Baggas’ Blog

Haven’t done this for a while so here’s a snapshot of a day’s general practice clinic for me. In view of patient privacy I’ll mix this up and not go into much detail but here’s a list of the consults today :

1. Antenatal checkup 32 weeks
2. Child immunisations
3. Antenatal checkup 29 weeks
4. Abdominal pain - postnatal
5. Baby immunisations
6. Antenatal checkup 36 weeks
7. Hormone implant
8. Quick walk over to the hospital for a ward round to see a couple of post-op patients and their babies, and to check on my patient in labour. Narrowly avoided getting caught in the rain on the way back.
9. Neonatal check-up
10. Baby immunisations
11. Child immunisation
12. Antenatal checkup 24 weeks
13. Antenatal checkup 35 weeks
14. Child immunisation
15. Child immunisations
16. Antenatal checkup 20 weeks
17. Antenatal checkup 37 weeks   […by this stage the day is looking quite repetitive, but that’s fine by me.. usually it’s not quite this homogenous though]
18. Miscarriage
19. Depression
20. Eczema
21. Antenatal checkup 14 weeks
22. Child immunisation
23. Child immunisation
24. Wound infection
25. Burn
26. Antenatal checkup 29 weeks
27. Ear infection
28. Eye problem
29. Baby with abdo upset
30. Peripheral oedema
31. Injured finger
32. Abdominal pain
33. Knee injury
34. Antenatal check 38 weeks

And that’s my day.  Well mostly - I still have a patient in labour who could deliver any time this afternoon/evening.  And a pretty good day for appointments too - only had 2 who didn’t turn up which is a lot better than some days. Last appointment was 1350 and it’s now 1401 and I’m leaving to get some lunch before I pick up the kids from school. I like finishing on time

Well I’m back to working slightly longer days this week after doing half days for the school holidays. For the second half of the holidays it didn’t seem all that slack though as I still had babies being born almost every day which meant early mornings and late nights and other hospital visits in between. This week has been a little quieter on the baby front although I’ve got my second one on the way today (no idea what time she will deliver though) and work here in the surgery is reasonably sedate. I do have a smallish pile of paperwork to get through but rather than doing that I’ve been putting my time to us catching up with some episodes of the Amazing vlog show on YouTube. This is an almost daily video blog produced by Mr Internet and his compadres. The episodes are well produced, funny at times, and interesting. At least I found them interesting but I know most of the guys who are doing it so maybe if you have no idea who they are you might not be so enthralled.

Anyway here’s the first episode - I’ll leave it up to you to check out the rest if you want…

Just got a postcard from Germany from a patient. She had an attack of severe arthritis in her knee a week before they were due to travel to Europe, and 2 days before I injected it with cortisone. Well the injection worked and now she is enjoying her trip. Stuff like that makes me feel good about this job, and it was nice of her to let me know

Thought I’d better update after a few days away from the blog. We’re all still here - baby still well ensconced inside Jenni’s tummy although hopefully she’ll come some time soon. I’m cutting back my work hours a little in preparation for the birth. Basically I’m booking my mornings and then deciding on a day by day basis if I’m going to work in the afternoon. That way if Jen goes into labour and I need to take days off it only means cancelling half a day’s worth of patients. I had the whole day off on Friday though, since Jen was sick and I was exhausted after spending almost the whole night at the hospital in one of the most awful experiences of my medical and obstetric career. Sometimes this job is one of the best in the world, other times it’s one of the worst… Today is an in between day - keeping fairly well to time but a couple of patients who concern me, although I had some promising news about my patient in ICU. I’m finishing a bit earlier than usual so I can catch up on a little shopping and get the boys from school which makes the day a little less daunting too.

This week’s been a little quieter at work - no babies born so I’ve managed to keep well away from the hospital. Taking advantage of the odd bit of free time I’ve been working on getting my office a bit tidier and better organised. Now my office is by no means that bad - some of the other doctor’s rooms are incredibly messy. Even so, it’s been good clearing out the shelves and drawers and getting rid of all manner of odds and ends - mountains of drug company post-it notes, pens, out-dated drug samples, old books, drug information sheets, referral pads for services/specialists I’ve never used, various useless gizmos and other drug company paraphenalia, amazon.com boxes, and much more. Some of this stuff was 5 or 6 years old, from doctors who are long gone. I now have all this empty space that I can start filling up again - it’s wonderful.

