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Health Minister Nicola Roxon’s latest proposal that patients be allocated to doctors on a list basis is straight out of the playbook of Britain’s National Health Service.

Let’s think about this from the patient’s point of view. Some doctors are better than others, the same as some plumbers are better than others. The reason may be a better bedside manner; it may be they are more competent; it may be just that there is a simple personality clash—it may just be that, at times, the patient wants a second opinion. Or it might be that the patient has a potentially embarrassing problem that he or she does not want to discuss with his or her regular general practitioner.

Some people who are ill-suited to their career choice are always going to slip through the system. In other words, if you are allocated a doctor you don’t like or who is a dud, you are likely to be stuck with him. Of course, the government will make some noises about “freedom of choice"; but in the end, a doctor who hangs up his shingle and succeeds or fails according to the quality of service he offers is going to provide a better quality of service than a public employee.

Now, all doctors, including general practitioners, must be members of the appropriate professional body, which accredits them as qualifi ed practitioners. This means they must first finish medical school and then qualify as surgeons, physicians, ophthalmologists or psychiatrists.

This postgraduate training is arduous and expensive, and practitioners naturally expect a return on their investment of time, energy and money—the average medical graduate is left with tens of thousands of dollars in university fees.

Much is made of the top professionals who make millions, but the average GP is running a practice that gives him a barely adequate return on his investment in professional development. Indeed, many GPs complain they are virtually government employees relying on Medicare to pay their bills, but the “virtually” is important. They remain independent professionals who succeed or fail according to the service they provide.

The recent moves to widen the scope of nurse practitioners concern many GPs. While nurse practitioners may have a role in isolated areas, a nurse is not a substitute for a general practitioner, who has years of undergraduate and postgraduate training in family medicine. Expanding the role of nurse practitioners may simply be an axe to wield again the ancient enemy, the family GP. Many nurses have specialist training, which makes them indispensable in the medical system; but a nurse is not a substitute for professionally-trained general practitioners with years’ more education behind them.

Minister Roxon’s move to cut Medicare payments for cataract surgery again fl ies in the face of reality. On the face of it, it may seem plausible—better technology equals cheaper prices. If the Fred Hollows Foundation can do cataract surgery for $25, why can’t an Australian ophthalmologist? The reason is that an Australian eye-doctor is running a practice. He has to pay a receptionist, an accountant, rent for his rooms and so on—in other words, he has fixed costs, which means the money goes into a lot of pockets apart from his own. In fact, he can’t absorb the cost cuts that the government is asking him to accept.

From News Weekly, November 28, 2009

1. What did the Health Minister propose?
A. to cut the medical profession all over the country
B. to allocate the patients to doctors on a list basis
C. to increase the incentives of the medical workers
D. to revise the policy on the medical profession

2. The patient may think some doctors are better than others NOT because ________.
A. some doctors are more competent
B. there is a simple personality clash
C. they have more diffi cult problems
D. they sometimes want a second opinion

3. When doctors fi nish medical school, they may not qualify as ________.
A. surgeons B. physicians C. opticians D. psychiatrists

4. Which of the following statements about nurse practitioners is NOT true?
A. They may have a role in some isolated areas.
B. They are not a substitute for general practitioners.
C. They have less education background than GP.
D. They are the same as family general practitioners.

5. According to the passage, which of the following statements is correct?
A. People not well-suited to their career choice are going to slip through the system.
B. Average GP is given abundant return on his investment in professional development.
C. Most of the general practitioners are working for the government-controlled service.
D. Australian ophthalmologists have fi xed costs so they cannot do cataract surgery.

答案与解析：

答案：1. B
试题分析：本题为细节题。根据全文第一句“Health Minister Nicola Roxon’s latest proposal that patients be allocated to doctors on a list basis is...”可知应当选B。

答案：2. C
试题分析：本题为概括题。根据第二段可知原因可能是“some doctors have a better bedside manner”，“they are more competent”，或者病人“there is a simple personality clash”，“wants a second opinion”，“has a potentially embarrassing problem that he or she does not want to discuss with his or her regular general practitioner”。只有C没有提到。

答案：3. C
试题分析：本题为细节题。根据第四段“This means they must first finish medical school and then qualify as surgeons, physicians, ophthalmologists or psychiatrists.”可知只有C选项opticians（眼镜商）没有提到。

答案：4. D
试题分析：本题为概括题。根据第七段“nurse practitioners may have a role in isolated areas”，“a nurse is not a substitute for a general practitioner”，“a nurse is not a substitute for...general practitioners with years’ more education behind them”可知
A、B、C都正确，而根据本段内容nurse practitioner（护士）又不同于family GP（家庭全科医师），故选D。

答案：5. A
试题分析：本题为概括题。根据第三段“Some people who are ill-suited to their career choice are always going to slip through the system”可知A正确；根据第六段“the average GP...that gives him a barely adequate return on his investment in professional development”可知B错误；根据第六段“They remain independent professionals”可知C错误；根据最后一段“If the Fred Hollows Foundation can do cataract surgery for $25, why can’t an Australian ophthalmologist?”无法判断澳大利亚眼科医生无法做白内障手术，可知D错误。