Aniello Iannuzzi: All fired up

IT has not been a good start to 2013 for my town of Coonabarabran in the north-west of NSW.

Bushfires encircled our town, with about 60 families losing their homes. Even as I write, the fire rages on, predicted to burn for many more weeks.

Just like in any tragedy, the fire brought out the best and worst in people. The good greatly outweighed the bad, with so much generosity from our own and outside communities. The concern shown by so many has been very encouraging (including many readers of MJA InSight — thanks for the emails, calls and faxes.).

As I watched the drama unfold — thankfully without fatalities or serious injuries despite the intensity of the blaze — I got thinking about the firefighters and the victims, and how this compares and contrasts to doctors and patients.

The victims and patients clearly have much in common — some are in their predicament simply due to bad luck, some due to bad planning and some due to a refusal to accept the risks associated with where, or how, they live. Some are fully insured, some partly insured and some not insured at all. In an emergency all get treated equally, but down the track insurance will have a big effect on access and outcomes.

Just like doctors, firefighters are now ruled by the centralised government masters, even though at the local level they do have a little autonomy. Like doctors, local firefighters are often frustrated that their knowledge and experience is sometimes overridden by a top-down approach — such has been the case with respect to back-burning and other fire prevention measures.

But what about “lifestyle” and what about “identity”?

Although not subject to fires every day, firefighters work by the rule that fire and its victims take priority irrespective of what they may otherwise be doing.

As for doctors, many of us, and many members of the public, think we are the same. But are we really?

The medical profession has become increasingly focused on work–life balance. Reasons for this include a generational shift, concepts of safe hours, the feminisation of the workforce and the emergence of a team approach to how things are done.

An article on this topic in The New York Times a couple of years ago rang true as I looked into employing doctors for my practice. Working hours and on-call come up all the time.

General practice is especially seen as a lifestyle specialty, where you work less and earn less for a “lifestyle”.

Patients are shifted to second place when such thinking dominates. General practice, more than any other specialty, relies on continuity of care to achieve its best results. Patients do not choose when they get sick and most prefer to see a doctor they know.

I often hear GPs moan about patients not following up, patients doctor-shopping or other GPs “stealing” their patients (often within their own practice, mind you!). A critical question for these GPs is: “Were you there to put out the fire when it was burning?”

Another thing about firefighters is that they are instantly recognisable. All the Coonabarabran firefighters were in uniform. It was easy to see who they were and who was in charge. The same can no longer be said of doctors.

While much was made of the Garling report when it was released in 2008, few people referred to recommendation 62.

Garling was concerned that for the patient in hospital (but I reckon you can extend this to many other settings), it is difficult to know who is who. Is that young chap who just saw me a nurse, a physio, a radiographer or a doctor? And if he is the doctor, is he my doctor or a trainee?

The report recommended that a uniform system be put in place to identify health professionals, including doctors. The uniform we need is fairly straightforward — the white coat. It makes a doctor instantly recognisable, has history behind it and is cheap and convenient.

Concerns about hygiene have been greatly dispelled, and are well summarised by Sara Fraser, a Queensland medical student.

So in 2013, let’s be more like firefighters and put the patient first and identify ourselves clearly.

Wearing white coats again might also do one more thing —if the patients can see who we are, maybe we’ll remember it ourselves.

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

Posted 29 January 2013