On the subject of organisation, I’ve been doing some similar stuff at home - getting the garden tidied up, organizing the garage a little bit, tidying my study, organizing my music, doing 6 months worth of filing. Maybe it’s some sort of nesting instinct

I’ve also found an awesome piece of software to help get me organized on my Mac laptop. After trying a few similar options I’ve settled on a program called Together, for Mac OS X Leopard. Basically this is a great way of organizing my thoughts and various pieces of information, documents, pictures etc that I find as I surf the web from day to day. If I find something on the web I like, I just drag the URL to a little tab at the side of the screen, and the Together software will store an archive of that web site for me. Or I can just cut and paste a bit of text and store it as a note in Together. All this can be done through the little tab without needing to open the main window of the software itself so I can keep my focus in the browser or whatever else I am doing. When I do open Together, I can easily categorize webpages and notes etc through various Group and Folder settings, as well as tagging. For example in planning our trip to Denmark tomorrow I was browsing various websites and came across some good information and maps etc - I’ve just dragged these into Together so I now have an offline archive of all this info that I can easily retrieve, even if I am down in Denmark with no net access. I’ve also decided, with the aim of making my book reading more effective, to start typing the odd note or quote into my laptop - Together looks after this for me too. It also handles a large range of other file types, including email (handy to drag an important email across from mail) and media files. Another way of sending info to Together is using the Print command in any other application, and “printing” as a PDF file directly into the Together archive - very neat. I like the way Mac OS is so well integrated with PDFs. Anyway it’s a great piece of software. I don’t think I’ve really done it justice here so if you are a Mac user I’d definitely encourage you to check it out.

Your Privacy Is An Illusion: Bank intern busted by Facebook

As a doctor and facebook user, I found the above story interesting when I read it in a medical newsletter I subscribe to. Basically this bank intern in the US took time off work for “family reasons” but was busted by his employer when they found photos of him at a party that day on his facebook page. There’s copies of the photo, and related emails posted on the link above. So Facebook users, bloggers, and anyone with an online presence beware - big brother might be watching… Maybe I need to consider Googling people after I’ve written them a sick note

Rudd vows to fix doctor shortage | The Australian

KEVIN Rudd is promising to pay to fill a shortfall of doctors across the nation after a comprehensive audit of how many are needed.

Once again Kevin Rudd is sticking to his two main vote winning techniques. One is promising inquires, commitees, investigations, audits. And the second is throwaway slogans saying that he’s going to fix whatever problem it is he’s addressing. But always the promises lack any real detail.

The problem in this case is that you can’t pay to fix a doctor shortage. No matter how much money you spend you can’t magically make doctors appear out of thin air to fill a void. There is only a finite number of doctors to go around. Sure he could spend money to pay the existing doctors more (and I’m certainly in favour of that - lol) but that would not solve workforce problems. Even if by paying GPs more it encouraged more doctors to enter GP training that’s only going to add to a shortfall in other specialties. The only quick fix for doctor numbers is to import more from overseas, which is already being done to a huge extent. But that approach has it’s problems in terms of insuring quality treatment, and the questionable ethics of poaching doctors from other countries which may be experiencing their own doctor shortages.

The long term solution is more medical school places, and a shorter term solution is to work on measures to redistribute doctors to better address needs across the community. The Howard government has already taken steps on both these issues, although I’m sure there is more tinkering that can be done. Basically no matter what they do, this doctor shortage is a long term issue that is not going to disappear overnight no matter how many audits they do or how much money they spend. Rudd is again being disingenuous by suggesting that he will be able to magically fix it.

I feel a bit like Robinson Crusoe or Gilligan at work at the moment - cut off from the rest of the world. Since Thursday we have had no internet access and it’s driving me crazy being unable to check my email, blog, or browse the net between patients (though I’m keeping even better to time than I usually do). We got a call from head office saying there’s a virus and to unplug the net on Thursday and they have not done anything to fix it since. This is quite typical of the company that owns our practice - nothing ever gets done in a hurry, especially IT stuff. Any time we need anything sorted out we have to wait for ages. There’s been plenty of negative aspects to having had our practice bought out a couple of years ago but I struggle to think of a single positive. They haven’t improved the place at all. If it wasn’t for the brilliant location next to the hospital I think I would have given serious thought to moving by now… Anyway we’ll see if they get their act together when I get to work today. I’m not holding my breath.

Well yesterday, if my rough adding up is correct, I attended my 100th birth for the year. My previous best was about 98 last year so cracking the century in September is a pretty good effort, especially considering I was away for 5 weeks in July/August. This level of obstetrical busyness is quite a good place to be. Between two and four births a week but I still probably only get called to the hospital after hours an average of one time a week which means not too many sleepless nights or interrupted dinners (like last night’s). But delivering babies is not only a great and rewarding job in itself, it also has the added bonus of filling my GP clinic days with lots of pregnant mums and their kids, which is a quicker, more efficient, and more enjoyable sort of medicine than the geriatric patients the average GP’s case load would be comprised of. This allows me to stay mostly on time and get home to my kids at a decent hour. It’s all good

Number 101 is on it’s way today also, sometime later this evening probably…

Slow afternoon today. Every time I walk out and check my box there’s no patients waiting. I haven’t checked the appointment book but I don’t think it’s because of no-shows - rather a couple of families where they book 4 appointments for all their kids but it only takes 5 minutes each. Oh, and my 2:20 appointment didn’t show up but I’ll let her off because she was in hospital delivering her baby at almost exactly that time - pretty impressive timing!

