I am an emergency physician with over 20 years’ experience working in busy public hospitals. Part of my role is to intervene in the medical squabbles between inpatient registrars who refuse to accept care for patients with multiple health problems requiring admission. It is common to have a resident approach an inpatient registrar about a patient requiring admission and get the response ‘I’m not interested in that.’ I often face the ethical question of whether I am doing the right thing by forcing a medical specialty team to take the patient when they have often made a concerted effort to refuse their care. If I were the patient, I certainly wouldn’t want to be looked after by someone who has put in a pronounced effort to not take on my case.
The new National Emergency Access Targets aim to improve and expedite care for admitted patients. I work in two public hospitals. One has a medical assessment unit run by general physicians, and in this model patients are quickly cared for by senior doctors and rapidly transit the Emergency Department once it is established they require medical admission and are stable. In the larger hospital, where there are 44 different subspecialist consultants, it is extremely difficult to get patients with multiple problems admitted to the ward. I’ve watched this situation get worse over two decades and congratulate Hitchcock for having the bravery to let people know exactly how medical subspecialisation can and does affect patient care and for lifting the lid on what has become a culture that refuses to take care of the patients referred by Emergency Department staff.
Associate Professor David Green
School of Medicine, Griffith University, QLD