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Potential for patients and community level medical practitioners to influence high technology healthcare: evidence from Perth, Western Australia

Thomas, Terrance (2007) Potential for patients and community level medical practitioners to influence high technology healthcare: evidence from Perth, Western Australia. PhD thesis, Murdoch University.

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Evidence is presented from a Case Study of the Inquiry into King Edward Memorial Hospital, a tertiary level maternity hospital in Perth, Western Australia, that values of medical professionalism can be distorted and contribute to impaired standards of care. Moreover, it is argued that the managerial tools of clinical governance will be insufficient to remedy dysfunctional institutional care.

This thesis proposes that an augmented primary level doctor-patient relationship support a coordinating and advocacy role for general medical practitioners into the care and safety of their patients when those patients are admitted to hospitals under the care of medical specialists. A relationship between patients and primary level doctors willing to undertake such roles would reciprocally support the more personally involved relationship required. This relationship could expand to promote a more appropriate and sustainable use of medical technology.

Research in this thesis explores the adequacy of the primary level doctor-patient relationship in Perth to establish the individual level care of the type necessary to breakdown the present fragmented nature of healthcare services. Healthcare consumers in focus groups were presented with hypothetical situations designed to illustrate aspects of healthcare by general medical practitioners. There was found minimal support for the concept of continuity of care unless co-payments were discarded and attendance was made convenient and timely.

A number of experienced general practitioners in Perth were also interviewed on their views of the fragmented nature of healthcare, and the degree to which primary level medical care could contribute to its improvement. They all supported the concept that continuity of care was important to primary level healthcare and thought that most of their older patients agreed with this concept. The research found a significant difference in the perceptions of patients and doctors that requires being resolved. Some Perth general practitioners aspire to more demanding professional roles that could include leadership in total patient care. However any hope for an expansive contribution by primary medical care in promoting a patient voice in the use of healthcare technology, including in tertiary level hospitals, is at present unlikely. This thesis makes suggestions into reforms and research that could lead to a redirected healthcare system based around the concept of personalised patient care.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): Institute for Sustainability and Technology Policy
Supervisor(s): Booth, Michael and Marinova, Dora
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