We seek expert medical opinions when a relative is sick. However, 50% of medicine is evidence-based but 50% is based on clinical experience. Doctors need to analyse and decide which published research studies are valid, have robust data and results, and relate to their patients. There are many flawed and dodgy studies out there which do not extrapolate to reproducible good, safe patient outcomes. Many drug studies under-report side-effects of drug treatment and bias outcomes with specific patient selection and exclusions. Many research studies do not include very old frail patients. Accepted current peer medical practice is based on these observations. Doctors should always use their clinical judgement when deciding if a research drug study is relevant and safe for their individual patients.
Those patients with dementia taking “memory drugs” (Acetylcholinesterase inhibitors) should not be drinking any alcohol which is a neurotoxin, will worsen the memory loss, and counteract any benefits from the memory drugs. Alcohol causes detectable memory impairments beginning after just one drink. As you drink more, so does the severity of the memory impairments. Alcohol also impairs balance, motor coordination, mood and decision making. This is much more severe in patients who already have impaired brain function and abnormal brain scans. They have little brain reserve to cope with any extra stress on brain function. This is even worse when they are taking other sedative drugs such as anti-depressants, sleeping pills, anti-anxiety drugs and anti-pyschotic medications.
When a relative says a frail older driver is a “good driver”, this is unreliable, particularly in the setting of a medical consultation for memory loss. Relatives are generally very protective of their loved ones and don’t want to upset them or for them to lose their driving licence, even when they are cognitively impaired. Relatives’ assessment of “good” driving performance has a very low positive predictive value, but those relative who identify “bad” drivers has a very high positive predictive value.
When relatives try to help and correct their loved one during cognitive testing, or make excuses for incorrect answers this usually means they have dementia. This is even more so when the patient turns their head and looks towards the relative for the answer to every question asked of them.
Some of the first signs of dementia are generally slowing up physically and cognitively, unexplained weight loss, loss of interest in things before memory loss becomes more evident.
There is a new trend from government medical regulators to restrict access to anti-psychotic medication for the treatment of severe behavioural complications of dementia. These distressing symptoms of severe anxiety, agitation, aggression, paranoid delusions, frightening hallucinations cause enormous suffering for the patient and carers. Many of these patients respond dramatically to low dose of anti-pyschotic, sedative and anti-depressant medications. Appropriate treatment results is huge benefits of symptom relief for patients and carers, and improves quality of life. Unfortunately I now see large numbers of untreated dementia patients in nursing homes suffering from these severe distressing complications of dementia because the doctors and nursing homes are fearful of being reported to regulators if they use these drugs, and there are severe restrictions on their use. These drugs for the treatment of the severe behavioural complications of dementia are now called “chemical restraint” by regulators who describe it as a practice or intervention that involves the use of medication or a chemical substance for the primary purpose of influencing a care recipient’s behaviour. However , it does not include the use of medication prescribed for the treatment of, or to enable treatment of, the care recipient for a diagnosed mental disorder, a physical illness or a physical condition or end of life care for the care recipient. So if you are a psychiatric patient you can have proper drug treatment, with these same drugs but if you have dementia you cannot have these drugs to improve your comfort and quality of life.
Governments are restricting pain killer medications. GP’s (Primary Care Physicians) are restricted in prescribing narcotic analgesics and threatened with sanctions from medical regulators if they prescribe narcotics for severe pain. Narcotic analgesics in low dose have dramatically improved chronic pain management in the older patient. Chronic pain in the elderly is associated with an increased incidence of adverse outcomes, including impairment of daily general function, falls, depression, impaired sleep and decreased appetite. Older people have an increased risk of adverse drug reactions with pain killers which can also interact with other multiple pills that they are taking. Therefore the dose of pain killers should always start low and the patient should be regularly monitored for side effects. I see many older patients with severe chronic back pain limiting mobility and quality of life. They are frequently sent home from the public hospital emergency department without proper pain medications. There is a trend to use non-narcotic pain medications such as Gabapentin, Pregabalin and Amitriptyline which all have a high side effect profile including confusion and falls risk. The number of patients needed to treat with these drugs to cause harm is only 9.
Public and private hospitals must work more closely together. It doesn’t make any sense for a patient to be “Private” in a public hospital. The public hospitals want to use up the private patient funds, then try to off-load the patient to the private hospital. Unfortunately the health insurers decide how long they will cover the private funding for, so commonly after 10 days of acute care in the public hospital the private health funding runs out so the private hospital can’t take them. There are lots of beds in the private hospital system not being used. When the private hospital can manage the patient, then they should be transferred directly from the emergency department to the private hospital.
Paramedic ambulance officers must be allowed to refer patients from home directly to a private hospital specialist. If the private hospital and private specialist can manage the patient, then they should be admitted directly into the private hospital. This will free up public hospitals enormously and stop ambulance ramping/queuing at the front door to the emergency department.
Private and public hospitals should be assessed for merit awards so that good holistic comprehensive geriatric medical care is rewarded with extra funding, but poor care takes away funding- a penalty to provide incentives to do better- not to routinely reward bad care.
