Fulfilling Requirments

sayarsan's picture

Some time ago, about six months now i went to my local GP with several problems the most acute at the time being consistent with Gout but naturally enough the GP wouldn't confirm this without a blood test for uraemia. I have a terrible time finding any veins and so do the people in collection agencies and hospitals so i never look forward to it. The most direct way around it is to do a femoral jab which works fine if the practitioner is practised so i went to the local hospital's emergency section to have a doctor perform one but was forced to wait for six hours before giving up in disgust. The clerk at the counter had made some query as to the shortage of surface veins and i foolishly admitted to iv drug use so perhaps i was being punished. The waiting room was nowhere near full at any stage.
The clinic had been after me for a blood test since i first went there so i eventually went to their (Prince Charles Hospital) phlebotomist who managed to withdraw 20ml without any trouble much to my relief and i wondered if maybe i had a new crop of veins waiting to be exploited for various purposes. Not so, the clinic was after me for another blood test and i felt hopeful enough to let the local QML agency try. They only got a few mls, not enough probably for what they wanted. Now i am frustrated again at the bother both the nurse doing the collecting and i went through. What's more frustrating is i still don't know if i have gout and am left worrying about the state of clotting factors in my blood which could be a problem also. Clearly the fault is all mine so i should resign myself to the 3 hour return bus ride to Prince Charles Hospital in the hope i strike a phlebotomist who can get enough blood out of me to do all the tests. It is clear that the free health care we are entitled to does not extend to casualties of drug use. It is worth noting however that they also set me up for a stool sample to check for bowel cancer i presume and previously they had sent me for an ECG to check my heart so they are ensuring that i have a degree of scanning for health problems and for this i am grateful. Maybe i should get my case worker to talk to the local hospital to arrange for a big enough blood sample to do all the tests that need doing but it seems this is not as simple as it sounds. The impression is that some at least and perhaps many practitioners in the drug clinics feel constrained by the health department as i do and i wonder what if anything they can do about it.

Comments

felix's picture

The health system is perpetually bewildering, and I believe it is by design. If you do not work in the industry then you are most likely some sort of victim or casualty, and the best feeling you can hope for is one similar to the feeling a cow must get when faced with a disassembled iPod.
There is information aplenty in hospitals, but there is a definite code to not pass this information downwards to the rightful owners of that information, the patients. I witnessed a co-worker last week, ringing a hospital because his father had been sent there for an MRI. Now the father was unclear on why he was needing an MRI and it took the son saying to the receptionist "I'm a veterenarian" to unlock the information. It was amazing, once he had declared that he was a member of that particular club they were perfectly happy to tell them why his dad was needing the MRI. It didn't hurt that my co-worker knew a few choice words to throw in, such as 'myofibrous sarcoma' etc, all reinforcing his position as a fellow warden of the hidden information.
I have seen television shows where the doctor says to the patient 'Now is there anything you didn't understand about what is going to happen to you?', and I must admit I once went for minor surgery where a lady gave me a similar spiel about half an hour before the operation, but in TV's case I think it was wishful thinking, and in my case it was a long way down the chain, well past the point where understanding the problem was going to help me. Perhaps they get more honest when they realise you are about to be sedated and will probably not recall the conversation.
I guess there are those in the system who do feel it is right to share knowledge of a patient's medical condition with that patient, but it seems this is the exception rather than the norm. Being such a small part of a huge system must be very disheartening but they do earn my respect, those few who treat patients like people.
And that's just the attitudes you encounter as an average patient! Don't get me started on how you are treated if you present with an addiction - regardless of whether that addiction has anything to do with the eason you are presenting.

felix's picture

I should say that another idea I have had for this site (but I don't want to implement it just yet and get distracted and delay go-live even further) is to add a 'My Medical' section, where you can keep a kind of diary/calendar where you can do everything from record daily pulse, note down things like 'lost vein in right forearm after shooting oral morph for two weeks' etc etc, as memory has a habit of juggling events and times. This diary would intertwine (somehow!) with your Usage Tracking, presenting a nice report so if you go to a doctor you can grant them temporary guest access to see your history....I have to thank writers such as Cory Doctorow for firing up my imagination in relation to believing that one day individuals will own and maintain their own medical records rather than various state organs. The true and final revolution, as information slips out of the clutches of the state and into the individuals own data repositories...

sayarsan's picture

It's a good idea although it might be slow on the uptake. This resistance to giving out too much information to outsiders might be rooted in experience and the notion that a little knowledge can be a dangerous thing. I can easily imagine how health workers especially those in public drug clinics could tire of long discussions with stoned junkies/speed freaks/ coke heads who often seem to be doing little more than showing off what knowledge they have. Presumably that is partly what jargon is about. A way to filter out those who do not have the background to follow the conversation. Someone who is qualified as an enrolled nurse is still not equipped to understand much discussion in a specialist area of medicine yet they understand the jargon.
The notion of the individual taking responsibility for recording vital signs and other important information depends on that individual being educated enough to have some idea of the reasons for doing it, the methods of doing it, the relevance it has and more. It must be an important step to get people to start thinking about this kind of thing and a feature like this is a good start.

sayarsan's picture

On Saturday i was shown a letter from the clinic. They post them to the chemist who passes them on so i can't say i didn't get it i presume. This one was to warn me of the possible penalties involved for missing an appointment. The expected and only real lever they have- cutting off supply. But i am not negligent in this respect, if i can't make it, which is unusual, i tell them before hand. This was an indiscriminate warning not a hint for my benefit.

The first thing i thought was a typical reaction and then i had another thought along the lines that the clinic is hopelessly underfunded and understaffed. With only one Doctor (unless a second has been added recently) it must become almost impossible to deal with too many absentees. More likely it's impossible for them to fit in new appointments either way it is a result of lack of staff. When i was seeing a private Doctor i didn't have to do blood tests. Presumably the Doctor in it's wisdom could assess my drug taking behaviour enough without the need for pathologists. I suspect this might have a lot to do with how much time the Doctor could spend on me, coupled with a huge difference in work load. In retrospect the only time the methadone program has been suitable was when i was treated by the private practitioner. Every time i have used the public system for this, four in all, i have found the treatment to be so regimented and inflexible as to be difficult to tolerate.

I always expected attitudes towards drug use to become more enlightened but i may have been wrong. Perhaps the enlightened approach is to gradually move people onto a regimen of bupronorphine and naloxone for a while then set them up on naloxone alone which some can call an addictive drug but i still don't understand how an antagonist can satisfy a need for an agonist. While some countries are opening up to heroin programs Australia is moving in another direction and as this progresses it will become harder for a doctor to operate outside that model. For people who intend to quit there may be a place for treatment with an antagonist, i can hardly deny that but who makes the decision about 'to quit or not to quit'?