*waves*

I am still around but much of what I would say about my latest term in Gladstone is patient identifiable or involving local health politics that include information that is not in the public domain.

Suffice it to say that the work is great, we are understaffed ... still ... if you are looking for work as an experienced ED doctor, Gladstone is the placed to be.

Not paid for Mossman yet ...

.. the person responsible (apparently) was on leave .. now she is back from leave the assertion is that there are no signed timesheets to go with my invoices.

Interesting .. I stapled the time sheets to my invoices and personally observed the timesheets being signed off while at Mossman. I wonder how the invoices managed to get where they should have but the signed timesheets didn't.

Cheryl, while you are getting paid a regular wage to handle these things I am living off a line of credit because the system you work with fails miserably to respect the needs of the locum doctors. I know you are not necessarily personally responsible for this but you are now in the "firing line" ... I look forward to your speedy resolution of this matter.

This is not the first time QH in general and Cairns District in particular has been excessively slow in paying for work done.

I am curious to see if my Gladstone payment is made on the 15th of this month as it should be under the new "policy" arrangement where a third party handles the payments. I was informed that "receive the invoices by 10:00am Monday" is actually "if you want to be paid by the 15th of the month, all invoices/signed timesheets must be in before the end of the previous month".

/sigh

*edit

15th October - paid as expected by GN for my first "third party" payment for Gladstone, and the monies for Mossman appeared in my account same day. Was a good day to pay bills !

Next bookings ...

Intermittently in Gladstone, then booked for three weeks at Mossman over Christmas and New Year, where Lesley and possibly Caroline will come for part of the time.

Locums not being paid by Queensland Health ??

The regions responsible for paying locum doctors under the new directive from Queensland Health that obligates locums to be paid by a third party, not directly by QHS, (see the document here) seem not to be paying as required under the new policy. You work after hours and get called back, no pay ?? ... the regions concerned appear to be insisting on the old "daily rate for all work" but happy to proceed with the disadvantages imposed on us by the new arrangement.

Have it both ways hey ? if you are locuming in Queensland, watch your back and your purse !

ps ... I actually have my first locum coming up next week under the new system. I am in possession of a signed contract (signed by the district CEO) that states clearly I will be paid call-backs at the rates specified in the QHS policy. I will post here the outcome of whether or not I get paid as they have agreed to.

Update 18th September :

I am uncertain of the circumstances any more than what I have been told by the locum service but it now appears that the two regions in particular who were appearing to be not paying for call-backs will pay. There may also be an issue with locums charging for oncall time as call-back time ... hopefully this teething stupidity settles quickly.

I have also been told that the QHS policy is going to be changed. Bet you they will attempt to remove call back payments all together. Watch this space.

Apparently ...

... the med super here booked a long time in the past a training weekend this weekend in Cairns.

Apparently the locum that was booked to cover this weekend let the administration services who look after locums three weeks ago that he could not cover this weekend.

Apparently the administration services forgot to let the med super know this - she found out this morning.

The advanced rural trainee registrar is also on pre-planned training leave, starting tomorrow and over the weekend.

Today is Tuesday. A locum who will be arriving tonight to start tomorrow will be doing a 24hr shift Friday and a 24hr shift Sunday. Obviously that locum cannnot also do 24hrs Saturday to make it a 72 hours shift without a break. Safer to have no doctor than a "dead tired" doctor.

Apparently if urgent cover cannot be found Mossman Hospital will be without a doctor for 24 hours 08:00am Saturday to 08:00am Sunday.

Interesting ... very interesting.

*waves at the minister's office media monitors*

PS. I plan on being up here 21st December - 10th January ...

How long is too long ?

I wonder sometimes how one knows if you have been in a place too long ... is it when you start getting emotionally attached to the local politics of an area ?

This place suffers from the disease of many ( I can't say "all" as I have not been "everywhere" yet to find out, but it would be fair to say that every rural area I have worked in has so far qualified) rural communities - the lack of resource.

And why would this be so ? ... I ask myself tempting myself to make a gratuitous, opinionated reply ... would it possibly be due to the lack of political will of those possessively grasping the purse strings ? What does it take for the focus of attention to be placed where it needs to be ?