General Practitioner (Primary Care Physician) practices have to change to meet the needs of the rapidly growing older population. They can’t simply practise “milk bar medicine” any longer opening at 9am and closing at 5pm. Many older people at home and in nursing homes get sick after hours. Then they need immediate medical care to prevent a medical crisis and an avoidable acute public hospital emergency department presentation. The government must provide major financial incentives and resources including a huge increase in after hours billing revenue, a practice nurse and admin support to General Practitioners so they can provide a medical service from 5pm to 11pm, sharing on call with other local medical practices. This is much more cost effective than building more hospitals and emergency departments. Also General Practitioners must have urgent spaces during the day to see acutely unwell older patients. How can you expect a sick older patient to make an appointment and wait days when they are acutely unwell and need medical help immediately. How would they know when they will get sick- so what’s the point of making an appointment when urgent help is needed now!
Private Health Fund Insurance needs to radically change now as it is rapidly becoming unaffordable. We need proper Private Health Insurance where the patient is fully covered for everything without any out of pocket extra expenses. Patients in Private Health Funds should not be charged extra fees. They are already paying big dollars for expensive Private Health Insurance which is on a self destruct pathway by allowing extra charges and limited cover for the very people who pay to keep the Private Health Funds and Private Hospitals going. What type of insurance is it anyway when you are not fully covered? Why have it? Why bother? You might as well be better off saving your monthly premium in a term deposit account and use the money when you need better health care. My White Paper on Health Reforms shows that there are massive cost savings for Private Health Funds and Private Hospitals with spectacular health outcomes with holistic comprehensive geriatric medical care for older complex patients.
Doctors appear obsessed with checking serum Vitamin B12 and folate levels in geriatric patients as a “dementia screen” when it has little impact on their general health and dementia risk. I have never seen a patient get dementia from Vitamin B12 or folate deficiency! But yes we should measure serum Vitamin B12 and folate levels in patients with anaemia and Vitamin B12 for symptoms of peripheral neuropathy and replace if deficient. However, geriatric patients would be better served by detailed cognitive testing if dementia is suspected.
Hypothyroidism (under-active thyroid gland) is overrated in elderly patients. Whilst the symptoms of hypothyroidism are very non-specific, including lethargy, weight gain, constipation, fatigue, weight gain, cold intolerance, hoarseness, constipation, muscle aches I have only ever seen one older patient with confusion caused by an extremely underactive thyroid gland (severe hypothyroidism with serum TSH over 200- normal is less than 5) and fixed with slow thyroid hormone tablet replacement. I have never seen hypothyroidism cause dementia in an older patient! However, yes hypothyroidism must be treated when found.
Malnutrition in the elderly is the greatest moral medical challenge of our time! It is the most important risk factor for falls, infections, pressure sores, delirium, adverse drug reactions and acute public hospital emergency department presentations. This is all avoidable and treatable but commonly ignored by doctors and hospitals! Why? It is quite a paradox of modern medicine that most doctors pay little attention to the nutritional status of the elderly when it is such a common problem, leading to potentially catastrophic outcomes, yet is potentially reversible! Hospital bureaucracy is usually even less interested in it! Those elderly with 5% to 10% weight loss have a 30% higher risk of all-cause mortality, and those with more than 10% recent weight loss have a 290% higher risk of death within 12 months.Malnutrition is fatal in the elderly but treatable if screened for, looked for and managed in a holistic general medical multi-disciplinary setting. It is a win win situation for the Government with reduced health care costs and better health outcomes for older patients. For every $ spent on better nutritional care of the elderly $10 is saved in health care costs!
The greatest threat to the health and well-being of older people are family relatives who blame “old age” and “ageing” as the cause for treatable medical symptoms such as forgetfulness, becoming vague , confusion, slowing up, breathlessness, dizziness, falls, back pain, weight loss and more. Those relatives who blame “old age” for the physical and cognitive decline in older people are simply in denial which prevents or delays an accurate medical diagnosis and treatment. Older people do not become frail and unwell from “old age”. This is a myth but many believe it which is why so many older people who do suffer a decline in their physical and mental health from a medical illness do not get proper medical care. When relatives say foolish, unreasonable and ludicrous statements such as “ what do you expect for her age?”, “you know she is 85 years old”, “he is not bad for his age”, “memory loss and confusion is normal in old age” and “I couldn’t tell you who the Prime Minister is” or “I couldn’t remember those 3 words!” then you know they are in complete denial and use “old age” as a reassurance and an excuse to ignore physical and cognitive decline and illness in their older relatives!
Almost all older drivers who use a walking frame should not be driving a car. Most have significant brain disease with neurodegenerative walking and balance disorders causing significant slowing of movement and reflexes, impaired cognitive function, speed of information processing, inability to process multiple visual stimuli simultaneously and react quickly, all necessary for safe driving. They just don’t have the brain processing power to manage complex traffic situations which is why most impaired older drivers have crashes at intersections and roundabouts. Many of these people have undiagnosed cognitive impairments and dementia.
Those people who call a picture of a rhinoceros a hippopotamus during cognitive testing have a very high risk of having dementia. This simple observation has a very high positive predictive value for identifying dementia.
