RUOK?

[Mr Purple]

An Australia-wide shortage of IV fluids !!!
I have seen plenty of reports of this and it just staggers me - how in 2024 can this be considered acceptable and what on earth is wrong with public administration in this country that has lead to this ?

For those who are not familiar with hospitals it needs to be pointed out that IV fluids are the greatest tool since sliced bread and have saved countless lives since first became widely used almost 100 years ago (or thereabouts)

Those of us in the trade are very familiar with this sort of rubbish.

We're constantly running out of older drugs and supplies no-one can make money out of. They're essential but they're necessarily sold cheap, so there's no profit margins.

This is a problem of letting unfettered capitalism everywhere. We're often running out of ridiculous simple things like saline and morphine because capitalism can't make any money out of them.

I presume this occasionally kills patients as well.

[warthog1]

I'm a GP so this does sort of deserve to go in the RUOK thread but decades of neglect of general practice is killing.

Medical inflation is about twice general inflation, and the medicare rebate increases at half inflation. There's pretty much no way to continue bulk billing with those numbers and it gets harder every year. Rural GPs get paid pretty much the same as urban GPs, so there's no incentive to work rurally.

Where 45% of medical graduates became GPs 20 years ago now it's about 10%. And a third of the GP workforce is retiring in the next few years. I wonder why?

Thanks for your explanation here. It sounds unsustainable. Emergency depts are swamped with non-emerg general health complaints. I don't expect any improvement anytime soon then. EDs have to provide the service free, so the situation is going to get worse.
The only disincentive to people turning up there is the wait time. They end up getting aggressive with staff and EDs need security to deal with them.
That aint going to change. It is going to continue to worsen

[Mr Purple]

Thanks for your explanation here. It sounds unsustainable. Emergency depts are swamped with non-emerg general health complaints. I don't expect any improvement anytime soon then. EDs have to provide the service free, so the situation is going to get worse.
The only disincentive to people turning up there is the wait time. They end up getting aggressive with staff and EDs need security to deal with them.
That aint going to change. It is going to continue to worsen

As a reformed ED doctor I've experienced both sides. You're right, it isn't go to change.

I had a job for a couple of years in a major tertiary emergency department. Being one of few with a background in rural medicine/ED/GP we ran a 'fast track' department which was literally me, an equally qualified rural GP and two nurse practitioners.

This department had 150-200 presentations daily and collectively we saw 45% of them. Between 4 people. There were roughly 30-35 other doctors in the department who saw the other 55%. Our job was obviously to cherry pick the less complicated GP type presentations and so it was a lot easier, but also tells you something like 45% of ED presentations don't actually need to be in the ED.

The government at some level recognises this and is trying to do things like set up 'urgent care clinics' which are exactly that model above. However they've got no idea what they're doing, and basically just shovel large amounts of money at corporations who are the only ones who can afford to privately set up that sort of service. Their cost per patient seen (and they don't see many) is horrendous. They'd be far better off actually making the medicare rebate reflect the cost of providing the service and encouraging more people back into general practice.

The funny thing is they're not necessarily 'anti general practice'. They just have no control over the next year's budget for primary care. So if they fund it adequately and people decide to see their doctor more times than usual, the budget's shot. As a result they prefer to spend their money on specialists and hospitals, because at least that's fairly predictable.

[warthog1]

As a reformed ED doctor I've experienced both sides. You're right, it isn't go to change.

I had a job for a couple of years in a major tertiary emergency department. Being one of few with a background in rural medicine/ED/GP we ran a 'fast track' department which was literally me, an equally qualified rural GP and two nurse practitioners.

This department had 150-200 presentations daily and collectively we saw 45% of them. Between 4 people. There were roughly 30-35 other doctors in the department who saw the other 55%. Our job was obviously to cherry pick the less complicated GP type presentations and so it was a lot easier, but also tells you something like 45% of ED presentations don't actually need to be in the ED.

The government at some level recognises this and is trying to do things like set up 'urgent care clinics' which are exactly that model above. However they've got no idea what they're doing, and basically just shovel large amounts of money at corporations who are the only ones who can afford to privately set up that sort of service. Their cost per patient seen (and they don't see many) is horrendous. They'd be far better off actually making the medicare rebate reflect the cost of providing the service and encouraging more people back into general practice.

The funny thing is they're not necessarily 'anti general practice'. They just have no control over the next year's budget for primary care. So if they fund it adequately and people decide to see their doctor more times than usual, the budget's shot. As a result they prefer to spend their money on specialists and hospitals, because at least that's fairly predictable.

Thanks for the insight.
We have a call taking and dispatch system that cannot effectively sort emergency from nonsense. Its' primary purpose is to protect the service from litigation so does not triage very well at all.
We now have a virtual ED staffed by oncall Drs who can redirect pts elsewhere and attempt to reduce ED load and ramping. Works to a degree but a bit clunky to use.
Unfortunately anyone with any sort of pension pays nothing for transport so they treat it as convenience. Utilisation rates are very high and sometimes there is nothing available to respond to real time ctritical emergencies.
Misuse and a triage system that is heavily risk averse = higher load.

