A taste of generalism in the Great Southern

After a rather indulgent 6 weeks off, I’m now half way through a 4 week locum stint in Albany, about 4 1/2 hours drive from Perth, right down on WA’s south coast. Albany has a population of a bit over 30 000 and was originally settled for its deep water port before later becoming a major whaling centre, and nowadays its main industries are agriculture, fishing and tourism.

Sunset in Albany

Sunset in Albany

I’m working in a smallish GP clinic covering for a couple of different doctors while they take some well earned leave. In addition to the usual clinic work, I’m on duty for the hospital inpatients, on call for obstetrics, working a shift in ED and covering nursing homes, home visits and palliative care. This has been an amazing learning curve already as during my time as a metro GP registrar I didn’t do home visits or nursing homes and the last time I worked in a general ED was as an RMO back in 2009.  The sum total of my palliative care experience was one week in med school, which made for an interesting challenge when I admitted a patient to the hospice last weekend. Added to the realisation that I am now the most senior full time doctor at the practice and responsible for supervision of two registrars and medical students, the anxiety levels have been creeping up a little!

But here’s the thing I’m realising more and more; experience and knowledge in some areas of clinical practice are applicable to many others. The decision to discharge an asthmatic child, depressed / suicidal person, or frail elderly patient from the hospital is the same as for a post-natal patient. Ie, are we doing anything in hospital that the patient couldn’t do at home for themselves? Is it safe to discharge the patient without ongoing monitoring? Are there any social circumstances that impact on this decision? Do they have and adequate follow-up plan and safety net? Easy-peasy! Good communication skills, sensitivity to patient distress, and being an advocate for the patient’s needs is universally important.  Apart from all of that, if I’m in unfamiliar medical territory and I don’t know the answer, I’ll get an opinion from other team members who do. Luckily at Albany there is a well staffed hospital with a whole host of senior partialists and their junior team members, plus great nursing and allied health services so support is easy to come by.

The great thing about stepping into another doctor’s shoes is that you get to see a different side of practice to what you are used to. Back in Perth I worked in a large practice and with my O&G leanings my patients were predominantly women between 15 and 55 and infants under 12 months. Now, I’m seeing much more general adult medicine and have many more elderly patients. I’ve come across some things for the first time, eg diagnosing Bowen’s disease, investigation of newly diagnosed CRF, injections of anti-androgen for prostate ca and management of cutaneous sarcoidosis. Plus, elderly people are HILARIOUS. Some people obviously get to the stage where they just say whatever they think without fear of any social repercussions. My favourites so far: at a home visit to 90 year old “You’re name’s Penny? Oh that’s cheap *cackle* … are you training to be a nurse dear? What are you doing in my house?” and from a 94 year old laughing after a new diagnosis of bowel cancer “No doctor, I’m not afraid of dying. I don’t think I’ve been particularly wicked”.

Early morning fog

Early morning fog

However, I do miss my obstetrics and after 3 months without delivering a baby I’m getting serious withdrawal symptoms. I’ve only got one patient expected to deliver between now and when I finish up in Albany and I don’t think it will be enough to fulfil my cravings. It’s highly unlikely she will need a caesarean and so you’d better keep me away from any scalpels just in case I get twitchy and feel the need to practice my pfannenstiel incisions on someone… anyone!

The other advantage of locum work is the ability to see how different practices work from an organisational perspective. This has helped me to clarify what I do and don’t want out of a practice in the future. For example, I don’t like having all of my consultations booked up with repeat scripts and pre-immunisation checks and I don’t like the fact that I’m on call 24/7 and have to stay close to town.  But, I do like the way that jobs are communicated to the practice nurse and the way that care plans are managed. I realise how much I appreciate a practice that has a dedicated procedure room and nursing assistance for booked procedures. All these things have an impact on job satisfaction and hopefully one day I’ll find a practice that ticks all the boxes.

So from a work perspective, Albany seems pretty great. There is the opportunity to practice a very wide scope of GP and plenty of backup if required. But in my quest to find a town to settle down in the longer term, the non-work aspects are also really important. On paper, Albany is pretty perfect. It has indisputable natural beauty with its abundance of rugged coastline and has some of the prettiest beaches in WA. It has plenty of nice restaurants, cafes, boutiques, art galleries and every type of shop you need is here. The region is home to some fantastic wineries, tourist attractions and it produces fantastic produce – fresh seafood, perfectly ripe fruit and veg, handcrafted chocolate…. sooo good! You could certainly live a very good life here.

However, I must admit that I’ve found it a little bit more difficult socially than I expected. The first week or two I definitely struggled a bit with loneliness and boredom, compounded by the fact that I didn’t have any internet access at home and I felt a bit closed in because it was already dark by the time I finished work. It has improved a bit since I started working at the hospital so have had the chance to meet more people, including hanging out with some of the interns and RMOs for Friday night drinks. It was nice to have the company even if it did make me feel pretty old! The question I ask myself is how easy it would be to find people around about my age to become friends with here. I have heard a lot of people say that they come to Albany because it’s a great place to raise a family, but what about if you are a 30-ish year old single person? This is quite a contrast to my first locum in Broken Hill where I met a lot of single people who had come to Broken Hill because they were looking for adventure and decided to stay because the town was so socially welcoming. Maybe it’s just that Albany is a bigger town that it takes a bit more time to settle in to and I’m under no illusions that 2 or 4 weeks is enough time to really get to know what a place is like to live long term. Still, you do get a bit of an impression about a place and I’m not 100% convinced that Albany would be a good fit for me. In my final two weeks I’m going to try to look into a few different activities in the hope of meeting more people and maybe I’ll change my mind. In any case, I’m more than happy to be proven wrong. Locals – feel free to tweet me with advice or invitations!

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4 thoughts on “A taste of generalism in the Great Southern

  1. Great post Penny – articulates well some of the challenges of a rural doc.

    Don’t be afraid to share the decision-making with other rural docs – indeed, the tools of SoMe and sites like foam4GP.com and ruraldoctors.net are there to help you

    Fascinating day for me today – b’fast coffee with Toby Fogg of the Aus/NZ airwyregistry.org.au, phone link with Rochelle Phipps (@GP2GO) to offer some advice on a tricky local situation in rural practice up in QLD, then a GoogleHangOut video conference with a neurosurgeon and HEMS doc in London on ‘burr holes in the bush’ – you are NEVER alone as a rural doc with the FOAMed community!

  2. Hi there! This article could not be written much better!

    Reading through this post reminds me of my previous roommate!
    He always kept preaching about this. I am going to send this information to him.
    Fairly certain he will have a good read. I appreciate you for sharing!

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