Comments on: New economy shock! Telemedicine can improve people’s health

By: billie

billie — Tue, 03 Feb 2009 01:13:27 +0000

I had been wondering why Australia doesn’t have centralised electronic medical records yet. I know that the development work was done a decade ago and I knew there would be political impediments to it. Meanwhile Brazil has a medical system where a physician in Sao Paulo can access patient records from Rio De Janerio. Not sure that all Brazilians have electronic medical records as there is no universal health care there.

In rural Australia patients regularly wait 3 weeks for a medical appointment which may be for repeat prescription, medical certificate because unable to sit a university exam or attend work, or medical certificate to get subsidised taxis. Surely a nurse or pharmacist or vet with medical knowledge and integrity could certify this bureaucratic paperwork

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:48:56 +0000

If you come from the ambo in having had the paddles applied to your chest etc because of heart failure then you’ll get treatment quicker – but no quicker than if you come in grey looking with pains down the left hand side driven in by a taxi.

You get treatment quicker because of acuity – ambos have some input into the triage classification. But by and of itself coming in by ambulance doesn’t get quicker treatment.

By: Nicholas Gruen

Nicholas Gruen — Mon, 02 Feb 2009 11:39:12 +0000

It may be that it’s continuation of existing treatment that begins in the ambo. Amazing what a bit of reclassification does.

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:35:50 +0000

btw my youngest has asthma – rarely bothers him now but when he was small it was frightning when acute – I know what its like to be in A&E at 3 am etc.

Then about 15 years ago all treatment improved in an amazing leap with preventatives and acute self medications nand self management.

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:31:57 +0000

I’m trying to remember asthma treatment but I think that the ambos will have started something – do they start oxygen or salbutamol nebulised or corticosteroids?

If so then the hospital treatment will be a continuation of ambo intervention.

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:19:26 +0000

Perhaps theres a misunderstanding here.

Do you mean you get to triage quicker or that you get to treatment quicker?

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:15:43 +0000

nic – I would report any A&E for malpractice if it was doing what you said without proper triage.

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 11:15:20 +0000

nic – I would report any A&E for malpractice of it was doing what you said without proper triage.

By: Nicholas Gruen

Nicholas Gruen — Mon, 02 Feb 2009 11:04:50 +0000

FX,

I was introducing evidence to support my case. What’s yours?

By: Francis Xavier Holden

Francis Xavier Holden — Mon, 02 Feb 2009 10:20:49 +0000

The need for face to face is partly to stop fraud, partly to prevent patient harm and other stuff and largely good medicine. In general it’s not good medicine to advise or prescribe without a physical or some sort.

It’s not true that telemedicine is banned in Australia. In fact there is a specific item on MBS for tele consultations, at least for psychiatry, that I’m aware of since 2005.

Theres no way arriving by ambulance makes any difference to how soon you are treated at any A&E in Australia. You will be triaged on life threatening acuity just like everyone else.

Providing people can be commonsensical in discussing the symptoms

yeah well – there’s the rub mate

By: Nicholas Gruen

Nicholas Gruen — Mon, 02 Feb 2009 08:42:07 +0000

I’m not reporting an assumption basalisk, I’m reporting our experience – and also what we’ve been told by doctors and authorities. No doubt we wouldn’t be seen earlier if someone was at death’s door.

By: basalisk

basalisk — Mon, 02 Feb 2009 08:24:55 +0000

I’m sorry, but I’m sick of the assumption that if you pester the ambos to give you a lift to the emergency department, you’ll get seen before the shmoes stupid enough to walk in through the door.

I’ve worked in several EDs in two different states, and they all use the same triage guidelines. Mode of arrival doesn’t factor into it. You come to the front counter with chest pain and a history of prior MIs, you will be seen before someone who came in an ambulance to get their prescription for blood pressure meds. (Don’t laugh, it happens.)

DON’T USE AN AMBULANCE BECAUSE YOU THINK YOU’LL BE SEEN FASTER. YOU WON’T.

By: NPOV

NPOV — Mon, 02 Feb 2009 07:12:17 +0000

Is the Nurse-On-Call service no use for that sort of thing though? We’ve used that a couple of times, and the first time they reassured us it wasn’t worth taking our then 2yo into hospital, the second they confirmed it was worth doing so (nothing serious, just needed some suturing).