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.