It is 1979
Tom is a builder and walks into his his GP in Canberra’s office saying “Doc, my hip is buggered. What can you do for me”
Dr Dick examines the offending joint and sends Tom off for some x-rays. Does not cost much but it does take a few weeks to get done.
Dr Dick looks at the x-rays, turns to Tom and says “yep, it’s buggered but all I can offer you is some pain tablets and some exercises but essentially you need to find another job as your building days are over.
It is 1989
Tom presents and after examining him Dr Dick sends him for an x-ray which he gets back, with a written report, a week later.
Dr Dick looks at the x-rays and looks at the report and then decides to call his mate, Dr Harry.
Dr Harry is a an Orhopaedic surgeon but they went to University together, play golf once a week and Dick assists Harry in Theatre every now and then.
“Hey Harry I have Tom with me and I reckon he could do well with one of those fancy new hip replacements that you started doing”
Dr Harry tells Dr Dick “sure, give me his details, I’ll get my secretary to call the clinic at Woden Hospital and put him on the clinic list to be seen”
Dr Dick does a quick handwritten referral and gives Tom his x-rays to show Dr Harry
A month later Tom sees Dr Harry at the Clinic and two months later he gets the 8 hour long operation and stays in hospital for two weeks to rehabilitate. It does not work fantastically but he can still do a bit of work on the site and with a bit of pain relief manages to get another decade at work before it all gets too much and he retires.
It is 1999
Tom presents, is examined and send for x-rays. The Radiologist reports that one of the new fancy CT scans might say more so he is send back for one of those as well (Tom is starting to get a bit cranky about the costs of these fancy tests) – Dr Dick looks at the pictures and reads the report- it all confirms what Tom knew in the first place – his hip is buggered !
Dr Dick calls Dr Harry’s rooms – he has met Dr Harry at the occasional meeting. Dr Harry’s secretary however refuses to make a booking for an uninsured patient so Dr Dick faxes a typed letter to the Woden hospital Outpatient clinic.
Tom is seen by an Orthopaedic Registrar at the hospital two months later who agrees with Tom & Dr Dick and places Tom on a waiting list. Two months later Tom is admitted, has the 4 hour operation and is sent home after a week. He does really well and can get back to nearly everything at work that he used to be able to do.
It is 2009
Tom presents, is examined and gets his X-ray and CT scan. Dr Dick reads the report which confirms that he has “advanced ostearthritis”.
Dr Dick, having trained in South Africa is a bit uncomfortable to repeat Tom’s diagnosis of a “buggered hip”but agrees with Tom that he needs an operation. Thankfully Medicare paid for all of Tom’s examinations and investigations
Not knowing any of the local Orthopaedic Surgeons personally Dr Dick ends up spending 10 min typing up a referral letter in the software to the local public Orthopaedic Outpatient clinic which is faxed off. He feels sorry for Tom who cannot work so he bulkbills the whole consult.
Tom’s referral letter is triaged by the Registrar and he ends up being seen six months later. Dr Harry junior speaks to his Boss, Dr Harry, who agrees that a hip replacement is due and places Tom on the surgical waitinglist at the Canberra Hospital – which is estimated to be about three years.
Thankfully, for Tom, it is an election year and the ACT Government knows that Surgical waitinglists is a hot potato so they make a plan to artificially reduce the waiting lists.
Their solution is to remove Dr Harry & associates from the public hospital theaters and fund them operating on non-insured patients at private hospitals. In this efficient dollar driven environment Dr Harry can do ten or more hip replacements a day (as opposed to two a day at the Canberra Hospital) so Tom gets his 2h operation within two months and is sent home a week later – just in time to go and vote. He goes back to fulltime work a month later
It is January 2019
Tom presents, is examined and has his x-rays that same day. Not being a pensioner the x-rays gets to be a bit expensive. He clearly needs a hip replacement but Dr Dick knows that he now has to do a really good salesjob to get the team at The Canberra Hospital to take this seriously.
This means that Tom needs to see a Physiotherapist to see if they somehow magically could make his arthritis clear up. It also means he needs to fork out the money for a privately funded MRI of his hip as failing to do these things is likely to make him one of the 33% of GP referrals to the public clinic that is rejected each year.
Two months later Tom & Dr Dick have jumped through all of these hoops. Tom has been let go at the building site as he was too slow and always attending the Physiotherapy & GP.
A lot of time is now spent on figuring out Centrelink, Newstart and other red tape obstacles to put food on the table.
Dr Dick is now feeling hopeful that the “system” will accept the referral so he writes a referral and it is faxed of the Central Intake number where ALL referrals are now sent for all clinics.
A few weeks later Dr Dick decides to check what has happened to the referral and he calls the GP Liaison Unit who chases down the referral – he discovers the referral is a triage category three which means, in theory a 3 month wait, in practice closer to 9 months.
Nine months later Tom finally gets seen. Not by a Registrar or Orthopaedic Surgeon, but by a Physiotherapist who has the ultimate authority to disregard anything Dr Dick or any of the pre-hospital team has done. And often does this.
Tom gets told he needs more physio and to go and see his GP to get a Careplan and to come back if this does not help (Election year has come around again – patient has been seen “tick” )
Six more months goes by and Tom is no better – and no-one expected him to be.
He sees the Physiotherapist again who graciously allow him to be booked at the Orthopaedic Registrar Review Clinic. He is seen there three months later where they decide the original imaging tests are now too old so he has to have new ones. This is done and two months later he finally sees Dr Harriet who advises him that he needs a new hip.
And places him on the list.
He nearly had to miss this appointment though because the original referral letter was to Dr Harry and not Dr Harriet and the admin team wanted a correctly named referral in order to charge Medicare for the consult (even though everyone in the room was already being paid by ACT Health). Luckily for him Dr Dick was compassionate enough to tell his patient in front of him to please wait outside while he quickly typed up a new letter and had it faxed through to the clinic at the hospital – just a pit Dr Dick is not on a salary and is doing all of this for free.
Tom finally gets his new hips two years later. The operation only takes two hours and two days later he is discharged back to his GP’s care.
Unfortunately he now has been out of the workforce for three years and no building site wants him back so he never returns to the workforce.
It is December 2019
Tom presents, is examined and has his x-rays and MRI in order to try and make sure all hoops are jumped through.
But the rules have changed – Dr Dick, having reassured himself that a referral for a possible hip replacement is needed now needs to:
- Log in to the GP Healthnet website and browse to a complex set of Orthopaedic referral guideline pathways
- Do various assessment indexes and questionnaires such as the Oxford hip score
- Then log into the ACT Health pathways website and make sure what the latest policies and procedures are that need to be complied with when referring to the clinic
- Go back into the desktop software and fill in the new Smartform referrals to send the referral through electronically – assuming the software works and the Internet is up & running
Once all of this is done the pre-existing process of seeing the Physiotherapist, instead of the Surgeon, months later, starts.
Not so sure who is the winner in all of this.
Not the patients who effective drop out of the workforce after years of waiting and pain.
Not the GP who finds themselves doing referrals that now takes 30-45 min instead of 10 minutes and this is either done as a dodgy “long Medicare consult”or , more often, for free while only charging a standard, typically bulkbilled, consult.
Conceivable the only winners are an ever increasing bureaucracy and the Politicians