It takes so much more time to pro- |
ED, the fall guy of the health system |
vide antibiotic stewardship and general advice.
But some patients have no interest.
One patient told me he did not care about antibiotic resistance as
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‘ There is this narrative around— it’ s just lazy doctors’: The true story of ambulance ramping and ED deaths |
he would be long gone!
Dr Vicki-Lee Jefferson Medical practitioner, Perth, WA
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Dr Megan Brooks, thank you for telling it how it really is.
Those of us still working in the public hospital ED system are frogs in an ever-boiling pot.
There is no comparison between the volume, acuity, complexity and public expectation of healthcare today and 30 years ago.
And the decision density increases every year with more
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Calling out Medicare’ s monotony Medicare’ s magical number factory: Why do bureaucrats trust doctors to save lives but not to prescribe?
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knowledge, better diagnostics and more acute treatment options. The menu is expanding and with that higher expectations.
Patients are also older and sicker because medicine has kept them alive longer.
I feel our community is more anxious and fearful and less resilient than earlier generations.
Megan, again, thank you. You are a wonderful advocate for our profession and our community.
Dr Matthew Davis Emergency medicine, Sydney, NSW
This is a wonderful exposé on what happens when medical and nursing personnel do not manage the hospitals.
The old model of the superintendent and director of nursing running the hospital, with administrators being channelled to do what is important, is sadly missed.
Dr Jane Trinca Pain medicine, Melbourne, Vic
Good on Dr Brooks for laying out the issues so clearly.
So many of the problems she describes are due to the actions of other decision-makers within the healthcare system.
With no accountability, doctors like her then have to try to deal with the workarounds.
Blaming the doctors is not a solution; it is just a political tactic to kick the can down the road.
Dr Deborah Verran Medical practitioner, Sydney, NSW
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Many EDs have become nightmare workplaces and awful places to receive care.
But let’ s be clear: our system is designed for them to be like this.
The perfect storm occurs when ED becomes a backstop for gaps in every other health and social service— from homelessness to a second opinion to a GP being on holiday to a surgeon in theatre.
I find it hard because the same services are all happy to criticise
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ED when things go wrong.
Then you have the blocks preventing patients from going to the wards.
So you have the spectacle of ICU patients, psych patients, paediatric patients, the dying and the suffering stuck in ED for days while new patients keep flowing in.
An open front door plus a closed back door equal a block.
Those managers who can force staff to move into a poorly designed facility and use a clunky computer program are the same managers who are not requiring the inpatient world to accommodate incoming admissions from ED.
A lot more can be done to keep the flow going.
Dr Sue Ieraci Emergency medicine, Sydney, NSW
A taste of their own medicine Do doctors lack insight into the realities of being a politician in control of the health budget?
Doctors are telling politicians how to control the health budget because politicians are telling doctors what to charge to run a general practice.
Dr Maurice Wark Retired GP, Port Stephens, NSW
It is true that doctors do not fully understand the world of politics or politicians. There is no bottomless pot of money.
The problem is and remains that health ministers lie about providing free healthcare for all on instant demand.
This makes promises on behalf of other people( ie, doctors) that can never be delivered.
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To quote Aleksandr
Solzhenitsyn:“ We know they are lying.“ They know they are lying.“ We know they know they are lying.“ But they are lying still.” You do not have to understand the complexities of being a politician to see this.
Dr Joe Kosterich GP, Perth, WA
A refresher but not a remedy Half of patients using
Mark Butler’ s urgent care clinics as alternative to GPs, evaluation suggests
As a GP working one day a week in an urgent care centre linked to a major hospital, I find the experience both enjoyable and professionally rewarding.
It offers a refreshing contrast to my regular four-day schedule in community general practice, where I primarily manage chronic conditions and care for an older patient demographic.
In urgent care, I encounter a wide range of acute presentations, particularly orthopaedic injuries and laceration repairs, as well as O & G medicine, which I do not see much of as a male doctor.
All this allows me to maintain procedural skills and engagement in areas that I encounter less frequently in my routine practice.
I see urgent care as a valuable component of the healthcare system, especially for managing non-life-threatening issues that require timely attention.
However, I would add it can be a high-pressure environment, particularly during
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busy weekends, and that can be overwhelming.
I remain uncertain whether a significant expansion in the number of these clinics is the optimal solution to ED pressures though.
Dr Maxy Mariasegaram GP, Mornington Peninsula, Vic
The problem I have encountered with a few of my patients is that they are being told they have to call first before attending the urgent care clinic.
This, to me, sounds like a hidden appointment system, which can mean there is a lack of doctors to treat every patient.
Guess what? The patient attends the local ED instead.
Dr Alex Toh Healthcare professional,
Melbourne, Vic
Just what the doctor didn’ t order Why is it so hard to say no when patients demand unnecessary treatments?
It would be interesting to do a study documenting what percentage of medical consultations result in an altered clinical trajectory for the patient.
How many coughs, fevers, abdominal pains, sore throats, backaches and twisted ankles would do just as well without consultation?
How many patients experience iatrogenic harm from presenting?
The absence of bulk-billing is claimed to risk people’ s lives. But I also wonder if universal bulk-billing might risk the obverse.
Dr James Muir Dermatologist, Brisbane, Qld
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The authority script line’ s mundane on-hold music just zaps my brain while my patient and I stare at each other waiting for the voice at the other end, which sometimes feels like eternity.
And then I have to recite my personal details / numbers and the patient’ s name and numbers to a very courteous stranger at the other end of the line whenever the patient comes for their repeat scripts.
Dr Constantina Rodrigues GP, Melbourne, Vic
Groundwork or adding to the junk heap? Mandatory research projects for registrars part of a $ 100 billion problem: Professor Paul Glasziou
I am glad someone is finally publicly saying what I have been thinking for years: these research projects are an unnecessary burden for registrars and just encourage junk research.
Dr Paul Stevenson GP, Sunshine Coast, Qld
We are guilty of making the infodemic worse!
Dr Irene Lai GP, Sydney, NSW
I recall being allowed to do a formal literature review instead of a research study for the research component of my training, and I found it to be a valuable experience.
Not all of us will be researchers; I am definitely not that way inclined.
But we all benefit from having a robust understanding of how the evidence base for the treatment we provide evolves and how to critically assess the evidence available.
Dr Tracy Soh Medical practitioner, Canberra, ACT
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