Public hospital chaos

A chief doctor at a major hospital reveals below how our frontline medical system is in chaos. But many don't care, he says, until they need emergency treatment

I work in a public hospital emergency department, so that means any time you are in my part of the world, you are potentially my patient - you, your family, your friends. Tomorrow could be the day that a bad thing happens to you and your life is changed forever. That heart attack you knew was coming sooner or later, the crash on the freeway, the toddler found face-down in the swimming pool. Tomorrow, you could be rushed to my hospital - and I'll be doing my best to help you. But, as your doctor, I have to warn you: things are not good.

I'm a Queenslander born and bred and have worked in public hospitals since 1982. I am a specialist in emergency medicine. My team and I save people's lives for a living. We are good at it, and enjoy it. We deliver first-class emergency care to Queenslanders and those visiting (yes, tourists, I'm your doctor, too). I've travelled enough to know our state has a fantastic emergency response service and I'm proud to be part of it. Queenslanders expect it and you deserve it. So what isn't good? Put simply, our emergency departments - the place every ambulance rushes to - are already clogged with people. You'll notice that from the time you arrive.

It may be some time before we can find a space for you. Only the sickest people get immediate attention: the ones who can't breathe, the ones who are unconscious. If that's you tomorrow, I'll see you as soon as you arrive and I'll use my skills and experience to stop you from dying, work out what's wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don't remember me, but I don't mind. If I smile when I see you in the hospital kiosk next week, it's because I like seeing a good result. For everyone else, I'm sorry about the wait.

We try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year-on-year more people are seen in emergency departments across the country, that's not the only reason we're clogged with patients. A bigger problem is that we can't get people out of the emergency department.

Hospitals (public and private) often have no available inpatient beds, no available intensive-care beds, or no available coronary-care beds. Often, very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don't have rubber walls. Somebody has to suffer. Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we're both stressed.

As your doctor, I warn you that when you come to my emergency department tomorrow your experience may not match All Saints with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That's all I can do. Since you are going to be my patient tomorrow, I have requests for some of you:

TO THE 28-year-old salesman whose car hits a tree after the party tonight: You can't drive better with a few drinks under your belt. And don't take your mate's girlfriend for a spin; after tomorrow, she'll never look the same again.

TO THE 78-year-old male retired railway worker with chest pain: I know your GP is very familiar with the medicines you take, but I will need to know in a hurry and sometimes it's hard to get through to the GP. Please make a list of your usual drugs and keep it up to date.

TO THE 42-year-old businessman: Don't tell people you're going to kill yourself if you don't mean it, especially if you're drunk. It will take hours before I can talk sensibly to you and, yes, you do have to stay in my department all that time. And you have to have a blood test. Really.

TO THE 19-year-old student, nine weeks pregnant and bleeding: We know how upset and worried you are. We'll get you into a bed soon. But mostly, what happens will happen, whether we get you into a bed or not. But we'll still try.

TO THE 85-year-old retired coalminer and respiratory cripple: We have the technology to pull you back from the brink over and over, but it's like skipping a stone - each skip is shorter and lower than the last and eventually there's not a lot to be gained from skipping again. When a few more days or weeks aren't worth the needles, the tubes, the masks and the whole carry-on, let me know. Say you don't want to do it any more. I will look after you. But don't wait until tomorrow, because by then you'll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones now. Then tomorrow, when you tell me you don't want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and I will do my best to follow that wish.

TO THE 35-year-old female shop manager with recurrent abdominal pain: Please see your GP again before coming to us. Yes, we deal with belly pain, but your GP is well on the way to discovering what is wrong with you. Please persist with him or her. If you come to see us we'll just have to start all over again.

TO THE 21-year-old male: Don't inject speed. If you act psychotic we will need to treat you, even if you don't want it. Please don't hit us, bite us or spit on us, we are only looking out for your best interests.

AND finally, to the 53-year-old Queensland Health senior manager: We are drowning down here in the emergency department. I am your doctor, too, and I am tired of waiting for the problem to be fixed. Quality emergency care is critical for all of us. It's in everyone's best interest to get my department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. The situation needs some action now. We are all at risk.