Did you know that this area used to have two helicopters for medical transport ? ... there is no local airstrip so RFDS cannot provide a fixed wing service. Well apparently one of those helicopters is broke (rumoured permanently) and the other has been relocated to Townsville. It also appears that this gap in service has not been compensated for by increasing the resources to the local ambulance service who are now required to do the three hour round trip to transfer patients to the next level of medical care at Cairns. Earlier this week I needed an urgent transfer of a patient to Cairns but because the local service had been already overworked and for safety reasons was off duty, "fatigue leave" I think its called, an ambulance was required to drive the hour an a quarter from Cairns to pick up the patient. Fortunately the delay did not compromise significantly her care, but it could have.

The doctors who work here (currently three but a minimum of four is required for safe, quality service) work, when they do their 1 in 3 nights oncall, can work quite long hours, and sometimes unsafely so ... who provides them with fatigue leave ? .. yeah you guessed right, no one ... well actually they could, but then no one is available to provide the medical service needed (unless of course a doctor was able to come from Cairns to cover the 8 hours fatigue break .. its only a short helicopter flight !!). Maybe the local GPs could organise a roster to help out ?? And of course the penny-pinchers looking at the costs of the services in Mossman are complaining because the medical services budget is running "over budget" ... cut costs ? ... well where are those excess costs ? .. the overtime and the additional cost of employing locums of course. Cut costs ? ... Yes Minister, sure easy, no after hours medical service for the whole of the region, including the very significant population of Port Douglas who would no doubt prefer to travel the 20 minutes to Mossman instead of the well over an hour to Cairns.

Funding needs to be urgently found and committed - not like the funding that just mysteriously disappeared to employ an allied health worker just this week - really committed, to employ four doctors here full time (this would actually be cheaper than the current three doctor costs). This place is the perfect place for advanced rural general practice training leading in the a Rural Generalist specialty recognition. There should be no shortage of people wanting this sort of work - it just needs the funding.

And why not have an intern rotation here ?? ... in the next year or so there is in fact going to be a shortage of internship positions and it appears that only australian citizens will be guaranteed a position. Overseas students paying (very big) money to train in Australia may not be guaranteed a place for their first year after graduation. Give interns 3 months here under the mentorship of the doctors here and they will get a life-time of experience here. There is "good medicine" to be had here for all.

Caveat ... no I did not get paid, bribed or receive favours for this, as those of you who know me will be aware, I speak my mind.

How many crabs ?

Today I went into the Daintree and spent some time retracing the path our family took on the guided tour we took a couple of months ago, but on my own was at a much more leisurely pace, and with my camera indulged in quite a few photos. The "marsh" area was a lot drier, has not been much rain at all. But the wet season will return soon no doubt.

Oncall Staurday night was a little bizzare - expected to be busy so stayed in a room at the hospital. Put my head down at about 9:30pm and woke to my alarm at 6:30am. No attention required of me, although I did wake a few times overnight to check my phone was still working !

Sunday I went into Port Douglas ("Port" to the locals) and strolled around the markets ... bought a few things, including something for Allison and Caroline for their upcoming 18th birthday.

Mossman - Day 3

What can I say folks ? ( thats a rhetorical question ! )

Anyone who wants to consider rural general practice as a career path an extended stay at Mossman is on your list of "must do" positions.

A surprisingly good bunch of local GPs (okay I am biased because of some less than inspirational experiences with GPs in many locales over the years - btw - I am a GP who sets personally high standards so I speak from an informed opinionated position now, unlike my arrogant, ill-informed position as a hospital resident in the mid-80's), an energetic med super, one of the world's most beautiful places to work, and a job that gives the opportunity to be at the coalface of medical presentations and then directly involved in the ongoing responsibility of care for any admissions to the ward - continuity of care at its best and with the support of the local medicos (especially currently the med super and an advanced rural GP trainee), there is a great opportunity for experience in the style of medical management of patients one just does not get in city practice anymore. Wow that was effusive wasn't it !? .. sorry.

I have not worked a night oncall yet (thats tomorrow, Thursday) nor a weekend shift yet (thats Saturday with Sat night oncall) so the "honeymoon" period might vanish with a flash, but first impressions are good.

I met up with Mike who was leaving as I arrived (one day overlap) ... he has been here twice now and he enjoys working here (and the patients and staff love having him around too !). It brought back memories of "handover" time at Knox ED.

We have three medical students with us here - they are seeing (as I am of course) some great medicine, even this morning in ED we diagnosed a young man (incidental to his presentation really) Wolf-Parkinson-White syndrome. We may have just saved this guy's life.

I will post again after my Saturday working ... Sunday is off and what I do is dependent on whether or not I need some sleep catchup from Saturday night. Sunday I will probably check out the Sunday markets in Port Douglas, and Monday will be a trip into the Daintree.

