Wednesday, September 30, 2015

Why I've Been Using Uber Instead of Taxis

Uber is under attack.  

That’s easy to understand.  Taxi operators feel that their livelihood is at risk and state governments are losing out on tax revenue that they gouge out of the industry. To me, the arguments about safety and so forth is just disingenuous drivel to justify the attack on Uber. 

I have used taxis a lot but I now only use them when I really must. If I am not in a hurry, I would rather wait another 5 minutes to get an Uber ride rather than hop into an immediately available taxi.   It is not because it is cheaper - in fact I would be happy to pay a similar price for the service.  I am glad that Uber is disrupting the taxi industry as it seems that this is the only way to pull it into a customer focused service.

Taxi Drivers Need to Know Where They Are Going - Using a GPS is Okay

I am fed up with taxi drivers having no idea of where important landmarks are. Admittedly, I have this problem more so in Melbourne than any other Australian city. In recent times, I had a taxi driver who did not know how to get to the Hilton South Wharf (let’s make that he had never heard of the hotel). This is the major conference hotel attached to the Convention Centre and has been open for many years.  I showed him the way from the airport. When we were almost there, I pointed to the top of the hotel where the Hilton sign was easily visible. I put my head down for a few moments to check some emails and the next moment, he had missed the turn off and there we were, heading down Flinders Street towards East Melbourne.  Also, within the last 12 months, I had a driver who did not know where the Royal Melbourne Hospital in Parkville was located. I do not mind if they use a GPS - at least Uber drivers do not pretend to know where everything is located and will proudly use the GPS. In the two examples given, the drivers seemed too proud to use their GPS.  I have different expectations for taxi and Uber drivers in that I do expect professional licensed drivers to know where they are going. 

Clean Vehicles and Drivers Would Help

About 25% of the taxis I get into are grotty old vehicles or the driver is shabbily dressed and in need of deodorant. Just because they now need to wear a uniform has not necessarily made them look like professional drivers.  Maybe if they even just tucked their shirt in and did not have breath that smelt like an ashtray, that would be a good start.  Often the space around driver and the front seat is full of rubbish. To date, the vehicles I have encountered with Uber have been on average, far better than the average state of vehicles I have encountered with taxis.

Ordering a Taxi is a Painful Process

One of the most frustrating aspects of catching a taxi is when you order one. When the operator abruptly insists that 'it will be the next available', the eye rolling on their part is palpable.  You are subject to the lottery system where the 'next available’ taxi is who ever taps the accept button first.  Often I get a taxi that is 15 minutes away rather than the taxi that is around the corner from my pick up site because that driver was quicker with hitting the accept button.  To me, the next available taxi is the one that is closest to me that is available to accept my fare. 

Arachiac System of Standard Driver Shifts Needs to Change

The lack of flexibility of taxi shifts is also an annoyance. It seems that all taxi drivers are finishing their shifts at the same time - I am asking myself why is it that it is always at the time that I really needed a taxi pronto. This rigid approach is not customer focused. Uber has no specific shifts - drivers are available when they are available- simple as that.

No Andrew Bolt or Alan Jones on the Radio PLEASE

The radio. This is not a big ticket item at all but becomes a complaint to supplement all the other dissatisfaction with the taxi industry. They seem to have this love of talk back radio. If taxi drivers were to be thinking about their customers, they would and should know that many people find talk back radio with the likes of Alan Jones or Andrew Bolt to be offensive.  Any music of any genre is much less likely to offend a proportion of the patronage than that of toxic shock jocks.  My word of advice is to just not to have talk back stations on the radio unless requested and you will offend nobody.

As a grass roots user of taxi services, this is my take on it. 

Others may have a different take but my concerns about taxis are largely ignored and that is exactly why I am one of many who have gravitated to supporting Uber.  

Thursday, September 24, 2015

Do patients contribute to God complex in surgeons?

The recent EAG Report commissioned by the Royal Australasian College of Surgeons suggests that there is a toxic culture of bullying, harrassment and sexual discrimination in surgery.  There are probably multiple reasons why this toxic culture exists.  

