17 January 2020

A general theory on the relativity ratio of pubs to doctors

Grumpy Old Doctor RedHerring

Dear Julia,

Martin Luther King had a dream. I have a little theory.

Having worked around the country a fair bit, it seems to me that to remain viable and function harmoniously the ratio of hotels to full-time equivalent GPs in country towns should be no more and no less than one-to-one.

This is the the “Goldilocks Principle”, as applied to doctors and pubs in rural Australia.

A town in the Mallee with 1,000 residents had its pub close last year and has been unable to attract a full-time GP since. An open and shut case of “too little”.

On the other side of the Murray, a place well known for the mustering of utes, has a dozen watering holes in the district and 10 GPs. A couple of lively weekends in the emergency department of this place firmly convinced me that 12 hotels are “too many”.

However, in places such as Dunedoo and Wycheproof, where the golden one-to-one ratio is maintained, life is peaceful and the natives happy. “Just right”, as they say in the classics.

There are exceptions of course; this town in the Kimberley has just one pub but four doctors.
According to my theory, this represents either too few hotels or too many doctors. However, the reality is the one hotel is more than sufficient and four doctors are just barely enough. That’s the Kimberley though, the rules are different up here.

We arrived for our regular locum stint to find the town looking cleaner than before. Security has increased as the crime rate is up. But so is school attendance. The previously unimaginable 70% barrier had been broken in the last week of term.

Tourism is down, but diabetes, kidney failure, rheumatic heart disease and domestic violence rage on unabated.

In the eastern states, every second child is said to be “on the (autism) spectrum”. In the Kimberley they haven’t heard of “the spectrum” but a lot of kids have dropped off the radar. Bad things still happen to small children and there is always pus to be drained.

Brexit, interest rates, Donald Trump and share prices don’t feature much in conversation, but requests for “medical” transport often do.

A 9pm phone call, agitated female voice, strange background noise, hard to hear.

“Can you send the orderly to pick me up?”
“What’s the problem?”
“I’m bleedin’ from me ar….”.
“Bleeding from your arm? Where are you?”
“Not me arm. Me arse. I’m at the pub, come quick.”

The orderly was duly dispatched and the patient transported to hospital, whereupon she announced that she didn’t want to see a doctor. The bleeding had stopped. She just wanted to pick up her usual weekly supply of tablets.

Selfish and thoughtless, to be sure. But mostly just dumb.

Some people just don’t get it. Like those patients who present (usually in the early hours of the morning) with two days and nights of “excruciating” pain for which they have not thought to take so much as one panadol.

Or those who appear surprised to find that a week of drinking warm beer and Bundy rum from the back of a ute in Broome resulted in “ulcer pain”? (This bloke was quite convinced that the temperature, not the volume of the alcohol, was to blame).

And who would have guessed that a day of social bowls followed by numerous beers and countless glasses of red wine might render the negotiation of stairs problematical?

Is it really surprising that trying to spark up a campfire by pouring petrol from a plastic bottle on it results in a burnt hand?

Dangerous combination, dumb and drunk!

Which leads me to the dumbest medical invention ever: The “Pain Score”.

When asked to rate their pain on a scale of one to 10 a small minority of polite, sensible individuals will answer with a number between three and seven.

Commonly, these people will have taken something for pain prior to presenting to hospital, will give the ED doctor their full attention and will be in obvious discomfort.

Most other adult patients will say they “have a very high pain threshold” and give a score of anything from eight to 15. These poor souls will bravely soldier on texting while waiting to be seen, answer calls while being seen, and happily video the entire consultation for posterity.

The Pain Score should go the way of the dodo and be replaced with the infinitely more reliable NIPODIUM score: Not In Pain Or Dead If Using Mobile. It’s more accurate and requires no patient input.

I know, I know, I am becoming old and grumpy, I don’t tolerate exaggeration, confabulation, and plain bullshit anymore.

Recently I found myself empathising with a man who follows the poultry show circuit.

Allegedly, some base individuals are gaining unfair advantage by tarting up the beaks and legs of Australorps with black nail polish and texta. Apparently, such flagrant fouling of fowls goes unchecked because the judges are too timid to disqualify the birds, confront the perpetrators and tell them that they are cheating.

Fortunately for me, there are still individuals in country hospitals who call a spade a shovel. An older nurse explained the cause of a seedy young man’s Sunday morning vomiting succinctly: “It’s because you got a gut-full of grog last night.”

Clear and unambiguous. Should be more of it.

You really can take a panadol if you need to. Sleep well.

Love, Dad

Dr Max Higgs is a former country GP, a current rural and remote locum and a collector of stories

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