I watched the latest Michael Moore film ‘Sicko’ with much interest.

I found the film to be complex, almost overwhelming at times when comparing what I was seeing in the film to what I know of living and working within the Australian healthcare system. I knew the American healthcare system was different from much of Europe and Australia. But I never realized it was that different!

The film is certainly not without its faults. It’s hopelessly biased with its bottom up view of the American healthcare system. Michael deliberately doesn’t give each side of the debate an equal say. He doesn’t interview any frontline workers within the American healthcare system with their front-of-house views. Stunts like fronting up to Cuba and demanding the same treatment as Guantanamo Bay inmates, well that’s just plain stupid. Of course those poor souls get decent healthcare, could you imagine the uproar if the media discovered they were receiving shoddy healthcare?

Michael Moore makes it clear he thinks healthcare should be free for each US citizen. Sorry mate, but nothing in this world is free. Someone’s gotta pay somewhere along the line. Whether you pay indirectly via your taxes (that’s socalized healthcare) or via big healthcare corporations (that’s the US model), it doesn’t really matter. It’s costing us all somewhere along the line.

Australia and other European countries featured in the film don’t have anywhere near the same population as the US. Australia is a country of around 21 million, whereas the US is 300+ million. ‘Socialized’ healthcare in Australia is going to be easier just because of our relatively low population compared to other countries around the world.

The whole idea of ’socialized healthcare’ and how it could lead to communism is so unbelievably foreign to me. I don’t fully understand how free healthcare for all is communistic. It’s like looking at the argument from one extreme to the other, yet failing to see all the benefits in the middle. Technically we have socialized healthcare in Australia and we aren’t communists.

There are two basic divisions within the healthcare system in Australia, the public hospital system and the private hospital system. Incidentally one is technically a Michael Moore socialist model and the other is strictly ‘user pays’ unless you have insurance. I work for the public hospital system. The public hospital system is the larger of the two. It is wholly funded by the state government.

Every adult Australian has the opportunity to pay for private hospital insurance cover. It seems in the US your insurance cover is linked to your employment. In Australia you can walk into any large shopping centre, walk into the shop of the insurance company, pay your money and you’re covered. The private hospital system is more of a user pays system. In general, the better insurance coverage you pay for, the less your hospital stay will cost you. And you don’t need to have private hospital insurance to be a patient in a private hospital, you will just be hit with a large bill at the end of your stay.

The benefits of having private hospital cover in Australia can vary. The Australian government have various incentives to make taking out private cover attractive to everyday Australians such as potentially lowering your tax bill and rewarding people who take out insurance from a younger age.

Contrast this to the public hospital system where the patient doesn’t pay for their hospital stay. Some people argue that the private hospital system offers a higher standard of health care with more flexibility for the patient to choose their doctor and better overall facilities. Private hospitals may look nicer and have more single rooms but you definitely don’t receive better hospital treatment through the private system. In many cases you actually receive less service. For example, if you have a stroke and go to your nearest public hospital (as would be the case for 99% of patients), you’re likely to be reviewed by the allied health team within 24 hours. If you elect to go to a private hospital for stroke care, you’re less likely to get timely and appropriate allied health input.

Call it socialist, communist or whatever you want, healthcare in Australia is not without its problems. If you require routine and non-life threatening surgery such as a hip or knee replacement and you’re a public patient, you’re going to be waiting a long time for your surgery. It’s a consistent criticism of the public hospital system in Australia is that so many non-life threatening surgical cases wait a long time for surgery.

So who’s the Sicko in all of this? Your ability to pay or have insurance coverage should not affect the healthcare you receive. Michael Moore’s film leads the viewer to believe that if you can’t pay or don’t have coverage, you just don’t receive emergency hospital care in the US. At least in Australia, every Australian can access free emergency hospital care regardless of their income or insurance status.

Thank goodness for that. Common sense prevailed and the planned strike action was averted at the very last minute.

The threatened strike action received excellent media coverage. Check out this youtube clip showing the news reports on the strike.

The Victorian government have been forced to come to the bargaining table and negotiate with the union, something the union has wanted right from the start. It’s a shame that it took the serious threat of strike action before the government would agree to negotiate with us.

A recent comment mentioned the Michael Moore movie ‘Sicko’ and the differences between the American and European healthcare systems. The film was a real eye opener for me. I knew the American health system was different to Australia’s, but not that different!

I look forward to exploring ‘Sicko’ and the differences between healthcare systems between countries in more detail in a future blog post.

Members of the health professionals union voted in favor of a 24 hour strike in the ongoing fight to gain improved career structure and pay for health professionals employed in the public hospital system in the state of Victoria in Australia today.

This means that next Tuesday 18th March, health professionals employed in the Victorian public hospital system, including speech pathologists, will not front up to work in protest against the Victorian government refusing to negotiate better wages and conditions.

