better health by designLearn More

The failure to communicate is costing us billions


The Weekend Australian headline today, Sunday 24th April 2016 declared that

Healthcare waste costs $20bn a year

According to the graph on the first page of the paper there were 105-110 General Practitioners (GPs) or specialists in 2004. Although the number of GPs per 100,000 population has remained static there are now more than 130 specialists per 100,000 people . Therefore the rising cost of waste in healthcare runs parallel to the increase in specialists in the population. The source is quoted as the Australian Commission on Safety and Quality in Health Care.

But there is nothing new about this story. This trend was demonstrated in previous decades. More primary care equals lower costs the formula isn’t complex. Reading the papers today we recall the late Barbara Starfield’s words:

Six mechanisms, alone and in combination, may account for the beneficial impact of primary care on population health. They are (1) greater access to needed services, (2) better quality of care, (3) a greater focus on prevention, (4) early management of health problems, (5) the cumulative effect of the main primary care delivery characteristics, and (6) the role of primary care in reducing unnecessary and potentially harmful specialist care.

The disappointing thing about the accompanying newspaper commentary was the suggestion that the solution is political. The journalistic analysis is that powerful lobby groups have managed to influence policy to the point where there is subsidised over servicing of the population. Specifically prostatectomies, colonoscopies, arthroscopies, cataract surgery, hysterectomies and CT scans.

In a country where general practice remains the gatekeeper to specialist services we need to figure out how we might be able to tackle the problem for the sake of the economy. The solution is to remain circumspect about another quick fix because we have learned that politics and the need to be popular with the electorate rarely delivers anything like a lasting solution.

In medicine people are referred or persuaded to have treatment or investigations and under the ‘big data’ is the story of ineffective consultations. One where either the patient is not examined or an adequate history taken, or where the risk and benefits are not explained to the patient in a way that informs the decision. After all if that were not the case which patient at very low risk would chose to have a colonoscopy?

What is the difference between managing a request for an antibiotic for a cold and managing a request for a CT scan for mechanical back pain? To those who are cynical about the chances of getting the message heard we might say wait. When there is sufficient pain the bureaucrats will beat a path to your door. There is no solution as effective as improving how we communicate with patients, anything else will paper over the hole, no the chasm, in the budget.

Picture by Christopher Blizzard.


  1. Frank Jones says:

    Thanks Moyez
    As I constantly teach
    “It’s much easier to order a test/investigation and easier to do a referral than NOT.
    Thiis essential statement surely is what the scientific method is all about and translating that in context is the art and expertise of General Practice!

  2. I agree Frank. the real challenge in a consultation is getting to the point where you and the patient are on the same page. That doesn’t need to take forever. The skilled doctor is able to present the case for and against a course of action in a way that communicates the risks and benefits in digestible format. First it requires the doctor to know those risks and potential benefits. There is limited evidence for this. What we cannot or must not accept is that jaded, cynical, profit driven or burnt out individuals should be allowed to put people at risk because they posit that ‘the system’ is to blame.

  3. Ian Watts says:

    If we want this to really work, then we need to recognise that a key tool will be a single electronic health record to which the whole team has read/write access, allowing visibility of need and response.

  4. You may be right Ian. The challenge is getting people to use the electronic record consistently and correctly.
    An electronic record is an innovation like any other and will only succeed if people are motivated, triggered and able to use it. Sadly to date none of these are aligned largely for technical reasons.

  5. Linda Beaver says:

    Reinforcing the need to communicate effectively is essential if any hope of informed decision making is to be encouraged. Making sure the information has be digested by the patient is the key issue and more importantly remembered. It is great to see this being reinforced as integral to a consultative process.

Speak Your Mind