Groote Schuur Hospital's unsatisfactory service: Part 2

This is a follow-up to my previous post about Groote Schuur Hospital’s patient services (see here).

Readers might be wondering why I rely on public health and don't have medical insurance.  The reason is it's unaffordable to me. 

We know about how medical aid/insurance members who pay high monthly premiums may find they've reached the claims ceiling and must pay thousands owing to healthcare providers themselves, or find certain procedures are not covered.  At a general practitioner last week there was the sign that said since 2017 they’re not providing services to Discovery's Keycare members per the attached Discovery letter.

From time to time I've examined schedules from different companies to see if perhaps there are affordable plans.  But they're so complicated with numerous options under one basic plan.  In this they're like motor cars – different variations on one basic model depending on the level of luxury one wants.  It's unnecessarily complicated and confusing, and deliberately so.  People want a plan and will pay according to their means – low, medium and the Rolls Royce option – if they can find something to suit their needs.

Also, from the plethora of options, none I've seen – I haven't exhaustively researched it, though – provides exactly what I want: specialist out-patient and comprehensive hospital cover.  They either offer comprehensive (inclusive general practitioner to hospital) or hospital cover only.  That's it.  

I'm happy to pay general practitioners and medicines (fortunately I don’t have conditions that require expensive medication), which might be the bulk of the average members' medical costs, and have insured cover for infrequent but expensive out-patient specialist and in-hospital care.  

But even if the plan I want is available, it's likely it will be more than I can afford.

Last week I had a conversation with a medical practitioner.  I’ll refer to him by his initials TV.  He has a Master’s degree in medical ethics and is reading a PhD in medical justice.  Initially, his topic was the health minister Aaron Motsoaledi’s proposed National Health Insurance plan.  But the NHI plan is "complicated", they would have to “break down the existing health system and put the NHI in its place", i.e., they’re not fixing what’s broken with the existing system.  Also, it’s “top-down” and government has not consulted the intellectual resources offered by specialists (incidentally, he said they charge “three times medical aid rates”) and other practitioners like him.  Government keeps changing the goal posts and it will go on and on.  In short, it's unworkable.  So, as a thesis topic, it's a waste of time.

Then we spoke about the Western Cape’s public healthcare service.  He said it's “good”.  According to his friend who works in a senior capacity in the Western Cape Health Department, they have systems that are not coordinated but are working to improve it.  This coincides with what a Groote Schuur ER doctor indicated to me last year that there are “different models” of patient flow when I said it needs urgent remedying.  Apparently, none of these models are working (see Part 1 and below).

When I mentioned the Treatment Action Campaign’s report about the state of public healthcare in the province, TV replied they might have a “political agenda”, i.e. anti-DA.  I disagreed because the TAC challenged, and won, the ANC government regarding HIV/AIDS treatment.  And the annual South African Health Review 2016 placed the WC’s public healthcare third lowest in the country based on users’ perceptions.

Last week I had reason to put Groote Schuur's service to the test again.  I had a referral letter for an expensive scan and, this week,  a related one for a specialist.  The quote from private radiologists was a bit steep, so I contacted the hospital’s radiology department.  They said they don’t take private referrals directly and the only way is via the hospital's outpatients or ER to which I should present the letter as soon as possible.  I did so the same day last week.

Now, I know its system of patient referrals which has been in place for many years, but hoped since I'm presently an outpatient in another department my referral to radiology would be expedited.  The person I spoke to asked if I was an existing patient at the hospital, but I probably misunderstood it would be so easy to get attended to immediately. 

In short, referrals to state hospitals for patients who have private doctors are typically only via primary care community clinics.  Clinic patients can be referred to tertiary hospitals.  Years ago private general practitioners could refer patients directly to hospitals.  I don’t know why it was changed except to reduce hospital patient loads and make it more difficult to access specialist healthcare. 

But there are exceptions to the community clinic to hospital route: emergencies and, as my GP once said, referring doctors and patients know how to work the system. An example of the latter, a neighbour’s private GP got him an appointment at Groote Schuur’s cardiac clinic in one month when typical waiting periods are three to six months and then only where cardiology patients usually are admitted via the medical outpatients or another department like the ER.

Basically, that’s what the radiology department told me: try outpatients triage and emergency (if the former fails).  

I appreciated her advice, and so last week went to outpatient’s triage.  As far as I was aware, one doesn't just show up without an appointment unless another hospital department refers one.  

The triage room is just inside outpatient’s main entrance.  I wasn't aware it existed despite having been there many times over the years.  I found it after asking three staff members.  In the room, down a narrow corridor, I found two nurses, one of whom was having a loud phone conversation apparently with a friend or colleague because she said "shit" a few times.  The other was fiddling with her mobile phone and didn't look up.  The one on the phone looked at me and continued her conversation.  I waited almost five minutes.  She put the phone down and asked with a smile, “Don’t I know you?”  I replied, “It’s possible.  It’s a big place.” 

