Incapacitation

[dutchroll]

Yes but who is going to fund that all the way through to the 10 or 12+ years training to produce the end product and with what money? The Government goes "oh but we've funded many more university medical graduates!"

 

Who will fund the extra nurses?

 

The extra hospital beds?

 

The extra theatre time?

 

The extra orderlies?

 

The extra facilities?

 

They pump out hundreds of medical degrees from uni and then......silence. Crickets chirping.

 

 

[facthunter]

Which would inevitably lead to higher costs and staff sitting around just in case there was a "rush" on..Nev

 

 

[skeptic36]

Maybe if they stopped requiring a G.P to waste time seeing somebody who has a sniffle, so the somebody can get the doctors certificate required by their workplace (ie let somebody less qualified do the menial tasks) then that could free up some talent.

 

 

[Jaba-who]

And it's all about to get worse.

 

We now have a glut of medical students coming out ( I am a senior lecturer at a medical school and we have nearly doubled our student intake ) and they have no guarantees they will get a job upon graduation - nothing unheard of about that ( many uni graduates from other courses face same issue - except society has spent nearly a million bucks on training each one of the doctors and way less on arts degrees and lawyers and then if they don't work for a year or more and are then so out of currency that they require more of society's money spent on them to get back up to speed when the jobs become available.

 

The real place money has to be spent is on nurses and staffing the beds in the wards ( not in emergency departments).

 

One of the prime reasons patients spend so long in the sausage mill of the ED ( Emergency Department) is that there is bed block in the wards - the places where the ED patient has to go after being sorted out in ED. If there' s no where to go they stay in ED taking up staff, bed space etc.

 

Why has this happened at all?

 

About 20 years ago health departments federal and state conducted planning into future needs.

 

Doctors and nurses said we need more of what we have. Bean counters said "no you don't - we need less! In the future almost every operation will be keyhole surgery, almost everyone will be having daycare only surgery and we will need less beds. And besides more doctors means more work gets done and more work means more cost."

 

Well they forgot that we have an aging population who have more "medical" as opposed to surgical problems) which prolong hospital stays and not all hospital admissions are about surgery and not all surgery can be daycare and not all surgery can be keyhole. And not all social circumstances mean patients can be sent home same day. And Australia is a big place ( unlike Europe where they modelled this new age care) and you can't operate on someone and send me home if they live four hours drive away with no medical support there if they have a problem. Even worse if they are country person who has to wait till next Wednesday for the only flight, bus or train that goes to your home town.

 

Sadly a lot of the problems we have were foreseen by the front-line workers at the time but we were told we were just acting in self-interest.

 

 

[SSCBD]

What Pisses me off more than anything is sitting for hours without being told anything. My blood pressure raises like stall speed with angle of bank. Communication to the waiting is required to people waiting simple acknowledgement they are not forgotten and update timing.

 

Also I speak to a few ER nurses at the local dog park and they say that have a hard time with the "illegal drug induced " overdoses that are also tied to attempted suicide and use huge resources of people, police and time in the ER. One incident they said had NINE police called to keep the ER safe for patients from one guy out of control on ice. Stand off lasted four hours.

 

 

[Bruce Tuncks]

Ozbirdy, I wouldn't report anything. They will probably ground you. Not because they are bad guys ( although they may be ) but because by reporting it, you are making them responsible for any future problem. Grounding you solves their problem and it doesn't inconvenience them at all. By "them" I mean CASA or their medical consultants.

 

This guy I have flown with for 40 years has type 1 diabetes, and he is quite safe because he feels bad for hours before any event which would endanger him in the air. I reckon many medical conditions are like this, gosh you couldn't even walk up stairs if you were prone to sudden comas.

 

And SSCBD, what you say about ice-heads applies in Adelaide too. I would have cages for them at ER. They are quite dangerous.

