This is a very complex topic and I am unable to address it in its entirety here. However, I will outline some of the differences as it pertains to surgery and anaesthesia.


Public hospitals in Australia are funded by taxpayers, and patients access treatment at no out-of-pocket cost. As we are all aware, funding is a limited resource, so the most urgent and critical services are prioritised. These include both surgical and non-surgical treatments. This means that if you were to need urgent medical treatment or surgery, you will most likely receive it in a timely manner. However, this comes at the expense of prolonging the waiting list for less urgent (but undoubtedly still important) surgery. Additionally, public hospitals are where the majority of junior doctors undergo their training, which means that your operation may be undertaken by a trainee surgeon under the supervision of a specialist surgeon, and your anaesthetic may be given by a trainee anaesthetist under supervision from a Specialist Anaesthetist, and so on. While this is safe, it does mean that due to the burden of teaching (while meaningful and important), the number of operations that can be performed in a given period of time may be fewer than would be the case if all of your care was delivered by fully qualified specialists. This further adds to the pressure on waiting lists. At the public hospital, you are generally allocated a treating team rather than choosing your preferred surgeon/proceduralist.

Private hospitals in Australia are funded by patients. Health insurers and Medicare usually help patients cover the cost of their admission by paying part of the overall cost. When you are admitted to hospital there are the costs of the hospital: bed fees, operating theatre fees, equipment costs, staff costs, etc. If you have private insurance, there is usually an “excess” to pay and the insurer covers the rest. Think of this as the costs of the physical facility to have your operation. Now once you have a facility to have your operation, you need a team to actually perform the operation and look after you after the operation. This team of “providers” consists of your surgeon, anaesthetist, assistant surgeon, physiotherapist, pathology tests, x-rays, pharmacy, etc. These are usually independent businesses and contractors, not employed by the hospital, assembled to deliver the operation and peri-operative services to you. Private health care gives you choices. You choose your hospital and when to have your operation, and the waiting list is often significantly shorter than at the public hospital. Your operation will be performed by a specialist surgeon of your choice and your anaesthetic will be provided by a Specialist Anaesthetist. This is the same concept as you choosing your own GP, or choosing which local physiotherapy clinic to attend, or choosing which local pharmacy you wish to purchase your medications from. Each provider is independent and any questions you have about their services and accounts need to be directed to that provider’s office and not the hospital.

ICU is the intensive care unit, which is available in most major hospitals undertaking major operations. The ICU treats patients who are too unwell from their medical conditions to be managed on the general wards, but they also provide care for complex surgical patients after major operations where the patient may require additional support after surgery.

If you are having a major operation where significant destabilisation of your body’s systems are anticipated due to either your medical conditions or the complexity of the operation/anaesthetic, your surgeon or anaesthetist may pre-arrange a bed in ICU for you.

At the end of the surgery, the anaesthetist will make a decision regarding whether your body will cope with waking up immediately, the factors to consider include but are not limited to how well you are breathing, how well your lungs are at moving the required gases in and out of your bloodstream, how well your cardiovascular system is coping with maintaining an adequate blood pressure to perfuse all your vital organs, your temperature, anticipated pain levels, etc. If you meet these “wake up” criteria, then you will be woken up, breathing tube removed, and transferred to the post-anaesthetic recovery unit (PACU), where specialised nurses will aid in supporting your wake-up process. Once you are awake and stable, you will then go to ICU for ongoing monitoring and care.

If it is deemed that your body is not ready to be woken up, as your own body is not yet ready to take over all the vital functions yet, then the anaesthetist will keep you anaesthetised, and transfer you to the ICU directly. The expert specialist team in ICU is capable of keeping you asleep until your body recovers sufficiently to meet the aforementioned “wake up” criteria, at which point the team will wake you up. Sometimes this might be a few hours, sometimes a few days, and very rarely a few weeks or more.

