NEWS 7
ausdoc. com. au 11 APRIL 2025
NEWS 7
SPECIAL REPORT
Are‘ lazy doctors’ to blame?
PAGE 5 a symptom of an overcrowded ED. [ And we know ] the risk of morbidity and mortality— and this is very well established in the literature and has been for 20 years— isn’ t just for a patient who is delayed in an ambulance.
“ The risk of being seen in an overcrowded ED is experienced by the patient who is in the waiting room, it is experienced by the patient who is in a cubicle, and it also is experienced by the patients who are access-blocked as well.
“ To that point, ramping is a symptom; it’ s a symptom of an overcrowded ED, where clinicians like me are not working in an environment that allows us to make the best decisions.”
In the case of Mr Skeffington, the 89-year-old died in September 2021 during the COVID-19 pandemic, when the ED had been split in two to separate out the COVID-19 cases.
The inquest was told he waited in an ambulance for over an hour and 40 minutes before being taken into the ED in peri-arrest.
“ Unfortunately, we were very worried that something would happen like what happened to Mr Skeffington,” Dr Brooks said.
“ Where we would have a frail, elderly patient, who was a category 4 or a category 3, who wasn’ t suitable to go to the waiting room, who would experience a delay on the ramp, and we didn’ t have the right number of spaces in the non-COVID part of the ED.”
Working in a psychiatric unit
Dr Brooks spoke about the pressures on staff during COVID-19. But she also spoke more generally about the job of being an ED doctor.
“ Being an emergency clinician is an incredibly cognitively heavy task.
“ If I don’ t get the right piece of information, if I don’ t make the right decision, someone might die.
“ To do that in an environment where you are running your ED— which often it feels like … a psychiatric unit, with not enough staff, with equipment that doesn’ t work, and a physical environment with poor line of sight and challenging layouts— is incredibly difficult.
“ We know that we have added to the morbidity and mortality of every patient who has transited through an ED when it’ s overcrowded.
“ That risk doesn’ t stop in the ED; it continues with that patient throughout the entirety of their journey.
“ So rather than a focus on a small group of patients who have delayed access to timely care in the ED, who spend that time in an ambulance, my strong preference has always been to look at all the patients, irrespective of how they arrived, where they were seated before they got in a cubicle, and look at the harm that they might be experiencing.”
An attempt to silence Dr Brooks?
During her appearance before the committee last month, Dr Brooks was speaking
PHOTO: AAP under parliamentary privilege. This is important because without that protection, we may not have heard from Dr Brooks at all.
Last year, she had been called to give evidence by the state coroner examining the patient deaths linked to ambulance ramping.
She had wanted to give evidence, in part because she had seen how previous coronial recommendations had been made in ignorance of what the real issues were.
But she feared repercussions if she spoke out, saying that SA Health had refused to allow her to give“ official evidence” and that she could be liable for disciplinary action if she didn’ t comply
— a claim SA Health has denied.
To ensure she would make public her concerns, the Coroner’ s Court granted her immunity, a so-called“ certificate of privilege”.
She says she then received a letter from the Attorney-General warning her about what she was doing, stating that her evidence may“ intend to embarrass the state without notice”.
The government even appealed to the Supreme Court of SA, arguing the coroner’ s certificate had been issued in error.
In a ruling last year, the judges agreed and the certificate of privilege was withdrawn. The government has always denied it tried to silence her.
During her parliamentary appearance, Dr Brooks stressed that she finally secured permission from SA Health to speak with the coroner anyway.
But she said she remained concerned about prosecution for speaking out.
“ Such was the tenor of the correspondence from the Attorney-General that it was very concerning as a clinician to not be given permission to speak to the coroner.
“ It’ s a fundamental tenet of the coronial process that we have clinicians who are able to freely give evidence to the coroner, so we can ensure that the coroner has a deep understanding of the factors that may or may not have prevented a death.”
