Overwhelmed in Australia

Very intersting, the various twists and turns each individual takes in the comments section. A virtual nightmare no doubt when the BirdFlu hits.

"The emergency department is a coffee grinder. You go in one end and you come out the other end chewed up and bitter"

and this is with pandemic influenza and who knows what all in our future.

the last comment I saw -let's stop thinking like Americans that health care and education is just all about the bottom line - !- Americans mostly don't believe that - but, the governments we allow do.

:-(

(I really do start to think the country we love is dead, and the wind just hasn't shifted enough yet that the fact can't be hidden from all...)

How can health care workers get back to providing good health care, and, make a good living and get sleep and a family life while doing so?

The current administrators there and here will throw hcw (and the public) away in an influenza pandemic, and then what?

then what?

Then the rest of us learn what it is really like in Mumbai, Guatemala City, and Falujah.

Although, you care to reflect on the one group who could not obtain draft-deferrals forty years ago.

Misery loves hope. Unfortunately, those of us in the beleaguered northern hemisphere won't find it in the Land of Oz, where Bush clone John Howard apes the chimp.

Health care in Australia is provided by the States, not by the Federal government. It's actually more confusing than that, but the to the extent that Canberra has health problems (and it doesn't, on any scale that an American would recognise) it's the responsibility of the Territory government, which is presently Labor. That is, the party which is in opposition to John Howard on a Federal level.

Canberra is a funny place. It's an artifically created capital designed to house the burgeoning public service. It has gorgeous circular boulevards, leafy streets, vast amounts of green space, superb social services and so forth. I last spent a night there perhaps fifteen years ago. I still remember how eerily quiet the streets were in the morning.

Revere

Australian supports USA through thick and thin. Nice cheap shot at Howard. US administrations come and go . Australia stays. I can assure you Howard is no idiot like you know who.

You voted for him. I reckon people get the politicians they deserve. Look in the mirror.

CPG from Aussie.

In NZ if you are a stupid,drunken little twat and wrap your car around a tree at great speed and stand a chance of survival, you will likely get the best treatment in the world.We can do this.Kiwis are clever this way.But if you have any chronic,disablng medical condition and no insurance,you may die waiting for attention.What's new?

cpg: Of course I didn't vote for him. I don't understand your comment about "Australia" supporting the US. Australia isn't a person any more than the US is a person. It has a gov't which makes policy, in this case the Howard gov't. The US has a gov't which makes (foreign) policy, in this case the Bush administration. Both make colossal blunders. The Howard blunder was in sticking to the Bush blunder.

sigh...I know I'll regret commenting, but, once again, here goes...

revere, who in the hell are you going to blame all the woes of the world upon when Bush's term has expired? Do you REALLY believe our/Oz's healthcare woes are due to the current administration(s)? Seriously? If so, you are less knowlegdeable than I give you credit for.

I don't know how you became aware of these HCWs comments, but this has been the norm for the entire time I have been working, and that now encompasses over 2 decades. In my experience, in the US, it all started when DRGs were enacted (in the '80s).

As time has gone on, the acuity of patients has increased, funding has decreased, and the age of the HCWs has increased. This has become a GLOBAL situation. And it did not just occur with this administration.

I was under the impression that you were a physician. Do you ever see patients in the hospital? Or are you only in the lab or behind a desk? The world has been changing for DECADES in healthcare. When we made rounds as neophytes decades ago, patients were admitted for tests alone. Those days are long gone. Now, the same patients we used to see in ICU, are cared for by floor staff.

The characteristic set that entices people into healthcare are the exact characteristics that prevent them from insisting that these conditions be remedied: altruism, caring, selflessness, CO-DEPENDENCY, etc. Trying to get this type of personality to organize or to take a stand is almost impossible - nobody wants to be a focus of attention. So, the problems perpetuate and exacerbate. One good walk-out for 24 hours nation-wide, would get the attention of TPTB. Or even just try to get them politically active - they can't be bothered.

Hospital administration's focus is on money. The HCW's focus is on the patient. So the hospital admin pays as little as possible to get the most care from the least number of workers. The HCWs focus on the patients, tolerate the wages, get passive/aggressive because they see no way out, and keep getting older because they have warned their children not to follow in their footsteps.

The average age of a HCW (nurse or physician) in the US is approaching 50 y/o. How many swing shifts, lower back injuries, and exposure to "interesting" pathogens can one endure at that age? The boomers are about to hit the hospital years. Do you see hospitals paying higher wages? No. More staff? No. Friendlier work policies? No! We don't have to worry about a panFLU, we already have a HCW pandemic. Solutions to this problem have been discussed for YEARS! It will require a complete system change. And, as I mentioned earlier, it is not confined to the US, but is seen in all the developed countries, especially those with aging populations.

