Catching Up

I know, I know, it's been a while since I checked in. Truth is before I left for the US it was much of the "same old, same old" here. As we've been here going on 6 months.....yes, it has been that long, we are very much in a routine. With the shortage of MD's at the ER, John has volunteered to pick up more shifts and our leisure time is very limited. The things we do in his "off time" is much of the subjects of the blogs, so that has been a problem, but I'm back and will try to make some interesting entries in this the second half of our year here in Australia.

I did just return from a 3 week trip back to Wisconsin. I was there for the wedding of my bestie's son, Mark, to Maddy his lovely bride. I got to see all my kids, my dogs, my sisters and their kids, and grandkids, and generally just saw everyone I could in a short time.

For those of you wanting to come visit, you need to spend at least 2 weeks, from just making the trip back and forth again, it makes no sense to come for less time than that. The time traveling here (24+ hours) plus the adjusting to the time zone, will knock you out of commission for a day, or two. Like with any vacation, you take the good with the bad or just unknown. Try to make the fewest number of stops, with the shortest layover you are able to manage. Carry on your luggage! That way you can make the connections without the worry of a toothbrush on the other side of the flight.

Australia is VERY casual. You don't need fancy clothes, men don't need a sportcoat, just pack with the thought of everything going with every activity and you'll be fine.

Either one of these would work for most places in Australia.

Here's one for the guys, too. 

This is a winter capsule.

Remember a swimsuit, baseball hat, extra sunglasses and a sandal of some sort. (Flip flops are fine.) This advice is for all, men, women and children!

Whatever you feel you've forgotten or need, is available here. Bring the credit card with no foreign transaction fees and remember to let that company know you'll be in Australia. All of these things will make your trip here to visit us MUCH more enjoyable. 

All of this advice is to try and lure some of you here to experience this country which is so interesting but very far away. 

Being back just made me realize how much I miss all my peeps and hoping I can make the rest of this year fun with lots to look forward to.

I was very remiss in taking pictures while home. My phone didn't work there so I left it in my suitcase, that is my camera for most everything. Here is a picture from the wedding with my kids.

Wedding time

Really dark and minus Colin, who was my date. 

The other "family" I saw was the four footed one, Scout and Bear. We had a lovely reunion at the Haas's and they greeted me very warmly.

 

 They are so happy with Lois and Joe. Truly the two of them have never looked better. Lois believes in holistic dog care and she's carefully changed their food and treats. Their coats and eyes just sparkle, and you can tell how much they're loved. Once they go over me being there, Scout just cozied up to Lois, and Bear to Joe. It seems that Bear has gotten it in his head that when Lois isn't around he doesn't have to mind Joe when it comes to walks. Joe says he's gotten more and more stubborn, and just refuses to get up from where ever he is to walk. He picks his battles with him and wins 50% of the time.

How can you resist those eyes???????

Anyway, as we've said before, we could never have done this year aboard without Joe and Lois, we can NEVER thank them enough. They will be very sad to leave the golf course and dog bath, but we can't wait to be the ones dragging Bear for that walk!

While I didn't manage to take many pictures with my cell phone, I did manage to misplace it while home. So on my return to Bundaberg I had to purchase a new one. Buggers! (An expression used commonly but don't look up the slang for it, it isn't polite.) I bought a much cheaper one, not quite a flip phone, but close, and I don't expect to loose this one. In my defense, I was "sleeping around" quite a bit. I went from Evanston the first night to Lake Geneva, Bayside, Lake Geneva, Oswego, Lake Geneva, Bayside, Fox Point, Lake Geneva and back to Bayside. Whew.....it's a wonder I didn't loose more than the phone! All this traveling while jet lagging and trying not to complain. 

A big shout out to John who met me at Bundaberg Airport on June 4, which happens to be my twin brother's birthday. When I walked into the condo there flowers and balloons and 

this adorable little Scout!!! The wine was already in the frig waiting for me to shower and go out for dinner at Catalonia, one of our favorite places here in Bargara for dinner.

I'll end this rambling entry with the promise of better ones to come. I hope to hear that some of you will make the trip over to see all this for yourselves.

Healthcare (and random thoughts) Part 3

     Now let's say that you are sick -- not just a sniffle or runny nose but perhaps a cough with chest pain or shortness of breath -- and so you go to see your "G.P." (general practitioner).  First, I should tell you that all health care access to specialists in Australia seems to be governed by the G.P.'s (except if you are so sick that you get admitted to the hospital and need immediate access to a given specialist).  The G.P. is the Australian equivalent of going to a Family Practitioner.  Anyway, now you are sick -- that G.P. does not -- I mean never admit to our hospital.  On occasion a G.P. apparently admits to a private hospital (see later) but since we are the only Emergency Department in the town (neither of the private hospital have Emergency Departments) we pretty much see all the sick people.  So your G.P. will send you to the ED with a letter saying something like, "Mrs. Jones is an 84 year-old diabetic who has fever, shortness of breath and vomiting and needs further evaluation.  Thank-you for your assistance."  This basically translates into "This lady is sick and now she's your problem."  Your G.P. (who is supposed to be the person most knowledgable about you and your health) will not be involved in your hospitalization -- at all.  If you need to contact the G.P. to get background information, a drug list, information about allergies or recent changes in your patient's medications, you would probably be able to reach them IF you called during normal business hours.  But if you try to reach one outside of normal business hours, forget it.  So before 9 AM or after 4 PM or on the week-end or any holiday (and they have a LOT of these) -- pretty much whenever people are likely to present to an Emergency Department -- deal with it!

