Socialized health care: not a panacea
While browsing the news, I saw an interesting article, in which a mental patient masqueraded as a doctor to the extent that he examined five patients before anyone realized he wasn't a doctor. More worrisome, however, is what else the article said:
While none of the five patients was harmed, hospital sources describe the incident as a near miss. They say emergency department rosters are now dominated by "transients" such as locums -- making it all but impossible for regular staff to spot someone who should not be there.
More importantly, many of these temporary fill-in doctors are poorly qualified and undersupervised -- creating a perfect environment for "critical incidents" that threaten patient safety.
Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, told The Australian the problems in emergency wards were being experienced across the country and the situation was getting worse.
The federal Government's official Australian Medical Workforce Advisory Committee has declared that 130 doctors a year would need to enter advanced emergency training from 2004 onwards to meet demand.
But actual numbers are falling far short of this. In 2005, only 58 new emergency specialists were created, and the following year 86.
Of course, Emergency Medicine by its very nature is the highest pressure medical specialty, with the highest turnover rate. Still, how things are managed can make things better . . . or make them worse:
He said emergency doctors often had no meal breaks. Burn-out, turnover and drop-out rates were also high, ensuring a constantly high level of new staff unfamiliar with the hospital and its patients -- threatening standards still further.
However, personnel aren't the only problem:
He said state governments needed firstly to ensure adequate senior trained staff to oversee more junior doctors, and secondly to ensure adequate numbers of beds in the hospital, to prevent the problem of "access block" where emergency beds were occupied by patients waiting for inpatient beds.
Looking around the globe, it's not just Australia. In New Zealand, "Disaster Mode" is how the ER functions in normal times. One wonders what will happen when a real disaster occurs.
In the UK, which has the highest infant mortality rate in the developed world, some blame the problem on chronic staffing shortages in the National Health Service. As one woman put it, “To carry my pregnancies to a safe gestation I knew I needed help but no one listened. Only now that I have had three premature babies and two deaths, I’m getting the specialist help I need.”
Meanwhile, A consultant anaesthetist noted that up to 20% of job vacancies in his speciality had not been filled, despite thousands of junior doctors seeking posts. . . There was bad news also for Olive Beal, a great-grandmother who is wheelchair-bound and losing her sight, after she applied for a digital hearing aid which would cut background noise. She was told that she would be put on a waiting list of about 18 months. She is 108 years old."
The Canadian Medical Association is arguing that the solution to Canada's health care woes is partially privatizing the system. Under Canada's system, private health care insurance was originally illegal, meaning that the "option" to be seen outside the government system is only available to the wealthy and/or desperate. Recently, however, the Supreme Court struck those laws down, saying "Access to a waiting list is not access to health care". While things have improved, the reduced time spent waiting for treatment Canada hopes to have in place by the end of 2008 includes:
* Radiation therapy to treat cancer within four weeks of patients being ready to treat.
* Hip fracture treatment within 48 hours.
* Breast cancer screening for women ages 50 to 69 every two years.
* Cardiac bypass patients will get treatment within two weeks to 26 weeks, depending on the severity of the case.
My check of health care in France is handicapped by the minor detail that most of the words in French I can recognize are either military or musical jargon. Finding English-language sources that are neither obvious shills for the Right or the Left is hard; one Wikipedia article contains allegations made by both, which leads me to a preliminary conclusion of "probably right in the essentials." During the 2003 heat wave, France suffered almost 15,000 deaths caused by heatstroke, dehydration, and other heat-caused problems.
The heat wave occurred in August, a month in which many people, including government ministers and physicians, are on vacation.
The administration of President Jacques Chirac and Prime Minister Jean-Pierre Raffarin laid the blame on
* the 35-hour workweek, which affected the amount of time doctors could work;
* family practitioners vacationing in August (Many companies traditionally closed in August, so people had no choice about when to vacation. Family doctors were still in the habit of vacationing at the same time);
Many blamed Health Minister Jean-François Mattei for failing to return from his vacation when the heat wave became serious, and his aides for blocking emergency measures in public hospitals (such as the recalling of physicians). A particularly vocal critic was Dr Patrick Pelloux, head of the union of emergency physicians, who blamed the Raffarin administration for ignoring warnings from health and emergency professionals and trying to minimize the crisis.