Catch you all again soon.

Mossman

I have arrived in Mossman and settling into the accommodation and adapting to the weather change from cold Melbourne weather. The accommodation provided is at Plantation Resort, an older style "resort" that is a little away from the hospital (about 15kms) and sits on the main road near the turn-off to Port Douglas in a place called Craiglie (see google map below, Mossman is to the north west). Sounds nice but actually would be a struggle to stay here without a car ... its not within walking distance to anywhere and sits next to light industrial. The local supermarket (IGA) is open 7.00am - 9.00pm everyday, so I should be able to access the necessaries to be self sufficient foodwise that is. The facilities of the unit I am staying in are of a good standard, basic kitchenette (no oven or dishwasher), dining area/lounge, small laundry, two bedrooms each with ensuite. Ceiling fans in each room and ample airconditioning although I have found it not needed at this stage. Internet access is via 3G network (both Telstra and Optus have a good signal here) and I am hoping to gain access to the resort's wireless node, but the "office" is not open on the weekends after midday Saturday as its currently deemed "off season" and appears to be open only whilst I am working during the week. I start work in the morning, do a ward round/handover and then orientated to my tasks for the locum.

Will give you an update once I get into a work routine and get my roster. By the way, the photo is of the main entrance to the hospital grounds, its a "multi-purpose health service" as you can see by the sign. Took the photo today on the way past to the Mossman Gorge for a walk. I am hoping the longer walk around the Mossman Gorge rainforest will be open before I leave - the restoration works on the bridge are still happening and scheduled to continue until 1st September (at least). Also looking forward to rostered time off to go back to the Daintree, about 35km north of Mossman.

View Larger Map

I feel not that good ...

I had a Boostrix vaccination on Tuesday and since Thursday evening I have been feeling awful ... I thought I had been careless in ED and coming down with gastro or even the cane toad flu, but nope ... I checked the side effects list of Boostrix and I've got them all, and nothing else that would be considered consistent with a full blown flu or gastro. *sigh* I have not been able to multi-task all day, still fatigued and my muscles still ache. Fun fun .. I am oncall overnight tonight and tomorrow night before I finish on the Sunday and head home early Monday morning. I have been seeing interesting things and helping deal with significant illness over the last couple of weeks here ... as is normal for this place really. Fractured femur from a motocross accident, assisting with a previously healthy man dying from a massive intracranial bleed, shattered calcaneus from a fall from a water tank, pyloric stenosis in a 5 week old babe needing urgent transport to Brisbane, respiratory distress in a 1 day old neonate. I feel that Gladstone is becoming my home away from home ... great people to work with !



Photos for your viewing pleasure ... 1)&2) the inland dry of central Qld, 3) this what happens if you work with horses without your protective footware.


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The rules are a'changin !

This document is in the public domain and therefore I will take the liberty of making my own personal opinionated statements.

Click here if you dare to see the document I speak of.

My first impressions are somewhat sceptical ... Queensland Health forcing locum agencies to act as "employers" so Queensland Health can pretend to not be responsible as the employer !!? A few places may well have a better pay rate, but most will have less ... some quite substantially so. Now that aint going to bother the locums - the work is there elsewhere and if this goes badly (ie. lcoums work outside the QHS system) it will be the Queensland health consumer who may well be the loser.

Medical Indemnity no longer Queensland Health's responsibility ?? yeah sure .. betcha "Slater and Gordon" aint going to be suing the locum agency instead of Queensland Health if something goes badly wrong with a locum and the aggrieved wants retribution.

So now the base rate payable for each position now has all costs deducted and issued as a taxed salary if you opt for the employer/employee relationship with your locum agency. The locum agency is required to set up a "third party" to deal with all this ... and with such little notice both the hospital admin staff and locum agencies are in a spin. There is an option to be a "sub contractor" and not have income provided as taxed income - this may be a viable option especially for those who may have issues with deductibility of personal superannuation contributions.

All I can say is that I am glad I am on pre-1st July contracts for another month and should be six weeks before contemplating a position under the new system.

Just a head's up for those contemplating further work with Queensland Health ... "buyer beware" .. check the details of what you actually get in hand for the service you provide, make sure your oncall services are clearly defined and what is being paid for in addition to your "daily" base rate (for hours up to 12 hours per day) - don't get ripped off not clearly defining your payments for oncall/call-back hours, make sure you triple check what your medical indemnity changes will be and finally don't get screwed by being under classified for the job you are expected to do.

