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Ask Dr Dave - December 1997
Bloody Woolridge! He says he is not the Minister for Doctors' Incomes and that if I want to earn more I will have to work harder. What other group has had their income frozen for the last five years with no prospect of an increase in the next three?
Choking Dear Choking
The Federal Department of Health announced this week that support for Medicare had reached an all time high of 93%, up from 44% when it started in 1984. People like the fact that everyone is covered and it is considered value for money. This is almost the opposite of how they view private health insurance. Both Choice magazine and the Australian Consumers' Association deny that Medicare is in crisis and believe that because of its size and universality Medicare has kept cost rises in check. This is confirmed by Medicare figures showing a drop in real terms in payments per head of population.
You are doing an important job and are a pillar of the community. Being a general practitioner is like being a priest. It is a calling not a profession, because professionals are paid for what they are worth.
Remember to always look on the bright side of life. You are working harder for less money. This means your efficiency has gone up considerably. So when you see your accountant at the end of the financial year, you will have that warm inner glow to compensate for all your hard work.
Dear Dr Dave
We are constantly being encouraged to use computers so that we can work smarter and not harder. However, I read in a letter to Australian Doctor recently that communication over the Internet is unsafe and could be intercepted. I also heard that the HIC will not accept an email as a valid form of referral to a specialist. Are we just wasting our time and money by investing in this technology?
Stymied Dear Stymied
What you say is true. However, there are some recent changes that are making electronic communication easier, safer, more reliable and legal!
Firstly, the Department of Health and Family Services are reviewing the legislation that makes a letter the only valid form of referral to a specialist. The Department is currently reviewing the legislation so that email will be permitted. Like most users the Department is concerned that privacy is maintained and is looking at the various encryption options.
Secondly, the current breed of Internet browsers and email packages have digital signatures and encryption built in so that the security of electronic communications will be easier and better than using ordinary mail.
Thirdly, some of the more sophisticated patient management programs like Medical Director will have links directly to you favourite email software. Instead of printing the letter on your printer, you will be able to "print to email". It depends on your surgery's network configuration but it is feasible that the letter and all appropriate pathology and radiology results will reach the specialist or hospital before the patient leaves the room.
Finally, with the advent of the Point to Point Tunnelling Protocol (PPTP) it is now possible to connect securely to a distant server over the Internet. This means you could get information from any server connected to the Net for which you have access privileges. These servers could be located in your surgery or Division or hospital.
It will take some time before all this comes into common usage. However, the enthusiasts are beginning to implement this now.
Dear Dr Dave
What is this digital signature stuff?
Curious Dear Curious
The mathematics of digital signatures was worked out in the sixties but it is only now that it is gaining widespread application in keeping Internet communication secure.
The principle behind this secure communication is the use of a pair of linked keys that are called public and private keys. A message that is locked with a private key can only be unlocked with the corresponding public key and vice versa. You make your public key available to everyone with whom you wish to communicate. (It is usually included with your messages.) In simple terms you use your private key on the message to produce a digital signature. The recipient decrypts your signature with your public key. This authenticates the message because only your private key could produce the digital signature for this particular message.
Now that the recipient has your public key she can use it to encrypt a message to you. The message can only be read by you because only you have the private key that can decrypt it. She can also sign the message with her private key (as you did originally) so that you know the message could only have come from her.
The trouble with this system is in knowing if the person with whom you are communicating is using a valid digital ID. This problem is handled by the use of trust hierarchies.
A number of companies on the Internet have been set up to issue digital IDs. These companies are called certifying authorities. The best ones will issue a low level digital ID by charging US$9.95 to the user's credit card. The authentication process is therefore accomplished by both the issuer of the digital ID and the user's credit card company. Thus most digital IDs are as reliable as a credit card and this is acceptable to most businesses these days. One of the first and probably still the best certifying authority is Verisign Inc. You can read all about encryption and trust hierarchies on their Web site. http://digitalid.verisign.com/ask_veri.htm
Dear Dr Dave
I heard recently that a bloke developed RSI when he got hooked on the Internet. The orthopaedic surgeon said that the way he was holding his mouse wasn't the best ergonomically. Is surfing dangerous?
Grommet Dear Grommet,
Very dangerous. On the Net you can read how to make bombs and overthrow governments. If you know where to look there is some of the most shocking pornography imaginable. People have left their wives or husbands for someone whom they have never met in the flesh. Some people have lived a life of indolence by using their computers to steal credit card numbers and telephone accounts. The Net is one of the three major corrupting influences on modern life. The other two are public libraries and universal education. Still, you cannot believe everything you hear. As one wit commented when he heard about this Net RSI, "Are you sure it was the mouse he was holding?"
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