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!!