A friend of mine worked as a gynecologist in Australia and she shared a blog entry on her Facebook.
I clicked on it, thinking it was a light-hearted article and ended up reading a very genuinely-written article, highlighting the legal & work problems faced by the doctors in Queensland, Australia. The blog entry was written by a Emergency Physician who worked in the public hospital of Queensland.
Ran a Google search today and this came up:
I can't believe what I am reading. A government wanting to sue hundreds of doctors in its state??? According to the blog writer, his reason for refusal to comply was:
"I simply want to be able to do what I have trained my entire adult life
to do; To make sick people better, without being told that I can’t use
drug x, or device y, or technique z, because they are too expensive. We
take the doctor-patient relationship extremely seriously. From day one
in medical school, we are constantly reminded of the sacrosanct nature
of this bond...I have to be free to do my best for my patients, or I do
not deserve the title Dr."
From ABC news, hundreds of senior medical officers in Queensland are threatening to quit over new State Government contracts.
I can't quite fathom why the politicians will resort to such a biased medical contract that affects the morale and welfare of its state doctors so badly. I pray, with such a dangerous medical system in play, I will never ever need emergency care in Queensland. And please, Singapore, don't ever end up like this. Not so chek ark please. Sure will 折福折壽 & 絕子絕孫, no matter how many parenthood campaigns you run.
On another side note, if I ever have the tremendous fortune to be a great doctor (no no, not the aesthetics kind) in my next life, please don't let me be born in Queensland and suffer the fate of 英雄無用武之地.
Below is a re-post of the brilliantly detailed article of a hectic day in the life of the Emergency Physician, who have since resigned from the public hospital. I wish you well, Doctor. May your noble ambitions of serving the Queensland population in the public sector be fulfilled soon.
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It can’t be right!
That was ten years ago this year. Since then I have worked as a full
time Staff Specialist in Emergency Medicine in the public hospital
system of Queensland. I vividly remember the Bundaberg and Caboolture
hospital scandals, and have no wish to return to the days of skeleton
staffing and unacceptable standards of care. I deliver hands on, 24 hour
a day emergency care to the people of Queensland in some of the most
difficult moments of their lives. Sometimes I am with them as they are
born, frequently I help them as they confront a serious illness in
themselves or a loved one. Sometimes I am with them when they die. This
is the challenge and the privilege of Emergency Medicine.
I am starting a ten hour clinical shift in a metropolitan emergency
department. Most days we will see around two hundred to two hundred and
fifty patients per 24 hours. Every single one of these Queenslanders
brings their own unique medical problem in their own personal context.
My job is to see that each one of them receives the care that they need
in a caring, compassionate and timely fashion. I have a team of young
doctors with me, and together we aim to achieve this goal. Today, at the
8am handover, I learn that two of our junior doctors are sick. Since we
have a total of 6 juniors on the day shift, we have lost a third of our
medical staff before the shift has even begun. The Emergency Department
is already understaffed so there are no replacements. We will simply
have to “suck it up” as it is known in the trade. The night doctors are
tired. It has been a busy night, and the on call Consultant was called
in for a critically ill patient at 5am, having only finished the evening
shift at 1am. The call, however necessary, and her departure will also
have woken her partner, and probably her two children. We are on call
after an evening shift at least once a week, and the nights on call
don’t just affect us, but our families too. She is finishing her
clinical notes having just transported the patient to the intensive care
unit. The patient, a 47 year old man with a young family, arrived with
chest pain before promptly having a cardiac arrest in the emergency
department. My colleague led the team who administered drugs and an
electric shock to restart the patients heart, placed a tube in his
airway to allow him to breathe and called in and coordinated the arrival
of a Cardiologist and cardiology team to take the patient for an
emergency angioplasty in the “Cath Lab”. As the senior emergency doctor,
she personally escorted the patient with their life support machine to
the lab. She remained with them for the duration of the one hour
procedure, whilst administering anaesthetic drugs to keep the patient
asleep, before escorting the still unconscious patient to the ICU. She
should be back on duty in 5 hours, but has only had 3 hours sleep.
