Saturday, August 16, 2008
Sometimes I kiss my patients...
I've had a few people ask what a day at the clinic is like for me, so here goes.
After doing rounds on the ward at the hospital, I go downstairs to the clinic that I work in. There are four practices in Wairoa, Three of which have one doctor each, and ours, which has two doctors. Our clinic is the "go-to" clinic for anyone who has no doctor, is down on their luck or has been kicked out of another practice.
One of the things I enjoy about the workday here is that the pace is somewhat slower. My day is just as long, but there is no push to see as many patients as I can. Less patients means more time with each patient--for the most part. I do get called to the ward for emergencies, but these are not so frequent as to really cramp my style.
I won't bore you with the endless forms and bureaucratic compost I have to deal with as part of my routine (some of you do the same), but I will tell you that socialized medicine is not all fun-and-games. I've met more than a couple people that have had to wait for months (a year or more at times) for surgery or for a simple appointment with a specialist.
One feature of the medical structure is called ACC. ACC is a program under which all of your medical bills and up to 80% of your missed paychecks are paid by the government. This also applies to non-Kiwis. No wonder New Zealand's city of Queenstown had become so popular for extreme sports--go ahead, break your neck--it's paid for!!
The drawback is that there are people who take advantage of this program. I've been here only 10 weeks and can't tell you the number of people who are not working, but "on a benefit" as they call it. Unfortunately, human nature is such that some are tempted to complain of pain or disability that keeps them on benefit, but can not be proven or disproven with modern medical science. New Zealand does employ some "ACC Police" who catch the occasional bloke on benefit for back pain carrying a 150# boar out of the bush or digging fence post holes on the farm.
All in all though, the system is not a complete failure, and there are many people who get care that otherwise would have no access whatsoever. The very young, old and disabled often have special needs, and it helps me immensely that New Zealand has a program that lets me treat them all.
I've enjoyed getting to know my patients and learn from day to day the things I need to know to do good medicine in a culture that's new to me. One of my first lessons was from Rafi (my partner), who told me "Don't lean on the exam table when talking to patients." This was difficult and I still forget sometimes, but it's important because in Maori culture you never put your butt where your head or where food would go. Sounds simple, but think about it--how often do you lean against the counter while talking with a neighbor in your kitchen?
I see people of all ages of course, but one thing I look forward to is seeing a couple of the older Maori ladies. They are so kind and grandmotherly it makes my day. They usually put their face next to mine, cheek-to-cheek and we kiss. For a white boy from the cold North it was uncomfortable at first, but a nice custom once I got used to it.
Overall the day is quite pleasant, and with a steaming cup of joe on my desk and a raging infection sitting across from me I feel quite content for the moment.