Crook

Generalism is a speciality but it can be done badly.
One of the southland GPs (not one that teaches us) has a reputation for sending patients into the hospital with next to no history or clinical details, simply saying "they're crook."

Legend has it that a few years ago he sent someone in with the note- "Patient crook. Probably terminal."

He was admitted, a better (!) history taken, a full overview done. Nursing and medical officer consensus was that, actually, the guy was probably doing just fine. Nothing stood out.

The patient died the next day.

Again- it's legend- and i guess indicative of the whole skill of 'gut instinct' / years and years of experience knowledge that people build. This GP could be considered adequete, even maybe good or brilliant, if he was willing to communicate.

Being crook - it's a wide spectrum disorder :)

Assessments

this is more for Bryce's benefit.
all 12 of us round the country will be going through our first assessment soon.not sure what it's like at the other centres, but our Doc here is just as nervous about organising the whole thing as we are about having to do it.

it's a mixed bag. We could get tested from any field. And it's almost guaranteed we'll know nothing.
such is the risk and frustration of a simultaneous subject curriculum. (i.e. learning obs and gynae and orthopedics etc all-at-once instead of in seperated runs)

this is also why i'd never say that a GP isn't a specialist. Generalism is a specialty. anyway...

will keep you posted

Illegally Blind

Met a lady today - legally blind with cataracts. Didn't get around to getting them seen to until she started mistaking people for furniture at work. Had volunteerily stopped driving 8 months ago...
"There's a few people I'd like to run over, but I'd like to know I'm doing it"

Work hard, play hard.

It's 4:30am.

Go nowhere, head towards the middle (Lawrence), turn right for 25km up a dirt road and you'll be near the Waipora.

Call it public health, occupational health, or blind curiosity but something got Jenny and I out of bed long before the sun was up to go watch a gang of shearers. I had seen a handful of shearers come through Lawrence GP clinic and I wanted to get an idea of what the job was actually like.

This particular team was shearing 18'000 sheep over two weeks. That's a lot of wool.

We stood around awkwardly for the first wee while, just watching. The shed was warm and smelt stringent - wool and machinery and just a wee bit of sheep poop. The sunrise was pretty cool. Over the hill as the sun rose, the next flock (?flock) of sheep were coming over the rise and down into a valley. Impressive sight- heaps of them.

At 8am everyone stopped for smoko, and we got a chance to say who we were. A couple of ladies got us on the table (ripping the daggy bits off the edge of the fleece) and on the brooms, (getting the shorn crutch out of the way of the shearers, and any bits of wool so they wouldn't slip over). Jenny loved the wool press - I wasn't such a fan, after almost getting coned by the metal door when it sprung open.

We were in the way a lot, but the guys were nice enough about it. It felt to me kinda like the first time you go into theatre- not sure where to stand, what to do.

Lunch was at 10:45... early start equals early lunch. Curried mince and white bread. Tasty as...
the rousers were happy to describe what they hated about their job (sore backs, itchy, sweaty hard work) and what they loved (the pay... the people, the travel). Most of them were from the north island. The background culture of shearing is to spend what you earn ("I'm here for a good time, not a long time."). If you're still up at 3, it's better to stay up and work through the next day.

Not a hugely academic day - but good fun.

favourite consult for the day... not very patient centred....

Patient was a shearer with a crook back, who had just received a letter from ACC suggesting he should retrain in another field e.g. becoming a barista (!).Doctor... just stopped a lifetime of smoking last July.

"So, have you got your liscence back yet?"
"Yeah."
"That new cop is a bastard isn't he, trying to save your life like that"
"Aw I guess he was alright, but he's strict ay. Pulled up a kid the other day for pushing his bike with no helmet on."
"Ah Well..."

Here, the Dr and Patient exchanged looks and gestures. Dr: 'drinkie drinkie' gesture, followed by cutthroat gesture.
Pt: Nods.

Dr. rubs his chin.

"What do you reckon I'm going to tell you next?"
Patient looks down at his top left pocket. A 30 pack* of smokes juts out the top. He leans forward, two lighters rattle against eachother. He coughs, and looks at ceiling.

"After 46 years I managed to kick it. I tried eeeverything. I tried patches, didn't work.
And then I tried I tried some pills, side effects were terrible. And they didn't work.
and then I tried cold turkey, didn't work.
and then I tried following this book which taught me to think of something else when I wanted a ciggarette, to avoid people who smoked and so on but one day I walked past a guy lighting a cigarrette and I almost killed him. I was in there all arms and grabbing.
And then I tried gum. Tasted horrible.
And then I tried hypnotherapy.
And then I tried accupuncture. they put a point on my ear and I was standing outside on the cold mornings rubbing on my ear with one hand and smoking with the other."
Finally the doctor suggested another kind of pill, which he now swears y, because it was the only thing that worked. "do you see what I'm trying to do here?"

"Yes"

"I'm trying to take away everything you enjoy..."

Patient grins. "alright....I'm going to be one grumpy bugger without my drinking and ciggies"

"Oh, and when you go to the pub. May be worthwhile to drink a handle of water between each handle of beer.

"I think you've missed the point of why I go to the Pub, Doc."
------------

*A digression...back in the days when I worked as a 4 square checkout chick they didn't sell 30 packs. Realised the other day that smoking a pack a day means a lot more if they're smoking these massive things. They're an inch thick!- about the same size all round as the old boxes 3 1/2 inch floppy discs used to come in.

The sights of Balclutha

Jenny is going to kill me for putting up this shot...

We went out the other night to find what lay beyond the small township of Balclutha itself and found a lake out past Kaitangata. Near sunset, all the birds were coming in to sleep in trees. It was pretty beautiful. Tonnes of midgies but none of them bit. So far, so nice.


It's got a great track around it for biking and running etc. only problem is I'm pretty unfit.
Will work on that :)