Going private: obs & gynae on the Gold Coast

10 Aug

I’ve just realised that I’ve said very little about the actual medical elective I’ve been doing while I’m out here! I shall therefore try and sum up my eight weeks spent “working” on the Gold Coast for anyone who is interested…

Pindara private hospital

Pindara Private Hospital

On my first day here, I set foot in my first ever proper private hospital, full of moral misgivings about entering such a den of capitalist iniquity. However, I nonetheless found it hard not to be impressed with how nice it was! The carpeted “wards” – yes, carpet! in a HOSPITAL – consist entirely of private rooms, each one comfortable and nicely decorated with a big TV and a private bathroom.

Staff are treated to similar levels of luxury: the theatre staff room is amazing! It’s extremely comfortable – yet another thing virtually unheard of in Newcastle; comfy chairs for people who have to stand up for most of the day – with a selection of newspapers, snacks, hot drinks from an amazing machine, breakfasts and hot and cold meals all provided FOR FREE. You order what you want for lunch and by 11:30am it’s there waiting with your name on it, and if you’re not sure what you fancy there is also a salad bar and selection of hot things to choose from. I was absolutely gobsmacked when I arrived on my first day and someone asked me what I wanted for lunch, and then even more gobsmacked when I didn’t have to pay!

I’m pretty sure that if there’s one intervention NHS management can make to successfully improve staff morale, it would be giving their staff somewhere comfy to sit and a decent lunch on the house. That, and a guarantee of a parking space in the morning. That’s another good thing about Pindara!

The difference in the overall mood of the staff here was palpable: everyone is so relaxed and happy! This is probably due in part to the free lunches and the nice coffee, and in part to the fact that they’re Australians, but it’s also because they feel part of a team and that they are genuinely rewarded and appreciated for what they do. Many of them used to work in the public system but got sick to death of doing slave labour for little reward, and left to find better jobs. It was a joy to work in such a pleasant environment – I actually looked forward to getting up at 6am and spending a day with the lovely theatre staff!

Australia’s healthcare system is approximately 50% public and 50% private. Public healthcare (Medicare) is provided for free and paid for by taxes. Private healthcare is paid for by health insurance, and most people can claim some of the money they spend going private back from the government. The fact that health insurance is reasonably priced (because so many people use it) and there is a financial incentive to go private means that a lot of people do, and this significantly relieves the burden on public hospital waiting lists and resources. When I came here from the gloriously socialist NHS, I was morally opposed to the idea of private healthcare, presumably because  I assumed it would be like America where people are turned away at the door if they can’t pay for treatment. However, in Australia people go private because they want to, not because they have to. It’s relatively affordable and it means you have the freedom to choose exactly which doctor you want to see, with the guarantee of much shorter waiting times and a comfortable hospital stay. Also, most patients feel a sense of pride in having the means to go private and relieve the pressure on the public system – using public healthcare resources when you can afford to pay your own way is almost seen as “sponging off the state”.

Coming here has given me a lot to think about and has changed my philosophy on healthcare provision: I think that if it is to survive, the NHS needs to change its core principle from “free healthcare for all” to “free healthcare for those who are unable to easily afford it“. Our overweight and underexercised upper and middle classes are unthinkingly draining NHS resources, when they could easily afford to pay for their own antihypertensives, their own statins and their own insulin.

The rooms

Malcolm's rooms at 140 Ashmore Road

My main supervisor is Malcolm Frazer: my dad’s bezzie mate, published author, pianist and urogynaecologist extraordinaire. As a result I spent most of my time at Malcolm’s “rooms”, where he sees and reviews his patients and performs urodynamic tests on ladies’ bladders. It’s basically exactly the same as a clinic in an NHS hospital except for the fact it’s located in a converted bungalow on a busy street and operates as a private business. Linda (a qualified nurse and Malcolm’s wife) does education sessions for patients undergoing surgery, and they have a pelvic floor physiotherapist who comes in on Fridays. They also have “the chair”, which uses magnetic pulses to stimulate and strengthen pelvic floor contractions (some of the little old ladies look a bit flustered after using it).

