The Australian Letter is a weekly newsletter from our bureau in Australia. This week’s issue is written by Julia Bergin, a reporter based in the Northern Territory.
No medicine, no tools, no team: these are the working conditions for a remote Australian doctor.
And if that’s the case, if doctors don’t have a stocked pharmacy, an operating room, and an extra pair of hands to fall back on, then their work becomes increasingly focused on logistics and less on medicine.
Dr Rhys Harding, a remote GP, said his daily job involves asking questions that his colleagues in big cities never have to think about: “What’s wrong with me? Who’s here? What time does it get dark? Can the plane land?”
Next comes a long list of medical skills he’ll need, such as dealing with complex head injuries, taking X-rays and extracting teeth.
“I feel much more comfortable in my mouth than most doctors,” said Dr. Harding.
For Australian doctors working in some of the most remote locations in the country, practicing medicine can be borderless, restrictive, isolating and exceptionally challenging. The environment is harsh and the physical and mental demands on doctors, who are often deployed alone, are more extreme than in any metropolitan hospital setting.
Dr Michael Clements, vice-president of the Royal Australian College of General Practitioners, says it’s less about remoteness and more about resources.
“We can do a lot with just our hands, but overall we like to have our medicine, our toys and our team,” said Dr. Clements, who spent 13 years as a doctor in the Australian Air Force and traveled to places such as Afghanistan, Djibouti and Somalia.
Dr. Now based in the eastern Queensland city of Townsville, Clements operates as a fly-in-fly-out doctor for remote communities in Queensland, Northern Territory and Western Australia. These places, he says, are more medically challenging than most war zones he has visited.
“In the military we had access to surgeons and CT scanners, anesthesiologists and orthopedic surgeons and a lot of people to help,” said Dr. Clements, adding that a soldier with even a “tickle in his throat” would tend to immediately.
This is very different from home care in Australia, where limited resources can mean patients have to wait weeks for an assessment, prescription or X-ray.
Communication is also a challenge, added Dr. Clements admits, with poor mobile phone reception and internet in remote parts of Australia making it difficult for doctors to get a second opinion. Instead, they rely heavily on what he calls the “friend network.”
This means finding a friend or acquaintance who works at a local hospital and setting up a referral or liaison service.
“In the Middle East it didn’t matter if I was in the middle of the desert, I could easily call back Australian colleagues and non-GPs,” said Dr. Clements.
Dr Harding spent 18 months as the only doctor at the Australian base in Antarctica. He had, he said, “all the medicine in the world”, plenty of instruments, an operating theatre and even a dentist’s chair. Despite the extreme isolation of the South Pole, he said it was easier to work as a doctor there than in remote Australia.
But Antarctica also presents unique challenges, such as the possibility of having to practice medicine on its own. To avoid this, Australian doctors sent to Antarctica, for example, have to have their appendixes removed.
Dr Jeff Ayton, the Australian Antarctic Division’s chief medical officer, said the policy was imposed after a treacherous evacuation in the 1950s of an Australian doctor with acute appendicitis that required emergency surgery.
Ten years later, a Russian doctor on a mission to Antarctica, who also contracted appendicitis, enlisted a fellow expedition member to hold up a mirror and proceeded to operate on himself, using only local anesthesia. There have also been cases of self-diagnosis and treatment of heart attacks and self-removal of breast lumps.
To avoid medical emergencies, physicians may need to undergo other preventive procedures to qualify for deployment. Wisdom teeth those could be a problem that needs to be solved in the future. A changing heart valve, which doctors normally monitor, requires surgery. Under normal circumstances, the gallbladder would not be removed, but for a doctor in a remote environment — whether in Antarctica or on a military deployment — it could be a preventive requirement.
Despite the many obstacles, threats and risks facing physicians working remotely, Dr. Harding that the challenges make the work attractive.
And, he added, the setting immunizes him from the most troublesome part of the hospital system: the layers of hierarchical decision-making.
Dr. Harding compared it to someone going to the emergency department with a broken hand and then being referred to an orthopedic doctor – who might say, “Oh no, we’ll just do the wrist” – and then to a plastic surgeon – who says, “Where’s your boss, why can’t you do this?” – before being sent back to the emergency room.
Instead, Dr. Harding says every decision is his and the only one he makes when working remotely.
“It’s very liberating to think, ‘I’m the best person for the job,’” he said.
Now here are this week’s stories.
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