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  1. 1

    Mr Pastry

    Rather the Medicos than the MBAs. The lesser of two evils. MBA activity always percolates into restructuring organisational charts, office space and commissioning logos and mission statements, all other work gets dumped on others below. This MBA work could be easily handled by the old lady that volunteers in the coffee shop on Thursday afternoon before she goes home.

  2. 2

    Scott Grant

    One problem I have with the whole “doctors should be running hospitals” idea is that it entrenches the notion that doctors are the only people providing services to patients.

    We could start with nurses, who provide most of the actual care. What happened to the old idea of a “matron” running a hospital? (Nowadays called a “Director Of Nursing”). Send in a platoon of Hattie Jacques clones, I say!

    Then, within hospitals, there are many people providing services – physiotherapists, nutritionists, laboratory scientists, pharmacists, radiologists, cooks, cleaners, wardsmen, and so on. Then there the support services – electricians, plumbers, gardeners, clerical workers and so forth.

    Once upon a time the purpose of a hospital was a place of respite where, for the most part, people were cared for while they healed themselves or died as peacefully as was possible. I think we have lost too much of that as doctors have imposed themselves as physiological engineers, inflating the cost of treatment so that patients are now discharged before they are fully recovered, in order to save money.

    As the main article points out, area health services also provide services to the community – social workers, home nursing, community health centers and so forth.

    In short, doctors have a specialised, and useful, area of knowledge, but they are only one of many who provide and support health care. They are no more likely to make good managers than anyone else.

  3. 3


    Even the US Institute of Medicine proposed ten simple rules for the design of a 21st century health system in 2001 that proposed among other things a shift from the preference given to professional roles and dominance of the medical profession to incerased cooperation among clinicians. There is greater need for multi-disciplinary care as the health burden shifts to increasing levels of chronic conditions within the community.

    Medical care does not equal health care. The biomedical model of health does not adequately reflect the impact of lifestyle and behaviours on health status with its focus on treatment and cure rather than prevention. Medical input and medical performance is a critical component of health care but it is no less important than nursing care, pharmaceutical, nutritional and exercise advice. A doctor walking into hospital to perform their services requires and expects resources and support functions to be provided in the same way that a pilot does when entering the cockpit on a plane. The performance required to fly the plane from its origin to its destination is similar to the surgeon entering the operating theatre or the radiologist reporting on an image. Many activities occur before and after the virtuoso performance that do not require medical knowledge or input. With the incidence of fatal adverse events equalling the total loss of life on 13 jumbo jets annually (4500 lives) there is little prospect that anyone would choose to fly an airline with that safety record yet we have little choice in health care. For anyone to suggest that pilots alone could save that sort of airline from catastrophe would be questioned and yet that is what John Graham proposes for hospitals.

    The issues that require to be addressed in considering resource allocation, equity of access, effective, efficient and safe or quality care are system level views. They require a community or population-based perspective that individual clinicians treating individual patients don’t readily acquire. Clinicians don’t enter their clinical profession with an expectation of becoming the manager of a hospital. We need to recognise that there is a need for specialist players in the different roles that are required. Debate the need to improve management, debate the priorities that should guide the allocation of resources but don’t be simplistic about the answer to complex problems.

  4. 4

    Doctor Whom

    Theres nothing to stop doctors from running hospitals.

    In fact many do already. All doctors have to do is apply for jobs as they arise and get appointed on merit. Not all that difficult. There are doctors as CEOs, doctors as Clinical Executives, even some in ICT.

    I’m guessing John Graham doesn’t want his local GP or a physician (non-surgeon) running the hospital.

    Perhaps what people mean is that surgeons should be able to say how hospitals should be run by popping into a meeting thats half finished for 10 minutes, having blast or a brain fart, then buggering off to surgery and consults and the uni post for the rest of the week only returning next week to repeat the performance.

    Bristol, King Edward and dear old Bundaberg were a result of doctors running the hospital”. Jeez if Bundaberg had had even a basic safety and quality set up run by a junior work experience boy, whatsisname would have been out on his arse before he was even in.


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