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Hospital Waiting Lists

Kevin Maguire sent this in in response to the Write for Webdiary panel. He says of himself: "By many a definition I'm an old bloke, but to me I'm just right - others are either old or young. During my tenure as principal at one school (the Children's Cottages Special School) I had to cope with an unbearable amount of stress. This brought about a heart condition that has slowly been my undoing. After some other positions, I was a principal of Bulleen Primary School for some years until the Kennett era in Victoria. The closure of Bulleen Primary School and the destruction of the school community did not do my health any good. I retired. I moved to La Trobe University where I taught student-teachers how to use technology in their classrooms. When I retired from this position I established a consulting firm "Education Consulting Services" which offered teachers a non-payment assistance to develop their own culture of continuous professional develop - mainly in mathematics."

by Kevin Maguire

The other evening I lay awake listening to blood regurgitating in my weakened heart. I began to ponder the lot of others whose quality of life was also impaired. How many people were in a similar or a worse condition?

What was the fate of people living in pain for months on end? They and I are the result of the 'opaque' waiting list: a product of those hospital case conferences that prioritise our need for corrective surgery.

Since I was first diagnosed with heart disease some years ago, my condition has steadily deteriorated. I have become so accustomed to breathlessness at the slightest activity that I fail to recognise it. Reflecting on this brings me to the realisation that even showering can leave me breathless.

Lifting heavy weights has become somewhat of a problem (earlier this week I lifted a bag of washed sand. I am unsure whether I fainted or tripped over something but I fell backwards and had to lie there until my heart had stopped racing before I was able to regain my feet.) My adventure with the waiting list began some months ago (July to be precise) with a routine visit to the Austin Hospital Warfarin Clinic. My INR (International normalized ratio) level had been stable for some time.

However, what were of concern to the physician who examined me were my tachycardia and the extent to which my heart had enlarged to cope with the disease. I was subsequently referred to a cardiologist at the Austin Hospital. He broached to subject of surgery to restore my quality of life.

This surgery would repair the defective valve. Without this surgery my heart could weaken to such an extent that it would simply stop functioning. This was rather a sobering prognosis. An echocardiogram indicated that not only was the mitral valve allowing blood regurgitation but also the tricuspid valve was malfunctioning. In order for the cardiologist to gain a better understanding of my malfunctioning valves I underwent a transesophageal echocardiogram. This procedure was followed by an angiogram. All this took place within the span of a month or two. The prospect of undergoing corrective surgery to improve my quality of life was a little daunting but, nevertheless, one that I was willing to undertake. Once more I attended the Austin Hospital: this time to meet a nurse who sought basic information about me; a resident who requested additional information (and also provided some); and finally a surgeon. His explanation of the procedure was thorough, comprehensive and lucid. There was little left unsaid. I returned home with pertinent information about cardiac surgery and a tube of body cleanser to use in the shower the evening prior to the surgery. The next day I returned to the hospital. This time I met with the anaesthetist. Once again the explanation provided of his role in the procedure left nothing to doubt.

Like the surgeon he was friendly, thorough and his demeanour exuded confidence. I left the Austin Hospital confident that I would be in the hands of a professional, caring and thoroughly dedicated team of people. I was verbally informed that the procedure would be undertaken within thirty days. By my understanding this would place me in Category 1 urgency.

Although I received no written confirmation, I assumed that I had been placed on the waiting list for cardiac surgery. The next episode in my adventure was a series of blood tests, an x-ray and a visit to a dentist to ensure that I had not any dental problems requiring attention. Problems that could be of danger to the upcoming surgery. Not long after this I received a telephone call informing me that a likely date for the operation would be early November. Although this was a little later than the thirty days of the initial verbal information provided to me at one of my earlier visits to Austin Hospital, I was psychologically accepting of what was to me at least, a somewhat radical but seemingly common place procedure. This is where things appeared to go awry. Another telephone call to my home from the Austin Hospital stated that I would not be admitted to the hospital on 2nd November as initially indicated and there was no information as to when I would undergo cardiac surgery.

To me this series of events raised a number of questions. I would like to know how many people are on the waiting list for cardiac surgery at Austin Hospital. By what criteria are these people categorised; who is responsible for this categorisation; and, why was my categorisation evidently downgraded? It has been suggested that providing additional funds to hospitals would ameliorate the plight of those on hospital waiting lists. I wonder if this is an appropriate remedy. To me it appears evident that hospitals need additional professional people. Nurses, surgeons and anaesthetists appear to be a dedicated, competent and well experienced group of people. To overcome the trauma of the 'waiting list' our hospitals require not additional funds, per se, but more of the people who make up teams like those I met at the Austin Hospital.

