Lots of different things

For no particular reason, I’ve been very busy in the past few days, commenting on this and that.

There’s this piece on the recently announced (but still secret) Trans-Pacific Partnership Agreement.

Also, this SMH article by Clancy Yeates, citing my criticisms of the Productivity Commission case against penalty rates.

And, Campus Morning Mail links to my criticism of the bodies representing and regulating post-school education.

61 thoughts on “Lots of different things

  1. My son went to emergency on a recent long weekend because of appendicitis. The appendix was duly removed, and all is well. I noted a couple of things.

    Firstly, there were lots of nurses on duty. And that would be because Sunday and public holiday rates make it attractive for them to work. Good – that part of the system works.

    Secondly, there were not so many doctors. We had to wait quite a long time for a doctor to make some fairly trivial decisions about pain relief after the operation. I’m guessing that doctors don’t have penalty rates. And even if they did, their rate of pay is such that, unlike the nurses, they don’t *need* the money – at least not enough to forgo a weekend in the Margaret River holiday house.

    Thirdly, the medical system is unnecessarily rigid, seemingly modelled on the army. I knew what post operative treatment should have been given. I’m fairly sure the nurses knew, but they didn’t say. The junior doctor seemed to know but left one decision to the more senior doctor – I’ve no idea why. In the end, it all happened as I expected it to, just with hours of unnecessary waiting.

    This happened again when it was time for discharge. Much waiting until a senior doctor said we could go – which is what the nurses told us would happen when the senior doctor got around to it.

    Don’t get me wrong, I’ve got enormous respect for doctors and nurses – I could not handle the stress of being a doctor (or a nurse, probably). But the system is so archaic and dodgy, that I can’t help but feel there are a lot of vested interests being protected.

  2. @John Brookes

    An interesting point to note is that quite a bit of waiting in hospitals, after being admitted via Emergency/Casualty, and being initially seen to, is related to observation requirements. The staff often don’t make this clear but you are often waiting because they want an observation period to elapse to see how you progess / relapse etc. So they will come back from time to time and observe and take readings. When they are satisfied you are properly treated and safely stabilised they will let you go.

    Procedures and protocols are in place to reduce mistakes and to cover off liability. There is nothing wrong with protecting patient safety and vested interests at the same time. I’d rather my taxes (to use that worn out old phrase) are used for procedures and protocols to make hospitals safer places and not to fund the legal department to fight more malpractice cases because the place is trying fast-track people out the door with undue haste. Having said the above I have seen them take a long time and still miss important things with family members I have taken to hospital.

    I always believe that “Realistic Expectations”, “Patience” and “Politeness” are your friends in places that. Of course, if things go horribly wrong through incompetence or malpractice then of course it’s “no more Mr. Nice Guy.”

  3. @Ikonoclast
    I agree with your last paragraph’s first sentence. I had to wait for several hours at the ED on a week day, in pain and discomfort, before being treated. The reason was simple: people with chest pain were taking priority when they were first admitted, and so they should. Sometimes you just gotta take the rough with the smooth. Being intemperate and surly helps no-one, and just makes the staff’s working conditions worse for no good reason.

  4. I went in to emergency with a broken thumb once. I fell of my bicycle and knew the thumb was broken. But I still went to the the coffee shop for breakfast before heading off to emergency. I got the feeling they liked me because my complaint was bleeding obvious and required no judgement on their part.

  5. This is me getting off-topic but why isn’t knocking someone unconscious considered grievous bodily harm? People who follow Brisbane media will know which case I am referring to and that this case only made it to the Magistrate’s Court, which seems odd to me. I believe the case should have been in the District Criminal Court. A while back I was on a jury for a trial which involved a compound fracture to the appellant’s ankle from a drunken fight with a mate. (They were clearly no longer mates.) The appellant with the help of the police was making an attempt in a criminal case to establish GBH.

    In the Queensland Criminal Code we can note that;

    “(1) Any person who unlawfully does grievous bodily harm to another is guilty of a crime, and is liable to imprisonment for 14 years.”

