In this series, of which you can read part one here, we continue to unravel the crisis in healthcare, highlighting visible failures from a grassroots level view of a practising GP.

The corporatisation of medicine

Recently, I visited the local emergency department with a family member for what appeared to be a bad flu. For various reasons, this was an eye-opener, especially as I hadn’t been to the emergency department for a while. The triage nurse took a brief history that lasted around 5 minutes followed by a waiting period where we were wheeled into a cubicle to wait for the doctor. Instead of a doctor, what we got was a pathology collector followed by a radiographer for a chest x-ray. When the doctor finally arrived, he took another brief history and undertook an examination following which we were informed of inconclusive tests and scan results.

Medical training emphasises a proper history and examination followed by appropriate tests, if needed. Baffled by the inversion of the processes, I inquired of the director of the department at a mate’s level of discussion. He sheepishly admitted knowing it wasn’t the right approach but it helped the workflow to be more efficient and streamlined for a medium-sized private emergency department. What are we compromising in this pursuit of perfecting our models of care?

Today in 2024, generally, there is no real incentive for a doctor to practise good medicine apart from personal morals and integrity. This is due to widespread systemic failures such as those listed above. The average time spent in a GP consultation is between 2 and 15 minutes with various determinants to this. These include doctors working on limited time schedules, lack of holistic medical knowledge, ethics, empathy, and a willingness to be thorough. Expediency and systems efficiency, also plays a role along with time constraints to appointments, religious adherence to protocols, and meeting financial targets and KPIs take precedence. To add to this, there is a heavy reliance on algorithms and guidelines alongside the use of diagnostic investigations that out-compete positive patient outcomes. The duration of a patient-doctor interaction is a prime and direct determinant of patient health.

A thorough physical examination, as taught in medical schools, is a vital aspect of medical care. A large part of the diagnosis hinges on history taking and physical examination and I would argue that it could be as much as 100 per cent. The doctors of the past would agree, as they had no other choice, lacking the facilities and resources we have today. In current-day medicine, this can be overlooked quite easily. A doctor does not have to touch the ill person, and this happens a lot of the time. The pandemic years have shone a light on how off-track medical practices have gone with the introduction of telehealth and, how could we forget the technology to support these practice models such as the no-touch thermometers that were recommended to doctors across the country? A doctor wary of touching a patient is a real worry.

Walk into a local emergency department and you will have a full set of investigations arranged in the waiting room even before you see a doctor. Uber Medicine was the only thing left to try and we’re nearly there. Is this a sign of progress or that of a tired and misdirected system that has lost its way and is falling asleep at the wheel?

Over-dependence on tests and scans

At the visit mentioned above, the treating physician diagnosed my family member with ‘massive’ lung clots that were noted on preliminary scans and immediately initiated blood thinners as per the protocol. I was shocked and bemused as my clinical assessment of the condition based on careful observation over the week was that it was an evolving infection (like pneumonia) and not a case of blood clotting. My discussion with the private lung specialist was met with disdain and resistance as the ‘modern technology scans had conclusively proven’ the clots and that should settle the debate.

Back home a few days later, shocked and bewildered, my nagging worry caused me to seek further advice from overseas colleagues and proceed to request the gold standard scan for these issues (a CT Pulmonary Angiogram). This confirmed my clinical suspicions by refuting the clot diagnosis. The blood thinners were immediately ceased and antibiotics and inhalers were commenced and the patient recovered fully as expected. How did we even go down that path of thinking of clots when there was no inkling of doubt in the history, physical, or biochemical finding with the only suggestion being the scans which eventually was a false positive?

Even to this day, medical training stubbornly teaches doctors to never treat test results or scans but to always focus on the patient before them. The progression of healthcare means we now have a medical system that is heavily reliant on tests and imaging modalities with the basics taking a backseat.

Loss of empathy and sympathy

An elderly Christian woman, a choir member, came to see me, distraught with widespread inflamed body rashes across her arms, neck, and buttocks. She went to a dermatologist who conclusively advised her that she was wilfully scratching herself to create these sores. She returned to her GP clinic for help and was seen by a different GP who not only did not examine her but sat through the entire consultation, eyes fixated on the computer with no eye contact whatsoever. As she concluded, ‘The specialist has confirmed, you do have a psychotic issue…’ Out came the script pad for an anti-psychotic drug (no kidding) with strict advice to take the pill prescribed. The patient’s pleading to have sound mental health, supported by her husband, fell on deaf ears. Further, she was advised: ‘Due to this situation, maybe you will have a greater understanding of your congregation and mental health illness in the church.’ Long story short, a biopsy we did proved that she had a possible tick or mite bite reaction that had caused the massive inflammatory response. She was started on appropriate treatment and is doing better (oh yes, and bringing me the minute ticks on Vicks-soaked tissues that she has been wiping herself with).

As disheartening as it sounds, I wonder what is causing this indifference… What do we need to change to get things back in order? Do we need to start by becoming vulnerable and admit that we may not have all the answers? Do we need doctors to put themselves in their patient’s shoes first before passing judgements? Would listening with empathy and a gentle physical touch help? Would medical schools change curricula for doctors to be trained in the art of medicine rather than the science of medicine? Is it our ignorance or the unwillingness to change or is it that newfound disorder of puffed-up pomposity following credentialism?

The pressing question is can we effectively address the problems confronting medicine? Could this happen while contending with regulatory persecution and resistance from the medico-political-industrial complex that is rooted in profit-centricity with glaring conflicts of interest? Most importantly, will doctors and scientists be allowed to freely discuss science or are we being herded into expert class-driven group-think ‘guidelines’ medicine at the behest of governments that slowly continue stripping away our freedoms?