I was expecting Malcolm’s patients to all be members of the glittering super-rich, but once again my expectations were way off the mark! Admittedly there was the odd lonely millionaire’s wife who’d never done a day’s work in her life and clearly enjoyed coming to the doctor because it meant she had someone to talk to, but generally his patients were “normal” people: teachers, nurses, midwives, secretaries etc… which just goes to prove my point that a lot of people can afford to go private here if they want to.

Another thing that surprised me was the stubborn refusal of a lot of Australian women to grow old; some of the 70-year-olds managed to still look about 45 due to a combination of a healthy lifestyle and a good session with a private cosmetic surgeon!

Urogynae: Making a difference

Incontinence is a huge problem and causes a great deal of misery and anguish

Fair enough, urogynaecology may appear in one’s initial estimation to pale in comparison with my previous placements in congenital cardiac surgery and lung transplantation, but I’ve remembered while I’m here that medicine is about quality of life as well as quantity of life, and just because a disease won’t kill you (in Malcolm’s words, no-one ever writes ‘prolapse’ on a death certificate) doesn’t mean it can’t make you completely bloody miserable. Any procedure that can relieve the distress of a long-suffering patient is intrinsically incredibly worthwhile, and a lack of blue-light ambulances and marathon surgeries in the middle of the night does not make the results any less impressive or valuable than the outcomes of the ‘cooler’, crazier specialties I’ve experienced previously.

The obligatory photo of a humongous prolapse

Here are some interesting things I’ve seen:

  • an elderly lady who’d been suffering in silence for years with a MASSIVE prolapse having it sorted out in the rooms in 5 minutes with a simple pessary: the expression of disbelief and gratitude on her face was unforgettable!
  • generally seeing enough prolapses of various bits of insides to put me off childbirth for life: I’ve started doing pelvic floor exercises!
  • dozens of women with humiliating stress incontinence who now have freedom and a new lease of life after a simple operation that takes under an hour to perform.
  • a lady with fairly severe dementia and an overactive bladder, whose husband and daughter were struggling to cope with her care because she needed taking to the toilet around 30 times a night. She was hardly getting any sleep, and her fatigue was exacerbating her confusion and anxiety. She was given oxybutinin and within a fortnight was only getting up two or three times a night,  so she and her family were able to get a good night’s sleep and enjoy more quality time together.

Interstitial cystitis as seen on cystoscopy... if you fill the bladder with too much water the muscle just rips apart (image from iTriage)

  • interstitial cystitis: every organ system appears to have one fecking awful disease that can affect it – lungs get fibrosis, brains get subarachnoid haemorrhages, bowels get Crohn’s disease – and this is the bladder’s. Interstitial cystitis is a chronic inflammatory disease of the bladder characterised by agonising pelvic pain, incessant urgency and urinary frequency. Patients can only hold tiny amounts of urine in their bladders before a combination of pain and urgency drive them back onto the loo. Any semblance of a normal existence becomes pretty much impossible. Hydrodistension to stretch up the bladder, intravesical dimethyl sulphoxide and oral sodium pentosanpolysulphate can help a bit, but some genius needs to find the cause before we can actually treat it effectively.
  • bladder cancer and breaking bad news. Horrible. No further comment.

Voiding cystourethrogram showing urethral diverticulum (image from American Journal of Roentgenology). Gross gynae fact of the day: if one of these gets infected and you poke it, pus pours out of the urethra

  • a urethral diverticulum: a rare little thing that is a bit of a surgical faff to get rid of.
  • a lady with an artificial urethral sphincter – she wrecked her pelvis by driving a jet-ski into a tree – which meant she could decide when to empty her bladder. I think this would be really convenient!
  • the removal of a copper IUD which had been inserted in Russia 30 years previously and subsequently forgotten about… it was pretty disgusting.
  • a haematometra. This was also pretty disgusting.

Lichen sclerosus with vulval scarring and adhesions (image from YourDoctor). OUCH.