It’s true, she did look familiar.

I showed her the referral letter and what the radiology department suggested.  But she referred me to C15, the floor designation for the ER, and that I should accompany her because she was going that way.  Outside, she spoke of the weather then took off, going elsewhere.

At C15, where I've been before, I found the usual “gatekeeper”, this one an older nurse (a nurse's aid really) sitting at a little school desk at the closed entrance (she I recognised from a previous visit).  “Are you the gatekeeper?”, I asked.  She smiled and said yes.  I told her where I had just come from.  

She read the letter and told me “they”, being the ER doctors, “won’t see you” and something about another department.  She asked where my nearest community clinic was and to go there.  I replied those clinics don’t have specialist X-ray equipment or perform the scans the letter requested. “Ask the doctor”, I insisted, “and if they won’t see me, fine.  But please, don’t keep me waiting if they’re not”.

She told me to wait and went inside. She came out soon after and told me to go to the relevant outpatient clinic for an appointment.  On the referral letter a Dr E (name withheld) had scribbled the same.  At the clinic I was seen promptly and letter taken to a registrar.  I was given an appointment on July 10 [1] for an assessment.  She asked if I had had the scan (X-ray).  I replied no.  

The receptionist nurse asked why I went to the ER.  When I told her the triage nurse sent me, shook her head.

I had the scan privately the following day.  Despite the cost  (it was less than quoted, though) I can't wait until July for the results.  The referring medical practitioner examined the scan results and report and confirmed the condition requires a specialist consult and appears concerning.  Yesterday and today I tried by phone to bring my Groote Schuur appointment forward because the matter is urgent but had trouble communicating with the person there [1].

The above highlights a problem that occurs from time to time: staff, sometimes doctors but invariably nursing and administrative, turn patients away who may have serious conditions with traumatic outcomes if untreated, which the health department always denies. 

My experience where the ER nurse was about to send me away until I politely insisted she speak to the doctor, which would have been a repeat of one I had in 2001 at the hospital’s hand clinic with a disastrous medical outcome for me, prove nurses who have little to no relevant medical competence are assessing conditions only doctors ought to do.  (In the 2001 case, the hospital’s/head of department's much-delayed evasive and obstructionist report blamed me for not insisting on treatment.  I had an appointment but due to an administrative bungle my folder had not been ordered from records and the receptionist too indifferent too request it.)

That the problem of patients been sent away persists shows the Western Cape's hospitals and health department are not addressing it.  

Groote Schuur is a large, busy hospital as are other public health facilities.  As a user, my opinion is it’s inefficient, and like the national public healthcare system, can be better if its management and politicians stop running it as they do all public facilities as if the lowest common denominator applies. 

They're the incompetent ones and why the system is borderline dysfunctional when it could be so much better.  Less than 10% of the country's state healthcare facilities meets the standard required for the NHI.  But they're thinking of a significant, hugely expensive system the country can't pay for believing it will run as well if not better than private facilities.

Groote Schuur and other facilities are burdened with high patient numbers but they have sufficient staff, so many that they get in each others' way, and resources to provide better service than they do at present. Anecdotally, the standard of medical care varies from good to horrifying. Personally, I've had bad, patchy and good ones. The bad, negligent ones are avoidable, though. It’s just that they’re not utilising the available resources, which are plentiful but not infinite, effectively. 

Patients may not get seen on the day or month they want, but they ought to be seen if they have an appointment or it’s an emergency.  It can’t only be patients’ misunderstanding when they’re refused care as the health department wants the public to believe.

During the Eerste River Hospital scandal in 2012, the ER head was fired for publicising dire conditions there.  The department fired him on a fictitious pretext.  According to the Cape Argus which broke the story, the department warned staff not to speak about the matter under threat of been fired too.  They attacked the Argus for allegedly conducting a “vindictive witch-hunt”.  That’s rich considering what they did to the doctor.  About two years later an arbitration inquiry cleared him and severely criticised the department.

In emailed communication with the then departmental spokeswoman, she first aggressively dismissed my questions and the public’s concern, but when I didn't bite, slightly penitently climbed down from her high horse and admitted there were “problems” that they were working on it.  I couldn't and still don’t understand why their highly paid managers, all doctors (disclosure: I went to school with the district manager, Dr Giovanni Perez, that Eerste River falls under), don’t proactively prevent problems from occurring which is a manager’s job. 

Unfortunately, they refuse to listen to well-intended advice, and the problem is never theirs. 

Footnote: [1] On April 18 I phoned the department. They acceded to my request to advance my appointment to next week due to urgency.  This was an unexpected surprise.  I appreciate it.