Hypoglycemiaor low blood glucose less than 6mmol/L is common in frail elderly hospitalised inpatients and predicts increased in-hospital mortality. Hypoglycaemia is common and an underecognised serious complication in frail older diabetic patients. Elderly people are more prone to hypoglycemia during hospitalisation because of frailty, malnutrition, poor dietary intake, multiple comorbidities and polypharmacy (just too many drugs with side-effects). Hypoglycemia is commonly missed in the frail elderly due to cognitive and functional impairment that interfere with early identification and appropriate treatment of hypoglycemia. Older patients do not get the obvious, typical symptoms that younger diabetics get with low blood glucose such as sweating, shaky, looking pale, hunger, headache, palpitations. Hypoglycemia causes functional brain failure and brain cell neuronal death. Achieving target blood glucose levels whilst avoiding hypoglycaemia is a major challenge in the management of elderly patients with diabetes. Elderly patients with diabetes often have impaired renal function, which interferes with drug elimination and thus predisposes them to prolonged life-threatening hypoglycaemia. Repeated episodes of hypoglycaemia cause significant physical and cognitive decline, worsen dementia and Parkinson’s disease, makes them more confused, worsen neurodegenerative walking and balance disorders and old stroke weakness, worsens depression and general day to day function. Many such patients with overtreated diabetes and low blood glucose commonly report a “foggy head”, dizziness, drowsy, “woosy” lack of energy, worsening confusion, agitation and increasing falls and and cardiac events. Frail older people with diabetes have a higher risk for hypoglycemia due to reduced physiologic reserve and responses to low glucose levels. Unfortunately many Doctors and Nurses insist on treating blood glucose levels in elderly diabetic patients to the same lower level as that of younger diabetic patients who require much tighter diabetic control over many years to prevent vascular complications such as blindness, kidney disease, stroke, heart attack and loss of circulation in lower limbs. Keeping an older person’s blood glucose below 6mmol/L is just like a sledge hammer hitting the the brain to worsen neurological function. Older diabetics must be treated differently from younger diabetics with the priority of hypoglycaemia avoidance. The paradox is that we sometimes need to run the blood glucose higher in frailer older patients to prevent hypos.
Many older patients with walking/balance problems and high falls risk who use a walking frame commonly leave the frame in the car when going out with family. Their excuse is “we are only going a short distance so I hang onto my daughter”. This is an unsafe practice and dramatically increases the risk of falls. They should always use the walking frame wherever they go. Also almost all of these people twist and turn their body with their feet stuck on the ground when changing direction using a walking frame instead of walking forward in a large circle. Twisting and turning is a high risk complex movement which dramatically increase falls risk, but almost all people do it!!
We need to rebuild the current health system in Australia as it is no longer fit for purpose with the rapidly ageing population. Australia is getting older, faster. In 2026, 22% of Australians were aged over 65 (6.1 million) — up from 16.3% in 2020, which was already double the 8.3% at the start of the 1970s. In 2026 there were 1.35 million over 80 years. By the year 2060, the number of Australians aged 65 and older is projected to more than double, while those aged 80 and older are expected to more than triple to 3.5 million. This is like a 600 metre tsunami that will rapidly hit the health system in all countries who are just not prepared for it at all! The health system is too acute hospital focused, wrong Doctors, wrong training. We just don’t have enough properly trained Doctors who can provide comprehensive holistic general medical care to complex older patients. The “SOD” (Single Organ Doctor) or Specialists just do not offer holistic comprehensive general medical care to manage these complex older patients, just sticking to their own small specialised area of medicine. This costs governments up to 1000% mark up in medical care instead of a single Geriatrician or General Physician caring for these older patients and dealing with all of their complex medical problems. I am not saying that you can’t have a sub-specialty interest in medicine, I am not saying you can’t be an expert or Specialist in one area of medicine, you just can’t be a SOD and practise SOD medicine- you must provide comprehensive general medical care. My White Paper from 2007 on major health reforms is relevant for all OECD medical systems. The highest levels of Australian Government and NSW Health agreed with my White Paper in 2008 but then did nothing! Since then I had no response from Politicians including Federal and Local Members of Parliament. When I first started hospital medicine at Westmead Hospital in 1982 there were no bureaucrats and managers not qualified to run health. Rather the Doctors ran the hospital. Now there are more of these bureaucrats and managers without medical qualifications than Doctors. Governments are using consultancy firms with no medical qualifications to advise on health- not Doctors. I propose the “CLEG” (Clinical Leadership Expert Group of Geriatrician or General Physician, General Nurse and General Surgeon) to run health-and reporting directly the state Premier. No politicians and no Health Ministers. Health requires portfolio-specific expertise- Doctors not politicians who have no medical training. Politicians have not solved the crisis in Australian hospitals and ambulance ramping in front of Emergency Departments in many years. I can’t see how non-medical hospital managers and bureaucrats controlling Doctors is helpful. The health system must stop the Hospital centric focus . Most good is done outside the hospital. Comprehensive Geriatric Medical Assessments improve patients outcomes and prevent hospital admissions. We also need the greatest attitude shift to the elderly and ageing in 40 years- that you are never “too old” for good medical care and that blaming “old age” for illness simply denies older people early and appropriate medical care. We are all living longer and want better health. These issues are similar in other OECD countries. There are massive cost saving for Governments by preventing unnecessary Hospital Emergency Department admissions with early treatment at home and restructuring General Practice-NOT blaming “old age”- early diagnosis and management is the key. Australia could buy 3 Virginia Class nuclear submarines ($4.3 billion each ) every 2 years with cost savings of $AUD6 billion yearly from my White Paper health reforms. The USA could buy 6 x $13 billion Gerald Ford Aircraft Carriers per year with cost savings of $USA80 billion per year from my White Paper. THE USA DEPARTMENT OF GOVERNMENT EFFICIENCY (DOGE) SHOULD LOOK AT THIS HUGE COST SAVING FOR HEALTH- IT WILL SAVE $US320 BILLION OVER THE 4 YEARS OF THIS CURRENT ADMINISTRATION!