To other doctors: I am your doctor, too. Please help me when I ask you for help with a patient. I'm not doing it to spoil your day. I've got people building up behind them and there's nowhere else to go.

Politicians and powerbrokers: I am your doctor, too. I know you have private medical cover; I know you have a good GP and other specialists who look after you well. But tomorrow it may be you who collapses while walking the dog, it may be you collected by the BMW that lost it on the corner, it may be your child who is hurt on the school excursion. No one is going to check for a private health insurance card. They'll bring you to me and I'll be your doctor then. How prepared and capable do you want me be?

To all of you who are my patients: I am doing the best I can under the circumstances. I can't save everyone. I can't be right every time. I won't be able to get to you as quickly as I would like, and nowhere near as quickly as you would like. And please be understanding. It's hard enough keeping you alive without being abused while I'm doing it.

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The Left's grip on learning

Comment by Imre Salusinszky



When I abandoned university teaching at the beginning of 2003, after 20 years, I was careful not to construct a "God that failed" narrative around my reasons for going. You know what I mean: how the university system let me down, by its surrender to political correctness, or managerialism, or economic rationalism, or whatever.

In fact, while all those forces had some impact on the working lives of academics between 1983 and 2003, universities remained outstanding places to work. There are few jobs, possibly none, that allow their employees as much freedom to pursue their own interests. And within the constraints of increased demands for accountability -- demands that have affected every sector of the workforce, not just tertiary education -- universities in Australia continue to provide supportive environments for teaching and research.

I left for largely personal reasons and without a trace of bitterness or resentment. That said, there were irritating, almost daily incidents on campus that confirmed the takeover of universities by the world view of the green Left. For example, there was the exchange student from the US who, close to tears, told me of how, during a role-playing exercise in a drama class, his tutor had instructed him, in front of the other students: "You're an American, so you play thebully."

Then there was the honorary degree proffered to anti-nuclear messiah Helen Caldicott. Modern universities are creatures of the Enlightenment and should advance its aims. If there is a more potent counter-Enlightenment figure in Australia today than Caldicott, I can't think of him or her. At the time she was honoured, I mused on the confused response I would surely have elicited from the relevant committee if I had nominated a true Enlightenment figure and a genuine intellectual, such as Paddy McGuinness, for a doctorate.

And speaking of the counter-Enlightenment, every election would see the doors of some of my colleagues in the humanities faculty plastered with Greens propaganda, with several standing as candidates.

All of this was harmless, up to a point. One of the lessons life has taught me is that the inherent qualities of human beings -- their decency or mendacity, goodwill or nastiness -- cannot easily be read from their political opinions. I got on well with my colleagues and, even after I "came out" as a supporter of microeconomic reform and started moonlighting as a columnist who specialised in sending up the cultural Left, most of them seemed well disposed towards me.

Along with much else, the situation in universities, and my own situation, shifted ground after 9/11. Following the terror attacks, the cultural Left (as distinct from the mainstream political Left) made the classic misjudgment it has made whenever democracy and fascism have come into conflict in the past century: it refused to pick sides on the principle that anybody who attacks the US and its allies cannot be all bad.

My colleagues' expressions of horror at the loss of life on 9/11 were heartfelt, but were almost always followed by a subordinate clause beginning -- like this one -- with but. Exactly a week after the attacks, I received an email from the academics' union representative on campus inviting me to a candlelight "vigil for justice and peace" in support of the victims of 9/11: not the 3000 victims of the terror attacks, but the arbitrary and so far hypothetical victims the Great Satan was about to unleash his fury upon.

"We have all been saddened, horrified, at the events in the US last week," the email began. "Many of us are now extremely worried about the talk of war and vengeance on the yet unidentified enemy, and the escalation of violence that may occur if bombing of towns and cities in targeted countries occurs." The email went on to encourage union members to attend the vigil, "if you would like to stand up and be counted and send a message to our civic leaders and fellow Australians that indiscriminate violence against 'suspects' will not be OK, that the targeting of Muslims, Arabs, Afghanis or other people of a certain ethnicity, as undesirable, is not OK, or if you just want to be with others who are sad, worried and concerned about war and justice." I didn't. Events such as this, while they did not cause me to leave the university, certainly did not incline me to linger.

