I trained in a hospital where every common condition came with an online, localised, step-by-step guide. Then I worked in more than 30 Australian hospitals without one. The gap is costing doctors confidence and patients safety, and it is one of the simplest problems to fix.
In one regional Victorian hospital, I went looking for the guideline on managing a STEMI, a serious heart attack.
The hospital kept its clinical guidance in a library of around a thousand PDFs, searchable by title only. The guideline existed. It was filed under “Tenecteplase”.
Nobody looking after a patient with a heart attack types tenecteplase into a search box. They type STEMI, or chest pain.
That small absurdity sums up the state of clinical guidance in most Australian hospitals. The knowledge is usually there, somewhere, in a format that nobody under pressure can use. And the doctor who cannot find it is often the most junior or new person in the building, treating a patient in a town with no specialist down the corridor.
I have worked in more than 30 hospitals across Australia and New Zealand, as a student, an intern, a locum filling short-term gaps in regional hospitals, and now as the founder of a company that places doctors in regional health services. I know what good looks like because I started with it.
What I had in Christchurch, and what I found here
I did my clinical years at the University of Otago’s Christchurch campus and my first years as a doctor at Christchurch Hospital.
Almost every day I used HealthPathways, the localised clinical pathways that Canterbury, the health region around Christchurch, built for its hospitals and general practices. Each pathway is a short, agreed guide to one presentation (the problem a patient walks in with: chest pain, abdominal pain, a fall), written and approved by local senior clinicians and kept current.
I used it for clinical reasoning, to study for exams, and to check that any decision I made as a junior doctor was clinically validated, backed by the health system and consistent with how that hospital did things.
I assumed this was normal.
When I moved to a large Melbourne hospital, the closest thing to a pathway system was a set of almost 1000 Word documents that one emergency physician had built himself.
They were respected, organised by presentation and hard to navigate, but they got me through the year. Then I started locuming, first in regional Victoria and by the end of 2021, across much of the country, and the support fell away.
I had thought localised, easy-to-follow guidelines were standard practice, particularly for junior doctors and for locums or new staff arriving in a health service.
Instead, I was working alone in regional towns, making decisions at the limits of my experience, with no quick way to confirm what the evidence said or what the local service expected. I spent hours in PubMed, the medical research database, and in newsletter articles.
Therapeutic Guidelines, the national prescribing reference, helped with some decisions. It is organised around drugs and conditions, though, and a sick patient arrives with a presentation.
Locum doctors set up message groups to pool what we knew. I also went back to the Christchurch Hospital HealthPathways from regional Victoria. The referral routes belonged to another country, but the questions to ask on history and the findings to check on examination were the same on either side of the Tasman.
The result for me was a lot of clinical anxiety and unnecessary delay. The result for the hospital was a less efficient, more anxious doctor who relied on nursing staff to explain how things were done here. You don’t have a cardiology department, so what happens with a STEMI? Do we give clot-busting drugs here, or transfer? Who do we call, and how?
A hospital should be able to answer those questions before the patient arrives, in a form a new doctor can find in the moment.
The deep end keeps getting deeper
We throw junior doctors in the deep end, and every year the deep end gets deeper.
Two things have changed. The first is the workforce.
Medicine is moving to a more flexible workforce, and the doctor who has spent 30 or 40 years in the same hospital and carries every local protocol in their head is becoming rare.
The second is the knowledge. A junior doctor in the 1980s or 1990s had a short list of drugs to learn and prescribe. Today the list runs to around 500, and if you choose one blood pressure medication over another without knowing the patient’s kidney function or whether they have diabetes, you are considered careless.
The scale is astronomical, and we apply the same weight of expectation to junior doctors even as we talk about safe working hours.
Junior doctors also make most of the day-to-day decisions in a patient’s care. A consultant may have 50 to 100 patients under their name. The resident prescribes the medication, orders the test and decides who to call. If that resident phoned the consultant every time a drug was prescribed, the hospital would stop.
So, they need easy-to-access, clinically validated, consultant-approved information they can act on, plus a clear framework for when to escalate to a senior and when not to.
Through StatDoctor, I place doctors in regional health services. The barrier to taking a regional job is never price or location. It is always support.
