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Lumen Summer 2008 Issue
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NO QUICK FIX for health care

Health care has changed irrevocably in the past 30 years - and not all for the better, according to a University of Adelaide medical graduate who has been part of that revolution.

When Dr Trevor Mudge delivered Adelaide's first IVF baby in 1982 it was regarded as a minor miracle. In those early years of in vitro fertilisation the gratitude from parents was overwhelming.

Today, if women are not pregnant in their first cycle of treatment they are thumping his desk, demanding to know what has gone wrong.

It's indicative of a worldwide trend that is shaping up to be one of the real challenges for the medical profession in the 21st century.

"As the capacity of medicine to improve people's lives has increased, so have people's expectations - often unrealistically," Dr Mudge says.

The President of the Medical Board of South Australia and his colleagues are confronted daily with a new ethical dilemma: how to balance finite resources and patient need.

In times past, doctors basically dealt with life and death. But a huge segment of health care these days is centred on lifestyle improvements - hip replacements, hysterectomies - where the degree of medical necessity is no longer absolute.

"We are dealing with a finite number of resources in the medical profession, yet the expectations from society have never been greater. Everyone expects a magic potion that will fix their health problems and it's just not possible," he says.

The loss of respect for doctors, coupled with a societal trend away from personal responsibility has reached a critical point.

"Certainly over my lifetime in medicine, self reliance has diminished to a point where if people have a problem - be it medical or otherwise - it's not a question of what they can do about it but what somebody else can."

This is nowhere more evident than in the IVF field, where specialists are being forced to set down new guidelines for eligibility.

"In the United Kingdom, for example, obese women whose body mass index is above 35 are not likely to receive NHS funding for IVF treatment under new arrangements," Dr Mudge says.

Likewise, cardiovascular surgeons in Australia are looking at rationing their services for patients who smoke and are overweight.

The justification behind these controversial decisions is that if global health resources are limited, they should be offered to people most likely to benefit.

"It's a real ethical dilemma for doctors and it's probably unfair to ask them to make those decisions, but is society prepared to take the lead in this? Politicians certainly aren't."

On a larger scale, the issue of recruiting doctors from developing countries to fill workforce shortages in the First World also warrants debate, Dr Mudge says.

"The whole of the developed world has got its sums wrong for the requirement of doctors and is systematically raiding the less developed world of its most precious resource - doctors.

"The average doctor/patient ratio on the Indian sub-continent is 1:100,000 and in Australia it is 1 doctor for every 4000 patients, so what justification do we have for luring them here? It is a massive ethical issue that should be discussed."

In South Australia alone, 30% of the medical workforce are international medical graduates, many from poorer countries whose need for doctors is even greater than ours.

Dr Mudge argues that governments of both persuasions in Australia have created the problem by failing to plan ahead for workforce shortages.

While the number of undergraduate medical places at universities across the country has doubled in the past five years, the same cannot be said of clinical resources.

"Clinical teaching specialists are being stretched to the limit, so while we can expect more medical graduates in the next few years, the resources aren't there to train them adequately for the workforce."

Despite these pressures, and the constant challenge of meeting patient expectations, medicine continues to be a profession in demand.

The University of Adelaide alone receives more than 2400 applications each year for 150 medical places. Demand far exceeds supply and although the average TER for successful applicants is over 99, high marks alone do not guarantee selection.

"Altruism still lies very much at the core of the desire to study medicine, Dr Mudge says. "For the vast majority of doctors it is a huge privilege to be involved in people's personal care." Dr Mudge was appointed President of the Medical Board of South Australia in 2005. Established in 1844, the Board's charter is to promote professionalism among the State's medical fraternity to ensure the highest standards of medical care for the public.

Dr Mudge graduated from the University of Adelaide with a medical degree in 1972. He specialises in obstetrics and gynaecology and in addition to his Medical Board role he works in the private health system.

STORY CANDY GIBSON

Dr Trevor Mudge
PHOTO CHRIS TONKIN

Dr Trevor Mudge
PHOTO CHRIS TONKIN

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