As my three years as ACT president of the Australian Medical Association (and an extra year for Covid!) come to an end, I don't know how to express my humble thanks to everyone in every part of our health system.
Having spent so much time working - collaboratively, respectfully but very doggedly - with government and systems to improve patient outcomes in our territory, I wondered how to frame these thoughts.
Ghastly Offspring Number Four suggested I complain about the injustice of a pass mark being 65 per cent or more for a driving test, bristling at the thought of having to make an effort.
"What's wrong with 50 per cent?" he declaimed, like Hamlet on a whinge because he'd have to miss Ophelia's party to study for the Danish road ready. Fair question - he'd only just finished hearing my pontificating to his older brother, Home-Too-Late, warning him that "perfect is the enemy of good". If you strive for something to be perfect before you action it, you won't get very much done.
"So why should Number Four be perfect in this test?" said the middle brother, Work-In-Progress, who is both a journalist and a pain - an apparently common combination. Their sister, Raised-by-Wolves, came to my rescue.
"What Dad means," she spoke through a mouthful of other people's breakfasts, fingers breaking the internet, "is that sometimes things have to be excellent every time. Anything else doesn't work."
Hmm, said Number Four - "give me numerous examples, Dad, and send them to my legal people before the end of first term. I'll form a subcommittee to do a scoping study to decide whether I should get back to you, funding pending. Oh yeah - can I borrow 20 bucks for Desdemona's party at Big Splash?"
Challenge accepted. Sure, I got 51 per cent in enough exams, and yes, the Raiders winning by a point is as good as by 30. But if one of those Raiders gets a broken ankle and does not diligently stick to his rehab program, ending up with a 70 per cent recovery? Hopeless, all acceleration lost. Eighty per cent? Still hopeless. Ninety-two per cent? Career. Over. If it's not close to 100 per cent, it's not good enough. In fact, the sporting field is where we learn a lot about excellence. A 97 per cent tennis player will usually get thrashed in straight sets by a 99 per cent tennis player, especially if I've got her on a multi with whoever's playing the Dragons. Do you really think the Wallabies, who've lost the Bledisloe 18 years straight, aren't brilliant players? They are. Just not completely excellent, which the All Blacks (very hard to say this) ... are.
Our hard-working emergency doctors will tell you a patient saturating at 99 per cent oxygen is fine; one at 92 per cent is seriously struggling. Our wonderful public health physicians understand herd immunity in a vaccination program across a nation does not come when 50 or 60 per cent of us are immunised - it has to be a lot more. And my friend Works-Too-Hard has a goal every hour or two - do the surgery perfectly and make sure the patient is alive and healthy afterwards. Every time. For the past 30 years and counting. Anything less than 100 per cent success is unacceptable.
You think that's hard? Ask a teacher, a childcare worker, or any of those to whom we entrust our kids, and for whom anything less than a perfect safety outcome is unacceptable. One particular mistake for a train or bus driver, a police officer in a crisis, a pilot, a building safety inspector, a sparkie - any of 1000 people - is potentially career-ending and life-ending.
If you are wondering where this is going, it's the usual two things. One: let us thank and praise the army of people in Canberra being relentlessly excellent, careful and safe in their jobs, every day of our lives. That includes our front-line health workers who do so much heavy lifting. Two: the standards we strive to maintain need to be articulated, clarified and agreed to by a government with its citizens, and followed through with rigorous application. Fifty-one per cent is not good enough for a health service. Neither are the years of consistently poor performance, so often the worst across every state, by the ACT in emergency and outpatient and surgical waiting times, and a whole range of other parameters, that the AMA has been pointing out publicly for years, because - guess what - so many health people feel scared to point it out themselves and need an independent voice to speak for them.
How do we fix this? Firstly, bring it to people's attention, as we've been striving to for years, until leaders listen. Our Health Minister recently announced some brave numerical targets with numbers and with dates, such as 70 per cent of ED patients being seen within clinically acceptable times by October this year. Our Mental Health Minister also took promises to last year's election that we have not yet seen manifested, including 13,000 free psychology visits for Canberra under-25s.
We also need to thank and support those who often get blamed - the hard-working and committed bureaucracy in ACT Health whose desire for excellence is no different from that of clinicians, and whose efforts are so often unrecognised. Benchmarks, SMART goals, time frames, measurement - all of these things sound great, but particularly when accompanied by accountability. This is vital - our health landscape for decades has featured great policies and marvellous announcements, often with a delivery that is patchy or, sometimes, not at all.
We will add the final piece of that puzzle by holding people to account for the promises they make to their citizens on a quarterly basis. This will include our soon-to-be released scorecard on all of the key health promises made by Labor and the Greens before the last election, and how they are progressing against them. The only thing I can tell you - 51 per cent is not likely to get them a pass mark from the people they administer, so many of whom work every day striving for excellence.
Finally, I'd like to thank the wonderful people of Canberra for listening to the AMA for all these years, and I know my successor, Professor Walter Abhayaratna, will lead us kindly and brilliantly. Thanks so much to my families at Yarralumla Surgery, including our wonderful and patient patients, my brothers Rajeev and Damien and Wal, and that wonderful family in our loud happy home, led ruthlessly by my wife Cath, who puts up with me doing two full-time jobs.
Getting people off Manus and Nauru, advocating for good policy and the end of childhood incarceration and LGBTQi injustice, protecting the vulnerable, helping federal and state leaders navigate Covid, and 1000 other issues - it's been an honour. My eternal thanks to all those brave people fronting up to work in the healthcare sector every day in this town, for whom every day is the search for that 100 per cent excellence, delivered with compassion and brilliance. It is for you and your efforts that my past three years in this role has been worthwhile.
- Dr Antonio Di Dio is the outgoing president of the Australian Medical Association (ACT).