Transcript - ABC Radio - ED presentations

Transcript: AMA Queensland President Dr Maria Boulton, ABC Brisbane, Sunday Mornings with Kate O’Toole, Sunday 23 July 2023

Subjects: Emergency department presentations, GP funding

KATE O’TOOLE:   The last time you went to a hospital emergency department, was it for a major reason or a minor reason? There's an interesting angle on a long-running story in the Sunday Mail today. It won't surprise you that it can be hard to get to the GP. You know that there's problems with the health system, right? You would have heard about people going to emergency sometimes instead, either because they can't get in to a GP or because their local GP doesn't bulk bill anymore.

But what I thought really was interesting in this story is the stats on some of the minor reasons that Queenslanders turn up to emergency. Over a period of 16 months, the paper says more than 6,500 people went to ER for a repeat prescription, which is something that is like the opposite of an emergency, right? It's something that you very clearly see coming. As you're going through your medication, that idea of needing to get a repeat is something that could be organised. But it's an interesting indicator of the problems in the system.

Another in that 16-month period, 3,700 people turned up to emergency requesting a medical certificate for work. There's got to be a better way to prove you have a cold, right? There has to be a different way to do that. Also, the paper looked at stats in the first four months of this year, there were almost 500 presentations for ingrown toenails, for example. There were heaps of presentations for sunburn and things like that.

Dr Maria Boulton won't find any of this surprising, I know. She's the President of the Australian Medical Association of Queensland and a GP. That's right, Maria, isn't it?

DR MARIA BOULTON:   Yes, good morning. I'm a GP, I've been a GP for 20 years and I've also worked regionally in Queensland as well.

KATE O’TOOLE:   So what do these numbers tell you? Because it's more than one story, right? What's going on here?

DR MARIA BOULTON:   People present at emergency departments for many reasons. Certainly it used to happen 20 years ago when I worked in ED at Mackay Base Hospital. For example, with the sunburn, people can get severe sunburns. In Mackay we used to get tourists who would go out to the Whitsundays, get completely sunburnt and be in agonising pain, ending up in emergency. So sometimes there's a really good reason for it. But certainly what we're seeing is that cost of living pressures are starting to bite and unfortunately the Medicare rebates for people to access their GPs, particularly after hours, just haven't kept up with the cost of providing the service.

When you speak to my emergency colleagues, they are really busy because of many other reasons, not just because people are presenting to an emergency department for a script. They’re busy with a lot more serious issues, such as people presenting with higher frequency of chest pain or stroke, but also because they're having issues transferring the patients from the emergency department into a hospital ward. So there's bed pressure.

At the end of the day, what Queensland needs is more workforce. Our workforce is very, very stretched, both in the hospital system and also in primary care. And that’s why it's essential that both governments - and it will need both state and federal government - look at not only relieving the pressure in the emergency department, supporting doctors and nurses working within those emergency departments, but also ensuring that patients do have excellent access to their GP when they need to see their GP.

KATE O’TOOLE:   You mentioned, Dr Boulton, that sometimes sunburn can be serious or it can be because of tourists. And some things I guess that look minor could be worth heading to the ED for. Bruises, for example. I thought oh well, that could be wondering whether you've got a broken finger, a broken bone or something that might need to be checked out. One of the things that's on the list, though, is hiccups. Only 13 people turned up for hiccups, so it's not like a major drain on the health system. But, I mean, do people present even to the GP for hiccups?

DR MARIA BOULTON:   Oh, most definitely. There are many causes for people who have persistent hiccups, and it's really quite debilitating. These are people who have had hiccups for 24, 48 hours by the time they present to see a doctor. Sometimes it can be quite serious, it can be a little lesion irritating something that is causing that hiccup to happen. When you look over the 17 Hospital and Health Services and the entire of the Queensland population, there's not a lot of people overall presenting for that and, as I said, for the person who has had hiccups for a long time, it is quite distressing.

KATE O’TOOLE:   In this story in the paper, you're quoted as saying that there could perhaps be a greater use of the 13HEALTH number to triage what needs to go to ER and what doesn't. Is that an underused service?

DR MARIA BOULTON:   Absolutely, and it's a service that's readily available. I'm a parent. I see lots of adult patients as well. And sometimes it's difficult. I've had 12 years of medical training to call myself a GP. For someone who doesn't have that medical training, sometimes it's quite difficult to decide whether or not it's an emergency, and services like 13HEALTH are there to provide that advice.