This is my story. If any of the events referred to above are incorrect or out of sequence I beg forgiveness. My words are coloured by my condition and bias. I hope that nobody takes offence with what I have written for none is intended. The people with whom I dealt at Austin Hospital form a dedicated, professional and competent group of people. I only wish there were more like them being trained.


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Our system is fine ,just don't be a "grey"....

Actually, if the Federal gov wanted to cause a state budget collapse via hospital system funding blowout it would be easy as pie. it is all about the bizarre cost shifting that goes on between medicare (federal) and Hospital (state). I may have this wrong as i tried to follow it but A bit of Merlot at the time was a challenge. So all those hospital clinics charge medicare to see the hospital doctors and the money goes to running the hospital and paying the staff in a system that has been chronically underfunded and run by those with Economic/budgetary goals rather than community service and care.  Hence the shut down of public patient operations despite such long waiting lists when the budgets needs a twitch to save money. Shocking really.

going back to the sandwich course for nursing would be a big step forward, mistakes should always be corrected, and nurses would have hands on and paid jobs and accomodation as they train and more would be in the ward to get things done and learn better in real life rather than out of books. Copying the US system was the biggest mistake. Also more HECS free for areas of need. 45,000 is about the top rate and experienced teacher gets isn't it? not bad for starters.

I have one who is doing the HSC and she wants to do medicine. Hard to get in, unless one has a cool 35 grand ... per year for NSW. Uni. Something wrong when money rather than merit enables places. More back to Johnny's days stuff i guess.

It's a great pity some seem to find the need to politicise everything. Foreign worker issues?  -but are they properly accredited and trained and English speaking? In my experience talking with others and as a consumer it depends upon where they come from. give our kids the training and jobs and don't take away from other countries their trained experts-except when refugees of course.

And who will make the decisions if the health system cannot cope in the next ten years? Already "grey area" babies are sorted by a ecent ethics decision. Will there be "grey" adults,eg Alzheimers/demented etc ?Will that be decided as fewer therapies are available to those with just public purse funding? "Grey" poor people. We saw that with a breast cancer drug that was in the papers and took ages for the health minister to fund, a drug only for the rich despite working so much better. Will the private system have the rapid heart operations available and the public have a long wait ... too long for so many?

Americans are finding this as their system is far more stretched than ours due to decades of underfunding of the public system,relying upon a smaller and smaller pool of private patients to pay for all the mandated therapies for all patients. 

By the way.....here is a dooosey. did you know under the FTA now we can have blood products quietly sourced from overseas, paying donors and all? any alarm bells ? there should be!

Right facts -> good analysis

The kick-off pay for graduate nurses, Frère, is about $45,000 after three years uni, plus shift and week-end rates. I believe those in non-metropolitan areas get about an additional $4,000 from the federal govt. through the FBT system. Their HECS, currently called the Student Contribution, is about half what a science student pays.

Getting a first job is pretty easy. Their career options are pretty sound. Those who don't like the real front-line stuff can utilise their investment by switching to health management or public health. Salary increases within nursing are quite reasonable, probably higher than many other professions. Contract work at contractors rates is available.

In sickness and in health

I don’t agree with your analysis, Jay White, or Jenny Hume, that our illness management systems are at the point of collapse. It is a lot of scare-mongering based on misconceptions tied to false mental models.

It is true that population health is expected to fall soon, reversing a historical trend of  improvement. But this is blamed on a rise in obesity, which is being actively tackled. If we take out obesity, I suspect population health will continue improving, possibly faster than in recent decades.

Talking of an ageing population is propagating a false picture. What we are seeing is an increase in the productive life of humans. If we change our concepts of work and retirement, the problem vanishes.

Let’s not put doctors and nurses on pedestals. They are professionals, working in a system, and in all systems, improvements can be made, both at the systems level and the individual level. Our current practice of randomly picking a mistake, and either suing the bejesus out of them, or figuratively taking them behind the barn and shooting them is not very productive.

Nursing never was fun. It involves cleaning soiled patients, night shifts, dealing with pain and death, blood and gore. It was done by women, and paid poorly, which is changing. Increased public aggression is faced by everyone serving the public. Ask  Telstra call centre staff.

