What’s It All About, Dr Alfie?

Alfie_original

Yesterday was not an unusual day for me in many respects, but comments on LinkedIn by a doctor that it was ‘very disturbing’ that unions in Tasmania might pursue a change that meant that PTSD was assumed as caused by work in some high risk occupations, lead me to reflect on some fundamentals about the role of doctors in our compensation systems and about the raison d’être for the schemes themselves. Not that I necessarily disagree that work causation should not be assumed without evidence, but more fundamentally what is a doctor’s role within our compensation systems and what is the objective of compensation schemes.

I have previously provided some commentary on related issues, the CommInsure scandal –Another Elephant? – Lessons from the Comminsure Scandal

Day to Day Experiences

In addition to snippets from Social Media, my interactions with patients and other health professionals at work and at professional gatherings provide examples of some of the roles taken by doctors in compensation systems.

I saw a patient to provide a report to their lawyer, mainly about the extent of impairment. The patient is well-known to the practice and has progressive CRPS as a complication of a work-related limb injury. The condition had progressed to affect the contralateral limb. The claim is approaching settlement. I am providing an opinion about impairment. The insurer have sought opinions from another doctor who, at the last assessment, tried to justify the use of an impairment methodology that lead to the lowest impairment rating, barely accepting that there was a significant medical disorder, let alone a progressive debilitating disorder preventing any return to work or quality of life. Since my previous assessment about a year earlier, the condition has progressed with X-ray evidence of osteoporosis, gross swelling, skin changes and other classic features of this horrible condition, yet my expectation, if the other doctor is true to form, it will again be argued whether the condition is real or an assessment of the condition conducted in a way favourable to the insurer’s liability. I hope my predictions are proven wrong, but experience tells me otherwise. Is this the role of a doctor in our compensation system?

I saw another young patient under my care who has suffered musculoskeletal injury at work. The patient had become suicidally depressed with a near-successful suicide attempt as a result of the incapacity and effects on their career prospects. There is no previous psychological history. I am reluctant to add the psychological diagnosis to the certificate because I know it will lead to a dispute and complicate management. A proposal for limited ‘without prejudice’ funding to assist with psychological treatment (already psychological treatment is mainly funded by the public purse) has already been rejected. What is my role as the doctor coordinating treatment here? I suspect a no-win situation for the patient whatever I do about trying to expedite appropriate holistic management addressing physical and psychological factors, but will do my best.

Another patient, also well-known to me, contacted me yesterday concerned about a letter from the insurer advising about a dispute based on an IME assessment. Despite a legal requirement that the insurer provide the treating doctor with the IME report, I hadn’t received a copy yet to be able to talk through the opinion with the patient. More unnecessary stress for the patient. I will talk that through with them.

I did have some more satisfying experiences yesterday. A worker with back pain referred by their employer attended for advice about management. The employer isn’t concerned about the cause, they just want to get their employee better. I was able to help. I also reviewed another patient where a clear occupational disease diagnosis had been established, based on objective investigations. There are clear workplace implications – a change of job role is necessary. So far this has been accepted by the worker and hasn’t been challenged by his employer (indeed they seemed pleased to have an answer about the cause) and I remain hopeful that the insurer will accept the situation and not try some strategy to escape their role is supporting appropriate management. This is the role of a doctor working within a compensation system.

Another recent experience is my attendance at a conference about the health effects of compensation systems. I have just come back from the Australasian Compensation Health Research Forum conference – ACHRF 2016  in Melbourne. The conference was co-sponsored by the leading Melbourne-based research organisation in this field in Australia – The Institute for Safety, Compensation and Recovery Research (ISCRR) and the New Zealand Accident Compensation Corporation (ACC). I commend the conference organisers and the many insurer and compensation authority, researcher and health professional delegates who attended to learn about the state of knowledge in this relatively new area of research. I was disappointed that I couldn’t see anyone amongst the nearly 200 delegates from Tasmania’s Private Insurers or WorkCover/WorkSafe Tasmania. They didn’t get to see the presentation I made on behalf of AMA Tasmania about a unique initiative, driven by concerned doctors putting forward ideas to improve health outcomes in Tasmania’s Workers Compensation System. Most initiatives are driven by insurers trying to improve scheme outcomes or researchers and academics. The AMA proposal involves an alternative clinical pathway for workers assessed early on in their claims by GP’s as having a potential poor prognosis. See the earlier article for details – Towards Simplicity – Complex Case Management by Doctors. The AMA ideas did achieve some recognition though, with the conference organising committee’s award for the best Poster Presentation at the conference. Is involvement in system level change an appropriate role for doctors? I think so – otherwise I declare I am a hypocrite.

