Monday 13 August 2018

There is no doctor

available in more and more rural communities in Downunder.
I saw a letter written by a young girl yesterday. I even did something unusual for me. I posted it on social media and asked,
"Anyone want an adventure?"
Actually it would be a very stressful adventure. Being a doctor is stressful enough. Being a lone doctor in a rural area is extremely stressful.
There are complaints in this morning's paper that those doctors who are there are reluctant to treat mental health patients too. I can understand that.
Before anyone condemns them for not wanting to do that I'd ask you to consider the stress these doctors are under.
When I was a kitten and we lived in a remote community there was no doctor. The nearest doctor was almost an hour away on an unsealed road. We were considered fortunate because there were people who were much further away than that.
The doctor lived in a small "town" - a village by Upover standards. He was the only doctor and his practice spread over hundreds of square miles. He was in charge of not just his practice but the "hospital" - a few beds in a house that had finally been built for the purpose. He was expected to be able to perform emergency surgery.  He had to do all the paper work with a limited amount of assistance from a part-time nurse/receptionist. 
My mother had to have a medical examination to return to teaching full time so we met the doctor. When we met him he was performing outside surgery on the plumbing - so he could wash his  hands and go on being a doctor.
The local community considered him slightly "barmy" and willing to try anything to save a life. He once did a major medical procedure on the roadside at night under the light of car headlights and lanterns. The man he performed this cardiac surgery on lived to tell the tale.
But it all took a toll on the doctor. He died relatively young. 
Nowadays doctors and their "union" are more aware of the likely problems and doctors often last only a couple of years in rural areas. They simply cannot cope with needing to be available 24/7,  often without a nurse/receptionist to back them up. The paper work has increased, internet connections are poor or even non-existent. There are no back up facilities within a reasonable distance. They are no longer permitted to do some of the things that the doctor we knew performed as a matter of course.  That means making decisions about the urgency of a matter and considering the logistics of getting a patient to where they can be treated - which might mean travelling hundreds of kilometres. Patients in rural areas often don't have any private health insurance and doctors are sometimes not getting paid anything for seeing patients with mental health issues - and waiting months for what the government gives them for seeing other patients. If they suspect a patient is suicidal they can do nothing more than get a relative to take them to a hospital in the nearest community with a mental health facility - and those facilities are few and far between.
There is also something else that they have to cope with and that is the internet. Almost all schools have some sort of internet connection - even if it is not particularly good. Communities now use the school libraries as community libraries, including computers. People can and do "research" their illness on line. They have their own ideas about how they should be treated. It puts doctors under even more pressure. There is an increased fear of litigation.
The Senior Cat remembers another young doctor in another isolated community. He misdiagnosed a patient. While he was away another doctor saw the patient and changed the diagnosis. With new treatment the patient began to improve. It wasn't fatal but the young doctor was devastated. He thought it would be all over the community. (It was - but the community was surprisingly sympathetic with comments like, "You can't be right all the time".) Despite that it nearly broke him because, left untreated, it could have been fatal. 
I have immense sympathy and concern for young, inexperienced doctors who are expected to work alone. They have to make so many serious decisions every day. There is no let up. They can't discuss their patients with their colleagues the way city doctors do. They don't have the resources city doctors have. They don't have the same support services.
And on top of all that they know we need a healthy rural community because it is the rural community which feeds the rest of us.
Rural doctors need support just as much as the farmers they are supporting. 

1 comment:

Jodiebodie said...

I would like to see the politicians in capital cities practice what they preach and experience the results of their election promises; e.g. better connectivity in the bush, better health services etc. Let the pollies go out their to see how far their fancied ideas got to fruition. I would love to see each member of parliament relocated to a country area for a term and to conduct their business, including parliamentary sittings, by videolinks etc and existing remote resources. They need first hand experience to grasp the profound hindrance to our nation of inadequate infrastructure and resources in the regions rather than glib notions of 'just use the c internet'. It's much more complex than that. Do our pollies have the courage?