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 !