Welcome to rural South Australia

Recently received the Winter 2013 edition of Ruraldoc, News from the Rural Work Force Agency.

This government funded  organisation is tasked with ensuring that those South Australians lucky enough not to be living in Adelaide can maintain still access to quality health care.  I received funding when I moved to Kangaroo Island and I remain grateful for this. In addition RDWA provide funding and support for ongoing medical education which is likely to be very welcome if the current Federal Labor government gets its way and caps self education expenses.

Snuck on the back page a list of a list of new country doctors for rural South Australians. I couldn’t help observe that some of the names are very difficult to pronounce. Without wanting to incite any racial redneck ranting, I do have concerns about the use of overseas trained doctors in country areas.  I recall a young doctor arrive who arrived in Nhulunbuy on the Friday afternoon flight from Darwin, jet lagged after flying in from Harare with his young family.  The first thing he asked me was were he could change his Zim dollars into Australian ones. He wasn’t the only overseas doctor whose first experience of providing medical care in Australia was remote Arnhemland. Hopefully this has changed and doctors who arrive from overseas have been orientated and nurtured with local practitioners.


To these doctors I would say welcome to country South Australia. May you all find a support in your community, your work enjoyable and  your patients grateful. And if any of you are Australian trained I do apologise for any perceived racial slurs.

Slave to Fashion

Following a recent discussion about appearances I have decided that I need a wardrobe next to my consulting room library.

Dr Stephanie Dancer, a Scottish Microbiologist, has suggested that informal dress amongst doctors “erodes the image of doctors as responsible and competent” and “also intimates a lack of personal hygiene”.

Apparently in her opinion “Doctors are members of a distinguished profession and should dress accordingly. Untidiness erodes the image of doctors as responsible and competent. Scruffiness is synonymous with being untidy, dishevelled and unkempt, with having straggly hair, ill fitting clothes and scuffed shoes – or trainers – as well as not wearing a tie and so on. Together these might be taken as a flashing neon sign that says ‘I don’t care’. Scruffiness, however defined, also intimates a lack of personal hygiene and correspondingly lower standards of hygienic behaviour.”

Seems pretty harsh condemnation for a doctors who works in T-shirt, jeans and sneakers! I do know a few. I wonder  what she would think of a doctor with a pony tail and a Ned Kelly beard!

The responses to her BMJ article seem to be pretty revealing about the medical professions perceptions of itself at least in the UK.

Apparently, what I wear tells my patient I don’t care about them and worse I am incompetent and dishonest.

So now for my elderly patients I will don a crisp white shirt, dark suit jacket and pants, buffed oxfords and bow tie, quickly changing to smart casual pants and sport jacket for the antenatal clinic, changing to shorts and a polo top for a young adult then finally to the clown suit for immunisation clinic.

Hippocrates is claimed to have implored “physicians to be clean in person, well-dressed, and anointed with sweet smelling unguents”. That was unguents (soothing ointments) rather than ungulates (hoofed animals).

I think apart from the latter, I have satisfied his criteria. Ever since starting my medical career I have nearly always worn a smart casual short sleeved short, smart shorts and comfortable boots. Everything including my jocks and socks you will be glad to know gets washed at the end of the day.  My hair has also been cropped at a number 1 or 2 since I lots the dreadlocks when I was 17 and had to visit Singapore in the early 80’s. Once I wore a tie to work just to see if anyone noticed (they did – and laughed at me) and I have never worn a white coat. The last white coat I had ended up being tied dyed purple on the last day of Pharmacy school. Oh and I have a diamond stud in my ear, the right on of course.

An interesting paper which gained a mention in the Australian Doctors commentary about Dr Dancer’s opinion was published in the JAMA. Four hundred were surveyed and the author suggested a 76% favoured a white coat over scrubs over business dress over casuals. Respondents also reported that they were significantly more willing to share their social, sexual, and psychological problems with the physician who is professionally dressed. Respondents overwhelmingly favour physicians in professional attire with a white coat. Wearing professional dress (ie, a white coat with more formal attire) while providing patient care by physicians may favourably influence trust and confidence-building in the medical encounter.

The survey was carried out in Charleston in the US hence the white coat preference. I couldn’t help muse whether in the Deep South whether the pictures used to judge preference were of Caucasian or African-American faces.

Reminds how easy it would be to wander around a hospital dressed neatly with a stethoscope draped around the neck….

And as a little exercise type “Stephanie Dancer” into Google Image (with safe settings activated) and try to pic the Microbiologist!

Surely,  I earn my patient’s trust and confidence by how well address their needs rather than what I wear, may sound like, how tall I am, how long my hair is etc etc etc.

Let me know if I am wrong?


Some things in General Practice make me cross!

Recently I saw a young man who had a workplace injury.

It was a relatively minor injury from a machine that could have done quite a bit of nasty damage. Reminds me of the fellow who feel out of a tree whilst pruning with a chain saw but that is another very messy story.

I cleaned and debrided the  wound, reassured myself there was no serious damage done and tacked it back together. It has since healed well.

A few weeks latter I received a letter from his insurance company saying that now he has made a claim on his income protection I need to send his entire medical file to the insurance company. They were willing to pay a small fee for this.

And I thought to myself why should his insurance company want his entire medical record?

So after a chat with the patient I sent just the medical notes relevant to the injury.

I have now received a second letter saying thank you for those notes but I need to send them his entire medical record.

A week latter I have yet to receive a reply from the insurance company for the reasons to trawl his entire medical record.

So it would seem that once you sign up for insurance you no longer have any health secrets.

I recall I when I was searching for income protection, one insurance company refused to cover anything to do with my skin because I got dermatitis when I regular scrubbed for OT working as a registrar. That meant that if I got any kind of skin condition mentioned in any of the four volumes below I would not be able to make an income protection claim! I argued with their medical department for a while about their misplaced logic but eventually gave up. They didn’t get my business!!

Blackwell Reference Online