by Genevieve Yates

Winning entry in the AUSTRALIAN DOCTOR GPET WRITING AWARD 2008 and made into an educational film, “What would the Coroner think?” 2009.

‘I JUST can’t do it anymore. I don’t think I’m cut out for this rural GP gig. Small-town people are horrible!”

My registrar, Anna, was fighting back tears during our Thursday afternoon teaching session. Despite my half expecting this, my heart sank deeper into my chest and a surge of helplessness overcame me. I was torn between sympathy for my registrar and loyalty to my town and practice. I didn’t know how to fix this, nor did I know how things could have gone so dreadfully wrong for such a promising registrar.

Six weeks earlier, Anna had bounced into my small rural town practice with youthful enthusiasm, an impressive CV and a very un-“generation Y” work ethic. Best of all, she was passionate about rural medicine. There were of course the usual ‘Basic GP term’ registrar teething problems such as ordering too many investigations, difficulties with time management and struggling to manage undifferentiated and/or psychosomatic illnesses.

Some patients found her use of jargon and rapid rate of speech confusing. One mother seeking clarification from me said: “Dr Anna told my daughter that her cervix has caught the Human Pavlova Virus and that she needs to be treated with lettuce to fix it. I know that veggies are good for you, but how can lettuce kill the virus? And why does she need to go to the city to have it done? We grow top organic lettuce here!”

Some brief education on HPV and LLETZ treatment cleared up her misunderstanding and gave me an amusing anecdote to share with my colleagues!

Other patients found her thorough history-taking and examination methods excessive.

One elderly man reported: “I just came in for a script and she goes and asks me loads of personal questions, then pokes and prods me from head to foot. She even asked to stick her finger up me bum … no bloody way!”

However, Anna’s willingness to learn and her perceptive/reflective skills led to rapid improvement in all of these areas. A dream registrar!

Three weeks into her term, two unfortunate incidents occurred within two days of each other. The first was mistakenly giving a six-month-old infant the immunisations for a 12-month-old. The second was rupturing the tympanic membrane of a 65-year-old man, Tony, during a routine ear syringe. Neither was terribly uncommon nor catastrophic, but circumstances were not in Anna’s favour.

Tony is a difficult patient at the best of times; a loud, strongly opinionated man and one of the town’s personalities. Owner-manager of the town’s supermarket, everyone knows him and he knows everyone. In fact he’s related to half the town, including the infant who had received the incorrect immunisations. After storming out of the treatment room, he loudly proclaimed to all and sundry: “You are an incompetent fool. First you nearly kill my grandson and now you have wrecked my ear. You haven’t heard the end of this my girl, believe you me!”

He was true to his word. Within days, Anna’s professional reputation was suffering. Like a game of Chinese whispers, stories of her mishaps had mushroomed along with the details becoming wildly exaggerated. Not only did the entries in her appointment book diminish, but she became the object of whispers and stares when out and about around town.

I did my best to douse the flames but it was like trying to put out a bushfire with a single bucket of water. My hope lay in the belief that my beloved townsfolk would come to their senses or at least be distracted by some new piece of gossip for long enough to see what an exceptional young doctor was Anna.

Alas, it was three slow news weeks later, and Anna was telling me that she had reached the end of her tether. I convinced her to stay for at least another week — until we could talk to her training provider to try to sort something out.

Two days later, while relishing the freedom of walking my dog, I received a frantic call from my receptionist. “It’s Tony … he’s collapsed on the waiting room floor. Please come in … and hurry!” Of all the rotten luck for poor Anna … all alone for the Saturday clinic. Literally dragging my poor, sedate, elderly Labrador down the street, I rushed post-haste to the surgery, only to find Anna in complete control, calmly and confidently managing the unconscious Tony, who was in anaphylactic shock brought on by a bee sting. (How many times had I scolded him for not carrying around his Epipen!) Anna’s recent ATLS course and ICU term had certainly come in handy.

After the crisis was over, Anna and I sat down over a cuppa to debrief. She said, “Strangely enough, it was one of the first times this term that I’ve known exactly what to do. The only thing that I was worried about was that if he died and an autopsy was performed, how would the ruptured ear drum be explained?”

Tony made a complete recovery (tympanic membrane included) and from that day on was Anna’s biggest fan. “The young doc brought me back to life!” he boasted with pride to anyone who would listen. Within a few weeks her perceived mistakes were well and truly forgotten, and her appointment book rapidly filled to overflowing.

Anna completed her first year of training in our small town and has since settled in a nearby area. She reports that she is still very reticent when syringing ears …“Give me a medical emergency any day!”