[Theme Music Starts]

RUBY:

From Schwartz Media I’m Ruby Jones, this is 7am.

More than three million Australians face a health crisis that can severely impact their quality of life -- chronic pain.

But many people experiencing chronic pain are let down by an outdated healthcare system.

It’s a system that frustrates both patients and doctors, so is it time for a radical overhaul of how public health operates in Australia?

Today, Beth Atkinson Quinton speaks to The Saturday Paper’s health columnist Dr Mel Cheng about the challenges doctors face when trying to help patients with chronic pain, and how we ended up with a system that fails to address it.

It’s Wednesday, August 4.

[Theme Music Ends]

BETH:

So Mel, the health problem that everybody is talking about is Covid-19, but the healthcare system was already overwhelmed long before Covid, what's going on?

MEL:

Well, as a GP working in Australia, chronic pain is always front of mind. Nowadays, almost one in five GP consultations involve the management of chronic pain conditions. And while I can count on one hand the number of patients I've seen with covid-19, I couldn't tell you how many patients I've seen with chronic pain, it’s that many.

The figures around chronic pain in Australia are quite staggering. Currently, there are 3.4 million people living in Australia with chronic pain. And so it's a huge issue. It's at crisis levels.

Archival tape -- Shakira Hussein:

“I've had remitting relapsing multiple sclerosis for most of my adult life, it seems, although it wasn't diagnosed until my mid thirties and the pain has come with that it's ebbed and flowed.”

MEL:

And I know that one of the 3.4 million people in Australia who experiences chronic pain is Shakira Hussein.

Archival tape -- Shakira Hussein:

“I have to say, I've not encountered a GP who was knowledgeable about pain management or even particularly comfortable about discussing it. It's just the way that the system is set up.”

MEL:

Shakira’s experience isn’t unique, many of the patients with chronic pain share these frustrations with the healthcare system. GP’s are seeing more people for chronic pain, in fact patient encounters have risen by 67% over 10 years. And I’m seeing that the current system isn’t really adequate to manage these huge numbers of patients with chronic pain.

BETH:

Okay, so it sounds like patients like Shakira, experiencing chronic pain, are really struggling with the current healthcare system. Why is that?

MEL:

Well, I think it comes down to the modern medicine model. I certainly know during my training as an undergraduate, the focus was really predominantly on acute illness. Much less time was diverted during my training to managing chronic illnesses.

Archival tape - [Massive Attack / House theme plays]

MEL:

And I think pop culture has some influence over this as well.

Archival tape - [House]

“I can cure him...”

Archival tape - [House]

“Cure him? Even if the fountain proved anything, fixing hypothalamic dysregulation isn't going to regenerate brain...”

Archival tape - [House]

“No but it’s scar tissue on his hypothalamus...”

MEL:

I often think to the popular TV series House and how that also creates this idea that there is always a diagnosis. A failure to find one. You know, for instance, is a failure on the part of the doctor. I think doctors know that there is no easy fix, and I think some of us are scared by that prospect.

Part of it comes down to training. You know, we're never really given the tools during our training to deal with some of these more complex issues. And I think some of us would rather, you know, avoid it altogether.

BETH:

Mel, take me through why we have this system? Does it match the realities of your current work demand?

MEL:

So most GP's have, you know, 10 to 15 minute consultations as a default. Currently, there's not a lot of financial incentive for GP's to spend a lot of time with patients.

Archival tape -- Shakira Hussein:

“A standard GP appointment is really just long enough to describe a medical issue quite briefly and come away with a prescription.”

MEL:

The Medicare benefits schedule is how GP billing works. And when we see a patient, we have to choose an item number to bill Medicare. And these item numbers are often time based. It's more financially rewarding for a GP to see lots of patients quickly than to see a few patients and spend a long time with each patient.

Archival tape -- Shakira Hussein:

“There's a GP for day to day stuff, but really I only see the GP to get prescriptions filled again because they can't deal with the more complicated stuff.”

MEL:

There are public multidisciplinary pain clinics, which are really the gold standard when it comes to managing chronic pain. Unfortunately, patients can wait up to a year, if not two years sometimes to be seen in those clinics.

Archival tape -- Shakira Hussein:

“I've been told at various points that I could be referred to a pain clinic, but the waiting list for the pain clinics is so long that I have never got to the top of it.”

MEL:

And so access is an enormous issue, even for those managing really severe and chronic pain like Shakira. So what happens instead is that while we wait, GP's like myself, are managing patients like Shakira for, often years.

Archival tape -- Shakira Hussein:

“The medical system is geared for you to walk into the doctor sick and hopefully walk away well, and I think this cultural idea that you have the power to make yourself well has its limitations.”

MEL:

So what we're really seeing here is a failure of the medical system that we've got to be able to handle the current burden of patients with chronic pain. And we're certainly not prepared for the likely ongoing surge and influx of patients in the future who are going to be presenting to their GP's with chronic pain. So, you know, I and other GP's like me feel quite stuck and often quite unsupported to be able to manage these patients. And patients like Shakira obviously can feel very frustrated and let down.

