An (almost) country practice...

As many of you know, I've just started my general practice rotation, which will be my final rotation as a medical student - if God wills, I'll be having exams after that and graduating at the end of this year! This is just a few short paragraphs I wrote about my first week at the practice, which I hope you find interesting!

I'm doing my rotation down in Mornington, about 50km from the city, a really beautiful area by the beach! The bright sunshine and the lazy pace of this beachside community are both reflected in the sunny, relaxed disposition of the staff at the clinic. Such a refreshing change from the early starts and rush of the city hospitals!

At this clinic, a stone's throw from the neighbouring Bays Hospital, there are six senior GPs and two registrars, four nurses, many friendly faces at the front desk, and many others behind the scenes. They service predominantly an elderly population, mostly of upper class, who come in with all sorts of complaints from the common ear niggle to frustratingly difficult-to-treat generalised pains. I recall a patient, thirty-something male, all neatly outfitted in a business suit, looking like he dropped in on his way to work. He complained of an occasional twinge in the ear. Cursory examination found no source of inflammation or focal lesion, and it was hardly distressing for him. The GP prescribed some drops for the ear, but other than that, the consultation was over within two minutes or so. The patient continued on his way to work. In stark contrast, another patient was a most interesting fifty-something man who looked more like eighty. He had so many medications, and a list of past history that filled the page, the sort of patient you would expect would require, at minimum, low level care. With profound weakness in all four limbs due to severe injury and deformity of his cervical spine, secondary to lesions of neurofibromatosis and steroid-induced osteoporosis (he also had a history of Crohn's disease), it was a wonder he could maintain any degree of independent mobility. But with his scooter and stick, he made his way around Mornington, and gets by with assistance from his daughter at home. The variety certainly keeps one guessing and interested in the job, from both the medical and psychosocial perspectives.

The nurses run the theatre, a small, three-bed room, reminiscent of a rural emergency department. Here, they and the doctors do (and provide me with opportunities to see and do) minor procedures, dressings, triage assessments, administration of injections (e.g. intramuscular, intra-articular) including immunisations, nebulisers and so on. Sometimes, I am allocated the third bed (which is in the room next door) to see patients by myself, which is a helpful exercise. This is also the place to catch up with the up-to-the-minute news of what transpires in the lives of each of the practitioners and their families! One of the doctors' rabbits had a baptism of fire - brought home from the shop, that night it escaped its pen and was mauled by the dogs. Poor rabbit, still battling to survive several days on. Not even the new medical student is exempt from ending up in the gossip channels. Most of them knew my name before I saw them, and rapidly found out about me having been to the same school as many of their children, my upcoming concerts, about my relationship, and about my planned trip to Canada! I think I should be careful what I let out of the bag.

The practice does mostly private billing, but bulk bills certain patients. It is good to see the doctors doing what they can to ensure that patients pay no more than they should, especially with regard to drugs and so on. I've learnt a lot simply through observing their discussions with patients about drug choice. It's easy to forget the financial burden of pharmaceuticals in the clinical setting sometimes.

Women's health day (Tuesday) was difficult for me, as a male medical student, with most of the women opting that I be excluded from their consultation. It's fair enough, of course. I don't plan on being an obstetrician or gynaecologist anyhow, but one of the female doctors with a special interest in women's health was kind enough to give myself and the registrars a tutorial ensuring that our pap smear technique is still competent.

One of the more surprising, but heartwarming, aspects of the practice was home visits (in addition to district nursing). My GP supervisor takes two or three half-days each week to drive around (in his huge four-wheel-drive, but it's necessary for getting around some bits of the region) and call on patients in their houses. He has some regulars, and some who need more intense follow-up at home after a visit to the hospital, or after a disease flare. Patients with mobility problems are given priority. Most home visits are unremarkable medically, mostly a brief "how are things going?", systems review, and filling prescriptions. But when I see these people in their natural habitat, I am provided with a wealth of information beyond what I would get in a consulting room. The fact that their house looks tidy, and doesn't smell, means they are really keeping quite well. And I get to see the luxury of many of the Mornington residents!

Enough babble from me. I never really gave GP much of a thought before. But this rotation, it's really growing on me. It has, in many ways, restored in me a faith in medicine (and the medical system) by showing me a more human side of the profession. I am refreshed to see doctors really connecting with and caring for their patients, and enjoying it too. I am thoroughly looking forward to the remainder of these five weeks!