The Dim-Post

November 25, 2008

Hello Nurse

Filed under: general idiocy — danylmc @ 11:01 pm

‘So I woke up and there was the nurse taking care of me’

‘Couldn’t she take care of herself?’

‘You bet she could, but I didn’t find that out ’til later.’

- The Marx Brothers, Cocoanuts

Idiot/Savant takes a sceptical look at the new National government’s policy to address A & E overcrowding:

The policy is based on UK Labour’s attempts to improve quality in the NHS by introducing these sorts of absurd targets, and Ryall claims that policy was a success, having led to a reduction in the number of patients waiting for than four hours from 23% to 3%. But that success was an illusion. As noted in Adam Curtis’ documentary, The Trap, faced with pressure to improve their statistics, NHS managers created a new and unofficial post, the “Hello Nurse”, whose sole purpose was to greet new arrivals to A&E so they could claim for statistical purposes that the patient had been “seen”.

It’s worth pointing out that having a nurse that says ‘Hello’ to you would actually be a huge improvement to the Wellington Hospital A & E service where they have an unheated, unstaffed brightly lit reception area in which a member of the hospital administration makes an occasional appearance to admit new patients. If they had someone there who was a nurse they could do also some preliminary triage while they said ‘Hello’.

For reasons I’ve never understood, Wellington has the worst hospital in the country by a fairly staggering margin, so patients in other districts might not be so thrilled by the prospect of someone saying ‘Hello’ to you when you stagger into the emergency ward but it would be a massive improvement for us in the capital. Bring it on!

MacDoctor has additional comments on the policy. My only response is that Capital Cost Health doesn’t appear to have a shortage of beds, it just has a shortage of doctors and nurses to look after the people in those beds.

Because most wards have to maintain a set patient to caregiver ratio the hospital dumps almost all new patients in the A & E ward because there’s no limits on the number of patients in an emergency ward.

When I went to hospital earlier this year (just back from India, 41 degree fever) I was seen after about twelve hours and told that I needed to be quarantined in the infectious diseases ward, but that there wasn’t any room there so I’d have to lie on a gurney in the hall of A & E for a few days before they could free a spot up. I decided that instead of being a vector for a pandemic I’d rather die in the comfort of my home so I discharged myself against the doctors advice and sat in my lounge watching Lost, swallowing fistfuls of codeine tablets and dripping with sweat for a week or so, before I recovered.

I’m not sure I got very good value on my tax dollar there.

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44 Comments »

  1. You are supposed to see a triage nurse within five minutes of arrival. The fact that you didn’t is little more than criminal. The triage nurse is supposed to load you on to the computer system and let the doctors know how urgent you are. Until that happens, you are not in the ED system and may as well be in MacDonalds, where it is at least warm and you can get some food or whatever it is they put in those little boxes…

    Comment by macdoctor01 — November 25, 2008 @ 11:57 pm

  2. I gather the various wellington ED departments aren’t a terribly fun place to work compared with other hospitals in the country. My understanding is each ED department has some specialisations and so the work each ED registrar does is fairly one dimensional. Party pill ODs go to one hospital, car crashes go to another, etc…

    Comment by mjl — November 26, 2008 @ 6:33 am

  3. i believe the phrase you’re looking for is “completely useless”.

    after many trips there with heart trouble, by far my favourite character is the nose-picking doctor.

    he really gets his index finger up there. i think his nostrils have expanded on account of it.

    and he does this right in front of you, and doesn’t wash his hands.

    Comment by Che Tibby — November 26, 2008 @ 6:49 am

  4. Sometimes you’re a raving lunatic left, and sometimes there are some sane observations. On the worst hospital, that’s probably Middlemore in South Auckland. But what’s actual problem and solution Danyl?

    Does socialist health care work? So it is just doing the right thing and suddenly everything comes together?

    Comment by Berend de Boer — November 26, 2008 @ 7:20 am

  5. yeah, you can try and make this a partisan issue berend, or you can think.

    the delivery model is independent of the funding model. while they inter-relate, simply making funding private won’t improve services in and of itself.

    you still need to be able to hire staff who know how to:
    1. establish a working set of systems or procedures – wellington? fail.
    2. keep their fingers out of their noses. wellington? epic fail.

