OPINION 19
Maximise † patients ’ chances of quit smoking success
ausdoc . com . au 13 SEPTEMBER 2024
OPINION 19
Insight
The sausage in the machine
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Dr Pam Rachootin GP in Adelaide , SA .
My story of future healthcare in a time of specialist shortages .
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When my daughter made it through the consult room doors , a dermatologist took a complete history , performed an examination but was unable to diagnose the condition and ordered two biopsies that were done by a nurse .
She could return in a week for removal of sutures by a nurse or go elsewhere .
Results would be available in
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4-6 weeks ; however , she would not need to repeat her efforts on that day and , instead , would receive an actual appointment time .
One of the dermatologists interviewed about the facility for a media article said he had seen 130 patients that day .
It seems that many Toronto GPs ( who are now doing telehealth ) are diagnosing and treating half as
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many patients with skin problems as before . It turns out almost half the dermatologists in the state are over 55 and only seven new ones are being trained a year .
As I also struggle to get timely private dermatology appointments in Adelaide after retirements and closed practices in my area , at least there are skin cancer clinics and procedural GPs happy enough to
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take up some of the slack .
However , I have totally given up on public hospital dermatology appointments beyond my renal transplant patients and other highly immunocompromised individuals .
I worry , when it comes to private dermatology , we are not far away from what is happening in Canada .
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IT is often worth looking around the world to get an idea of the sausage machine we are heading into when it comes to future healthcare .
It is not that the world is all the same , but when it comes to accessing specialist care , the forces at play seem familiar . And that is because of the global shortage of specialist doctors .
My case study is my daughter in Toronto , Canada , and her experiences seeing a dermatologist after her GP had been unable to diagnose her skin lesion .
She received a referral but was told that the anticipated wait time to see a dermatologist for a non-urgent appointment was 7-8 months .
Researching her options , she found a possible fix : a walk-in , rapid-access dermatology clinic advertised as seeing a limited number of patients on a firstcome , first-served basis from 8am until 11am .
She got up early , arrived at 6:15am and joined the queue ; she was number 17 .
One doctor said he had seen 130 patients that day .
Chatting with the folks in line , she learnt it was not uncommon for the queue to extend for more than three blocks .
The rules of engagement for this clinic were as follows : you needed a referral from a GP , the referral could not be for a second opinion , only one problem would be addressed and it could not be for wound care of ulcers .
Once she was registered , she felt very fortunate that she was in the waiting room .
People further back in the queue had to go away and would receive a text stating when they could return . No priority access was given . Although a woman on oxygen was allowed to sit in the waiting room , that was no guarantee that she would be seen , which depended on how far back her friend was in the registration queue outside and whether or not they made the time cut-off . If they failed , then the woman and her friend would have to come back and try again another day .
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References : 1 . RACGP . Supporting smoking cessation : A guide for health professionals ( 2nd edition ), Melbourne . 2 . Cancer Council Victoria . Pharmacotherapies for smoking cessation . Available at : https :// www . tobaccoinaustralia . org . au / chapter-7-cessation . Accessed April 2024 . * Source : Circana Total Smoking Control , AU Grocery & Pharmacy ( units and dollars ) MAT to 07 / 01 / 24 . † Compared to single Nicorette products . 2 NICORETTE ® products contain nicotine . Stop smoking aid . ® Registered trademark . AWID 112143 .