So I’ve been keeping busy with miscellaneous things, paying bills, reading blogs, updating my medical board registration, reading the latest political news, and drinking far too much coffee and Coke. Yesterday I was in Perth attending a course on Neonatal Resucitation - it was actually a pretty worthwhile course and I feel my confidence in this area boosted, although I hope I don’t have to put these skills into practice. Fortunately, today’s baby came out screaming, so not much resus required there

Allow me to get a little bit political for a few moments … It’s good to see that health has finally opened up as a bit of a battleground for the upcoming election, after a couple of fairly quiet years on the health policy front. This was sparked off by Kevin Rudd’s headline grabbing “policies” of a federal takeover of state hospitals and something called GP “super clinics.” There’s been plenty written about the former idea and all the potential problems associated with it (including maybe an increased GST) but not much press on the Super Clinics. Like most of Rudd’s policies to date, it seems to be a flashy title designed to beguile the public and make Rudd seem like a sensible man of action, yet has very little substance behind it. As if building these new clinics is going to address the problems of a nationwide doctor shortage and overcrowded emergency departments. Where are they going to get these doctors from? If they manage to attract doctors to shift into these practices (and so far the only “incentive” I have seen mentioned is a $15,000 payment which really won’t attract many GPs at all, especially if these clinics are to be bulk-billing clinics which would actually reduce most GPs’ income)… but even if they can attract GPs to work there, aren’t they just shifting the problem from one place to another, making it even harder to get appointments in the practices the doctors woul be forsaking? When there’s only a limited pool of doctors, building new clinics won’t go a long way towards solving the problem, they need to add to the pool of doctors… HOW? only two possibilities spring to mind - one is increasing the medical school intake, which the Howard Govt has already done, but which is a long term solution only since it will be years before these new docs are practicing. Or secondly increasing the amount of foreign doctors allowed to work here, but this is both morally ambiguous (since we might be “stealing” doctors from other countries who need them even more) and slightly dodgy politically (after the recent doctor terrorist scare) and medically (since it’s hard to assure the quality of medicine practiced). So Super Clinics is all headline (don’t you just love the word “Super”!) but no substance. But hopefully it will have the effect of upping the ante and making health a bigger issue in the upcoming election. Hopefully the government can come up with a better plan than Rudd’s efforts so far.

Glad to be coming to the end of the working week. It hasn’t been too bad a week, lots of colds and flus, lots of minor procedures today for some reason, only one life and death emergency the other day which all worked out okay. But it’s my first full 5 day week for around 2 months so I’m glad to be approaching the weekend.  Next weekend is my first on-call since being back, which may not be a bad thing to help pay the bills, and to start saving for my time off in October on the next Uganda trip. Have had a few emails over the last day or so from various people regarding the medical team which is a timely reminder that I need to start thinking about it and getting organised. Especially I need to start brushing up on my tropical medicine again - I might get out the cool African medicine textbook I picked up last month in Uganda.

Also today I was dropped off two big boxes of Lego which I bought off eBay from a guy in Mandurah. It was nice of him to drop it in to me at work, saving me a trip to pick it up. Also, in addition the the one box I had bid on, he threw in an even bigger box of Lego he had found. So it looks like me and the boys will be busy building stuff this weekend I used to love Lego as a kid and we are all pretty enthused about it after visiting Legoland. They had a cool “pick-n-mix” shop where you could fill a bag with lego pulled out of these little bins, kinda like a lolly shop. Anyway, better see my last couple of patients and then get outta here.

It’s good to see political announcements being followed by real, and fast, action.

I just received an email from the AMA calling for doctors to be involved in the outreach to Aboriginal children in the Northern Territory, following the Prime Minister’s recent announcement of an action plan to address the serious problems of abuse and other health issues in these communities. They are looking for doctors to head to the NT in the second week of July - just 2 weeks from now.

Obviously I can’t take part since I’ll be in Uganda then, but it is really pleasing to see that this call has gone out. I hope that our medical profession can show leadership in this matter by giving a strongly positive reponse to the call.

Well today I’ve been too busy to use twitter but it’s been an eventful day so I thought I’d just do a regular blog post now that I’ve finally got a lull.

This morning was pretty flat out with patients - I’ve got one in labour and was called to assist at another emergency delivery but fortunately didn’t really have to do anything.

