New migrant to Australia: what to expect of your doctor and the healthcare system

By Alok Das

(Disclaimer: The following excerpt must not be read as a piece of advice. It is a blend of some personal experiences and subsequent reflections. I strongly recommend wherever you have any medical issues, seek advice from a qualified medical professional.)

Two states

State 1

2003. A surgeon’s chamber in Dhaka in Bangladesh. I receive a sudden shock! To fix the health issue that I had, I had to be operated, the surgeon told me. At the surgeon’s insistence I was enrolled as a patient and then operated in a specific private clinic which proved to be very expensive using the income in a country versus expenditure scale. I was there for a few days. After I was released, I did not happen to see or hear from the surgeon anymore. No, nothing happened that could possibly lead you to think of something weird: the surgeon did not leave the country or medical profession; touch wood he is alive till date; not that his surgical skills were dissatisfactory, he was a highly skilled surgeon. The overall experience was nauseating as the nurses and other hospital attendants were extremely nastily behaved to my mother who was with me as my carer. Worst, before I left the hospital, the medical attendants (not doctors) came to me asking for ‘tip’. It was (still is) a culture there that they believed it was their right to ask extra money from you as ‘tip’. My mother and I decided to say something. ‘Why begging for ‘tip’ now when you were so misbehaved throughout our stay here? Stay clear of the doors now’, said I, gently but firmly, to the nurses and attendants. I try not to remember this event any more.

State 2

2013. A surgeon’s chamber in Sydney. The surgeon makes a funny comment about my tie and that makes me laugh. That makes the environment lighter to start a conversation. Then he draws a figure on a piece of paper, explains the issue to me and how we can treat and manage it. He tells me that his intention is to go to the root of the problem so he can work with me to fix it. To go to the root he thinks the best way for him will be to operate me, run a small sophisticated camera into a specific part of my body and later on, he can suggest me a management plan.

‘Are you willing to go through the surgery? You do not have to tell me know. Tell me in the next 5 days. I will tentatively book a date, so if you want to go ahead we do not struggle for my availability’ says the surgeon.

The way the surgeon explains the issue and shows me relevant scans and results from other tests creates a positive effect on me: I feel I am being educated, I start to get confidence that I am going to make an informed decision. I decide to go ahead. Then the surgeon hands me over to a nurse who explains to me how I should prepare for the surgery.

On the day of the surgery, my wife drives me to the hospital. I am seated in a special room and instructed how to prepare for the surgery; one friendly nurse asks me a few questions about me and what surgery I am going through. She asks me to relax. After about 15 minutes, another nurse comes to the room and in a very friendly voice repeats the questions the previous nurse had asked me. After some time the anaesthetist turns up into the room, smiles at me and introduces himself, explains what he will do and leads me to the operation theatre. Another nurse asks me if I am allergic to anything and a few other questions. The surgeon smiles at me and assures me I will be fine. I am assured I am in good hands. The surgery gets done smoothly.

The post-surgical care I get is simply superb. The nurses are very assuring. They encourage me to be positive. They talk to my wife about what she does, what her hobbies are and a lot of other topics.

Before I am released, the surgeon talks to my wife and myself, explains the post-operative care plan, hands me two documents: first one a list of Do’s and Do Not’s, and the second one, a medical certificate so I can use it for medical leave from my employer.

‘I will call you in a few days once I get the result of the biopsy tests’, he tells me. Then he pats on my shoulder and wishes me all the best. I am released from the hospital. The friendly nurses and a friendly receptionist wish me all the best. My wife drives me home.

In 5 days’ time I get a call from my surgeon at 7.30 in the evening. He apologises for calling me so late and cracks a small joke, quite typical of him, and makes me laugh. He assures me that results of the tests indicate that I have no reasons to worry about but I need to follow a certain plan.

‘I will write a letter to your GP with the details. Visit her, preferably as early as possible, so she can explain you in greater details. Should you have any concerns after that, you have my number and please feel free to call me’, says the surgeon.

‘Sure I will’, I respond.

‘And one very important point before I hang up,’ says the doctor with an apparent serious tone. ‘Continue to wear your lovely ties.’
‘You can’t suppress the comedian in you, can you?’, I say to him, laughing.

The quiz for you

For a moment let us assume you are in your high school years and have been asked to compare the scenarios above and note down the differences, what will you write? We all have been through such tests, haven’t we? There is a reason why I have used the high school analogy here: only to show that, to pinpoint the differences, you do not need to b super intelligent; rather common sense will do. I believe you have already made some points and now let us check if your observations match mine:

There are some points that are obvious:

• I have narrated the experience in Dhaka in 1 paragraph but the experience in Sydney in 12 paragraphs.

