Rural vs. peri-urban medicine

I first must apologise for the paucity of blogs and vodcasts on this site in the past few weeks. To explain, it has been a period of massive change and logistics. Firstly, was wrapping up my 12 month stint in Wudinna as a GP registrar. As I explained at the Australia Day breakfast, each town that I practice in from now on has it tough. I will be using Wudinna as the yardstick. During my time there, I could not have been more welcomed and well supported by the community, practice staff, hospital staff and my GP supervisor/baseball player Scott Lewis. It made for a bittersweet move. This was made especially difficult by the fact that many patients did not understand that GP registrars move on every 6-12 months asking “why are you leaving?!” Secondly, I am between residences at the moment. This means staying with some friends in the southern suburbs of Adelaide while I look for an apartment in the city proper.

Welcome to Wudinna

Welcome to Wudinna

Since leaving the Eyre Peninsula, I’ve started part-time registrar work in the Adelaide Hills, with the other half split between a research project and teaching undergraduate medical students at the University of Adelaide. It has been a great mix of academic work, medical clinics and some on-call rosters. During the year I hope to dedicate some blog-space to my research and some gems that I glean from teaching med students clinical skills and case based learning. In the past, there has been so much to learn from fresh student eyes. The move has meant that my commute has stretched from the not-car-worthy 1.2 km to 34 kms in peak hour traffic. The landscape in the Hills is vastly different too, with plenty of rolling hills, green trees and rows of vineyards criss-crossing the valleys.

Welcome to Hahndorf

Welcome to Hahndorf

Even already, there has been a notable difference in the casemix and behaviours between a remote country town and outer (or peri-urban) medical practice:

  • Patients know when their time is up: In the country, many patients are up for a long chat. This is fine for a simple repeat script, but not so much as the clock ticks closer to 20 mins in a 15 min appointment. I have found that patients in the peri-urban setting realise that there are plenty of other people to be seen and usually are out the door by 10 mins without subtle prompting! It could also be that they are busy themselves and are rushing off for a meeting in town.
  • Calling back about ANY results: In the peri-urban setting, there have been many more phone calls or emails to the practice about pathology results. Even 1-2 days after collection! Perhaps these patients are more interested in their health (or more health literate)? It seemed that in the country, patients were happy to be called only if something was worth discussing. I’m sure the previous AOGP academic registrar Annabelle would have something to add here. Her research in 2012 looked at some of the predictors of this phenomenon, with rural patients not knowing as much about their health.
  • More children with viral illness: I have seen more children with parents saying “I think they’re ok, but just wanted them checked” in the past month than I did in the whole year in the country. Not sure about this one? Perhaps more doctors available for this sort of check up closer to the city? Or just tough country parents “I’m only taking you to the doctor if you arm is hanging off…”
  • Medical certificates: Many more patients in the peri-urban areas coming in just for medical certificates. Again, either tough country patients “Can’t come in to work today, Ive coughed up a kidney” or rural companies/businesses not being as strict with the medical reason for not coming in.
  • Less happy about waiting: Even after spending time with emergency presentations, *some* patients seem less happy to wait compared to the country. I’m guessing that rural patients are used to having the only one or two doctors busy at the local hospital with other sick patients. Perhaps even because they have been that sick person themselves?

I’m sure there will be plenty to add as the year marches on. In the meantime, hope to hear any other thoughts on the reasons for some of these simple observations.

1 Comment

Filed under General Practice, Rural GP

One response to “Rural vs. peri-urban medicine

  1. ..and of course variety. Today an epidural, then an emLSCS, an eye emergency, a psych consult, scripts and workcover, baby checks, bereavement, coughs n colds, hyponatraemia due to drugs, nerve block and pulled limb straight

    What variety

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