Issue 6 / 24 February 2014

THE media often describes summer as the silly season — there is usually not much worth reporting.

I escaped most of the silly season by going on a trip to Europe with my family, but couldn’t help contrasting their medical systems and actions to the way we do things here in Aussie medical land.

In England, the National Health Service was often in the news. Audits of GP practices, poorly trained Eastern European health workers and strained budgets were themes that rang the loudest.

While in London, we passed the Ecuadorian embassy and my sons raised an interesting question about Julian Assange, the Australian WikiLeaks founder who has spent more than 3 years in asylum in the embassy. The boys wanted to know what would happen if Assange fell ill — would it be Australia’s responsibility to treat him given he is Australian?

I didn’t know the answer, but it did make me think of the situation that can arise if a patient is stuck in an ambulance between one Australian country town and another.

Even in 2014, some health responsibilities remain rather nebulous despite the never-ending barrage of protocols, forms and ever-growing population of administrators who love to hold us under a microscope.

So what about the poor rural bloke who is whisked from Bullamakanka to Wallaby Base Hospital?

The doctor sending Old Mate clearly feels that the patient needs another doctor. The doctor receiving Old Mate will accept the patient — often reluctantly — as Wallaby Base has an obligation to receive patients from the surrounding towns. But the long road trip or air trip can take hours and many a complication can unfold along the way.

What if the two doctors cannot agree on the best management for Old Mate? Who is responsible?

In a small town emergency department, does the retrieval doctor take responsibility? And what about the junior doctors who field the calls and the “consultants” who work for the ambulance? And what about the intensivists miles away who might have a peek through a video camera for 5 minutes, throw in their 10 cents worth of advice, and then resume their work in University Metropolis Megahospital?

The thoughts faded as we headed towards the doom and gloom of Greece, where many people are forgoing basic health due to lack of money. We heard many say that to get things done in the Greek public hospitals cash had to be paid “under the table”.

Italy was the same, with the economic crisis staring us in the face. What also struck me in Italy was the fact that primary care is not nearly as developed as in Australia — there is a greater reliance on hospitals and specialists, and you can buy most drugs from pharmacies without a script. As a result, care is very fragmented.

However, the health system in Australia could learn a few lessons from the Italians. Some of the smaller rural towns offered surgical services that small towns in Australia could only dream of, such as a town of 10 000 having a hospital that can do coronary angiograms and stents, as well as cataract surgery.

The latest issue of the MJA discusses how cardiology networks improve acute coronary outcomes for rural patients. If only we had angiography suites in some of our rural towns, then we would not need such networks.

The observations in rural Italy also made me think that Australian rural doctors and rural communities should not be so defeatist in accepting constant downgrading of services.

We have to stand up against government attempts to downgrade services and working conditions. It was disappointing to arrive home to find the Queensland doctors’ dispute with the state government showing no signs of resolution.

I was dismayed to read that in Queensland contracts are more restrictive, tenure of work is uncertain, lower incomes seem inevitable and a nurse now heads the Queensland Medical Board.

Let’s hope that this attempt to downgrade conditions for doctors is defeated and does not spread beyond the Sunshine State.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

One thought on “Aniello Iannuzzi: Lessons from abroad

  1. Marcia Manning. says:

    Thanks

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