    Comment by Che Tibby — November 26, 2008 @ 7:48 am

  6. Wellington hospital DOES have a triage system: if you arrive in an ambulance your case is urgent, if you don’t it isn’t.

    To be fair, if your emergency occurs between the hours of 8-4 on a weekday the A & E is reasonably well staffed and well run. You REALLY don’t want to get sick on a Friday night.

    Comment by danylmc — November 26, 2008 @ 7:56 am

  7. “Wellington hospital DOES have a triage system: if you arrive in an ambulance your case is urgent, if you don’t it isn’t. ”

    That depends too – Mrs Llew tripped down some stairs & dislocated her shoulder in a major way – ambulance was quick to get there & to the A & E…

    Then it was a 6 hour wait to get the shoulder put back & another visit the next day & another 6 hour wait for followup treatment. ZDidn’t seem very urgent to me.

    Comment by llew — November 26, 2008 @ 8:02 am

  8. I don’t think its just an ambulance thing.

    Go in with chest pains they treat you pretty quickly, even if you drove yourself there.

    Shit, you get a big telling off for driving there though.

    (Something I discovered a few years ago)

    Comment by Rob Hosking — November 26, 2008 @ 8:06 am

  9. yup, been in with chest trouble a number of times. they get you into the A&E pretty quickly, but the longest wait in there (for me at least) was 10 hours.

    the shortest was 3, maybe 4.

    i’ve learned to take a book, my mp3 player, and my mobile phone charger.

    Comment by Che Tibby — November 26, 2008 @ 8:16 am

  10. There seems to be a pattern of reading Dimpost and developing chest pains…?

    Comment by Sam — November 26, 2008 @ 8:34 am

  11. …my mp3 player, and my mobile phone charger

    you should get one of the new iphones, Apple have combined it with a defibrillator – the iLive.

    Comment by Neil — November 26, 2008 @ 8:48 am

  12. to be fair to Wellington hospital, every time I’ve gone in there (which is a lot as my girlfriend likes to hurt herself playing indoor netball), they always load up the solitaire on the computer for me.

    Also Che…seeing as you have left your previous employer I don’t know how to find out if you won your little battle with the alarm?

    Comment by David C — November 26, 2008 @ 9:08 am

  13. danyl: the delivery model is independent of the funding model.

    OK, no hope then. Still a partisan. It’s the system that doesn’t work Danyl.

    Comment by Berend de Boer — November 26, 2008 @ 10:11 am

  14. I can add to the stories, but not for recent years. I’ve finally given up and go to the After Hours Clinic just down the road. It costs $70 to see a doc, but they’re there all the time, the wait is usually less than half an hour, and if you complain of agonising pain or can show off some blood a nurse gets involved straight away.

    Otherwise, there was the day I had a Gall-stone lodged and was in agony. A&E took three hours to see me, despite my doctor advising the appropriate resident I was on my way. After three hours I was put on a gurney and given two panadol. After sixteen hours I was transferred to a ward. After a night I was seen by a specialist. After another day I was scheduled for an x-ray. After two days I got a CT scan instead of the x-ray as I was screaming about the pain. After ten minutes I was whisked into surgery as the Gall Bladder had ruptured and parts of me were looking a bit gangrenous. After three hours I was back on the ward with a nice bag of drugs. After 12 hours I was in the Southern Cross hospital – still with the morphine drip. After another week I was discharged. What I found out was the After Hours would have referred me to a specialist at Southern Cross who would probably have removed the Gall stone the next morning.

    One happy note about all this? The pain and drugs made me forget about cigarettes, so after 40 years of smoking I gave up and have never smokes since!

    Comment by shocked and stunned — November 26, 2008 @ 10:19 am

  15. Wowsers all of you. As real men you should have tha ability to bleed in stoic silence allowing nature and clotting to sort everything out. Dislocated joints should be popped back in with no more than 2 shots of decent single malt scotch (not that heathen irish stuff). If your sufferuing heart pains whats wrong with either sticking your fingers into the electrical socket or using the jumper leads atached to your car battery.

    Bah – commentators these days have gotten soft and forgetten what it meant to not bleed on the carpet and sit quietly outside with a bowl of dettol and clean up your wounds.

