|
I don't usually set my friends homework before I agree to catch up with them, but I had questions — many, detailed questions, and only someone who worked in the emergency room of a public hospital was going to be able to answer them.
And to do that, my highly skilled, incredibly busy friend Nadine was going to have to sit down and watch all 15 episodes of The Pitt.
The series depicts 15 hours of one shift in an under-funded, overcrowded emergency department of a Pittsburgh hospital, and it's the co-creation of the star, writer and co-producer of ER, the most famous TV emergency room of all: the actor Noah Wyle, R. Scott Gemmill and John Wells.
The Pitt is riveting, real and unsentimental television, set in a time of fentanyl abuse, a national bed crisis and assaults against health workers. It's been lauded by many US emergency doctors as the most realistic medical drama ever.
Watching it you ask yourself one question over and over — is this how it really is? Is this happening here in Australia? I needed my friend to answer this for me.
Nadine is a specialist in one of the best-known emergency departments in the country. She has had the almost unbearable task of dealing with the aftermath of some of our most significant public tragedies. The day we made our plan to meet she had just finished a "rotten day: six trauma cases in the space of two-and-a-half hours."
By the time we sat together for dinner, almost everyone she knew in her field had told Nadine she had to watch the show, and finally she did. In one go.
Her verdict? "It's everything you ever see in emergency medicine all crammed into one day. And it's absolutely true."
Nobody in Australia who enjoys this incredibly well-written and brilliantly acted show will want to recognise any elements in our publicly funded system, of which we enjoy being proud. The US hospital comparison is one we only ever make to land the point about the importance of our universal, public coverage.
But increasingly, our intensivists, doctors and nurses will tell you that the experience is becoming the same. My friend talks of families of six children arriving early to her emergency room, clearly unable to afford or secure the multiple GP visits they need. The room is crowded by 11am and stays that way, with many cases better suited to the primary care that families can't afford.
Noah Wyle, who played young doctor John Carter on ER, has said that one of the key differences between his time on ER and now, and one of the reasons he decided to revisit the subject, is that in 1994 around 40 million Americans were without health insurance and relied on emergency departments for primary health care; that figure, he says, has now doubled.
This week both the ABC and the Nine newspapers have highlighted emergency department waiting times and bed shortages in NSW and Victorian public hospitals: wait times of up to 88 hours, no beds for admissions and deaths in EDs of untreated patients. Workforce shortages have forced mental health services to close and left staff struggling to keep the system functioning.
All the while, primary care in this country has taken a beating. The Royal Australasian College of GPs has argued over the years that governments have tended to direct more funding to hospitals and emergency services rather than investing in primary care, despite strong evidence that primary care reduces hospital demand.
According to the Productivity Commission, the average cost to the government when a patient visits an emergency department is $692 compared to $82.90 for 20 to 40 minutes with their GP for early diagnosis and preventative care. But you need enough GPs in clinics to make that a reality, and you need to fund Medicare well enough to make it worth the while of being a GP, which is one of the most important, complex and unsung roles in the medical system. Anyone who is lucky enough to have a good GP, and have them over the decades of their life, will attest.
During the election campaign, the Albanese government promised an injection of $8.5 billion into Medicare, but GPs argue that the focus, and money, needs to be on funding longer consults for patients who increasingly have co-morbidities and complex health conditions that a bulk-billed 15-minute consult can't solve. The government wants "nine out of 10 visits to the GP to be free" but with complex medical needs, this won't help cover costs for a doctor's visit that will keep you out of the emergency room.
If you have had the unfortunate need to turn up to an emergency department, I hope that like so many others you came away amazed and grateful for the generally excellent care that our public hospitals provide. If you get to see someone like my friend Nadine and her colleagues, you will be in exceptionally good hands. I just hope you don't find that you have to go see her because, in Australia in 2025, you can't afford to go anywhere else.
This weekend, if medical dramas are your thing, check out The Pitt or read about how to remove the burr under the saddle of so many relationships — dividing household chores. If you can't afford a doctor, you won't be able to afford a cleaner.
Have a safe and happy weekend and with the magical and otherworldly singer Marlon Williams in the country, have a listen to his latest album, Te Whare Tīwekaweka, performed in Maori. Here, he is collaborating with the singer Lorde. It's simply beautiful. Go well. |
