along with writing referrals

of everybody doing more .

seen by many as the repository

all the results of that radiology

Analysis

direct to specialists , independent of the patient ’ s GP .

But the implications are very real — fragmented episodes of

of a data dump , does not automatically notify you of red flags

report requested by the patient ’ s chiropractor down the road ?

Dr Paul Nisselle GP from Melbourne , Victoria .

Pharmacists and allied health are set to expand their practice scope .

The insurers

My gut feeling is that the current

insurers who provide cover for allied health practitioners cannot afford to ‘ wait and see ’ if claims against their clients go up — unless they have massive reserves on top of providing for known claims .

care does not mean fragmented indemnity risk .

There is one scenario that I guess all doctors fear .

Swamped by data

The scope of practice review

issues paper released in April talks a lot about ensuring practitioners post their doings and

as , for example , prescribing software does .

A legal smoking gun

When complaints are made following

adverse events , that piece of information buried in some report posted on My Health Record could come back to bite you .

Or the result of the pathology test ordered by the pharmacist now attempting to help out with the management of the patient ’ s diabetes ?

I am afraid the answer is , who knows ?

In all these cases there is little legal clarity because the cases that go before the court are all

Despite the hue and cry and

their findings on My Health

It could be a legal smoking

individual in their nature , and

genuine concern among doctors about what is happening , it is arguably the dollar figure of future premiums that will offer

Record in the belief that this will keep everyone up to date

gun . Lawyers are very diligent in looking for such opportu-

the outcome is dependent on the particularities of that case .

As such , the rules of the game are therefore blurred .

lution — the expansion of the scope of practice of pharmacists into independent diagnosers , prescribers and dispensers .

Pharmacists

It has already started in Queens-

a precise quantification of what those with skin in the game — the insurance companies — judge when it comes to the safety risks that are being taken .

The dollars are something more concrete than the bland

Do you have to go through all the results of that radiology report requested by the patient ’ s chiropractor ?

Test cases that give clear legal certainty are rare indeed and do not usually apply to the messy reality of clinical practice . There is still some way to go . We do not know yet what regulations will surround phar-

land with pharmacists , subject

reassurances from ministers that

macists and community nurses

to training , free to diagnose and

no-one should worry .

providing independent primary

prescribe for conditions ranging from gastro-oesophageal reflux disease , acute nausea and vomiting , allergic and non-allergic

Impact on premiums

However , there is a deeper question

, of much greater relevance

with what is happening to their shared patient .

But the capacity for mass information uploads risks GPs

nities for their clients to add codefendants .

At this stage , you will want me to provide you with some

care .

Quantifying risk

But some clever boffin within

rhinitis , to impetigo , shingles

to GPs , and that is the possi-

being swamped by data within

reassurance .

the insurance industry will no

and moderate atopic dermatitis . This is now well beyond

Schedule 4 antibiotics for UTIs .

ble impact on premiums for GPs stuck in this brave new world of independent prescribing and

which floats that one mote of information — an apparently minor symptom , a minor diag-

Who knows ?

Do you as the patient ’ s usual GP

doubt be tasked with quantifying not just the increased legal risk to their allied health prac-

Allied health

We also have the spectre —

diagnosing and diagnostic test ordering by those without a medical degree .

nosis , an apparently trivial finding or a drug prescription — that will have serious implications

have a duty to keep an eye on the patient ’ s health record as more and more information is added

titioner insured but also the possible impact of great GP premiums — I do not envy them .

raised by the Federal Govern-

It has been suggested that

for the patient ’ s safety if it is

so you can step in and advise the

Perhaps one or more of the

ment ’ s scope of practice review

the scope of practice review has

missed .

patient that you have concerns

medical insurers may wish to

— of allied health professionals

not paid much attention to this

It is the indemnity version of

about the care they are being

comment .

being empowered to order tests

issue , too distracted by what it

the kraken .

provided ?

As I said , it is a brave new

and imaging through Medicare

sees as the exciting possibilities

My Health Record , already

Do you have to go through

world .