On the Turning Away

By Jim McVeagh 15/12/2009


The news that Timaru Emergency Department is “turning away” patients (actually, sending them to their GPs) is exciting Labour’s health spokesperson, the barely noticeable Ruth Dyson.

Labour MP and health spokesperson Ruth Dyson believes essential frontline health services are being cut.

“You can’t get much more frontline than the emergency department. The Government promised there would be no cuts to frontline health services but I think Timaru is seeing the knife-edge of cuts to essential services.

Codswallop, Ms. Dyson. Had you known anything at all about emergency departments you would have know that they have always encouraged patients, who present to the emergency department with a problem that could be tackled by their GP, to go to the person most suitable – their GP. EDs have done this in a number of ways. Some have had a community campaign to discourage minor problems from attending the ED, but all have had some way of moving minor ailments out of the ED and back into general practice where they belong. The bigger EDs practice “attrition by waiting times” with nurses politely suggesting that a trip to the GP or the local A&M would be substantially faster than the four hour wait (on a good day) to see a harassed junior doctor. The smaller EDs, like Timaru, have lower waiting times in general and have to be more overt in their redirection. Note that nurses NEVER turn people away. They are redirected to their GP, with the nurse often making the appointment for them. They are also redirected only according to carefully worked out protocols. I should know, because I worked out one of the first sets of those protocols for Invercargill ED. And they were very, very conservative. In three years of use we had only one person return immediately from the GP (a man with appendicitis). He was inconvenienced rather than medically disadvantaged and the nurse had not followed the protocol properly.

Ms Dyson goes on:

Sure there will be some people that might be going to the emergency department that should be going somewhere else but they are going there because they need help. A lot of people can’t afford after-hours care.

Labour really should get themselves a new health spokesperson because this remark is just a confused, addled mess. Timaru has just negotiated the closure of their GP after hours service, so there is nowhere else except the ED. After hours is the only time the ED does not redirect patients. And if they need help during hours but are in the wrong place, surely it is better that they get help in the right place? Emergency departments are deplorably bad at managing chronic disease processes such as hypertension, sciatica and poorly-controlled diabetes (as opposed to diabetic emergencies). And if Ms. Dyson actually means that some people can’t afford a normal GP consultation, then that is an issue to be addressed in some way other than inundating expensive ED facilities with trivia.

Frankly, I find it fairly unbelievable that people say they have no money to pay their doctor but plenty to buy smokes and alcohol and play the ponies. But even should they be in the unfortunate position of truly not being able to afford the absurdly cheap medical care that New Zealand GPs provide, there is always WINZ, who are only too willing to provide. If all else fails, they only have to wait until the GPs have closed and then the ED has no choice but to see them. And yes, this is exactly what some do – even though they know they have a GP treatable condition. There; I feel better after my little rant.

This will not cure the enormous over-usage of emergency departments in New Zealand brought about by the abandonment of the part charge for ED visits. But it will at least remove some of the more egregious examples and allow the ED to be used for its original purpose – the provision of emergency treatment.

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