If France didn't have universal public health care, I can't imagine a few political appointees ensuring that doctors weren't on the job during France's greatest public health crisis since World War II.
While none of the five patients was harmed, hospital sources describe the incident as a near miss. They say emergency department rosters are now dominated by "transients" such as locums -- making it all but impossible for regular staff to spot someone who should not be there.
More importantly, many of these temporary fill-in doctors are poorly qualified and undersupervised -- creating a perfect environment for "critical incidents" that threaten patient safety.
Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, told The Australian the problems in emergency wards were being experienced across the country and the situation was getting worse.
The federal Government's official Australian Medical Workforce Advisory Committee has declared that 130 doctors a year would need to enter advanced emergency training from 2004 onwards to meet demand.
But actual numbers are falling far short of this. In 2005, only 58 new emergency specialists were created, and the following year 86.
Of course, Emergency Medicine by its very nature is the highest pressure medical specialty, with the highest turnover rate. Still, how things are managed can make things better . . . or make them worse:
He said emergency doctors often had no meal breaks. Burn-out, turnover and drop-out rates were also high, ensuring a constantly high level of new staff unfamiliar with the hospital and its patients -- threatening standards still further.
However, personnel aren't the only problem:
He said state governments needed firstly to ensure adequate senior trained staff to oversee more junior doctors, and secondly to ensure adequate numbers of beds in the hospital, to prevent the problem of "access block" where emergency beds were occupied by patients waiting for inpatient beds.
Looking around the globe, it's not just Australia. In New Zealand, "Disaster Mode" is how the ER functions in normal times. One wonders what will happen when a real disaster occurs.
In the UK, which has the highest infant mortality rate in the developed world, some blame the problem on chronic staffing shortages in the National Health Service. As one woman put it, “To carry my pregnancies to a safe gestation I knew I needed help but no one listened. Only now that I have had three premature babies and two deaths, I’m getting the specialist help I need.”
Meanwhile, A consultant anaesthetist noted that up to 20% of job vacancies in his speciality had not been filled, despite thousands of junior doctors seeking posts. . . There was bad news also for Olive Beal, a great-grandmother who is wheelchair-bound and losing her sight, after she applied for a digital hearing aid which would cut background noise. She was told that she would be put on a waiting list of about 18 months. She is 108 years old."
The Canadian Medical Association is arguing that the solution to Canada's health care woes is partially privatizing the system. Under Canada's system, private health care insurance was originally illegal, meaning that the "option" to be seen outside the government system is only available to the wealthy and/or desperate. Recently, however, the Supreme Court struck those laws down, saying "Access to a waiting list is not access to health care". While things have improved, the reduced time spent waiting for treatment Canada hopes to have in place by the end of 2008 includes:
* Radiation therapy to treat cancer within four weeks of patients being ready to treat.
* Hip fracture treatment within 48 hours.
* Breast cancer screening for women ages 50 to 69 every two years.
* Cardiac bypass patients will get treatment within two weeks to 26 weeks, depending on the severity of the case.
My check of health care in France is handicapped by the minor detail that most of the words in French I can recognize are either military or musical jargon. Finding English-language sources that are neither obvious shills for the Right or the Left is hard; one Wikipedia article contains allegations made by both, which leads me to a preliminary conclusion of "probably right in the essentials." During the 2003 heat wave, France suffered almost 15,000 deaths caused by heatstroke, dehydration, and other heat-caused problems.
The heat wave occurred in August, a month in which many people, including government ministers and physicians, are on vacation.
The administration of President Jacques Chirac and Prime Minister Jean-Pierre Raffarin laid the blame on
* the 35-hour workweek, which affected the amount of time doctors could work;
* family practitioners vacationing in August (Many companies traditionally closed in August, so people had no choice about when to vacation. Family doctors were still in the habit of vacationing at the same time);
Many blamed Health Minister Jean-François Mattei for failing to return from his vacation when the heat wave became serious, and his aides for blocking emergency measures in public hospitals (such as the recalling of physicians). A particularly vocal critic was Dr Patrick Pelloux, head of the union of emergency physicians, who blamed the Raffarin administration for ignoring warnings from health and emergency professionals and trying to minimize the crisis.
If France didn't have universal public health care, I can't imagine a few political appointees ensuring that doctors weren't on the job during France's greatest public health crisis since World War II.