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Sunday, January 8, 2012

Do we complain too much?


Some of us are old enough to remember Donald Horne and his 1964 book on Australia called The Lucky Country. This isn't about that book or those like Frank Hardy who subsequently wrote critically about this view of Australia.

 Recently, there have been a spate of criticisms that we Australians now whinge too much. How much right do we have to complain, really? In the light of the episode below, I'm inclined to agree that we do - or maybe the wrong people do, or about the wrong things.

Part of the front hedge
Tracey was hedge clipping last weekend, which, if you know our hedge, is a serious task. What you can see here is about one-eighth of the job. For several days, she has been quietly putting up with pain down the left arm, together with some other discomforts, hoping that it was nothing more than a muscular reaction from the effort of clipping and raking.

I want to add, if you are new to this blog, that it is frustrating for me, the hedge clipping master of this household since we moved in, not to be able to do this job any longer. You do need two fully functioning arms to clip a hedge, I'm afraid, and any vain attempts of mine to help are met with a response bordering on the impolite. Tracey knows that the time I did insist, I was having a seizure in five minutes, so I was packed off up the stairs quick smart, and ordered not even to look out the window.

 But, to return to the point: when the pain in Tracey's arm was getting worse rather than better, she decided to take action on it yesterday, knowing this sort of pain can indicate the onset of a heart attack or some other serious condition. Ignore continuous pain down your arm at your peril.

 I knew nothing about it at all till she said to me quietly yesterday morning, "I might go to Casualty and have a talk with them." Not complaining about such things is her usual way of protecting me from stress, but she couldn't put off telling me any longer. ("Casualty" is the term we use here for "Accident and Emergency" at the local Public Hospital.)

 It was Saturday - not the best day for getting medical attention from the GP. These things always reach the 'action' phase at weekends, don't they? It's a variation on Murphy's Law. She then drove to Casualty to see if she could get some action there. (It's also the day when all the Saturday sporting injuries come in to Casualty - not the best time from that point of view either - plenty of competition!)

 The Emergency team was terrific in its handling of her case, though it's not surprising that they jump to attention when someone presents with these symptoms. They know what such symptoms can predict.

 The short story is that they did a battery of tests, procedures and specialist consultations which indicated that there was no detectable problem with her heart. But one blood test gave a very abnormal count, suggesting she may have had a clot, possibly on the lung. This of course resulted in more tests.

 The investigations indicate none of the immediate frightening possibilities that we think of in these circumstances, but there's still a question mark over the abnormally high reading for that blood test. It could indicate a clot elsewhere.

 Tracey returned home after about four hours from when she left. She'll consult our GP at the first opportunity, and discuss things with him.

 The pain hasn't diminished but at least there's been a lowering of stress levels building over the week about the cause of the pain. Some of the worst possibilities have been eliminated through the long series of tests that have been done.

 This is why I posed the question at the start. Look at some of the procedures and consultations she had in those four hours.
  • An ECG
  • A spiral (3D) CT angiogram
  • Upper body x-ray
  • Extensive phone consultations with remote renal specialists based on data transmitted electronically, on whether contrast-testing could be performed (given that Tracey has only one kidney, the other having been donated several years ago to save a life.)
  • Several blood and urine tests, saline and dye infusion
  • Organ function testing
  • Detailed written report on the CT scan by the remote specialist
  • Continuous monitoring by nursing staff together with constant visits by an experienced doctor
This is a country public hospital in NSW, Australia. She was self-admitted to Casualty and not at any stage needing admission to ICU, so there was not that level of intensive observation demanded. This was standard outpatient care. Any person with similar symptoms would have received an identical level of treatment.

Cost?

If you lived in the USA, I wonder what sort of a bill you or your Medical Insurance fund would get for the above services, all delivered within the space of four hours? Perhaps my American readers might hazard a guess.

 The cost in this case was $0.00.  Zero.

 Well... I suppose it cost 50 cents for petrol to drive the one kilometre there and back. We can cope with that one.

 I know there are plenty of horror stories about bad diagnoses and long waiting times for public patients in Australian hospitals, but this level of care in a small hospital as short on funds and facing as many costs as any other in the state is remarkable; a tribute to the dedication of everyone involved now and over the many decades it takes to create and maintain such a service.

