“Surgery in Modern Models of Care”

Royal Australasian College of SurgeonsAnnual Scientific Congress

Tuesday 4 May 2010

Professor Jim Bishop AO

Chief Medical Officer

Australian Government Department of Health and Ageing

Australia compares well among OECD

Broad cause mortality trends Australia

NSW Population Age Distributions,Males (1977-2036)

Burden of major disease groups, 2003

Cancers with reducing death rates 1997 to

2006 – all ages

Lung, -18.5Colon, -19.6 Prostate, -19.7

Leukaemia, -23.7

Stomach, -29.4

Head and Neck, -23.7

Bladder, -18.5

Testicular, -42.2

Breast, -13.8

Cervix, -38.3

NHL, -25.1

Unknown, -24.8

Rectum, -19.9

Bowel, -19.7

All cancers, -13.8

, -24.3

-18.5

Kidney, -24.1

, -15.2

-31.9

, -21.1

-19.0

-19.0, -18.9

-7.9

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

Male Female

All Cancer- Mortality/Incidence ratios 2002

for selected countries

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Mor

talit

y/In

cide

nce

Male

Female

CANCERMilestones in Survival

Improvement

Preventions – Tobacco control

Early detection

•Screening

• Interventions

Better treatments – medical research

Clinical trials of better approaches

Evidence based standard practice

Breast cancer mortality

NEJM 2005SOURCE: N.ENGL. J MED: 353:17

WHAT IS THE SURGEON’S ROLE ?

Well oriented to patient needs and unmet

needs

Diagnosis/first advice following diagnosis

Multi-disciplinary team leader/member

Disease expert/International models of care

Teacher, mentor to new wave of graduates

Advocate for prevention and early detection

NSW CANCER PATIENT SATISFACTION SURVEY 2008

Courtesy of Doctors 95.5%

Risks benefits explained by Surgeons 90.0%

Patients received right amount of pain

medicine 89.6%

Cancer Institute NSW Patient Satisfaction Survey (8,800 cancer patients participated)

LOW LEVELS OF PATIENT SATISFACTION

Choice of Admission dates 28.9%

Patients having enough say about treatment57.3%

Patients being given enough information 58.6%

Patients given enough emotional support 61.1%

Source: Cancer Institute NSW 2008

BETTER INFORMED PATIENTS

NSW Patient satisfaction survey:

Comfortable asking medical staff questions about

their condition or treatment (73.1% satisfaction)

Evidence based questions given to the patient increases

understanding, retention and reduces anxiety

Medical Psychology Unit: Butow, Tattersall et al

The difference between localised and regional extent of disease at diagnosis

1%

10%

1%

11%

14%

6%

23%

23%

26%

21%

38%

28%

24%

28%

22%

23%

29%

20%

21%

21%

40%

26%

33%

9%

12%

5%

0% 20% 40% 60% 80% 100% 120%

Pancreatic

Liver

Oesophageal

Lung

Gallbladder

Unknown

Stomach

Tongue

Mouth

Head and Neck

Bladder

Larynx

Small intestine

Connective tissue

All cancer

Cervix

Ovary

Large bowel

Colon

Rectal

Kidney

Uterine

Melanoma

Prostate

Breast

Thyroid

Regional

Localised

Base: 2006 – n=14, 2008 – n=16

OPPORTUNITIES FOR TRAINING ANDMENTORING – HEALTH REFORM 2010

COAG AGREEMENT

60% Australian Government funding for Hospitals including teaching and research

100% funding for primary care Local Hospital Networks including Lead Clinician

Groups Three new National Agencies including Australian

Commission of Quality and Safety

HEALTH REFORM: SPECIFIC MEASURES IN WORKFORCE

Over all immediate COAG package $5.4 billion from 1 July 2010

Additional $632m – 5,500 places for GPs - 5,400 pre-vocational GP

Places - 680 Specialist

places Health Workforce Australia established

Initial emphasis on Clinical training places

CONCLUSIONS

Understanding our patient’s unmet needs

Training – in areas of future burden

Treatment – role in prevention, screening early

intervention, initial counselling

Leadership –work with multi-disciplinary

teams to develop and implement best practice

Review and promote high standards of care in

areas of expertise

FUTURE ROLE OF SURGEONS