Workcover no longer Queensland Health responsibility ? possibly .. that too comes out as costs from your "base rate", along with the actual costs of the infrastructure around paying you (stated to be about 9.75%) AND the commission the locum agency will charge you. Don't think the rates listed in that document anywhere represent the actual payment you receive for your services.

Superannuation ... if you enter an employer/employee relationship the locum agency is going to take 9% and put it into super for you .. that is the law. This has the potential to royally stuff up any personal superannuation contributions you make if you don't get additional financial/taxation advice. Consider "sub contractor" arrangements.

Now let me indulge by making a totally unsubstantiated assertion.

It is my firm belief that the health bureaucrats (or dare I say the health ministers' offices ?? ) have colluded and nominated Queensland Health to be the trial location for a new system that attempts to get away from perceived responsibilities and liabilities as direct "employers" of locums.

Final comment :- this rant is based on first impressions, both from reading the document and from dealing (or at least attempting to) with the people who have to implement this new policy. I reserve the right to change my opinion as things evolve and/or after I do more than just the first "male look" at the document.

Gladstone at sunset

Worked 2 hours overtime last night with a 15 year old who landed face first on the road ... please, please wear helmets when riding a push-bike, the damage that can occur without a helmet is horrific !

.. so I finished a bit earlier today and got out to the marina in time to see the sunset. There was some smoke around due to some distant fuel reduction burning so added to the color.

Feel free to check out a selection of the best here.

Melbourne is cold !

This week I am back in Melbourne after a wonderful week's holiday with the family in Cairns ... photos from this trip are in an album on Lesley's Facebook here - enjoy the best of our over 600 photos taken ! The joys of digital photography.

I will be back in Gladstone next week, have a week off so will "pop back" to Melbourne and then back in Gladstone for another two weeks. Two weeks off in Melbourne after Gladstone then three weeks in Mossman, just north of Cairns, to return to Melbourne in time for the girl's 18th birthday.

I have registered to complete additional training in Advanced General Practice, with the hope that in about 18 months will have enough additional remote rural medicine exposure (probably focusing on indigenous health, emergency medicine and D&A services as sub specialties) to complete this additional qualification.

http://www.racgp.org.au/fargp

Will post again in a week or so .. and keep you up-to-date with the work action.

Today ...

... will be my last shift for this block of four weeks. Heading off to Cairns to meet the family on the weekend. I had been planning a post describing some of my work adventures but I have been somewhat distracted by the fact that I still have not yet been paid a cent for working here and the one month financial cushion that I have routinely in place is now gone.

Not happy Jan!

Edit :

After tracking down a string of delays and errors a direct deposit was paid into my account 1st July 2009. It was a relief especially as we were at that stage half way through our family holiday and "running on empty".

So Yeppoon it was ...

Early rise and off inland to Biloela.   First thing I noticed even as I was leaving Gladstone was that things were a lot drier than in February.  Less green.  Weird approaching winter but up here its coming up to dry season.  The drive into Biloela and then north to Mt Morgan was a long, but interesting drive through inland country, much of it farming land.  Mt Morgan is a town at the peak of a mountain range, quite a nice place.  Apparently it can get really cold there.

 

Then through Rockhampton and to Yeppoon and around to Keppell Bay.  I ended up chosing not to go across to Keppell Island or do a coral cruise.  Just seemed a wierd thing to do by myself, so I wandered along the beach at Yeppoon and around the marina and exotic and no doubt outrageously expensive marina-side units.

 

The first photo is from Yeppoon looking towards Keppell Bay and the other is east out to the reef from the beach near the marina.

 

You can leave now .. just going to talk a about pathology testing.

 

If you are still reading you might want to pop over here to check out the terms specificity and sensitivity.

 

http://en.wikipedia.org/wiki/Sensitivity_and_specificity

 

If one designs the perfect test it is going to give 100% accuracy on determining those with the disease state being tested.  No one with the disease comes up with a "negative test", the false negative, and no one without the disease comes up with a "positive test" - the false positive.

 

I know of no such perfect test.  Some tests are to diagnose the presence of a disease and some tests are to exclude (if one can) the presence of a disease.

 

The "good" exclusion tests are used for screening, eg, faecal occult blood tests for bowel cancer.  See the wiki example for a detailed explanation.

