In 2008 I was a Staff Specialist Emergency Physician at a major regional hospital, located between two large cities. In the near decade, I had been there I had seen the demand grow and the resources shrink, as senior doctors left and were not replaced. The ED desperately needed more space and more staff. “Access block” was a relatively new concept but it was clear that it was here to stay. Often ICUs were full across the whole region. Another round of Department of Health funding allocation had just been announced and our hospital wasn’t on it.
I felt that no one was listening to us at the front line. Surely if people knew and understood how things were, they would fix it! The managers mustn’t be passing on the facts, or there would be action! We all need the ED to be functional for us, our friends, our kids. This is a crisis and no one out there knows about it.
Although we weren’t supposed to speak to the media, I was more and more frustrated. I felt unheard and powerless.
I spat the dummy.
I wrote a letter to the patients of tomorrow, the people who currently are well and whole and among us in the community, but who tomorrow will be in my ED as a patient, often experiencing the worst day of their lives. I wrote a letter to warn them. Because a doctor has a duty to warn.
I submitted it to the Sunday Mail and it was published the following weekend. I asked to remain anonymous. However, I had circulated a copy of the letter to all of the FACEMs in Queensland a few days before the submission asking for comments, so my identity wasn’t a secret; it just wasn’t published.
More than a decade later, the sentiments expressed in the letter remain relevant, arguably now more than ever, after the last 12 months of the pandemic experience. In 2021, our EDs are described as being in the worst crisis for 30 years
In 2008, this was the letter I submitted – and it feels possibly more meaningful now than ever before.
Hello. It’s me. YOUR Doctor
Surely not my doctor, you are thinking. Yes, your doctor. If you live in my area, or have even travelled from Brisbane to the Gold Coast, I am your doctor. That should be just about everyone reading this, all the way up to you, Madam Premier. I work in a public hospital Emergency Department, and when you’re in my part of the world you are potentially my patient. You, your family, your friends are all my patients, at some time or another. And as your doctor I have to warn you, things are not good.
I’m not supposed to talk about it, but since you are my patient it’s OK to tell you. Tomorrow you’ll be my patient. Tomorrow that bad thing is going to happen to you, and your life is going to change forever. That heart attack you knew was coming sooner or later, the crash on the freeway, even the two year old face down in the swimming pool. We’ll know tomorrow who you are, and I’ll be doing my best to help you.
Who am I? Since I am your doctor, you should know something about me. You’ll be too distracted tomorrow so I’ll tell you now. I’m a Queenslander born and bred and have worked in public hospitals since the 80’s. I am a specialist in emergency medicine. My team and I save people’s lives for a living. We are good at it, and enjoy it. We can deliver first class emergency medicine to the people of Queensland and those just visiting (yes all you tourists, I’m your doctor too). I’ve travelled a bit, and this part of the world has a fantastic emergency response service and I’m proud to be part of it. You as Queenslanders and as Australians expect it and you deserve it.
So what isn’t good? Put simply, the emergency department, the place the ambulances are rushing to, is already clogged with people. You’ll notice that from the time you arrive. If you arrive by ambulance it may be some time before we can find a space for you, but the ambos will take care of you until we can take over. It’s noisy, and everyone will be in a hurry. A lot of the staff haven’t worked here very long. So many of the experienced ones have left because of the stress.
You’ll probably work out who is who as you wait, unless you’re unlucky enough to receive immediate attention. Only the sickest people get immediate attention. The ones who can’t breathe, the ones who are unconscious. If that’s you tomorrow, I’ll see you as soon as you arrive and I’ll use my skills and experience to stop you from dying, work out what’s wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don’t remember me, but I don’t mind. If I smile when I see you in the hospital kiosk next week it’s because I like seeing a good result.
For everyone else, I’m sorry about the wait. We do try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year on year more people are seen in emergency departments across the country, that’s not the only reason we’re clogged with patients. A bigger problem is that we can’t get people out.
Hospitals (public and private, if any of you are losing interest) often have no available inpatient beds, or no available intensive care beds, or no available coronary care beds and so often very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don’t have rubber walls. Somebody has to suffer.
Winter is the worst time. Often there are no available public or private beds in South East Queensland. Patients on trolleys are lined up and down the corridors, and there they stay until one comes up. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we’re both stressed.
As your doctor then, I want to warn you that when you come to my emergency department tomorrow your experience may not match ‘All Saints’ with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That’s all I can do.
Since you are going to be my patients tomorrow, I have some requests for some of you.
Could the 27-year-old office worker please ask what the tablets are and tell someone before taking them tonight? It may not be what you think it is, but it gives us a start.
