Sunday, June 08, 2008

Vitum experiences medicine down under!

I didn't expect to find myself seeing patients in Australia this week, but there I was, in a general practitioner's office, shadowing as a medical student, just hours after getting off the plane to Australia.

I have a buddy of mine to thank. I've always wanted to visit the Southern Hemisphere, and since he is one of the estimated 1500 Canadians studying medicine abroad (a quick tribute to the limitd number of medical school spaces in Canada) it worked out well to combine a trip here with a visit to an old friend.

Not only that, but his preceptor graciously agreed to let me tag along with him during his placement in her office this week, an opportunity that I was very interested in taking part. It was fascinating learning about the similarities and differences between medicine here and in Canada, identifying some rashes I had just learned about in our Dermatology unit, and actually feeling like I have learned something in the last two years as I was able to pass on some things to the first-year medical students.

Don't worry, I'm not spending my entire break doing medical'll find me laying on beaches and hugging kangaroos the rest of the time I'm here. But it was really neat to see what a doctor does halfway across the world.

What's different?

So, based on my afternoon in a GP's office here, how does medicine in Australia differ from that in Canada?

Well, the first difference that I noticed right away was the layout of the office. In Canada, GPs generally have an office with their desk where they do paperwork, but that is in a separate room from the rooms where they see patients. In Australia, however, the GPs have a large office, one half of which looks like a typical office with a desk and computer and bookshelves, and the other half - sometimes separated by a curtain - is the clinical area where they see patients, with a patient bed, sink, and various instruments hanging on the wall.

Another difference I noticed was the hints of the two-tier health system here. The public system, known as "bulk billing," works alongside the private system, funded by patients or their insurance companies. I've been told it isn't that profitable for a doctor to only see bulk billing patients, and for the most part those that do are more similar to what in Canada is a walk-in clinic - where patients go for minor issues after hours, or mostly to get prescription refills. GPs who have their own patients shake their head at the mention of a patient getting antibiotics from one of these bulk billing "medical centres"... just like GPs in Canada shake their head at the mention of a walk-in clinic. As well, driving through a smaller town in Australia, I saw a large public hospital... and right down the street from it, past the independent pathology labs that contract out to the hospital, was a private hospital - smaller, and much fancier.

Finally, a comment about the public health victories in Australia. Like in Canada, doctors here have had a major influence on smoking rates and seatbelt use - but before even coming to Australia, I had heard that the doctors here have had incredible success with the "slip, slap, slop" campaign - to get Australians to be "sun-wise" and significantly decrease their risk of sun-associated skin cancers by covering up with sunscreen and long-sleeved clothing. Based on their efforts, wearing hats and long-sleeved clothing to outdoor events has become a way of life in Australia.

What's the same?

Indeed, those differences aren't really that major, and I'll go so far as to admit that the thing that stunned me the most was that there are actually many, many similarities between medicine here and how I've seen it done in Canada.

Many of the things I heard the doctor mention - drug names, medical conditions, and investigations for medical conditions (such as a glucose tolerance test, nuclear studies, ultrasounds, biopsies, lab tests) - had the exact same name and terminology we use in Canada, much to my surprise. Even those rashes I had recently learned about in our Dermatology unit showed up, and are called the exact same things they are in Canada. I suppose I had the idea in my head that everything would all be called different things here.

Not only that, but a couple came in to talk about their plans to get pregnant - every single thing the doctor mentioned in the prenatal counselling, right down to the numbers ("you have a 20% chance of getting pregnant each month" and "if you don't get pregnant within 12 months, that's when we'll start looking into the reason for that") and advice ("take a folic acid supplement" and "don't drink any alcohol now that you are planning to become pregnant!!!!") were identical to what I had just learned in my reproduction block.


I'll admit that the rumours I've heard about how hard it is for Australian doctors, and international doctors in general, to come to Canada had always given me the idea that the doctors here are perhaps less competent than those in Canada, or that maybe Canada is keeping them out for the protection of our own people. However, having seen these docs in action first hand, this misconception of mine has been pretty much wiped out. From what I saw of the docs here, they're just as competent as any doctor I've worked with in Canada...if not more so than some.

All of the doctors in the office seemed very enthusiastic to have students, and took the time to try and teach me. It was also really interesting to go to class with my friend and meet many other Australian medical students, see that they are learning exactly the same things I am learning in class in Canada, and share perspectives with some more of the Canadians in his class who are all studying here for different reasons.

Many thanks to my friend's GP (and all the docs in the office) who were more than willing to make this unique experience a possibility for me.

One last random thing...

If you want just a normal, regular coffee in Australia, ask for "filtered coffee" - it's not the same as "percolated coffee" (ask for that and you'll get an espresso). That should save you the argument with the barista... which, based on my experience, ends up with them thinking you're crazy, you thinking they're crazy, and you settling for a "tall black" (their name for an Americano). Just a tip.


doc-hopeful said...

just curious, did you have to get patient approval to shadow in Canada or Australia? Here in the U.S. there is so much concern over patient privacy that docs are really reluctant to let pre med people observe, or even med students in an office setting. O.R. is usually the first we get to actually see a real patient, unfortunately we don't learn communication skills there.

Anonymous said...

doc-hopeful, as part of our training in australia med students have a unit where you HAVE to shadow a GP for a few weeks to learn about general practice, doing examinations, etc. Most doctors are generally helpful and encourage students to learn with the patients... getting permission is as easy as asking the patient before they walk in if they would mind having a student sit in, some say no, but most are fine with it. Vitum... welcome to Oz! Which uni does ur friend go to? sorry about the weather at the moment, our summer holidays are much better, it sucks how the northern hemisphere's school terms are different than ours (sept-may vs. feb-nov)

make mine trauma said...

uhmmm, best be protecting your nether regions if you insist on hugging kangaroos.....

Vitum Medicinus said...

Howdy, Hopeful! Every patient I see in both Canada and Australia is usually notified at the time of booking their appointment that medical students will be in the office, and I alway start my interviews explaining my role and limitations, and asking for consent. Interestingly enough, in Canada I was once told by a surgeon that he would only let me shadow him once I became a medical student - "people in the OR," he explained.

Thanks Anon for your welcome - yes it has been quite rainy here - but there have been spots of sun to make me realize how close to paradise it is here! My friend is at Wollongong uni.

Lionel said...

Interesting... pleased your enjoying it here (apologies for the weather if you're here in Sydney).

On the coffee front, I think the phrase you were reaching for to describe your order is "tall black".

yublocka said...

Re ordering coffee, I remember an extremely painful experience in Canada trying to explain to someone there what a "flat white" was!! Glad you enjoyed Aus!!!