A simpler system. (Please?)

Health care in Australia is actually pretty good, compared to, say, Ethiopia. Still, there’s plenty of room for improvement. So I was interested in what would happen on 19 April, when COAG (the Council of Australian Governments) met to thrash out Rudd’s proposition to take over health care (currently divided between federal and state governments, the latter of which I personally believe should be abolished altogether).

I didn’t get my act together to comment on the results of the meeting earlier because I was busy with the aftermath of a hospital experience of my own — the birth of my second child. (I’ll get to birth politics in another post.) Since then, the Budget has yielded more health-related reforms to debate at dinner parties, but the agreement in April still holds my interest, and here’s why.

I’m generally a healthy person, so apart from a visit to emergency after spraining an ankle on a weekend, my main experience with the hospital system has been for natal (pre, peri and post) care. This was a fairly straightforward experience with my first child, at least in terms of continuity of care. With my second, however, things got a little complicated.

In retrospect, I didn’t help matters by choosing the “shared care” option of care. This meant that instead of taking the option of seeing the same midwife the whole pregnancy, I had most of my appointments with my general practitioner. This was more convenient for me and I like her, so it worked well until I was about 30 weeks’ pregnant and diagnosed with gestational diabetes. The midwife who broke the news to me slagged off my GP for not calling me to let me know (when actually she’d ordered the test so long before, I’d hardly expect her to be holding her breath for my borderline results).

And it all went downhill from there. I got a referral to an endocrinologist and a diabetes educator. I had to see an obstetrician to clear me to go back to shared care, and was transferred to a different obstetric team for that appointment, so that the appointment could be on the same day as the endocrinologist appointment.

Initially these changes, like the dietary changes and finger prick blood tests, were more of an inconvenience than anything else. But at 38 weeks, with work deadlines competing with my due date, I decided to skip my last endocrinologist appointment. I was meant to make a midwife appointment while I was there, but I figured I could see the GP instead. She was happy to give me a check-up but said that I really should be having my appointments at the hospital at that stage.

But we were both puzzled about who I should be seeing. The obstetricians had cleared me to go back to the GP but I’d been taken off my previous team, so I had no midwife to look after me. She called the shared care liaison officer and got a voicemail message. In desperation I tried to contact the diabetes educator and finally got lucky — another midwife, Fiona, answered the phone and squeezed me into her schedule. I made it to one appointment with her before my son was born.

The point of this story is that health care in this country is too complex, even for someone who’s fairly health literate. Communication between health professionals is poor. Outside of set appointment times, patients’ access to health professionals is pretty much non-existent. Fiona mentioned that the hospital was moving away from group midwifery (where women have one midwife looking after them for pregnancy and birth, which is obviously excellent) and more towards shared care — because the hospital was broke.

If this goes ahead, it will leave more women bewildered about where they fit in the system. When I worked as a medical receptionist, patients would often call to request a home visit when they really needed to have called an ambulance five minutes previously. Patients hold up GPs and even orthopaedic surgeons with their life stories, often (I think) because they genuinely don’t know who they really should turn to.

So when a government meeting promises to “[help] patients receive more seamless care across sectors of the health system”, all I can say is YES PLEASE. Whatever other criticisms can be levelled at Rudd and the current government, if they can actually achieve simplicity in health care, I’ll be impressed.

One thought on “A simpler system. (Please?)

  1. Disagreements among specialists is very common. Not limited to midwives and GPs at all. Urologists feud with oncologists. Physiotherapists regards chiropractors as quacks. In fact, learning lots of any brand of knowledge seems to create professional cults.