    Comment by What would Hayek say — November 26, 2008 @ 10:31 am

  16. I managed to get injured on a Saturday night. It wasn’t particularly bad – possibly a fracture I thought, but I’ve had enough experience with broken bones to know they can wait.

    I went in at 9.30 on a Sunday morning, was seen within a minute, taken down to be examined a few minutes later, and was out within 45 minutes. I was very happy.

    danyl[sic]the delivery model is independent of the funding model.

    OK, no hope then. Still a partisan. It’s the system that doesn’t work Danyl. [sic]

    Nope. You’re wrong. There are good public hospitals and bad private ones. How well they do has everything to do with the resources they have, and the practices they run.

    Introducing more private competition will divert resources away from the general public and towards those who can afford to pay – which might be good for you, but is unlikely to benefit John from Porirua. Private institutions can afford to give better service because they’re better resourced.

    Of course, private hospitals have to give good service because otherwise they’ll go out of business. But public hospitals serve those who can’t afford to pay, and simply can’t go out of business – there is nothing to replace them with.

    They can’t be privatised and run a profit because their patients can’t pay enough, unless services are squeezed further to cut costs and turn a profit. This is the well documented experience of the United States, and health outcomes there for all but the rich are an absolute disaster.

    Che’s point is about improving triaging and other practices – and giving them the resources to deal with those triaged patients.

    Comment by George Darroch — November 26, 2008 @ 12:30 pm

  17. George: Of course, private hospitals have to give good service because otherwise they’ll go out of business. But public hospitals serve those who can’t afford to pay, and simply can’t go out of business – there is nothing to replace them with.

    Good for seeing one side of the coin George. That’s better than most. But the issue is a bit more complex. With free hospitals people are also behaving differently because they don’t have no incentive to behave otherwise. I.e. eat too much, no exercise etc.

    Markets are the most efficient mechanism known where demand can meet supply. You advocate unlimited supply, i.e. all the healthcare you want for free. But no system can cope with the demand that follows, so how does such a system operate? They use queues and rationing.

    If you believe that you only need to tweak the system to make it work, you’re deluding yourselves. Yes, it’s sad that you can’t get the health care you would like to have. But that’s true under every system. If someone in my family got cancer, I was on the first plane out of here. The survival rates for cancer in NZ are horrendous. Barbaric actually.

    Would health become inaccessible to the poor? What is poor? You think NZers wouldn’t give generously to help like they do in many other situations? Why not take a loan in case you have an health issue? You can get loans for anything so why not for health care.

    On the US: please give statistics, instead of pompous quotes: do people live longer or not? Do they enjoy better health? What’s the average survival rate for various cancers? What’s the average time before you can get treatment? On all these issues the US scores far better than NZ. And you might not know it, but emergency care in the US is free, so everyone turning up at the hospital gets treated, including aliens. They have medicare, so elderly don’t pay either for practical purposes.

    Maybe your claim is: no one should have access to better health care than I get?

    Comment by Berend de Boer — November 26, 2008 @ 12:44 pm

  18. Berend, you seem to imply that demand for hospitals corresponds to supply? Your points on chronic diseases are certainly valid, but ‘personal responsibilty’ is only a small part of the overall picture that is being discussed here – accidents, hip replacements, cancer etc…

    Comment by StephenR — November 26, 2008 @ 1:14 pm

  19. You think NZers wouldn’t give generously to help like they do in many other situations?

    They might, or they might save the whales…

    I was hoping that National will outsource to the private sector a bit more, but this particular policy seems a bit odd.

    Comment by StephenR — November 26, 2008 @ 1:16 pm

  20. @david c. nope… the fkcers.

    @george. even worse, there is heavy suspicion that privatisation *raises* costs. the ACC is actively resisting having it’s contracting processes to private providers evaluated, because the small evidence available suggests they’re inflating the market for services.

    Comment by Che Tibby — November 26, 2008 @ 1:41 pm

  21. @berend “But the issue is a bit more complex. With free hospitals people are also behaving differently because they don’t have no incentive to behave otherwise. I.e. eat too much, no exercise etc.”

    so… that would suggest that in a country like the US, where hospitals are private, obesity should be low?

    like stephenr says, you can only argue for responsibility on the individual to a certain degree before it distorts reality.

    further “And you might not know it, but emergency care in the US is free, so everyone turning up at the hospital gets treated, including aliens”

    untrue.