Doctors who blame “old age” for symptoms, illness, physical and cognitive decline and then say that the patient is “too old” for medical treatment are not practising evidence-based medicine. There is always something a Doctor can do to help an older patient with a proper medical diagnosis and management plan tailored to the patient’s needs.
The “super-sized markup” costs of multiple single organ medical specialists (SODs) versus one holistic general medical Physician sorting out the “whole” patient “in one go”- it is obvious which one produces better health outcomes and massive cost savings for patients, hospitals and governments. Even my SOD colleagues agree with me that holistic general medical care offers the best outcomes for frail, complex older patients. I have always said that Doctors still can have a special interest and expertise in one area, but all must practise holistic general medicine and deal with all of the patient’s medical issues. Wouldn’t it be so much better if all Doctors focused on cognitive function, falls risk and balance, postural dizziness, risk of adverse drug reactions and potential drug interactions, nutrition, swallowing problems, as well as all chronic medical conditions and how they affect the physical function and psychosocial well-being of the patient, with the main goals of improving symptoms, general function and quality of life. With a rapidly ageing population we must go back to holistic general medicine!
Ambulance “ramping” outside hospital emergency departments and hospital “bed block”- both can be completely fixed with Dr Lipski’s WHITE PAPER ON HEALTH REFORMS. Most ambulance presentations to hospital emergency departments can be avoided in the first place with better care in the community and in nursing homes. Building more hospitals does not sort out these problems!
The definitive fix for Medicare and the Australian Health System-
All Doctors to practise General Medicine, not Single Organ Medicine (SOD). SODs can no longer use the excuse that General Medicine is out of their “scope of medical practise”.
GPs (General Practitioners or Primary Care Physicians) to stop “farming out” patients to multiple SODs (Single Organ Doctors- SOD Medical Specialists)- this alone will save $Billions and produce better health outcomes by avoiding multiple Medical Specialists (The Medical Merry-Go-Round) for the one patient. They should consult a General Physician if needed.
Dismantle current health system and rebuild it-not fit for purpose with ageing population in the 21st century- this is a priority-medical training needs to be in General Medicine- not SOD medicine! General holistic medicine produces very good health outcomes and huge cost savings.
Hospitals to be run by Doctors, not bureaucrats, not administrators, not consultants with no medical qualifications but hospitals can be run by the CLEG ( Clinical Leadership Excellence Group )- not Politicians who have no medical qualifications. Bureaucrats or administrators without medical qualifications should NOT be able to control or tell a Doctor which patients can be admitted to hospital, when the patient should be discharged and what treatment they can have. Otherwise it’s just like the passenger flying the plane!
Focus on relative value payments for Doctors- encourage long comprehensive holistic consultations- Medicare to reward General Practitioners for this which produces better health outcomes and avoids hospital admission.
Medicare currently rewards short consultations and procedures- change the focus to reward comprehensive general medicine consultations.
Transfer Medicare payments from single organ (SOD) Medical Specialists to General Practitioners- increase Medicare rebate to GPs for long consultations by at least 500% which will save money in the long term by improving health outcomes and reducing hospital admissions. This will also encourage more younger Doctors to train as General Practitioners.
Stop the “milk bar” model of GP (Primary Care Physician) practice opening at 9am and closing at 5pm . Most people get sick after hours when there are no Doctors available. GP practices need to be encouraged and funded to stay open late from 2pm to midnight to cater for emergencies-Medicare to fund Secretary and Practice Nurse with 500% increase in Medicare payments to GPs for after hours GP Practice- these can be on a roster in local areas to share the after hours load.
GPs to be mandated to have 30% walk in slots for acute medical problems- how can you predict when you get sick? How can you make an appointment and then wait 1 week to see a GP when you are acutely unwell?
All Doctors including Medical Specialists must do at least 20% of their practice as home visits to access Medicare payments which prevents hospital admissions.
All Doctors must include Nursing Home visits as part of their Practice including Medical Specialists, which prevents hospital admissions. Why should older Australians in Nursing Homes have second rate medical care?
All nursing homes to be attached to district hospitals and hospital medical teams to provide after hours emergency cover and weekly ward rounds to provide better care and prevent unnecessary transfers to hospital EDs.
Nursing homes should provide better medical and nursing care to older Australians in the last few years of their life to give them better comfort, dignity, quality of life, prevent unnecessary suffering with conditions that can be easily treated and avoid transfers to public hospital ED’s unless the condition requires hospital treatment. The health system must provide training for nursing home care staff in identifying major geriatric syndromes such as delirium, dementia care, postural hypotension and falls risk, basic nutritional screening, swallowing disorders and be supported by at least 2 registered nurses in every nursing home. It is not good enough for nursing homes to just provide untrained care staff to wash and dress the residents who have complex medical issues.
Paramedic Ambulance Officers to refer selected Privately insured and Veterans patients directly to Private Hospital General Physicians under Medicare to free up the public hospitals, where their medical problems can be managed in the private hospital.
Audit of all non-clinical staff in public hospitals and Department of Health- how many are there and are they all needed??
