oneworldtalk

Misguided abuse hurts staff and chance for change

Phil Huang
October 4, 2007

I have just finished four evenings in emergency at Ryde Hospital, part of the North Shore network, with minimal sleep over the long weekend. I am a mere intern, fresh out of medical school, driving with a learner's licence, but driving nonetheless.

Recent events at Royal North Shore Hospital and its aftermath have brought tremendous sorrow into my life. Sorrow for the mother who miscarried, sorrow for the hospital and sorrow for our health profession. What is more unfortunate however, is that the event has become a platform for politicians to campaign while the real problem disappears into the background.

There is no doubt that what happened to Jana Horska was a tragedy. Miscarriage at any stage is a harrowing experience and you do not need medical training to appreciate that.

We live in a time of medical miracles. Heart attacks can be prevented and stopped as they are happening, degenerating hips are replaced with synthetic ones, cancers can be beaten into submission through chemicals. But we are helpless in effecting change in the early period of pregnancy. There are no absolute predictors for which pregnancy will proceed and which will terminate. Such is the nature of conception. Mothers are usually fit and healthy. Telling them that something may go wrong is exceedingly difficult.

For better or worse, our emergency departments are designed for emergencies. Patients are categorised by severity and reversibility. It is unfortunate but necessary. Patients who may die from a easily reversible condition are given priority over patients who we are helpless to assist.

In an ideal world, Ms Horska would have been placed into a bed and protected from the ultimate horrors that ensued, but hospitals in their current form cannot provide that. We as health professionals have no control over who receives a bed. Guidelines and codes determine which patients receive a bed.

The attempt to categorise human suffering has led us ultimately to this destination. Having spent all my student years at Royal North Shore Hospital and feeling like I was part of a family, I have watched it degrade over the past five years. It is no secret that many hospitals are underfunded and under-resourced. Budgets are exceeded each year and the response by the bureaucrats is to give less. This will encourage less spending over the next financial year as workers attempt to be more fiscal at a cost to patients. Thus reports of budget "blow-outs" are often misrepresented because hospitals have less to work with each year. Hospitals are not businesses and yet are managed as such with boards and chief executives. Patients are not profits and yet economic models are applied in attempts to manage them. These are the cards we are dealt everyday.

There is a belief that we practise medicine for financial gain yet, any doctor working in today's health system will laugh when this is suggested. I am not implying that doctors are scraping the poverty line and most do live quite comfortably. But the sacrifices made to attain that level of comfort come at the expense of their own families and their own lives. Thus the real reward in medicine lies in the ability to help another even if there are difficulties in expressing this undeniable truth.

I was completing a research masters at Cambridge when my professor discovered I was finishing to pursue medicine. He laughed and tried to dissuade me. "What would you rather, Phil?" he asked in a typical pompous British accent. "To affect the life of one? Or the life of millions ?"

I chose the life of one. The doctors, nurses and health workers I have encountered at North Shore and elsewhere have served to confirm my initial decision. I can confidently say that most I have encountered hold the above ideal true.

This ideal is what brings my colleagues and myself into work every day, to face abuse from patients for an article they read that morning, to go through shifts of 14 hours or more without breaks and to find increasingly that we have less to work with. This ideal and its current state forms the basis for my compulsion to write and make an impassioned plea.

As the hype settles and the blame game takes its turn moving around the board, I hope the real issue resurfaces. What happened with Ms Horska is the tip of the iceberg of faults that exist in the health system and not just at Royal North Shore Hospital. Inquiries and articles blaming doctors, nurses and health workers may satisfy the anger of the mob, but it will never effect change.

In a period of prosperity, the resources of hospitals and universities have dwindled. Politicians will debate the foibles of my colleagues and seniors, shifting blame and providing a smokescreen to the truth. I love my job and medicine in spite of the system and I can attest that many of my colleagues feel the same. Yet the current system has drained the passion away from so many, turning them apathetic as they are blamed for actions beyond their control.

The media have tremendous power and effect. Effect that can be directed towards change and empowering individuals. Effect that is lacking in current stories about blame and fear.

Dr Phil Huang is an intern employed by Royal North Shore Hospital.

http://www.smh.com.au/news/opinion/misg ... ntentSwap1

One stricken hospital exposes a national malaise
October 6, 2007

So much for the brand "public health". What can it be worth in NSW after the damage of the past 10 days? No private enterprise relying on its reputation could hope to survive so many accusations of neglect and mistreatment. Casualty wards would be empty, and the receivers would be showing the NSW Health Minister, Reba Meagher, the door.