    Comment by Che Tibby — November 26, 2008 @ 2:00 pm

  22. Che: untrue.

    No true. You really think they check your passport if you turn up?

    Che, tell me, what country has the most obese persons? Come on, Google the statistics.

    Comment by Berend de Boer — November 26, 2008 @ 2:40 pm

  23. “You really think they check your passport if you turn up”

    no, but they do ask people to show their health insurance. which i why you’re always recommended to purchase it before travelling to the US. anything minor enough will result in your being forced to pay.

    my cousin, a new zealand national, encountered this in NYC. serious heat exhaustion was not considered serious enough. mind you, had she had a car crash this wouldn’t have been the case, but…

    and the answer to your second question appears to be… the USA!

    but let’s not let facts get in the way of a liberal “argument”

    Comment by Che Tibby — November 26, 2008 @ 3:30 pm

  24. I thought a couple of the island nations (Samoa and the Cooks) had the highest obesity rate.

    Comment by danylmc — November 26, 2008 @ 3:43 pm

  25. Che: no, but they do ask people to show their health insurance.

    Nope. Emergency healthcare is free. Sorry che.

    Danymc, you’re right.

    But that was only a minor point. So the US is the most obese. A big indicator for health risks. Take that into account if you want to compare health statistics and mortality rates. Now compare us on the WHO health care list with the US.

    Comment by Berend de Boer — November 26, 2008 @ 4:58 pm


  26. Why not take a loan in case you have an health issue? You can get loans for anything so why not for health care.

    In most of the world, this is the case. If you have a medical issue, you have to pay. And being that most procedures are not things people can budget ahead for, you either have ‘socialised medicine’ where risk is pooled and treatment is automatic (like that of NZ and the countries with the best health outcomes), a for-profit insurance based system (that encourages providers to shirk and exclude anyone considered a threat to their profits), or post-facto payments like you suggest.

    As for what you suggest, there are three possible outcomes for someone without the means to pay for medical treatment: being in debt for a very long time, being bankrupted, or equally likely simply not being able to secure a loan to pay for the treatment and suffering the effects, is abhorrent to me, and not something endorsed by most New Zealanders.

    The alternative isn’t perfect, but it’s better than what you’re suggesting.

    @danyl – that’s my understanding too: that 6 of the top 10 most obese nations are Pacific islands. It irks me to see the OECD referred to as ‘the world’.

    Comment by George Darroch — November 26, 2008 @ 5:07 pm

  27. Private hospitals are not the answer to problems in A&E. They do not run emergency services because they are not profitable; it is not possible to manage patient flow. Almost by definition, emergency departments have to have over-capacity to manage unpredictable peak times. Just as private hospitals are not interested in providing cancer, intensive care and some other specialist services because they are very expensive. They are also not really interested in treating poor people because their health problems tend to complex and intractable, therefore not possible to treat eeficiently. Private healthcare can provide some simple and predictable surgical or diagnostic procedures to those who are likely to recover easily, and really not much else. True this can free up some elective surgery beds in public hospitals (beds, in hospital jargon, does not just refer to physical beds, but all the resources, particularly nursing, that go into caring for the patient) but public hospitals will always be left with the complex and resource-intensive cases. Comparing the efficiency of public and private hospitals is not valid, they have different purposes.

    On the other hand, my recent experiences in Wellington A&E (once for myself, and twice for family members in the last couple of years) have been variable. It is easy to see that most of the staff are jaded and dehumanised. I used to work for capital and coast, (not in the emergency department) and I think that this attitude comes from an entrenched culture of defensiveness resulting from appalling treatment by a manangment that doesn’t value them, and the sheer emotional hard work of dealing with a difficult and demanding job and knowing that you are not able to provide the level of care that you know you should. It is not only a matter of resources, there also needs to be a culture change, so staff feel that they are being supported to do the best job they can.

    The constant negative scrutiny from the media doesn’t help. I have had some inside knowledge of some of the scare stories the the Dom is fond of running, and the situation is never as simple as is made out, but the staff involved do not get a right of reply because of patient confidentially. I guess I am saying that while Wellington Hospital really does need to improve, there are no simple solutions, and the staff are just human beings, most of them doing the best they can with what they have, in a shitty job.

