201702-Stafford-Amanda-Dr Dec16

Dr Amanda Stafford’s efforts to make life better for ED frequent fliers may have come up with a solution.

I jokingly call myself a Specialist in Hopeless Medicine. My passion for helping alcoholics and homeless people, two of the most unloved groups of patients coming through the door of ED, often puzzles my colleagues. The general view seems to be that it’s admirable, albeit dreadful, work. But nothing could be further from the truth.

My career in Emergency Medicine started late, after nine years spent in Europe doing basic research in molecular biology. On returning to Perth, the expected route into academic medicine took a sharp turn in the direction of EM with its relentlessly fast pace and problem solving.

About four years ago I became interested in a notorious ED ‘species’, the ‘frequent flyer’ – officially known as the ‘ED Super-user’. These patients could reach truly astonishing levels of ED attendance. Some presented so frequently with chest pain that a copy of their ECG was left pinned to a wall so we didn’t have to wait for the old notes.

Dealing with these people taught me the importance of forming networks both within hospital and on the ‘outside’ to provide the support these patients need to loosen their attachment to the ED. Presentations that, incidentally, rarely solve their problems.

But as some of the simpler problems melted away, two in particular came to dominate the frequent flyer list: alcoholism and homelessness.

The alcoholic patients we saw in ED were train-wrecks trapped in an addiction of incomprehensible ferocity. Most had been through the gamut of treatment options, often repeatedly and without any appreciable effect. We felt helpless and often angry, both with the patients and at our own inability to make a difference.

In late 2013 I stumbled across Baclofen, an old medication being used in France with unprecedented effectiveness for alcoholism due to its ability to literally extinguish cravings.

No one in addiction medicine here in Perth was prepared to give it a try so I started treating alcoholics myself. Baclofen works, it’s that simple. My focus is now on getting this form of treatment into GPs’ surgeries where it will do the most good.

The other group of deeply entrenched frequent flyers were homeless people coming to our ED in search of medical care, food, drugs and a place to stay. We had to tread a fine line between compassion and pragmatism otherwise we risked becoming a homeless shelter every night.

We started ‘doing it better’ by bringing staff from the Homeless Healthcare GP practice into RPH and they link our homeless patients to housing, the only thing that actually improves their lives.

Yes, I’m more than exasperated by our willingness to spend large and seemingly limitless amounts of public money on the consequences of homelessness. We spend and spend on health, welfare, justice and policing while simultaneously baulking at paying the infinitely smaller cost of improving housing and support services.

If we addressed this issue effectively it would permanently eliminate our chronic street homelessness within two years and reap immense savings in both human misery and the health budget.

And my response to those who think homeless people don’t deserve priority housing? Try living on streets for six months and then see how you feel about ‘joining the queue’.

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