The weirdest experience was at lunchtime when I was interviewed by a guy from Canberra who’s doing marketing for the outer metro grant (basically a payment aimed at getting doctors to work in outer metro areas - I got mine last year which partially financed our first trip to Africa - the timing was most providential). Basically he’s putting together some advertorials to go in all the major medical magazines in Australia to let people know about the grant. The interview part was fine but the weird thing was having a professional photographer along to do a “shoot” for pictures to accompany the article. He was snapping pics while we talked and then we walked across the road to the park where he got me to pose in front of the lake and on the bridge and then snapped away whilst I was walking. The guy was fine but it all felt a bit artifical and uncomfortable - sure makes me glad I’m not a celebrity having to deal with that all the time.

Finally got my tax bill today which I’ve been expecting for weeks. This is the massive unexpected one that my accountant sprung on me back in May. Well I’ve been expecting it ever since and have come to an arrangement with the bank to deal with it but was worried it may not arrive before we head off on our trip next week. So I most most relieved to see that it had finally come and even more relieved when I saw it was nearly 2 thousand less than I had prepared for - which if nothing else makes it even easier for me to justify buying a guitar when I get to Nashville in 3 weeks time. Still probably leaning towards the Fender VG strat. As it’s been out a while now the reviews have remained positive and I like the idea of having a fully fledged American stratocaster yet with additional versatility. May also consider getting a little battery powered cube amp at the same time so I can actually play the guitar a bit for the rest of our trip. Luggage should not be an issue as we are on the American system which means we can each check 2 items up to 32kg (much better than the Australian system - 1 item 20kg). The other big advantage of this is it means we can pack a fair amount of stuff to take to the orphanage in Uganda and just leave the spare old suitcase there when we travel onwards to Britain.

Anyway more patients have arrived so I’d better get back to it if I want to stay on track.

The Drug Pushers -

This is a very interesting article from The Atlantic online about pharmaceutical company representatives, better known to us as “drug reps.” Far from being a scandal driven expose the article presents a balanced, almost resigned, portrait of this industry and how it has changed over time, culminating in a sobering look at American medical care in general (and to think I’m giving thought to working in such as system?) :

We simply live in a country that has decided that the traditional figure of the doctor is not worth preserving in the face of modern economics. Instead, we put our trust in the market.

Perhaps we are right to do so. We can get used to a world without doctors. As Lantos points out, we have gotten used to a world where we have shoes but no cobblers. We can copy documents without scriveners, make tools without blacksmiths, and produce books in the absence of bookbinders. We have left the old world behind, and for the most part, we don’t miss it.

As the figure of the traditional doctor fades away, it is being replaced by a figure akin to the drug rep, one whose responsibilities are to compete as vigorously as possible in the medical marketplace. Patients are being replaced by “health-care consumers,” who shop for the best medical bargains they can find. If it is true that the drug rep does not put my interests first, the same is true of everyone else in the marketplace.

Read the rest of this entry »

Was just talking to a drug rep and she asked whether I saw more diabetes or depression (since she had drugs to treat both!) - and I had to answer that I see way more depression. I just assumed that was true for most doctors but according to her, she gets an even mix of GPs who say they see a lot of depression and those who see hardly any. Now part of me wishes I fell into that second group as I really don’t much like mental health (when I was a surgical trainee I was ashamed to admit to the fact that I won the Psychiatry medal in med school). But unfortunately (for me anyway) patients with these problems seem to keep coming to see me, which I guess must mean I am at least doing something right? I could never be a psychiatrist though, it must be depressing listening to all these terrible life stories all day long. I’d stick to mums-to-be, surgery, and babies any day if I had the choice… but the thing about General Practice is that I don’t get to choose the patients, they choose me. Which is important to keep in mind.

Common comments I hear from my patients :

“It’s getting so hard to get an appointment with you”

“I had to wait a week for an appointment”

“I phoned five different medical centers to get an appointment”

The usual answer to this is that we have a doctor shortage - not enough doctors to service our population. And while this is definitely true let me give you some statistics that point to another major reason why people can’t get appointments :

This morning I have had 15 appointment slots thus far - 6 of these patients have not turned up.

Now to be fair one of those 6 actually had a baby at 8am this morning and I saw her then in the hospital, so we’ll let her off the hook. But even so that’s 5/14 that didn’t turn up, didn’t call, didn’t apologise - nearly one third! Deprives people who need an appointment of that opportunity, and it deprives me of income. Maybe I’ll start quoting that when people complain they can’t get an appointment.

Anyhow it’s not all bad - I’ve been consoling myself by eating some nice chocolates given to me by a grateful patient earlier this morning - the job does have it’s good points at times

Another quiet day at work today, although I have a patient in labour at present so it’ll probably get busier.

Thought I’d play around with my mobile and YouTube to give you a sneek peak into the place where I spent most of my day’s - my consulting room. The quality isn’t perfect as it was filmed using my Palm Treo, but I hope it’s clear enough to get a bit of an idea of what my room looks like. And it’s relatively tidy at the moment too!

