Locum Adventures in Rural and Regional Australia

By Max Higgs published on 13/05/2020 Locum work, Rural Generalism /

Working as a locum in rural and remote Australia will present you with your fair share of unique and offbeat characters—just ask Dr Max Higgs. Since selling his Inglewood practice of 24 years, he has been locuming in rural towns across the country: each one unique from the last, with work environments that certainly won't be found in city practice. Max has been keeping a record of his rural and remote locum experiences in his Grumpy Old Doctor column, featured in The Medical Republic. It's highly entertaining and plays up the quirkier aspects of rural and remote locum life. Max has given his permission for his article 'How To Cope With Life And Ice' to be published here.

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You can only work with what you are given, so locuming in a different town every two or three weeks is a challenge. 

The accommodation might have Wi-Fi access but no fry pan, coat hangers but no clothes pegs. There may be a butcher in town, but no counter meals at the pub because the cook has shot through with the plumber. Newspaper choices will be limited—though you will always be able to get The Weekly Times or The Stock And Land. The television remote will have flat batteries and the toilet paper will be the thinnest, cheapest, most abrasive that the local health service can buy. 

Mono-layered Home Brand is a fact of life for the country locum and there is no escape from gastro-oesophageal reflux either; your first patient will always want a repeat script for Nexium. Apart from that, every new location will provide a fresh cast of characters, each with a unique understanding of illness and an individual world view.

“Your first patient will always want a repeat script for Nexium”

My second patient last week worked miracles with vitamin C. He awoke with a cramp in his calf, took a capsule, went walking for ninety minutes and got better, leaving him convinced that ascorbic acid had cured him. I didn’t want to start arguing with patients on the first day so let it pass and also backed away from a religious discussion with the next customer, who announced “I don’t like the Dali Lama, he’s too similar to the Pope. Too religious keeps promising things he can’t deliver”.

Interviewing Madam Four X

Country nursing homes have a relaxed feel, the residents are chatty and the routine flexible. After a week of weather in the mid forties Mick announced on Friday afternoon that he had a thirst, was giving carpet bowls a miss and fired up his gopher for a trip down town to “Interview Madam Four X for a while”. The nurse in charge advised him to wear a hat and have a couple for her.

Saturday evenings in ED provide a standard diet of geriatrics who have fallen, depressed forty-year-olds, freshly assaulted teenagers, and a child who tripped over the cat and cut her head. Bigger towns with more hotels provide a drunker clientele; a patient who recently spent a night under observation (reason unspecified) did not enjoy the experience because “Everyone else was drunk, in pain, being catheterised or had the shits”.

You can't kickstart a rocking horse

Working with inebriates is unfulfilling. Working with children and animals is more rewarding, but mixing the two in the consulting room can produce unpredictable results. A young man in a Harley Davidson T-shirt came in “For a Centrelink certificate and some pain killers”. He was accompanied by a partner with the slogan ‘Run Wild’ boldly emblazoned across her chest and three small children who took that advice literally. The toddler opened every cupboard while her older sister tested all the medical equipment. The three-year-old was drawn to a large wooden toy in the back corner. It’s the first time I have worked in a surgery equipped with a rocking horse; it was a novel experience for the child too. “Brayden! Brayden!” his mother roared. “You can’t kick start it Brayden. It’s a horse. It’s not like your motorbike”.

Brayden will find out soon enough that the facts of life are harsh and the innocence of childhood transitory. Betty is ninety, she and her brother used to ride a real horse to school. She still recalls learning a tough lesson about the abruptness of death on the way home one afternoon. “The horse dropped dead. It was amongst thistles and we got prickles in us”. Bronwyn is forty-one and healthy but haunted by the memory of falling gravely ill with leukaemia when she was eleven. “There were thirteen kids in the haematology ward and I am the only one left. All the rest died young”.

On the issue of ice

Many parents know that raising children doesn’t always become easier as they get older, especially if the kids develop a taste for ‘ice’. Kevin is an old patient I keep in touch with; I asked him how his boys were. “Pretty good thanks doc. The older ones moved to Ballarat and the younger bloke’s in jail for dealing. At least he’s got plenty of time to keep up with his reading”. Barry is separated from his wife and teenage daughter but still contributes to parenting. “The missus rang the other day and I asked her how our daughter was. She said ‘Ashleigh’s pretty good. She’s only smoking a little bit of ice at home’. I said “S**t, that doesn’t sound too f****n’ good”. Trevor is back on the cigarettes. “I’d given up until my daughter got on ice, that threw a f****n’ spanner in the works. I took her up to the local hospital and waited forty-five minutes at reception. The receptionist had to piss off home because her son had been busted for drugs”.

Ice is now intergenerational and the parents are not always the innocent party. Candice is thirty-eight and in a dysfunctional relationship. She has no money, a broken leg, two teenage children, an ice habit and is unable to see beyond her next fix. Sometimes parents give up on their children and at other times children have no choice but to abandon their parents.

A fond farewell

Bluey was taking a road trip from Melbourne to the top end and his old mate Macca asked to come along. On arrival in Darwin, Macca wanted to head straight to the beach, which mystified Bluey as he didn’t know his mate could swim. He was even more surprised to see him stride, fully clothed, into the surf and, with the water lapping his midriff, upend the contents of an urn into the Timor sea. On exiting the water Macca explained that the ashes were those of his father and no, casting them into the ocean was not a sentimental gesture. “He was a hopeless addict and a complete bastard. I just wanted him to be as far away from me as possible. Can we go home now?”

A very big thank you to our guest writer, Dr Max Higgs. This article originally appeared in The Medical Republic under the title How To Cope With Life And Ice.  Read more of Max's work at the Grumpy Old Doctor. You can follow Max's rural locum adventures on Instagram.

Ochre Recruitment sends locum doctors all over Australia and New Zealand, but perhaps the most unique experience we offer is the chance to practice medicine in rural communities. Most of our doctors find it rewarding on both a professional and personal level. You won’t find fractures, diabetic comas, snake bites, pneumonia, petrol sniffing, retrieval medicine, pregnancy, floods and psychological issues all in one day in metropolitan clinics.

As a rural GP locum you’ll learn new skills, become more resourceful and adaptable, you’ll challenge yourself as a doctor, form lasting relationships with rural communities and explore pockets of the country you would never normally think to visit. And in a rural setting, medical practitioners are the backbone of the communities – you are truly appreciated. The satisfaction of managing complicated presentations with limited resources and achieving a positive outcome can be for want of a better word, exhilarating.

If you haven’t yet had the opportunity to locum in a rural or remote town in Australia or New Zealand and you are curious, why not contact a member from our rural generalist team. Many of our rural locum roles do involve hospital work so in addition to having your FRACGP or FACRRRM, you will require ALS2 or equivalent.

If you are a rural locum doctor and have an interesting story or anecdote to share, we’d love to hear from you.

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