Cynthia Busuttil
Family doctor finds 'emergency' experience refreshing but frustrating
After 20 years as a general practitioner, Michael Gonzi has gone back to hospital to give a helping hand at the overstretched emergency department, feeling refreshed professionally but also taken aback at the petty cases that sometimes turn up.
"I have seen patients come to the emergency department for a verruca. It is ridiculous to go there," he said.
He is one of only nine family doctors who applied to spend a few hours a week at the department.
"I had been thinking about spending some hours in hospital for quite a long time and when the opportunity cropped up, I snatched it," he said, adding that he felt a refresher course in emergency treatment was needed.
The GPs working at casualty are seeing the least acute cases, dubbed category three, as this is where waiting times are the longest. Earlier this month, the director general for healthcare services, John Cachia admitted that the health authorities were still not satisfied with the waiting time patients were facing at the department.
Dr Gonzi said family doctors were able to treat category three patients but lacked the necessary equipment, like X-ray machines, at their clinics.
"Here (at my clinic) I cannot treat a patient with a sprained ankle but have to send him to the health centre or hospital for an X-ray in order to see whether his ankle is broken. But at Casualty I can analyse his tests and decide on the treatment," he said, adding that it was very gratifying to follow a patient throughout.
This has helped him greatly in dealing with his clinic patients.
"I took on this challenge because I wanted to improve my skills and today I feel better able to deal with orthopaedic cases, which make up a good part of category three patients. I am in a better position to determine what sort of injury a person has even before an X-ray has been taken," he said, adding that his experience had also opened his eyes to injuries he had never come across before.
But then there are other patients who turn up with injuries that do not deserve hospital attention and are pushing up waiting times, which have long been the reason of complaints by patients.
Dr Gonzi believes that people go straight to Casualty because they want investigations to be carried out there and then, without having to wait for a doctor's referral.
"I cannot understand why a patient insists on going to the emergency department and wait five hours when at a health centre or his family doctor he will get the same treatment much before."
Dr Gonzi said strengthening the IT system within private clinics and at health centres would allow more work to be done within the community, easing the burden on hospital. "If I send a patient to the health centre for an X-ray and can access it from my clinic, I will be able to recommend the treatment myself. And if I need a second opinion, I can send this X-ray to a specialist."
He admits that he often tells his brother, the Prime Minister, what he believes the health sector needs to move forward. "Everyone tends to focus on his particular area and when I meet my brother and tell him that certain things need to be done, I expect them to be done immediately. Sometimes this is not possible but I am convinced that primary care will make big strives forward," he said.
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Andrew Camilleri
Apr 27th 2009, 20:26
I also apologies to Dr Tabone Vassallo, but it seems I misunderstood your comment. What I do think is that there is a place for young medical staff at A+E, otherwise how will there be any learning without experience?
Andrew Camilleri
Apr 27th 2009, 20:24
@Michael Spiteri: From what was written it seemed that she was saying there should be no junior doctors at Emergency. I'm not yet a doctor, but will hopefully graduate in the next few years, and I'd like to spend time at the Emergency department without being told by people that I shouldn't be there.
Michael Spiteri
Apr 27th 2009, 19:57
Mr Tabone Vassallo is a respected emergency physician with an extensive experience both in Malta and abroad. I am sure that his advice is sound and this is experience talking. Certainly there is a place for junior doctors to be part of an A&E team but definately they cannot be expected to form the majority of our staff. After almost ten years working as an emergency physician myself, I can assure you that this is a highly gratifying speciality. On the other hand this speciality demands that you take decisions in a short time and based on minimium investigations. Being a frontline department it is essential that doctors taking such decisions have enough experience to spot a potential serious case before it is too late. I can assure you that this skill is not learnt by reading textbooks or by working in other departments but by getting coaching and training by someone who is experienced and trained in emergency medicine and who can help you to take good decisions. Unfortunately as the Association of Emergecy Physicians of Malta (AEPM/GMTE) rightly poined out recently, the current ratio of junior to senior staff is far from ideal.
Andrew Camilleri
Apr 27th 2009, 18:04
@Maria Tabone Vassallo: Well how do you want us young medical students/ young doctors to learn then? No young doctors at the emergency department, and you get no doctors at all when the older ones retire. You want experienced practitioners, yet you say they shouldn't be getting that practice! Come on! Get real! The medical student is an 'apprentice', as it were - learning has to be practical. What Dr Gonzi means by a refresher course is probably not only knowledge based information, but also practical things which a family doctor does not routinely do. I'm not saying anything against you personally, but such attitudes are really a case of 'not in my own backyard'. You can't have the cake and eat it.