One reason that seems to attract less attention is the attitude of self importance and self entitlement and being beyond reproach – or in other words a God complex that surgeons have acquired through their own experiences and being trained to think this way from their mentors. 

Hardly a working day goes by without a patient or their relative telling me how brilliant I was in helping them in their prostate cancer journey. I am always humbled and appreciative of these positive comments.  However, I am a very well trained surgeon who works hard and is obsessive compulsive in trying to do the best for my patients.  I’m just doing my job.  I’m well paid for what I do.  I have amazing job satisfaction.  Often I feel that I have the best job in the world.

But why such adulation for a person who is simply doing their job well?  What we do for our patients is very personal so obviously means a great deal to them.  Additionally there is a significant power imbalance, particular with knowledge and the fact that patients effectively surrender their trust upon us when we perform surgery upon them.

Patients are complicit to the God syndrome acquired by surgeons.  Health reporter Harriet Alexander is on the money when she  writes “For every surgeon who has a God complex, there is a bevy of complicit patients.”  If you keep telling surgeons how brilliant they are, after enough times, they’ll really start believing it.  By all means be appreciative of the work done by surgeons but time to stop the excessive praise for well trained individuals who are simply doing a great job of what they were trained to do.

Saturday, September 19, 2015

The Royal Australasian College of Surgeons elections have commenced. Will it result in positive change?

The Royal Australasian College of Surgeons has been rocked by the scandal of there being a culture of bullying, harassment and sexual discrimination in the Expert Advisory Group’s Draft Report that was handed down just over a week ago.  We have seen a formal apology from the President of the RACS and a promise that there is going to be change.  RACS policy and culture is determined by RACS Council which is made up of elected Fellows. 

Without doubt, the EAG Report is the ‘biggest ticket’ item that requires the attention of the RACS Council. The final EAG Report and the recommendations that arise from it will again place the RACS in the public spotlight.  The RACS has been applauded for commissioning the independent EAG Report which had every expectation of producing findings that would be highly damaging to the reputation of the surgical profession. When the RACS announces how it intends on tackling bullying, discrimination and sexual harassment for the future could be a watershed moment in the credibility for the organization and profession.

Right now is an extremely important time for the RACS. Voting in the elections for members of the RACS Council opened on Friday 18 September and will close on Monday 5 October 2015.  How the Fellows of the RACS vote could impact on public confidence on how serious the organization is in tackling bullying, discrimination and sexual harassment.  

There are 38 candidates for the 8 positions that are up for grabs.  The EAG Report should be the biggest ticket item on the agenda, but only 10 candidates have made mention of issues surrounding the findings of this report.  That’s right, only 10 candidates thought the issue important enough to place in their electoral statements.  Of those 10 candidates, 5 are women.  It gets very interesting when we consider that there are only 6 candidates who are women. It is clear that women consider the findings of the EAG Report to be of considerable importance and arguably more so than their male counterparts.

Let’s also look at the ethnicity of the candidates.  Of the 38 candidates, 34 are Caucasian, 2 Chinese and 2 from the subcontinent.  Of further interest, surgeons who either currently hold senior positions within the RACS or have done so in the very recent past have nominated 22 of the 38 candidates.  These nominating surgeons carry very high profiles and are highly respected within the profession and their support of a candidate does carry weight.  If this were not the case, candidates would not seek to have their names listed next to theirs in their electoral statements.  Alternatively, rather than these candidates seeking to have such nominators, could it be a case of like minded candidates being the ones who get the tap on the shoulder?

The average age of the candidates is 56 years, ranging from 34 to 72 years. The majority of candidates are clustered between 50 to 60 years of age. There are only 5 candidates who are less than 50 years of age. There is only one candidate who is less than 40 years of age.  How dare this person run for RACS Council you might ask?