    Comment by Alice — November 26, 2008 @ 5:10 pm

  28. @berend. well, i’m assuming you’re basing your assertion of free ER treatment on something you read somewhere. that or from watching Greys Anatomy.

    here’s the first thing to pop up on google regarding “emergency health care + USA”.

    if you’d like to provide a definitive source to establish the validity of your assertion, it would be good. especially in light of you pulling a “talking-point” figure out of your wahoo regarding obesity.

    Comment by Che Tibby — November 26, 2008 @ 5:32 pm

  29. Since when was idiot/savant a talking point? the guy is a maladjusted upset lefty not worthy of discussion

    Comment by Buggerlugs — November 26, 2008 @ 10:13 pm

  30. George: where risk is pooled and treatment is automatic (like that of NZ and the countries with the best health outcomes)

    Are you crazy??? NZ’s outcomes are among the worst in the world. Just look at the WHO health care list. If you really think you have any chance of survival here if you have cancer, you’re greatly, very greatly deluded. Had a look at how many people die here while on the waiting list?

    Friday an elderly friend of mine, 92 years old, broke his hip. Only after getting experts in and putting enormouse pressure on the hospital he was treated on Tuesday morning. Four days he was in agony and being starved because he was prepped for an operation that didn’t happen day after day. I treat animals better than he was treated.

    Comment by Berend de Boer — November 26, 2008 @ 10:24 pm

  31. I actually had really bad experiences with the Wellington After Hours Medical Centre, and a better experience with A&E.

    My girlfriend took me in to the After Hours when I had a really painful kidney infection. The doctor prescribed me 3 days of Noroxin. I told him that I often get urinary infections, that they’re often not sensitive to Noroxin, and that even when they are it always takes more than 3 days. The doctor replied that he had never seen a urinary infection that couldn’t be cured by 3 days of Noroxin. I was way too out of it to argue forcefully, so my girlfriend agreed to the doctor’s instruction, paid the bill, and took me home.

    When I got home, my flatmate said ‘to be this out of it, she must have a really high fever’, and took me to A&E. There they quickly put me on morphine and strong IV antibiotics, which cured the problem, but I later learned that they hadn’t got to it quick enough to stop it damaging my kidneys and making me prone to dangerously high blood pressure for the rest of my life.

    It was a long time before I was ready to trust the after hours medical centre again.

    Comment by kahikatea — November 26, 2008 @ 11:00 pm

  32. remember that insurance companies are in the business of growing wealth on assests and invested capital, not providing health services. that costs money

    Comment by Chris — November 26, 2008 @ 11:03 pm

  33. Berend wrote:

    “With free hospitals people are also behaving differently because they don’t have no incentive to behave otherwise.”

    honestly, if someone isn’t going to do what they can to look after their health to avoid a long stay in hospital, do you think they’re going to do what they can to avoid a long and expensive stay in hospital? Surely the incentive to avoid getting sick is enough for anyone who is thinking that far ahead, and the cost isn’t going to influence anyone who isn’t thinking that far ahead.

    Comment by kahikatea — November 26, 2008 @ 11:05 pm

  34. Oh and Berend, for someone trying to make a reasoned point, can you please spare us the waffly, qualitative, anecdotal bollocks and work in hard, generalisable, quantitative facts? Please?

    Comment by Chris — November 26, 2008 @ 11:05 pm

  35. Are you crazy??? NZ’s outcomes are among the worst in the world.

    Bullshit.

    Notwithstanding the problems with the real problems with healthcare that we all acknowledge here, NZ comes only somewhat behind the countries with the highest life expectancies, which all have public healthcare systems (or are very rich).

    Health is a budgetary black hole – past a certain point medical treatments are particularly expensive. I pity your friend, and have seen (and received) a fair bit of that kind of incompetence myself. A large part of the problem is low expenditure on health – NZ spends much less than the OECD average, both as a percentage of GDP and in absolute terms. We manage to do quite well from that amount in terms of outcomes, but some things simply must be bought. We have much less expensive equipment than many other countries for example. That means scarce resources, and people get rationed in ED and for operations and treatments. Doctors aren’t sadists and give people treatment as soon as they can. With that wait however comes often terrible consequences as we know.

    The solution (as well as more preventative medicine and avoidance) is simply better resourcing for the public sector – to allow doctors and nurses to do what they do best.

