The vast majority of GP visits are 3 minute jobs where the patient just wants a prescription. It’s a huge waste of time and money.

Oh FFS dude your going to become a father so its time to start learning how to waist time and to shell out cash.

I for one am happy that GPs specialists and surgeons have a closed shop and keep the dregs out.

If you want to see what an open shop looks like go to a “holistic” birthing centre! estrogen soaked no-responsibility femborg quackery at its best…….. afterall there only risking your kid.

I have long thought that the Government should ban workplace agreements requiring workers to obtain a medical certificate for a sick day UNLESS they are taking 3 or more days off. This is a definite waste of Medicare funds as well as the doctors time.

As to point 2. With a very large false negative rate yes the results need significant expert apraisal and it could generate more GP visits I take this point, but I’m unsure as to what degree this is really would be a problem. Perhaps if people were visiting GP’s less for trivial referals then it would free up enough services.

3. As I said maybe more goes on than I appreciate. I didn’t know there were immunization clinics but it is good that there are I quesiton how many there are though.

My opinion on this is formed from spending time in say a hospital. Obviously you’ve spent more but perhaps from a different perspective.

“I was told that the blood bank’s testing would not be sufficient from detering the doctors at the hospital from administering the injection,”

The blood bank’s test is enough to determine whether you get anti-D (see http://www.ranzcog.edu.au/womenshealth/anti-d.shtml) but there are many other antigens that can cause haemolytic disease of the newborn. I guess the issue is also non-paternity as we discussed. NHMRC guidelines for anti-d administration can be found in this FAQ word document approved by the ARCBS: http://www.transfusion.com.au/FILES/RhD/Clinical.doc

“without a referral from a doctor, which would of course require an appointment and cash”
This is a whole other argument/debate about the decline in bulk billing doctors. Ideally, most GPs would bulk bill and it wouldn’t require shelling out “cash” but due to the inefficiencies in our federal/state system, cost shifting has resulted by the federal govt has resulted in a system where less GPs bulk bill and therefore more people go to “free” EDs.

I think your article is an excellent summary, and I agree that the line could be drawn at blood type, but I think the point raises a number of issues about access to health and testing as you’ve outlined. Just a few additional points i’d like to add:

1. In an ideal system there is a role for GPs doing “health prevention” (see http://www.mja.com.au/public/issues/183_02_180705/rus10405_fm.html) so that if a person is “forced” to see a GP to get something they think they want, the interaction should have more quality than to just focus on why the person has come but allow the GP the opportunity to discuss other health issues like hypertension and cholesterol etc so the person might make changes before its too late (i haven’t articulated that well but see: http://www.mja.com.au/public/issues/185_08_161006/har10079_fm.html). Young men are especially bad at focusing on their health before it’s too late.

2. With respect to whole body scanners, another aspect to consider is that the scan may show something of uncertain significance (because the test is now being used as an unevaluated screen rather than having a pre-test probability for a certain diagnosis) and then the person having the scan will be referred to a GP to discuss the result. Thus if lots of rich people start paying to have these, they may displace poor people from access to GPs, to discuss results which no one knows the significance of.

3. “Its always seemed to me that the gap between doctors and other medical professionals seems unnecessarily large”
There is a gap within the medical profession itself and I think it is simplistic to lump “doctors” in one group and “other medical professionals” into another (fostering an “us v them” mentality that is populist but destructive) as both groups are as diverse as each other. For example Steve, have you seen a physiotherapist or speech pathologist lately? Are you aware of the fees charged by allied health professionals? Immunization clinics do exist. As for other things, nurse practitioners are increasingly performing tasks in public hospitals which seems to work well. There are many issues to consider such as getting to a situation where rich people see doctors and poor people see nurses etc and also the issue of liability and insurance but i’ll leave discussing them for another time.

My friend wasn’t told this though, just to find out what it was.