Certainly, as in most complex systems, many things could be done better. Several interest groups have carved out lucrative niches. But nothing is going to collapse, like most public systems, we will continue to tinker with it, blocking the worst excesses and keep it going.

Queensland’s recent circus is an excellent example. Everybody (except the few who got burnt) had a gala time, people getting excited, jumping up and down and waving their arms about, the newspapers sold extra copies. But when push came to shove, everybody settled down and voted Peter Beattie back into government. What had he actually achieved? Possibly the most important health outcome was to put fluoridation on the agenda (though the last I heard they were bickering about who was going to pay for it.)

Health and life, Kevin

Not only our quality of life Kevin Maguire but also the quantity.

And that’s the issue.

Our troubled, two-level health system does its best to prioritize patients, then enhance or save their lives.

Creating a growing cohort of sometimes chronically ill, sometimes disabled Australian baby boomers, who may also live with pain. Dharma bums from whichever financial or private health insurance abyss they might have fallen.

And the wheel goes around.

Meanwhile we do a couple of things very strangely.

Nursing is an unattractive career to many kids. It’s known to be hard , stressful work with complex training. The kickoff pay is poor and don’t get much better.

Nurses trying to pick up money, in fact, punish themselves by taking relentless back-to-back shifts or the like.

Pretty soon some become tired and unhappy, and then often add to the cohort of ex-nurses doing “easier” jobs. Seeing the kids or families more, too. Or attending to their own often buggered health.

And Australian kids thinking about nursing know all about this, but still line up at the end of secondary education to give a shot at a college of nursing being whittled away by the federal government’s cheeseparing approach to education and training.

Then HECS is added to the pure yakka of training and clinical placement. Oh yes – we bill them for the privilege of running at top speed to help us. A bit like the top brass shooting Simpson and his donks, instead of the Turks.

Unless of course they want to use their gap year to go nursing in the army or another arm of the defence force, the kids will PAY.

Who would miss the chance to go to Iraq and nurse?

Why in buggery would they bother? And have Australians really decided with any thought whatever on a health system riding on the backs of decreasing group of bright, strong, altruistic Australians? Or is it all ad hoc to the nth degree?

Does our Prime Minister ever stir his thinking on this exploitative matter? After all, in just a few short years, when he is aged 100, and finally gets his telegram from King Harry while still in office at Kirribilli, it’s very likely that at least one or two selfless, underpaid nurses will be by his side.

Paid peanuts to administer his endless enemas and massive medications and change his diapers and put up with the incessant whining. Show crazy Janette (again) how to work the remote control so they can watch Tim, Melanie and Richard Howard’s version of The Glass House on their ABC.

One hopes the PM does something about the situation before the next shift comes on to give him his celebratory bedbath.

Perhaps he’ll recruit his nurses from Kazakhstan. Borat will tee it up, never fear. He’s very good on the visa thing and all the other complications.

DISCLOSURE: Frère Jihad Jacques OAM, née Woodforde is not a nurse, but he knows some, somewhat from three near-death experinces, which brought him very close to Kerry Packer for once. But he would deny it.

When I'am 64

Jenny Hume I guess one could add security guards to my list. They seem to be everywhere nowdays, so why should a hospital miss out?

I do not fully agree that "nothing can be done", I think something can always be done it is just a matter of finding the correct course of action. The present course is obviously failing badly and will not be improving. I think nearly everyone would agree with that statement.

Even if one was to spend all the past few years surpluses on health it would only be a present day stop gap measure (the highest section of spending pie by all governments is health). Supplies and medicine and even hospitals date. Better methods and equipment are constantly coming onto the market. And people as you would rightly expect in a wealthy nation want worlds best practice.

The problem is that "health" as such could almost do with unlimited funds. Obviously in the real world this is not possible. There is a limit to everything and money is no exception. For every dollar that health takes another area of spending (often worthy) misses out. Finding that balance is almost impossible and a persons sense of balance often depends on the situation one finds ones self in.

Actually I am very surprised this thread did not get more interest (up until now anyway). This issue will be really big in the not to distant future. It will also be, bread and butter issue's such as this one that make and break governments. John Howard for example will not be getting booted out of office over Iraq, Israel or any other world affair. Bread and butter issue's such as health though, could be a whole new ball game. As is the case for all state governments.

