It started with an odd sensation in my leg as I ate chicken and leek pie in a Sydney CBD restaurant a few weeks back. I thought there must have been late-night jack-hammering as the floor felt as though it was vibrating.
Then at home in bed, at 2 am, I was woken by a weird sensation in my foot. It felt like a buzzing, similar to the feeling in your pocket when someone calls your mobile which is set to vibrate only. It was as if my foot was the buzzing phone and someone wanted me to take the call.
It even had the timing of a mobile, it rang for a second, then paused for a second. I realised it was linked to my pulse.
I reached over to my mobile and googled this strange symptom. The first website link which came up was titled Learn the early signs of heart attack.
As I now live on my own, my imagination took over, and I catastrophised that I was about to go into cardiac arrest and would not be found for several days.
I dressed and rode my bike up the Pacific Highway to Royal North Shore Emergency. It was 3 am.
While I was being triaged, the medical staff seemed a lot more relaxed than me about this strange symptom. One even seemed incredulous that I would present in emergency with something so trivial, although I noted he was not clear on its cause.
I considered the foot buzzing so strange that it must have been a sign of something serious. The medical staff, all of them polite and professional, could barely take it seriously. I’m pretty sure one was sniggering.
But what did impress me was the lengths they went to in order to prove nothing was happening. I saw two triage staff and two doctors.
They kept me under observation, put me in a comfortable chair, and offered a blanket.
Around 6 am my foot stopped vibrating. Humiliation came over me, and I decided to check myself out of the hospital. But they were not done.
As the source of the vibration had not yet been explained, they were reluctant for me to leave. A doctor visited again. He asked questions about lifestyle, diet, smoking, drinking – offering gentle little bits of advice at times. He then cleared me to leave but instructed me to return if anything changed or deteriorated.
As I was leaving, he delivered his key point: ‘Perhaps next time you could go and see a GP first. Do you have a GP?’
It was a good point and embarrassing for me to hear it. Yet my experience revealed something important about our health system… It provides a very comprehensive hospital service, at zero cost. And this zero cost means it is going to be awfully overused.
Let’s consider the alternative path that I could have used to have my buzzing foot diagnosed and treated.
Instead of going straight to the hospital, I would have had to wait until 8.30 am to make an appointment with a GP. At times, even GP visits can take up to a week to schedule.
Let’s assume a slot is available that day, so 3 pm. All day I would have had to wait, potentially quite nervous that I was about to experience a cardiac event. Then you get a 15-minute consultation, and if a diagnosis cannot be provided within that time, it is likely that you will be referred to a specialist or, at a minimum, a series of further tests. Remember, it was not immediately obvious to the hospital doctors why my foot vibrated.
Getting a specialist referral then sends you down a whole new scheduling palaver, probably involving a two-week wait for a time. You probably also need to go to a pathology service in the meantime to get some blood taken.
Once you get to the specialist, either the problem is definitely diagnosed on the spot, or more tests are requested, and future appointments will be necessary. You get onto a sort of merry-go-round, tests, results, appointments. The harder the diagnosis, the longer and more draining it becomes.
With both the GP visit and specialist appointment, it is likely that the patient will need to pay money, even if they have private insurance, as most medical professionals now charge gaps.
In contrast, by going directly to the emergency department of a public hospital, a patient avoids all out-of-pocket costs, all doctor consultations and tests are paid by taxpayers. It can sometimes require waiting in a queue, but once admitted into the emergency system, the hospital will quickly roll out a whole lot of free diagnostic and free services.
While the financial costs are one incentive to favour hospital visits over GPs, probably an equally critical issue is the length of time a diagnosis can take in the private system. The hospital staff are likely to keep testing you until they have found a reason for your symptom, it happens in real-time, avoiding scheduling specialists and fronting for tests.
The inefficiencies of the GP/private system need to be addressed otherwise people will increasingly walk into emergency to get routine treatments for things as trivial as a foot with twitching nerves. An alternative is to charge a fee for every hospital visit, perhaps supplemented by a rebate system for low-income people.
By the way, the vibrating foot mystery was solved by a female friend who researched the issue for me using Chat GPT. She discovered that my vibrating foot can be caused by an excess consumption of calcium.
As it happened, a few weeks before the problem, I’d changed my diet and had been eating a lot of plain yoghurt. Apparently, too much calcium can block some other vitamin, resulting in a twitching foot. I stopped eating yoghurt and the problem has not re-occurred.
My guess is that fixing inefficiencies in the health system won’t be so simple.
Nick Hossack is a public policy consultant. He is former policy director at the Australian Bankers’ Association and former adviser to Prime Minister John Howard.
