The illusion of simplicity in modern health policy.
In chess, a move can look simple. Anyone can move a piece across the board.
What matters is understanding the position — what came before, what comes next, and the consequences that follow.
Medicine works much the same way. Yet modern health policy is increasingly drawn to solutions that focus on the move rather than the board.
A seductive phrase appears in almost every announcement: improving access. It sounds unquestionably virtuous. Remove barriers. Increase convenience. Expand choice.
But in medicine, convenience and care are not the same thing.
Australia is currently debating major reforms to scope-of-practice laws and pharmacy prescribing. These proposals are framed as solutions to workforce shortages and access barriers in primary care. But when policy focuses primarily on redistributing clinical tasks rather than strengthening access to medical care, it risks misunderstanding the problem it is trying to solve.
Two decades ago emergency contraception moved into Australian pharmacies under the banner of access. In the process something subtle disappeared — the consultation.
The clinical encounter that once accompanied it — conversations about contraception, STI risk, menstrual management, consent, risk behaviour management, cervical screening, vaccination and sexual health — quietly fell away.
Around the same time something else began to change.
Australia began to see a sustained rise in sexually transmitted infections. Over the past decade notifications of gonorrhoea have increased dramatically. Syphilis has risen several-fold. Chlamydia remains one of the most commonly reported infectious diseases nationally.
Correlation, of course, does not equal causation. But when timelines align so neatly, clinicians are entitled to ask uncomfortable questions.
Emergency contraception prevents pregnancy after unprotected intercourse. It does not prevent infection. It does not initiate STI screening. It does not provide the clinical conversation that often leads to testing, partner notification, vaccination, menstrual cycle management, risk behaviour assessment or long-term contraceptive planning.
Emergency contraception is highly effective at the individual level. Yet population studies have struggled to demonstrate a corresponding reduction in unintended pregnancy rates following expanded access.
When the consultation disappears, it is worth asking what disappears with it.
The medical consultation is not an inconvenience in the healthcare system. It is the healthcare system.
Yet increasingly, elements of women’s health are being relocated into retail settings where consultation becomes transaction.
This shift sits alongside the rapid commercialisation of women’s health more broadly.
Globally, the menopause “wellness” market alone is estimated to be worth billions of dollars annually. Shelves are filled with supplements promising hormonal balance, vitality and symptom relief.
Many of these products achieve a remarkably consistent pharmacological outcome: expensive urine.
Meanwhile the medications that genuinely alter physiology — oral contraceptives and menopausal hormone therapy — are powerful drugs requiring careful clinical judgement.
Ask most doctors what the most dangerous routine prescription in everyday practice might be and the answer is often surprising. It is not antibiotics. It is not sleeping tablets.
It is oestrogen.
Used appropriately, hormonal therapies transform the lives of millions of women. But they carry real risks, including blood clots in susceptible patients. Prescribing requires risk assessment, clinical context and ongoing review.
The illusion of simplicity arises because expert care makes complexity invisible.
When a specialist inserts an implant or prescribes hormone therapy, the technical act may look straightforward. The difficult part happened beforehand.
Years of training, pattern recognition and clinical judgement determine whether the intervention should occur at all, how it should be performed, and what risks must be managed afterwards.
Anyone can move a chess piece. Understanding the position on the board is something different entirely.
Related
Modern contraceptive medicine also tells us something important about what truly works.
Long-acting reversible contraception — intrauterine devices and contraceptive implants — represent the most effective strategy for preventing unintended pregnancy. These methods dramatically reduce failure rates compared with short-acting hormonal contraception and provide years of protection.
They are the gold standard of modern contraceptive care.
They also have one inconvenient commercial feature. They do not need to be sold every month.
Healthcare systems rarely acknowledge the quiet influence of economic incentives. Repeat dispensing generates revenue. Durable interventions do not.
Women’s health is increasingly described by investors and industry analysts as an “expanding market opportunity”. When healthcare begins to resemble retail commerce, it is reasonable to ask whether the incentives of the marketplace are shaping clinical policy.
None of this diminishes the essential role pharmacists play in the healthcare system. Pharmacists are indispensable to medication safety and patient care.
But prescribing and dispensing within the same commercial environment inevitably alters the dynamics of care. Medicine has historically separated these roles for good reason.
The expansion of pharmacy-based prescribing is often framed as a solution to workforce shortages and access barriers. Yet if that expansion erodes opportunities for prevention, screening and comprehensive reproductive care, the long-term public health consequences deserve careful scrutiny.
Convenience may improve transactions. It does not automatically improve health.
Women deserve healthcare that is integrated, evidence-based and centred on long-term wellbeing — care that sees the whole board, not just the next move.
They deserve medicine, not retail medicine — and certainly more than expensive urine.
Because women’s health is complex, even when the move looks simple. And convenience should never be mistaken for care.
Dr Elizabeth Jackson is a specialist obstetrician and gynaecologist and president of the National Association of Specialist Obstetricians and Gynaecologists.
