Perhaps it is better not to resuscitate

Emergency room doctors all eventually face the issue of refusal to resuscitate someone. If a patient is clearly frail and sickly, do you have a duty to resuscitate him or her? The same question might be asked of health care - so frail and sickly that maybe it would be better to cut off the oxygen and start again.

I’m going to focus on Queensland. If these issues aren’t on the front pages of your state’s newspaper, it’s only because they have more interesting news to publish. Health is in crisis across Australia. Queensland has only compounded the problems with the sheer incompetence at some hospitals, and by bureaucrats and ministers.

The objective of any health system is to promote and contribute to a healthy population.

Some people define “healthy” as a state of physical and emotional well-being that goes way beyond anything that any health system can do. Here, we are simply talking about keeping people well. But health care in Australia doesn’t keep people well. It cures the sick.

Hospitals with the bulk of state health budgets do nothing to keep people well. Community health services do a little more but are notoriously underfunded, with long waiting lists for even the simplest of services. By the time you make the list, any problem will have escalated to the stage where you need to go to hospital. And in general practice, there are thousands of items on the Medicare Benefits Schedule for curing people but few to stop them getting sick.

People seem to have no real interest in their health. After years of advertising about the effects of cigarettes, a quarter of the population still smokes. Drinking and non-prescription drug use are continually increasing. But smoking, drink and drugs pale into insignificance when compared with what people eat.

There used to be a phrase “he’s eating himself into the grave”. This society is eating itself into the grave. Fast food, fat and sugar consumption goes up each year while rates of exercise fall. Unsurprisingly, obesity also goes up each year. And right behind, again unsurprisingly, diabetes, heart attack, kidney problems, cancer and other diseases continually go up.

Hello! This doesn’t sound like rocket science. But when I tell parents their children’s diet means they won’t live as long as me, I watch the parents take the family off to a fast food outlet to talk about it.

In the end, we have a health system focused on fixing people who are sick and a society focused on getting sick. The two really suit one another extremely well. Unfortunately, we are rapidly running out of both the health care workers and the money needed to maintain this uneasy balance.

Let’s talk about health care workers. The argument that we aren’t training enough of them needs nuancing. More would be good but a major part of the problem is that many now don’t want to work full-time. The loss of doctors and nurses through a reduction in average working hours is even more significant than numbers lost through retirement. Where do we draw the line? How many can we afford it if training more health care workers just allows them work shorter hours?

Reluctance to work full-time affects specialist numbers. Research says many doctors choose general practice rather than becoming specialists solely to work part-time. Hence we have a shortage of specialists. Similarly, many nurses aren’t interested in becoming nurse practitioners because they don’t intend to work the hours that would justify the investment in study.

The second point we need to stress is that every trade and profession in Australia is desperate for people to take up training. From carpenters to engineers, we are short of teenage entrants. That’s just one of those things that happen in an ageing society.