 

Some tests are not good .. but still used.  Why are they not good ?   Because of the high rate of false positives.  And why is this not good ?  Not only is this not good for the mental health of the patient without the disease but an abnormal result but can lead to potentially invasive and harmful investigation to exclude the disease that the first test with its false positive failed to exclude.

 

Why do we do these tests ?   I have a suspicion it is related to lack of clinical confidence and fear of mistakes and subsequent litigation.

 

So who then is to blame for the persistent use of tests that a positive result is more than 50% likely to be a false positive even ... and is the cost of the false positive worth the use of the test simply because it rarely gives a false negative and therefore a negative test result can be reassuring ? .. you try to answer that one if you can.

 

Back again sometime soon.

They say it's cold

Sunset from the unit is beautiful. The weather reports colder than
usual weather for the whole of SE Australia although I note that the
lows here in Gladstone are similar to Melbourne's highs. I plan
travelling inland tomorrow to Biloela and the north via Mt Morgan to
Rockhampton and the out to the coast at Yepoon. I might take a cruise
out to the reef if I have time perhaps stay overnight to catch an
early trip Sunday and back to Gladstone. I will post again after the
weekend - and might have a chat about treating numbers instead of
patients and the specificity and sensitivities of tests.

Catch you then. Meantime greet the sunset of last night looking out
over the hospital.

Found my scrubs !

 

The scrubs I ordered in February were here waiting for me ... yay !  Like the color ?

Gladstone - June 2009

Well, its back in Gladstone ED for four weeks. It actually feels good being back for a number of reasons. Familiar place and faces help but I think the more focused and purposeful work is what I was missing.

Day 2 and 3 were days off, but starting yesterday was the beginning of a nine day stint. No problem with this though as each day is a set shift, and apart from the two nights I am second "on call" the time off between shifts is my own.

Have done some walking around the Botanical Gardens. It was very wet in February and I found it not possible to explore the gardens much when I was here then, but in June its much dryer and more amenable to being explored. The design of the gardens is interesting ... small sections representing examples of different forest areas around Queensland and northern New South Wales, some endangered.

Yesterday I received a phone call from the nurse at Hawthorn. She was experiencing the frustration of one of my patients who had been refused to be seen by more than one of the doctors at Hawthorn. This is one of the reasons I left Hawthorn, no medical services teamwork, no commitment of the majority of the doctors to quality patient care and the singular lack of respect for the humanity of the patients of the practice. As a community health centre where the socially disadvantaged, those with the ills of the human condition should be able to attend for their medical needs, such cherry-picking behaviour from doctors should not be permitted. It shames me to admit it openly but it feels good to be out of that place. I also feel greatly saddened for the patients who became dependent on me as their GP and who will have difficulty finding someone else who will treat them with respect. I also feel distress for the nurse who does care, and will be feeling the same frustrations that I did. Saying more in this public forum is not appropriate.

I also had an other interesting phone call the day before yesterday from a GP down in Melbourne who informed me that I still had a DD permit for one of my methadone program patients. Interesting that notifying the Drugs and Poisons Unit that I was leaving pharmacotherapy and all existing permits needed to be canceled by 15th May did not seem to produce the desired outcome. I know they received it but it appears no one acted on the body of the notification, that I could no longer hold any DD permits and needed current permits canceled. Quite a few years ago for process expediency permits that automatically lapsed after 12 months and had to be renewed, became permits that never lapsed unless actively canceled. Since that time those who "fall off" the program have a permit still in their name and unless a doctor recognises this fact will hold a permit in perpetuity for no functional reason other than permits no longer lapse. I guess I may need to call DPU reminding them of my written notification and request when I get back to Melbourne.

As a final note I wanted to say that one of the doctors who works here at Gladstone sat his second part Australian Medical Council exams and received his results yesterday. He did not pass. This guy has many years experience, highly competent and from a culture very similar to Australia. I am baffled why he did not pass, although his results were such that he almost passed and so is going to be given a "re-sit" of the examination. I wish him all the best in this reassessment, and express my concern that perhaps the AMC examination is in fact a little too rigid. I know no details of the examination pass criteria, but having worked shoulder to shoulder with him in February and now having the pleasure of working with him again now, I find it perturbing that he did not pass. Yes I know a standard of care and competence is required, but he is certainly one I would trust with my life and the lives of my family.

There is some incongruity here.

Thanks for sharing my thoughts with me. I will post again in a few days time.

