Note: This is the fourth installment in a seven-part series Brian Doyle prepared to help colleagues make the most of an emergency medicine rotation Down Under.
Part IV:
Rationalization of resources
The public seem to understand that the public system has limited resources and is “willing” to be inconvenienced at times. This is likely one of the cultural aspects that allows the public health system to function without becoming bankrupt. (This is the reason why I don’t think public health care would function well in the USA- too many unreal expectations. “I want my fries now, I want them hot, and I don’t want to pay for them!” – am I being too cynical?) They don’t seem to be too unhappy when they see an intern or demand to see the consultant. (BTW the term “attending” does not exist in Australia… you will be called a “consultant.”)
Patients often wait a long time on non-urgent operative lists for things such as joint replacement or cholecystectomy. They also wait a while to see a specialist… Good luck seeing a neurologist, urologist, dermatologist, unless it is very urgent. It might be months for the next routine neurology appointment to become available. But if you speak to the specialist directly and think it is urgent, they will sometimes see the patient quite soon… usually the next day.
Most Emergency Departments do NOT have 24 hour routine radiography… this includes regular radiographs. At my hospital, after 8:00pm, there is no radiographer, but one may be called in for urgent x-rays. All non-urgent x-rays that present after-hours are asked to return the following day at 8:00am for their ankle, wrist, or whatever film. I have yet to find a patient who was not understanding and fine with returning. You can get any x-ray, ultrasound, or CT scan urgently if it is needed, but you would be surprised at how infrequent this really occurs. But some of this is also a reflection of the lack of reliance upon technology or advanced imaging…
Many EDs are fortunate to have some good orderlies or “attendants” (USA term “tech’s”) that will put on back-slabs (splints), get crutches, etc.