Yesterday was a super hot Tuesday here in Perth with the temperature hitting 42 degress Celsius. Luckily for me I had pre-arranged the day off to get my car serviced and for the Foxtel man to come and so I ended up being home most of the day, of which a lot was spent in the pool. Today is forecast to be just as hot but I haven’t been outside since I got to the surgery this morning so I can’t verify that. Will be jumping straight back in the water when I get home though.

For now, let me give you my weekly round-up of what’s happening in my world…

READING : for some reason I haven’t had much time to read over the last week or so, but the book I’ve started most recently is Jeffrey Sach’s The End of Poverty - this is a book on global poverty and the economic causes and possible solutions. Only read the first couple of chapters so far but it seems really good.

WATCHING : for a couple of years now we’ve had Foxtel, which is a Satellite pay TV system, but haven’t really made good use of it, aside from the kid’s channels. Partly this is due to the fact that when we sit down to watch there often doesn’t seem to be anything appealing on, and if there are good shows they are not on at a suitable time for us. Primarily this is a symptom of the time delay, since Foxtel is based on Eastern Australian time (ie. when their prime time shows are coming on at 8PM, it is still only 6PM here) - well now these problems are solved for us. Yesterday we had our Foxtel unit changed over to the new Foxtel IQ which is a satellite receiver box which contains a hard disk recorder. This means we can now scan the guide for the programs we want to watch and with the press of one button set them to be recorded. You can record two programs at once and even playback a third recording at the same time. It also allows pausing and rewinding of live TV which is handy. This, combined with my use of Windows Media Center for recording free-to-air digital TV, means we now have no excuse for missing anything on TV (aside from the little fact that we have very limited time to watch it…)

WORKING : first day back at work today after 4 days off and it’s been psycho. Funnily enough though virtually all of my consults have been one of three things - pregnancy, babies (most immunisations), and mental health. I got considerably behind this morning, mostly due to the latter, but managed to catch up so I was only 10 minutes behind at lunch time. On the obstetric side of things, after a quiet month in February, things are starting to get busy again. I have a number of inductions booked in over the next week or so, which has been a bit tricky co-ordinating since Jenni is off to Sydney next week. Still it’s all good - helps keeps me busy and helps pay the bills.

Also today I was given a free electronic blood pressure machine, courtesy of the government and a drug company. I vaguely remember filling out a form a couple of months ago for it, and it was delivered today. Very nice $1500 machine - I normally prefer to check BPs the old fashioned way but this machine is the best I’ve seen. Nothing like another gadget to keep me happy. Might be the last for a while though, unless more freebies come along - I’m now on a serious financial-restraint effort. We’ll see how it goes.

Anyway that’s enough, I’m getting a bit behind again. I would mention what I’m eating today but there was no drug lunch so my stomach is empty! Oh well, time to keep plowing along.

… in this job are easy and light … but then once in a while the realities of death, grief and crisis hit you in the face. Those days are not so easy…

Periodically in the past I’ve given a snapshot of my day at work as a GP, and it’s about time I did it again (partly cos I felt the urge to blog and couldn’t think of anything else to say). So here it is, a day in the life of me :

0830 - arrive at work. Startup computer. Check Email. Answer blog comments. Plug my iPod in to the PC and start playing some Bright Eyes (Album : I’m Wide Awake It’s Morning). Go through paperwork. Sign about 20 pathology results and some hospital attendance faxes (for patients of mine who have been seen in Emergency in the last couple of days). Check the same path results on the computer so they will be stored in the patient’s computer files (we have this incredibly inefficient hybrid paper/computer system here)
Visit the hospital to check on my patient who delivered last night and her newborn baby.

Start seeing patients. Conditions for the morning include :

• Heart disease
• Antenatal checkup
• Drivers License Medical
• Planning induction of labour
• Olecranon Bursitis
• Baby immunisations
• Leg ulcer
• Antenatal checkup
• Baby sleep issues
• Baby immunisations
• Plantar fasciitis
• Scalp laceration
• Premature baby
• Antenatal checkup
• Antenatal checkup

Amidst all this I did a bit more sporadic paperwork. I like to do my paperwork and signing throughout the day - as it hits my in-tray I deal with it, thus avoiding a big pile at the end of the day. Did a few prescription requests. Had a couple of coffees. Leafed through The West Australian in the tearoom, and read some of my book (Colossians Remixed) whilst listening to Bright Eyes. Not all days are like this but today has been a very easy pace - of course having a few patients not show up is a part of that…. and I opened my office window and enjoyed the sound of the rain falling outside…

1158 - finished with last morning patient. Fixed problem with telephone system. Discussed a job-offer. Read some more of Colossians Remixed and listened to some more music. Enjoyed a drug company lunch of chicken and salad and a nice chat with some other doctors…

Anyway that’s enough for now - quite a good morning actually. Three more hours of the same and then I can head home. Unfortunately I’m on-call for the weekend so I can’t totally relax but at least it’s the end of another working week.