Close the Federal Department of Health. Health is run by the State Governments. What a waste of money having 2 Government departments!
Incentive payments for Private Hospitals who provide comprehensive holistic general medicine, safe discharge from hospital and good clinical outcomes with the introduction of merit awards A, B and C levels for Private Hospitals following holistic medicine principles from Dr Lipsk’s “White Paper”.
All privately insured patients should NOT be in public hospitals, but rather be in private hospitals if the private hospital can manage their medical condition. Public hospitals encouraging patients to use their private health insurance in the public hospital just clogs up the public hospital system when there are already beds and capacity in the private hospitals. This just contributes to ambulance ramping in the public hospital emergency departments.
All hospitals should drastically improve their food quality and food services. For every $1 dollar spent on improved food, then $10 is saved on health care costs! You are what you eat. Rather than being proud of how little they spend and cost cutting on food, hospitals should aim to be proud of how much more that they spend on better food for inpatients!
With a rapidly ageing population, looking after older patients in hospitals must be “core business” now for hospitals, Doctors and Nurses. All hospital staff must have expertise in the management of delirium (acute confusion). Hospitals must be skilled in looking after confused and agitated elderly inpatients with high falls risk. Hospital medical wards must be designed for safety and be secure to cater for wandering confused elderly inpatients. The use of HI-LO beds (sleeping close to the floor to minimise injury with falls out of bed) and gentle physical restraints (table top chairs) when necessary approved by Doctors must be considered to prevent falls and serious injury or death. Allowing a confused wandering patient to keep getting up, repeatedly falling , then causing major injury is unacceptable, and worse, then telling the family (“your mother died of skull fracture and major brain bleed, but oh, we are not allowed to use HI-LO beds or physical restraints- we just let her get up whenever and fall”).
Geriatric inpatients in hospitals waiting for nursing home beds do NOT BLOCK hospital beds. “Bed Blocker” is a very negative derogatory slur against an elderly person who deserves better. Large numbers of elderly patients waiting in hospitals for nursing home beds is a health system failure. The first question is- why do they need to go into a nursing home? In my Geriatric Medicine Practice over 90% of my frail elderly hospital inpatients returned home in better health and general function. These people need better comprehensive holistic general medical care in the community before they deteriorate and end up in hospital, and then if in hospital with comprehensive holistic multidisciplinary general medical care focusing on early mobility, fixing malnutrition and reducing adverse drug reactions can drastically improve their chance of returning home again! Most nursing home placements can be avoided with better care. The main reason for needing to go into a nursing home are multifactorial immobility usually from neurodegenerative gait and balance disorders and advanced dementia with behavioural disorders when family are unable to care for them at home. Medical care should not stop in hospital when the patient is waiting for nursing home placement. These frail complex older inpatients need ongoing comprehensive holistic multidisciplinary medical care to maintain function, well being and prevent further complications.
Health system must focus on community medicine to prevent acute medical problems, the sudden decline of frail elderly and avoidable public hospital admissions. Governments tend to focus on building more acute public hospitals rather than focusing on a rapidly ageing population and preventative medicine which will reduce acute public hospital admissions and save a lot of money. When there is no access to Doctors in the community, then people end up in the public hospital emergency department!
When a medical specialist says to a patient or family- “nothing to be done, nothing can be done”, come back in 6 months for another billed appointment- then this is simply NOT good enough! There is always something that a Doctor can do to help an older patient and family, manage their symptoms and improve their quality of life with good holistic multidisciplinary care, even if there is no cure for their condition as is the case for most chronic medical problems.
NOT all old people get frail! “Old age” does NOT cause frailty! If someone is frail, then they are very sick and in need of proper medical help. Most frail people have multiple underlying causes for their decline. A frail person needs urgent medical attention, accurate diagnoses of the underlying medical problems, holistic medical treatment to fix them. Giving someone a negative stereotype label- “oh, he’s just frail and decrepit from old age” is just plain stupid and harmful as it denies that person proper medical care.
The 2007 White Paper on NSW Health Reforms, written by prominent Australian geriatrician Dr. Peter Lipski, proposes an evidence-based roadmap designed to overhaul how the Australian healthcare system manages elderly patients.
Though originally drafted in 2007 and lauded by the NSW Director General of Health at the time as "the best improvement in NSW Health ever," the systemic solutions were largely sidelined by bureaucratic inertia. Dr. Lipski has since continued to campaign for these changes, most notably publishing them in his book "Your Ageing Parents' Failing Health: Is It Ageing Or A Treatable Condition?" and submitting them as formal evidence to the 2023–2025 NSW Healthcare Funding Inquiry.
Dr. Lipski's White Paper focuses on holistic care, structural reform, preventative measures, and significant cost savings with spectacular improvements in health outcomes:
Holistic Medicine: Criticizes the "medical merry-go-round" of single-organ specialists and advocates for comprehensive care managed by a single geriatrician or general physician to reduce hospital stays.
CLEG Model: Proposes replacing administrative bureaucracy with a Clinical Leadership Expert Group—consisting of a geriatrician/physician, a nurse, and a surgeon—reporting directly to the state Premier.
Preventative Focus: Targets geriatric malnutrition (noting a $1 investment yields a $10 acute care saving), adverse drug reactions, nursing home integration with public hospitals, and mandatory home visits making up 10% of a doctor's practice.
