Why One Size Doesn't Fit All (An Open Letter to Medicare Australia)

Yesterday morning, I woke after a particularly awful night. Pain had been my constant companion in spite of heavy duty painkillers and a sleeping tablet. I felt exhausted and frightened. For fear of becoming overly dependant on morphine based pain relief, I'd defaulted back to Paracetamol and Codeine. For fear of seizing up, I'd battled on crutches to stay upright and moving. I was rapidly descending into a fog of pain and fear.

My knee was pumping out heat and discomfort. My calf muscles were rigid. Pan levels were leading to avoidance of my exercises. I was ten days post surgery and I was not in control.

So I rang the Boy Wonder's rooms. Could I have an infection? Was this pain normal? What should I do? The advise I received was to go our my GP and get my leg checked.

We live one hundred and thirty kilometres from Perth. Our general practitioners are sixty-eight kilometres away. Getting to the surgeon's rooms or back to the hospital where my operation took place were not realistic options. So, we set out for Northam.

I snagged the last appointment of the day. Doctor Richard, the husband of our other GP Stephanie, took us into his room and began to review my situation.

Richard had been an orthopaedic surgeon prior to becoming a GP. As we talked and he checked my knee, I could see he was fuming. Not at me. At the one size that doesn't fit all system. For example, the Boy Wonder would receive payment for postoperative care. That involved him seeing me after four weeks. In the meantime, any other care I received elsewhere, such as from Richard the GP, might or might not be honoured by Medicare Australia, so I had to be charged the standard fee. As a pensioner, I am normally bulk-billed. Because of a bureaucratic, unwieldy system,  I am not supposed to receive aftercare services from another doctor apart from the surgeon.

Which would have been fine if I'd been given sufficient discharge advice. Here is a list of some postoperative information that would have been really useful last Wednesday when we set out for home. Except I had to wait five days for Richard to tell me what I needed to hear -

that knee replacements are very painful for two or three weeks
that removing the staples will reduce the discomfort
that I need a physiotherapy programme starting in the third week
that good pain relief is paramount
that my knee needed to be propped up on a pillow at rest
that nothing I do can actually damage my new knee.

Leaving the Mount, I was handed three discharge sheets telling me to check for infection, constipation, use ice to reduce swelling, do the exercises given to me by the physio and make a post-op appointment with the surgeon. My crutches were incorrectly adjusted by the resident physio and I was given an inadequate prescription for enough pain relief.

My five-day stay at the Mount had an approximate quote of $10000, according to our private health fund. I am sad to say that the Mount failed me on this occasion. And my aftercare has been provided, in part, by my GP, and Medicare does not have the flexibility to reimburse more than one provider of this care.

The good news is that today is another day and I am in a more positive mood, with less pain.

Not happy, Jan...

Please?

Grey Street Surgery

Still no...

My knee and me are feeling a bit better tonight.