The youngest candidate is Dr Nikki Stamp who has everything working against her in having any chance of being elected.  Apart from being female, she is also by far the youngest candidate and does not have the nomination support of the high profile RACS 'heavyweights'.  She is however, passionate about equality in all aspects of healthcare and determined to see the RACS make a difference with the issue of bullying, harassment and sexual discrimination.  She has her own stories but right now there is a bigger missionat hand and in order to make a difference, she needs to be elected to the RACS Council. She will disrupt the RACS Council but for all the right reasons.

If you are Fellow of the RACS and feel serious about change, do vote for Dr Nikki Stamp.  If otherwise, tell surgeons that you do know, to not just consider her candidature, but to vote for her. 

The RACS needs to change but the demographics of those who seek positions on the RACS Council makes me nervous about what the future holds.


For those interested, this previous piece "Action Must Speak Louder Than Words" which is  about the EAG Report may be of interest

Monday, September 14, 2015

Action Must Speak Louder Than Words

Medical Oncologist, Dr Ranjana Srivastava wrote on the subject of “how doctors treat doctors may be medicine's secret shame “ in the Guardian newspaper back in February 2015. About a month later, vascular surgeon Dr Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession.  She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, her career was ruined. Her statement that  she would have been much better to have given him a blow job” made national headlines in Australia.  This opened a can of worms and numerous stories suggesting a toxic culture of bullying, harassment and sexual discrimination (BDSH) were aired.  Under pressure, the Royal Australian College of Surgeons acted swiftly and appointed an independent Expert Advisory Group to investigate and to make recommendations.  Six months later, the draft report of the EAG  was published and results were “quite frankly shocking” as in the words of the President of the RACS.  The report was released in conjunction with a formal humbling RACS apology that has been uploaded to YouTube.

Prior to the release of the report, I had noticed a lot of discussion on social media and in real life on how the prevalence of bullying, harassment and sexual discrimination was overblown and stated to be no more so than in any other profession. Whilst the EAG Report makes clear that these assertions are absolutely wrong and that there is a special case for surgery that requires serious reflection and action.

On this basis, I then tweeted the following:- 

I followed the above tweet with the following:-

The tweet above generated interest and that evening was aired on the Lateline news program on ABC television.  This tweet does not suggest in any way that individuals with all of these attributes are part of the bullying and harrassment culture but think about it; they are the ones who are least likely to be subjected to it or to see it. If they chose to, they had the best opportunity to be untouchable.

As expected there is some criticism of the EAG Report as well as to my own comments.  The following tweets are more than likely to represent the tip of an iceberg for those who share similar thoughts. It is obvious that the vast majority in this camp have gone to ground since the release of the report but they will be observing closely and we can only hope that time will bring about attitudinal change.  I commend these commentators for publicly sharing their thoughts as it informs those of us who embrace the report as to the battles that lie ahead.

Some of the worst perpetrators of BDSH continue to be in roles of significant power.  We all know who they are and even subsequent to the EAG report, there will be reluctance to report or expose them.  How the RACS intends to deal with these perpetrators and exactly how they propose to change the toxic culture that exists within surgery is the major challenge ahead?  Whilst the RACS has worn the brunt of criticism for BDSH in surgery, hospital administrators have got away scot free.  They are equally, if not more, responsible for the reasons we have come to where we are now.  We eagerly await the final report of the EAG and detail of the proposed path forward.


Those of you who have read this piece may also be interested on this subsequent piece about elections to the RACS Council.

Thursday, September 10, 2015

More on Crowd Funding

Let’s say you need to fly from Sydney to London. You are a member of the frequent flyer program with Qantas.  If possible, you’d like to fly with Qantas because you feel loyal to the brand.  The problem arises in that you do not have the money to buy a ticket.  You set up a public crowd funding appeal and you explain how your Nanna is sick and you really need to visit her because it might be the last time you ever see each other again.  We all empathise and hope that you get some support.  