Farewell to Hawthorn

I finished at Inner East Community Health, Hawthorn on Friday. It was nearly three years of an experience worth having but it is time for me to move on. I will be doing more locum work over the next 18 months and my time in Melbourne between locums will be not working - hopefully adequate compensation to my family for the longer time away from home. Good luck to you all at IECHS ... hope the pig flu does't cause you all too much anxiety. Surely I must have brought it with me from Melbourne to Gladstone (everyone in Victoria has it don't they !?) and will be kissing a few cane toads in hope of creating a mutant superbug !

Hope the flowers were nice !

Will continue with "Gladstone Mk II" and beyond !

I've done it again ...

Final entry for my Locum late again .. but it has had time to mature I guess.

I ask myself the same questions I did after Babinda.

Would I work at Gladstone again ? - yes, but as with my answer to the same question about Babinda, with my desire to vary my experiences in advance of rural GP relieving I plan to vary my near future locums and wont specifically seek out my next locum at Gladstone .. but maybe another there before I venture into GP relieving.

Two lessons learned ?

1) (Beware : unsubstantiated anecdote incoming) .. international medical graduates (IMGs) (what we used to call OTDs - overseas trained doctors - maybe the term OTD is not politically correct somehow) need support. The ones I met at Gladstone (with the exception of the one mentioned in my parting shot) are dedicated, and all that I met are competent but lacking confidence - perhaps rather fearful of not meeting the AMC (Australian Medical Council) standards for practice in Australia. I found one of the significant side benefits of working at Gladstone ED was to be able to mentor (for a while at least) some of these overseas trained doctors. I wish all the ones I met the best in their endeavors.

2) The standard of care in rural towns (well that is a broad sweeping statement given I am really talking in regard to my Gladstone experiences) is a little lacking, but not for the want of desire, personal dedication and skill of the medical, nursing, paramedical and allied health professionals working in Gladstone. They are a group of people to be proud of. So I guess its not "standard of care" as such ... its limited ability to provide the broader range of services really. There is a singular lack of the level of resource one comes to take for granted in the city .. yes accessible to Gladstone, 6hrs drive away, or an hour's flight away.

Pointers to others considering working at Gladstone Hospital.

1) Have no second thoughts ... do it.

2) Enjoy the surrounds of Gladstone .. yes, the city is perhaps more a place to live and work, rather than visit or tourist, but with your days off the wonders of the Central Queensland are accessible.

I look forward to posting again with my next locum, with some luck, good timing and planning around June/July this year. Until we meet again !

Parting shot

I have just finished my 13:30pm -> 22:00pm shift finishing at 23:30pm. Thanks to the doctor who gratuitously left an hour early ( " I didn't get my lunch break today so I am leaving an hour early" ) you contributed to an excessive waiting time in the ED for the majority of patients arriving after 6.00pm when you left, and created the need for my 90 minutes overtime. There were still 5 patients waiting in ED for the overnight shift doctor to see by the time I had to leave at 23:30pm. And oh, by the way, I did not get a meal break either.

Thanks.

You need to revisit your priorities !

meh ... you probably won't ever get to see this, but I needed to publicly rant. Most of the doctors in Gladstone ED prioritize patient care and are prepared to put in the personal sacrifice when needed - I did not see this happen this afternoon.

As promised I will post after I get home ... waking early to pack ( planned on doing this tonight but need sleep ) and get to the airport by 9.30am.

Fraser Island

 

What more can I say ? ... a beautiful place.   Spent the day on a 4WD bus tour of Fraser Island on Thursday.  Today is my last shift here at Gladstone.   I will feel a little sad with the leaving.   I will post a final entry after getting home.

Free association - warning medical terminology incoming !

Overdose of dangerous amount paracetamol with (very) delayed presentation.
Spontaneous bleeding gums : Idiopathic thrombocytopaenic purpura.
Rest pain in a 36 year old 10 days post STEMI.
Guillain Barre complicating EBV in a 16 year old.
Penile fracture - transfer to Brisbane for urgent surgery.
Overseas tourist, snake bite - without envenomation.
Pool vacuum system injury in a child.
Chronic back pain ...
Mental health care services difficult to access on the weekends.
Patient with a CVA, not migraine.
Mother exhausted and stressed with young son's difficult to manage eczema.
Afternoon/evening shift to be followed with oncall overnight to be followed by morning shift !
Unresolved issues for patient's husband tainting presentation for unrelated problem.
Chest pain in IV drug user - obtains IV morphine from QAS on trip to ED - discharges self against medical advice - staff just managed to get IV cannula out in time before patient absconded - am I wrong being sceptical??
Cellulitis, skin infections - seem to be common - I wonder if its related to the warm, humid weather.
Some local GP's (still) expecting the impossible or impractical from "referrals" into ED.
Got paid for the first week today - a cheque arrived in the post at home (despite filling out paperwork and providing details for direct deposit ... no matter, at least its now in system and being paid)
Bush fires still a problem near home ... significantly effecting areas close to friends and family (not my own fortunately - yet)
Mentoring AMC trainees.
Teaching medical students.
Congratulations Heath on your Oscar.
Seeing familiar faces in the supermarket and the local pizza shop - small town ?
I hate Steam ( no not the hot water variety - you computer gaming geeks will know exactly what I mean and probably agree)
Six days and I leave for home.

