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Tough toes a requirement in the bush

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BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

Rural Doctors need to have fairly tough toes. They get stepped on so often.   We know when our toes have been stepped on because it hurts.  Stepping on rural doctors’ toes can take on subtle forms.

Role Substitution

Throughout Australia this is happening: nurse practitioners prescribing medications; pharmacists giving out medical certificates and flu shots; physician assistants doing colonoscopies. In the rural regions this role substitution was based on a dire need for manpower – understandable but if the doctor is there, please mobilise these role substitutes elsewhere.  Further, it would be nice to let local rural doctors know and have a say in how the allied professionals will be liaising with us. 

When another cook comes into the kitchen, it’s okay if we invited them.  However it is toe crunching when they come into the kitchen, chuck out the soufflé, move the pots and pans around and tell the diners they cook better than we do.  I ask you, is this going to motivate me to stay in the kitchen?

The other day a patient said she would wait for the visiting pap smear nurse to visit to get her routine pap smear done.  Ouch.  I am a pap smear queen.  I travel with my pap equipment, what’s wrong with me, the good ol’ family doctor doing it?

The Non-Existent Discharge Summaries

Patients often come to us saying: “Back two or three months ago they cut out my appendix. You know, they must have told you.” Or:  “They told me to get my blood pressure and sugars checked as soon as I got back home.” Or even: “Sorry, doc I just remembered I was supposed to show you my scar.”  I cover for my hospital colleagues by saying their bookkeeping must be behind, I am glad they are okay, I regret that I did not know until this minute that they just about died two months ago.

Retrieval Service Extraordinaire

They swooped into my ED, looking through me as If I was not there, stern blue with flashy fluorescent stripes on their trouser side seams. Efficient, military precision, hardly saying a word.  They pulled out the IV I had carefully started and replaced it. They took off the splint I fashioned and replaced it, hoisted my patient on their snap-snap stretcher and they were off.  At one point I tried to introduce myself: “Hi, I’m Dr S….”.  I think one of them nodded, never introduced themselves, never gave me a thump on my shoulders to tell me “well done”, and they did not tell me what was wrong with my IV and splint.  Later I commented to the nurse they could have just kidnapped my patient.  I have every confidence my patient is okay, but my toes hurt.

Rolled Up Eyes

Oh, that doctor from St Elsewhere put the patient on the wrong “xyz” drug, they missed the “abc” sign of the obvious disease called blankety blank.  Yes we make mistakes, but we need the support from you, not the criticisms.  When we catch our own failings, we step on our own toes in shame and self-recriminations.  Can you be kind and advise us to not to crunch our own toes so hard?  It will help keep us here in the outback healthy.

Continuing Medical Education

How do you think it feels to hear that nurses and medics who take the exact same rural procedural courses pay almost half what we do to attend?  Do we pay more because we get a $2000/day stipend for taking rural procedural courses?  Why should a rural GP spend precious Government funds on attending a course that has only the intrinsic value of less than the quoted price?  Shouldn’t the course reflect the unique difficulty of the work of a rural medical officer and not the allied health provider?  The Department of Health’s toes must hurt this time.

The Visiting Specialist

Please remember you are visiting. I live in this God-forsaken part of the world.  Scabies, chronic suppurative otitis media, syphilis, rheumatic heart disease, post streptococcal glomerulonephritis, chronic disease management plans, is my meat and potatoes work.  So how do you suppose my toes feel when a visiting team tells the community they have come to “clean up” the scabies, the CSOM, and get “caught up” with all the management plans?  Hey guys, I am trying to do the same thing, with limited resources, could we join forces?

In the end it comes to patient care.  It is their toes we are all looking after.

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