Huge Disclaimer.....John Blogging.....A bit loquacious....Enjoy

Bundaberg Base Hospital

For those of you who have ever received a voicemail from me, you know this may be a bit painful. It's just what it is.  First another disclaimer:  I'm still trying to make sense out of a bunch of stuff (as will be apparent) so some of this is probably wrong (what's new?).  But that gives you some more accurate insight as to what I'm experiencing... I'm often not sure what I think I "know" is actually correct.

Today I'm going to try to introduce you (confuse you as) to the medical "system":  The medicine practiced is certainly "first world" in the sense that the facilities and training are in line with what you would expect in an up-to-date smaller Wisconsin town's Emergency Department (think Beaver Dam) and the specialties represented are primarily the basics with complex issues having to be transferred;  for instance, we have no cath lab, no neurosurgery on-call,  no interventional GI doctor, etc.  Also, there are restrictions ("guidelines") as to the appropriate tests or medications that you may order without "permission" from above, based upon protocols.

My personal experience is that of an old guy (who worked in the same department for 30 years) struggling on many fronts.  Naturally, I don't know where any equipment or supplies are, I don't know anyone's name, plus I'm having to learn several new computer systems (there's a separate system for labs, one for x-rays, and one for the tracking board in the department and the patient notes).  Those of you who know me, know this is all playing right into my productivity strength.  Add to this a department full of people whose positions aren't entirely clear -- there are "specialists", senior medical officers (SMO -- that's where I am now), PHO's (Primary House Officers), Registrars (resident equivalents, I think), and Interns.  People are training here from all over Australia and the world, which means that you get to experience accents from the United Kingdom, Scotland, New Zealand, Zimbabwe, Ireland and probably others to those from Melbourne, Perth, Sydney, and Mackay -- and you have a Tucker asking people to repeat themselves multiple times.  They probably think my hearing aides need refurbishing.  True we all speak a form of English but Australians use a lot of slang so even when I do understand the words, I often don't know the meaning.  For example, "to spew" is to vomit but "spewing" is to be very angry; "rotten" is drunk, feeling "crook" is to feel sick or ill.  I have no idea how many people I've misinterpreted already!

Dr. John Tucker

Next week we get all new interns.  They only stay at a given location for 6 to 12 months and then travel to another training location for their next stint of training.  I'm not sure I get it -- they must always be applying for a new position.

Oh, I haven't mentioned that almost all the medications have other names (e.g. acetaminophen or what we would commonly know as Tylenol is "paracetamol" and ibuprofen is "neurofen" -- and those are just the over-the counter examples).  So now the "weak" 83 year-old, who doesn't know her past medical history, hands me a bag of medications (none of which I'm familiar with) so I will "know" what her previous medical issues are -- I think you're beginning to get the picture.

The department has several "areas".  There is an "Urgent Care" area, an "Acute" area which is composed of 14 telemetry beds with 2 "resuscitation" beds and a "trauma" bed (we are the main trauma recipient for the region), and an "Observation" area.  Admissions can go to Observation (<24 hour stay planned), MCDU (Medical Clinical Decision Unit) if it looks like a 2 to 3 day stay, a full admit bed (longer looking admits), ICU, or CHIPs (their version of VNA but patients return to the ED for follow-up).  Clear so far??

Every day at 7 AM we do "hand-over" where there is supposed to be a short teaching session (assigned on a rotational basis) -- that's only happened once so far while I've been here; followed by turning over the patients in the department to the people who have the assignment for the area those patients are in.

Senior Medical Officer (SMO) shifts are 10 hours plus 1/2 hour built in for lunch (very civilized!) Shifts run 7 AM to 5:30 PM or 12:30 PM to 11 PM -- only junior house officers do nights with an SMO or Specialist "on-call".  We do 8 of those 10-hour shifts every 2 weeks (averaging 40 hours/week) but most people group their shifts so that they then have a string of days off.  Two of the SMO's actually live in New Zealand and come to work their block of shifts and then go home to New Zealand.  With this system, I started with 7 shifts in a row.  As you can only imagine, Ellie was "thrilled" to have the only person she knew on the entire continent walk out the door to leave her alone with all the "fun duties" that needed attention (e.g. setting up the house, getting groceries, straightening out health insurance, etc.).  She has made her displeasure clear -- if you catch my drift.

For those of you who are still interested, Australia is waiting for you.

My next entry will be about the types of patients we see -- it's worth the second read.

Tuck