Junior doctors want to know who they can call for help and what systems will keep their practice safe. Good guidelines support doctors more than most people will ever realise. They are an encyclopaedia in your pocket.
Australia is spending billions on electronic medical records, but that won’t solve the problem. A system that records what happened is a different thing from a system that helps a doctor decide what should happen next.
I am a strong advocate for AI in healthcare, and I do not believe a chatbot pointed at the literature fixes this either. More information does not make a doctor safer.
Ask an AI about a patient who is taking an unfamiliar medication and it will offer 700 literature reviews, some good, some bad, none of them about how to manage that patient’s heart attack in a town with minimal support.
Where AI helps is in surfacing the right local guideline quickly, and that only works if the local guideline exists, is current, and has been written and approved by the clinicians who run that service.
What good guidance looks like
HealthPathways is written the way clinicians are taught to think in medical school: history, red flags (the warning signs that must never be missed), examination, investigations, management. That structure is why students and junior doctors take to it immediately.
When I show them the Canterbury Hospital HealthPathways, the reaction is always the same: this is so easy to follow.
I still use it myself. If I meet a presentation I know less well, say a suspected aortic dissection, a tear in the body’s main artery, I can open the pathway and check the red flags in a minute, instead of crawling through websites or PDFs.
It also changes how juniors talk to seniors. The consultant on the other end of the phone, who may be in Melbourne or Sydney or Brisbane while you are in a regional emergency department, will ask very specific red flag questions. Low back pain: any change in bladder or bowel function? A junior may not yet understand why that matters.
If they have worked through a pathway, they have already asked. The consultant’s decision rests on the quality of that history and examination, and the two doctors are relying on each other completely. If I tell you there are no red flags, you are assuming I know what the red flags are. A good system is what makes that assumption safe.
Many health services believe they already have guidelines. Often they have a document repository. A statewide list of antibiotic choices is useful. It does not tell a new doctor how this hospital manages the patient in front of them, or when to pick up the phone.
What health leaders can do now
If this is so obviously useful, why are clinicians not demanding it? Partly because people get used to what they have or don’t know how to advocate.
I recently worked in a NSW hospital that was breaking at the seams through lack of staff. I asked the nurses how they coped with it day after day. They said they had been doing it for years. I had come from over 30 other hospitals and could see how bad it was. For them, it was all they knew.
You do not know what you do not know is out there.
People who feel the gap most sharply, junior doctors or people new to teams, have almost no power in the system, or feel they have none, and partly because healthcare is still behind in technology.
Every other industry has been transformed by it. The patient-facing side of medicine is starting to move, with AI scribes that write up consultations and smarter records, but the systems behind the scenes, and the way we actually deliver care, have a long way to go.
So change has to come from the top.
Chief medical officers and medical directors need to say that this matters for junior doctors, that a patient in a regional town should receive the same quality of care as a patient in a metropolitan hospital, and that closing the gap in outcomes between regional and metropolitan patients starts with giving every doctor and nurse the equivalent quality of locally endorsed information.
There is a simple test for any medical director.
Ask a doctor in their first week with your service to find your guidance for a common presentation. Can they find it in a couple of minutes? Does it reflect the services you actually have? Does it say when and how to call for help? The answers will tell you more than the number of documents on the intranet.
We don’t need to start from scratch: take the guidelines a hospital already has, pull them into a structure a clinician can navigate, and ask the local clinicians whether it works.
In Victoria, where health services are being grouped into regional networks, some are already signing up shared rostering and credentialing systems for their regions. Shared clinical pathways belong on the same shopping list.
Picture your mother, your father or your child arriving at a regional hospital, and the doctor seeing them is in that building for the first time. What standard of care do you want? The same quality of care as an experienced specialist in metropolitan Melbourne would give.
The only way to deliver that is to put the right information in front of that doctor, in the moment, in a form they can use. I had that in Christchurch as a young doctor. Every doctor in Australia should have it. It is a no-brainer.
Dr Anu Ganugapati is a doctor and the founder of StatDoctor, which places doctors in regional health services across Australia. He trained at the University of Otago and Christchurch Hospital, has worked in more than 30 hospitals across Australia and New Zealand, and is now based in Brisbane.