Sometimes when you have a health issue it can take a long time to tease out exactly what is responsible for your presenting symptoms. In my own case this applies to the debilitating post-viral fatigue that I developed after a trek in Nepal in late 2011.
The jury is still out, but I have already been assessed by three departments of one of our major teaching hospitals, including Infectious Diseases, Haematology and Neurology.
Many of my appointments have involved the customary long wait in the Outpatients Department along with a herd of other people. I think at worst this has been about three hours. On this occasion one saintly staff member started bringing around cups of water to the waiting crowd.
We are lucky to have a fine public hospital system in Australia that gives people access to the specialist care that they could not otherwise afford, but it is a pity that there does not seem to be any antidote to either the lengthy delay in scheduling of appointments or the crowded and slow-moving waiting rooms. Despite these trying circumstances, people are generally still very resigned, patient and polite and remain grateful for the attention they receive. We are conditioned to accept that it "is what it is" in terms of waiting for healthcare, whether it is at the GP or in the Emergency Department or Outpatients.
However, I digress. For my neurological symptoms I was fortunate to see an experienced consultant whom I knew of by reputation. In addition to blood tests I was scheduled for a Neurophysiology nerve conduction study and two MRI scans (brain and lumbar spine). There was a little bit of a wait on the day of the nerve conduction study and I was a little concerned whether I would get back to my car within the two-hour parking limit but fortunately I got back with about five minutes to spare. The study itself was an interesting experience. I had used a nerve stimulator on other people during anaesthetics training and had tried a TENS machine on myself, so initially it was quite similar to this, with electrodes being attached to my skin and conduction being measured with electrical stimulation, both before and after "exercise". As my muscles were getting fatigued with exertion, I had assumed this aspect would involve at least moderate exertion of a reasonable duration, but this was a faulty assumption. This component involved only a small number of repetitions of almost minimal movement e.g., opening and closing your thumb. The second aspect involved the insertion of fine needles under the skin, identifying pairs of nerves and measuring conduction. This caused a little bit of bleeding in my forehead so pressure had to be applied to prevent a haematoma and bruising. I was quite surprised that this area was exquisitely tender for about ten days afterwards.
My first MRI (brain) was in the public section of the hospital. Once again I did not have to wait too long to be called through. After changing into a hospital gown there was a little bit more of a wait before one of the nurses inserted an IV cannula in my arm (for administration of contrast) and went through the safety checklist. The cannula took two attempts but we had a nice conversation, and I was asked several times if I was warm enough. I was given some headphones to listen to music during the MRI scan (rather loud and bombastic classical music unfortunately) and was again asked several times during the scan if everything was OK. There were lots of loud noises, clicks, whirring and even some vibrating from the scanner, but time passed quickly enough. I can see why some people might feel claustrophobic in the small narrow tunnel, but I just closed my eyes and tried to assume as meditative a state as possible, and all was fine.
The second MRI (lumbar spine) was in the private section of the same hospital one evening. This time it was a long wait for the scan and in the holding bay before the scan, but the staff was attentive and caring. I had a 7pm appointment and left at 9pm.
My outpatients appointment was on 22 March, but the day before the second MRI I received an unexpected letter advising me of an appointment for a third MRI on 9th April. I queried this at my second appointment, and was advised that there had in fact been three MRIs requested (brain, lumbar spine and cervical spine), but this had only just been realized so a third scan had been booked. I was concerned that this booking took place after my outpatients appointment (for which I had already been waiting several months) had been scheduled. In the end I was just told “sorry, we can’t make it any earlier”. I then contacted Outpatients, and asked for an early appointment after my third MRI scan. It was a case of “sorry, the earliest is 10th May”. A few weeks later I received a letter advising me (without explanation) that the appointment had been moved to the 25th of May, which was two months after my previous appointment.
I will now be having the review of my blood tests and investigations six months after my initial appointment with the neurologist. It will then be over eighteen months since I first attended the hospital seeking a diagnosis for my post-viral fatigue.
I have gone through this process to date the same as any other person, without any special favours due to my vocation. This first-hand view of a compartmentalized and overstretched system is not reassuring in terms of the health care of the average person without the benefit of medical training to assuage their fears. On an individual level, everyone is doing their job and doing it well (with the exception of failing to book a third scan around the same time as the other two) and as is so often the case it is perhaps systemic issues that need to be addressed. Surely we can do better. It would be interesting to know how often logisticians and systems analysts have been included in review teams focusing on how to make our health services function more efficiently.
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