  • lichen sclerosus: another horrible idiopathic disease which results in white scarring and painful adhesions in the vulva and vagina. Thankfully steroids work a treat in most cases.
  • a lady with enormous labia (I’m talking several inches) which were causing real problems: she couldn’t empty her bladder properly, and couldn’t keep things clean so she was getting recurrent UTIs and rampant thrush. We did a labioplasty – from a female perspective it was PAINFUL to watch – which tidied things up nicely. Apparently labioplasties are where all the money is in gynaecology: a cosmetic gynaecologist would charge at least $5000 to do one, and they only take half an hour! Other things you might find them doing for exorbitant sums of money include G spot augmentation, “vaginal tightening procedures” and, more disturbingly, hymenoplasty: “reconstruction of hymen to a virgin-like state”.
  • a moderately insane woman with persistent haematuria and sterile pyuria. Despite having pretty much every test going and being reviewed by several urogynaecologists, an infectious diseases specialist and a renal physician, there was no evidence of any underlying cause, and she remained completely well. Either she has some never-before-seen weird syndrome, or (much more likely) she’s my first ever proper Munchhausen’s case!
  • meeting (i.e. saying hello to) Mr Ash Hanafy, who is currently making valiant attempts to figure out how to do a womb transplant… interesting stuff!

Obstetrics: Making babies

As I’m sure most of you will be aware I adore obstetrics, so I’ve relished the chance to get stuck into bringin’ some babies while I’m out here under the supervision of Ben Bopp, a true blue Aussie obstetrician and top bloke. With it being a private hospital, there is unsurprisingly a pretty high Caesarean section rate (over 60%). Consequently, most of my obstetrics experience here has involved assisting with joyful, civilised elective Caesarean section lists. The difference from the NHS is striking, not in terms of quality of resources or quality of care but in terms of all the little added extras. Parents are allowed to bring cameras into the operating theatre to photograph the birth, and there is also a professional photographer available for hire. I think this is a fantastic idea – I always felt really sorry for the excited dads-to-be at the RVI, who would bring all their camera gear only to be told they weren’t allowed to take any photographs of their own child being born in case the hospital got sued. Also, there is a paediatrician present at every Caesarean birth, who gives the baby a full check before letting the midwives take over. Other than that, everything is pretty much identical to the NHS, so I won’t blither on about it.

One of the midwives let me manage a normal delivery on my own, which was amazing! I wasn’t allowed to physically deliver the baby (the woman has paid for the consultant to do that) but I was the one who got her through it by monitoring her contractions, telling her when and how to push and constantly telling her how well she was doing! I saw some tiny premature twins who had to go to special care. I witnessed my first third degree perineal tear and wanted to scream (I think I have PTSD – I keep getting flashbacks of it). They do a lot of IVF here so I saw some egg harvests. Oh, and I saw a bicornuate uterus, which was pretty funky: it was shaped like a heart with the baby up on the right and the placenta up on the left (the placenta did explode slightly, which was a bit scary but all in a day’s work for an obstetrician).

Anaesthetics: Making people sleepy

On my days in theatre I also learned a great deal of invaluable information about anaesthesia, pain control and general principles of patient management from the legendary Dennis Wooller. Thanks to him I finally understand the difference between an epidural and a spinal. He also gave me lots of very educational top tips on places to visit whilst in Queensland. Cheers Dennis!

Memories & milestones

  • becoming a pro at catheterising grown-ups having originally learnt on babies
  • doing a cystoscopy and getting wee all over my shoes
  • literally ripping out with my own hands a scarred incontinence tape that had been causing a woman pain for years – pretty brutal!
  • helping to bring even more tiny new people into the world, even if they were Australians
  • seeing people eggs (which look surprisingly similar to chicken eggs) in a Petridish waiting to go party with some sperm and become actual people
  • double-gloving every time I scrubbed and as a result almost certainly defeating my needle-stick paranoia
  • actually being able to RELAX for a bit because none of the patients I saw were dying or imminently about to risk dying
  • meeting a wonderful group of caring, dedicated, talented people who have enlightened me as to what I should and shouldn’t have to put up with in my career – we are NOT slaves to the system!
  • spending plenty of time “watching Diagnosis Murder“, reading novels and sitting in the sunshine

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