An Experience with the Australian Medical System
by Dan Danz
This tale was written in 1994 in Sydney Australia
as a letter to friends and relatives at home in the USA. The format has
been changed slightly for presentation on the Web. These are my
impressions, experiences, and humble opinions.
Sydney Australia
Sunday, July 24th, 1994.
It all started with pizza and beer...
First, what happened: On a Friday night, Judy and I had
some great pizza at a restaurant near the office. Late that night, Judy got
severe stomach cramps, lots of stomach gas, and spent most of the night and
the next day in the bathroom. By Saturday night, she was feeling better, but
now I had the same thing.
By Sunday night we were both feeling better, so I kept my
scheduled trip to Japan that evening. I left Sydney at 10PM and by the time
I arrived in Tokyo at 7AM the next morning, I was feeling pretty good. But
by the time I got from Narita International to downtown Tokyo (two hours on
the bus), I was feeling very weak. And after hassling with a taxi driver who
didn't speak English and wanted to give me 4200 yen change in 100-yen coins,
I was really wiped out when I got to the hotel. So I called the office and
told them I would spend the day recovering at the hotel.
Touch and go in Tokyo...
The next 4 days were touch and go ... I managed to get
through several presentations to customers and company folks, and even tried
some Mongolian barbecue and Japanese beer (not bad) in a bit of camaraderie
with two of my Japanese cohorts. However, Friday night dinner with my boss
was a bit too much. It was at a shabu-shabu restaurant where you cook
your own food in a steaming pot of water on the counter in front of you, and
the food tasted good. But my system wasn't ready for that much (or kind?) of
food. After spending the whole night in the bathroom, I vowed that I'd make
it back to Sydney on Saturday by not eating or drinking anything (even a few
sips of water were enough to trigger cramps and more diarrhea).
My flight left Tokyo at 11AM Saturday, and I got home in
Sydney at about 10:30 PM. The trip was uneventful. But when I took the first
drink of water at home, I was off to the races again. Only from now on, it
was obvious there large amounts of internal bleeding.
Internal bleeding
So, by Sunday afternoon, I decided to try the Australian
medical delivery system. I called for my GP, but she was on holidays
(vacation). Her boss, another GP, took my symptoms over the phone, decided
she didn't need to see me in her surgery (office), and then made
arrangements for me to check in at the Casualty section of Royal North
Shore Hospital, which is in St. Leonards, just a few miles from our
place. We'd heard and read about a lot of grumbling over the long queues at
the medical facilities. Under Australia's socialized medicine, it doesn't
cost anything for Aussies to show up at the hospital Casualty Section
(Emergency Room) at night and on the weekends. It doesn't matter what the
problem is, so they handle everything from sniffles to shootings. We'd heard
that you could wait for hours unless you were seriously injured.
Triage at the Royal North Shore
Well, they must have thought my life was threatened,
because the first person we encountered, the triage nurse, took my history
and sent me almost immediately to the Acute Care section. I was quickly
examined by an on-duty resident doctor and attended to by several very
competent nurses. Despite their competency, however, it was always a doctor
who stuck a needle in me during the entire stay. Come to think of it, even
my GP draws blood herself rather than having a nurse to do it. In the Acute
Care section, when they needed to start an IV drip on the back of my hands,
the resident flunked two tries. However, an intern came to the rescue with a
trick: He splashed hot water on the back of my hand for several minutes and
then, on the first try, stuck me where I didn't even know I had a vein.
Where a registrar doesn't register...
Next, the resident told me that he was going to refer my
case to a registrar. I was confused. What would a hospital
administrator know about diagnosing the cause of my problems? But, he
explained the curious names in the Aussie medical hierarchy: A doctor
progresses from intern to resident to registrar to specialist.
The registrar on duty that night was a young Chinese doctor who spoke with a
precise British accent. He cut right to the quick of the problem, and
immediately decided that I needed to be seen by a specialist and that he was
going to admit me to the hospital so that they could continue to give me
fluids intravenously. About three hours had elapsed since I came through the
Casualty door. I figured it would be in the morning before the specialist
looked at my problem. He was at the hospital 15 minutes later...even before
I'd left the Acute Care section. His examination was very thorough, and his
bedside manner was very comforting.
A very competent Doctor...
Specialist/Dr. Cameron Bell turned out to be the
head of the gastrointestinal facilities at RNSH. He called in an assistant
of his, Registrar Dr. Emily Malcolm, and together they put me through an
endoscopy examination of the upper and lower gastrointestinal tracts. Now,
they tell me I was conscious and talking to them through the whole
procedures, for which they inserted a tiny color television camera rectally
and used it explore my innards, but I don't remember a thing. They gave me a
mild sedative and it apparently wiped out my memory!!
Dr. Bell explained that they had found a slight
ulceration in the stomach - ones that might be explained by my taking
Feldene for shoulder pain, or by the 325 gram therapeutic dose of Aspirin
that I took daily. But it didn't explain the massive bleeding. The upper GI
tract was very red, inflamed, and ulcerated. But again, not enough to
explain the amount of blood I had lost. However, the lower intestine (colon)
was filled with old blood and showed evidence of more severe inflammation
and ulceration. Now, we knew where the blood was coming from but not the
cause. I worried about colo-rectal cancer and the like - but two days later,
the results of several biopsies he had taken ruled out cancer but offered no
further clue.
The culprit is found...