• I have narrated the experience in Dhaka in using past tense but the experience in Sydney using present tense. Why? Frowning at me? Precisely, I want not to remember the experience in Dhaka but I cherish the experience in Sydney. So I have taken the ‘poetic license’ to narrate two past events differently: the ugly one using past tense and the sweet one using present tense.

The key difference is that the surgeon in Bangladesh:

• did not show any empathy to the patient.
• did not explain the issue to the patient.
• did not give the patient any options and time to decide.
• did not do any post-surgery care plan.
• did not show that he cared about the wellbeing of the patient.
• did not bother about the patient’s post-operative care.

The most disgusting point, as I understand now, is that the surgeon in Dhaka did not educate the patient.

Another point becomes clear to me later on: in Sydney the intention behind two nurses asking me the same set of questions prior to the surgery and at a gap was to ensure that I was fit to go through the surgery.

I feel that in example 1 above you can quite comfortably replace Dhaka with any other city in most third world countries.

Setting and managing your expectations

Allow me to reiterate my position here: I am neither a medical professional nor any kind of expert on health systems nor have any qualifications to give any ‘advice’ on medical issues. I am just sharing my experiences with you in case it helps you in getting an understanding of some aspects of the healthcare system in Australia. If you are a migrant from a country with a very good healthcare system, for example, France, Italy, Germany, the UK, Denmark, you will probably feel that the system is very similar to what you have seen in your own country. But if you are from a third world country, you are more likely to relate to my experiences and observations. The main points based on my experience and observations are:

• The main feature of the Australian healthcare system is that it is very well organised in terms of infrastructure and different types of highly skilled healthcare professionals.

• In Australia medical professionals use very sophisticated technology and knowledge bases to perform their jobs.

• The main cultural difference between the Australian healthcare and the healthcare systems of many other countries is that here healthcare professionals educate patients. Managing health issues is not just a matter of administering some medicines or conducting a surgery. There is more to it. It is a joint effort between you and your medical professional. Instead of prescribing you any medicine, if they give you a management plan, follow it. There must be a reason why they have advised you to follow this plan. No point in doctor shopping in the expectation that the new doctor will give you a medicine that will solve your problems overnight. However, this is not to suggest to you that you should never seek a second opinion from another medical professional. If required do so. If your medical professional has given you some literature to read, read it. Ask them questions, if you want to.

• In general the culture in Australia is that people are well behaved. Medical professionals behave very nicely with the patients. In some cultures it may be a practice that to display one’s importance they have to display arrogance.

• You cannot decide what specialist you want to see. You have to explain your problem to your GP who will then assess you and advise you of the next steps. This makes perfect sense. With many years of medical training and experience the GP is the best person to dictate this.

• Medical professionals do not just include doctors, there are many other types of professionals, for example, nurses, physiotherapists, chiropractors, exercise physiologists, dieticians, psychologists, optometrists, and many more.

• You cannot dictate your doctor to give you a specific medicine, for example anti biotic medicine. Very logical, you are not the doctor and so why would you dictate? I know from my experience, from experiences of friends and doctors from other countries that in many countries patients (especially if they are ‘powerful and influential’) are quite comfortable in dictating doctors on what to prescribe.

• If you have a medical issue it is better to talk to your GP first, instead of checking with friends who are not doctors and, at their advice, consuming over the counter medicines.

• If there is a complex medical issue, then different medical professionals can work in liaison with each other. For example, a GP, an orthopaedic surgeon, a physio and a counsellor may treat a patient in different phases of the road to recovery, and they keep each other in the loop about the overall progress.

• One piece of advice that my GP has given me and I find it quite helpful: living healthy depends on a number of conditions.
Some you can control, some you cannot. But use your control power where you can, for example, eat healthy food, drink a lot of water, have enough exercise, have sufficient sleep, avoid smoking, avoid sugary stuff. Remember, not my advice, my GP’s advice. So here I will remind you, consult your GP whenever you have an issue and follow their instructions.

Also be mindful that I haven’t touched upon Medicare and private health insurance systems and how they work, as that would be too technical. I recommend you visit relevant websites for details.

A perfect healthcare system?

Do you have a question in mind whether the Australian healthcare system is a perfect healthcare system? I am unable to answer this question on many grounds. To mention a few, I am myself not a healthcare professional nor any other kind of health expert, and your definition of ‘perfect’ may not match with mine. This system has its problems too. But the difference is here in Australia the authorities acknowledge the problems and continuously work to improve the scenario. There are many points where you can raise your concerns and complaints. Overall, this is a very transparent system with a sense of commitment at every level. And Australian healthcare system, for sure, is better than the health care system in most other countries.

If you ask me personally, I am grateful to Australia for such an awesome system.