Financial Impact: Projected annual savings of $6 billion (2007 figures) and calculated a cumulative loss of $98 billion in missed savings between 2007 and 2023 due to government inaction.
Compare his proposed model to the current National Health Reform Strategy (2026-31) currently being rolled out in Australia-
The National Health Reform Strategy (2026-31), backed by the landmark 2026–2031 National Health Reform Agreement (NHRA) Addendum, targets many of the exact same pain points identified by Dr. Peter Lipski. Both models intensely focus on resolving fragmented patient journeys, delayed hospital discharges for older patients, and the disconnect between public hospitals, Medicare, and aged care. However, while they share the ultimate goal of moving away from episodic, uncoordinated hospital care, their execution philosophies differ sharply. Dr. Lipski advocates for direct clinical leadership and immediate preventative medical frontline interventions, whereas the 2026-31 National Strategy relies on systematic multi-government bureaucratic funding and control mechanisms, inter-jurisdictional data systems, and digital health infrastructure. Key Ideological Differences-
Top-Down Bureaucracy vs. Top-Down Clinical Power: The 2026-31 Strategy tries to fix the system by aligning Commonwealth and State funding policies, managing data across portfolios (NDIS, Medicare, Aged Care), and relying on digital infrastructure. Dr. Lipski argues that this type of administrative alignment is exactly what causes bureaucratic inertia. His model cuts out the administrative middleman entirely, handing systemic control directly to a small triage of medical experts (CLEG).
Data Integration vs. Clinical Practice: The current national strategy sees a lack of data flow as the primary roadblock to smooth patient transition. Dr. Lipski's core argument is that the issue is a failure of clinical practice and model of care—specifically, the over-reliance on single-organ specialists who treat illnesses in isolation rather than managing an elderly patient's overall frailty and nutrition.
Arguments surrounding the superiority of Dr Peter Lipski's white paper on health reforms over the Australian government's official strategy focus heavily on immediate clinical practicality, massive financial savings, and specialized care for the elderly. Avocates for Lipski’s model point to specific areas where his evidence-based approach is considered more effective. The critical differences between the two frameworks can be broken down as follows:
1. Concrete Financial Savings vs. Bureaucratic Budgets
Dr Lipski’s Paper: His reform model claims specific, massive cost savings of $6 billion per year (cumulatively estimated at $98 billion if it had been adopted when first formally recognized in 2007). It relies on a targeted framework to achieve these reductions through clinical efficiency. [1, 2]
Government Strategy: The 2026–2031 National Health Reform Strategy focuses primarily on the interjurisdictional funding agreement between state and federal governments. Critics often point out that these strategies lean heavily on hospital-focused funding loops and administrative pilots rather than capturing immediate systemic savings.
2. Clinical, Peer-Reviewed Specificity vs. Broad Administrative Goals
Dr Lipski’s Paper: framework is an evidence-based, peer-reviewed clinical model published in medical journals and backed by his experience as a geriatrician. It provides exact medical paradigms for treating reversible conditions in seniors rather than writing them off as "just old age".
Government Strategy: The national strategy functions as a macro-level policy document. While it targets areas like patient flow, data connectivity, and systemic fragmentation, it is frequently critiqued for omitting execution details—and relying on broad, abstract priorities.
3. Targeted Elderly Care vs. Fragmented System Logistics
Dr Lipski’s Paper: targets the root pressure point of the Australian healthcare system: the ageing population. By improving senior healthcare outcomes, correcting polypharmacy (too many pills), and accurately diagnosing treatable conditions, his model aims to keep a massive demographic out of public hospital beds.
Government Strategy: Because the responsibility is split between federal Medicare/primary care and state-run hospitals, the government strategy often struggles to seamlessly merge these systems, resulting in chronic care patients falling through the gaps of a complex funding maze.
Dr Peter Lipski’s clinical recommendations are designed to combat systemic ageism by treating the physical declines of older patients as treatable medical conditions rather than inevitable consequences of "old age".
His model relies heavily on addressing specific, overlooked clinical gaps that frequently trigger unnecessary emergency department (ED) presentations. His core clinical recommendations cover several distinct areas:
1. Reversing "Geriatric Malnutrition"
The Problem: Families and general clinicians often assume it is normal for older people to eat very little, leading to silent starvation. Dr Lipski notes that losing more than 10% of body weight in a year increases an older person's mortality risk by 260%.
The Change: Implement mandatory nutrition screening tools (such as the HUNGER initiative trialled at Brisbane Waters Private Hospital). His protocol prescribes high-calorie, nutrient-dense diets rich in healthy fats, meat, and extra snacks (even cakes and ice cream) to fuel older bodies fighting chronic illnesses like Parkinson's, dementia, or severe arthritis.
2. Eliminating Polypharmacy & Adverse Drug Reactions
The Problem: Seniors are routinely over-prescribed medications by multiple independent specialists (single-organ medicine), making adverse drug reactions the single most common cause of preventable ED visits. [1, 2]
The Change: Enforce strict, regular medication de-prescribing protocols. This includes halting the dangerous overtreatment of frail, diabetic elderly individuals, whose blood sugar is often pushed too low, causing neurological decline, dizziness and subsequent trauma.
