Tuesday 27 October 2009

ICE, ICE baby.

My first trip out to clinics. Driving in the 4-wheel drive, up barely-there tracks, smashing through puddles and dodging cows, with a bag of drugs in the back, I really felt like a 'bush doctor', how I had thought SA would be.
But the reality of the clinics is that, not unlike the hospital, we offer an incredibly limited service. My job today was to see the patients that the nurses have selected in the lat 2 weeks as needing MO reviews. This ranged from hypertension and diabetes reviews (but none of the patients have home glucose monitors so even the insulin dependent diabetics only get about one reading a fortnight, and most of these are more than 25) to a child with ambiguous genitalia. But any blood tests will take at least a few days to come back and patients have to come to Mosvold for x-rays. So perhaps a little like a GP practice really. Only that there's no way of keeping good notes (all you have to write on is the handheld cards that the patients carry which are about the size of an appointment card at home, invariably tea- and other substance-stained and regularly get lost) so follow-up is variable at best. It's also incredibly difficult to refer patients to tertiary centres; there's no letter system, you just have to call and hope to get through to someone who will agree to see them (often not for many months by which time the patient has forgotten) and then when they come back, there is rarely any communication so you don't know what happened (I currently have a patient in the ward who I think has metastatic prostate cancer but although he has seen specialists, had investigations and possibly even some treatment, I'm struggling to get this confirmed). Very frustrating.
The other difference to GP is that I was at each clinic for 3 hours and saw 20 patients at each. That's an average appointment time of 9 minutes. Given that it is all done through a translator, I think I can safely say that I am not eliciting their ideas, concerns and expectations!

1 comment:

  1. i'm thinking maybe their idea is that they'll get some medical help; their concern is that they're going to die quite soon; and their expectation is pretty much nil

    pretty different to hear me thinks.....

    xx

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