Monday, 19 March 2012

Our rural doctors

do it the hard way. They have always done it the hard way.  There is a letter in this morning's paper explaining the consequences of a state government directive that will cost rural patients more - and add to the pressure of rural doctors. It is one of those ill thought out policy decisions designed to "save" money which will actually cost more than it saves because yes, if you have broken your arm or leg you do need to go to hospital but you may not need to stay there. If however you do not get admitted for an overnight stay then it is going to cost you more because you should, apparently, have this dealt with by your GP.
Sometimes that just is not possible.
When we lived in "the bush" we always had to travel a considerable distance to see a doctor. As my mother did not approve of doctors and refused to let us see one unless my father insisted this was not a particular problem for my family. As children we were relatively healthy. We caught the occasional cold. We had mumps and chicken pox and measles before there were vaccinations for such things.  My youngest sister broke her leg falling off a bike on a rough country track but, fortunately for us, there were no major medical emergencies.
The doctor who delivered us was later knighted for his services to rural medicine. He built up a hospital in the rural community I was born in. It is still there and likely to remain there because it is almost commuter territory these days. Other places have not been so lucky.
The doctors in the rural areas we lived in were sometimes "characters". One drank too much but the locals still had the highest respect for him. He had operated on one of the locals at the side of a dirt road under the spotlights used for kangaroo hunting. It was a far cry from the antiseptic surroundings of an operating theatre but the man survived having his chest opened.  He just shrugged it off. He was a doctor. It was the sort of thing a doctor did. In reality of course it was quite extraordinary.
When we found another my mother had to see for the medical to return to teaching he was helping to put in the drains in what would become his surgery.
One of the other rural doctors told my father that he had misdiagnosed a patient. It was caught by a locum who had come across for a week so that he could go to an update course. The patient survived but the doctor was deeply distressed by the fact that the misdiagnosis could have cost the patient's life.
My father's last rural appointment was in an area where the local doctor was the wife of one of the farmers. She also acted as the local vet on occasion.  She turned up at the school one day to do some immunisations having first seen to the delivery of a calf.  The same doctor cut short a much needed holiday and came back to care for a critically ill patient. He survived and farmed for another eleven years.
There are many other similar stories which could be told so why would the government make it more difficult for rural doctors to do their jobs? They are already under stress. If they are working solo, and some of them are, they cannot even call quickly for another opinion. That just adds to stress. The rural hospital might be a long car journey from where they practice. They will not send a patient there unless they think it is absolutely essential. If a rural patient is going to be charged extra for using the hospital without being admitted there is going to be even greater pressure not to send them there. Patients in urban areas can go to outpatients without being charged extra.
It seems our state government believes that rural patients do not need hospitals or doctors. Apparently rural residents do not break bones or cut themselves open or threaten suicide or roll their cars. Rural residents are never supposed to be ill. Living in the bush is healthy - or is it?

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