Occasionally, a patient may go to ICU unexpectedly. This might be due to a previously unanticipated medical condition declaring itself during surgery, or unanticipated destabilisation during or after the operation. If this occurs, we do our best to keep the next of kin informed of the admission to ICU and progress.

In the past it was believed that there is a risk of lymphoedema in susceptible patients when things like intravenous cannulas and blood pressure cuffs were used on the limb which underwent lymph node resection for cancer in the past. This has now been shown to be not correct.

The Australian and New Zealand College of Anaesthetists have a website detailing the latest advice on this: More information on the ANZCA website

My take on this is: In situations where it is equally safe to do the measurements and the cannulas on the non-affected side, then why not just do it on that side for peace of mind. However, if a situation were to arise where we had limited options but to use the affected side, then you can rest assured that the available evidence confirms that it is safe to use that side.

Most providers will have a fee which they charge for their particular service, and if this fee is above what your health fund will rebate, then you will receive a bill called the “out-of-pocket” cost. Since it is impossible for providers to constantly keep track of the vast number of health funds and their constantly changing rebates and policies, the resultant “out-of-pocket” costs can vary greatly between health funds even if the providers were to charge exactly the same fee.

Choosing a health fund is a complex decision. But don’t forget to consider their rebate levels as part of your overall decision to purchase their policy. Many patients assume that having “top cover” means their rebates will be excellent, however “top cover” often gives you a great extras plan but the hospital and provider rebates component may not necessarily be any better than a lower or cheaper plan. Be sure to ask your health fund all of these questions and that you fully understand the implications before signing up.

The Commonwealth Ombudsman for Private Health Insurance has an excellent website here which explains how health insurance works, and there is a comparison tool on that website to help you compare policies. It is important to note that the Ombudsman’s website has a comprehensive list of all the policies of registered health funds in Australia, whereas commercial comparison websites might only include products and insurers with which they have a commercial relationship.

The answer here relates specifically to operations that are done under a general anaesthetic, regional anaesthetic, or a combination thereof. This answer does not apply to procedures where the sedative is the primary mode of anaesthesia, such as for endoscopy.

When you are about to undergo a general anaesthetic or regional anaesthetic, it is possible and in fact very common that you may feel a bit anxious. Some anaesthetists will routinely give the patient a preoperative sedative, after which your recollection of events can become hazy, and you may not fully recall having your regional anaesthetic performed or having your general anaesthetic induced.

I appreciate that everyone’s feelings and anxieties are different. I have met patients who were not anxious at all and are quite happy to go without a sedative. I have met patients who were anxious about being aware of what’s happening and prefer to be “out of it”. But perhaps interestingly, I have also met patients whose main fears are more to do with the loss of awareness or inhibitions and these patients actually prefer to avoid having a sedative. If we simply assume rather than discuss this with the patient, there is no way of knowing which category an anxious patient falls into. Therefore, in my practice, I prefer to give patients the option after discussing the pros and cons, rather than to routinely give it to all patients.

Patients who are particularly anxious could benefit from a sedative. Sedatives can hang around in your system for a period of time, which is great if you are waiting for your operation, or sitting through the performance of your regional anaesthetic. However, sedatives do make it harder to walk around as your balance may be affected. Also, drugs which hang around in your system may affect the quality of your awakening, especially if your procedure is short and you aim to try to go home and resume your usual life routines quickly without feeling a bit off for the rest of the day.

There is sometimes not much to be gained by having a mild sedative when you are literally minutes away from having a full general anaesthetic, and at the end of the operation to have the general anaesthetic wear off quickly, only for the sedative to give you a hangover for a period of time afterwards. This is less of a concern for major operations where patients may prefer to be hazy afterwards.

Some patients prefer to regain their bearings quickly after their operations, while others prefer to feel hazy, so there is no definite answer here. A sedative before a general/regional anaesthetic is a personal choice in most circumstances. If you have strong feelings about it either way, please discuss it with me on the day.