Do I think the HCWs will rise up and demand change? NO! They'll just complain, uh...ventilate. Unfortunately, that may be the only thing being ventilated in a panflu.

nsthesia: Yes, I am a physician and I have been around a long time. I am licensed but don't see patients any more. I have been primarily an academic for most of my career. But I have been around and worked in hospitals for over 50 years and have seen many changes in health care. I remember medicine in the US before third party payers (i.e., before Medicare) and through the many intervening periods.

Whom do I blame? Whoever is in charge making policy. I was a bitter critic of Mr. Clinton and Bush turned out to be even worse. I know the difference policy can make in health care because I've seen it - a lot of it. I've also worked at many levels in a hospital, including maintenance (highschool summers), orderly/transportation, medical student, doctor. I now serve on committees in a major inner city medical center. It hasn't always been this way and it doesn't have to be this way. I've seen different times and different systems in other countries.

So I am gearing up to beat up on those Democrats that deserve it and praising the ones that don't. There weren't any Republicans to praise so I didn't. If we are unlucky there won't be any Democrats either, but I'm hoping there will be. There sure as hell will be plenty to damn.

Re the state of healthcare in Oz under 14 years of Howard "leadership", which is universally recognised as under-funded, I can't resist one observation.

Recently an investigative commission (the Cole Commission) on the Australian Wheat Board (AWB) scandal has concluded that in the order of $300 million dollars was paid by the AWB to Saddam's regime in Iraq as kickback bribes for wheat contracts, at precisely the same time Australia was hitching up to Bush's camapaign against Iraq, with Howard proudly acknowledging himself as the regions deputy sheriff to Sheriff Bush. Money that was probably spent by Saddam on weapons to kill American and Aussie soldiers. Has the irony hit home yet?

So what has this got to do with underfunded healthcare in Australia? Only the observation that the $300 million that was given to Saddam by Australian taxpayers and that was supposed to be scutinized by the dolts of the Howard government, COULD have had a positive impact on improving healthcare issues here in Oz if spent in a more productive manner.

But that wouldn't have been as big an ego stroke as playing deputy sheriff though, would it?

Bottom line is like Tan06 in the Netherlands that you pay for universal healthcare and then they cut out what is covered...so you still get to pay for crappy services. Ns is right and its easy to blame those in charge. We have a lot of IF's going right now. IF it doesnt come then they will say we did too much, if it does they'll say we did too little. If it comes high path and continously shifts its antigenic patterns then it wont matter what Revere, NS, Greg, or me or anyone else because its going to hit the population of the earth like a flyswatter. Universal healthcare will be over, so will managed healthcare. Medicare, Social Security, all the gimme's and all the pork gone. Bust.

Its either diseases or wars and this time it may cull us repeatedly across several years with disease to only about a billion or so. Give the earth time to recover a bit and prove survival of the fittest really works. Nasty thought but politicians always survive in every society.

Firstly, i am humbled to receive a link from someone I hold in such high regard.
We recently participated in Exercise Cumpston 06 which I believe was the largest pandemic response exercise held in the world to date. What did we learn? This and This.

What i'm saying is that Australia through Howard supports the USA. The reasoning is secondary. Are you saying when the next iraq comes around and the USA needs allies we tell you to get lost. Australia policy is about supporting US policy not supporting bush. I give it to you Bush and Howard are close but US/Austrailan relationships are closer.

The main problem with Iraq as I see it was 1: the lack of exit strategy when / if it went pear shaped. You guys have a pentagon thats supposed to work this out. 2: imposing democracy on a country that has no idea what this means in practice. Democracy has failed in most cultures that have non-western ( roman /greek / british ) outlook on life.

Hindsight is a great thing. Revere ! you would have them get out now and let the mass slaughter happen. Which blunder is bigger.

Re voting: I meant you (US citizens) voted for bush so the majority of you supported Iraq. You dont like it now so you turn and eat he hand that feeds you. Seems pretty stupid. You made this mess so fix it or just walk away like you did in Vietnam.

Either works for me.

cpg: "Are you saying when the next iraq comes around and the USA needs allies we tell you to get lost." Yes. I would hope so, for your sake and for ours. Many of us saw from the outset Iraq was a lie, a blunder and a trap. half of the Democrat in Congress voted not to give Bush war powers. Many in Australia figured this out, too, and they had massive demonstrations against the war on Feb. 16. This is isn't hind sight. It is an example of blindness and stupidity of those who got us into this originally.