And I’ll be one of them.

The career structure for health professional in Victoria currently is bottom heavy. Jobs, career structure and improving pay is readily available to entry level clinicians and those beginning their clinical careers. Once health professionals like myself have been practicing for a 5 or 10 years and have reached the peak of the available clinical career and pay structure, you’re stuck with no where else to go. You’re in grade 2 limbo land. Clinicians like myself with years of experience and knowledge are driven out of the clinical domain searching for further career options and improved pay.

Improving the career structure for health professionals in Victoria is worth fighting for to bring us into line with other states in Australia (like Queensland).

It will be very interesting to see how the Victorian government reacts to the strike action and whether the career structure demands will eventually be provided by the government.

I’m interested to learn what other clincians and those overseas think of this current situation. Who controls your career structure or your rate of pay? Would you walk off the job to get what you want? Is the health professionals union doing the right thing? Let’s hear it!

I thought it worthwhile to recognize some notworthy numbers.

SK has notched up 10K hits in under 9 months since I started writing. Pretty impressive. The numbers continue to grow as this blog gains momentum and popularity.

I’m discovering that many of my readers fall into similar categories. Students, firstly, are tech savvy and are more at home in the internet and blogging world. They can work the internet in their sleep. Then there’s speechies who are disillusioned or annoyed with some aspect of their working life, start googling and end up here. No problem! Welcome to both groups! Glad to have you on board and tell your friends! What I would really like is to get this blog into the mainstream, get ASHA or important powerful people to notice that blogs and sites like mine exist, almost in a different world to the one’s they’re used to.

If you’re an avid blog reader like myself, you’ll groan hearing blog writers whinging about having no time to blog. I don’t want to bore you with the same story. I’ve decided 2-3 blog posts per month is more than adequate at this point. So many of my previous blog posts continue to generate so much discussion, the blog almost writes itself.

I noticed today that my feedburner list hit 10 subscribers. Now I know that number can flutuate like the wind, but I’m still worth mentioning. Feeds are new and scary to many. Don’t be scared, they will streamline your dealings with regularly updated internet content. A major timesaver.

SK

I read this recent blog post on HR World with great interest. It lists the top 25 signs of a dysfunctional workplace. It was number 25 that really got my attention. Number 25 says..

No one ever gets fired, no matter how ineffective they are at their job. Finally, while employees need hope, they also need expectations and standards. If doing a bad job doesn’t get a worker reprimanded or even fired, what’s the point of doing a good job?

In all the years of working as a speech pathologist I’ve never known a healthcare professional to be fired from their job. Have you? Again this relates to my previous post where I was trying to point out that healthcare and private business work to very different rules. If you’re under-performing or not working out in a position, private business can end your employment. It’s not the same in healthcare (in Australia at least) and I’m not really sure why.

It’s good for an employee knowing they’d have to do something very dramatic like punch a patient in the face in order to get the sack. But there’s so many more negatives for individuals and organisations and hence why it takes out the number 25 spot on the list of signs of a dysfunctional workplace. Here’s why..

1. Lack of being able to fire someone for whatever reason means that managers hiring new employees go to extraordinary lengths to ensure they hire the best possible candidate for the job. Managers are more interested in a person’s ‘fit’ with their existing team, often at the expense of the candidate’s experience or suitability for the clinical work.

2. Teams and workplaces get bogged down by stale and ineffective employees and managers who have no need to change or improve their ways because they know they can never be fired from their job.

3. You can try to manage an employee’s performance until you’re blue in the face, but having even the slight threat of termination can be enough to effect real change in an under-performing employee.

4. If you’re in a job you shouldn’t be, others around you can put tremendous pressure and hardship on you so you’re eventually forced to leave anyway.

Healthcare’s inability to fire employees for whatever reason goes to show how different we are from mainstream business with many negative consquences for those stuck with employees that should have been fired a long time ago.

Last weekend I had lunch with a group of girlfriends that I went to high school with. In the 10+ years it’s been since we graduated from high school, we’ve each taken a different path. Each of us are university educated, intelligent and successful in our chosen careers. Between us there is a lawyer, an economist, a HR consultant and one’s in marketing.

We compared our work responsibilities, working hours, work-life balance, how varied our work is and prospects for career advancement and improved salary. As I suspected, my salary as a speech pathologist is considerably less than my peers who chose different career paths. Much less. Not surprisingly, my lawyer and economist friend struggled with longer hours and finding the right balance between work and play. They were handsomely rewarded for their efforts with overtime pay and other recognitions. All of my friends reported they enjoyed the scope and breadth of their current roles. I described my role as being under-staffed, mostly mundane and predictable. They all reported good prospects for career advancement and therefore improved salary. I reported my career prospects as a clinician were limited and that I’d reached a salary peak of what I could realistically expect to earn as a clinician (Australian health professionals with recognize this as ‘grade 2, year 4′) with very few roles above me to strive for.