[TrikeTragic]

Hi: Yes, I'm OK but...
I've just clicked over 70 years. I'm a day away from the third major procedure to deal with a skin cancer on my temple (an SCC if you want to be a bit clinical). This pesky little bugger appeared earlier in the year, actually in an area where I'd had a series of excisions and radiotherapy last year to remove two previous SCCs.
This one initially felt like a retained stitch from those treatments, and didn't cause concern at the 6 month review with the Alfred oncology team here in Melbourne. However, within weeks when he appeared on the surface as a lesion, he felt all wrong. A trip to my GP, who has the ticket for skin cancer, and a biopsy confirmed he was an SCC.
Referred to the Alfred who then arranged an MRI and whole body scan. No secondaries, and the MRI detected he was a 5 cent piece on the surface but a 50 cent piece size underneath, and deep enough to have attached himself to a small bone running from the top of my ear to above my jaw. The Alfred plastic surgery team assessed the cancer as "aggressive" based on his rate of growth from when the GP saw me in May, so had me scheduled for surgery within a fortnight.
Two operations so far: first to remove the bugger with a decent safety margin, plus slice the affected bone and remove a decent piece. Attempted to move some muscle from above my ear (my "frown and surprise" look muscle) into the void and take a graft from my thigh. A week's stay.
Then back two weeks later for the second: the graft didn't take, not enough blood supply into the wound area apparently, so it and the relocated muscle had to be removed. Three day stay, sent home while we waited for the bone biopsy result - couldn't schedule the final surgery until we had that (and it's clear). Look like a cyborg with a vacumn dressing that applies a constant low level vacumn to the wound, keeping the capillaries open, with a tube drain and a spiffy little battery powered unit on a sling.
So tomorrow, back in for the third (and hopefully final) procedure, a new graft to be taken from my left thigh, carefully bonded onto the wound area in a fairly long operation. Then a week's stay to fill me with IV antibiotics and make sure the graft is successful.
This for a bloke who's rarely crook, had only very occasional stints in hospital, even then never for more than a day here or there, and is otherwise fit and healthy.
I'm not about giving gratuitous advice - OK, this once. Get an annual skin health check if you haven't started the routine!
Cheers

[warthog1]

Get an annual skin health check if you haven't started the routine!
Cheers

Good advice, thanks.
Hope the graft is successful.

[foo on patrol]

I'd go as far as saying get skin checks done every 6mths because sometimes the spot can change and spread fast.

(AT) Trike Tragic, I hope you have better success with this graft because they are a pita when blood flow is not good and also elevated blood pressure doesn't help thing neither.

Foo

[blizzard]

The government at some level recognises this and is trying to do things like set up 'urgent care clinics' which are exactly that model above. However they've got no idea what they're doing, and basically just shovel large amounts of money at corporations who are the only ones who can afford to privately set up that sort of service. Their cost per patient seen (and they don't see many) is horrendous. They'd be far better off actually making the medicare rebate reflect the cost of providing the service and encouraging more people back into general practice.

I used the urgent care clinic at Dutton Park when I came off the mountain bike early in the year. I had a fair bit of skin off and was sore, swollen hand, but no broken bones. No option of seeing my regular GP on a Saturday and I didn't think it warranted a ED visit.

There was only 2 other patients, the doctors were good, cleaned out the wounds further and decided I didn't need stitches just steri-strips and gave me a tetanus shot. It didn't cost me anything out of pocket, and they even paid for the parking. All in all, it was a good experience, but it was not long after the clinic had been setup, I'm not sure how busy it would be now.

[fat and old]

I'd go as far as saying get skin checks done every 6mths because sometimes the spot can change and spread fast.

(AT) Trike Tragic, I hope you have better success with this graft because they are a pita when blood flow is not good and also elevated blood pressure doesn't help thing neither.

Foo

My Mum had a big one removed from her lower cheek that left a big hole. She was to get a graft 7 days later, on a Monday. On Saturday the wound was stable, on Sunday a growth had appeared that was almost 15mm out from her wound. Mondays graft turned into admission and cut out the new growth. Then radiation. Then regrowth in her lung. Then radiation. Then growth to app. 50mm tumour before she died of unrelated things. It was the same initial site she'd had one removed from 10 years earlier. Whole process spanned about 18 months.

[foo on patrol]

I'd go as far as saying get skin checks done every 6mths because sometimes the spot can change and spread fast.

(AT) Trike Tragic, I hope you have better success with this graft because they are a pita when blood flow is not good and also elevated blood pressure doesn't help thing neither.

