World TravelERs: New Zealand


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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN

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Frank T. -

I'm definitely interested in hearing more about the systems in other countries, and I look forward to all of these segments. One suggestion: add a bit about whether the actual practice of EM is different in each country. Without EMTALA, is there a difference in how low acuity care is managed? Are people ever referred away to another facility without being seen? In New Zealand specifically, I've heard many smaller EDs may not have CT scan, thus patients would need to be transferred for a scan if needed, but such a need must also be well justified. Such nuances to emergency care in the different countries would also be interesting.

System level info is also quite interesting. Thanks for the segment!

Ryan R. -

My experiences are limited to a large referral center in a mid-size city, so my exposure is not complete. I would say, despite the non-existence of EMTALA, the ED still tries to help folks within the scope of practice available to them, regardless of their reason for visit. There's no "patient dumping", since it's all publicly-funded, regardless. There are some facilities experimenting with self-referral to urgent care with better capacity than the ED, but not in our area – the urgent care centers are just as busy as we are.

As far as rural centers without timely access to CT, they certainly exist, but are gradually diminishing as the benefits to advanced imaging clearly outweigh the costs of observation/transfer. The overall system capacity has a ceiling, however, and there is a layer of review for appropriateness.

Byron F. -

It is interesting, but data should be added to the impressions.

Vashun R. -

I practiced in two emergency departments in New Zealand. Overall, I think it is the utopia of Emergency Medicine if you're willing to settle for a set salary. It's almost the equivalent of working for the VA in the U.S.
One of the major factors in the practice of em there is the lack of legal liability. Given that medical bankruptcy is not even a concept there because of universal Healthcare, there is no need to recoup damages for a missed diagnosis. In the U.S., hundreds of thousands of dollars can be owed by a family to a hospital, even after a botched diagnosis or medical mishap. How can a U.S. family even begin to consider paying medical debts if the household provider falls ill?
In New Zealand, folks are hearty and stoic. There is a sense of personal responsibility pervaise throughout the country. Should a physician miss a diagnosis, there's a genealogy sense of "well... stuff happens". And the physician wasn't the cause of the medical problem. Playgrounds for instance are some of the most dangerous places in the country. They still have "monkey bars" which are practically banned in the United States. They also have really dangerous fast moving, unmanned swings typically seen at U.S. adventure parks. Should a child break their elbow playing at their own risk, it is not seen as anyone's fault but their own. Novel concept! Additionally, the diagnosis, workup and followup will be covered. No need to get the playground owner to cover the bills.

Ryan R. -

One of the key things I failed to mention in the segment was the "ACC" system, which is basically the NZ alternative to the US tort system. Anyone suffering an accidental injury – including those harmed by medical mishaps – have access to compensation and reimbursement for a wider range of necessary services. There is a centralised health quality board that reviews complaints, and can undertake investigations and make specific advisement regarding system changes or individual education in response to adverse medical outcomes.

Robert M. H. -

I've been working in an Urgent Care in NZ for 6 months. We share WR with ED. One ED and one UC for 50K people. One CT and one MRI. Both very buy usually. Here there is a bad shortage of GPs and usual wait for an appt 2-3 weeks so all urgent care comes to us. Nationwide there is a crisis of burn-out in Family Medicine. They schedule them to see a patient every 15 minutes and I suspect that is largely to blame.
In our urgent care we see most all ortho and follow most ortho in out "fracture Clinic". Minor stuff coming to ED is told to come to urgent care the next day. The attending ED docs don't staff nights but rather on-call if registrars (residents) need help.
We nave nitrous oxide other sedation is in ED.
We have v limited suture material, no choice in needle size, often run out of scalpels with handles , have no long acting local anesthetic. Our EMR is stone age and paper work is tedious.
ACC paperwork and charting can require 5-6 signatures.
The patients are fabulous and almost everyone is appreciative not entitled, and even the kids says a sincere "thank you".
As has been said the kids are free range and broken bones just part of growing up.
The staff are great and the atmosphere very casual-I'm "Robert" The dress code is also very casual. A little blood on the floor just gets wiped up. Paper on exam tables unless we run out then just vinyl wiped off between patients.

We do a lot of clinical medicine with limited resources and I love it! Anybody interested and able to roll with shortages come on down. They really need docs and it's very cool to work here. Did I mention the scenery is jaw dropping beautiful. And the Kiwis are just happy people and lovely to live with.

I know Ryan and I would be happy to help anyone thinking of coming to NZ

Ryan R. -

Massive practice variation between the geographically isolated rural facilities as far as the subtropical north to the gateway to the Antarctic, with major and minor international destinations in between. I'm fortunate enough in Christchurch you could walk in and almost imagine yourself to be in any suburban academic hospital in the U.S.; the few things that are mind-blowing (paper orders, glacially-slow "modern" EHRs) are far outweighed by the ease by which the "right" thing can be done for patients. Not to mention the fun of working with colleagues trained all over the world. Now, if only this COVID thing would go away ....

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EM:RAP 2022 February Full episode audio for MD edition 218:21 min - 240 MB - M4AEM:RAP 2022 February German Edition Deutsche 98:08 min - 135 MB - MP3EM:RAP 2022 February PA Edition PA Edition 73:32 min - 101 MB - MP3EM:RAP 2022 February Farsi Edition Farsi 164:48 min - 226 MB - MP3EM:RAP 2022 February Canadian Canadian 31:52 min - 44 MB - MP3EM:RAP 2022 02 February Board Review Answers 190 KB - PDFEM:RAP 2022 02 February Board Review Questions 888 KB - PDFEM:RAP 2022 02 February MP3 Files 260 MB - ZIPEMRAP 2022 02 February Written Summary 311 KB - PDF

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