Majority rule doesn't meant that once a vote is in you acquiesce. You keep fighting, legally, against those things that are wrong. Many of us have done that. My conscience is clear but my heart is heavy at the damage that has been done to so many -- needlessly.

My parting shot for this thread...

revere, you wrote: "So I am gearing up to beat up on those Democrats that deserve it and praising the ones that don't. There weren't any Republicans to praise so I didn't. If we are unlucky there won't be any Democrats either, but I'm hoping there will be. There sure as hell will be plenty to damn."

IMO, damning those you disagree with, does no good. That was exactly my point earlier. HCWs ventilate; they bitch. They do not act. Perhaps that is a reflection on the great number of women in healthcare and including males in touch with their caregiving side. (I can say this, I am female). They tend to verbally assault issues vs. physically and actively responding.

And with all due respect, your comment that you have been in academia for most of your career and now serve on committees in a hospital, is another part of this problem. IMHO. And I triple-dog-dare you to ask those ED nurses from OZ if they agree with me...physicians (or any HCWs) that make policy and who do not have CURRENT experience working with patients are a large part of our problems! Especially those who are mired in academia!

If one ever wants to see a damper on creative thinking and rigid adhesion to archaic paradigms, get thee to the supreme bureaucracy of a university hospital system! Two bureaucracies (medical and education) for the price of one!!! I spent years waiting for those who were making policy and had not touched a patient in years to retire (or expire) so we could see some change! Only to come to the realization that the system was self-perpetuating, and that they were growing clones of themselves in the basement to fill committee vacancies.

The problem is that those who are working themselves to death, seeing more patients, getting less reimbursement, and growing OLDer, are not the ones that have enough time to sit on all of these committees. Because the process ends up being the focus, NOT problem resolution. I've spent YEARS working on committees that could not/would not adhere to any time line. It gives all those tenured souls something to do, but little productive results.

IMO, we need to clean up our own house, before damning any political party. We need a complete HC system change, from recruitment, to education, to reimbursement. Of course, I'll probably be sitting on a committee for "change" for the next two decades working towards a solution, after I've quit clinical practice...and, thus, the cycle will perpetuate...

nsthesia: LOL. "IMO, damning those you disagree with, does no good. That was exactly my point earlier. HCWs ventilate; they bitch. They do not act." The rest of your comment is a long complaint about academics and other assorted people you disagree with. Welcome to the crowd.

I happen to agree with you about a total change in the health care system. I am a single-payer advocate. I assume this will cause you hearburn.

No doubt there are many idiots about, blathering pols, inefficient administrators, clapped out academics with silly charts, a lot of hot air, wasted time, foolish cosmetic band-aids.

Money.

It comes down to money. Double the size of the ED, double the staff, and let them get on with it.

And that kind of money is top Government policy, and their responsibility.

revere: "I am a single-payer advocate. I assume this will cause you hearburn." Au contraire, cher... Methinks that is exactly what will happen (by necessity) if/when a high CFR panflu ever hits. But lacking a major impetus, changing any major bureaucracy like healthcare will take a generation, IMO.

Ana: "It comes down to money. Double the size of the ED, double the staff, and let them get on with it.

And that kind of money is top Government policy, and their responsibility."

Ana, perhaps in a socialized medicine situation your statements are valid, but not here in the US. We have a system that includes private, public, and government-funded hospitals/EDs. And that list is even more complex when you add in the for-profit/not-for-profit qualifiers. Funding to expand an ED may come many sources, and "top government" is not usually part of the equation, nor is it their responsibility (federal facilities are the exception).

Funding may come from corporate monies in a for-profit system, or from approved referendums or bond sales in a local or state run facility.

As an addendum to your comments, even if we had all the beds and facilities needed to care for patients, where would we get staff? As I mentioned earlier, we have a global shortage of educated professionals. Patients go to hospitals for healthCARE, not to lay in a bed.

Increasing salaries and working conditions may indeed help recruit professionals, but studies have long shown that a HCWs main satisfier is not money. That then leaves all those system changes that exhaust and dismay so many. And enticing today's soundbite youngsters into a field that requires: delaying monetary gratification for perhaps a decade (or more), spending massive amounts of time away from family, working erratic and long hours, exposing themselves to constantly evolving pathogens, etc., etc.,
is a challenge.

PS. In the US, HCW salaries are ALSO not under the jurisdiction of the federal government, except for those federally-funded facilites. All the rest (the majority) come from various sources.