The dilemma of after hours health care.

Imagine – it is outside normal business hours and now someone in your household is quick unwell.  You knew they were unwell earlier in the day, but between your job/s, lack of childcare and no appointments available at your normal family doctor, they haven’t been seen.  Maybe you were also sub-consciously hoping they would get better by themselves.  But now you think they really do need to see the doctor.  You are close to an after-hours medical clinic, but going there means you will be waiting – maybe for hours, and it is expensive.   Your budget is tight.  Paying the medical bill means something else will have to be dropped – maybe the petrol you need to get your child to sports practices.      You could go to the emergency department at the local public hospital, which is free, but you could be waiting for a long time (in a very boring waiting room with the unwell person and several other dependents whom you can’t leave at home) and you know that this isn’t an emergency….yet.

These are the real dilemmas that many people in Auckland face.    To see an after-hours doctor with significant strain on the budget, to take a non-emergency to the emergency department and wait for many hours, or wait at home and hope things don’t get any worse until you either have the money, or you can see your (normally cheaper) family doctor.

A community organisation in West Auckland has recommended that people who would have difficulty affording the after-hours fees, should go straight to the local public hospital, where they would be seen for free.  http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11867276

Sounds reasonable doesn’t it??

BUT!  The local public hospital is overstretched and would rather that unless it is a true emergency, people should see the local accident and emergency clinic, because that is what they are for.    You could also be waiting for up to six hours to be seen.  Often people are so time poor, that they don’t have this amount of time.

I can see both sides of this dilemma because I have been on all sides of this situation.  I have worked after-hours in the pharmacy attached to the medical clinic and seen the sheer desperation on people faces when I have told them that they do need to see a doctor, urgently.  When they admit to financial crises, I have recommended they go to the hospital.  I have worked in the emergency department of the hospital and seen how urgent, but more minor issues that could be easily treated by a family doctor delay treatment for much more urgent cases – those that can only be treated in the hospital.

To me, this suggests that there is a much deeper problem.  We have a large part of our society who are working longer hours for relatively less money.  They often find it difficult to get to the doctor during the day.  The cost of living is going up.  People are more transient, and when they move suburbs – or further – they may have to find new family doctors or travel much further to see their existing one.  Health is getting worse – diseases that used to only affect the older population are now affecting the young.   We also have many “sandwich mothers” (mothers with dependent children, who also need to look after their parents with increasing health needs, who also maybe trying to maintain a career).   Trying to fit urgent medical appointments with a very demanding schedule often means something has to give.

The demands on our health care systems are growing.  We have an aging population.  While older people do have increased health needs, our health care workers are also aging.  We know that earlier and better access to medical care improves morbidity and motility outcomes.  These treatments cost money and can be quite expensive.

More money for health care is not the only answer.  Although this would relieve some of the dilemmas as described above, we need to prevent many of the diseases from occur in the first place.    We have increasing rates of diabetes, cardiovascular disease, dementia and cancer.  Having diabetes increases your risk of many infections.  In West Auckland, there are also high rates of certain preventable infectious diseases.  These are better managed with other social interventions as they can be diseases of overcrowding and poverty.   We need to get better with preventative health measures, such as diet, and warmer and drier homes.    Earlier diagnosis and management of hyperinsulinaemia – a known leading risk factor for many non-communicable diseases would also help.  For many of the preventative measures, it will take years to see their benefits resulting in less pressure on our health system.

Having worked in West Auckland, I have seen all sides of the challenges but have no answers.  Just empathy.  Empathy to the health care workers who are under enormous pressure, empathy to those who have to explain the costs or the wait times to patients,  empathy to the person having to pay the bill, but mostly empathy to the person who is unwell or injured trying to navigate the health system.

It is election year in New Zealand.  Soon the politicians will all be out trying to woo the voters.   Many strategies will only last three years – or until the time of the next election.     My question to the politicians – what is your LONG-TERM strategy for managing this issue??