Similarly to other countries, Australia has both national and private health care services. Everyone can decide where to go to be treated. The case I am writing about refers to the national health care system. A thirty-year old man suffered an injury when he was hit in his face. It was a double fracture of cheek bone in the left part of the face. The fracture caused a collapse of the nasal fornix which led to limited nasal breathing. The patient visited his GP who referred him for further examinations. One of them was an examination by an ophthalmologist to exclude internal haemorrhage around the eye and other possibly pathological changes, and the other was a CT scan to determine if there was a fracture and other possibly pathological changes. Having undergone all the examinations the patient had to make an appointment with his GP again. The GP collected all the results and referred the patient to a CT specialist to assess scans. The patient had to first make an appointment with this specialist.
The care of the patient was taken over by the CT scan specialist who worked in the hospital. The specialist confirmed the double fracture and offered the patient a surgical treatment. As the patient experienced difficulties with breathing he agreed with offered procedure. Three weeks passed after the accident and the bones were starting to heal. The patient’s condition was not assessed as acute and therefore he was put on a waiting list. A consultation had to be held before the surgery in order to determine what procedure to use during the operation and whether other specialists would need to be invited. The date was to be set within two months.
Pre-operative, operative and postoperative period
The patient waited for the date of operation. He was informed about the date by phone and then also by mail. The letter which he received contained all instructions related to pre-operative preparation (they are the same as in the Czech Republic – what to take to the hospital, including documents, fasting for 12 hours before the operation, everything about taken medication, if applicable).
On the day of operation the patient registered with the central reception at the hospital and was sent to the reception of the relevant ward. A nurse met him there, explained the procedures at the ward and showed him to his bed. The patient received hospital clothes and a plastic bag with his name for his personal belongings. The nurse filled out the patient’s past medical history, checked his physiological functions (body temperature and blood pressure, pulse and saturation), bandaged his legs and attached bracelets with the patient’s name and address to his wrist and leg. Then the patient met with the surgeon who took the patient’s past medical history again and filled him in about the operation. The pre-operative preparation (medication) was done by a theatre nurse who took the patient’s past medical history again.
At the operation theatre and recovery room
Following the patient’s preparation for the operating table the anaesthesiologist took the patient’s past medical history again and filled the patient in about anaesthesia. The surgery lasted approximately two hours. The incision was lead through the inner upper lip. The surgeon separated soft tissue from hard tissue all the way to the cheek bone fracture. As the fracture had already partially healed it had to be broken again and a titanium implant was inserted underneath it. It was to help the bone heal correctly, thus relax the relevant sinuses and help improve breathing. The surgeon then restored the soft tissue, sutured the wound and attached a plaster to prevent excessive movement.
After the surgery the patient was taken to a recovery room where he spent two hours supervised by the hospital staff. After two hours the patient was given food and liquids. Once the patient had eaten, drank and urinated and showed no postoperative complications, he was discharged from the hospital which was two hours after the surgery. The patient had to be supervised at home by another person for the next 24 hours. The patient was discharged with no medication. If there are no complaints, the first check up at the surgeon is in one week and the following in the next six weeks. If there are no problems after the first check up, the patient can go to work again.
My opinion
I think that the patient waited for the operation too long and therefore the facture had to be broken again. The whole process was too lengthy also because the patient always had to wait for information about his appointment by telephone and then by mail (it takes at least one week to make an appointment with one doctor). The truth is that if the patient had gone directly to a hospital, the waiting time could have been substantially shorter and the injury could have been operated immediately as an acute case.
I was also surprised how soon after the surgery the patient was discharged from the hospital and as well as by the number of patients per one nurse. One ward nurse takes care of four patients. The care is provided in a calm atmosphere without any stress. The nurses are responsible only for their tasks as the hospital has a sufficient number of nurses, nursing assistants and orderlies. I think that Czech nurses are very skilled, flexible, well educated and prepared for their job; unfortunately, they are overloaded and stressed because of lack of staff and substantial cost savings at inappropriate places.
O autorovi: Darina Smíšková, Centrum ambulantní gynekologie a porodnictví Brno (Smiskova Darina@seznam.cz) Překlad: Mgr. Alice Křížová