Saturday, January 6, 2007

Cervical Erythema

DownUnder, our healthcare system has been struggling to meet adequate staffing levels for many years now.

This is most evident in general practice and in the public hospital system.

Both are, to be blunt, kept afloat by overseas trained doctors (OTDs) recruited into the Australian system. There has been a boost in medical school places in the last couple of years, but there will be a long delay before this has a positive impact. It takes at least 10 years to train a family G.P. in Australia, and even longer in many other specialties.

The OTDs are generally forced to work in "areas of need" for many years after entry. This entails usually one of two things - being forced to work in our struggling urban public hospitals, or (especially for GP's) to work in a remote and isolated rural or semi-rural area.

If Brits stopped coming here on extended "working holidays" and filling many of our junior grade hospital positions, the entire system would collapse.

What Dr Dork suspects is most challenging for OTDs, however, is that of ending up in the Australian bush for those of a different cultural origin.

 Image source

Rural medicine in Australia is very different from city medicine. Australia is vast, our population relatively small. And most of that population is concentrated in our urban coastal enclaves. In the bush, there aren't many hospitals. Or many specialists. Ancillary services may be a thousand kilometres away. Our indigenous people, to our great shame as a nation, are plagued by Third World health concerns whilst in our cities there are Botox clinics and 5-star private hospitals.

Dr Dork has worked in the bush. He still does, not infrequently. Dr Dork's grandparents were farmers, yet he still finds it hard at times to connect with and adjust to bush life. He can only imagine how hard it is for those coming to Australia from extremely different cultures in places such as Europe, Africa or even our Asian neighbours.

Dr Dork had this illustrated today quite explicitly. A patient came to see Dr Dork for a second opinion. This patient lived in a rural area, and had been under the care of a doc local to his area for a few weeks. From the name on the documentation shown to Dr Dork, this doc was clearly of Middle Eastern extraction. The care he had provided, as far as Dr Dork could ascertain, was perfectly appropriate.

Yet the patient was rather disenfranchised. Very derogatory in regards to the other doc.

The problem was not clinical competence. Perhaps communication with the patient had not been ideal as there was some degree of language barrier. But mainly, it seemed about race.

Dr Dork treats all his paients the same, he likes to think. Be they saint or sociopath.

For some the mask is harder to wear.


The MSILF said...

Hmmm...I always see the recruiting ads and was kind of tempted to try it for a year. But sounds like maybe it's not such a good idea? Do you like practicing rurally?

scalpel said...

And how exactly are the poorer rural areas supposed to support "five star private hospitals?" That isn't shameful, that's just life in the real world.

Bo... said...

I hear similar issues discussed here in the rural areas of Texas.

Dr Dork said...


Rural medicine is a matter of choice and personal preference to a large degree, but one must be comfortable without ready access to other specialties, tertiary referral centres and the like.
It's not as bad down here, really, as my post perhaps suggested. I was P***ed off by this racist drongo and needed to ventilate a bit! We have a shortage of docs, and it's a decade until we create enough new ones. If you were to come here as a junior doc, you would probably have no trouble getting a job in the hospital of your choice in the city of your choice, or near enough to. In general, conditions for junior docs have improved greatly in the last 20 years, and if you decide to enter a training program here you're treated pretty much the same as local graduates.

My dear scalpel,
Diseases such as trachoma, syphilis, and malnutrition are rampant throughout our remote aboriginal communities, and unheard of elsewhere. Personally, I think such gross inequity of healthcare is shameful in a supposedly civilised society. From our previous discourse, I suspect we might just agree to disagree.

Bohemian RN,
I find it ironic, in a way. Most of our countries wealth is generated in our farming and mining communities, yet such are treated like poor cousins.

scalpel said...

I figured we'd disagree, I just couldn't resist giving you a poke. I would also like to suggest that the racist may in fact be the patient rather than the physician in the example you presented. Hmmmm?

Dr Dork said...

I thought it was clear that the patient was racist ? Hence the post title. Sorry if that didn't come across as clearly as I hoped.


Health Psych said...

To me, it was clear you were referring to the patient, Dr. Dork.

I think for many of your overseas readers, it might be a real stretch to imagine that in parts of Australia some elements of the community are really living in third world conditions, with the disease processes associated therewith. Certainly, it was an eye opener for me when I came over from the UK.


scalpel said...

Sorry for the misunderstanding. When you said "Dr. Dork treats all his patients the same" and that "for some, the mask is harder to wear" I got the impression that you were suggesting that the other physician was somehow rude or condescending to the patient because of racial or ethnic disparity and that was what upset the patient.

Never mind. :)

Sid Schwab said...

cervical erythema. Good.

The admission dean of my med school, when he asked why the applicant wanted to be a doctor, and received the cliche'answer "because I like people," used to respond: "but do you like sick people?" Like healthy people, not all are likable. Bite the tongue we must.

Dr Dork said...

Hi Sid,

Understanding why we dislike certain patients sometimes reveals our own deficiences. Some people are just nasty. Still get the same treatment, naturally, but can lead to Blog Ventilation Syndrome.

Charity Doc has an intriguing post on a rather emotionally demanding patient encounter.


Dr Scott said...

Thanks for the welcome to the blogosphere, Dr. Dork! I would love to visit the Australian outback someday, but in the meantime, i can relate to your encounter. My two fellow pediatricians in my small town are Phillipino and Indian. I frequently receive patients who mercilessly slam my colleagues, usually for no other reason than being "foreigners." (Ironically, my Phillipino friend has been in practice here for some 25 years, though he does keep a heavy accent which some patients have difficulty understanding.)
When that happens, I usually just sigh, nod my head, and move on.
PS--love the illustrations on your most recent post.

Dr Dork said...

Hi there Dr Scott.

No problemo. The outback is a beautiful part of the world...which I obviously adore. The US, as Oz, is founded on immigration and is inherently multicultural, one thinks. Ironic.


Sheila Smart said...

Images on the internet are not for the taking, even for blogs. The images of the Devils Marbles is my image and I do not recall giving you permission to publish this on your blog. Please either remove the image or place a link to my image on my website

Sheila Smart

Dr Dork said...

Dear Ms Smart,

My sincere apologies. The offending photo has been removed.


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