john wighton   19/12/2017 2:15:34 PM

great news but its a pity our local after hours cooperative will become unviable and likely will need to close down

Mai Maddisson   19/12/2017 5:45:29 PM

I have no quibble that the care of patients should never become a market place. The prerequisite for such is an honest relationship between the care provider and the patient.
I am now projecting on my experiences as a clinician and trying to do a transposition into patient modes. I was part of the original committee which generated one of Melbourne’s few after-hours facilities, and helped man it for 18 years. It is now about 3 years since I worked there.
During that time I saw many changes: Initially it was a mutually respectful arrangement. The doctors covering the area did their bit by volunteering, the amount of time committed varying with their stage in life and access to the hours required. The patients too did their bit: They did not come along with elective problems which could readily wait until office hours and they understood that given the nature of the facility, everyone in that waiting room needed to be seen as soon as possible, accepting the triaging by the receptionists who were always spot on to recognise when a patient needed to be seen more urgently. Perhaps the word for it was team work.
When I retired it was not so: There were very few of the local doctors in the crew and the patients had remodelled the facility to a proverbial 7/11shop, and sadly the doctors on the crew at times were very intolerant of a colleague who went that extra mile to ensure that the patient truly was safe until office hours, and of colleagues who did not dump patients on their already overworked colleagues in the A and E nearby. The patients were commonly aggressive if they were not proverbially seen ‘instantly yesterday’: They had a party they had to get to!
But many patients were observant: For those of us who did put in that extra mile they expressed surprise at such diligence: I recall momentarily feeling shaken wondering if I was for the 'high jump’ when a patient asked if I was a doctor: Their reasoning that they had never seen a doctor spend more than 7-10 minutes with them or their family.

But all that is a fantasy now. Those few clinics are rapidly in demise. Home visits—possibly commonly unnecessary, are becoming the order of the day. And through the eyes of a patient, how could they even be sure that the person ringing their door bell, is there in response to their call: It sounds like a very precarious arrangement for anyone living alone. At least in the ‘good old days’ such patients knew the other doctors at the clinic by sight.

The patient needs to feel that the person who walks through their door, having contacted the after care facility has insight into their limitations. I wonder how many doctors no matter how qualified would be humble enough to say “I don’t know the answer: I will need to contact a colleague to confirm/discuss some concerns with them.” After all, if a doctor claims to be an expert in the life of another they have never caste their eyes on, how could they rationally justify such action: Indeed why do we have specialists? Surely that concept per se is recognition that no clinician can know everything there is to know about anybody.

As a potential patient, give me the humble doctor who will not strut into my presence armed with the belief that they know it all. I am not sure how I would react if I spotted a writing pad or other device with those words “I am your expert in life” embossed of it: I fear I would point them to the door. Experts are very dangerous people!