When somebody presents to you with an urgent problem, it may be urgent for them. It's important those people feel like they're being cared for and don't feel like they're wasting your time, because you do want them to continue presenting with their other problems in case one day they present too late. But it's quite difficult, and that's why those services like 13HEALTH exist.

The other thing is the statistics for repeat scripts. A lot of GP clinics now have online repeat script services for their patients and sometimes people just aren't aware of that. Ask your GP, look at their website, see whether you can get a repeat script online if it's reasonable. Sometimes the requests can be a little bit unreasonable and the patient will need a review prior to that script. But that's a service that's really easily accessible.

KATE O’TOOLE:   So call your local GP and see if that service is available. You should really be able to organise a repeat script, it shouldn't be an emergency situation unless you've lost it or something like that. Dr Maria Boulton is my guest here on ABC Radio Brisbane and Queensland, talking about reasons people turn up to the emergency departments in hospitals, after a story in the paper today cataloguing some of those reasons for presenting that.

So the 13HEALTH number you can call to get advice about how urgent it is to see a doctor. That's a useful way to support the system without necessarily going into ED unless it's required. Another reason people were presenting in large numbers over the last 16 months was to get a medical certificate for work. Dr Boulton, pharmacists do have a role here, but their role is very limited. Should it be expanded?

DR MARIA BOULTON:   Look, at the end of the day, the whole of the entire health workforce is under pressure, including pharmacists, physiotherapists, psychologists. Everyone is under pressure. This is where we need a little bit of reform. I'm not a workplace lawyer, but looking at the way that employers certify their sick employees and whether they could perhaps do a statutory declaration instead is part of the broader picture in ensuring those clinical services are available for clinical solutions.

For example, when COVID happened, it just didn't make sense for people to come in for a medical certificate to not go to work because they had COVID. It would have made more sense to maybe sign a stat dec or take a photo of the RAT test or whatever. That needs a different section of the government that looks into business and workplace law to see whether there's a solution there that's that doesn't take up so much of the health resources.

KATE O’TOOLE:   Right, because I was thinking pharmacists, they're very limited in the scope of where they can provide certificates. Like basically if you've got a cold, that kind of level of thing - they're not equipped to diagnose anything else or give any broader certification aside from what they see day-to-day. That's my understanding of their role. But they can't backdate a day and they can't give you more than, I think one or maybe two days. The common cold lasts longer than that. So, you know, to avoid having to turn up multiple times, you'd think if they could have greater power for an extended certificate, for example, that could help.

But you're saying even to give the power to the individual to be honest with their boss, write a stat dec about not being able to turn up to work for minor reasons and remove them from the health system entirely for those things?

DR MARIA BOULTON:   Yeah, that's right, for reasonable things. The other thing is that sometimes people see medical certificates as just a medical certificate or scripts as just a script. But the reality is that when people come in or phone us for a consultation for a script, say, for example, for the oral contraceptive pill, we talk about everything else. So it's not just a piece of paper. It's ensuring that the medication is still the best medication for that patient, that there's no contraindications, that they're doing okay. We even use that as an opportunity to screen for domestic and family violence.

Similarly with the medical certificate, sometimes when people present needing a medical certificate because they're unwell, it's assessing to see what they have. But it’s also about ensuring that, for example, if they have symptoms of influenza B and if they're particularly at risk of severe disease, then we can safety net them to ensure that they don't end up in hospital sicker. So it's never as simple as just a piece of paper. But perhaps there is a solution there that can be worked out with employers.

I'm an employer and most GPs are. We employ a lot of people in the community and at the end of the day for us, we don't want someone who’s sick coming in because that will mean that they'll place the rest of the team at risk. We prefer them to stay home and get better and come back to work when they're well.

KATE O’TOOLE:   Do you think that the urgent care clinics that have been promised will make a big difference to any of these stats?

DR MARIA BOULTON:   I don't think so. When you speak to our emergency colleagues, what they'll tell you is that, at the end of the day, there are studies that show they won’t make a difference. When you look at the number of urgent care clinics, it's 58 across Australia. Queensland is the largest decentralised state in Australia and a lot of our population lives in regional and rural and remote. And you know what? If you live in Emerald, are you going to have access to an urgent care clinic? No.

So it would have made more sense to put that money into each GP, because we know there are more GPs in Queensland than any other medical profession. It would have made more sense to put that funding into general practice to help patients access their own GP in their own country town, rather than 58 urgent care clinics located in larger regional centres, which is not going to help those people west of the coast in Queensland.

KATE O’TOOLE:   Thank you, Dr Maria Boulton, for your expertise and experience that you've shared with us this morning.

23 July 2023