So what has prompted these autobiographical meanderings? It is that the Young Liberals have launched a campaign, under the banner Make Education Fair, in which they are asking university students to report examples of political bias by their lecturers, with a view to holding a Senate inquiry into the issue. The Young Libs have already been accused of a sinister exercise in McCarthyism, but that tends to be the response whenever the question of bias in public institutions -- schools, universities, public broadcasting, museums and galleries -- is raised. Those for whom diversity is a key buzzword appear to flee the concept when it is applied to them.

I don't think there is anything wrong with left-leaning academics or ABC broadcasters. I don't think they need to be disciplined, far less sacked. But the dangers of allowing the political spectrum in these institutions to begin at Bob Brown and veer left from there are manifold. It leads to a bifurcated culture in which intellectuals lose contact with the mainstream and frequently develop a sense of hostility and embattlement towards it. Second, it means students are not being introduced to some of the most exciting intellectual ideas of our time, those associated with free-market economics and contemporaryliberalism.

And in the longer term, the effect of an undiluted green gospel, presented as a curriculum in schools and universities, could be devastating. If the idea is allowed to take hold unchallenged that, rather than wealth creation, it is the effort to limit and regulate wealth creation that underwrites our wellbeing, future generations will have a much lower standard of living than we enjoy.

Rather than sinister, I regard the Young Libs' campaign as quixotic. You won't, and shouldn't, change the beliefs of people who work in universities or other public institutions; rather, you should try and make sure there are a range of beliefs represented. Diversity really is the point. But when it is those already in place who control recruitment, courtesy of staff capture, the possibilities of cultural change quickly recede.

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The rise and rise of the secretive state

Below is a Saturday editorial in "The Australian" which says that freedom of speech has become a critical issue in Australia

TODAY'S World Press Freedom Day is about much more than journalists being able to do their jobs unimpeded. It is about the public's right to know the truth about how the governments they elect and the services they pay for, such as police and hospitals, operate. This year, the day comes at the end of an appalling week for press freedom.

On Wednesday, armed police from the Major Fraud Squad raided the Perth office of The Sunday Times newspaper. They spent four hours trying to prise out the source of a story that had embarrassed the Government of Alan Carpenter, a former journalist. The story was in the public interest, relating to a request by Treasurer Eric Ripper for $16 million to pay for advertising for the Government's re-election campaign. It was the second time in a month that police, whose stretched resources would be better employed fighting crime, had entered the Sunday Times offices to uncover the sources of political stories.

Speaking on behalf of the media coalition, Australia's Right to Know, News Limited chairman and chief executive John Hartigan said: "This is a disturbing reminder that governments in Australia will resort to legal muscle to redress political embarrassment. Do we now live in a country where whistleblowers and journalists can expect to be hunted down and charged if they reveal government information that is a matter of legitimate public interest? The answer, regrettably, appears to be yes."

The armed raid, reminiscent of those in countries such as Malaysia, erodes Australia's credibility in speaking out against the intimidation again meted out to the media this week in Fiji. The Fijian Government, known for its brutality, corruption and totalitarian rule, arrested Evan Hannah, managing director of The Fiji Times on Thursday night, forcibly removing him from his home, pending deportation. The arrest came two months after another Australian, Russell Hunter, publisher of the rival Fiji Sun, was arrested in a night-time raid on his home and deported.

Amid such repression, it should be reassuring to know that federal Labor, in the run-up to the November election, promised a mature and open approach to freedom of information. A Rudd government, the ALP's policy document said, would "drive cultural change across the bureaucracy to promote a pro-disclosure attitude". Information would be withheld only "where this is in the public interest". The Australian community would be able to "properly access information in the possession of the commonwealth Government."

These fine commitments have already melted into hollow rhetoric with the federal Government using FOI laws to block the release of advice about the wage-push inflationary effects of its industrial relations changes. In response to an FOI request from the ABC, the bulk of the 38 pages produced this week were censored. A Treasury official's lily-livered excuse was that full disclosure would "be contrary to public interest as they are internal documents containing information which could raise unnecessary debate on matters considered by cabinet". This ridiculous mindset, reflective of Orwell's Big Brother, deems economic debate "unnecessary" and against the public interest.

