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Dr Jeff Brown: Presidential Address to Annual Conf

Presidential Address
ASMS National Conference 2005

Delegates, guests, visitors, colleagues – what the hell are we doing here?

When patients are queuing for our care?
When we could be upskilling?
When we could be producing?
When stressed and stretched colleagues are covering us back home?

What do we expect over the next two days?

What does this record number of attendees at the 16th ASMS Annual Conference want from your time at Te Papa?

I offer three themes.

To strengthen branches.

To lead clinical networks.

To support ourselves.

Before exploring these themes I thank, on your behalf, the national office. Ian, Angela, Henry, Yvonne, Kirsty, Barbara and Kathy have individually and together achieved more than even the most demanding member can envisage, as we will hear in the presentation of the highlights of the Annual Report.

First a celebration. The national DHB MECA was formally signed by every chief executive after a trip through the byways and highways of New Zealand that would make even Billy Connelly proud. And then the hard work started.

To strengthen branches

Implementation. The task of turning the words into action. We strode out on the path of Joint Consultative Committees to rejuvenate branches. The message of the last Annual Conference was to encourage branch members to lead change in their own workplace, to focus on eyeball to eyeball meetings with those at home who can promise change. To force the promise into action. We learned yet again that many human resource managers and some chief executives have a penchant for dichotomy when what’s needed is nuance. And, with backing from national office, we have cajoled the jejune and the merely dilatory to translate the intent of the MECA into tangible improvement in our daily lives. Some have achieved more than others, some have further to travel, but all are guided by the same underpinning of the hard-fought MECA. And it needs renegotiating next year!

I also thank your National Executive who have governed your national office and been a sound sounding board for the demands placed on them by the complexities of a union with 92% penetrance, by the demands of over 2600 members, and by the demands of myself. And in particular I thank the wise counsel of your Vice President David Jones and National Secretary Brian Craig.

These are all doctors fighting for doctors.

Fighting to strengthen branches. To re-establish local members forming local JCCs to meet together to plan strategy, to meet with their own managerial menagerie, to negotiate an agreed path to cohesive, and occasionally coercive, progress. Ian has improved his airpoints status while rediscovering the joys of each DHB’s diverse discussions. Implementation of the clauses may have different emphases in each DHB, but many share the same frustrations and opportunities to learn from each other. To empower SMOs to demand of their human resource departments and chief executives benchmark behaviour, to require the best of the best. We have been able to point out to our paymasters the difference between a shaky or out-of-focus photograph and a snapshot of clouds and fog-banks. That information without perspective is merely a higher form of ignorance.

These - your - branches will need to drive not only implementation and improvement of local workplaces, but also the direction of imperatives as we move forward to the next round of national negotiations. You will need to shape and sharpen the focus of your team to achieve the next version of your MECA. To build on the gains to recruit and retain a high quality specialist workforce in New Zealand’s DHBs.

To lead clinical networks

A workforce that can lead clinical networks. That can reclaim the leadership of the health service to translate tax dollars into health outcomes. We have read public opinion polls that the health service is crumbling. Many of our members consider their workplaces to be under more stress than ever before. Yet we know that more dollars are pouring into health than ever before. Neither politicians nor public servants enjoy the mismatch between perceptions and policy. But they have insisted on being satisfied to find an answer to any question, not insisting that the answer is correct. They do not realise the profound difference between learning from the world and learning about it. That distant and dispersed decision making is inevitably shallow and without substance. That a muddy puddle may pretend to any depth; a clear pool cannot. Only when those who swim in the currents and rips of medical practice determine the dispersal of lifeguards can the public safely dive in.

For we have a unique contract with the patient. There is no-one else who has the same contract. We cannot abrogate it. We may devolve bits of our practice to other health professionals. But there is none other as well equipped to lead the team, as well qualified to make the difficult decisions, as well trained to tailor the dollar to the demand.