Now let's say you have a serious underlying illness (renal failure, sarcoidosis, cancer, severe emphysema, you pick...) and you need to talk to the specialist to get expert advice.  The specialists --people who have the highest clinical rating by their respective specialty societies -- are awarded the ranking of "Consultant".  These are the people who have the most knowledge and experience within their specialty.  They are also the people who are being paid the most by the government.  These people are also the LEAST accessible.  When you call to speak to the specialist, you will speak to their "registrar" (resident taking call) who will not attempt to call their "consultant" unless it's the most dire of circumstances.  The reasons for this are probably multiple but unless you ask specifically, you will usually not go further up that ladder.  So Australia is paying the most money to the people with the most knowledge who are the least accessible and work the least (doesn't sound like it makes great economic sense to me) -- very frustrating.

I have to say a special word about acute psychiatric care.  Maybe I'm spoiled by the fantastic care and service that was provided by our Behavioral Health departments at Aurora (particularly the Intake Coordinators), but I'm going nuts here (pun intended)!  We frequently see people presenting with suicidal ideations and attempts.  A psychiatric nurse or registrar will come to evaluate the the patient after we have medically stabilized them (performed medical clearance) and will almost invariably tell me "they have a good support system at home and I think this was an impulsive act and we can have them followed-up closely [meaning when an appointment becomes available sometime in the next 2 weeks].  I feel comfortable letting them go home."  These are people who aren't just thinking about suicide or even those with a plan, but they have just made a serious attempt.  So my reply goes something like, "Let's see, they just took 45 tablets of _______ (pick a drug) that they had to punch out of a blister pack and you think it's an 'impulsive act'?  And is this the same 'support system' they had before their overdose?"  To me it's a huge issue of not treating people who are in crisis and I am unsure if it's due to underfunding, not recognizing the problem, or just not treating people properly who are crying out for help.  I do know that there is a very limited number of inpatient beds and they rarely admit people involuntarily.
    http://www.couriermail.com.au/news/queensland/queensland-has-most-suicides/story-e6freoof-      1226075248748

Now some other observations.  First, let me remind you that I am practicing at the regional medical center (referral hospital) --

Bundaberg Base Hospital

 If you present to the Emergency Department at night there is no ability to get x-rays at night without calling a technician in from home.  I'm not talking about CT scans or ultrasounds -- just x-rays.  If people need an x-ray, they are either held in the department overnight, asked to return in the morning, or a technician gets called in.  No matter when an x-ray is taken, it won't get read by a radiologist while you are in the Emergency Department -- it will get read by a radiologist DAYS later.  As the Emergency Medicine physician, I will read the film and act on it.  Days later, the radiologist will read the film and fax his reading to our department.  He/she has no idea what our read was so we have to weed through stacks of readings and see if there is any disagreement between their read and ours (very efficient -- sarcasm intended).

Finally, don't get old in Australia -- especially if you have a chronic illness.  If you are over 75 (or certainly 80) the philosophy is that you've had a long life and further resources being expended upon you are pretty much a waste.  An 80+ year-old with a GI bleed and who might be hypotensive is not going to get an ICU bed.  They may not even qualify for an endoscopy should they survive the night of their presentation.  If you are septic with pneumonia and present from a nursing home, I hope you can turn the corner with the oral antibiotics they give you when they send you back to the nursing home.  Pretty much after 80, get ready for the plug to get pulled....

Now for a few random thoughts and observations (that may warrant further details in future blogs):

People don't like co-pays here.  Even though they have access to a health care system, there is apparently a small co-pa for visits to the GP -- but not in the Emergency Department.  So guess what is happening to their ED census in the past few years?  Let's see, I can make an appointment and pay $20-$30 or walk into the ED and pay butkus... What should I do?

People in Australia think everyone in the U.S. has a gun -- and is not afraid to use it.

People in Australia think you can only see a doctor in the U.S. (even in Emergency) if you have money.

Fosters beer isn't sold here -- ANYWHERE!  The main beers are Victoria Bitters ("VB"), XXXX ("Four X"), and Hahn's Super Dry.

No one says "Shrimp on the barbie" (unless someone laid crustaceans on a doll)

Driving with even a low level of alcohol in your system will get you busted and random traffic stops for breathalyzing are common.

Their beaches are AWESOME!!