 I do invite you though, to ask where the money comes from..... I'll bet there'll be some mixed views on that, but let me get in first. I spent my entire working life paying my taxes! And a great many people have contributed productively to make it possible as well.

8 comments:

  1. I agree completely! the Public Hospital in Armidale is amazing, so thorough and efficient. To think we have such a push on to privatise our medical care -yes I know it takes money, but private money goes into private hands and the share holders are always hungry for more! Same with public schools.I hope that today you have discovered more about Tracey's problem, or that it has gone away! As for hedge clipping, when we worked as gardeners we did such things for a living. My mother's house also had a large privet hedge which we clipped once a year - M and I, and a hired man with a truck, the last time. You need to have the right equipment.

    Julie

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  2. It may also be true that in their deternination to be thorough, and not to be accused of negligence, they can go too far with testing. GPs don't always agree with what procedures have been carried out, nor that the results of such tests are conclusive enough to justify some of the actions taken. For example, not all GPs would prescribe a Spiral 3D Angiogram at an early stage of testing, because high dosages of radiation are required for it. So there is a health risk as well as a cost.

    As to a once a year hedge clipping, the growing conditions for privet have been spectacularly good this year and it looks like 3-4 clippings will be necessary this season. Christian is going to be doing some extra stints. The right equipment certainly makes it much easier.

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  3. It's incredible that you didn't pay anything for that. That would have costed a small fortune in the U.S. In Chile, as well. There are public hospitals and private ones. The care is usually better and faster at private hospitals but you have to pay out of pocket first and then your insurance reimburses you later. My boyfriend had to have a tumor in his neck removed and that cost him $7,000 he has yet to recover.

    I want to move to Australia.

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  4. Well, you've put your finger on one of the problems - people DO move to Australia! The system is seriously overloaded and the pressure on these services has increased. That means waiting times have increased.

    I was at a major public hospital in Melbourne for the bulk of my treatment with radiotherapy and chemotherapy. There were many costs involved and a lot of waiting and travel time.

    The chemotherapy there was oral (but intravenous here in Armidale later). I should make it clear that the prescribed pharmaceuticals were not free, and in my case at least, Avastin, our last resort, was almost $6000 per treatment for the first four. To the supplier's credit, they have supplied free of charge all doses after those first four. If I had to pay for all those, the cost would now be in the region of $150,000 so far with no end of that cost in sight.

    That would be far out of our league and I wouldn't even think of trying to raise $6000+ per month. Oncologists and private GPs are not free, of course, and that's why we have private health insurance.

    So even with a reasonable public health system, most is far from free but nothing like the costs in many places. In my experience, the care and dedication of public health staff are outstanding, given what they're up against. There are mistakes and close shaves, but I'm surprised there aren't more, given the pressure on the public system.

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    Replies
    1. Well, then it sounds similar to the US and Chile. In the U.S., so far there is no national public system. They are working on it, but also it will be challenged in the Supreme Court. Instead, each state has a service for people with few or no resources to pay for or procure health insurance. I was on it for two years because I have preexisting conditions and then because after my surgery I was on medical disability for a year.

      In Chile, the public system is filled with long waits, bad attitudes, and outdated forms of treatments. I heard of someone waiting six months to have a brain tumor resected. The whole time they had no idea if it was benign or malignant or if it was growing. Then, you find cases like my boyfriend's where he gets diagnosed with a tumor one week and they can operate asap in a hospital that looks and feels more like a hotel because he's got private insurance.

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  5. Nowhere near as desperate for the poor as the US, I'm sure. As I said, anyone coming into Casualty would have got this treatment if there was a possibility the condition was life-threatening. In my own case, the treatment was slow - the decision to get anti-seizure med into me way too slow, I think. But I was being monitored constantly.

    To wait 6 months to have an operable brain tumour resected is lamentable, especially in the case of a GBM4. In fact, the person would have died of the tumour before they got to the operating theatre if that were the case. In my daughter's case, the operation was performed through the public health system within a day or two of detection. Her story - one with a happy ending - is here:

    http://tinyurl.com/wr1ght-0116

    If the USA spent a tenth of what it spends on war on public health and medical research, it could be the healthiest nation in the world - if it could also cure its 'take-away' addiction. So many 'ifs'....

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    Replies
    1. Next time I might remember to direct the reply to the particular comment. Sorry, Sara.

      Delete

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