Foo

My Mum had a big one removed from her lower cheek that left a big hole. She was to get a graft 7 days later, on a Monday. On Saturday the wound was stable, on Sunday a growth had appeared that was almost 15mm out from her wound. Mondays graft turned into admission and cut out the new growth. Then radiation. Then regrowth in her lung. Then radiation. Then growth to app. 50mm tumour before she died of unrelated things. It was the same initial site she'd had one removed from 10 years earlier. Whole process spanned about 18 months.

You just don't know what this mongrel disease will do and why I said get rid of it because I'm not interested in waiting and watching for what it will do in the future.

Foo

[Mr Purple]

I've caught myself occasionally wondering why my shoulder/chest is slightly sore on occasion so I reckon it's almost fully healed! Even the 60 second to 3 minute power is coming back, back up to 430W odd for a minute now.

Still have a follow-up appointment with a private orthopaedic surgeon next week because my wife is making me, but I think even if he offers surgery I'll say 'no'.

If there's any positive out of the whole thing it's that the broken left scapula caused a right sided jaw spasm (now fixed) that revealed decay in a tooth that was fortunately saved with a crown rather than a root canal. Get those teeth checked, particularly anyone racing. The combination of dehydration and sugar is a bad one - I hate to think how bad the pros teeth are.

[TrikeTragic]

I'd go as far as saying get skin checks done every 6mths because sometimes the spot can change and spread fast.

(AT) Trike Tragic, I hope you have better success with this graft because they are a pita when blood flow is not good and also elevated blood pressure doesn't help thing neither.

Foo

Hi:
Released home early "on good behaviour" after an apparently successful procedure on Wednesday. Can't say enough about the professionalism and care I've been given at the Alfred Hospital. Pedro, "my surgeon" (Mack the Knife) and others from the Plastic Surgery team. Nurses on the Short Stay and 6 West wards who were, without exception, professional, warm and considerate, and more than occasionally funny. If there's a crisis in the Victorian Health system, I didn't see signs of it in my three trips and 16 days in care. Just bloody grateful!

[foo on patrol]

Good news.

Foo

[fat and old]

G’day F and O, have you tried a hydrocortisone injection into the worst affected ankle area ?
They can be done with precision guidance at a medical imaging place - if your Orthopaedic Specialist advises.
Not a long term solution but does tend to work quite well for a period of time, up to a few months

More severe forms of Ankle Arthritis usually need surgery in the long term.

Here is a neat and logical website that gives a bit more details :

https://www.sportsmed.com.au/ankle-arthritis/

It’s a Sportsmed focused website but gives a fairly diverse and comprehensive overview.

Almost a month later and saw the Ortho last Monday. On the Fiday before I considered going to emergency, the foot had blown up to where it wouldn't go into a 4E wide runner and was looking angry. I spent the w/e with it up, immobile and lots of RICE and waited it out while the swelling went down (I'd spent 25 minutes on my feet on Friday morning.). The ortho had me put into a roboboot on the Tuesday, on the Friday I had that injection. The local gave me 4 hrs of blissful sleep . Since then the meds are down to a panadol per day, but sleep is an issue. I'm on a total no walk or drive, leg up in boot/compression stocking until I see him next week. So bored xxxxless. And I have no doubt he'll say Good, swellings down, go get these tests and come back in two weeks.

[MichaelB]

Bugger !

[warthog1]

Hope you get some improvement soon F&O

[foo on patrol]

Jebus, I'd be close to loosing my cool and having a major eruption with frustration.

Foo

[foo on patrol]

I go back in for the next op on my ear tomorrow morning. Hopefully they get everything this time and the skin graft heals as quick as the last one did. Then I'm praying that another lot doesn't turn up in the future because I'm almost guaranteed that I will lose a large part of my ear.

Foo

[warthog1]

Hope they get the pharquar out Foo.

[foo on patrol]

Hope they get the pharquar out Foo.

So do I.

Foo

[MichaelB]

I go back in for the next op on my ear tomorrow morning. Hopefully they get everything this time and the skin graft heals as quick as the last one did. Then I'm praying that another lot doesn't turn up in the future because I'm almost guaranteed that I will lose a large part of my ear.

Foo

Good luck and keep thinking positive !

[TrikeTragic]

I go back in for the next op on my ear tomorrow morning. Hopefully they get everything this time and the skin graft heals as quick as the last one did. Then I'm praying that another lot doesn't turn up in the future because I'm almost guaranteed that I will lose a large part of my ear.

Foo

Best wishes for a successful procedure, Foo (and a clear biopsy of course), then the graft does you the right thing!

Cheers

[foo on patrol]

Thanks blokes. No graft this time but have lost the top part and some.



Foo

[warthog1]

My ears are mangled from getting 'em pinned back as a kid. Tony Abbott ears I had. Dropped my 100m sprint time by a second. Less wind resistance on my racing tadpole shaped head.
Main thing is the cancer is gone Foo.
Ears are stupid looking things anyway.

[Retrobyte]

Thanks blokes. No graft this time but have lost the top part and some.



Foo

Chopper!

But seriously, glad they got it all