Another Consultant, probably on their day off, will come in to cover the
first half of her shift. The late notice phone calls to come in to work
are just accepted as part of the job, but are disruptive to family
life. Our children quickly learn that Mummy or Daddy’s promises to be at
their sports day or school music concert actually come with a silent
“unless the department needs me” on the end!
The Emergency Physicians and some of the Intensive Care doctors are
the only senior doctors who work shifts. We know that a patient who is
seen by a senior emergency doctor on arrival is more likely to survive,
and we are committed to this concept. If you are sick, we will be there
for you – 24 hours a day, 7 days a week, 365 days a year. That is the
commitment that we make to you.
The day has begun badly, but it often does. We just have to deal with
it. Public Emergency departments don’t close just because they are full
or because there are no beds in the hospital or because of staff
sickness, so we work on…
I see a 98 year old lady with a broken hip after a fall. She tells me
that she is looking forward to getting her telegrams from the Queen and
Governor-General. I prescribe morphine for her pain and order x-rays, a
heart tracing and blood tests. I can’t just assume that she has
tripped. If I miss the fact that actually she has had a heart attack,
seizure, sudden disturbance in heart rhythm or any one of a dozen other
conditions that could have led to her fall, then those telegrams may
never become a reality. I reassure her that all will be well, and that
our doctors will refer her to an Orthopaedic Surgeon for surgery.
I see a 27 year old girl who is 8 weeks pregnant and has started to
bleed. This is probably a miscarriage, but I can’t assume anything. I
need to be sure that this is not something more sinister like an ectopic
pregnancy, where the fertilised egg develops outside the womb causing
pain and catastrophic bleeding. I ask a female junior doctor to perform
an examination on the young lady, and order an ultrasound and blood
tests, whilst making sure that a transfusion sample is taken just in
case. She also receives painkillers. The possibility of miscarriage is a
devastating psychological blow for this patient, and a nurse and myself
spend time trying to reassure her and put her more at ease before her
partner arrives. I offer to break the news to him when he arrives.
I see a 19 year old heroin user who came in overnight having been
found unconscious. The night team saved his life by giving oxygen and
medication when he stopped breathing. Since then he has been sleeping
peacefully, but now he is awake and angry. I want to x-ray his chest to
make sure that he did not inhale any mouth secretions whilst he was
lying unconscious in the park. He throws his breakfast pack at a nurse
and delivers a stream of obscenities. I intervene and attempt to reason
with him whilst security are called. He spits at me, but the presence of
three burly security guards deters him from further violence and he
relents. The x-ray is performed before he is discharged in search of
more heroin.
The scan result on a 23 year old girl in our short stay unit has come
back saying that she has a blood clot on her lung. Left untreated, this
is life threatening. I prescribe medication to thin her blood, having
calculated the correct dose, and explain the implications of her
diagnosis and that she will have to be admitted to the hospital for
further treatment and investigation. I refer her to a Respiratory
Physician.
An alarm sounds, and our team rushes to the resuscitation area, where
a middle aged lady arrives on an ambulance trolley looking sick. Very
sick. This lady is now my absolute priority. Everyone else will have to
wait. She has an abnormal heart trace, but also has back pain and low
blood pressure. The resuscitation team, of which I am the leader,
quickly apply oxygen, place intravenous drips and administer
medications, but she rapidly deteriorates and her heart stops. I
coordinate the resuscitation attempt, standing by the patient and
managing the team’s interventions, whilst simultaneously alerting the
rest of the hospital to events in the ED. I call ICU and a Cardiologist
in order to mobilise the resources which this lady may need if she
survives. She rallies for a period of time, but sadly dies without
regaining consciousness. I ensure that she spends her last moments with
her husband, and take time to express my condolences and to offer
support. Putting my hand on his shoulder as he cries, I ask our social
worker to speak with him, and offer him a telephone if he wishes to call
anyone. Even in his moment of grief, he thanks me for caring for his
wife.