My friends were shocked and sympathetic. I talked about how healthcare organizations are seriously strapped for cash and how the government who ultimately pay our wages pour money into other areas of healthcare while failing to recognize the need to nurture and not alienate allied health clinicians like myself. Our medical colleagues wouldn’t stand for the same career or pay structure, so why should we? Why don’t we enjoy a similar profile to our medical colleagues to allow us to demand the career structure and pay that we deserve? I described how powerless, frustrated and disillusioned I often felt with my chosen career path. Someone suggested private practice but there’s no market or demand for an adult clinician like myself.

The conversation shifted towards how each of my friends work in private enterprise and healthcare is considered a public or government enterprise (note that’s probably very different from the US where I believe hospitals are businesses themselves). I argued that private companies independent of the government earn money and have a bottom line to consider. Those employed within government controlled industries like healthcare are reliant on the government to allocate money rather than having to earn money for themselves, like a private business would. Ultimately the system is flawed as clinicians like myself are being short-changed because we can’t negotiate for individualized structure or pay like my private enterprise friends can do.

I got to a point in my working career where I completely burned out. Recent comments on this blog have mentioned burnout as well. Once you’re burnt out in a job, in my experience, there’s no turning back. You need a complete change of scene in order to move on. 

When I was burnt out, my work completely consumed me. I felt tremendous pressure from all aspects of my job. I’d been forced to take on extra work and responsibility with no thought from my superiors about my expanding workload. My superiors were unsympathetic and one actually told me that I wasn’t being asked to take on more than anyone else in the department. I’d be at my desk at 7am. I was gripped with chronic insomnia and daytime sleepiness. I worked tirelessly but mostly unproductively and to a reduced standard with no thought for my own wellbeing and for no extra credit or recognition. I got every cold or cough going around. I was too tired to do any exercise after work. I absolutely dreaded getting up and going to work in the morning. The world could have opened up and swallowed me whole. I’d collapse in a heap on Friday night after work and spend all weekend dreading Monday morning. I was horrible to be around and the relationship with my husband strained. I felt terrible. I knew the root cause of my burnout, it was the increasingly strained relationship with my manager at the time.

How did I dig myself out of such a hole? I left. I just couldn’t do it anymore. And I sought treatment for depression. Leaving that job was the best move of my career to date. I was upfront with my new manager about my recent experiences. I haven’t looked back.

In researching this post it didn’t surprise me to learn that the highest levels of burnout are found in health professionals. As acute hospital clinicians, we pay a high price for caring and working with people in medically complex, emotional and highly stressful situations. Often despite our best intentions and appropriate treatment, outcomes for patients can be negative and heartbreaking. Unfortunately some patients in acute hospitals die. Taking this on every day is a tremendous burden for health professionals that’s largely unrecognized by the profession and our managers. Couple this with inadequate staffing, large caseloads, limited time to participate in activities beyond clinical work and limited prospects for career advancement and enhancement and you’ve got a recipe for disaster.

If you’re nodding your head reading this post thinking, yep, I’m there, do something about it!  There’s plenty of excellent resources online to assist in recognizing and treating burnout in health professionals. One of my favorite bloggers recently posted on happiness and burnout. She includes an excellent self-assessment to determine if you’re at burnout point and other useful links on the subject. Another useful post I found specifically for health professionals is here. 

Don’t ignore the signs of burnout, in yourself or your colleagues. When you’re in the throws of it, burnout is soul-destroying and destructive. Seek help if you need it.

If you practice with aphasics and you haven’t heard of Audrey Holland, then there’s something wrong! She’s a prominent American aphasia researcher. In a presentation she gave at an aphasia conference in 2002, she provides some very practical suggestions on what speech pathologists can do to assist asphasic patients in the early stages post stroke. Here’s my summary of that presentation.

Having a stroke is scary. The psychological impacts of early stroke for the patient and their family can’t be understated. The early focus is often on early survival of the stroke rather than language or communication.

It’s a novell experience. Aphasia is a completely novell experience for most acute patients and their families. Most would never have thought something like this could occur after a stroke and hence they’re often not in a good position to receive factual information about aphasia or how to remediate it. 

Expect spontaneous recovery. Look for it, praise it, document it and consider it when discharge planning.

Don’t conduct a formal assessment. Whatever you do! It’s well known that spontaneous recovery happens early after a stroke. These patients are likely to be changing quickly so there’s no point conducting a formal assessment that may be irrelevant in a few days.

