Teaching an Old Dog Old Tricks

 

“Good morning, Doctor.’ The good-looking man is new to my practice. He offers a hand, shakes manfully, breaks no bones but leaves none unfirmed. His smile launches a promising relationship. ‘I’m new to Melbourne, doctor. Just moved here – for my studies.’

 

The man looks a young forty. I check his date of birth; he’s forty-nine.

‘What are you studying?’ – I ask.

‘Philosophy. Classic Philosophy, the greats, you know, Plato, Aristotle, Aquinas, Maimonides…’

He’s won me.

 

‘I used to be a lawyer. Made some money, made a family, four kids. Now it’s time for me. Time to pursue wisdom.’

‘Share it with me when you find it,’ I say.

He smiles.

 

‘Doctor, I wonder if you can help me out. Awkward situation. I’ve left my tablets in Sydney. They’ll arrive Monday next with the family. My doctor prescribed a short course of Temazepam for sleep. Exams next week and I can’t sleep. If I don’t sleep, I’ll fail. If I fail I’ll never find wisdom.’ The winning smile again.

 

 ‘What are the tablets?’

‘Temazepam, the weaker ones, the tens. I’m scared of anything stronger.’

‘Very wise. They’re habit-forming.’

The man looks shocked: ‘Habit-forming? Really? My doctor never mentioned that. I just want enough to get me through these exams. I finish in three weeks.’

 

 

The man and I spend a little time discussing Temazepam, natural remedies, his own preference for a long hard run (‘Wouldn’t you know, Doctor, my running shoes are still in Sydney?’) The man looks up at the marathon photos that cover my walls where other doctors show their degrees.

‘Are you still running, Doctor? Marathons? Really? Amazing!’

 

 

The man leaves my room with his limited prescription, leaving behind his protestations of delight, his vows he’ll be back, how lucky our paths crossed, he’s found a disciple of Maimonides, he wants me to be his new doctor.

 

 

A couple of patients later the receptionist buzzes me and pricks my balloon: ‘That new patient, do you know what he said about you, Howard?’

‘No.’

‘”What an amazing doctor! Still running marathons!” Says you are a scholar, an expert in Greek Physiology.’

 

‘You know what else he said?”

‘What?”

‘He said he left his wallet in his car. He said he’d be back in five minutes to pay. I asked him for his Medicare card, but that was in the car too. But he knew his number, he said, and I took it down. Thirty minutes and he’s not back. I rang Medicare: there’s no such number and they have no record of that name at the Sydney address he gave. I rang his mobile. “Optus advises the number you have called is incorrect or has been disconnected.”

 

 

Three years pass. Three years are not sufficient to heal a wound in trust.

Last week a new patient registers with Reception. He presents his Medicare Card, asking a series of questions:

‘What doctors are consulting today?

‘Who will I be seeing?’

‘How long has he been at this practice?’

‘I just need a prescription. I’ve lost my tablets and my wallet too. Can I pay with my credit card?’

 

 

The relatively new receptionist was not with us three years ago. She calls me: ‘Are you with a patient, Howard?

‘No.’

‘May I come in and talk with you?’

‘Certainly.’

The young woman is shaking: ’I think your next patient is lying. I think he might be the man who came here a few years ago and lied to you to get tablets.’

 

 

A phone call to the Doctor Shopping Line at Medicare. I give the Medicare number of the new patient. ‘We suspect he’s a doctor shopper’, I say. I give the new patient’s stated name. The Medicare person confirms the validity of the card and the truth of the name given. ‘We have records of that patient’s recent prescriptions. He’s had eighteen prescriptions since March first, every one of them for twenty Temazepam tablets, each prescription from a different doctor in your area. You might like to inform the patient of these facts, Doctor.’

 

 

Health is not a Human Right

I am about to make some shocking suggestions: 

Health is not a human right.

The Morrison-Turnbull budget cuts to Medicare Rebates are not completely bad.
Running in the dark this morning, I noticed the illuminated sign outside the local hospital. It read:

PRIVATE HOSPITAL.

 

I felt unhappy reading that. A hospital is a place where human beings help other human beings with their health. The meaning of a hospital cannot be realised with that label. ‘Private’ tells the reader that some humans will be admitted and others turned away. Privacy as a personal property might well have been eclipsed by the internet, but ‘private’ survives with this message, unkind to some, saying ‘keep out.’

 

If health were a right we’d need to outlaw Down’s Syndrome, premature death and disability. We would legislate and make ourselves ridiculous. The error of language here betrays an error of thinking. We cannot assert a right to health, but we can create a right to equal access.

 

I am a private doctor. I am a public doctor. The public is composed of private persons. I treat one person at a time, privately. That is, personally, confidentially; two humans together, doing what every human does in a lifetime: ordinary transactions of care.

 

Doctors generally share a number of characteristics. We are serious, careful, committed and proud. We are defensive of our liberties, self-righteous and voracious of cures. We are expensive; I mean someone, somewhere, always pays for cures. In its new budget the government has pegged Medicare rebates. This skewers doctors and patients: either the doctor loses or the patient loses. There is nothing new in this.

 

When Hayden-Whitlam introduced Medicare I bulk-billed everybody. I thought it was a wonderful thing that a person, be she rich or poor, might consult a doctor equally. I thought so then and I think so still. To assure doctors they would not lose, the Hayden-Whitlam Government set up a referee who increased the rebate in pace with the rising costs of practice. This was costly. So the government told the referee to stop indexing rebates. And I stopped bulk billing. Often patients found themselves facing a choice – see the costly doctor or feed the family. When this occurred all doctors I know abated their fees so the patient might afford both cure and food.

 

What a government does in tightening benefits is to create the need for a new force to operate in care. The force is not one of rights but of grace. The doctor and the patient gaze upon each other as we did through all history, unmediated by refunds and rebates, freer now of the obscuring presence of the insurer. Two humans in a situation of human need.

 

The words ‘Private Hospital’ jolt me. They remind me that health is not merely a matter of economics or of civil rights, but of civil opportunity.