Opinion
The care has been stripped from WA healthcare. But we can turn things around
Dr Lucy Caratti
General PractitionerThere have been some alarming cases of misdiagnosis and refusal of treatment for patients in Perth emergency departments recently. With a lack of trust in the medical system already at an all-time high, the news of the death of toddler Sandipan Dhar, and of a tiger snake bite being dismissed at the same department, leave me very worried.
Lucy Caratti says WA’s health system is in crisis, but hopes it will become a turning point.
As an integrative health specialist and GP, I was reminded of the pressure that emergency departments are under when I spent six hours in one last week with my grandmother.
I witnessed patients being given medications and IV drips in the waiting room, alongside patients on multiple ambulance gurneys, sitting patiently. This is not about criticising the medical staff who are under incredible pressure, with such high attendance rates and protocols to move patients on to relevant departments or out the door within a certain timeframe. Hats off to these incredible doctors, nurses and other staff.
At a recent medical conference in London one speaker asked where the care was in healthcare now. That came to mind immediately when I heard about the Sandiphan Dhar tragedy, in which his parents did not feel they were listened to, and the 10-year-old sent home when the ED did not believe her story of being bitten by a tiger snake.
This is exactly the issue Victoria is trying to quash with its Inquiry into Women’s Pain. The lack of patient belief, particularly when it comes to women’s and girls’ health experiences, is something all of us in the medical profession need to consider every time we encounter a patient.
This is about asking ourselves, how did we get here?
For one, I believe many doctors are forgetting a crucial part of our medical training because the demands placed on GPs have evolved over the years and the skills in diagnosis fell to the wayside.
When I was at medical school in the early 2000s, we were taught that by the end of the history-taking with a patient, 90 per cent of your diagnosis should be made. Physical examination should confirm this and laboratory testing or imaging was used to differentiate between differential diagnoses and assess severity.
But in time-poor medical situations, including high-pressure emergency departments and 10-minute GP consultations, less time is taken in actually talking to the patient and history-taking, and more emphasis is placed on testing and imaging.
This is undoubtedly contributed to by the number of doctors being referred to the medical board and a sense of doctors wanting to cover their bases with testing and imaging.
Then there is pure dismissal of a patient’s experience. I see this commonly in my area of women’s health, where patients have seen multiple GPs about their symptoms, only to be told the symptoms of menopause are just a “normal part of ageing” or that the pain of endometriosis is mostly in their head. I even had one perimenopausal patient suffering from depression who had been told by another GP that she may feel better if she stopped wearing grey. This patient is now taking Hormone Replacement Therapy, which has resolved her mood issues, as well as improved sleep, cognition and all other areas of functioning.
Even factoring in the future workforce, there will be a projected shortfall of at least 10,600 full-time GPs by 2031-32 if nothing is done, according to the Australian Medical Association.
How have we got here? In part, because of the changing relationship between GPs and their patients. The ongoing relationship between a patient and GP, with knowledge of past and family history, the patient feeling comfortable discussing all aspects of health, is an integral part of our healthcare system. But many patients do not have a regular GP for many reasons, from inability to access appointments to not finding someone they feel confident in.
The recent federal budget has done little to improve this burden on GPs, with the increased cost of living meaning patients have less to invest in their primary care providers. I strongly believe this lack of connection, preventative health and lifestyle management is the missing link in where the care in healthcare has gone. But little to no resources are going towards changing this. This will lead to even more pressure on the tertiary hospitals, compounding the issue.
We are at a crisis point in WA’s healthcare, but I hope that it becomes a turning point. If we stopped, we would realise this crisis reminds us that listening to patients, believing our patients and allowing our patients to educate us in these areas will lead to a more compassionate healthcare system where trust on both sides of the system is restored.
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