Dr Jason Thompson (@Simulated_Jase),  a well-known researcher at ISCRR tweeted today about the release of a study – Differences in perceived fairness and health outcomes in two injury compensation systems: a comparative study. This study provides evidence that differing ‘perceptions of fairness’ between compensation systems can affect outcomes. I doubt this study will immediately or directly affect what I do in my day-to-day medical practice, but it is an example of the growing evidence base about the factors that can affect outcomes for claimants in compensation systems, relevant to the design of compensation systems.

Over the last few days there has been publicity about PTSD in Ambulance Officers and Firefighters with a recent Four Corners Programme Insult to Injury. Concern about this issue has now extended to the south of the country with Tasmanian Ambulance Officers and Firefighters asking for system change to avoid the damaging effects of having to prove PTSD as highlighted earlier in this article.

The Conversation published an article by Petra Skeffington 2 days ago about PTSD – One in five police officers are at risk of PTSD – here’s how we need to respond. The following notable statement appears in this article:

“However, an ethical compensation system must deliver timely and warranted assessment and outcomes for claims in a way that protects those who are distressed and psychologically unwell.”

My opening paragraph also refers to this issue and the concern about a doctor seemingly having the principal motive of raising concern about a measure designed to improve health, without any apparent examination of the evidence from a health perspective. One could be forgiven for concluding that the motive was to protect the financial viability of the insurer rather than advancing health.

In another blog article I referred to Dr Barry Gilbert’s view of the role of an IME assessor – Barry Gilbert on IME’s.

It is worthwhile revisiting one of his most important points:

it is essential doctors always use their skills and authority to always act in the patient’s best interests”

I agree with that sentiment.

Why Do We Have Compensation Systems?

Workers Compensation Schemes are intended to serve the interests of those injured at work and are not primarily concerned with providing a profitable line of business for a financial organisation. Of course there is a need for the system to be affordable to the payers, the businesses and organisations that pay premiums and ultimately the community. It is worthwhile however remembering that while most workers don’t have choice about whether they end up within a compensation system, private insurers do have a choice about whether to participate in the offer of insurance along with the expertise in risk management to calculate a fair premium for that role.

Insurers have a choice to participate in compensation systems – workers don’t!

Doctors should be professionals whose overriding responsibility is to advocate for optimum health outcomes, no matter their role or who pays them. This is so whether doctors are working at individual case level or providing strategic or policy advice at a system level.

Doctors can provide advice to whoever seeks it, but it is not their role to bend the medical truth for the financial benefit of organisations that choose to operate in the compensation space. It is their role to be fully informed about health issues, including the impact of the various processes involved in assessment on the individuals involved. Indiscriminate surveillance is a good example of a potentially harmful practice, as raised by the recent Four Corners Programme.

See my earlier blog article for my own perspective on this issue:

Surveillance – Sharp Focus or Blunt Instrument?

Doctors should also be concerned about processes that lead unfairly to avoidance of liability by any third-party payer. This is not only because that might disadvantage the individual’s access to treatment and rehabilitation, but because cost-shifting of health care costs from  insurers and employers to the public purse has the potential to overload our already overstretched Public Health System and remove the incentive for employers to address controllable health risks.

In conclusion, Doctors who work within compensation systems need to be cognizant of the growing evidence about the health effects of compensation systems and to always act in the interests of health outcomes whatever their role.

 

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The Law Trumps Health! – or so it seems

Law trumps health1

In my blog article at the start of 2016, I outlined a plan for a series of articles about  various ‘insults’ to the achievement of positive health outcomes in compensation systems, in accordance with the theme of this blog.

I also realised that there is also a need to showcase examples of “Best Practice” and I have plans to write about the ‘blessing’ of a positive relationship between an injured worker and their employer, so important to achieving good health outcomes. This article touches on this issue, but it is a subject unto itself.

I did manage to post an article about ‘complexity’ in compensation systems, but at this stage I haven’t made any real progress on writing about the other ‘insults’ – too much else is going on and not enough time!

Distractions This Year to Date

This year there have been various issues I have written about:

There are also the continuing challenges posed by chronic pain, degenerative and computer-related disorders for our compensation systems.

