Twelve months go by and it is time to review the year that was. 2012 began with 2011 Christmas and New Year in Julia Creek and then almost three weeks in Normanton, both under the auspices of the Mt Isa health district of Queensland Health.It was also the year I started a little photographic project, taking a photo every day for the year of 2012 and unimaginatively called it "Project 366".
You can find the link to the final product here ...
on my Facebook page.
It was a full year. I entered into a challenging financial arrangement by purchasing a high end property in a fast falling market (ie. bought at about about 70% of the building cost) which has now stabilised but has a high mortgage to service for the next 5 years before settling to a basic interest/principle repayment system. I deliberately loaded repayments at the front end to minimise risk if the valuation goes pear shaped. As a result any non-full-time working life has been pushed to about 15 years into the future, which suits a "standard" retirement age rather than "early" retirement and gives me a more focussed approach to work planning.
So yes, 2012 was a full year. Julia Creek, Normanton/Karumba, Gin Gin, Gladstone (Indigenous health), Clifton, Cooktown (incl Wudjal and Hopevale), Orbost, Gladstone (hospital ED), Innisfail (2.5 months), Brisbane Northgate, Yulara (2.5 months) and for the first time in a few years, spent Christmas at home.
The year was professionally and emotionally challenging. Firstly my Queensland Health state-wide credentialling was up for renewal and there was talk about an "unfavourable reference" that, of course, all refused to give me details of what and who for "privacy reasons" and for a period of about ten days I discovered what sleepless nights was all about.
At the same time a locum that was pre-booked and already contracted to the Mt Isa hospital ED was cancelled without explanation other than talk about my credentialling being renewed and the "unfavourable reference".
As it eventuated, my credentialling was renewed and shortly afterwards I was given a Queensland Health job for two weeks in Cooktown.
As the year progressed it became more obvious that I had been "banned" from working in the Mt Isa district, without explanation, without formal notification and without recourse. In a petty sort of way, I got enjoyment from the fact that the $1300 airfare that Mt Isa paid in advance for my locum that was cancelled was actually not recovered by the Mt Isa district but lost because no one cared to follow up the cancelled locum's expenses. We hear about financial mismanagement within Queensland Health, this was just a small example of financial carelessness.
The medical director of Mt Isa hospital rang and welcomed me to the district during my Julia Creek placement but did not show any sort of professional courtesy in letting me know why he refused to allow me back into the district after my Normanton placement.
To the best of my knowledge there has been no formal complaint to the Medical Board about my professional competence, there has been no formal complaint to the Health Services commissioner, there has been no formal complaint to the Queensland Health Director General. Simply a "you cannot work in the Mt Isa district".
I have pondered for almost the whole year how to address this issue. I have come to the conclusion it was a reaction to my harsh and quite verbal criticism of the standard of care being provided to the community of Normanton and Karumba. A standard of care that was in my less than humble opinion, substandard, unsupervised and delivered by someone who showed disrespect for other people around them. The staff of the clinic and local hospital feared to speak up, and the community (85% indigenous) did not like him and dreaded his return each time a locum who covered his leave left.
I drafted on more than one occasion a letter of concern to be addressed to the area Medical Director (Mt Isa), to the Queensland Health Director General and to the Australian "medical board" AHPRA.
I ended up leaving it as a detailed and harsh appraisal through the locum agency.
I feel sad for the community of Normanton, but the standard of health care in the world is not my personal responsibility - I simply provide the best I can where-ever I am at the time.
During the year of 2012 I had the good fortune to meet someone who knew the circumstances in Normanton personally and her experience was not too dissimilar to mine and from that time I felt a little more comfortable that my assessment of the standard of service provided in Normanton was pretty close to the mark, not purely personal bias.
About mid-year, I went back to Gladstone Hospital ED to revisit a place I had become fond of years earlier. It was an experience that left a bitter taste in my mouth.
Most of the good nursing staff had left (and continued to leave later in the year), all the good doctors had left, as had the personal assistant to the Medical Superintendent and the hospital was still managed by a "locum" Medical Superintendent who I found hard to be convinced was actually serving the hospital's best interests. The welcome to me from the Med. Super. was to pass on a petty, unfinished business from two years earlier where I was accused (inappropriately) of leaving my accommodation in a mess and he instructed me that this must not happen this placement. He in fact interrupted my attempt at explanation and with that I knew this whole experience was not going to go well.
A "primary care clinic" was set up as a trial alternative for lower acuity emergency department patients in preparation to create a Medicare scam to have patients who otherwise should have had their care funded by the hospital (state funded) to be funded at least in part by Medicare billing (federal funds). The state vs federal war has been going on for decades, but I was not happy being placed in an, in my view, immoral setup that was incompetently managed with dysfunctional workflow. I made my views clear, including to a unit manager who had the audacity to complain to me that the wait time was too long when 8 patients who all turned up to ED at about 8:30am were all triaged to my "primary clinic" queue (single doctor) whilst the ED was empty of patients and two doctors were sitting on their arse doing nothing.
I was also, under duress, required to complete a purely theoretical training package to "accredit" me to perform procedural sedation. I pointed out that a theoretical training package without any practical component was in fact potentially dangerous ... and not surprising, something that again they did not want to hear. I answered the "test essays" truthfully and listed the minimalist approach I would take based on my lack of anaesthetic training and skills and received absolutely no feedback despite assurances by the "medical trainer" that I would.
My second week was, without prior notification, a week of night shift, solo senior doctor not only in the emergency department, but for the whole hospital. Could I keep my mouth shut ? No, of course, and it came to a crisis point that despite the hospital knowing well in advance I was flying out on the Friday morning they had rostered me on the overnight Thursday night shift. I refused to work the shift.
The reference I received, not surprisingly suggested that I was "unsuitable for emergency department work". Yes, I am old and grumpy enough to not tolerate substandard and under-resourced health care systems. Once again, not a formal complaint to the Medical Board or the Health Services Commissioner about my competence as a doctor, just simply a closure of another door because I was outspoken enough about perceived competency and service level deficiencies at such a level to be potentially dangerous for patient care.
In the context of consistently positive references for the previous four years, and the rest of my 2012 references of a similar high standard, I was confident that it was my lack of "keeping my mouth shut" that resulted in a process where the assailed became turtles and sought to deny me further access to the ability to observe system and possible personal failings.
Yes I am arrogant ... my role as patient advocate drives me to speak out against injustice.
So, with needing two emergency department references to work in emergency departments and without two references I could not work in emergency departments to actually obtain the necessary two references, it was clearly time to move on.
2012 and the early part of 2013 has reinforced my desire to continue to work supporting communities in rural and remote Australia that lack good quality health care services and confirmed that doing locum work is still a privileged way to see Australia, especially when I am paid to do it and when Lesley, my wife, has the opportunity to travel with me any time she chooses.
I make a final note of my 2012 experiences that I am greatly honoured to have spent 10 weeks in the country around Uluru and Kata Tjuta, central Australia. I acknowledge with heart felt thanks the traditional owners of the land and the elders of the Anangu people.
PS ... as a gentle reminder to younger doctors who's career is dependent on whose arse you lick and turn a blind eye to, seek legal advice if you are ever to "open your mouth" against injustices and medical incompetence. You have a difficult choice to make.
This article was originally published at The Conversation.