In reality, Treasury concerns about Labor's abolition of the Howard government's IR reforms have been known for months. In August, Treasury secretary Ken Henry underlined the importance of flexible labour markets for sustaining full employment. Months after the triumphant abolition of Work Choices, full disclosure of the relevant Treasury advice would have been no more than mildly embarrassing for the Rudd Government. But a cynic might suggest it feared the advice could come back to haunt it in the event of an inflationary wages breakout. The public interest, however, demands openness rather than a cover-up and Mr Rudd's silence on the subject yesterday was deafening.

This penchant for secrecy pervades both sides of politics and much of the legal system, to the detriment of public life. This newspaper, for instance, spent much of the last parliament battling former treasurer Peter Costello's blocking the release of data about bracket creep and the use of the First Home Buyers Scheme. The Australian lost the case in the High Court.

In a report released at last night's Australian Press Freedom Media Dinner in Sydney, the Media Entertainment & Arts Alliance noted numerous perturbing instances of censorship. These included the sentencing of former public servant, Allan Kessing, to a nine-month suspended jail term after he was found guilty of leaking a report on serious gaps in airport security to The Australian. The issue was vital to the public interest.

In the US, freedom of speech is fundamental to national culture and guaranteed under the First Amendment. Australia's establishment, in contrast, is increasingly embracing the censorious, "less is more" mentality of the taciturn British civil service. At every turn, civil libertarians battle to keep the public in the dark about lawyers' clients facing charges. States such as Queensland keep pertinent school performance data under wraps, while Tasmania refuses to release details of secret proposals for taxpayers to subsidise pipelines to service the controversial Gunns pulp mill. Secrecy, control and spin have rendered free speech fragile. This is bad for democracy and the issue deserves elevating to the centre of national debate.

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Chair sniffer defended

It's a sad day when harmless jocularity is persecuted



Troy Buswell's wife has vehemently defended her husband - saying he is a good man and that others in parliament behave far worse. In her only interview following the latest damaging revelations about his past behaviour with women, Margaret Buswell also said the beleaguered Liberal leader was deeply remorseful about the chair-sniffing incident, but it was "just a joke that missed the mark''.

Mrs Buswell said her support for her husband was "rock solid'', that he had never done anything she would be ashamed of and that he should be judged on his policies and vision, despite the recent reports that have left him fighting for political survival. "He's sorry for what he did. He understands that what he did was offensive. But he would never intentionally offend someone,'' she said ahead of a party meeting tomorrow that will decide whether a leadership vote will occur.

"I think it was just a joke that missed the mark. I've known him since I was 16 and he's always had a sense of humour. That's probably one of the reasons people love him so much.'' She said her husband had a lot of integrity and she and both their families were very proud of him. "I think there's a lot of other people (in parliament) who should be worried, but it doesn't come out,'' she said. "Troy's not corrupt. He's not an adulterer. He hasn't run off with anyone up there, and that's all going on (in parliament). "That's why so many good people don't go into politics, because of all the rubbish that goes on.

"Is there anyone who could stand up and say that they've not done something that was misinterpreted in the past?'' The 39-year-old accountant said it should be remembered that the incident, revealed by The Sunday Times last week - where Mr Buswell sniffed the chair of a former Liberal female staffer in his parliamentary office - dated to 2005. That report followed others in this paper revealing Mr Buswell's infamous bra-unclipping incident, which happened at parliament in October 2007.

"He's changed his behaviour since he became the leader,'' said Mrs Buswell, who also spoke to this paper in March about the first incident. "He understands what is required of him now and he's trying to lead his party to the next election.'' Mrs Buswell said her husband initially denied the sniffing incident because he wanted to protect the woman involved, who had insisted that the events not be publicised. "That's the truth,'' she said. "The timing sucked. She changed her mind. It may have been the pressure she was under.''

Mrs Buswell understood why women might be offended by the reports of her husband's behaviour, but they weren't getting the full picture. "I'm not making excuses for what he did,'' she said. "What he did obviously offended (the woman) and if you were to hear about what he did on the radio, or read it in the newspaper, you may find it offensive. "But we've had hundreds of emails and texts and phone calls of support, non-stop, from people who know him and know his personality and sense of humour. "(They) know that he would never intentionally offend someone like that.

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