It’s apology time again. I’ve been pretty slack on the blogging front of late, in fact ever since I returned from Africa. A combination of Christmas, New Year’s, Owen’s eye problems and health scare, and work being insane has led to the blog taking a back seat. I can totally identify with ob1’s comments of last week.

This week at work has been psychotically busy. Partly it’s because I have extended my work hours by one hour a day (to help pay off the debts from our recent Africa trip and hopefully then set us up financially to plan for future trips… I can’t wait to go back), but partly it’s work itself. Many of my patients seem to be having health crises or urgent problems that need sorting out, other doctors here seem to be asking my advice a lot more all of a sudden, and my hospital obstetrics has been very busy the last 2 weeks as well. In the last 2 weeks I’ve had 13 babies born into my care!

Today is a little more settled again. Not sure if it’s the usual bunch of no-shows but I seem to have a lot more free time on my hands this morning. But I’m not complaining - it’s a nice change from the chaos of the last few days.

Five weeks away from work have not changed the number of patients who are late or don’t show up at all unfortunately. In the last hour and a half I have had about 3 patients show up out of 9. It’s a colossal waste of my time and money and it also denies access to other patients who might want an appointment. Every day people complain to me about being unable to get an appointment which is ironic when over at least 10% of my appointments are no-shows

If they have any excuse today it might be because they are busy watching the cricket. Since I’ve been bored I’ve been catching some of the current Ashes Test on internet radio. Australia has just bowled out England in their second innings and now has to score 168 off 36 overs. If there was ever a time to send Gilchrist in to open, this has to be it. Just wish I was at home watching it rather than bored here at work.

One thing about cricket radio broadcasts - replays don’t work on radio quite so well as they do on TV. A while ago they said “In case you missed the wicket of Pietersen, have a listen to this…” and then they replayed the guy calling the delivery. Never heard that done before.

Anyway better go see if there’s any more patients before the Adelaide Tea break finishes…

I’m not normally given to criticising our public health system too much. The reality is, with all it’s shortcomings, the health system in Australia is still among the best in the world. Australians have access to advanced health care at little or no cost, when the vast majority of people in the world cannot even get the basics.

Having said that, I do have a constant feeling of frustration as I continually have to battle the beaurocracy on behalf of my patients, who are often let down. Sometimes the things that come out of our great public hospitals are so crazy you just have to laugh.

This morning I received a fax from one of the major hospitals saying “Dear doctor, we regret to inform you that your patient has died…” however they neglected one important piece of information - the name of the patient! So now I’m sitting here stressing, wondering which of my patients it is that has died. The flip side of it is that at least it makes me extra pleased to see people, that they are still alive! Crazy.

There’s only so many times you can hear the words “well i’ve had this cough for a few days” (or variations thereof) in a row without going insane! The reign of coughs, colds, and chest infections is upon us. People are dying by the second in other parts of the world for lack of medical care and I spend my days doing this, whilst people whinge about the “doctor shortage” in Australia. Well this doctor still has appointments available for Thursday and Friday so there’s plenty of spaces for more coughs and colds to be checked and told they don’t need any treatment. Crazy!

Like never before, I sure was glad I drive a 4WD today. Around 7:30 this morning we had a deluge and by the time I left at 8:30 the roads were flooded. Driving down the main road through Warnbro was like driving in a river - it was up to a foot deep in places. Broken down cars were littered everywhere, and as often happens in bad weather, everyone went a little bit crazy and put on a display of insane driving. Owen was stressing in the back seat but with 4WD engaged I felt secure and almost found myself enjoying the adventure.

Not surprisingly though, half my patients so far this morning haven’t shown up. I’m prepared to let the weather and the roads stand as a valid excuse, but such was not the case yesterday, when I had 8 out of 30 booked appointments fail to show. That’s a quarter of my day wasted. Not only a waste of my time and a loss of income, but it deprives other patients of the chance to get an appointment, which is a big deal in our current climate with a shortage of doctors. More and more now I’m getting complaints from my regular patients that they just can’t get in to see me when they need to and have to settle for someone else. Having a quarter of wasted appointments does not help.