So as we've seen this problem grow over the past decade and is likely to increase into the future, it's really going to become something that GP’s and other doctors can't avoid anymore. And we need new ways of looking at chronic pain and managing the patient with chronic pain, or else the system is really in danger of failing Australians entirely in the long run.

BETH:

We’ll be right back.

[Advertisement]

BETH:

Mel, we’re talking about the chronic pain epidemic that Australia faces and the healthcare system’s failure to properly address patient care. Why do you think chronic pain has been ignored as a health crisis?

MEL:

Measuring chronic pain is often difficult due to the subjective nature of the pain. And also because while chronic pain is a diagnosis in and of itself, the principal causes of the pain are so many and varied. And from things like injuries to gynaecological causes like endometriosis to neurological causes like migraines and in Shakira's case, multiple sclerosis. So chronic pain doesn't fit so well or easily into the traditional medical model of diagnosis, treatment and cure, and the management really is about functionality and quality of life.

Archival tape -- Shakira Hussein:

“It makes you feel like a burden and a problem to be dealt with. And it makes you feel like the stereotype of the whinging woman. I'm so wary of being seen like a hysterical drama queen that I downplay it even to my doctors.”

MEL:

And unfortunately, what happens is that sometimes the patients are made to feel like they've failed in some way because they're not getting better in spite of the treatments. So in reality, it's not a failing of the patients, and there's actually several factors which make it more likely for certain demographics to develop chronic pain.

Archival tape -- Shakira Hussein:

“I feel that my experience of pain management has been very shaped by my gender and probably my race as well, that women are seen as being, on the one hand, overly likely to complain about pain, to whinge, but on the other hand, to be able to endure pain because, goodness, we go through childbirth, don't we? And so we're used to pain. Our bodies are built for it. I think women of colour are particularly perhaps subjected to this.”

MEL:

I think patients with chronic pain, especially female patients, are often dismissed by health professionals. And we also know that people from the lower socioeconomic areas are almost twice as likely to be hospitalised with chronic pain as those from the higher socio economic areas.

BETH:

Do you think we will see any change in how chronic pain is managed in our health care system?

MEL:

Well, the good news, just this year, a National Strategic Action Plan for pain management was actually endorsed by all Australian governments.

Archival tape -- Unknown Person:

“It sets out diagnosis, education, treatment, pathways to recovery...”

MEL:

The next step is to make sure that the governments provide the funding to realise those actions outlined in the plan.

Archival tape -- Shakira Hussein:

“The system is seriously not set up to deal with people with chronic pain. it's very difficult to get disability support and the criteria for disability support don't really take pain into account.”

MEL:

We know that it costs government and society a huge amount. They estimate about 140 billion dollars per year and that 10 million missed work days and 40 percent of the forced early retirements are actually due to chronic pain conditions. So there is a financial benefit in addition to the humanitarian benefit of this investment.

And I think the Covid pandemic has made us realise that investing in public health is crucial. It just needs the resources, it needs the specialists, and it needs the funding.

BETH:

Okay, and until we get that funding, what can be done to think about chronic pain differently. What have you learned as a GP about pain that’s changed your perspective on it?

MEL:

So GP’s are generalists by default and so we know a little bit about everything, but it's impossible really for us to remain abreast of all the latest treatments available for all conditions which cause chronic pain. And that's where I think GP’s are feeling somewhat lost and unsupported. And so we need that support. We can't do it on our own.

Archival tape -- Shakira Hussein:

“I think if there was a broader cultural shift towards seeing a good outcome as being improved quality of life, which is not irrelevant in the current system, but I think that what counts as a win for doctors is a patient who's either no longer sick or if it's a disease like multiple sclerosis that doesn't have a cure, but whose disease is at least on the leash and not flaring.”

MEL:

I think training of the future generations of GP’s as well as current GP’s needs to also reframe these goals and outcomes away from eliminating the pain altogether, away from a cure from the underlying diagnosis and much more towards, improving functionality, improving emotional and social well-being, and taking a much more holistic and individualised approach to chronic pain management.

BETH:

Thanks so much Mel.

MEL:

No worries, thanks for inviting me.

[Advertisement]

[Theme Music Starts]

RUBY:

Also in the news today…

The Prime Minister Scott Morrison has revealed the modelling used to determine vaccination targets set by National Cabinet, in developing the four-phase roadmap to reopening Australia.

The modelling - by the Doherty Institute - suggests that vaccinating around 70% of the population aged over 16 would allow Australia to avoid lockdowns while being confident of constraining new outbreaks.

On Tuesday New South Wales recorded 199 new local cases. Of those at least 82 were infectious while in the community.

Queensland recorded 16 new locally acquired cases, all linked to the Indooroopilly Delta cluster.

Victoria recorded four new local cases, all cases are linked to known outbreaks and were in isolation for all of their infectious period.

I’m Ruby Jones, this is 7am, see you tomorrow.

[Theme Music Ends]