Iain Martin, the new Dean of the Auckland School of Medicine, says that what differentiates doctors from all others who would claim portions of the practice of medicine, is the broad intelligent mix of skill and apprentice based training that equips us to constantly reshape our practice. To lead all health teams, not as mere members but as shapers and shifters.

In a country of only four million with 21 DHBs and layers of managerial manipulation, the only rational way to improve both public and professional confidence is to have health professional led networks. To strengthen the networks that clinicians have developed, to encourage clinician led change in regional rationalisation and national direction. To follow the model of the Orthopaedic Society to decide on the best system for increased joint replacements. The model of the Cancer Control Strategy to lead national determination of access and services (although specific resources for health professionals are yet to emerge. But not to repeat the morale sapping exercise of the Paediatric Society’s “Through the Eyes of a Child”. Almost every paediatrician in the country contributed voluntary hours of sweat and toil to produce a Tertiary Services Review, only to see it languish in the corridors of the capital. To see only a very few improvements become shining beacons of what could be possible with health professional led change, but the rest consigned to the dusty shelves. Leadership has to be divested to those at the coalface. To those with feet firmly grounded in daily patient contact, not those with heads in the clouds of fondly remembered but distant past practice.

To those who every day juggle sitting at the bedside empathising with a patient and also engaging with purveyors of policy. Who juggle having our hands inside a warm body cavity and also preventing well meaning and pernicious managerial mishaps. Who juggle inserting our intellect inside the mind of misery and also advancing regional rationing of resources. Who know the entanglement with the patient – physical, emotional, ethical – that enriches and enhances the doctor-patient relationship on the shared path to healing. When we have a health professional led health system we can truly get value from the best of the passionate, persuasive, perfectionist SMO workforce with over 2600 individual answers to what ails us. Seize power, not for its own sake, but to effect change. To streamline, to strengthen, to support clinical networks. For the patients.

To support ourselves

But only if we support ourselves. If we own our own behaviours. If we own our own destiny. We all see colleagues suffering under the stress and strain of professional and private lives. Whose performance, whose enjoyment, is impaired. In whom we recognise portions of ourselves, fragment of our own frailty. Who we are only too quick to malign, in unguarded moments of tiredness or tribulation. Who occasionally come to the attention of Henry orAngela, or other less friendly agencies of angst. And when their foibles do unravel, inevitably uncover stress, lack of support, isolation, unresolved conflict or conundrum, and many ignored signals of suffering. Whose years of training and dedicated sacrifice risk being lost forever from an already stretched thin workforce.

How can we do better for each other? Can we act as doctors for doctors? Not leave it to unused employer funded EAPs or to indemnity ambulances at the bottom of the cliff? Or can we establish an “Empathic Flying Squad” to provide sage advice and wise council. With no strings attached, merely support. Funded by doctors, for doctors. Is it our obligation to establish a national network of support for the stressed, the stretched, the struggling amongst us? So that we can be helped before we break. Do we leave it to someone else? Or do we look after ourselves?

Delegates, colleagues. While patients are queuing, while some are technically upskilling, while others are producing, while your colleagues are covering, what will you be doing here? Over the next two days you will hear about efforts to strengthen branches. You will hear about proposals to the new Government and Minister for health professional led clinical networks. You will hear about how the stress of complaints and investigations truly affects your performance. You will hear proposals to establish doctor support for doctors. You will have chances to debate and discuss your own experiences and expertise.

I encourage you to challenge your Executive and national office. To tell us what we are doing well, what we can improve, and how we might improve. For as a Harvard Professor of Government has said, a society needs lively exchanges of ideas in the middle and not just loud voices from its eccentric fringe. Too often the fringes get the reinforcement of repetition, and what is said often enough is believed as truth.

If we strive to strengthen our branches, lead clinical networks, and support ourselves, we will show that truth is not merely bullshit that has lost its stench. Truth lies in collective and collegial discourse and action in the middle.
It is based in the art, the difficult decisions, the complex ethics, the resource allocation, the true mentoring of a profession that really trusts our colleagues, our teachers, and our learners.

All the wise doctors you are privileged to sit beside today.


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