I got a letter this week informing me that my name has now been officially entered in the register of Fellows of the Royal Australian College of General Practitioners. This means not only that I now have the qualification FRACGP to put after my name (in addition to MBBS and DRANZCOG) but more importantly that 12 years of my medical education are officially at an end. Of course the last 6 years I’ve been working full time as well but technically I’ve also been studying most of that time also, first for my exams as part of Surgical training (which was a lot of study), then exams in Obstetrics (considerably less study), and finally the GP exams (study? what’s that?) I think after 12 years I’ve well and truly had my fill of medical education, and although I’ll try and keep up with the latest developments, I think that’s the end of serious medical study for me for the forseeable future. It’s not necessarily the end of tertiary study - in fact I’m quite keen to go back to Uni and do some study in some completely unrelated disciplines at some point in the near future… Just no more medicine please - don’t get me wrong, I love the job - I’m just totally over the text books (other than as an impressive sight on my bookshelves - lol)

The Australian: Work and worry making doctors sick [March 11, 2006] - this article about doctors’ health problems, in particular mental health, is pretty spot on. I tend to be cope fairly well and don’t let other people’s problems get beneath my skin, but this can be a big issue for many doctors, with serious consequences. I must say I fit squarely into the younger generation of doctors who don’t want to work insane hours and have a life outside of work - that’s the number one reason why I decided to be a GP in the first place instead of a neurosurgeon. Have a look at the article though - it has some very good insights.

Five out of six patients didn’t turn up last hour - that’s gotta be some kind of record. It’s not only frustrating but it costs me money - for every patient that doesn’t turn up is lost income. Which at the moment is definitely a concern given that we have a big new mortgage and I’ll have a full week off work next week for our holiday (I don’t get paid holidays)

On a positive note, my new iPod just arrived so I’ll be able to start playing around and transferring songs to it tonight. 60gig, yet it’s virtually the same size as my old 40gig one, yet with a much larger, clearer colour screen. I look forward to trying out the video capabilities of it
And being an iPod lover, it seems I’m in pretty good company - it seems the Pope loves his iPod too, having been spotted around the Vatican with those distinctive white earphones. Wonder what podcasts he subscribes to?

Strange day today at work. I’ve been sorting through the pile of paperwork in my bag, paying bills, writing emails etc, and each time I walk out to check my box expecting to find myself running behind, yet there’s only ever a maximum of one patient waiting for me at a time, often none. Not sure if it’s the usual problem of people not turning up or if I’m just doing well at keeping on time. Anyway I’m getting a fair bit of non work related stuff done, so I’m not complaining.

It seems I have a major exam to do in less than a week. Next Saturday is my final clinical exam for Fellowship of the college of GPs. I’ll certainly be glad to get it over with (assuming that I pass) not because I won’t have to study anymore, but more because I can continue my current non-studying lifestyle without feeling guilty about it. People tell me I shouldn’t have any trouble passing, but there’s always that lingering doubt. Worst case scenario if I fall then I repeat it in another 6 months, of which the worst part of that is that I’ll have to pay another $3000 to sit the exam. But then again if I pass then some time next year my insurance premiums will go up by more than that amount so it’s kind of a lose-lose situation. Aside from that, pass or fail, not much else changes. Either way I’ll still be working in the same place, earning the same pay, with no real difference either way except a few additional letters after my name, a small sense of achievement and a theoretical freedom to practice wherever I want, even though I plan on staying put.

Anyway I’m off to do some more non-studying. Chesterton awaits…

Well yesterday I finally had the RACGP written exam, which was composed of two papers lasting 3 and 4 hours respectively. It certainly wasn’t a walk in the park and there were a few curly questions right out of left field. I think that doing months of study probably wouldn’t have made much difference, and I still have my doubts as to whether this is really a good assessment of how good a GP a person is. I won’t say too much more but I think I probably passed, and I’ll let you know in a few weeks. The second part of the exam, the practical component, is in another 4 weeks time.

Today we’re off to see a concert in Perth from Australia’s highest paid band, who according to today’s paper earned $45 million last year, and are international superstars. I’ll write a review of it later, perhaps. Anyone got an idea who the band might be?

Oh, and for any guitarists reading, I’ve got a few effects pedals selling on eBay at the moment. I’ve decided to offload some of the pedals I don’t use much and use the proceeds to get a multi-effects board. I was thinking about the Boss GT8 (since I always tend to be a Boss man - love their gear) until a guy in the guitar shop tried to convince me to get the Digitech GNX-4, which in addition to amp modelling and effects, also has a built in 8 track recorder, MP3 player and drum machine, and much better computer connectivity. The effects sound good on both, but they are the kind of units that will require hours of tweaking to get it right. Biggest downside to the Digitech unit that I can see is it lacks an Auto-wah, and I love my Boss AW-3 autowah pedal. Anyway I need to sell my old pedals first so if you’re interested, take a look at what’s on offer.

It’s amazing the power that a simple word of encouragement can have. Just when I was feeling a bit down and discouraged (see the previous entry for why) I got a thank you card in the mail from one of my favourite patients, with an attached birth notice from the newspaper (at least I’ve gotten some positive media coverage of late… lol). I don’t know if all doctors are the same, but for me personally receiving something like this means a lot. It gives me a huge boost and the inspiration to keep going. I normally wouldn’t quote this sort of thing, but it provides a nice counterpoint to the article I quoted before (sure makes me feel better anyway) and I’m sure the patient wouldn’t mind.

