Dita De Boni 's Opinion

Business columnist, with a political twist, for NZ Herald

Dita De Boni: Standards fail health test

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League tables for doctors? If it works in education ...

Illustration / Anna Crichton
Illustration / Anna Crichton

Next time I want to change my doctor, I'll consult the new government league tables.

I know, you're saying there's no such thing. Preposterous, you suggest: how could every doctor in the country be ranked according to his or her competence? Can they, or should they, be compared? Is that even possible? And won't that pesky junior doctors' union and other lefty figures in the all-powerful medical fraternity kick up merry hell?

Well, that may all be true, but that's no reason not to do something, is it now? The catch-cry these days is freedom. Freedom of information. Freedom of choice. Openness and transparency of information.

Look, I grant you that doctors in more affluent areas are bound to hold an unfair advantage under the kind of scheme I am proposing. Their patients are probably more likely to eat wholegrain bread, drink moderately and - most importantly - have the money to consult the doctor more often, long before gangrenous toes and clapped out lungs compel less fortunate souls to visit the clogged-up corridors of the local A&E.

But come on; gangrenous toes never stopped anyone taking three buses across town to attend a doctor's surgery with better "national standards", did they?

Because that's what choice is all about. The patient decides where to go, who to consult - he or she isn't just turfed into the local primary health organisation or subjected to the medical specialists at the closest hospital. If we could just dump the socialist claptrap for a second, we might realise that not all doctors are created equal; some are terrible, while others can keep you alive on statins and injectable insulin long after you should, by rights, have clapped out entirely.

It's true that a patient's genetic makeup probably has just as much, if not more, to do with how healthy he or she is, as their doctor's performance. But it's inconvenient for this argument, so we'll put that aside.

Another beautiful thing about this plan is that it does away with the notion that doctors must be trained to a certain competence, and that senior members of the medical fraternity are the best to judge who should practise. The research debunks those ideas.

In the new system, costs will be contained by allowing the cleaner to double as a practice nurse, and the receptionist will prescribe contraceptives. Panel beaters and zoo keepers will be empowered to come in and assess doctors' professional ability. All in all, cutting through the red tape that too many small businesses face as a result of the last government.

Finally, the data. How to use it, what it will show, and how it should be interpreted. It will mean nothing in the first year, next to nothing in the second, and depending on who submits it and what their individual criteria are, you'll need a PhD in statistics to make head or tail of it in the third.

Note that assessments may vary from one doctor to the next. For example: "Doctor is above standard in ear-wax excavating" might accidentally be given the same weighting as "doctor is below standard in assessing where appendix is situated during surgery".

But I'm confident these are small issues, to be ironed out as the system beds in. After all, it's working in education, right?

* Illustration by Anna Crichton: illustrator@annacrichton.com

- NZ Herald

Dita De Boni

Business columnist, with a political twist, for NZ Herald

Dita De Boni is a columnist, commentator and TV producer/journalist. She first wrote columns for the NZ Herald in 1995, moving to daily business news in 1999 for four years, and then to TVNZ in Business, News and Current Affairs. After tiring of the parenting/blogging beat for the Herald Online she moved back to her first love, business (with a politics chaser), writing a column for Friday Business since 2012.

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