Keep it functional. Keep your early assessment functional. Conversation, conversation, conversation! Conversing with the patient in the presence of family can show them how to do it themselves. Track how well they understand general conversation. Use what’s around you. Read get well cards, fill in menus together, check to see if the person remembers your name and role. Check the patient’s yes/no response, name objects around the room,  ask absurb questions and note the person’s reactions to social greetings.

Once a day for 15 minutes. That’s it. Don’t drag the patient to your office. Meet them in a somewhat familiar environment (the patient’s room). You’re more likely to meet the patient’s family as well.

Don’t put jargon in your notes. It’s my pet hate and often points to an incompetent and incomplete clinician! Document functional changes or lack of them.

Be repetitive. Don’t be afraid to be repetitive in your assessments. Repeating your daily assessment can help demonstrate spontaneous improvements to you, the patient and family.

What were they like beforehand? Find out about the patient’s personality and communication style prior to the stroke.

Be in contact with families. Don’t run away when you see them coming. Provide them with reassurance, education and counselling. But don’t be surprised your education attempts don’t sink in.

Audrey’s final note. “Wherever possible, and to the best of everyone’s abilities, positive emotions such as warmth, grace, good humour and laughter should be part of the therapeautic process”.

Amen to that.

BTW, where did the first 2 weeks of 2008 go? I’ve been drafting several posts in recent weeks and I’ve been having a terrible time trying to decide which post to display first. So we’re going to begin 2008 with some good old-fashioned ‘venting’… here goes. 

There’s an acute speech pathology department in a major hospital in the city I work in that has a terrible reputation for being bitchy, elitest and overly-medicalized. It’s engrained in this department who have held this reputation for many years. And there’s no way I would ever work in that department. I could not work within a culture of constant, soul-destroying competitiveness and bitchiness. I’m not sure who’s to blame for the reputation this department has, if the manager of the department is to blame or if some of the staff that have worked there for many years are the culprits. I don’t want to know. That department and all of its members scare me and they are best left alone to do as they do best and to fight it out amongst themselves.

Unfortunately for the rest of us, there’s a flow on effect from such a department. People do eventually move on out of this department and they go on to ‘infect’ other unsuspecting workplaces with the similar traits. I’ve seen it happen before where a seemingly well-functioning department is turned around in a matter of months into a new hybrid of the bitchy and competitive world that culprit has just left behind. Beware of the reputations of the workplaces your fellow colleagues have come from. You might be infected next.

Reputations are relevant not only for small speech pathology departments but for entire healthcare organizations as well. The reputation of my employer (a large healthcare organization) is shakey at best. It has a reputation for its relentless cost-cutting, rigid and unbreakable workplace cultures, under-valuing of allied health staff and for playing catch-up rather than leading the way in healthcare. Unfortunately I discovered much of this after I started working for them. I’ve learnt my lesson and there are some healthcare organizations I would happily avoid because of their negative reputation.

Is there a manager or other speechie out there you would deliberately choose to never work with because of their reputation? I could instantly name a dozen speechies I would happily never see the sight of again either having heard of their reputation or having experienced it first hand in the workplace. It’s bothered me over the years that so many of my previous co-workers have turned out to be evil enemies that I scorn if I happen to ever see them again at a mutual speechie-related gathering. In cases where I have worked with such an individual in the past, I continue to reflect on what went wrong in our working relationship, what exactly I despise about them and what I would do differently if I had my time over again. I’ll be willing to bet they aren’t doing the same thing back to me. At the end of the day I just don’t fit the ‘pearls and twin-set’ mould of the standard acute speechie. I’m comfortable with that. It’s a reputation I’ll happily stamp to every future job application.

With the new year approaching I’ve been considering some new personal and professional goals to work towards in 2008.

All this thinking was spurred on partly by this blog post from Dumb Little Man called Personal development: How old are you really?. He talks about the differences between one’s age and maturity, where we get older without trying but maturity requires work and effort. Amen to that. I really believe that you’re only as old as you feel and surely your maturity level has something to do with that too.

On a different note, by far the post that attracted the most attention in 2007 was… can you guess? ‘Who out there hates being a speech pathologist’ was (according to my WordPress stats) the most popular post on this blog in 2007 with 419 hits. It is also my favorite post and a topic that has obviously hit a cord with many readers. I’ve always thought this blog has tended on the negative side when exploring the profession and sub-speciality of acute hospital work, but obviously I’m not alone when I wrote my thoughts on that topic. WordPress also lets me know what phrases people input into search engines to reach my blog. Alarmingly just about every single day I’ll find some kind of phrase like ‘i hate being a speech pathologist’ that some poor soul has entered into a search engine with the hope of finding blogging gold. The second most popular post was ‘About Speechie Keen’ with 403 hits. I’m thrilled so many people are interested in learning more about me!

Cheers 

SK