In April 2020 Dr Anthony Fauci, an internationally renowned immunologist and an adviser (somewhat reluctantly) to President Donald Trump as the lead of the White House Coronavirus Task Force, said in an interview before The Economic Club of Washington D.C. ‘What keeps me up at night is the emergence of a brand new infection, likely jumping species from an animal; that's respiratory born, highly transmissible, with a high degree of morbidity and mortality. And, lo and behold, that's where we are right now.’
To date the USA has had over 86 million cases of confirmed SARS-CoV-2 infections and a million Americans have died from the disease (in Australia around 50 people are still dying of the disease weekly). The country’s death rate was the second highest worldwide, only slightly behind the leader, Brazil. Such a result seems incredible for the country with the most advanced health systems in the world, although access to high quality care is restricted and depends on being able to afford expensive treatments. It is far from universally accessible.
American author, Michael Lewis, looked at the first year of the American covid epidemic in his book, The Premonition - A Pandemic story. He describes how the American approach to pandemic planning evolved under the George W Bush administration arising out of the Biodefense Directorate of the Homeland Security Council in 2005.
There have always been demands for efficiency in health care and this only seems to increase. Year after year, the Australian health budget grows by a greater percentage than GDP and this is not sustainable. The COVID-19 pandemic has further increased the need for efficient delivery of medical services. Local disasters like the steriliser breakdown in Grafton or the terrible floods in Lismore and surrounds further blow our surgical waiting lists out.
I have been in Northern NSW for a bit over 10 years but it wouldn’t be a surprise if waiting lists for elective surgery in the public system are as bad now as they have ever been. That also has flow on effects for the provision of care in the private system, where especially in Victoria, significant private capacity has been used for the provision of public elective surgery.
There is clear impetus for change here. As clinicians though, improvements to our models of care ideally arise in a patient focused manner with the motivation being to do the best we can for the patient in front of us. In many cases that will also result in more efficient health care. Day-only total joint replacement is an exciting example where patient centered concerns align with a benefit at the health resource level.
This is not ground-breaking stuff. It is self-evident that, all other things being equal, it is both a better patient experience and more cost effective if a patient recovers from (say) pneumonia more rapidly rather than more slowly. So why, aside from a few isolated pockets of ERAS (enhanced recovery after surgery) programs, aren't we seeing more of a concerted effort to have people recover more rapidly after surgery?
Written by Dr Sam Martin, orthopaedic surgeon, Grafton
