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Thursday, 29 May 1997
Page: 4062

Senator WEST(8.07 p.m.) —I rise tonight to talk about an issue which is probably quite topical and appropriate, given the ABC's program on men's health that starts at 8.30 tonight. I want to draw to the attention of people in the chamber and anyone who may be listening what I have noticed lately as a plethora of advertisements, appearing often in the Sunday newspapers but certainly in weekend newspapers—in the city newspapers, but now beginning to appear in country ones—about men's clinics. Often these ads begin with questions such as, `Do you have a problem with impotence or premature ejaculation?' I am a little concerned about some of the things that I am hearing or have discovered about these advertisements.

One of my constituents came in to see me last week. He had seen an ad in the local regional newspaper which offered a men's clinic. He thought it was in the local community, because the ad mentioned the local community medical clinic—and I do not want to identify the area. The ad gives a 1800 number, it gives the times to call and it says, `bulk-billing available'.

My constituent is an age pensioner. When he rang the clinic, he was told that the charge would be $40. After having got to the clinic and having had his consultation—which he says took all of something between three and four minutes—he was charged $80. When he inquired as to why he could not, as an age pensioner, be bulk-billed—because I think every one of the GPs in this community bulk-bills aged pensioners—he was told that they only bulk-billed people who were in receipt of disability support pension, which is the old invalid pension, those who had health care cards and those who were in receipt of unemployment benefits.

He was very upset the first time this happened. He then took the receipt down to Medicare to make a claim. Of his $80, he got back $37.65. Because he also had to have a blood test, he was told to come back four or five days later. He went back to get his blood test, that again took a matter of two or three minutes, and he was told that the bill would be $42.35. This is a gentleman who is an old age pensioner, he did not have that money on him and, after some discussion, he was bulk-billed a second time.

But my constituent was very angry and very upset, and made his way straight from those premises down to my office. I thought it was a bit rude because, when he came in, he had a card giving the appointment date for that particular day's appointment—the second appointment—and that card had the name of a different men's medical clinic on it. My constituent did not know the name of the doctor he had seen because it all took place so quickly.

I rang the 1800 number only to discover that it was actually a Sydney number, and that apparently this person comes to the area once a fortnight or once a week to conduct these clinics.  I then further looked at my constituent's Medicare statement of claim, a copy of which he gave me. I had all along been assuming that the people who were conducting these clinics were specialists. I could not work out how he could be going to these people without a referral from his GP.

His Medicare statement of claim referred to his consultation as being under item 36. After talking to the office of the minister for health and the shadow minister for health, I discovered that item 36 in the Medicare schedule is a general practitioner visit. It is for professional attendance involving the taking of a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems, and lasting at least 20 minutes; or a professional attendance of less than 40 minutes duration involving components of a service for which a number of other items apply. That was the item that he had been charged under, for which the rebate was $37.65.

I was most surprised to learn that these clinics appear to be being conducted by general practitioners, not by specialist urologists—the appropriate group of the profession, I would have thought, to be conducting these clinics, particularly for elderly men where there are problems with prostate for which they want to have regular examinations and regular checks which usually involve a physical examination, as there is still a lot of conjecture about the efficacy of the blood test examination with the number of false negatives and false positives that may show up in those procedures. But, no, it would appear from this document that the people conducting these are general practitioners.

I rang the clinic because I could see where it said `bulk-billing available' in the ad, and I wanted to know why they were refusing to bulk-bill my age pensioner constituent. After a number of phone calls, I finally spoke to the doctor. All along I was being told that they only bulk-billed—this is what they were saying to me—invalid pensioners, those in receipt of sickness benefits and health care card holders. When I said, `But health care card holders can be old age pensioners,' they said, `Oh, no, no, no; we can't afford to bulk-bill all of that particular group.' I do not know the rationale for choosing to bulk-bill disability support pensioners or recipients of sickness benefits. I also find the rationale of not being able to afford to bulk-bill aged male pensioners rather alarming, because we know that men do not look after their health as well as women; they do not have checks as often as women do.

My constituent tells me that on his second visit he asked about snoring, which he also has a problem with. He alleges he was told by his doctor that he could not do anything for that. I have advised my constituent that in future he should, in fact, see his general practitioner and, if he is hesitant about having an examination for his prostate by his general practitioner, to ask for a referral to a urologist. There is a very highly qualified urologist in the area, whom he had previously seen and whom he thought was absolutely wonderful because he took time to explain what was happening.

I have also told him that if he is having problems with his snoring he should see his general practitioner again and that there is in fact a sleep and snoring clinic at Royal Prince Alfred Hospital that is looking very closely at and doing research and valuable work on this problem of snoring. My constituent was very pleased about that.

I am most concerned that it appears that a number of these men's clinics are not being run by specialists, as I had assumed they would be. Men probably prefer to go to men's clinics for the same reason that a lot of women prefer to go to women's clinics, in that they are dealing with very sensitive and personal issues and the examinations are not enjoyable. Dropping the trousers is not something that comes naturally to anybody.

Senator Brownhill —This is a heavy speech!

Senator WEST —It is a very serious issue, Senator. I am sure you recognise this. It is an issue that people feel very uncomfortable with. Men feel equally uncomfortable about having rectal examinations as women do about having vaginal examinations. The reason why a lot of women go to women's clinics is that they do not have to see the doctor or the person performing the examination socially, or when they go back to the doctor for another reason they do not have to face the embarrassment that they feel about discussing these issues. It is a sensitive issue for a number of people.

I can understand why men are doing it, but I would urge a great deal of caution, because it strikes me that there are a number of—I do not know whether I can say rip-offs and sharks, those might be words that are too strong, but I certainly have some grave concerns, from the information and the allegations that my constituent has supplied.

As I say, I have already followed it up with the minister's office and the shadow minister's office and I will be following it up further at estimates because I think this is an issue and an area that needs to be looked at more fully and in more detail. I will certainly want to know more about this plethora of clinics. The doctor did talk to me about competition, and competition in health care and competition for men's sexual and reproductive problems is something that is an anathema to me and I would think an anathema to most people in this place.