That’s the heading of an article by Gerry Fitzgerald appearing in the online journal ‘MJA Insights’ (ie short stories from the Medical Journal of Australia).   This article will be of interest to paramedics who are concerned about hospital delays and being called to what they consider inappropriate calls.  Dr Fitzgerald says:

Professional emergency health care has been transformed over the past four decades with the upgrading and modernisation of both prehospital and hospital-based acute care and the development of new professional roles of paramedic, emergency physician and emergency nurse.

While the improvements in health outcomes are unquestioned, this transformation has also been associated with system-wide congestion which is known to have adverse clinical, organisational and social outcomes, and which is caused by the combined impact of increased demand, access block and increased clinical capability.

However, the public policy responses have tended to be predicated on blaming someone rather than an in-depth understanding of the causes of the problem and designing solutions based on that understanding.

We have tended to blame the patients by calling their attendance “inappropriate”. Or we blame the clinicians or the government for cost shifting, inefficiency or insufficient resourcing.

However, the evidence collated over the past 10 years in particular has shown an entirely different picture and the trends have been confirmed in the recent report into emergency department care by the Australian Institute of Health and Welfare.

Demand for emergency health care is growing by 2% per capita each year (3% for ambulance). Growth is among the more urgent triage categories, across all age groups and both genders and across the system as a whole.

Further, interviews with patients confirmed that the decision to seek acute medical care is generally a conscious and well considered decision based on weighing up the alternatives and often supported by advice from family, bystanders or health professionals.

So if the issue isn’t patient’s abusing the system, what is the issue and what’s to be done?  Dr Fitzgerald has a number of suggestions but rather than repeat them, you can read the full article here: