All That Glitters Is Not Gold

I’m into my second year as a locum now and my search continues for the perfect country town to call home. After a fairly length break from clinical work, 2014 kicked off with a four week stint in the wild west town of Kalgoorlie. Kalgoorlie is an historic gold rush town, established alongside the “Golden Mile,” reputed to be the richest square mile of gold bearing earth in the world. Gold is still the major industry, dominated by the impressive “Super Pit” – Australia’s largest open cut mine and visible from space. In fact, gold actually grows on trees in Kalgoorlie.

The Super Pit - if you look really closely you can just see some of the massive dump trucks looking like tiny ants.

The Super Pit – if you look really closely you can just see some of the massive dump trucks looking like tiny ants.

I was also hopeful to strike career gold.  On paper, Kalgoorlie seems like it should suit me pretty well. It fulfils most of the criteria on my wish list; it’s got great facilities, lots of events, some pretty good eating and drinking options, and generally nice weather. It falls down a little on the “proximity to the ocean” and “the more remote the better” criteria, but you can’t have everything. Most importantly there is a huge potential for a busy and satisfying GP and obstetrics workload, with the opportunity to do pretty much as many deliveries as I could handle.

There’s also a good precedent for me having a good time in Kalgoorlie. I lived there as a 5th year medical student with the Rural Clinical School and really enjoyed it, so I was looking forward to seeing what had changed in the 9 years since I last called Kal home.

On the surface, the town is much the same as it was back then; The Little Boulder Sweet Shop still satisfies the chocolate craving, the Oasis still has my favourite gym class on a Sunday morning and the best show in town is still a sunset lightning storm seen from the Mt Charlotte Lookout.

View from Mt Charlotte

View from Mt Charlotte

The major difference was that pretty much everyone I used to know had left.  It seems there’s been a major shift from those days when there was a stable group of long serving local GPs, to now where several practices have gone through closures, changes of ownership, a shift towards corporatised practice and a greater reliance on overseas trained doctors. The medical community also contains some big personalities, with some pretty dysfunctional GP-GP and GP-hospital relationships, which seems to affect the general morale about town.

The turbulence in the GP sector was reflected in the frustration of patients. Many of them had bounced between two or three different practices leaving their continuity of care (not to mention medical records) in a shambles. I’m sad to say I also saw a number of patients who had fallen victim to bad 6-minute medicine from poorly supported overseas trained doctors in stretched bulk-billing clinics, some with devastating consequences.

As I’ve travelled around the country I’ve had a lot of patients ask hopefully if I’m staying for good, but never with so much pleading desperation as in Kalgoorlie. A few more long term, caring and competent GPs would be so welcomed by the local community. My hats off to the very busy, hard working doctors who are serving the community out there now under sometimes difficult circumstances.

I feel terrible to say that I’m not going to be one of them.

The work side of things wasn’t bad, in fact it was overall very good. The mix of obstetrics and GP was ideal, I got to do lots of fun pregnancy ultrasound scanning in the practice itself (a rare novely), the patients were lovely and the practice staff were without doubt the nicest bunch I have worked with. There is great support from visiting and resident specialists at the hospital and most allied health services are available locally, too.

Socially, however, Kalgoorlie was my toughest job yet. Partly it was because I worked in a small practice and not a hospital so just physically did not come across as many new workmates. Partly it was because I didn’t have an “in” to the local social scene; someone I already knew who could introduce me to their friends and invite me along to things.

It’s not like I didn’t make an effort. I went to the weekly parkrun, I went to the touring comedy show (by myself, on valentines day), I went to the markets, I went out for dinner, I went to education sessions at the Medicare Local, I went to the local cake stalls and even went to the local crossfit gym. Despite all this, I came up against a social brick wall time and time again. Maybe it’s just a function of being a slightly bigger city where people are busy and already have plenty of friends, but no one really seemed interested in talking to a new person, and I never really felt like I fit in with any of them.