78 year old male retired railway worker with chest pain: I know your GP is very familiar with what medicines you take but I will need to know in a hurry and sometimes it’s hard to get through to the GP. Please make a list of your usual drugs and keep it up to date. Often your chemist can help.
28-year-old car salesman, car versus tree after the party tonight: you can’t drive better with a few drinks under your belt. And it’s not clever to take your mate’s girlfriend for a spin, after tomorrow she’ll never look the same again.
19 year old student pregnant for the first time, nine weeks and bleeding: we know how upset and worried you are. We’ll get you into a bed as soon as one comes up. Mostly what happens will happen, whether we get you into a bed or not. But we’ll still try.
85 year old retired coal miner and respiratory cripple. Modern medicine is a wonderful thing and we have the technology to pull you back from the brink over and over again. Just remember it’s like skipping a stone: each skip is shorter and lower than the last and eventually there’s not a lot to be gained from skipping again. When you have had enough, when a few more days or weeks aren’t worth the needles and the tubes and the masks and the whole carry-on, let me know. Say you don’t want to do it any more. I will look after you. But don’t wait until tomorrow, because by then you’ll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones, and you need to do it now. Then tomorrow, when you tell me you don’t want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and how you feel. I will do my best to follow that wish. Everyone wins.
Unknown male approximately 25 years old, found on the footpath in Fortitude Valley in the early hours of tomorrow morning: I don’t know if you can hear me but I will talk to you anyway. Maybe I won’t say enough but it’s hard having a one-way conversation. Rest assured that I will be caring for you as well as anyone can. I will look after your airway, your breathing and your circulation while the cause of your coma becomes clear. I will talk with your relatives, and I will tell them that I will bring you back to them as soon as I can, hopefully with a diagnosis. If it is drugs, please learn from this.
35 year old female shop floor manager with recurrent abdominal pain, please see your GP again before coming to us. Yes we deal with belly pain, yes we have good drugs. But what you want is to know what is wrong with you and that is something your GP is well on the way to discovering. Please persist with him or her, if you come to see us we’ll just have to start all over again. Your GP is the person to see for a second opinion when things aren’t getting better as planned. Even if they were the first opinion.
26 year old male driver of car versus post on the way to work tomorrow, you may have broken your neck and moving it may make things worse. Wait until we make sure it is safe before worrying about the car. We may take some time, there’s often a queue for x-ray. Yes, you do need to lie there and keep the collar on.
21 year old male, don’t inject speed if it does that to you. If you act psychotic we will need to treat you, even if you don’t want it. Please don’t hit is, bite us or spit on us, we are only looking out for your best interests.
53 year old Queensland Health senior manager, we are drowning down here. I am your doctor too, and I am tired of waiting for the problem to be fixed. You have a list of priorities, I understand. There are lobby groups all around you. Good quality emergency care is critical for all of us, you me and everyone else. It is in your own personal interest to get my emergency department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. I know you have to have the data. I know you need to analyse the situation. But this needs some action, and it is needed now. We are all at risk. There are things which can be done, now.
Other doctors, I am your doctor. Please help me out when I ask you for help with a patient. I’m not doing it to spoil your day. I’ve got people building up behind them and there’s nowhere else to go. If you’re in the private sector, please let me know if you don’t want to take patients from the emergency department because it will save me some time in phone calls. When you are my patient, please let me get on with my job as well as I can, and I’ll try to treat you like anyone else.
Politicians and powerbrokers, I am your doctor too. I know you have private medical cover; I know you have a very good relationship with your GP and a variety of specialists who look after you very well. But tomorrow, it may be you who collapses in the park walking the dog, it may be you collected by the BMW that lost it on the corner in the middle of town, it may be your child who is bitten by the snake on the school excursion. No one is going to check for a Medibank Private card. They’ll bring you to me and I’ll be your doctor then. How prepared and capable do you want me be?
To all of you who are my patients: I am doing the best I can under the circumstances. I can’t save everyone. I can’t be right every time. I won’t be able to get to you as quickly as I would like, and nowhere near as quickly as you would like. I have a lot on my plate. Please be understanding. It’s hard enough keeping you all alive without being abused while I’m doing it.
Back in those days social media was only for geeks. People read the newspapers. It made an impact. And no one tapped on my shoulder; I was still anonymous. I went to work as usual and that week the Sunday Mail contacted me and asked for comments on what actions the Health Department should be taking. I told them. The following Sunday, they published what I had said. Still anonymously.
The next day I received a message via the AMA that the Premier wanted to know who I was so that she could meet me to talk about the issues I had raised. I agreed and we met a few days later in her office. The Health Minister was there as well.
I felt very thoroughly listened to.
Later that year, my hospital still hadn’t been offered any substantial relief.