 

 

[Jaba-who]

Maybe if they stopped requiring a G.P to waste time seeing somebody who has a sniffle, so the somebody can get the doctors certificate required by their workplace (ie let somebody less qualified do the menial tasks) then that could free up some talent.

Unfortunately while it's the first thought - you've missed the point. It's not doctors where there is a shortage. It's beds and nurses. But politicians and bureaucrats have been missing the point for decades.

The reason there is a GP shortage ( which is not what this thread is about because that's a completely different set of problems) is the governments closing down of funding for GP training after doctors graduate from hospital training positions. But it's a very complex situation so would not help the current thread by complicating the story here.

 

The other thing that misses a very significant reality is the "let somebody less qualified do it" and leave the difficult stuff for the doctor" is that's like saying -" let's have a a low hour ppl in the pilot seat of the airliner ( plenty of us would do it for free for the hours in the log book) for the easy flights and just save the talent of the ATPL pilot for when it's really required. "

 

Well very soon the ATPL has his skills eroded by only being required intermittently and then you have no one with the experience to do the job. Doctors maintain their complex skills by constant doing the easy easy stuff!

 

And the other really annoying thing is doctors are now required to do huge amounts of recurrent training, continuing medical education etc ( I personally have to to do hundreds of hours of point scoring Continuing medical education per year) because "we are aren't safe" unless we do it, yet there is a push to use people with less skill and training to do the same work because it will cost less. Well we could do it better and cheaper if we didn't have spend so much on education too.

 

Something doesn't make sense there when you look at it.

 

 

[facthunter]

Jaba. A doctor (GP) can get assistance in diagnostic situations by using plenty of online sites they pay for. This may actually be a good thing at times . The analogy with the Airline pilot situation relates more to surgery. The team the preparation the discipline, training skills etc. Emergency is taking a lot that would be done by 24 hour call facility by GP's (which is non existent virtually) Most specialists take the week ends off, so your stent can wait till Monday if you end up at one of those places. Medical people are now exposed to "OFF their Head" violent people in the course of their jobs too much. It's more common everywhere. That is not good, and I generally think medical people do a great job, in emergency situations. It's pretty traumatic for them. I'm a good patient. I'm in their hands.

 

Airline pilots operate 24/7 in practically all weathers to a schedule. Keeping the schedule becomes a very important facet of it , sometimes too emphasised. Management want it . Pax want it.

 

Recreational pilots can pick when they fly and IF they fly. Much more fun. Nev

 

 

[Yenn]

I don't know where all the doctors we are training in Auistralia are, but it is not where I live. My GP practice has 1 Aussie and 5 non Aussie doctors. Others have an even poorer ratio and some cannoot speak understandable English.

 

As far as emergencies go I would not go to the hospital with a foot that was uncomfortable to walk on, that would be for the GP.

 

I did go to the emergency a couple of days ago and it was bedlam, Not enough room nor enough staff, but an hour later it was all sorted. I was attended to, maybe slowly, but safely. My suspected broken kneck was confirmed to be OK. Total 4 hours, but what else was I going to do.

 

I did note that a doctor posted on this forum that there was an incompetent docter where he worked and they could not get rid of him. Reminds me of Jayant Patel at Bundaberg. Same state as well.

 

 

[red750]

Part of the delay in treating my son was poor communication. We were instructed to sit in the front waiting area near triage. Apparently the doctors expected us to be in the Fast Track waiting room down the corridor, not visible from the front area. When we weren't there, they assumed we had left, without checking the front area. When Fast Track closed, we were sent back to the front. So we went to the back of the queue, as others coming in much later were treated before us.

