Aniello Iannuzzi: Immunisation confessions

FEELING in a penitential mood, I wondered which consultations are the worst — the heart sink patients.

Is it the narcotic drug seeker who gives the sob story about his dog chewing his authority script for OxyContin only 2 days into the 30-day course? Or is it the 160 kg diabetic smoker who just cannot understand why I cannot improve the circulation in his blue toes? Or is it that family who always books in one child and then expects me to see all four children every single time?

However, a new category of patient is threatening to overtake all of the above. Believe it or not, the typical description of the new patient is the young adult, fit, intelligent, well-spoken and so healthy that he/she has not needed to see me for about 6 years.

“Doc, I am about to do my first uni prac in hospital next week and they need you to fill in this card for me …”

At that point I usually become bradycardic, hypertensive and am reaching for the nearest ventriculoperitoneal shunt to ram into my own brain.

GP: “Did you bring in your immunisation records?”

Patient: “No. Mum said you’d have all the information.”

GP: “You did not start coming to my practice until you were 10 years old.”

Patient: “Don’t worry, Doc. The lecturer at uni said that if you do not have the records you can order a blood test or just give me a booster.”

By now my shunt is working, so I can mutter: “You do realise you may need five needles in that case?”

Patient: “Say I have the blood test?”

GP: “The results could take up to 2 weeks to come back.”

Patient: “But my prac is next week!”

GP: “How long have you had the form?”

Patient: “About a month.”

GP: “And why did it take you so long to bring it in?”

Patient: “I thought it would be easy to fill in.”

GP: “And did anyone explain to you that the TB testing has to be done via a hospital clinic or special TB clinic?”

Patient: “No.”

Given that it seems almost every family in Australia now has one member studying a health-related discipline, this scenario plays out for most GPs on a regular basis.

The university and hospital administrators have taken a pretty hard line on this documentation of late, but I wonder whether such a draconian approach is needed.

I can’t recall a single case of a student or clinician getting tetanus, diphtheria or mumps from a patient. The diseases we do fear catching — HIV, hepatitis C and most viral respiratory illnesses — have no vaccines.

And who should pay for this time-consuming chasing of past records, given that it’s a demand imposed by the administrators and not really a concern for most students?

It appears to be a classic cost-shift away from the hospitals and universities onto Medicare and GPs.

Serologies are slow and expensive. GPs are often expected to collate the results and pass them onto the students gratis. It’s another case of expensive, unpaid red tape for GPs.

Vaccines, too, are expensive.

As taxpayers we have to ask how many unnecessary serologies and vaccines we are funding. I wouldn’t be surprised if this is amounted to millions of dollars a year.

The ACIR (Australian Childhood Immunisation Register) is one example of a centralised bureaucracy that genuinely simplifies this sort of work for clinicians.

The ACIR keeps good records of vaccination up to the age of 7 years but it might be time to expand it to include all vaccinations for all age groups.

The universities and hospitals could then simply email or call the ACIR. It would save GPs and their student patients a lot of time and heartache … and sore arms!

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 23 April 2012

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