3. Correcting Blood Pressure & Preventing Falls
The Problem: Doctors and nurses routinely measure blood pressure incorrectly in older patients by failing to test them while standing up. This misses postural hypotension (a sudden drop in blood pressure upon standing), which causes dizziness and severe falls.
The Change: Enforce standardised orthostatic (lying and standing) blood pressure testing across all clinical environments to accurately diagnose and manage fall and gait risks before a fracture occurs. Such a simple intervention has massive positive health outcome benefits in reducing adverse drug reactions, and falls.
4. Mandatory Cognitive & Delirium Screening
The Problem: Acute confusion (delirium) is routinely misdiagnosed as baseline dementia or dismissed entirely, leaving severe underlying adverse drug reactions or infections untreated.
The Change: Mandate standard cognitive assessments and acute delirium screening for all hospital patients over the age of 70 immediately upon admission.
5. Multidisciplinary Surgical Teams
The Problem: Surgeons routinely operate on patients over 70 using standard surgical protocols without adjusting for geriatric frailty, leading to high post-op delirium rates, mortality and cognitive decline.
The Change: Require all surgeons operating on patients over 70 to work within a multidisciplinary team alongside a geriatrician, incorporating extensive, mandatory pre-operative and post-operative geriatric assessments.
6. Integrating Nursing Homes with Hospital Medicine
The Problem: Residential aged care facilities operate in silos, isolated from mainstream medicine, relying on emergency services whenever a resident declines.
The Change: Legally bind nursing homes directly to their local district public hospitals. Under this framework, hospital medical teams—including junior and senior doctors—conduct weekly clinical ward rounds and provide dedicated after-hours emergency cover directly inside the facility to treat acute changes on-site.
The explicit Medicare incentive updates he proposes for general practitioners (GPs) to support this model.
To incentivise General Practitioners (GPs) to move away from "single-organ medicine" and proactively manage fragile older patients, Dr Peter Lipski proposes structural changes to how Medicare rewards general practice. He argues that the existing fee-for-service model rewards brief, reactive consultations rather than the time-intensive work required for geriatric medicine. His explicit Medicare incentive updates for GPs include three key changes:
1. High-Value Incentives for Comprehensive Medical Assessments
The Proponent Update: Medicare must introduce substantial incentive payments specifically tied to Comprehensive Geriatric Assessments (CGAs) conducted by GPs.
The Clinical Goal: Instead of a standard brief consultation rebate, GPs would be financially compensated for dedicating extended time (often up to an hour) to systematically screen for the "silent killers" of the elderly. This includes mapping nutrition levels, testing for orthostatic hypotension (blood pressure drops while standing), identifying cognitive decline, and mapping gait/fall risks.
2. Funding Mandatory After-Hours & Midnight Care
The Proponent Update: explicit Medicare incentive payments for GPs who provide dedicated evening medical services up until midnight, 7 days a week. [1]
The Clinical Goal: A vast number of nursing home and at-home elderly admissions occur after standard business hours when a patient's regular GP is unavailable, forcing families or carers to call an ambulance. Funding a structured after-hours GP framework keeps clinicians available during these high-risk evening hours to manage acute changes on-site, cutting down on unnecessary emergency department overcrowding.
3. Mandating Home Visits via Medicare Access
The Proponent Update: To access standard Medicare billing pools entirely, Dr Lipski suggests a regulatory stick alongside the carrots: all GPs must complete at least 10% of their medical practice as home or facility visits.
The Clinical Goal: This reform forces primary care back into the patient's immediate living environment. By physically conducting consultations in the home or aged care facility, GPs can visually assess environmental fall hazards, verify food security/nutrition status, and physically audit the patient’s medication cabinet to stop dangerous polypharmacy (accidental double-dosing or taking expired pills).
The direct structural contrasts between Government and Dr Lipski models span four key dimensions:
1. Opt-In Administration vs. Strict Legal Mandates
The MyMedicare (GPACI) Model: This framework is a completely voluntary, opt-in registration program for both patients and practices. It requires a dual layer of red tape, forcing the patient (or their family) to register with MyMedicare and the general practice to manually map the "GPACI indicator" to the patient's digital profile.
Dr Lipski's Proposed Model: throws out voluntary registration entirely. He proposes a regulatory mandate: all GPs must complete at least 10% of their medical practice as home or facility visits to retain full access to standard Medicare billing pools. Rather than asking doctors to opt in, it uses a structural rule to force primary care back into the patient's immediate living environment.
2. Micro-Incentive Payouts vs. High-Value Clinical Funding
The MyMedicare (GPACI) Model: The government’s incentive is mathematically rigidly structured around a low-tier annual cap. The responsible GP receives $300 per patient per year and the practice receives $130 per patient per year, split and paid out across four quarters.
Dr Lipski's Proposed Model: argues that a $300 yearly payment is mathematically trivial and fails to compensate for the extreme complexity of comprehensive geriatric medicine. He advocates for high-value Comprehensive Geriatric Assessment (CGA) rebates that financially match the actual time spent (often up to an hour) carefully reviewing medication lists, assessing cognitive deficits, and conducting orthostatic blood pressure tests.
3. Rigid Service Checkboxes vs. Flexible Real-Time Clinical Care
The MyMedicare (GPACI) Model: To clear the hurdle for government payment, a practice must tick specific, rigid service boxes over a rolling 12-month period: exactly 2 care planning services and a minimum of 8 regular face-to-face visits (specifically requiring 2 visits per quarter in entirely separate calendar months). If a doctor misses a single monthly window due to a fluid clinical situation, the quarterly incentive is entirely forfeited.
