Post by Peter MoylanPost by Rich UlrichPost by Peter MoylanPost by Paul CarmichaelPost by jerryfriedmanAmericans are often at least as baffled by "surgeries" in
British politics, which have nothing to do with surgical
operations or even places where operations are performed.
Every town in the UK has a "doctor's surgery" where they rarely
perform surgery.
But they do sometimes, at least in Australia. I've had a growth on
my finger sliced off by a GP in his own surgery. (Without
anaesthetic, and without warning, which was possibly the best way
to get the job done.)
The normal qualification for a GP here is MBBS, which means
Bachelor of Medicine and Bachelor of Surgery. In small towns,
hospital surgery is often the responsibility of a GP, when the
hospital is too small to have a resident medico.
I easilty accept the idea of a GP doing a minor bit in his office.
But I think of offices having doctors, and clinics having doctors on
hand or at least on call. Hospitals, in my mind, from my American
experience, are large, with multiple doctors.
Instead of small hospitals or even clinics, people in our small
towns often have no care nearby, at all. That is my impression. I
grew up in a small town (pop. 1000) and doctors + hospitals were 14
miles away in the larger town (pop. 25 000).
Slightly relatedly, I do not understand why US medicine is so enthusiastic
about hyper-specialisation. It always has been, but you need generalists for
sparsely-populated areas, of which you have plenty.
Post by Peter MoylanThe town I grew up in (pop. 4000) is an intermediate case. It has a
hospital, but it's staffed only by nurses. (Plus people like cleaners,
cooks, etc.) One of the GPs in the town is appointed to a position where
he visits the hospital once a week, or more often in emergencies. (This
is my memory from years ago, but it's probably still much the same.)
Local doctors are probably handling routine things like childbirth,
appendectomy, etc. More difficult cases are sent to a big-city hospital
about 100 km away.
From my discussions with Australian GPs and with colleagues who have worked in
Oz, that’s the usual structure. For uncomplicated childbirth or appendicectomy
you need at least two doctors, and the usual rhythm of things is that one GP
has extra training in anaesthetics with the other having extra training in
surgery or obstetrics. Now even uncomplicated childbirth can get hairy very
quickly, and I would be unwilling to have someone close to me give birth in a
hospital without an anaesthetist plus someone who can perform a Caesarean
section, but the above set-up works.
I like procedures and I do an awful lot more minor surgery (in my doctor’s
surgery) than most of my Irish GP colleagues. I would quite like to perform
either of the above roles, mainly because I want to have as much relevant
experience as possible for any emergency that shows up, but we do not have the
Australian tyranny of distance here and so there are no GPs who do this.
Anaesthesia is performed by anaesthetists and obstetrics and general surgery
are performed by obstetricians and general surgeons resspectively. This is in
general better for the patients because if one does something all the time one
is better at it, but it’s worse for the skill level of the generalist.
I am very rural for Ireland but the closest hospital is still only an hour and
twenty minutes away by road, or fifteen minutes by helicopter.
Post by Peter MoylanA weakness of the system is insufficient medical expertise. Towards the
end of his life my father had frequent falls caused by anaemia. So
regularly he'd be taken by ambulance to the hospital. The nursing unit
manager would say "He's just dehydrated", give him a drink of water, and
send him home again. It wasn't the right treatment, but the nurse didn't
know what else to do. On the other hand the nursing staff usually do
have sufficient expertise to know when someone has to be sent to a
bigger hospital.
The nursing unit likely did not have a blood bank to transfuse him. Was he seen
by doctors during these attendances?
Post by Peter MoylanPost by Rich UlrichPeople in small towns have to go down the highway to find doctors.
There is a bit of a crisis emerging in the US from the closure of
hospitals in even the medium size towns, leaving many people hours
away from care. As I understand it, the people losing out are
especially the ones who do not have private health insurance and
they are in states that refuse to accept Obamacare funding.
At least we don't have your political problems. The state hospital
systems will take all the federal funding they can get. The biggest
political problem that arises is over the problem known here as
"ramping", where ambulances are queued up at the hospital entrance
because the emergency department doesn't have enough staff or space to
unload them. As a result, ambulance paramedics are left looking after
patients when they really should be out on the road dealing with further
emergencies.
There's also an excessive reliance on private health insurance. People
who don't have it might have to wait for two or three years for a
procedure that they could get in weeks if they went to the private
system. This is in part because specialists don't get paid as well if
they take on public patients.
In general the assessment of the Australian health system by colleagues who
have worked in Ireland, the UK, or both, is very positive. You don’t have the
dependency ratio issue that we always did (previously with a very high
proportion of children per working adult, now with a high proportion of elderly
per working adult).
--
‘As I sat looking up at the Guinness ad, I could never figure out /
How your man stayed up on the surfboard after fourteen pints of stout’
(C. Moore)