Somebody then points out that for the particular dates you are flying, that you could could save a significant amount of money by flying a different airline of equal quality such as Cathay Pacific or Emirates. You decline to consider this because you’d prefer to fly Qantas.  Your crowd funding campaign gets some publicity and both Singapore Airlines and Etihad hear about your plight and offer to fly you for free. You gracefully decline these offers as you have always been with Qantas.  People will either wish to donate to your crowd funding campaign or they won’t. That’s fair enough.  You are getting bit emotional and say your confused because you’re worried about your Nanna.

You are starting to get a few donations. What if your donors knew that you had turned down the option of flying a lower cost carrier? What if your donors knew that you had turned down offers to be flown for free? If they were to find out, would donors now look upon similar crowd funding exercises with cynicism. 

So what is this all about?  This piece needs to be considered in the context of this previous blog piece (click link to read) about crowd funding for prostate surgery.  

Sunday, September 6, 2015

Crowdfunding for Prostate Cancer Surgery - Just Shouldn't Be Necessary in Australia.

It has always saddened me to see crowdfunding campaigns to raise money for individuals to undergo live saving surgery in the private hospital sector.  Notoriously, we have seen campaigns for particular specialties and we could go further if we wanted, in specifying particular surgeons whose names come up repeatedly.  I was grateful that this was not something that we tended to see in my specialty of prostate cancer surgery but I guess it was only a matter of time.

The reason why I have thought that this would only be a matter of time was the intense competition that we see for robotic radical prostatectomy cases amongst Australian based urologists. Do a Google search and you will see a plethora of robotic surgery marketing in Australia. The fancy websites will have surgeons boasting about their extraordinary achievements in becoming experts in this aspect of surgery in their quest to entice you to utilise their services. Often there is the line of ‘most', ‘first', ‘pioneer' and so on. I was the first to do a robotic surgery operation in my hospital - I say 'big deal'. There is also the goading of site visitors to seek out a second opinion with the subtle suggestion of an expectation that they will be in better hands if they do so. 

There is also an issue of cost as the out of pocket expenses can be very high.

One reason why the out of expense costs can be high are the costs of consumables.  The consumables are the throw away items associated with the use of the technology.  It’s an amazing cash cow for the technology companies.  Hospitals have to spend huge amounts of money to buy the instrumentation and then have to pay for the privilege to use the machines by virtue of expensive servicing contracts and disposables (consumables).  Private health funds are not obliged to cover the costs of the consumables used in robotic surgery. Some funds will cover part or all of the consumables costs but if your health fund does not cover these costs, you could be up for as much as an additional $4000 out of pocket.  The other reason for the huge out of pocket expenses is that some surgeons feel a sense of entitlement to charge what they think they are worth. In some instances, this out of pocket expense of what is above the amount that can be claimed back from Medicare or Private Health Insurance could be over $10,000.  Robotic surgery is sexy and expensive. 

Thankfully, robotic surgery is available to non-insured patients at Nepean Public Hospital. Most people would not be aware that this is the case. I personally have had no issue in referring patients to Nepean Hospital and stand on my record for doing so.  There is however, no incentive for surgeons to notify patients who have financial difficulties that this service exists.  My colleagues performing surgery at Nepean Hospital are well trained and very competent at what they do.  It would be a brave prostate surgeon to claim and prove that they were significantly better than these surgeons.

I saw this appeal appear in my Facebook feed and not surprisingly caught my attention. I do not know the circumstances behind this case at all. I wish there was some way to tell him that he can receive ‘robotic keyhole surgery’ with a ‘top surgeon’ at the Nepean Public Hospital. He seeks to raise $35000 which suggests to me that he is either uninsured or his surgeon is charging an extraordinary surgical fee.  Most surgeons (I would like to think), no matter how good they think they are, will try to help out with the surgical fee if the patient is experienceing financial difficulties. Once again, I do not know the details of this case but I am saddened see a case of where prostate cancer surgery costs necessitate a crowd funding campaign.

Note:  This blog piece reflects circumstances specific to Australia and may have little relevance to circumstances elsewhere. In Australia, we have a public health system, which in spite of its many faults, will see that all can have access to necessary cancer treatment.

Update - see following related blog piece (click link)