In this field there is so much happening that is worth sharing. There are my experiences at the ‘Coal-face’ of occupational medicine interacting with injured workers, employers, insurers and other health practitioners, political experiences in the processes to try and make changes to the system from within and developments in understanding of the ‘science’ of this challenging area of medical practice.

I am particularly looking forward to attending ACHRF 2016 in early August. A likely source of inspiration for a further article from me.

Insights from the Tasmanian State Service

A significant proportion of patients under care at my own practice are employees of the Tasmanian State Service. Several recent cases have illustrated the difficulties posed for workers with complicated or prolonged claims due to the structural arrangements in place to manage cases, particularly in the smaller agencies.

While State Service claims are administered by a contracted private organisation (Currently broking firm Jardine Lloyd Thompson), the Agencies themselves make decisions about liability and overall injury management. Each Agency is apparently autonomous in that respect.

Each Agency have their own Injury Management Co-ordinators (IMC).  In the smaller agencies, the same person within the organisation has the responsibility to administer ‘care and concern’ to injured workers, while having an eye to liability and costs of the claim. I am not aware of how each IMC’s performance is formally measured by their employer, but is is apparent that there is (and must be) some focus on claims costs under this management arrangement.

With longer running claims, this conflict for the IMC becomes apparent. Usually the focus on cost containment wins out and even the most caring IMC starts to be seen by the worker as a barrier to their recovery. Unsurprisingly the IMC no longer welcomes contact from the worker and the relationship sours. With a long-term injured worker this relationship is often the only remaining contact with the Agency.

What hope is there for recovery and rehabilitation without any positivity in that relationship?

Treating Doctors – Part of the Team or Outsiders?

As a doctor, and outsider to the formal management system, trying to implement a co-ordinated treatment programme, can be frustrating. On the one hand the treating doctors are supposed to be part of the injury management team but, on the other, doctors are on the outside excluded from information held by the claims managers.

Tasmanian legislation supports transparency and information sharing. The key role of Primary Treating Medical Practitioner (PTMP)  and access by that doctor to the IME opinions obtained to manage the claim (via Section 90 requirements), is contained in the legislation.

However once there are concerns about costs of a claim and/or lack of progress or resolution, legal involvement starts. The legal ‘rules of engagement’ are quite different to those adopted by doctors in medical practice, as discussed in my earlier article.

Reflections on Medical Decision Making

This works against collaboration, information sharing and timeliness of decision making. The objective becomes a reduction or avoidance of liability and associated claims cost.

Currently some lawyers are using technical legal arguments to deny access by PTMP’s to IME reports e.g. on the basis that only an initial IME report has to be released, contrary to the intention and spirit of the legislation to support transparency.

With the State Service there is an obligation to use only state-employed lawyers with the additional restraint of limited resourcing which can add significant delay to the mix of barriers.

Interestingly, in one recent case, after making appropriate enquiries, informal reports from an internal IME adviser were released to me as PTMP, throwing light on the otherwise mysterious behaviour of the Agency in response to a medical management proposal. A small win for common sense.

Unfortunately despite the best intentions of legislators, it seems that common sense and  collaboration can fall victim to over riding demands to follow legal processes to the detriment of health outcomes for those injured at work.

The legal duty of an employer to contain claim expenses does not sit well combined with a role to provide compassion and care, as it does in some State Service IMC roles. These roles need review, combined with acceptance of the principles of transparency and engagement with treating practitioners, to achieve better outcomes.

THE LAW TRUMPS HEALTH – no matter what the guidelines say

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Barry Gilbert on IME’s

Barry Gilbert

I attended the ANZSOM weekend meeting held in Hobart last weekend. Dr Barry Gilbert, specialist public health physician and occupational medicine consultant, was one of the presenters.

I didn’t realise until I talked to Barry at the meeting that he is is now a permanent Tasmanian resident – hopefully this will help boost the depleting numbers of local occupational specialists.

Welcome Barry!

Barry’s presentation was about his take on IME assessments and I thought it was worthwhile posting his presentation so that perspectives other than my own get an airing on this site.

Barry Gilbert Presentation – The Independent Medical Examiner

My take home messages:

  1. it is essential doctors always use their skills and authority to always act in the patient’s best interests”
  2. “being an IME shouldn’t be a vocation in itself”
  3. the challenges for IME assessment that stem from developments in the understanding of the mechanisms of chronic pain
  4. the value of “Peer review audit of reports”
  5. the value of IME assessors getting together to discuss impairment assessment methodology to improve consistency

A worthwhile read!

