Andrew Miller: The most vulnerable patients are out of patience, pollies need to put ED fix as top priority

I am not a detailed “to-do list” sort of person, much as I respect those freaks who are. Since the days of the Palm Pilot - may it rest in peace alongside my Nokia and Blackberry - I have failed to evolve an obsessive persona that tracks the metadata of life. Personalities, as we learn at school reunions, are set in concrete before the age of six. I get stuff done, when I have a minute, based on the volcano principle - whatever is hot rises to the top, and if it falls down and gets cold, it probably never needed doing. My mate Gio, a Milanese software engineer and thinker, says that if we maintain thorough-enough checklists about what we should do, we have no time left to do. On company boards I have approved many Gantt charts and detailed project roadmaps - planning is essential - but the risk is that the plan itself becomes the holy grail, and inflexible people start twisting reality to suit the paperwork. You cannot understand complex issues until you have all the information, which only emerges along the way. Just ask any triage nurse treading water in the maelstrom of an Emergency Department. A most reluctant patient, I sat on a plastic chair clutching my sick bag in the crowded ED waiting area, between an ominously quiet anaemic old bloke and a rambunctious twenty-something healthcare consumer in a hospital wheelchair. He was yelling at the triage nurse “if you don’t effing get me in right now, I’m gonna pass out!” “I’m watching you sir, never fear” the nurse replied, poker faced. Western Australia’s Health Minister Meredith Hammat has been keen to remind us recently that triage occurs in ED’s, meaning that we prioritise based on superficial screening. The Minister was responding to the accelerating meltdown of our stalled public health system, which is now giving her government political chest pains. Is it passing indigestion, or a polling heart attack that could decimate Labor’s bloated back bench? The answer is uncertain, the consequences of being wrong are severe, and even veterans can get it wrong. Just ask former emperor, Colin Barnett. I have sympathy for the Health Minister - she was only recently appointed as Chief Deckchair Steward on the Titanic. However, if she thinks she can reassure suffering patients with reminders that others are sicker than them, then she is launching the wrong lifeboat. When you are down more than a thousand beds through incompetent planning, blaming other politicians over in Canberra sounds desperate. Whatever is bad in the city, is worse in the regions. This might turn out to be electoral cancer, and treatment delayed is treatment denied. Triage in ED’s was never designed to substitute for a proper diagnosis or wildly inadequate resources. The public are not silly enough to think it is reasonable to wait days for emergency care, or to have elective surgery repeatedly cancelled, however curated the queue may be. If they put you in category three instead of one, by the time someone realises the mislabelling you might be on the verge of becoming another cold statistic. Diagnosis is frequently difficult, complicated as it is by the interaction of medication, chronic disease, aberrant physiology, human memory and communication difficulties. It takes decades to make a great diagnostician, and even then, rare serious problems presenting with common signs can fool everyone, except time. Some patients we just need to observe for a while, but that luxury is unavailable today. We spend a lot on health already, but rather than this being an excuse, it should make us focus on why the massive flow of taxpayer dollars is failing the coalface. Planners listen to management consultants, instead of annoying doctors and nurses who work with patients. The government’s chest pain won’t subside quickly. They must first accept that if they don’t radically reconfigure their outdated plans, the public might plot some changes of their own - at Parliament House. Andrew Miller is an anaesthetist and director of the Federal AMA