Country GP is boring

Doctor/pilot x 2

Doctor/pilot x 2

I remember a colleague in medical school commenting on my intended choice of general practice saying “oh, I couldn’t do that…how boring.” Perhaps a small part of me agreed with them. Sure, I had sat as a student in a room with an urban GP and even completed a 6-week GP term in the country with some tedious moments. But now at the end of 12 months and my first registrar placement in rural general practice, I can look back and see how wrong my classmate was. I can’t even remember the number of times that my supervisor, Dr. Scott Lewis (above), and I would see a particularly interesting case and remark (tongue in buccinator) “geee, how boring is country general practice!”

During the year we have retrieved and transferred patients via RFDS for a variety of conditions including:

  • Haematemesis with a Hb of 55
  • Three appendices in the last 2 months
  • Suspected septic knee joint in an 18 month old
  • 2 cases of severe bronchiolitis in the space of 2 weeks (Thanks RSV)
  • Numerous renal colic, some with pyelonephritis
  • Suspected spinal epidural abscess

But it’s not all about the high end critical care stuff, no matter how much the PHARM/ED/ICU/anaesthetic gurus will trumpet. The nuts and bolts of GP are there too:

  • Immunisations and baby check ups
  • Cancer screening
  • Preventative care for heart disease and diabetes
  • Family planning
  • Skin lesion removals
  • Antenatal care
  • One of my favourites, ear syringing
  • Palliative care planning, to name a few

For this reason general practice (and country in particular) has been termed “womb to tomb” or “cradle to grave” care. However, I do prefer the alternative: “crack to croak.”

Perhaps the real scope of rural general practice was demonstrated a few weeks ago. Wudinna recorded the highest temperature in the country that day, reaching 48.2C. To add further difficulty, my supervisor (the only other doctor in town) was away. Luckily I had the help of a great Flinders 4th year student. Here’s a brief summary of what happened:

End of a *hot* day

Start of a *hot* day

Woken up at 3am – Chest pain brought in by ambulance – MSK, likely thoracic spine in origin

Morning Clinic

  • Fasting bloods x2
  • 12 month immunisation
  • Funny rash on shoulders – pityriasis versicolour
  • Follow up after USS for ?DVT

Up to hospital for foreign object in eye – used slit lamp to examine

  • Follow up after ureteric stenting
  • 18 month immunization

Up to hospital again for facial laceration – 7 stitches and epiglue

  • Change in bowel habit with PR bleeding
  • Diverticulitis

Lunch

*** Cut short by a car rollover with three occupants 30 km out of town. All self extricated. Blood alcohol levels on each and C-spine XR on driver to clear neck and removal collar. ***

An ex-Ford Fairlane

An ex-Ford Fairlane

Afternoon Clinic

  • Hoarse voice in 7 month old

Up to hospital. 3-year-old not tolerating orals, vomiting – admitted for observation

  • Diabetes check-up
  • Blocked ear – eustachian tube dysfunction
  • INR check
  • 6 week post-natal check
  • Chronic leg ulcer

Would be hard pressed to call that day boring! Was it stressful? Yep. But fortunately the vast majority of our days were not this busy, but the variety was always there.

More than one SAAS crew at hospital = bad

More than one SAAS crew at hospital = bad

General practice allows the doctor to be a true jack-of-all-trades and master of some. Some have said that specialities are learning more and more about less and less, until one day they know everything about nothing. The converse might also be said about GP work. But as long as I know what to look for and ask my specialist colleagues for help at the right time, I’m happy. Not only with the management of patients, but also my choice in medical specialty. General practice is never boring, you just need to look for inspiration in right places.

@ruralflyingdoc

Applying for GP training: http://www.gpet.com.au/ApplyforAGPT/NewApplicants/

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9 Comments

Filed under Emergency Medicine, General Practice, GPRA, Rural GP

9 responses to “Country GP is boring

  1. Alison

    Shhhh- don’t tell everyone! They’ll all want to come now! Oh, wait… That might be a good thing! Rural GP lets you cover the whole gamut of medicine. Stimulating, challenging, fascinating, rewarding, connected, sometimes tiring… But no- never boring! … From a 20 year veteran!

  2. ..and pays well

    Espec if do procedural.

    I love the high end crit care stuff. But some days ear wax is enough – patient comes in miserable, quick procedure and all is well again

  3. martins

    Yes but what i recall about the pt with the hb 55 is the start of the doctors walking down the street regime and boy does it suck getting back quick! ..

  4. Amanda

    Where did the OTHER ambo come from? I didn’t even know Wudinna had one!!

  5. Shame you weren’t there when my son was diagnosed with Henoch Schonlein with renal involvement, joint pain and hydrocele. That would round your list off nicely!

  6. Sunny

    Love it Gerry. Keep up the good work

  7. Pingback: Flying training vs. GP training | ruralflyingdoc

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