“The health system we have right now in Australia is not normal, not fair and not safe”

17 May 2022

I have always felt some anticipatory anxiety before working a shift in the emergency department.

When I was just starting out, I thought it was only me. My turbulent insides seemed at odds with the calm exteriors of my cool-as-a-cucumber colleagues. I worried that I might not have what it takes to make it in a physically, cognitively and emotionally challenging specialty like emergency medicine.

As I got more experienced, I came to understand my pre-shift nerves in a positive light. I used the travel time between home and work to mentally rehearse management of medical emergencies.

I would run through the advanced cardiac life support protocol in my head or think through the details of how to assess a patient with acute stroke, injuries from severe road trauma, or amphetamine-induced psychosis.

I felt this showed a healthy respect for the heavy responsibilities that came with my role. After all, life and death decisions are part of my day-to-day work.

Recently, the dull roar inside my head has become a clamour. When I am rostered to work an evening shift, I find myself ruminating about what might go wrong from the night before.

These days, it is not recalling detailed facts about how to manage medical emergencies that I am worried about. After more than 20 years working in the acute hospital system, I know I have enough training and experience to handle almost any clinical problem that might arise.

Overwhelmed

Instead, I worry about all the other things that might go wrong.

I worry that there won’t be enough staff, enough equipment, or enough physical space to provide people with the care they need, in the time frame they need it, and with the dignity and privacy that they deserve.

I worry that I am not enough, that I will let people down – patients, carers and the clinical team. I’m worried that people will be angry and upset with each other, there will be arguments, and in some cases, physical aggression, and violence.

I worry that mistakes will be made, and that a patient might have an adverse outcome. I wonder how I would live with myself if a patient, or a member of the clinical team, came to harm while under my care.

I worry about medicolegal risks – referrals to the health care complaints commission or the medical board. I think – will something happen on this shift which might limit my registration or end my career?

I am watching my colleagues get tired, cranky, cynical and burnt out. I know they have put years into their clinical training and that they care a lot about helping people and doing a good job – possibly too much.

I worry that healthcare workers are being damaged while doing jobs that they used to love.

I’m hearing from colleagues all over Australia that conditions are the worst they have ever seen. Emergency departments are dangerously overcrowded, with cubicles full, beds lining the corridors and ambulances queued around the block.

There are critical staff shortages in emergency departments, especially in nursing, meaning that even simple care measures, like providing pain relief, cleaning a wound, or a speaking a few words of explanation and reassurance, are delayed or missed.

Then I talk with friends in general practice, on the hospital wards, working in community mental health services or aged care. It’s the same story. Right now, the entire healthcare system is totally overwhelmed.

I’m hearing from teachers, police officers, bus drivers, and university lecturers. They are also under-resourced, under-staffed, feeling under-valued and are leaving in droves.

The other day, my mum said to me, ‘it’s as if the social contract between government and the people has broken’. We’re a wealthy country, a democracy, so I don’t really understand why. I thought the role of government was to create conditions which allow citizens to thrive.

We have experienced two very difficult years. During the pandemic, we have learned about the devastating impacts of social inequity the hard way. We have also discovered that when we work together, we can solve difficult health and social problems.

Solutions exist

When I took on the role of ACEM President last year, I dropped back to part-time clinical work. As demand for emergency care has increased, many of my colleagues have made similar decisions. At the moment, the system feels so hostile that working part-time is the only way to survive.

With the wicked problems facing the health system, I suspect that health service executives, the Health Ministers, and perhaps even the Prime Minister are feeling pretty nervous about things too.

But I keep going, on the dark days, because deep down, I know that even the most difficult problems can be solved.

Healthcare workers are hard-working, skilled, caring and tenacious people. They are innovative, flexible and very determined to do the best for patients, their colleagues and the communities they serve.

I know that most politicians are driven to stand for office because they hope to help people, to make a positive difference in their electorates and for the broader society. They might even aspire to make a mark on history.

I know that the Australian public has endured the pandemic, is sick of waiting too long for inadequate health services, and is absolutely desperate to see meaningful change.

The time has come for all of us to work together to design a better, fairer, safer system.

Good health is about far more than healthcare. Healthy people live in healthy societies, in healthy environments, and healthy people generate healthy economies.

History has shown that pandemics trigger significant social change. Right now, we have a once-in-a-generation opportunity to create a better, fairer, safer health system.

We must put people at the centre. Hold a conversation with the Australian public to determine the values that will shape the health system, then make sure that financial and governance drivers are designed to achieve the patient outcomes and experiences that the community wants.

I imagine that election candidates are feeling some anticipatory anxiety about going to the ballot box next Saturday. I hope they feel healthy respect for the heavy responsibility of their role.

I hope they have health reform on their minds. I want to reassure them that healthcare workers are here to advise and support them if they do.

Because the health system we have right now in Australia is not normal, not fair and not safe. With leadership, courage and collaboration, it can be fixed.

We must not let this moment pass.

This piece, initially composed as a thread on Twitter, was written based on my own experiences and stories related to me by colleagues working in emergency care around Australia. Thank you to the team at my hospital. From the emergency department, to the wards, the clinics, kitchen, switch, the clerical team and executive suite, you are all working hard, pulling together, and doing your very best to provide excellent patient care under pressure. Your skill and care are appreciated.

Dr Clare Skinner in President of the Australasian College for Emergency Medicine, the not-for-profit organisation responsible for training emergency physicians and advancement of professional standards in emergency medicine. She works clinically as a specialist emergency physician in suburban Sydney. Follow on Twitter: @ACEMPresident.

https://www.croakey.org/the-health-system-we-have-right-now-in-australia-is-not-normal-not-fair-and-not-safe/