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A Day at the Beach – Just how much of a GP’s time involves Workers’ Compensation?

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In a comment about Tilting at Windmills, Richard Gilley made the following statement:

“The total Tasmanian workers compensation medical benefit spend for 2014/15 was $43 million. HIC payments to Tasmanian GPs (NRAs) in 2014/15 were $130 million i.e. not counting private consultations or over the rebate fees, up to 33% of GP payments were workers compensation related.”

To me a suggestion that workers compensation made up to 33% of a doctor’s income seemed grossly inaccurate, based on discussions with GP colleagues.

I attended a meeting of ANZSOM tonight, for a presentation entitled “Occupational Medicine in Tasmania’ from Dr Mark Spearpoint. Dr Spearpoint referred to data from “the Beach Study” (Bettering the Evaluation and Care of Health) from the Family Medicine Research Centre.

The report from 2013-14 includes the following table:

Beach2

This table indicates that only 1.7% of GP encounters were claimed as workers compensation.

The study also provided the following detail about work-related attendances at GP practices. This showed that 2.4 per 100 of GP encounters related to work-related problems, but this rate did not mean that all these encounters were funded through workers compensation.

Beach1

I also talked to a well-respected general practitioner in a ‘somewhat’ occupationally focussed practice and he analysed his billings which indicated that less than 7% of billing income relates to workers compensation.

The calculation method used by Richard Gilley to suggest a third of doctor’s income come from compensation payments is seriously flawed, probably because use of the medical benefit spend of $43 million in the Tasmanian workers compensation scheme as the numerator in his calculation includes many other types of payments not just payments to doctors. His denominator of $130 million is probably also an underestimate as it does not take into account income from consultations not funded by HIC.

I hope however to get comments from the data experts at WorkCover Tasmania.

Although as an occupational physician I agree with Richard that GP’s could do better with greater emphasis on better management of workers compensation cases, the reality is that workers compensation is considerably less than 10% of an average GP’s work and there is likely to be a lot more focus on non-work related chronic disease management i.e. diabetes and hypertension.

CONCLUSION

Richard’s data is probably wrong by an order of magnitude. There needs to be alternative means to get GP’s interested other than by suggesting a significant proportion of their income is from compensation systems, which it is not.

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Tilting at Windmills?

Tilting at Windmills2

 

In response to my recent article commenting on the ComminInsure scandal there was a feisty response from Richard Gilley on LinkedIn – in the  Group Workers Compensation Australia.

The thrust of his comment was to point out the conflict between a GP’s need to earn a living and their often-stated primary goal of provision of patient care. The non-medical commentator pointed out that most GP’s charge fees for services rendered and suggested (having recently completed an environmental medicine course and the knowledge that it can take upwards of half an hour to take a comprehensive patient history) that GP’s spend insufficient time dealing with work injury matters and that it is ‘simply a matter of finances’. Further Richard suggested that when a compensation payer makes an arrangement with a care provider an important relationship develops with power by the payer over the payee and this issue is magnified when the care provider is an employee of the payer. The suggested solution was that all GP’s be salaried by the government, but suggested that doctors would strongly object.

In response to another comment by Rosemary McKenzie-Ferguson who runs a support service for injured workers in Adelaide, Richard suggested that to raise concerns about the matters referred to in the article was ’tilting at windmills’ presumably referring to the insurers (or perhaps the whole system) as Don Quixote’s windmills i.e. an imagined issue.

When I flagged the need for a considered response to his comments, Richard suggested that I relate my response ‘as a GP’ not as an occupational physician. This is difficult for me as I have not worked in General Practice for 30 years when the current issues did not exist (or I had not experienced them), but I can make observations about modern-day general practice based on discussions with GP colleagues.

Firstly, I would say that GP’s and some Medical Specialists and people involved in supporting injured workers see a side of our compensation systems, not seen first hand by most of the other participants. Referring to my own experience, I remain surprised about the sheer numbers of people who attend my practice who appear to have been unnecessarily ‘damaged’ by the system. In a small state like Tasmania, you might think the numbers would be small, but I usually see 2 or 3 people each week for IME assessments and I would say that the majority of those have suffered some unnecessary harm from the system. In addition, amongst those patients referred by their GP’s due to complexity there is a high rate of unnecessary damage. Recently adverse events affecting patients I am treating became so common that I have implemented ‘Adverse Event Reporting’ in my practice. Since this policy was implemented on 01 March, I have completed about 6 reports of significant adverse events that have complicated recovery. Some events relate to the management of the claim and some to medical and rehabilitation management. These are not minor events, but include significant clinical setbacks causing total incapacity for work, additional need for medical or psychological input and, in one, case psychiatric hospital admission. These reports are being circulated to WorkCover to help build a picture of what is happening at the coal face.