Joseph E Briffa
Apr 27th 2009, 17:33
A campaign to educate the general public should be launched on TV at prime time say after the 8 p.m. news. Furthermore it appears odd that the number of patients at E&A Dept is always much much less on Sundays and public holidays; similarly I have always noted that less people attend a funeral on Sundays and Public Holidays. Has this by any chance got something to do with some people finding every excuse to stay away from work?. Well done Dr Gonzi, you are giving an excellent example!
G.Zammit
Apr 27th 2009, 16:57
The system mentioned by Carmel Ro was adopted last year in Italy. Priority 3 where charged Euro 30 and for Priority 2 - Euro 20. From day one of this system being implemented, the number of these type of patients in Italy's emergencies saw a 50% drop. Money makes miracles!
r.spiteri
Apr 27th 2009, 16:02
I agree with Carmel about teaching the general public what is an emergency.Bill boards are not enough.i think the most effective are spots on television.however well Done Dr.Gonzi
J. Debono
Apr 27th 2009, 14:03
There is really one solution to decrease the number of petty cases going to A&E.
If the doctor seeing the patient feels that the patient, could have been adequetely treated at the Health Centre/Private GP, the patient should NOT be treated and referred immediately to the HC/PG.
As long as the patients are treated in A&E for these petty cases mentiones by Dr. Gonzi, they will continue to crop up. But start referring patients to HC/GP after waiting for 3 hours in A&E waiting room without being treated, and no. of patients going to A&E for simple things will drop overnught.
Alfred Pace
Apr 27th 2009, 12:08
I think that health centres needs improvemnet. Try Mosta Health Centre, there is hardly any room for patients to sit down, we have to wait in the coridor. Sometimes we can only get one doctor which means a waiting time for over 2hrs. Some of the doctors don't even have the proper equipment needed to test patients.
Mario Tabone-Vassallo
Apr 27th 2009, 11:53
Ma nistghagibx li naqbel f’kollox ma Dr Michael Gonzi, tabib tassew kapaci li kull fejn qeda, hareg ta’ ragel u impressjona; mhux l-inqas fid-Dipartiment tal-Emergenza. Sa issa, 5 biss, mid-9 li applikaw, Tobba tal-Familja bdew jahdmu fid-DE. Ninnota li wkoll tabib meqjum u siewi bhal Dr. Gonzi, b’20 sena esperjenza, hass il-htiega ta’ iktar tahrig [refresher course] biex jahdem fid-DE fejn jindokra pazjenti tal-kategorija 3. Dan kien li geghelna nwissu kontra li tobba ghadhom kemm lahqu jintbaghtu jahdmu fid-DE. Bhalissa, 63% tat-tobba li jahdmu xift, m’ghandomx ‘warrant’ ghax ghadhom kemm lahqu. Dan, la xieraq ghall-pazjenti u l-anqas ghat-tobba godda. Zgur, fost affarijiet ohra, izid id-dewmien biex tinghata l-kura. Tassew li hafna mill-110,000 elf ruh li kull sena jigu d-DE jistghu jkunu kkurati mit-Tobba tal-Familja. Tassew ukoll li t-twessiegh ta’ l-informatika taf tghin hafna. Grazzi Dr. Gonzi
Jeremy J Camilleri
Apr 27th 2009, 11:47
Whilst I agree that the waiting lists are usually a result of bad planning and sometimes outright abuse, Dr. Gonzi's actions are to be commended.
Charles Micallef
Apr 27th 2009, 11:20
Dr Michael Gonzi is a dedicated and well respected Medical Practioner in St Paul's Bay and District and above all he is an example that other GP's should follow!
GaleaL
Apr 27th 2009, 10:31
Isn't the overcrowding at the emergency section the result of the closing down, limited services and limited doctors available and the long time waiting to be seen to at local/ regional health centres?
Carmel Ro
Apr 27th 2009, 09:41
Two things could solve the emergency waiting problem: (1) first spend time teaching the general public what constitutes and emergency. (2) After the public is thought about emergencies, start charging a nominal fee for what is referred to "category three" cases.
The fee should be similar to those charged at private doctor's clinics. Patients visiting health clinics should remain free.