But of course I DID meets lots of new people inside my consulting room, and some of them were the sort of people that I could see myself becoming friends with. But is it ok to become friends with your patients? And if so, how would you even go about it? Let me pose a few hypotheticals:

  • You see a young lawyer for a simple repeat pill script and you get chatting about books after you see her reading your favourite novel in the waiting room. She mentions that she’s in a book club that’s meeting at a local cafe on Sunday. Is it ok to join her at the book club meeting? What if she was hosting it at her house?
  • A physiotherapist comes in for a pap smear. She has recently moved to town with her FIFO geologist boyfriend but admits that she’d finding it really hard to make friends and is quite lonely, too. You find out you have some mutual friends back in Perth and seem to get on pretty well. Is it ok to suggest you meet up for coffee one weekend? What if you thought she was actually depressed and started her on anti-depressants?

I know we are always taught that we need to maintain clear black and white boundaries between our doctor-patient relationships and friendships, but to be honest I think that when you’re new to a country town there are a lot of shades of grey. Some other rural GPs have also experienced this dilemma (see here and here) so it seems to be a pretty common problem. The question is where is the line between what is ok social interaction with patients and what is completely unacceptable? Does it depend on the size of the town? The nature of the problem they consult you for? Whether they are male or female? What about supervisor-student friendships? Are they ok?

There are no easy answers, but with young, female, rural doctors being identified as particularly vulnerable to poor mental health, I think it’s worth asking the questions.

Luckily, I did strike Gold a couple of weeks later, with the overwhelmingly awesome experience of the smaccGOLD conference. Read my post about it here.

Next stop, Port Hedland. Stay tuned to hear how it turns out in another red dirt mining town…

A rainbow over the Super Pit at sunset, beyond a section of Kalgoorlie pipeline.

A rainbow over the Super Pit at sunset, beyond a section of Kalgoorlie pipeline.

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7 thoughts on “All That Glitters Is Not Gold

  1. Love your blog penny….my rule:once your my friend you can’t be my patient and once your my patient you can’t be my friend…there is the in between time of seeing someone for minor stuff-the pill or a pap where you are not quite friends and they are not quite ‘your’ patient where you can suss out possible friendships..I explain that once we are friends I can’t be their GP or conversely if they have slipped to being patient then I say we can’t be friends…people are generally very understanding..does mean however missing out on possible friendships and a bit more socially isolated but as I plan to stay long term I think I have needed to be clear from the beginning so as not to get ‘blurry situations’….now the question of colleagues as patients..phew.that’s tricky….

  2. Another wonderfully written and thought-provoking post, thanks Penny.Loved your hypotheticals – really got me mentally weighing up the factors. I agree with you, there are definitely more shades of grey in the bush re: boundaries, but decisions on such still, of course, need careful consideration and management. Size of town, nature of problem/s consulted, number of consultations, male/female etc. all probably affect where the line will end up. In the Medical Board’s eyes, having a romantic relationship with a current patient is always, absolutely, definitely a “not acceptable” but lesser transgressions e.g. striking up a platonic friendship with a same-gendered patient (assuming heterosexual) is not in the “hanging offence” category.

  3. It’s beautiful, Penny. I loved rural practice. Couldn’t manage the social brick wall partly created by the town but mostly by professional etiquette.

    You’re breaking down the walls. More strength to your arm!

    Cheers Janice

    Dr Janice Bell MBBS BA B Ed(Hons) Grad Dip Integ Med Grad Cert CHM GAICD FRACGP

    Chief Executive Officer

    WAGPET Level 2, 16 Brodie Hall Drive, Technology Park, Bentley Western Australia 6102 phone: (08) 9473 8200 │ fax: (08) 9472 4686 │ mobile: +61 418 911 622

    This email is intended solely for the intended addressee. If you have received this email in error please notify us immediately by return email. Please do not re-transmit or print this email message, or take any action as a result of knowing its contents, but destroy all copies and any attachments. Any claim to privilege or confidentiality is not waived or lost by reason of mistaken transmission of this email.

  4. good to here any honest view from a visiting doc . hopefully we can improve the way things work in the future. We could definatly need a better way of getting docs involved in the community . all work and no play not good. Good luck in finding the place for you.Its out there somewhere.

  5. Pingback: Feeling at Home in Hedland | Nomadic GP

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