    We can further note in definitions;

    “grievous bodily harm means—

    (a) the loss of a distinct part or an organ of the body; or
    (b) serious disfigurement; or
    (c) any bodily injury of such a nature that, if left untreated, would endanger or be likely to endanger life, or cause or be likely to cause permanent injury to health;

    whether or not treatment is or could have been available. ”

    Given all that we now know about the dangers of concussions, (including king hit punches and especially those which result in a “dead-fall” to the pavement), it would seem eminently supportable to me that a knock-out punch leading to a “dead-fall” to the pavement (as this case did) that this would be;

    (c) … bodily injury of such a nature that, if left untreated, would endanger or be likely to endanger life, or cause or be likely to cause permanent injury to health;

    Health professionals would want to ambulance to hospital and then treat and observe such a person precisely because they apprehended a real concern that such a double-concussive injury would be “likely to cause permanent injury to health” if left untreated.

    These king-hit cases should be going straight to the Criminal Court IMO. As a side note, the Magistrate apparently made statements which clearly showed he(?) does not know how to admit and balance all relevant evidence (again IMO). The Magistrate’s Court is not competent IMO opinion to hear such cases. As for the Magistrate, I had better say no more.

  6. @John Brookes
    “I am guessing that doctors don’t have penalty rates…..”

    It depends on the hospital and the state. ED doctors in a fully funded base hospital will probably be on salary and will be paid penalty or shift rates. They are most often junior doctors (interns and first or second year registrars and many would be overseas trained.

    A small rural hospital may be staffed by GPs on a roster. These GPs will be working on a fee for service basis from the hospital or will be charging the patient who claims a Medicare rebate.

    In the first situation the junior doctors will not be highly remunerated. In the second situation that of the GP they would be earning more but are also likely to be on call after hours for a pittance. In the practice I manage, the doctors receive approximately $12/hr for being on call then fee for service when they actually treat someone. After hours this could mean no one to treat – there is no consistency on how busy after hours can be. The doctor has to be available, some of our doctors are on call for 200+ hours a month in addition to normal clinic hours.

    As far as waiting is concerned,Ikonoclast comments are correct. Patients will be triaged into one of five categories this in the higher categories -1 being the highest will be treated first, admission if required may not be immediate bu observation preferred. There are many unnecessary attendances at ED – toothache or earache for example that could just as easily be treated by a GP or home medicated if a GP was not immediately available.

  7. @John Turner

    “In the second situation that of the GP they would be earning more but are also likely to be on call after hours for a pittance. In the practice I manage, the doctors receive approximately $12/hr for being on call then fee for service when they actually treat someone.”

    “The doctor has to be available, some of our doctors are on call for 200+ hours a month in addition to normal clinic hours.”

    An extra $2400+ month for doing nothing except being available/on call isn’t a pittance. It’s pretty much the minimum wage in this country. ie. not much less than what 1.8 million Australians earn for working 40hrs a week.

  8. @Nick

    Perhaps you can point me to professional or a tradesman who is prepared to be on call after hours for 200 hrs in a month, meaning they have to be within 15mins of the hospital. It completely disrupts their family and social life.

    Also during that time taking phone calls at any time of the day or night from hospital nurses and providing advice in relation to patients for which they are not paid. Frankly I would not do it even for twice the amount.

  9. Apropos of nothing in particular, the only person I have ever met who owned a Ferrari (it was his second) was a GP in rural practice.

  10. Hi John.

    I didn’t say that amount of money is unreasonable. I said that amount of money is not a “pittance”. Anyone who considers that amount of money (~$30k a year) a “pittance” is clearly not hard done by in life.

    To answer your question, a good friend of mine is an engineer at Boeing. He is on call 24/7 and has exactly the same kind of restrictions on his movements as a result. He gets zero base rate for being on call, and no overtime on the many occasions a month he is called in.

    The team of engineers he supervises are a bit different. They have the choice of accepting a flat rate (~$5-6/hr) for every hour they’re on call (which is not 24/7), and no overtime when they’re called in. Or, no flat rate, and double time when they’re called in.

  11. Perhaps you can point me to professional or a tradesman who is prepared to be on call after hours for 200 hrs in a month, meaning they have to be within 15mins of the hospital. It completely disrupts their family and social life.

    Sez the bloke what reckons that penalty rates are evil.

    It’s almost as if

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