Thousands of children with minor ailments are visiting emergency departments each year. Photo: Kim-Cherie Davidson
Parents are bypassing GPs and swamping hospital emergency departments with children suffering from minor complaints, in a trend one expert warns would “break” our healthcare system within a decade.
The Royal Children’s Hospital in Melbourne has recently been pleading with parents of children with minor ailments to see GPs after demand for its emergency department reached a recordthis year, causing some people to wait more than eight hours to be seen.
On Thursday, Victorian Health Minister Jill Hennessy said the hospital would receive extra funding to deal with the spike and to create a new 10-bed ward for low-priority patients. She urged parents to visit their GPs for low urgency problems.
Professor Gary Freed.
In recent Facebook posts, the hospital said as many as 290 children a day were attending its emergency department to enter queues as long as 83 deep. A large number of the children had “cough and cold symptoms”, it said.
Professor Gary Freed, an American paediatrician who has been studying Australia’s health system for five years at the University of Melbourne, warned that if the trend continued it would “break” the healthcare system.
“In a decade, your system will break. It’s already fracturing,” he said.
Hundreds of parents responded with outrage at the trend, while others complained that their children had not received proper care at other hospitals or from GPs.
“Sadly I feel like this is why I was turned away from an emergency dept with my son who had pain in his side,” one mother wrote. They sent us home saying he must have a virus. It’s a pity they didn’t investigate more as he had leukaemia. But if they are getting that many kids in…”
Another, who said her son had been misdiagnosed at another hospital, said if other hospital staff and GPs treated children with the same level of care as the RCH, more parents would vote with their feet. “There is a lack of trust from past experiences unfortunately from many parents,” she wrote.
But Professor Gary Freedsaid children with GP-type problems were bombarding hospitals across the state, not just the specialist hospitals. The trend also represents something of a cost shift between governments because states largely pay for hospitals and the federal government for GPs through Medicare.
He said research suggested a perfect storm of factors was driving the trend, including a lack of awareness among parents about suitable health services, a tendency for GPs and Nurse-On-Call services to direct parents to hospitals, as well as a possible deterioration in GPs’ exposure and confidence to manage children’s health problems.
One study of 1150 children who attended hospitals for a low urgency condition found only 43 per cent of parents had attempted to see a GP first. And of the 320 who did see a GP first, two thirds of them (212) were instructed by their GP to go to hospital. GP-type problems include vomiting and diarrhoea without severe dehydration, sprained ankles, and mild asthma.
The research also found that 20 per cent of parents had contacted the Victorian Nurse-On-Call service before going to a hospital. Of those who did call the phone line, 70 per cent (162) were told to go to the hospital.
After using a “secret shopper” survey of GPs to see if access was a problem, Professor Freed found there was no shortage of appointments within four hours, and that many were bulk billing, meaning cost was not a factor.
Professor Freed said children were making up a smaller proportion of patients seeing GPs. Thirty years ago, children made up about 34 per cent of GPs’ work, now it’s about 24 per cent. Medicare data also shows long GP consultations with children are diminishing, suggesting a shift towards specialist doctors.
His research also found that trainee GPs were seeing vastly more adults in their training than children and that their exposure to chronic illnesses in children and other conditions may be quite limited.
“Our research raises the question of whether or not parental confidence is playing a significant issue in emergency department presentations for children,” said Professor Freed, warning that if nothing was done about the pattern the system would be overwhelmed causing even longer waiting times and undermining consistent care for children.
Dr Kaye Atkinson from the Royal Australian College of GPs said while GPs received at least 12 weeks of training in a hospital treating children before they became fully qualified, the college wanted to know more about the reasons underlying Professor Freed’s findings.
She said parents should know that GPs can treat most problems, including some broken bones and sprained joints, and that it was possible some parents simply insisted on going to hospital regardless of a GP’s competency to manage their child’s problem.