It might be useful for other participants to spend a day (or even a week) in a medical practice or an Injured Worker’s Support Facility to understand the reality of our current compensation systems.

I think I do have some understanding of the insurer’s and employer’s perspective. I have worked in a management role with a large employer (Health & Safety Manager for Hydro Tasmania), more recently than I have worked in general practice and much more recently I have had a role as adviser to an insurer. My knowledge of general practice comes from day-to-day interaction with GP’s who refer to my practice, in addition to interaction with GP’s through my role with the AMA’s Workers Compensation Reform Committee and more recently with the RACGP.

The first point to make is that the issues about potential conflict between  the need to make a living and the goals you seek to achieve at work are common to everyone in our society. Doctors are not unique in that regard.

I was talking on the weekend to another doctor originally from the UK with an interest in medical ethics. He pointed out that the tradition of the UK medical fraternity is of independence from authority and a focus on a patient’s best interests.. A German colleague had apparently pointed out to him that it was unlikely that the UK medical fraternity would have got involved in the type of atrocities committed by doctors in Nazi Germany due to differing traditions. The ethics of Australian doctors are still probably largely based on those traditions from the UK.

Ethical Australian doctors do put patient care as their priority, but this is not to say that there are not financial imperatives that might drive the way that is undertaken. I too have reservations about some aspects of fee for service, enshrined in our systems, most notably our Medicare System which carries over into the AMA Fee schedule. The system dictates use of defined ‘item numbers’ that describe particular procedures and consultation activities, mainly those activities undertaken ‘face to face’ with a patient. This system can drive unhelpful practices. If a doctor can earn more per hour through multiple short appointments, when a single longer appointment to properly consider a complex issue would be better, then the billing system is counterproductive. If there is no item number for telephone contacts, meetings, prolonged consultations to take a proper history or other valuable activity then those activities might be neglected to the detriment of good outcomes. There might be an argument that doctors should just change an hourly rate for their services, like lawyers do. But that would introduce a whole new set of issues, for the payers I expect, and an opportunity for the very small proportion of unscrupulous doctors.

In my view, the issues of doctors doing the bidding of an insurer are not in the same league as the issues that drive doctors behaviour in a private practice. Most doctors still want to achieve the best health outcome for their patients, although the system might not support the best way to achieve those goals at present.

The suggestion that the average GP providing treatment is at risk of becoming beholden to  a workers compensation insurer is a nonsense, especially in an underwritten state like Tasmania, where there are multiple private insurers. For the average GP treating work injuries is a tiny fraction of their workload. Drivers other than relationships with insurers are far more influential. A risk might arise in a practice that develops a preferred provider arrangement to provide treatment services for a large employer, but the most significant risks arise with direct contractual or employment arrangements between doctors and those organisations that carry liability, particularly when the doctors involved only do that type of work as highlighted the CommInsure scandal.

I agree there needs to be a review of remuneration arrangements for doctors providing both treatment and IME opinions, but I doubt anyone is going to support a change to a model where all GP’s are salaried by Government.

I don’t think we are ‘Tilting at Windmills’. There is increasing evidence, becoming increasingly apparent  from ISCRR and other research, about the hazards associated with compensation systems. The windmills, or should I say the mist-shrouded giants, are real – the entrenched negative attitudes towards injured workers within the system and the short-sighted financial drivers within an insurance-based system that actually increase the costs in the long run from work-related ill-health and injury. That cost is ultimately borne by the whole community – measured in suffering, lost productivity and cost-shifting to our social security system for those who end up on the scrap-heap.

I thank Richard for his candid comments and look forward to his response.

 

 

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The Power of Social Media

Stipic

 

I only ‘met’ Mark Stipic “The WorkCover Guy” quite recently and I am still to meet him close up in the real world. We were apparently both present at the December 2015 ISCRR Forum in Melbourne, but I didn’t know about him then.