 

 

[facthunter]

A lot of people just walk out without letting anyone know. It's a bit of an education in some of those rooms. Nev

 

 

[Jaba-who]

Jaba. A doctor (GP) can get assistance in diagnostic situations by using plenty of online sites they pay for. This may actually be a good thing at times .The analogy with the Airline pilot situation relates more to surgery. The team the preparation the discipline, training skills etc. Emergency is taking a lot that would be done by 24 hour call facility by GP's (which is non existent virtually) Most specialists take the week ends off, so your stent can wait till Monday if you end up at one of those places. Medical people are now exposed to "OFF their Head" violent people in the course of their jobs too much. It's more common everywhere. That is not good, and I generally think medical people do a great job, in emergency situations. It's pretty traumatic for them. I'm a good patient. I'm in their hands.

 

Airline pilots operate 24/7 in practically all weathers to a schedule. Keeping the schedule becomes a very important facet of it , sometimes too emphasised. Management want it . Pax want it.

 

Recreational pilots can pick when they fly and IF they fly. Much more fun. Nev

Sorry but I couldn't disagree more with all the bits except the issues about meth-amphetamine. .

 

In fact it's the GP who has the greatest need for seeing and doing the simple stuff in significant numbers because they are the ones who first see the rare and dangerous in amongst the dross.

 

Specialists are often spoilt- we get sent the filtered, already diagnosed.

 

The GP is the guy/girl who needs to see a thousand kids with a fever, mild rash and sore throat to know that number 1001 has not just got a cold but because the rash looks subtly different he has meningitis and if the doc doesn't treat him correctly now, he'll be dead in 12 hours.

 

The GP is the one who sees a thousand people with high blood pressure but has to not be lulled by the banality so they don't miss that the patient says in passing he gets a headache when he pees and actually has a malignant adrenaline secreting tumour of the bladder.

 

Don't for a minute think that high level knowledge and capability and the constant need to exercise the basics is restricted to the specialist.

 

Won't say anything about specialists taking weekends off - except "I wish!"

 

If your doctor (GP or specialist) is using doctor Google you need a new doctor. There have been several very large studies looking at the use Internet sites for diagnosis and treatment and they have been uniformly scathing.

 

When patients or doctors (who purposely don't use their knowledge) do their own googling the likelihood of a wrong diagnosis is 80 - 85%.

 

When a doctor uses it to make a diagnosis when he doesn't already know the diagnosis the chance of a wrong diagnosis is still about 15%.

 

So essentially if your doctor sits in front of a computer making the diagnosis. Go somewhere else as fast as you can!

 

 

[Jaba-who]

I don't know where all the doctors we are training in Auistralia are, but it is not where I live. My GP practice has 1 Aussie and 5 non Aussie doctors. Others have an even poorer ratio and some cannoot speak understandable English.As far as emergencies go I would not go to the hospital with a foot that was uncomfortable to walk on, that would be for the GP.

I did go to the emergency a couple of days ago and it was bedlam, Not enough room nor enough staff, but an hour later it was all sorted. I was attended to, maybe slowly, but safely. My suspected broken kneck was confirmed to be OK. Total 4 hours, but what else was I going to do.

 

I did note that a doctor posted on this forum that there was an incompetent docter where he worked and they could not get rid of him. Reminds me of Jayant Patel at Bundaberg. Same state as well.

There is a BIG problem with mal-distribution not with total numbers. Once people graduate from medical school there is a huge difficulty in getting them to move to rural areas. ( much of it real and in fixable. And some possible to fix but difficult) and worse once a specialist is qualified their family is ensconced in the big city and unable to move due to all the things that families get involved in.

But there is another issue and that's the bottle-necking in training. We have a huge number of medical students ( still in university) who will have no intern jobs in the next couple of years and a large number doing internships ( first year out of uni, limited experience and very little idea of what's important and what's not. Not yet allowed to practice without supervision) and a few years after internship they still are not capable of practicing fully alone without backup.

 

So what we get is a distribution of Aussie doctors stuck in the cities and they import doctors from third world countries for rural posts. And that is a huge other problem area we could discuss for weeks.

