Things are grim when getting urgent care becomes impossible, even for a doctor.
Recently, I had occasion to seek care for my youngest via the local emergency department.
My kid woke up and came to me, hunched over, in tears. I examined them, and as it was my day off, gave pain relief and said, “let’s watch and see”.
Two hours later, with the pain no better and tears plopping down their face, I contacted my friend who works in ED nearby. She wasn’t rostered on, but said wait times were around 10 hours and suggested I should at least head in and join the queue. Another friend, a FACEM in Melbourne, suggested I not wait either as the issue potentially needed surgery and was not a community based problem to fix.
So we drove in. It took us an hour just to be seen at the triage desk, and we were told there were no paediatric beds in ED and the wait for one was currently three hours. We went back outside to wait. “Do escalate if there are any concerns or the pain gets worse,” they said.
I tried calling local imaging places to see if I could organise an urgent ultrasound as a doctor myself, as friends told me most EDs would need one, to expedite matters. All places locally were fully booked and short-staffed, with no fit-ins possible.
Two hours later, I checked if we were any closer. Nope. Pain was still 9/10. An hour after that, we were called in. The urine sample was taken, weight was checked. The lovely nurse I apologised to said, “It’s ok, primary care is a bit of an arse right now.”
We were moved to another area to wait. Different nurses came to see us and to do observations. There were truly sick babies around us, coughing, vomiting and more. By this time, my kid was perking up. The pain, which had been 10/10 at home and 9/10 outside, was now 7/10. I suggested we go home as obviously everyone was busy, and we were holding up resources I was no longer sure we needed.
The nurse we spoke to, who’d commenced the afternoon shift, said a doctor would be in soon and to please wait. It was close to six hours by the time the registrar came. She was with us briefly, and agreed with me that we could probably go home once she’d checked with her boss. She came back to advise that her boss agreed, but could we wait for an ultrasound outside as they needed the bed. So we moved back outside.
After waiting over another hour, my kid’s pain went from 7/10 to 3/10 at which point I was asked if we could “go home and get fries on the way”. That was my cue to leave.
As we left, I reflected on how unsafe I’d felt, even as a doctor, all day in the emergency department, where I was essentially treated as a layperson and, thanks to my time away from hospital medicine, knew no one. Sitting in the waiting room, with my kid hunched over, I’m not sure who I could have approached or asked for help in that crowded waiting room had things taken a turn for the worse.
FACEM Dr Bethany Boulton, writing recently in TMR about the time pressures in ED, opined that “the government is constantly urging clinicians to choose wisely, but if those in power invested their resources more wisely they would achieve better health outcomes. One way to do this is by bolstering the existing staff and infrastructure that manages chronic disease – namely general practice … which, if managed promptly, would reduce the likelihood of deterioration requiring a presentation to ED and admission to hospital.”
Funding general practice adequately so as to attract enough people to choose it as a speciality and to enable us to work within it safely would help with community care. On this occasion in ED I wondered: if general practice was funded adequately and commensurate with our hospital peers, how many of those who sat for hours in the crowded waiting room could have seen a GP in a timely fashion instead? Doing so would have allowed those who could only be seen in ED – those for whom no amount of prior primary care would have prevented them finding themselves there – to access care faster.
As more and more universally bulk billing practices begin to move towards mixed billing and charging gap fees, we are faced with irate patients trotting out the usual “greedy GPs” trope. This time, however, it has galvanised my colleagues, equally burnt out, exhausted and now angry at the chronic disrespect from the public to simply charge a fee that will enable them to stay in business instead of trying to negotiate or to wait for the paltry patient rebate to be raised. Most of us have accepted that this will never happen, and it is a matter between the patient and the government, their insurer, much as with childcare rebates and private health insurance rebates.
More and more of us are accepting the fact that if we want to stay solvent, and provide timely, accessible care at a fraction of the cost of ED, we need to charge most if not all people a gap fee and provide suitable care for it. In the meantime, we will continue to field irate comments on social media and in clinics, and anger from patients who, often for the first time in their lives, are being asked to pay to see a GP and do not understand why.
Those who cannot pay will have the option of going to their local ED and waiting many many hours for often sub-optimal care, because emergency departments were never designed to manage non-acute chronic issues.
As the landscape of health changes, with more of us living longer coupled with higher expectations of our doctors, this is the next thing in health we will have to address and manage. Change always hurts, but I am hopeful we will find a balance before there is further attrition of general practice as a speciality.