Earlier this year Mark and I connected on Twitter and two weeks ago he interviewed me for a Podcast for his RTW Nation Series. His interview with me is the eighth he has done. In the interview I was able to explain some of the background to my ‘activism’ on Social Media, how I have applied hazard management principles learnt in my training as an occupational physician to risks from compensation systems, as well as explain the approach I take to managing cases referred by general practitioners, so-called ‘complex cases’ as outlined in my previous blog article ‘Towards Simplicity – Complex Case Management by Doctors’.

In addition, I had the opportunity to put out there some new concepts such as ‘Adverse Event Reporting’ by doctors in compensation systems and even answering the ‘magic wand’ question i.e. with a magic wand what would you change about the current system. You can be the judge of whether it is of value by listening to the podcast. Here is a link:

RTW Nation Podcast Episode 8 – Peter Sharman about Complex Case Management

What is different about Mark’s approach is that he is trying to make workers compensation subjects engaging and interesting. He has done multiple (100, I understand) video clips to answer commonly asked questions in his field.

Social Media provides a powerful tool for engagement and discussion between practitioners and other stakeholders who are geographically separated and might not otherwise interact. New ideas can follow this interaction providing impetus for positive change, based on the evidence and experience in the real world.

Keep up the good work Mark.

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Another Elephant? – Lessons from the Comminsure Scandal

CBA Elephant

The ‘Comminisure’ Scandal broke this week putting a media focus on the role of doctors within organisations and the potential for commercial interests to over ride the usual ethics of the medical profession.

For those who didn’t watch 4 Corners here is a link:

Link to 4 Corners – ‘Money for Nothing’

The Conversation on-line news published an incisive article authored by bioethicists in response :

Comminsure scandal reminds us commercial forces are at play in medicine

This article emphasises how doctors involved with insurers can get caught up in the commercial interests of the business with adverse effects on patient care. The authors emphasise how this current scandal demonstrates issues that arise with conflict of interest:

They state:

‘The phrase “conflict of interest” refers to situations in which there is a tension between “primary” values or commitments (interests) and the other “secondary” interests’

The primary value for doctors is that of the medical interests of the patient, described as ‘patient well-being’. Secondary interests can conflict with this primary value. Examples are provided of the potential conflicts that arise with doctors employed by insurance companies, sporting clubs, prisons and refugee camps and for occupational physicians employed by major companies. Does this issue extend to doctors employed in hospitals and government roles?

The key paragraphs in the article are quoted below:

‘Because doctors are so powerful, and because enactment of these powers can have major consequences for vulnerable patients, it is essential doctors always use their skills and authority to act in the patient’s best interests’

and

‘Any relationship that has the potential to get in the way of this primary commitment needs to be navigated with the utmost care. The obligation remains even when doctors work for, or within, an industry that appears to have lost its moral compass’

The Comminsure Scandal brings to the fore another ‘elephant in the room’ in our compensation systems. While the previous ‘elephant’ I referred to in How Big Is the Elephant in the Research Room? is getting smaller with increasing evidence and understanding about the factors that affect outcomes in compensation systems, the hidden conflicts affecting doctors with important roles in our compensation systems has received inadequate attention. It is important that those employed doctors perform a self-analysis, and ask the following questions in relation to potential conflict of interest posed in educational material from the  Australian Institute of Company Directors (AICD):

‘Do I have a conflict of interest?

If you think you might have a conflict of interest, ask yourself these questions:

  • Would someone from outside the company or outside my family think I have a conflict of interest?
  • What would I think if I heard of someone else doing this? Would I think there was a conflict of interest?
  • How would I feel if my actions were printed on the front page of the newspaper?
  • Who could be disadvantaged and who could benefit from my actions?
  • Do I need to get an independent opinion about these issues?’

This scandal has also highlighted issues with excessive use of covert surveillance by insurers as detailed in the Sydney Morning Herald.

Link to SMH Article

SUMMARY

The Comminsure scandal highlights potential issues where doctors are employed by or contracted to organisations that administer or oversee our compensation systems. These factors may contribute to poorer health outcomes in our workers compensation schemes than might otherwise occur if such doctors adhered to fundamental principles i.e. having primary concern for a patient’s or injured worker’s best interest and always using their skills and authority to act in the patient’s best interests.

Perhaps this issue is more important than the conflict that can arise with a doctor’s personal interests to earn a salary, care for their family, maintain a practice and advance their career as can arise in a typical practice setting.

Over to ISCRR to do the research!

 

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