's mainly occurred in what are called the inter-regional areas, the major rural cities like Bendigo and so on. rather than in the more remote and rural areas. Similarly, with international medical graduates, again, we push those out into the remote communities.