Rural Patient Dialogue: A Primer For Locum GPs
Working in rural General Practice serves up a slice of life that you certainly won’t find in an urban setting. Dr Max Higgs knows this better than most. His chronicles of GP locum work in rural Australia are vivid, raw, and above all entertaining. Let’s take a look at his latest outing, originally published as a letter to his daughter under the title Mind Your Language.
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Apparently, the pandemic has made country practice a tempting option for some of my city colleagues. If any of your medical mates are thinking of making the move inland, tell them that an understanding of rural language and customs makes the job easier. A working knowledge of key expressions used by old farmers is particularly useful.
There are a lot of animals in the country, (that’s where all the minced meat that people panic buy in the supermarkets comes from), so we’ll start with them. Firstly, a cow is not a ‘beef’ and a pig is not a ‘ham’; therefore domestic fowls should always be called ‘chooks’. ‘Chicken’ is the meat of a young chook.
Secondly, the words used to describe an animal’s health are strictly species-specific. Fat sheep and cattle are ‘in good condition’, a race-fit horse ‘in good order’, and a match-fit footballer (or well cared for second-hand piece of machinery) is ‘in good nick’.
When it comes to the farmer’s own physical well-being, asking if he has any health ‘issues’ or ‘challenges’, will draw a blank stare. If worried about his mental wellbeing, never start with “Are you in a good/bad space?”; the response will be another blank stare and “Well bugger me dead! I don’t know”.
To rapidly triage the state of a farmer’s health, familiarity with four terms is required.
- “In fine fettle”—Nothing wrong, came in for a chat and a repeat prescription.
- “A bit under the weather doc”—Likely has an infection requiring intravenous antibiotics (pneumonia or cellulitis).
- “Crook”—Seriously ill. Think myocardial infarction or, if there is any history of trauma, (“Came a gutser and fell off a silo last week”), major internal injury.
- “About rooted doc”—Profoundly depressed, near death, or both. (Some only ever present when “about rooted”.)
The language of the younger males is colourful. Most miners and truckies swear fluently enough to routinely use ‘f*ck’ as an adjective, a verb and a noun in the one sentence. A thirty-year-old with gout limped into E.D, pointed at his big toe and declared: “I don’t know what the f*ck is wrong with the f*cker doc’, but it’s f*ckin’ sore”.
Nick, a shearer, was no less expressive, but harder to follow.
“I think I might need a referral to a geologist doc.”
“A geologist? Why?”
“I’m not sure if I need a light up me clacker or not.”
I deftly joined the linguistic dots, “Ah! You need to see a gastroenterologist for a colonoscopy?”
“Yeah, that’s what I said. Waddyareckon?”
“Any change in your bowel habit?”
“Hard to tell with some of the stuff the tucker-f*cker at work serves up”.
“Tucker-f*cker?”
“The cook”.
“I see, thanks Nick. Ever get any pain in your belly?”
“Did last week when a big ram caught up with me; dropped me like a bag of shit”.
“What about your family? Any history of bowel trouble?”
“Sort of. My father had bowel cancer, but it didn’t kill him”.
“He still alive?”
“Naah. Didn’t make forty. Took off with someone else’s missus just after the op. Six months down the track her husband and a few other blokes caught up with him one night”.
Rural women don’t swear but can make the doctor want to. Gladys, president of the local garden club, was organising a ‘do’ and not getting much help from her committee. “You can train, you can tell, you can yell; some people still don’t listen, doctor”.
I was running late, but sympathised, “Must be frustrating. What can I do for you today Gladys?”
“Frustrating all right! I go to a lot of trouble to issue precise, unambiguous instructions. I was a school teacher you know. I need a repeat for my blood pressure pills, thank you”.
“What is the name of your blood pressure pill?”
“I said pills, not pill! I take three. One is called something, another is called something else and I can’t recall the name of the third one”.
“Thanks. Can you tell me anything else about them?”
“They’re for blood pressure. There’s a pinkie-orange one, a green one and a little white one. You’re the doctor, you should know what they are”.
Appearances matter, especially in the hospital setting. The GP dressed in scrubs will always be called a nurse, the one in casual attire, I favour t-shirts and jeans after hours, can also cause confusion. Shirley, a keen golfer, took a tumble off the veranda of the nineteenth hole. She regained consciousness while I was checking her over and didn’t like what she saw.
“Who the hell are you?”
I explained.
“A doctor! Are you sure? I thought you were a man who just wandered in from the bush”.
My suggestion that a knock to the head can cause confusion did not go down well. “Rubbish! I know what a doctor looks like. Old Dr Philpott always dressed properly. Wasn’t much good, but at least he looked the part”.
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Many thanks to our guest writer, Dr Max Higgs. A former country doctor, Max has been locuming as a rural GP since selling his practice in Inglewood. This article was originally published under the title Mind Your Language.
Would you like to know more about working as a rural locum doctor in Australia or New Zealand? It's a life-changing experience. We recommend you reach out to a member of our rural generalist team. Many of our rural locum doctor jobs 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 some cracking yarns to share, please get in touch!
