On Thursday morning, our doctor arose before 6am, and after pottering around the home for a while, opened up their laptop and spent half an hour checking on patient results and letters to ensure no urgent issues for the day.
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Chris Holmes
Associate Professor and Director of Monash Rural Health - Bendigo, Deputy Head of School, Monash Rural Health
After kissing their partner goodbye, they headed off to work before 8am, to find a full day of bookings, five urgent patients already seeking 'on the day' review - most elderly patients with acute COVID infections requiring prescriptions for antiviral medications - and started on the work of the day.
In the midst of this fully booked day, an elderly veteran called in, having cut a finger with a knife, and was still bleeding profusely, clearly requiring sutures to repair the injury.
"We are heading down the road to an American style health care system, with its associated problems and poorer health outcomes for the whole community."
Our GP was faced with a choice - suggest the patient go straight to the Emergency Department at the local public hospital, where in all likelihood as a low-urgency case he would wait for some considerable time before having his wound effectively treated, increasing the stress and workload in a busy department, contributing to delays in care for other, perhaps sicker, patients and negatively reinforcing the impressions on the current standard of general practice, or they could put the patient in their treatment area and suture the hand themselves.
Our highly skilled GP washed the six centimetre laceration, put in an anaesthetic, placed several sutures, dressed the wound, gave the patient and his wife instructions on how to care for the hand, and made an appointment for review in 10 days to remove the sutures. All for the princely rebate payment of $49.
Having spent 30 minutes treating the patient, our GP forewent lunch to catch up on the further delayed patients waiting to be seen, apologising to them for not running to time, and worked their way through the backlog. At 7pm, they finally finished the day's work, and returned home to see their family.
The canary in the healthcare coal mine
This story, or variations on it, is played out in hundreds of general practices across the county daily.
The pitiful rebate payment - from which the GP has to pay for the anaesthetic, the syringe, the sutures, the dressing, the other consumables, the nurse who assisted and all the costs of running a small business - is illustrative of the problems facing primary care in our community.
Only one in nine medical graduates see general practice as a career choice, and the implications should deeply concern everyone.
If there is no financially viable primary health care system, preventative screening and early care will decline and more people will develop preventable medical diseases at earlier ages, requiring early and much costlier interventions to try to mitigate - never completely cure - the resulting damage.
Inevitably, the total health care costs to the community will rise to unsustainable levels, and only those with the resources to fund their own healthcare will be able to access the treatments we currently take for granted.
This will widen the divisions between the 'haves' and 'have nots' and will result in worsening social disadvantage and inequity.
We are heading down the road to an American style health care system, with its associated problems and poorer health outcomes for the whole community.
The canary is fluttering weakly at the bottom of the cage, and we ignore the warning at our peril.