Like everyone else I do not know the answer to cure all ills. I have a few ideas that may work or may not. I am interested in hearing other views. I do think that it is certain that there will come a time when people do have to sit down and start working through "seriously" these very pressing issue's.

As I have said previously some of the ultimate and realistic answers are definatly not going to be to all peoples liking. In fact I really do see the time dawning when some very sacred cows are going to be slaughtered in a manner of speaking.

The time of being able to play politics on this issue is very close to being at an end.

Nursing is not a lot of fun these days

Being a nurse these days is not a lot of fun. Back in the 60s/70s when I did a four year stint, one could reasonably expect not to be attacked or abused, except by the odd drunk. Not so these days when hospital staff are frequently bullied by both patients and family members alike, both sides stressed by the inadequacies of the system. And back then hospitals I worked in had unlimited supplies of all the basic necessities. Not any more. Even towels are not guranteed, let alone bandages. It is an appalling situation that we cannot resource the hospitals in the good times. Heaven help us if there is ever another recession.

While there are often beds with no staff, there are also many times when there are simply no beds. The last three times I accompanied a sick person to the main Canberra hospital that was the case. One was a 92 year old mother of a friend who had collapsed in her home, one was a neighour who could not walk due to a back injury, and the other was a dangerously ill person in the midst of a severe psychotic episode. On each occasion I had to refuse point blank to take the person home, stressing myself and no doubt the staff, but what does one do. Beds were ultimately found for those patients but it was a case of push up hill all the way. 

A wait of 8 hours in the Canberra hospital outpatients is quite normal. Frankly, despite the distances to a doctor out west here, I have never been turned away at the hospital door. In many ways one has a better chance of treatment in a bush hospital than in the big city hospitals, even if they have no towels or bandages.

Jay White is right. It is only going to get a whole lot worse, and there is probably not a whole lot that can be done about it.  The surpluses that could have gone a long way to improving the system are, like the water, gone. So it is not surprising to hear patients are being prioritised, and not always on the basis of the severity of their illness. As one Doctor said, "if you have an elderly person and a young person, and you can only save one, then a choice has to be made". As I head for my twilight years, I know I have little hope of being put at the head of the queue, no matter how ill I am.  And there isn't much I wil be able to do about it. 

One small point

"To me it appears evident that hospitals need additional professional people. Nurses, surgeons and anaesthetists appear to be a dedicated, competent and well experienced group of people. To overcome the trauma of the 'waiting list' our hospitals require not additional funds, per se, but more of the people who make up teams like those I met at the Austin Hospital".

I agree with this statement to a very large extent. How many times have we heard a hospital spokesperson make the comment it is not the number of beds, it is the number of people to staff them? This is also not just a "professional people" issue. This goes across the board from maintanence staff, cleaning staff, hospitality staff etc etc etc.

Now without trying to make this political (seriously) that is the biggest problem I have with the current Labor oppositions dog whistle in regards to foriegn workers. When one does cut to the chase, it is apparent that many of these "foriegn workers" are intended for places such as understaffed hospitals. Not out and about to steal the local factory workers job.

This dog whistle may very well prove to be politically effective. It is though a very dangerous one, that will also prove to be a disaster and eventually a failure. There simply is not one realistic short term solution to what is a MASSIVE problem that will continue to extrapolate as the doomsday of the aging baby boomers retirement gets closer.

The days of political quick fix solutions and other assorted hijinx are very rapidly coming to a FORCED ending!

Health will become the most important issue of them all

This is not meant to sound harsh. Any person that has ever been sick or has known closely a sick person (guessing everyone) would understand the trauma.

We like every other wealthy western nation are at the beginning of what was always inevitable. An aging population mixed with much longer life expectancy and the continual improvement of both medical procedures and medicine (rising cost). The perfect storm for want of a better phrase. Add to this the utopian and often totally unrealistic expectations that all no matter when, where and how can be cured of all ills at the minute.

Something has to give and it surely will whether people like it or not.

It really has become a pointless and surreal exercise taking part in the funding blame game. The game itself is not working and it will not work. The game itself become akin to running about attempting to plug ever more appearing holes in the ole dam wall. The dam though will eventually burst and every person that has bothered to look at it, knows it.

What is needed is a completely new dam wall. What that should be and how that should come about is the 64 million dollar question.

I am guessing like all tough realistic questions, many are not going to like the answer. 


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