A slip in time — a simple injury and relearning the medical system

This is about the best that the trail looked — it often disappeared and reappeared, especially when close to Kangaroo Creek.

Hospital Visit 1: This is simple

I have a decent first aid setup at home, so I thought there wasn’t much chance of infection, but Monday I stopped by the GP and she sent me straight to the emergency room. My right leg was red and swollen. At the St. Vincent’s ER, where the wound was cleaned, the docs diagnosed me with cellulitis, gave me IV antibiotics, and they released me with 5 days of antibiotics. I felt pretty poor about my wound cleaning skills.

Leigh is very skeptical that this is really a great trail. The trail is skeptical that I know where I’m going.

Hospital Visit 2:

On a follow up with the GP four days later, she felt that the leg was getting worse. Back to St. Vincent’s Emergency! Under the cautious eye of an infectious disease specialist, they didn’t think it was that severe. “A few more days of antibiotics should do the trick.” When all you have is an antibiotic hammer…

They draw an outline in pen so they can track whether the infection is growing or shrinking. If it shrinks, that’s good. If it grows, they draw another line.

Hospital Visit 3:

A week after, the would was looking good, but my ankle had swollen up and explosive to walk on at night. A scheduled phone check-up with the infectious disease specialist over the phone, they told me to go into the ER and ask for Ortho to check for a septic joint. Turns out that is unrelated to a septic tank.

My Nephrologist steps in

I had been keeping my nephrologist in the loop as the case went on, and after 72 hours of staying completely off the foot, with no improvement, she decided to take action: she ordered a gallium bone scan! This was my first “nuclear medicine” test, but I received absolutely no superpowers whatsoever. Meh.

Hospital Visit 4: Futility

As much as St. Vincents was plagued by delays, Royal North Shore crawled at a geriatric turtle’s pace (which matched my current walking speed). The only reason I was admitted was to get an MRI, which I did not receive until 48 hours later. Neither hospital was handling COVID cases at this point so that wasn’t the reason.

An imaging report, in a foreign language called “medicine.”

What did I learn?

Medical staff are challenged during COVID, be sympathetic to them

First and foremost, any complaints I have are more about the system than the individuals. Nurses, techs, and doctors all wanted to help, but were either too swamped with cases, handcuffed by the system, or following the procedure dictated to them even though they knew it was sub-optimal for the patient. With the rise of COVID, it’s even worse. Medical personnel are under more regulations, stress, and case loads. Of course, the best thing you can do for the medical staff (and other patients) wherever you live is to get vaccinated and help reduce the case burden!

GPs are more of a referral engine than a care coordinator

Friends of mine in the medical profession have talked about the decline in diagnostic skills by GPs. It’s much easier to forward you on to the ER or a specialist than work on the diagnosis yourself — and often the patient is left coordinating their care without an understanding of the system.

Australia is missing internal medicine in hospitals

In many hospitals in the US, when you are admitted, you have a doctor in internal medicine coordinating your case, who understand how to work the system, how to get all the right specialists involved and react to their input, how to get your tests back quickly, to minimise your stay in the hospital. Much of the use of internists was driven by economic reasons but it also generates better outcomes for patients. Whoever owned my case in each of my Australian hospital visits just didn’t have the time or the breadth of knowledge to coordinate my care (or even to just make the hard call to dismiss me early and do it all as an outpatient).

The system cannot handle “half-serious” cases

If you’re seriously ill, hospitals are optimised for you. If you’re not, they just don’t work well. Heart attack? Hospital is the place for you. Trauma? Head to the ER. Something you need removed from an orifice before your kids get home? They have gloves and lube at the ready. Non-urgent, complex medical issue which will take some time to sort out? Good luck in a hospital. Of course it completely makes sense to prioritise the critical cases, but it means if you’re not critical, you should seriously re-think whether being in hospital is for you.

Not the worst view in the world, but I’d rather be in my own bed.

They call it practising medicine for a reason

The number of mis-diagnoses (or lack of a diagnosis) is staggering. The inability to explain things to the patient is perhaps the largest crime. The younger doctors were 10x better at explaining things (usually I find in life, the more recent you learned something, the better you are at explaining it). Unless I interrogated the doctor, the current situation, the next steps, and the reasons for those next steps, would rarely be communicated.

And yet, no bill…

There’s a wonder to the Australian medical system, in that I never had to trade off the financial cost (the cost of time was the issue for me) or even consider it. I never saw a bill the entire time I was in hospital. One financial coordinator came to me during one visit to make sure I understood that any additional costs would be covered by my supplemental insurance, but that even it was unlikely to be used given the coverage by medicare. We pay a decent chunk of taxes for medicare, but even with all of the problems I experienced, it’s worth it.

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