Gladstone Midway

Weekend exploring ... not quite what was hoped but an interesting experience anyway.  Saturday I visited and walked around the local botanical garden, checked out Boyne Island and Tannam Sands and then headed inland a way, south and back out to the coast to see Agnes Waters and Seventeen Seventy - two small towns very close together near one of Captain Cook's east coast landings.   Overcast and intermittently raining.  After a wander around these two towns and a stroll along the beaches, I headed further south to Bundaberg with the intentions of taking one of the evening guided tours to the beach of Mon Repos where a conservation park protects the turtle laying and hatching.   I arrived at the information centre and looked at the display, but discovered one needs to book ahead - no tickets left for the evening tour.  Not necessarily a bad thing though - there was torrential rain on the drive back to Gladstone and no doubt would have made the tour most unpleasant, if not impossible.   It was certainly a challenge driving in the rain and the dark, with some places water on the road making the surface less than ideal, and the headlights of the oncoming semi-trailers/trucks intermittently a nuisance ... oncoming headlights being much brighter than the reflection of the markers on the road, the headlights temporarily made the road ahead very difficult to navigate until the truck passed.   Not at all a relaxing drive back.

 

Today, the weather has significantly improved - a little cloudy, but dry and sunny.  Interesting given the temperature was still around 30 degrees and the moisture from the previous day's heavy rains made it quite humid.  I walked along the beach area, then went back to the marina for a casual walk around the grassed areas (green and damp) and then bought some fresh seafood from the seafood market.  Looking forward to a nice piece of baramundi for dinner tonight.

 

The two photos I have attached are from the botanical gardens near Gladstone, and the beach (a very small one) in the more exclusive section coastal section of Gladstone.

 

I will be working straight through the next two weeks ... should be managable given when I am not working my time is my own and the working environment is good be in.  Gladstone is a livable city, but not a place I feel the need to spend a lot more time exploring.

 

Will probably post again before I leave.

First week completed

I have realised a week has passed.  It seems less imperative to post on my blog as I can speak with Lesley easily and have done so each day.   This post's photo is just one of the lounge area of my unit.

 

The weather has been kind here ... none of the extreme weather that has lead to the devastating fires down near Melbourne and the repeated floods further north.  Its quite surreal actually.  Today I planned going for a walk in the gardens or near the marina and it was raining.  With 30 degree temperature (30degree Celcius for those who still use Farenheit) and the rain, the humidity was quite high ... breathing was an interesting exercise in itself.

 

I worked the weekend and Monday, and had today (Tuesday) off.  The shifts are certainly full in terms of workload, with both Mondays being quite busy, and confirming the claim that Mondays are busiest.

 

The logistics of working in the Gladstone ED are interesting and suffer from a number of problems both self inflicted and imposed by the medical fraternity outside the hospital.   The admissions clerking is done by the ED medical staff, not ward staff.   This effectively adds another 30 minutes or so of additional paperwork to each admission through the department, contributing significantly to the waiting time in the department, both in delay of admission, and for those out in the waiting room wanting to be seen.  Given that this means ward doctors don't have to do this I have concerns that this lack of clerking by the ward doctors means they in fact don't know as much about the patients under their care as they would have otherwise .. and there is a risk that we, in ED, under pressure to keep up with the very significant demand on our time, we may well be a lot less thorough (mostly because of our problem focussed approach in ED) than what would have been able to be done if a dedicated ward doctor spent the 45 minutes taking a detailed whole person history and clerking the patient.

 

I notice also that nursing staff, the more distant they are from the coal face in terms of patient care in the ED, seem to have a greater value placed on holding that empty bed for that expected patient, Justin Case.

