[ExI] simple solution to health care

Stathis Papaioannou stathisp at gmail.com
Thu Jun 25 12:40:06 UTC 2009

2009/6/25 Emlyn <emlynoregan at gmail.com>

> The experience in the emergency department is interesting; it's a real
> feeling of having been consumed by a slow but inexorably moving
> machine. You have no real power in there, you just hope the mechanism
> is working correctly, and you wont be mangled in the gears. That's
> institution I guess. Nurses come and go, doctors come and go, with
> gaps between them measured in multiples of half hours. You never
> really get to know anyone's name, or know what's going on, or get the
> sense that anyone else knows what's going on; each staff member seems
> to have a very narrow responsibility to fill, and no overview. Yet,
> they all seem competent, which alleviates the anxiety somewhat.
> There's not much sense of care, and you spend a lot of time alone.
> People say it's because resources are stretched due to underfunding,
> but I must contrast that with the sense that there were always large
> clumps of nurses nearby doing clerical work or talking about their
> weekends or doing lots of anything except tending to patients. Is that
> normal?

This is probably a "normal" experience. There is a lot of waiting
around: waiting for test results, waiting for Xray to be ready,
waiting for the radiologist to look at the Xray, waiting for the
urology registrar to come along and offer an opinion, waiting for the
ED consultant to give the final OK when the patient is ready to go.
Even if some parts of the machine are idle at a particular moment,
other parts might be otherwise occupied. There is overview: you have a
particular nurse and doctor every shift who is supposed to know
everything about their patients, and are coordinate all the other
people with more specialised roles. The other part you probably don't
appreciate as a patient is that the machine is set up so that it is
sensitive to potentially life-threatening events which require an
immediate response, and these get priority. You get anxious if things
are taking a long time to happen, but this in fact means that the
clinicians' assessment is that you will come to no harm from waiting.
The ED is extremely good at making sure a disaster is averted, less
good at dealing with serious but non-life-threatening problems such as
kidney stones, and not so good at dealing with minor problems that
should have been seen by a GP.

Nevertheless, in Victoria in the past few years waiting times in ED's
are a big deal. Hospitals get fined if they don't meet certain
performance indicators (time from arrival in ED to time seen, total
time spent in ED), and managers are liable to be sacked if there is a
consistent problem. On the other hand, hospitals are forced to work
within their budgets, employing the minimum number of staff who are
capable of doing the job. There are of course times when staff are
sitting around because not much is happening, but it's also very
common to have to stay back (unpaid) to finish paperwork or other
work. The paperwork is probably the single greatest source of
inefficiency, in my opinion. Hospitals are fanatical about documenting
everything in excruciating detail, sometimes multiple times by
different people. This is partly to ensure that there is good
communication between the various parts of the system and partly for
medicolegal reasons, to ensure that everything that should be done is
done and is seen to have been done.

Stathis Papaioannou

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