A few months ago an elderly patient, whom I have been looking after for many years, attended my clinic. Things were changing and it was clear that she would soon need to leave her home and move to a Nursing home.
Her daughter asked me: ” Dr T, will you look after Mom in the old age home ?”
And sadly I had to decline.
Why? Why have such large numbers of GPs such as myself and my wife given up on this aspect of our work?
The answers to this question are complex and are best described by describing how a typical week went when I was still looking after patients in these facilities.
My last attendance at a RACF involved looking after only three elderly residents – all had clear wishes to not go to hospital and the staff had a very clear instruction to call me before they sent any of my patients to a hospital – I would attend and assess the situation and try and deal with things at the facility.
Request for prescriptions from the chemist.
Time taken ten minutes after work.
Income for this work – nothing
Drive to the facility for the regular four weekly review
15min drive there in own car. No payment for this
10min tracking down staff and files. No payment for this
10min tracking down one of the patients – at hairdresser despite the Dr visit being booked four weeks ago. No payment for this
50min spent with the three patients – 3 x standard consults – $ 53 for each patient from Medicare
20min advising RACF staff what needs to be done. No payment for this
15min drive back to rooms. No payment for this
30min doing notes, scripts and other paperwork. No payment for this
Receive notice from hospital that one of the patients had been sent to hospital overnight with shortness of breath. My instructions to call me were ignored. The patient has endstage chronic lung disease and has a severe anxiety disorder to the point where she had not left her room in years. She is in a palliative stage of her life.
45 min spent on the phone trying to explain the background issues to the very smart doctors in the hospital. And being ignored. No payment for this
20 min more spent explaining the issues to anxious relatives. No payment for this
Received script from Pharmacy for medication that they had issued without a valid script and now urgently want me to write a backdated script
10 min spent during lunchtime doing (not backdated) scripts – Unpaid work
3PM call – patient has been sent home and is in a mess I need to come and see her as soon as possible.
drive to RACF after work – unpaid time
Arrive at RACF after 6PM and doors are locked – takes 20min to get someone to open the doors as the severely understaffed team is busy elsewhere. No Nurses on-site afterhours and carers have no clue on where paperwork and notes are.
See patient for 60 min – $150 from Medicare for this. Fix the kinked oxygen tubing, help to make a cuppa, find the missing glasses & TV remote. That’s the easy stuff.
Hard stuff is restarting the sedatives that the hospital doctors stopped.
Horrible medication that is dangerous for her breathing. Correct.
That she has been using for fourty years and are absolutely addicted to and cessation is causing intense distress. What other option do I have than to source the medication somewhere and restart her on the pills. There are no staff members or relatives to sit there and hold her hand while she is having a huge panic attack and the only other choice is to send her back to the hospital – which she made me promise not to do.
further hour of unpaid work
Drive 25min from home to check on her – unpaid time
Spent 15min checking on her – Medicare pays $85
Spend 30min on the phone tracking down the very smart hospital doctors to find out why they stopped her regular medication before sending her home on a Friday afternoon without even contacting me.
“but Dr the drugs were dangerous” – yes I know. And stopping like that is even more dangerous.
“but Dr you were not concerned that the patient arrived naked”
A further 45min between RACF and ambulance service determines the patient had such a severe panic attack when she went to hospital that she tore all of her clothes off. She was covered with a linen sheet and sent home with that same urine soaked sheet four days later.
A further 60min is spent on drafting an official letter of complaint
All unpaid work
Call at midday – Dr needs to urgently review the other patient’s leg wound.
“What wound? No one mentioned one when I was there few days ago
Lunchtime a 30min drive – all unpaid travel
Find the nurse, find the patient and look at the tiny little wound on her leg that looks absolutely fine. To calm the waters an alternative dressing is prescribed – Paid $85 by Medicare for this work
Call from RACF staff – third resident’s son has some questions regarding her chronic medication and wants to see me. Explained that I am fully booked but will be attending to review the other resident on the Friday (Public Holiday) and will see him then.
Stack of faxes arrive from RACF with forms they want filled out before their pending accreditation visit. Done. All unpaid time
Attend the facility on the Public Holiday.
Anxious patient has settled but, typically of a long term sedative addict tries to coerce more of the medication out of me. Instead of a 5 min prescription I spend 30 min talking to her about ways and methods we could try to use to avoid this. She still called me an awful horrible human being who did not care about her
I reviewed the second patient whose leg I had seen urgently a few days earlier – who still had the same dressing on her leg that she originally had on – my instructions had been ignored.
Then it was time for the meeting with the third patient’s son.
Who was late.
When he arrived 20 min later he proceeded with a verbal spew about my audacity to call him in on a public holiday instead of doing it during normal working hours. And then informed me that it was unacceptable that the chemist had changed his mother’s medication to a different brand that cost them $5 more per month. Which had nothing to do with me.
I billed Medicare for patient 1 & 2 (total of $120) and went back to my Clinic to spend a further 30min on making notes. The session with the relative was again unpaid time.
These were typical weeks – hours and hours of unpaid work and, what was paid, was paid very poorly.
Meanwhile a Clinic had patients waiting for me with staff and bills to be paid.
Attending a RACF was simply an uneconomical and unfeasible option and, like so many of my Colleagues, I had to pull the plug.
We do appreciate the impact that this has on people who trust and rely on us but there is only so many hours in a day and sometimes hard choices need to be made.
And these hard choices may not be understood by those running the Royal Commision into this industry