    Comment by George Darroch — November 26, 2008 @ 11:10 pm

  36. George, you know that Labour pour 4 extra billions into health. There were no measurable outcomes from that amount of money. It’s not money. And comparing amounts of money isn’t fair, you need to compare percentage of GDP. Our wages are lower, so we spend less of course.

    And that’s another thing: with a government rationing system wages in health are as low as the government can get away with. Wages are not determined in a free market where everyone can earn as much as possible, but wages are as low as possible.

    Comment by Berend de Boer — November 27, 2008 @ 6:53 am

  37. “Wages are not determined in a free market where everyone can earn as much as possible, but wages are as low as possible.”

    so…. this is the “fantasy” free market where employers pay their employees as much as humanly possible, even to the detriment of their bottom line?

    it often amazes me how how right-lending people have no idea about things like “running a business”, or, god forbid, “economics”.

    Comment by Che Tibby — November 27, 2008 @ 7:46 am

  38. kahikatea: Surely the incentive to avoid getting sick is enough for anyone who is thinking that far ahead

    Hospitals do far more than emergency. I.e. elective surgery and the like. And why should I pay to help someone who has been smoking all his life? The moment you remove all the incentives from one group, the patients, and only have incentives on the other side (hospitals) to give treatment at a price as low as possible to the paying party (the government) you have a system that can’t possibly work.

    If hospitals make money by treating patients well and early, they will respond doing so. That’s a simple fact. Currently hospitals have no incentives other than avoiding bad headlines or a rap on the knuckles by the minister. That simply doesn’t work.

    Comment by Berend de Boer — November 27, 2008 @ 8:12 am

  39. And why should I pay to help someone who has been smoking all his life?

    I thought that’s why cigarettes were taxed so heavily?

    Comment by StephenR — November 27, 2008 @ 8:24 am

  40. “I thought that’s why cigarettes were taxed so heavily?”

    exactly. it’s a market-based disincentive.

    berend is also overlooking that many diseases are unpreventable.

    so for instance it’s difficult to get health insurance for a man of particular age, because the risk of heart disease is too high. you can exercise, eat well, take care of yourself all you like, but the statistics clearly say “middle-aged man” = “high risk”.

    consequently insurers will either avoid you, or charge you through the roof, even if you are working to prevent the disease. this problem is worsening because of advances in medical science that will allow insurers to pinpoint individuals with a high genetic risk of heart disease. it could get to the point where some men *will not be able to get medical insurance at all* because they might have a heart attack.

    but in a socialised system this same individual gets covered.

    Comment by Che Tibby — November 27, 2008 @ 8:38 am

  41. che: but in a socialised system this same individual gets covered.

    True, but won’t receive treatment, but die on the waiting list. You’re confusing cover with being able to receive adequate care.

    Comment by Berend de Boer — November 27, 2008 @ 10:55 am

  42. “True, but won’t receive treatment, but die on the waiting list. You’re confusing cover with being able to receive adequate care.”

    Oh, and of course the private hospitals will welcome him with open arms despite his lack of health insurance, right? Um… maybe not, unless he’s saved enough for the eventuality despite not being able to afford private cover.

    Otherwise, he’s dead in this scenario too. But that would simply be the market’s righteous judgment upon his failure to get a gym membership and earn >$100k per year, wouldn’t it? Have I got this down right?

    Comment by Sam Finnemore — November 27, 2008 @ 4:16 pm

  43. “but won’t receive treatment, but die on the waiting list. You’re confusing cover with being able to receive adequate care.”

    yeah… i think you’ll find that this doesn’t actually happen all that often, compared to the number of people who receive successful treatment.

    i should come clean and say that socialised treatment has been a fcking nightmare for me personally. but, it hasn’t cost me a cent other than medication and gp visits.

    i see that as my 39% tax rate in action.

    Comment by Che Tibby — November 27, 2008 @ 5:42 pm

  44. Che Tibby wrote: “i should come clean and say that socialised treatment has been a fcking nightmare for me personally.”

    It’s had its good points and its bad points for me … but I wouldn’t be alive without it, because the health insurance industry won’t touch anyone born with the range of medical problems I was born with.

    Comment by kahikatea — November 28, 2008 @ 10:10 pm


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