 

 

[facthunter]

Jaba.... Are you suggesting that as an example, a GP can prescribe an additional drug /mixture of drugs without referencing data on their compatibility? Should it be done from memory? Just on this one I and others, (chemists nurses, I source Mayo clinic) have picked up errors that would have had serious repercussions. You appear to be happy to NOT LISTEN to what I'm trying to say. That's your privilege. Nev

 

 

[Jaba-who]

Jaba.... Are you suggesting that as an example, a GP can prescribe an additional drug /mixture of drugs without referencing data on their compatibility? Should it be done from memory? Just on this one I and others, (chemists nurses, I source Mayo clinic) have picked up errors that would have had serious repercussions. You appear to be happy to NOT LISTEN to what I'm trying to say. That's your privilege. Nev

I'm sorry if I've made it sound I was being derogatory to your comment. That wasn't my intention. I apologise.

 

With regard to the use of computers I was only thinking of using the Internet for diagnosis. In regard to using it for drug interactions etc.

 

Well, yes. It has its uses in that area. Not as much as you might think but with the bewildering array of generics available now I use the Internet mostly for just finding out what the brand named drug actually is, more than for interactions.

 

Most Australian patients are on a surprisingly small range of medications ( some may be on many drugs but many are from a small range of family groups with each member of the family having similar interactions side effects etc. ) that's how come a community pharmacy/chemist shop can have all their prescription drugs in one relatively small room - way smaller than the room they keep their stocks of vitamins, cosmetics and shampoos and conditioners and other chemist goodies in.

 

No one stops and look up every drug we use every time and chase up possible interactions in the Internet.

 

And yes , while they happen - For every uncommon time someone does miss an interaction they would be prescribing hundreds or thousands of times safely without having to look it up.

 

So yes. In general GPs do and should be able to prescribe without having to go look up interactions. In our exams we are expected to be able to quote verbatim the multitude of interactions and contra-indications between standard commonly used drugs. Student doctors and doctors sitting specialist exams are also are expected to be able to relate the significance and rates of interactions. Not just list a whole screed of interactions but to actually know which of these is likely to happen frequently versus rarely happen and what the significance of the reactions are.

 

Of course there will always be someone who forgets but many studies have shown the cause of failure to detect potential complications is more commonly related to not asking or knowing what patients are on rather than not knowing the interactions they cause.

 

In terms of sitting with a computer on the desk, that was one of the biggest complaints in a Med Journal of Australia report a couple of years ago. Patients overwhelmingly complained of feeling ignored by doctors who used computers during the consultation. I guess that may be generational thing because statistically most patients are elderly. But for now it's a bad look to sit hidden behind the computer like an accountant while the average patient wants a caring doctor who is on full view to them and who at least appears to be solely focused on them.

 

Don't take it from the above that I'm an anti-computer old fogey. I have 2 iPads, an iPhone, a laptop and a desktop. Wifi through my house and my practice has 7 computers and our own server. Just that like all tools it's not always as useful and pain free as it might seem to the onlooker.

 

 

[dutchroll]

In general GPs do and should be able to prescribe without having to go look up interactions. In our exams we are expected to be able to quote verbatim the multitude of interactions and contra-indications between standard commonly used drugs. Student doctors and doctors sitting specialist exams are also are expected to be able to relate the significance and rates of interactions. Not just list a whole screed of interactions but to actually know which of these is likely to happen frequently versus rarely happen and what the significance of the reactions are.

It's been 16 years since she was a GP before going to the dark side and becoming a specialist and my wife still knows most of the drug interactions off the top of her head, and certainly all the common ones plus the ones which apply to her speciality (ie all the pain relief drug classes). Drug interactions seem to be reasonably uncommon and often the result of a swiss cheese scenario rather than ignorance.

I don't think she's ever gone to the web to search for an answer to anything because I imagine tapping away on your computer in front of a patient might distract from a proper history taking and examination from which almost all the info necessary for a diagnosis (or at least figuring out if further testing is needed) is gleaned. I have witnessed the occasional dragging out of very thick medical textbooks at home though!