But this is the public sector: accountability strictly limited. Faceless bureaucrats are still in place; their political masters, too. They know the public has little choice, and neither do the many dedicated front-line health professionals who work in public hospitals. So more blame-shifting between NSW and Canberra has been the chief response to the extraordinary litany of complaints sparked by last week's shocking tale of how Jana Horska was left to miscarry in the toilet of Sydney's Royal North Shore Hospital.

Recriminations abound, facts are few. However, thanks to the Federal Government's own Australian Institute of Health and Welfare, we can see how Canberra has reduced its share of annual funding for public hospitals over the Howard years. A decade ago, Canberra and the states and territories contributed equally. Now the states and territories put in $12.4 billion a year, and Canberra puts up $10.1 billion. If the Federal Government had continued to match the states, that would mean an extra $800 million annually, or thereabouts, for NSW public hospitals.

The federal Health Minister, Tony Abbott, says the institute's figures ignore the Government's contribution to private hospitals via the 30 per cent tax rebate on private health insurance premiums. Add that, says Mr Abbott, and the Commonwealth's share of total hospital funding equals that of the states and territories. But the argument in NSW is not about hospitals generally, but public hospitals in particular.

When the Federal Government introduced the 30 per cent rebate eight years ago, it claimed that the rebate would reduce the burden on public hospitals by encouraging patients to go private. The Herald argued then that if the Government wanted the cost of the rebate - now a whopping $3.5 billion a year - to go to public hospitals, it should simply pay it to them directly.

Certainly there has been a marked increase in the use of private hospitals in recent years, and no doubt this owes something to the rebate. The problem is that demands on public hospitals have grown even more. Those facing long waits for essential surgery in NSW public hospitals may be rightly irked that the health insurance rebate helps finance less urgent procedures in private hospitals.

But more federal funding is only part of the answer to the problems in NSW. In the longer term, the system needs to become less reliant on large public hospitals, and put greater emphasis on community care. It is moving in that direction, but all too slowly. Equally, there needs to be more emphasis on preventive medicine if we are to restrain the exponential growth in demand for treatment. Immediately, however, the Government has to do better with what it has.

That means heeding the advice of those on the front line, and there has lately been no shortage of frank talk from chiefs of emergency medicine about the frustration and ultimate demoralisation that comes from constantly trying to do too much with too few and too little. They are particularly scathing about being bullied by bureaucracies and management they find as uncomprehending as they are unaccountable.

Worryingly, this seems to have come as a revelation to "The Grim Reba" Meagher, who said after meeting heads of emergency from major hospitals that their relationships with the department "seem to have broken down". Seem to! Meanwhile the Premier, Morris Iemma, is busy keeping his inquiries into Royal North Shore as narrow as possible despite giving Jana Horska and her husband, Mark Dreyer, the impression he would investigate all their concerns.

So we have a Health Minister who doesn't know - and a Premier who doesn't want to know. Just as well these are not matters of life and death.

http://www.smh.com.au/editorial/?page=f ... ntentSwap1

Foreign doctors already working in the UK must not be "scapegoated" as the Government tries to cut medical immigration, the British Medical Association (BMA) said.

The Department of Health is considering changes to the rules for medical graduates from outside the European Economic Area applying to specialist training posts next year.

But the BMA, giving evidence to the consultation, has said that while medical immigration should be better controlled, the thousands of doctors and medical students from overseas who are already in the UK should not be penalised.

Dr Terry John, chair of the BMAs International Committee, said: "Long-term, the UK should be able to produce its own medical workforce and managing medical immigration in the future will be necessary.

"However, the thousands of overseas junior doctors currently providing essential services in UK hospitals must not be scapegoated for the governments poor workforce planning.

"They came to the UK in good faith, and the honest expectation of training opportunities in the NHS.

"The BMA is particularly concerned about overseas students currently spending large amounts of money an average of 23,000 a year during their clinical years to study at UK medical schools.

"International medical students are often making huge personal and financial sacrifices in order to study in the UK.

"If they are not allowed to apply for postgraduate training posts, and are forced to return home, they could face a huge struggle in repaying outstanding debts."