“It is wonderful to have a doctor we can trust, who has our best interests at heart. We really appreciate all you’ve done, and look forward to your continuing care and support. With many regards, and much repect…”

I may or may not be much good as a blogger, but at least someone thinks I’m a good doctor, and ultimately that’s so much more important.

The waiting room here at work today is chokkas and as a result almost every patient I saw said something along the lines of “gee it’s busy today” to which I replied that I was not. The reason I was not busy was that I had 5 patients in a row not turn up between 10 and 10:50. I’ve complained about this on here many times before so I won’t go on about it, but it’s just so frustrating! Anyway time for lunch and then I have a house call to make.

The biggest problem with having a container of lollies on a doctor’s desk is when the doctor ends up eating half of them.

Another problem I seem to be having is that for some crazy reason, some patients seem to like me. And unfortunately they are often the ones with a series of complicated even unresolvable problems. When they say “I like you better than Dr X - I think I’ll come and see you always from now on” I never know what to say (even though on the inside I’m saying to myself “Noooo! Go and see Dr X please!”) Maybe I need to learn to not be so nice to people, which is hard because I don’t think I’m especially nice to begin with. Oh well.

Anyway time for lunch and then I’ve got a Caesarean to go to and then later this afternoon my regular fortnightly date with the dentist. Better put those lollies away for now I think.

It’s that time of the year again, where two out of three patients are coming in with coughs and colds and flus. Now that might sound boring but I actually don’t mind dealing with it so much because it’s fairly easy quick work, checking people out and then telling most of them that antibiotics won’t help. Simple syptomatic treatment and sick notes form the bulk of my treatment. Shame I can’t give myself a sick note though, I’ve got the same thing today, but in general doctors don’t take time off. I normally have to be pretty crook before I’d consider it, especially now that I’m “self-employed” and don’t get paid sick days any more. It would cost a lot of money to be sick.

Tonight I’m off to a drug company dinner in Perth on the topic of psychiatric drugs in pregnancy and lactation. I normally don’t go to these things as I’m too busy at home but since this is a subject I deal with very regularly I thought it would be good to go. For a single doctor who lived in Perth and didn’t have anything better to do it wouldn’t be so bad though. I normally get invites for several of these dinners a month, often at quite nice restaurants too. A bit better incentive to prescribe a drug than a dodgy pen and a pad of post-it notes (if you ever come to my house let me show you my pen and post-it collections - lol) I did get a quite nice coffee travel mug today though, which is also a bit of an improvement - made up for the dodgy sandwiches the drug rep brought.

Anyway I’d better get going. I’ve got another 5 or 6 patients to see here (if they turn up!) and then have to go to the hospital to induce an overdue pregnant patient of mine before I’m finished for the day. I hope to have an hour or two at home with the kids before I head off to this dinner tonight.

Today I had 6 out of 30 patients not show up for their appointments! And most days there are at least 3 or 4 minimum. People around here often complain that it is hard to get in to see a doctor - well this is one of the big reasons why - appointments being wasted by people who don’t have the courtesy to even ring up and say they can’t make it. It’s very frustrating! But anyway I now have a long weekend to stay away from medicine and spend time with the family, so my frustrations will soon be forgotten

Funny day today. Once again I’ve been sitting around waiting for much of the day. At present I’m still waiting to be called for a Caesarean section that was supposed to be an hour ago but I still haven’t heard anything. The frustrating thing about that is that I had a half hour block left open for that, and I rushed through another patient’s surgery to be ready on time, but it never happened. So now when it does happen it’ll mean heading out and delaying other patients’ appointments and myself. I guess I shouldn’t be too bothered though - think of the poor woman who’s waiting nervously for the operation and the birth of her new baby. The delay will be much more of a big deal for her than me, for whom it is just a mild inconvenience. I need to learn to see things more from other people’s points of view.

The last few days every time I put my stethescope in my right ear it is very painful just inside the external meatus (entrance) of my ear canal. Consequently I cringe every time someone comes in with a cough or to get their blood pressure checked in anticipation of the pain. After consulting one of my colleagues it seems I have a mildly inflamed area and he gace me a tube of steroid ointment to see if it settles it down. If not I might have to go on compo - lol (at least I would if I wasn’t technically “self employed”) I’ve never heard of the condition of stethescope ear before though.

In other ear related news I have lost my good Sony earphones for my iPod and am back to using my original iPod ones, which I am not too happy about. It’s okay for podcasts but for music the audio quality is nowhere near as good.

This is from a letter I just received from an hospital doctor regarding a patient of mine :

“I would greatly appreciate it if you could recheck his blood pressure at the next appointment with you. I suspect that today’s reading was an abhoration.”

Gee those hospital docs certainly take blood pressure pretty seriously nowadays! I wouldn’t want anyone to check my blood pressure at the moment as it is now 1:30 and my 1 o’clock patient has still not arrived. Just one of those days I suppose.