Over many decades (seven of them) I have had the occasional need to call on the assistance of health professionals. Most have fallen in to the non-emergency category, but there have been a few cases where without appropriate assistance I probably would not have survived – polio and hepatitis are two that come to mind.
In recent decades I have found myself in the emergency department of the public hospital in a nearby city, with no clear recollection of how I got there. I suffer from a form of migraine that often mimics the symptoms of a stroke. It requires an EEG and an MRI to rule that possibility out. Then there was kidney stones where I do remember the painful half hour journey by ambulance to the hospital.
However, today’s post is an observation of how the service of non-urgent medical treatment by General Practitioners (GPs) have changed in recent years. I can only speak of my experience in the town where I live – Feilding (population 15,000). It may be different in other parts of the country.
When we first moved here around 1986, we enrolled with a GP (general practitioner) in sole practice who shared a receptionist and practice nurse with another sole practice GP. This was an a change from what we had in our previous location. There, the family was enrolled with a sole GP where the duties of receptionist, etc were carried out by his wife. Generally an appointment wasn’t necessary. One simply turned up during surgery hours and waited. At the new practice it was necessary to make an appointment first, and usually one could be seen the same day or the next. If it was urgent, but not an emergency, then one could typically be seen within the hour. When our doctor decided to leave general practice and specialise in industrial health, we found ourselves looking for another GP.
Wanting a practice within easy walking distance limited out options to two and we settled on a group practice consisting of four GPs and a number of support staff covering several fields. At first, non-urgent appointments could be booked two days in advance, but over the course of a decade, waiting times became longer until it reached the stage where non-urgent bookings were typically a week away.
Since the start of this millenium there had been discussion about forming a community health centre for Feilding that could provide additional services beyond those that a typical small private or group practice could provide. It could be viable only if all the GPs in town provided services from the same facilities. It was a slow process but a few years ago Feilding Health Care Hauora Tangata opened for business.
While it provided radiology and other services previously only available in the city of Palmerston North (about a 30 minute drive), I can’t say there’s an improvement for non urgent medical attention. At this point I feel the need to mention that what constitutes non-urgent now includes conditions that would have been deemed urgent just a few years ago. Take for example my recent experience.
Weekend before last, I did something that caused an old injury to flare up. When I was 17, I suffered a lower back injury that resulted in one collapsed disc (two vertebrae now grind against each other wearing their faces down), one seriously compressed disc, and another with less severe compression. Over the years I have learnt to manage the injury, and for the most part, it doesn’t cause continuous pain. When I am careless and do something to silly, I can find myself in considerable pain exacerbated by any movement of the torso or legs. This was one of those occasions.
There are a number of exercises I have been taught to assist in recovery when my mobility is compromised like this, and generally within four or five days after a flare up I can reach the stage where the pain has been replaced by discomfort. However this time, the pain severely limited what I could do. As the weekend rolled around again, there had been no improvement and my mobility had become more restricted. So first thing Monday morning I phoned to make an appointment to see the doctor.
It was then that I was reminded how much of an improvement had been made over recent years. After describing my condition to the receptionist, I was advised that my assigned GP was away until August and even though I was in considerable pain and could scarcely walk, it didn’t qualify as urgent and there were no non-urgent spaces available for the next month! After some strong words from me she relented and said she would arrange for a duty nurse to contact me later in the day to evaluate my needs.
At four thirty, the nurse phoned and after a short discussion, she too said that I wasn’t able to book an appointment. However, I could see a doctor if I attended the after hours clinic which opens at six each evening, although I might have to wait a while before being seen. I was there before six but already there was a line of people at the check-in desk. Just as it was about to be my turn, the receptionist put an “Appointments closed” sign in the desk. I wasn’t pleased, and in the condition I was, I didn’t care who knew.
I think the receptionist took pity on me and said she’d try to have me seen by a nurse. Well, that’s better than nothing I suppose, and half an hour later one appeared. She told me the good news. All the doctors on duty were fully booked up for the evening, but if I drove across to Palmerston North I could attend an after hours clinic there. I asked if I could be guaranteed being seen, but no, they too ran their after hours service on a first in first served basis.
By this time my pain was so severe that I could only talk in gasps, and as best as I could I asked if it was reasonable to expect someone of my age, who has nyctalopia and cataracts in both eyes to drive to Palmerston North at night when they can barely walk or sit just on the off chance that a doctor might be able to see them. She conceded it wasn’t reasonable. How generous of her. I asked her what my options were to which she replied she wasn’t sure but she would find out.
She returned about ten minutes latter to give me “great news” that if I was prepared to wait and if a doctor finished all their cases before eight o’clock then he/she would see me, but there’d be no guarantee that I would be seen. I waited. And waited some more.
Some acquaintances tell me I have the patience of a saint, and on Monday evening that played to my advantage. Two people who were ahead of me in the queue were becoming more and more agitated as time wore on. Eventually one, then the other left in anger after waiting around an hour and a half. Ten minutes later, my name was called.
To cut a long story a little shorter, the doctor decided there was no new nerve damage (I’d already determined that) and that with some pain killers, I should be back to normal within a week. I was sent home with a single pain tablet to be taken when I arrived home. A short while later I received an SMS message informing me that a prescription had been sent to my preferred pharmacist and could be picked up in the morning.
The prescription was for Tramadol, which I’m supposed to take three times a day. No way! I tend to experience the worst side effects of every medication, and Tramadol proved to be no exception. Within an hour of taking it, I became fuzzy headed, unable to think clearly and found difficulty staying awake. Shortly after, my irregular heart beat became pronounced. I regularly miss about one heart beat in ten, but it increased to one in every four or five and was very noticeable to me. Then a headache set in. About time to research Tramadol’s side effects.
The possible side effects as described on Drugs.com make alarming reading, and the description on the NZ Health Navigator only slightly less so. I took two tablets yesterday, and only one today and I’m struggling to keep my eyes open as I compose this post. However, I think it has done the trick in relieving the pain as I am now able to do my exercises for managing back pain. Fingers crossed it stays that way.
On a brighter note. I received a phone call shortly after six last evening from Feilding Health Care inviting me to get my first Covid jab. They had a few surplus doses and if I came immediately I could receive my first of the two Pfizer shots. The wife and I were there and had our first vaccination within half an hour, and our next vaccination is booked in for later this month. We had been booked in for our first jab in August, and while there’s no sense of urgency here in Aotearoa New Zealand, it is comforting to know that our personal risk is now even lower than it has been.