Dr Brooks resigned as clinical director back in 2022.
‘ It’ s just lazy doctors’
She said in her resignation letter that the state of the ED“ offends the very humanity of doctors”.
It is probably no surprise that the
Minister for Health Jack Snelling at the new Royal Adelaide
Hospital in 2017.
main theme running through so much of her testimony was about doctors and the way the attitude towards them from management, policymakers and politicians has become laced with cynicism, born of a basic failure to understand how doctors actually see the world.
“ As a doctor, I like to know the data. If you ask me to change a medication I use, I want to see the data behind it,” she said at one point.
“ If you are going to ask me to change my clinical practice, I want to see the data, and it has to be done in a way that is really statistically robust.
“ But to date, there has been this narrative around,‘ Doctors don’ t want
‘ It was very concerning not be given permission to speak to the coroner.’
to change’ … This narrative around,‘ It’ s just lazy doctors’, or other narratives that I have heard over and over and over again.
“ These are very smart people who have dedicated their working lives to caring for their patients.
“ Taking the time to truly understand the nature of the challenges and barriers that they face to discharging patients is really important, and that is a lot of the work that we are doing.”
She referred to clinician involvement in SIFT, the Statewide Interfacility Transfer process.
It is an attempt to deal with the access block by improving the transfer of patients between hospitals and also into rehabilitation services.
She said 35,000 patients who would have stood a very good chance of being ramped in the back of an ambulance were able to access care directly to the wards as a result of freeing up beds.
She said it worked because it was a data-driven approach which understood clinicians’ decision-making.
“ We can’ t just say,‘ Well, we popped out a policy. Stop this today or do this over here.’
“ You have to spend the time understanding the problems. Einstein was very wise. He said,‘ If I had an hour to solve a problem, I would spend the first 55 minutes understanding it and five minutes solving it.’
“ Unfortunately, we have a long history of doing the opposite, which is five minutes coming up with a solution, maybe without talking to anyone who really knows it deeply, and then 55 minutes telling people what they should do.
“ It doesn’ t work.”
THINK
TRIPLE
*
THINK
TRIMBOW1
* Trimbow is the only triple therapy PBS listed for severe asthma in two strengths and COPD( 100 / 6 / 10) 2
Trimbow 100 / 6 / 10 & 200 / 6 / 10 are indicated for maintenance treatment; in adults with asthma not adequately controlled with a maintenance combination of medium dose or high dose ICS / LABA respectively, and who experienced ≥1 exacerbation( s) in the previous year. Trimbow 100 / 6 / 10 is indicated in adults with moderate to severe COPD who are not adequately treated by ICS / LABA or LABA / LAMA. 1
PBS Information: Authority required( STREAMLINED). Severe Asthma. Chronic Obstructive Pulmonary Disease( 100 / 6 / 10 mcg presentation only). Criteria Apply. Refer to PBS for full information.
Please review Product Information before prescribing. Product Information is available by scanning the QR code.
NEW PBS LISTING
FOR SEVERE
ASTHMA 2
Abbreviations: COPD: chronic obstructive pulmonary disease; ICS: inhaled corticosteroid; LABA: long-acting beta 2 agonist; LAMA: long-acting muscarinic antagonist; PBS: Pharmaceutical Benefits Scheme; pMDI: pressurised metered dose inhaler. References: 1. Trimbow Approved Product Information. 2. Pharmaceutical Benefits Scheme( PBS). www. pbs. gov. au. Chiesi Australia Pty Ltd, Hawthorn East, VIC. 3123, Australia. Tel: + 61 3 9077 4486; Fax: + 61 3 8672 0792; Email: medinfo. au @ chiesi. com. Copyright © Chiesi 2025. All rights reserved. Date of preparation: January 2025. AU-TRI-2500008. CHIE00211C.
CHIE00211C ADG TrImbow third vertical 80x375mm _ FA. indd 1 28 / 1 / 2025 10:28 am