The laser again

A personal memoir for a change

It is a couple of years since my last visit to the laser but last Monday I had to go again. When my skin cancers get too big for excision or freezing, the laser is the last option before a graft.

So about three weeks ago I rang the best dermatological surgeon in Brisbane -- Russell Hills -- and made an appointment to see him a few days later. He agreed that it was laser time and booked me in for the procedure a couple of weeks later. If I had gone through the public hospital system, I would still be waiting for a consultation and the procedure itself would be a year or more off.

As I have had so much dermatological surgery over the years I am a connoisseur of it so when I say that Russell is the best, I am in a position to know. His excisions and joinups are so fine that they heal with maximum rapidity -- which is the main thing from my viewpoint. That skill does however make him much in demand by ladies for their facelifts etc. You can't see the scars where Russell has been.

Anyway I arrived at Northwest Private Hospital at the appointed time in the late afternoon and went through all the introductory bureaucratic procedures that are mandatory these days. I was however at the end of the day's listings so I was the victim of all the prior medical misadventures of the day. Russell's anaesthetist had been much held up by unforeseen circumstances on his morning list (surgery that was more complicated than foreseen and which therefore went on much longer than planned) so I was two hours late going into theatre. Russell came out personally to apologize and explain to me shortly after I arrived, however, so I kept my cool about that. Being treated with courtesy makes a big difference to my responses.

And in theatre I was given only locals at my request so I was awake and alert there. And I had the odd chat and joke with Russell and the nurses while my lesions were being attended to. It was very civilized.

So Brisbane private medicine is a dream as far as treatment of patients is concerned. I guess not all patients are on first-name terms with their surgeon but it can happen for repeat customers like me.

But there is a but. It costs a lot. Not nearly as much as in America but a lot by Australian standards. Russell charges $140 for a consultation versus $40 for a GP consultation and he charged a $850 co-payment for the laser work. The hospital charges were all covered by my insurance.

So if you get an education, work hard and save your money instead of spending it all on beer and cigarettes, you can get the first-class medical service in your declining years that everyone aspires to. I did and I do.

As I sat down to write this little memoir, I was listening to "Goodbye" (from "The White Horse Inn"). Most pleasant. You can see a small picture of the white horse referred to here





Australia: NSW public hospital agonies continuing

Yet another general manager of the Royal North Shore Hospital has left, increasing pressure on the beleaguered Health Minister, Reba Meagher, who tomorrow travels to Bathurst to face the latest debacle in the state's public hospitals. Mary Bonner, who was appointed two years ago, is the eighth general manager in 11 years to walk out of Royal North Shore, the hospital that has become the symbol of all that is wrong with the state's public health system. It is not clear why Ms Bonner has left but her departure follows the recent resignations of two other health chiefs in the Northern Sydney Central Coast Area Health Service: the project manager for Royal North Shore redevelopment, Andrew Bott, and the general manager of Central Coast Health, Ken Cahill.

Ms Bonner had vowed to do all she could to help turn the hospital around but the Herald understands budget constraints and pressure to meet performance targets despite several years of under-resourcing made her task insurmountable. It is also understood that she felt recommendations from the recent parliamentary inquiry into Royal North Shore were so vague they would not rectify problems, and more funding was needed for real change. Several clinicians told the inquiry of their criticisms of the hospital's redevelopment, including a lack of beds and poor cancer and pathology services.

The latest resignation came as Ms Meagher yesterday dodged questions on how the Department of Health or the builders or project managers of the new $98 million Bathurst Base Hospital got the redevelopment so wrong that it failed to meet national patient safety guidelines. The Department of Health also remained silent on how the Bathurst plans were approved when some areas in such acute services as intensive care and emergency were too small to function adequately. The building company, the John Holland Group, and the project manager, Capital Insight, also refused to comment.

"It's a bloody scandal," a Bathurst doctor, who did not want to be named, said yesterday. "Somebody somewhere has to put their hand up and say they caused this mess ... heads are going to roll." The Herald visited Bathurst Hospital yesterday, where all but the most urgent surgery has been suspended indefinitely due to problems with communications.

One doctor, who did not want to be named, said he was concerned for a patient due to undergo breast cancer surgery tomorrow, and was searching for another hospital. He said patients had been sent to Nepean, Mudgee, Lithgow and Orange hospitals for surgery. "There was no surgery here over the weekend apart from two emergency obstetrics patients - one was an emergency caesar and the other was a miscarriage," he said.

The doctor said he had been told that it could take months before the problems were fixed. The paging system had broken down several times a day, the alarm system and backup were inadequate and the situation was so desperate that inquiries were made about whether the fire alarm system could be connected to the switchboard as a public address system. There is also no mobile phone coverage. Telstra maintained yesterday it had always told the Department of Health that it could not complete the required infrastructure until at least the end of March.

The department has denied rumours that the John Holland Group was given $2.8 million in bonuses for finishing the job early. The department said the project was incomplete because the old hospital had to be demolished and the finishing touches put on the new one. It said no bonuses were paid.

One department, ambulatory care, has been left out altogether from the new hospital, and the Bathurst Medical Staff Council is asking for it to move into the mental health unit. Staff are refusing to occupy that section because they say it is unsafe for patients because there are sheer drops and potential hanging points.

Ms Meagher was due to turn the first sod for the Orange hospital redevelopment tomorrow. Yesterday the Greater Western Area Health Service said it would delay construction after doctors there complained that plans are also flawed. "I won't be turning the sod and I have required the Infrastructure Board to undertake a complete audit of the Orange plans to ensure we are not going to have a repeat of the Bathurst incident," Ms Meagher said.

The Opposition Leader, Barry O'Farrell, said the Health Infrastructure Board, set up last year to oversee big projects, "was just another short-term fix designed to distract from the Iemma Government's ongoing incompetence in delivering health facilities". "Reba Meagher can't even tell the public who is responsible for this latest infrastructure disaster," Mr O'Farrell said. "The public can have no confidence Reba Meagher will not repeat the mistakes at Bathurst at similar hospital upgrades at Orange or Royal North Shore."

Brendan Smith, the co-director of intensive care at Bathurst, said doctors had told the John Holland Group that there was no mobile reception as early as September last year. "In this day and age every doctor and his dog has a mobile phone and that's the standard way we communicate ... none of the areas where we have to run to fairly regularly have mobile reception. We pointed that out at the time."

Dr Smith said there had been "very, very limited consultation". "We were never allowed to see the plans; we were never allowed to have copies of the plans," he said. "With the operating theatres, two of the four were meant to be 50 square metres and that's a national standard ... there's 39 square metres. How the hell did they lose 11 square metres?" A spokeswoman for the Greater Western Area Health Service said it was discussing problems with Telstra. The Bathurst Medical Staff Council said the area health service appeared committed to fixing the problems.

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