Ground up at the medical meat market

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After receiving treatment in the private health sector, Bruce Haigh asks whether medical specialists need to be taught manners and common decency.

LAST YEAR, 2015, began my serious exposure to the medical profession, support staff and ancillary services in Australia.

It began in March with a major operation for glaucoma. The surgeon was competent and the procedure successful. However, his fees were high and the gap between them and what my health insurer was prepared to pay was large.

I rang the health insurer. The woman who took my call agreed that the gap was large. She offered the advice that I might like to negotiate with the surgeon to reduce his fee against an increased one off payment by the health insurer.

I said the proposal sounded a lot like horse trading and she agreed. Wondering why my surgeon’s fees were so high, perhaps he had six children at private school, I asked a few gentle questions. No, his two children were very young; what did he do for relaxation? Property, ah, that helped to explain — I was contributing to a deposit on another unit.

Tests during the year revealed that I had prostate cancer. An operation was advised — by the much touted robotic method. The fee quoted, after private health insurance and Medicare rebates, was outrageous. To rub salt into the forthcoming wound, payment was required before the robot was deployed. I would not have been surprised if I had been asked to pay cash. I discussed the proposed operation with friends interstate, both of whom had their prostates removed robotically. They paid half of what I had been quoted.

Subsequently, I was advised that there was little difference in the medical success rate between the robot method of removing a prostate and removal by laparoscopy. The main difference was price, with the robot procedure far more expensive than laparoscopy. The fear of members of the male middle class apparently favours the more expensive procedure — and, yes, I got sucked in, but without all the facts and alternatives before me.

I went back to my surgeon, who flicked me onto his office manager, who reduced the bill by $4,000. It made me angry to see how much fat had been built into the bill. Even after the reduction, the bill was still higher than his interstate colleagues.

For family reasons, I elected not to go interstate, although I had been accepted as a patient. The operation went longer than expected and the anaesthetist charged more than was quoted. I negotiated and the fee was reduced. None of this is easy immediately after an operation.

As part of the procedure, I had stents placed in my bladder; as a result, I was required to keep a catheter in place for over a week. I live in Orange, a city with a large hospital. I requested that my catheter be taken out in Orange, as getting down to Sydney,  particularly with a catheter in place, would be difficult.

I was told by the office manager this would not be possible and she had made arrangements for me to have the catheter taken out in Sydney at 9am on a particular Thursday. (I did not want to pay for a night’s accommodation in Sydney. I had already had the unnecessary expense of a weekend in Sydney when she booked me in for my pre-op on a Friday for an operation on a Monday.)

When I asked why it had not been possible to get the catheter removed in Orange, she said she had "spent hours trying". I said it would not be possible to get from Orange to Sydney by 9am. She said I had to because that is what the doctor had instructed.

I said, "wait a minute, I am the patient" and she hung up on me. That was one day after a six hour operation.

Clearly, she didn’t care or know about the logistical problems confronting country patients. In the event, I was able to secure transport to and from Sydney. I changed the appointment from 9 to 11.30am. I expected my doctor to be present but he was not. The doctor who took the catheter out walked into the room without acknowledging me or introducing himself. I had to ask him to do so. I am not a piece of meat, although by that time I felt like I was.

The procedure over, I knew I had to urinate before I left the hospital, but I had no instructions and no one to report to. The nurse present when the catheter was taken out, got me to drink water and, eventually, I urinated, but to whom should I report? I decided to go to the ward where I had recovered. The competent Ward Manager took me in hand, dressed my incisions, declared that she was satisfied I had urinated and that I could go, which I did.

I needed physio treatment, but I have had to arrange that myself. Both my interstate friends received assistance from the practice for physio and follow up calls from their doctors as to how they were travelling. I had blood taken when the stents were removed, but I had to chase the practice for the results.

I paid a lot of money for the procedure, only to end up in the hands of a dysfunctional money making machine. I believe the doctor to have been competent, but his practice was not. I will not return and I will not recommend his practice to anyone. One day out from an operation, I do not like having the phone hung up on me by an office manager.

The sense of entitlement that pervaded the practice was palpable. The patient was a commodity, a piece of meat, a problem to be disposed of as quickly as possible.

When I was overseas with the Department of Foreign Affairs in some difficult posts, staff were expected and were willing to work around the clock to help people injured in road accidents or from other causes. Both the victim and family in Australia were assisted by personnel at the post and by the department in Australia. This was done willingly and for no extra remuneration. The people in that practice would expect such treatment, but when called on to show the same consideration, care and compassion, they did not.

Is this how we are going to treat each other in the future? Is money going to increasingly guide the hands of medical specialists? Do they believe themselves to be so needed and so important that there will not be push back from the community? Do they and their staff expect forelock tugging? Are patients the problem, through doctor deification? Did I pay through the nose because I was a private patient?

My quest is to see all doctors, specialists and surgeons treat their patents with genuine respect and, if they have to be taught manners and common decency, so be it. Stand up for yourself, no more forelock tugging, no more being treated as a second class citizen, demand equality, answers and civility!

Bruce Haigh is a political commentator and retired diplomat. You can follow Bruce on Twitter @BruceHaigh2.

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