The day continues. At 3pm I realise how hungry I am and that I
really, really need to go to the bathroom. Time pressure has meant that
food and bathrooms have not been an option until now. I have limited
time, so the bathroom wins. Lunch will have to wait. There is always one
more patient to see.
The last time I checked, if I chose to work in a private ED then I
could earn two to three times what I do now. It’s not that I can’t work
in the private system. The two fellowships I have completed during my
training mean that my qualifications are as good as, if not better than
many of my private colleagues. It’s simply that I don’t WANT to work in
the private hospital system. I see my job as delivering high quality,
compassionate and timely emergency care to the WHOLE population of
Queensland, not just those lucky enough to be able to afford private
insurance. I also value my role in helping to teach the next generation
of Emergency Physicians, a responsibility taken on almost solely by the
public hospital system.
Work pressures in Emergency Departments are increasing, as are
emergency attendances, while at the same time budgets are being cut. We
are constantly being told to do more with less. What is expected of the
staff in this high stakes environment continues to increase. I work at
least one evening shift and night on call a week and every third or
fourth weekend. This has a significant impact on my home life, my
partner and my children. I have accepted all of this without complaint.
Emergency Medicine is not glamorous and rarely makes the headlines. I
accept this. I just want to be able to do a good job and take good care
of my patients.
My employer is now asking me to sign an individual contract with
them, which removes all of the rights and protections which I currently
enjoy under the award. My right of appeal to the QIRC has been removed.
If I sign this contract, my ability to protect YOU from bad decisions by
bureaucrats is massively compromised. I can be fired for speaking out
over important issues, or for “refusing a reasonable direction” from a
manager. This could include being ordered to not prescribe a particular
drug or to open the Cardiac Cath Lab out of hours on the grounds of
expense. At the moment I have the right to fight them, to fight for you,
but I have a wife and two children to feed and clothe. I can’t afford
to lose my job.
They have also removed the existing fatigue provisions from the new
contract. Tired doctors make bad decisions, and these clauses protect us
from being forced to work excessive hours by an organisation who’s own
report into fatigue in doctors, produced at significant taxpayers
expense, concluded that we should just drink coffee! The contract now
states that fatigue will now be managed “locally”. I think we all know
what that means.
The worst thing about the contract is that any aspect of it can be
unilaterally and retrospectively changed by my employer without my
consent. Half of the doctors leave? No problem, we’ll just flog the rest
harder, they can cover the extra shifts. No need to employ any
expensive new ones. After all, they can just drink coffee, our own
report says so, and the patients will never notice. If the doctors
complain, we’ll change their contract and put them on the minimum wage,
or just terminate their employment. Try to open an operating theatre for
a sick patient in the middle of the night? The bureaucrats might think
it’s too expensive. Argue with them? You are terminated with immediate
effect. That will make you think twice!
One leading employment lawyer described the contract as the most one
sided contract they had ever seen. Like many emergency doctors, I have a
mortgage to pay and a partner and two children who depend on me as
their main bread winner. It will be a cruel irony indeed if my employer,
the Queensland Government, forces me into the private hospital system
by its insistence that I sign a contract which fundamentally shifts the
balance of power in the health system away from those who actually care
for patients, and towards accountants and bureaucrats, who only see the
financial bottom line.
I work for the organisation which employed Jayent Patel, and then
flew him out of the country when it all went wrong. It closed Caboolture
Emergency Department by letting the working conditions become so
hazardous and unbearable that all the senior staff left. It left us
unpaid for weeks at a time by its incompetent management of the new
payroll system, but now I am being asked to trust it, and put my
employment rights and YOUR health in its hands.
The public health system is sleep walking into a disaster for patient care.
Queensland, I need your help!
I have always been there when you need me.
Will you be there for me?
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Metta,
欣雨 Xinyu