 

So looking outside, a number of newcomer GPs in town seem to be rather unaware of what facility Gladstone Hospital does and does not provide and possibly even lack a full understanding of the role of an emergency department.  Where-ever those GPs came from before they came to Gladstone, clearly MRI imaging was as easy as writing a prescription, and specialist access was only obtainable by getting their patients to deliver a referral letter in person to the emergency department.  I have not seen anything that causes me distress about the quality of the care provided by these GPs - it just strikes me that many have undoubtedly not set foot in the place and seem to have little concept of how to work in a community without a tertiary level care hospital on tap.  Anyone from the rural GP training or AMC mentoring programs who happenstance see this, please give these naive, well meaning GPs a tour of the hospital so they can see what is available and what is not, what is appropriate to send to ED and what is not necessary to.

 

I am delighted to see GP patients in ED .. hey, I am a GP too .. however, not when a template style letter is dumped onto a piece of paper from your computer records software, and then given to your patient with unrealistic expectations on what will be done on their presentation into ED with that piece of paper.

 

To those who asked, I am well ... no, I have not contracted dengue fever (although rumour has it that the mosquitos of concern are slowly heading further south from the hotspots up north) ... and with set shifts I am sleeping well and feeling relaxed between shifts.  Local shopping is as good as I can get at home, there is even a cinema walking distance from here.   I went to see Gran Turino Monday night ... a very powerful movie.   Many young actors that one can tell are new to the art, but Clint Eastwood portrays powerfully a character dealing with his own inner demons while a community around him changes and challenges his values and beliefs.  A very intensely emotional movie .. my only warning is that you may need the rolling credits at the end as recovery time before you leave the cinema.

 

Gladstone is not the tourist mecca that I experienced at Cairns, but there will be enough for me to explore this weekend that I have off.  I checked out town and the area around town last week (some photos with my first Gladstone post) so I will wander a little further a-field .. try to get some coast and inland.   I have a full week next week (week 3), and have agreed to work also a full week for week 4 of my stay, but the roster is not yet provided.  I am happy to do this, with set shifts and time off and a great group of people I am working with in ED, it will not seem a chore to work straight through the last two weeks.

 

My new experience this weekend past ... a stonefish sting .. and my role as an SMO in the ED was to reassure the doctor who looked after this patient that an antivenom was not necessarily a prudent thing to use.

 

I just want to finish this entry expressing my deepest sorrow at the great loss many have experienced from the bushfires of the past few days.  I worked in Shepparton during the fires of the early 80's and lived and worked in the Dandenong Ranges during the fires of the 90's.  I experienced some of the community angst of those fires, but never experienced the personal loss that I see others now experiencing.   I especially want to acknowledge the loss of life of someone I met many, many years ago, Dr Chris Towie.  I worked with Chris for a year and during that year he was of great professional support to me and I counted him at that time as one of my friends.   

Go well Chris.

First two days

Welcome to Gladstone folks. First two days were morning shifts in the Emergency department, interestingly the first day's (Monday) numbers were the busiest for the ED for over a long time, no I won't take credit for that ! Tuesday night was on-call and had two calls but quite manageable.

Today (Wednesday) and tomorrow I have rostered off. I woke normal time, about 6:30am ... but as Queensland does not have daylight savings it was the same as 7:30am for my body clock so no difficulty waking and getting up. A short wander around town, down the the Information service at the Marina and gathered up a handful of tourist brochures for perusal to decide on what to do for days I have off here.

3G mobile phone (and therefore also internet access) is good, so phone communication with my family is easy. The weather has been overcast, humid and in the low 30's. I have escaped Melbourne's heat and dry. Today has been raining lightly on an off all day. I drove a little north west of here inland for a look-see ... the green is certainly prominent. There seems to be a lot of land dedicated to raising cattle and a huge amount of coal is being shifted along rail into the port for shipping from Gladstone. There is a power station, aluminum smelter, many other industries and a very large industrial shipping port here. I must read a little about what makes Gladstone what it is.

The photos today are the hospital, the building where I have been given a unit ( mine is on second floor so no significant views to the distance) which is well appointed and air conditioned. The third is one from the lookout towards the marina.

I will keep in touch every few days.

Gladstone

The new locum will be four weeks in Gladstone, starting Monday 2nd February, finishing 28th February. As usual I will post as I can to keep friends, family and casual observers informed.

Meantime some links for your pleasure.

http://www.gladstonerc.qld.gov.au/

http://www.weather.com.au/qld/gladstone

http://www.health.qld.gov.au/wwwprofiles/cqld_gstone_hosp.asp


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