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.