Rural Med - that's a wrap

Well I have finished my rural med rotation already. Things generally went as predicted. It had many great moments; it was sometimes lonely, sometimes boring, but mostly relaxing (The lack of traffic, the country air, the generally slower pace of life was fantastic – to live I am not sure, but as a break from tertiary hospital life – awesome!) Unfortunately internet access was very difficult to get (except to quickly check an email or download a paper and was definitely not conducive towards blogging) and therefore my rotation passed by very quickly with no updates here.

Orientation week was busy, lectures and intro to rural medicine. Generally this week was helpful, but it did seem a bit dragged out. It also provided an opportunity to hang out with fellow students also on that rotation (about 40ish) which was great.

I spent weeks 2-7 at a small rural centre. I was welcomed and put to work straight away (Got there Sunday afternoon, called in to the hospital Sunday afternoon to assess patients about 1-2hrs later!) Sometimes, particularly after big sporting events (which saw people coming in from outside regions), the trauma workload was intense. We didn't have access to CT, an operating theatre or any obstetric services and any bloods needed to be flown a few hours away to a regional centre, taking >>6hrs for any results and so anything major involved stabilisation, finger crossing and flying out (Helicopter or small fixed wing plane with the RFDS) if the patient survived. This made you think about how essential advanced imaging/testing really is. Clinical judgment is more important than ever, and I think it help to really develop your clinical skills!

The hospital (About 10 beds) was staffed by Nurses and the town GPs (there were 2 doctors not 1 as previously thought) would take turns to cover the calls from the hospital. I was usually 1st call, I assessed the patient(s) and called the doctor on duty for advice/to attend. Sometimes I was scared, but a few slow breaths, a quick read of the therapeutic guidelines (similar to the BNF in the UK I think) or UptoDate and remembering to return to basics - Good history, comprehensive (but case specific) assessment - and things usually went pretty well.

A few of the things I learnt were...

• Common things present commonly! OMG how many people with a slight cough or obvious URTI did I see. Patients/Mothers who had made up their minds before attending that they required antibiotics.
• How to examine a eye and remove foreign bodies
• Venipuncture – lots of practice
• Stabilisation of trauma patients (particularly suspected neck trauma)
• Assessment and management of general orthopaedic trauma – rolled ankles, fractures, dislocations

Running in the back ground of all this was a rural health project where we had to design and carry out some sort of project that benefited the community medically, justifying in terms of current literature. This had to be written up by end of week 8.

The final week (week 8) consisted of exam revision, last minute lectures and study. The exam was only short (1hr) and was quite predictable (stabilisation of trauma, bush bugs e.g. Q fever and Brucellosis, aboriginal health, skin cancer, management of medical problems in a rural environment requiring transfer, referral etc) – the least stressed exam I think I have ever had. I'm really looking to the week off to catch up with my friends and family, do non-medical things (except maybe a little anatomy study for surgery rotation ;) )

Rural - an introduction

As I am in my "week off" I have been mentally preparing for my upcoming rural rotation. In case I forgot to mention previously, all my clinical rotations are 8 weeks long. The first week involves staying in a rural centre (in my case 8+ hrs drive away) and consists of an intensive orientation with lectures and procedural skills.

Weeks 2-7 are at another location (small rural town) where I stay at the local hospital and learn about rural med. From what I can tell will be a cross between general med and general practice without the luxuries of CT, Operating theatres etc. In Week 8 I go back to where I was for the first week and attend more lectures. The exam is on the Friday of week 8.

I am really looking forward to the rotation actually. The doctor (one doctor in this town) has to rely on his clinical acumen a lot (lack of access to many tests/pathology services). Of course anything major will be transported to a larger more metropolitan location or even back to a tertiary hospital, but we (him and I) will be there at the start. And while I appreciate that I still have a LOT to learn, I am not too nervous. I am, however, very glad that I have already done General Practice and have just gone through General Med. As I will be away from home and very homesick, I am sure I will update you much more frequently for this experience then I have previously (that is, if I can access the internet!!)