Small Town Medicine, Whew

Well, San has given a little preview that my work here in Whangamata is quite a bit different from everywhere else we have been. Actually the practice is like the others in being a rural general practice in a small town with no hospital or ER, but they even have no local lab or x-ray. They’ve not had very many locums here and I think now I know why.

They expect a locums to “earn their keep” w/in a day or two of getting here. That means seeing 4-5 patients per hour from 8:30-12:30 and 2-5:30 PM. It means sharing in the 1 out of 3 call system. (They have 3 full time docs, but one position is shared by a lovely English husband/wife team.) Also they are contracted with the government to be what’s called the “Prime doctors” in the area. That means that when on call you are responsible to attend/review every patient that the ambulance is called to. So you might have to leave the practice to go to the scene of a car accident to evaluate patients still trapped in a wrecked car or attend a cardiac arrest in the ambulance or home . For instance, I have attended a man after a motorcycle accident (beat up and bruised with clavicle fracture), a 51 yr man who collapsed comatose drinking/eating in local restaurant, and a schizophrenic depressive who probably overdosed on her pills. Today I also ran over at lunch to pronounce someone dead and do a death certificate at the local nursing home. These are to be expected. But to start doing this 4 days after starting to work in the community has been hard. Then to do it over the first full weekend and run Saturday PM and Sunday clinics with no nurse or receptionist, not knowing where everything is--that is all a bit much.

However, that said, it is a wonderful group of people to work with in a beautiful ocean-front beach community. It is a typical GP practice but unlike the last one which had mostly Maori and many children, this one is more retirees with the usual geriatric problems and issues plus out-of-town tourists Still some kids, too and today that included a very depressed teen and 9 month old preemie twins, one of whom was just discharged from Auckland hospital after a collapsed lung/resp arrest and pneumonia! Ah yes, primary care in small town general practice.