Finally, cultures grown from samples taken by Dr. Bell
showed the cause - a relatively common bug called campylobacter jejunii and
at last he could attack something. A few days of antibiotics and I was not
only out of the hospital, but feeling a lot better.
Billing for it...
The bills are still rolling in, so we can't compare full
costs. However, everything at the hospital except the endoscopy and
specialist doctor bills was included in a A$640/day (US$ 467/day) charge. No
$2 aspirins, no $1/cup ice cups, $25 thermometer, etc., that US hospitals
like to pad the bill with. Just a plain per-day charge that covered
everything. Very impressive.
Unimpressive facilities...
The facilities were less than impressive. Everything was
old, and the whole place could've used a few coats of paint. The two wards I
was in were both on the south side of the 11th floor, and had stunning views
of the harbor and central business district from about 5 miles away, but you
could just barely see through the grime on the outside of the windows. I'd
guess the building is 15-20 years old, and I'll bet they've never cleaned
the windows! Judy said it reminded her very much of the Veterans
Administration hospital in Topeka, KS.
Not exactly The Cat's Meow...
When we were checking into the casualty section, and
orange and white cat of dubious breeding wandered quite casually through the
examining area and treatement rooms. The triage nurse explained: "Oh,
that's just Louie, making his nightly rounds."
Equipment-wise, the hospital was adequately- but not
superbly- equipped; for example, the Acute Care section probably could use a
few more electronic monitors to free nurses of constant checking on severe
trauma cases. Generally I got an impression of the kind and amounts of
equipment in a US hospital ten years ago.
The Wards ...
Now, about the wards: there are few private and
semi-private rooms on each floor, and the chances of getting one are very
slim. So, I was put into a ward with three other beds. I shared the first
room with two others men. The first was a young man who had just injured his
eye when a nail flew up into his face; he was quiet and doped up most of the
time. The second guy was getting ready for colo-rectal surgery and spent a
lot of time in quiet meditation. In general, it was very tolerable.
After a day there, one of Doctor Bell's assistants
explained that they were moving me to the ward down the hall that was used
for most of their patients. BIG CHANGE. I got put in with three old farts
that were anything but pleasant. The first thing that gave me a clue that
this wasn't going to be fun was the nurse who was loudly admonishing one of
them that he had gotten out of bed without her assistance and despite her
correct predictions that he would fall, so he could just himself back in
bed. She wasn't going to injure herself trying to lift him off the floor,
and it would take a while for the male orderlies to arrive. The guy thought
it was a big joke, and just gave her a silly grin that provoked her further.
This went on for two days, until his daughter, her husband, and their
9-week-old baby showed up on the ward and everybody discovered that he was a
senile Armenian who didn't speak enough English to understand what the nurse
was saying or to explain that he was just trying to get to the bathroom!
Next to him was a 70-year old who was in for some
extended tests, and who kept complaining that there was too much noise in
the hospital at night. He swore that he didn't ever sleep more than 20
minutes at a time before some noise awakened him. Well, after several nights
observation, I'm here to tell you that he did sleep longer than 20 minutes
at a time, but 9 times out of 10 that he awakened it was his own convulsive
snoring that awakened him. But you couldn't tell him that.
The real prize in the bunch was the geezer next to me. He
was in the hospital because his wife couldn't control him at home. He'd been
burned about his hands and legs, and was one stubborn bloke. He didn't want
his dressings changed. And he needed assistance to be turned on his side or
back to prevent bedsores. So, he'd wake up in the middle of the night - and
without making any effort to find the nurse call button - bellow at the top
of his lungs:
NURSE !
He'd repeat this ear-piercing, wake-the-dead, call every
20 seconds or so until some nurse happened t be walking down the hall, or
until one of the others of us would push our call button to summon a nurse.
The last two days I was there, before he'd go to sleep, I'd tell him
"Just call me softly and I'll push the call button for you. Stop waking
the whole hospital." He'd agree, and then promptly forget about it
whenever he needed something.
The last two days that I was at Royal North Shore, Dr.
Bell had a difficult patient. I think she was mentally unstable. She was on
the ward next to me and I first became aware of her problem at 3:30AM. She
was stomping around the halls, trailed by nurses trying to placate her as
she loudly screamed that she was fed up with her treatment and she wanted
somebody to tell her what was wrong and FIX IT! This went on for several
days and I'm not certain it was over when I left the hospital.
Medical Skills...
All in all - I was very impressed with the dedication of
99% of the medical workers that I encountered; the immature nurse mentioned
above was the exception. The technical skills seemed excellent. Their
examinations were thorough, their record-keeping and communication among
peers was exemplary, and I never once got the same feelings as Ms.
I'm-Not-Gonna-Take-It-Anymore. Quite the contrary. I always felt that the
diagnosis and treatment was very much under control.
Now all we have to do is get the American insurance
company to accept the limited amount of paperwork that the Aussies are
willing to put out. They're not geared up for a massive amounts of
documentation. They just bulk-bill the government for most of their
patients, and since they are part of the governments medical delivery
system, their bills aren't questioned. They didn't seem too concerned about
getting their money, however. Checkout did not require any approval from the
accounting office; when I inquired, they said "Don't worry about it.
We'll send you a bill." And when Judy called with a question about
insurance filing, they didn't need an account number or anything like that
to find my records. The last name was good enough. Amazing.
Author:
L. W."Dan" Danz
Fountain Hills AZ
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Copyright
1995,1996,1999,2001