This is not the Bruce Shepherd of the 30-second TV grab _ the aggressive conservative getting stuck into Labor’s plans to “”nationalise medicine”.
This is a more reflective mellow man. Dr Shepherd stands down as president of the Australian Medical Association on Sunday (May 30).
What would he do if he were Minister for Health tomorrow?
You’d expect him to say “”tear down Medicare”, but no.
“”I’d put an enormous tax on tobacco,” he said. “”If there’s one thing we have learned it is that the cost of a packet of cigarettes has a tremendous influence on young people not starting smoking.
“”Every day we see so many tragedies from tobacco smoking. I’ve known politicians who’ve changed their mind about tobacco taxing when one of their family get a tobacco disease. . . .
“”When you think of what it costs the community in cigarette smoking, tobacco smoking, surely we can take more money out of that industry and get it into research at least so they can pay back some of the $4 billion a year that it costs the community to look after the people who get tobacco disease.”
Dr Shepherd tells the story of how he fell into the media trap and got his image. He had a message about Labor’s Medicare intentions in 1983.
“”But I didn’t even know what a press release was. I was playing tennis with someone who worked with the Fin Review and I asked him, “When you have got a message you want to put over, how to you do it’. He said, “You put out a press release’. I said: “What’s that?’.”
He sweated over the press release, but didn’t get one call.
“”You have to be outrageous or controversial, I was told.”
That’s how the image was created.
“”Someone said TV news is simply an entertainment and you get categorised,” he said.
“”It’s partly my fault. I don’t regard myself as particularly aggressive person. I tried to reason with the politicians before Medicare, but was getting nowhere.”
He now uses the language of conflict jocularly. He is sitting the AMA’s splendiferous new-age building in Barton “”a mortar’s lob from Parliament House” he jokes.
He refers to motor-bikes as Hirohito’s revenge. Hirohito was Japan’s wartime emperor. Japan swamped Australia with motor-bikes from the late 1960s and Dr Shepherd has helped pick up the pieces.
“”All my life I’ve had this trouble with motorbikes,” he said. “”In our trade they are known as Hirohito’s revenge. You get up in the middle of the night and some young fellow has come off a motor-bike. Often a beautiful young man. Mangled. And you just think: I hate bloody motor bikes.
“”We still have to repair them even though it is partly self-inflicted, like alcohol and tobacco.”
Is Dr Shepherd happy going back to medicine full time: “”Oh yes. I’ve got a number of papers I want to write on joint replacement. I’ve got all the computer data there to do it.”
And get out of the politics of it? He hesitates, trying to find the right words: “”Yes; I believe that I’ve had enough. I really didn’t want to get into it in the first place. I fell into it, more of less.
“”I ran into one of my older colleagues the other day. He’s been 50 years in AMA and just got his gong. I said to him, “You bastard, you’re the one who made me stand as state chairman of the Australian Orthopaedic Association’. That’s how it all started.”
Dr Shepherd launched his career in medical politics from the NSW branch of the Orthopaedic Association. He thought the AMA was not doing enough to preserve the independence of the profession, so he stood for election. He won the presidency in May, 1990.
But it has not been all conflict.
“”I think the AMA should co-operate with the government wherever it possibly can,” he said. “”But it should never sacrifice its principles. I think there are some things that Senator Richardson would like us to do that I don’t think we should do.
“”We can’t walk away from wanting to make our main responsibility and identification to be to the patient.”
Dr Shepherd constantly comes back to the doctor-patient relationship.
“”The relationship with doctor has a lot to do with the speed of recovery,” he said.
“”. . . My biggest single motivation is that I like to see the profession as far away from government as possible. We have a much more important role looking after our patients than worrying about what the government is doing.
“”I remember sq(the former Minister for Health) Neal Blewett saying something to me which I took as a complement. He said every other western country that has taken on the nationalisation of the profession has succeeded, why won’t you let it happen here.
“”I think the fact he attributed that to some of my efforts was a complement. It is a good thing for the country. Virtually every country that has brought in a free health system is walking away from it. Sweden last year brought in a rule that if you go to a family GP you have to pay $30 out of your pocket.
“”We can’t sustain Medicare the way it is now. Some form of rationing has to be maintained.”
More people had to take responsibility for their own health care.
“”That doesn’t mean I want to take away the safety net. I’ve worked all my life looking after people who could not look after themselves properly.
“”If you want to summarise it, I’d put a means test on Medicare. You can call it what you like. I’ve come to accept the word. For me, Medicare should be a safety net.”
You could offer carrots and sticks to encourage people to take out insurance, but ultimately “”you have to look after the people who refuse to take out insurance.”
No matter who the patient was, he said, “”I get the biggest buzz when I fix a hip and a patient says look how well I’m walking.”
He has mellowed on the insurance issue. He has now been convinced against the US system of risk-rating for insurance (so the aged and people more likely to get sick pay higher premiums pay more). He thinks all should pay the same premium, community rating. But community rating was now in danger now.
He was also worried that medical malpractice suits would increase. Australia was heading towards the US position, where people joked that “”you may as well get a lawyer to deliver the baby”.
“”We have got to find a way of sorting it out before the cost component of malpractice insurance gets too high, perhaps $30 to $40 a visit.
“”All it does is give work to lawyers. It does not make for happy patients. It doesn’t help the community a lot.”
The increase in malpractice suits came because there was an expectation of perfection in the community.
Dr Shepherd went to Sydney from Tamworth aged 16 to study dentistry.
“”Someone convinced me I was not smart enough to do medicine,” he said. “”But I liked the medical parts of the course.”
So he did medicine.
“”Dentistry is sheer hard work,” he said. “”Every day is an exam. You’re being checked on. . . When I operate now I’ve got a patient who’s dead meat. They won’t answer back. A dentist has to be all the time pacifying a patient reassuring them.
“”Not many people like going to the dentist; actually I’m one that does. They are ahead of us. They have got power tools. they have been using cold-curing acrylic for decades before we in the medical profession used in hip replacement.”
On leaving the AMA, as well as concentration his busy practice, he will do more with the Shepherd Centre (he is somewhat embarrassed about being convinced to change the name from the Council for Integrated Deaf Education). He has five centres helping 120 families.
He has resisted bowls despite urgings from Nick Sheheadie(??). He and Sheheadie(??) were the two youngest in the 1947-48 Wallaby team.
The best thing he has done in AMA over the three years was that people in AMA are now more interested and more involved. The look upon AMA as vehicle for achieving things.
“”Companies don’t understand that people are the most important asset,” he said. “”People are everything. There is only one asset _ that’s the people.
It would be like me doing your job; I’d make a mess of it. Or I could give you my practice, I mean everything is there . . . .”