Dr Lipski's Proposed Model: Rather than tracking calendar boxes, Dr Lipski's focus is on structural clinical capability. He advocates for funding comprehensive medical assessments when a patient’s health changes, alongside subsidised after-hours and midnight GP coverage (7 days a week) to directly intercept evening clinical emergencies before an ambulance is called.
4. Fragmented Practice Silos vs. Bound Hospital Systems
The MyMedicare (GPACI) Model: The government model attempts to keep residents tied to their existing local general practice, even though data shows that only 20% of residents manage to retain their regular GP after moving into a nursing home. It leaves the GP operating as an isolated external entity who travels back and forth to the facility.
Dr Lipski's Proposed Model: Dr Lipski’s model forces a complete structural merger. He proposes legally binding nursing homes directly to their local public hospital district. Under his model, hospital-based medical teams and doctors conduct mandatory, structured weekly ward rounds directly inside the facilities, making residential aged care a direct extension of acute hospital medicine.
At-A-Glance: The Structural Divide-
While Dr Peter Lipski advocates for the broader, internationally recognised Comprehensive Geriatric Assessment (CGA) framework, his clinical practice, peer-reviewed models, and white papers emphasize a highly specific, target-driven interpretation of the CGA. Instead of treating the CGA as a broad lifestyle or socio-environmental questionnaire, Lipski’s model isolates reversible physiological deficits that mimic standard ageing but are actually acute medical conditions. His preferred clinical criteria focus on specific diagnostic tests, clinical thresholds, and mandatory screening pathways across five core pillars:
1. Nutritional Status & Malnutrition Screening (The "HUNGER" Criteria)
Dr Lipski's model aggressively targets "geriatric malnutrition," which is frequently missed because lower food intake is assumed to be normal for older adults.
The Weight Loss Threshold: A mandatory clinical flag is triggered if an older patient loses more than 10% of their total body weight within a single 12-month period (a metric Dr Lipski correlates with a 260% spike in baseline mortality).
Active Caloric Tracking: The assessment demands a proactive calorie and macro-nutrient audit. Rather than restrictive diabetic or low-fat diets, his criteria mandate prescribing nutrient-dense, high-calorie food plans (incorporating healthy fats, meat, and high-sugar supplements or treats) to combat muscle wasting (sarcopenia) and provide fuel to fight severe illnesses.
2. Medication Toxicity & Overtreatment (The Polypharmacy Review)
Dr Lipski views polypharmacy (taking multiple medications simultaneously) as an acute clinical toxicity rather than a stable chronic routine.
The Deprescribing Directive: The criteria mandate a systematic review to actively strip away redundant or conflicting medications prescribed by independent single-organ specialists.
The Tight-Control De-escalation: A specific clinical criterion involves checking for the overtreatment of type 2 diabetes and hypertension in frail individuals. If medication is pushing blood sugar or baseline blood pressure too low, the protocol mandates backing off aggressive clinical targets to prevent hypoglycemic or hypotensive events.
3. Orthostatic Hemodynamics & Gait Analysis (The Fall-Prevention Protocol)
Falls are frequently treated as accidents of balance or environment, but Dr Lipski's model treats them primarily as cardiovascular and neuromotor failures.
Mandatory Orthostatic (Lying & Standing) Blood Pressure Testing: His protocol strictly forbids relying solely on seated or lying blood pressure readings. Clinicians must measure blood pressure while the patient is lying down, and then immediately upon standing. A drop in systolic pressure of 20 mmHg or diastolic of 10 mmHg establishes a diagnosis of postural hypotension, which is targeted as a primary fall risk.
Objective Functional Mapping: The CGA requires standardized functional physical tests, such as the Timed Get Up and Go (TGUG) test, to scientifically measure gait velocity, balance transitions, and frailty indexes before clinical discharge.
4. Neuropsychiatric Profiling (The "4Ds" Integration)
To stop clinicians from misdiagnosing treatable underlying issues as baseline permanent decline, Dr Lipski utilises a diagnostic grid to actively differentiate between four distinct neurological states:
Cognitive Decline: Baseline structural shifts.
Dementia: Long-term progressive neurodegeneration.
Depression: Chronic mood disorders mimicking cognitive slowing.
Delirium: An acute, fluctuating medical emergency. His criteria mandate immediate delirium screening (such as the Confusion Assessment Method) for any patient over 70 exhibiting sudden mental changes, forcing clinicians to hunt for an underlying driving infection, drug toxicity, or dehydration instead of charting it as worsening dementia.
5. Multidisciplinary Surgical Vulnerability (Pre-Op/Post-Op Frailty Index)
Dr Lipski's framework specifies that chronological age is never a barrier to major surgery, but unmapped frailty is.
The Joint Geriatric-Surgical Audit: For any patient over the age of 70 facing major elective or emergency surgery (e.g., total hip or knee replacements, bowel surgery), his model mandates a pre-operative geriatric assessment.
The Focus Shift: While surgeons review standard localized operative risks, the geriatrician's component of the CGA evaluates systemic organ reserve, metabolic baseline, and post-operative delirium risks to build an explicit multi-day post-op management blueprint.
For more information read Dr Peter Lipski’s book “ Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.