Melbourne Musings

I have now been in Melbourne just over a month.

I have settled into work at one of the teaching hospitals. We have secured a cute little flat within walking distance from work and a nice little coffee shop down the road. We have even taken our first trip to explore outside of Melbourne – heading to McLaren Vale and buying an unacceptable volume of Shiraz.

A couple of my new colleagues have discovered this blog, and one sent a screenshot to me asking if I wrote it. Aside from being amused at my now international almost-recognition, it led to me re-reading my last post, and I can’t believe how defeated I sound. I already struggle to recognise the Sheri who wrote it, barely 2 months on. I feel a little as if I am emerging from a thick fog. Things in healthcare here really are as good as people made them sound.

Traditionally this blog has been used to voice my annoyance at the general state of the NHS. It is odd to begin writing a post filled with positives. There are, however, in addition to the much nicer working environment, negative aspects of living in the Antipodes. I will probably end up comparing and contrasting more than just medical-related things over the next few posts.

Here are the things that have struck me thus far.

The COFFEE. Dear Lord, the coffee. I knew it was better. I was excited about sampling it. What I wasn’t prepared for was how difficult it is to get a mediocre cup of coffee in this city. Every small coffee shop has more delicious brews than the next. Chains like McDonalds (Maccas to my new friends) serve better coffee than independent shops back home. The Aussies are so focussed on superior caffeine, that even on night shifts there is a coffee truck that does the rounds of the Melbourne hospitals from 10pm to 6am supplying excellent beverages to all the night workers. Never will I be reduced to instant coffee again. Pure genius.

 

The rota (roster, as I am intermittently learning to call it). The shift pattern is just as terrible as back home. If anything, it is worse. I arrived in the country and immediately worked 3 consecutive weekends and then went straight onto nights. However, several vital factors mean that this did not bother me as much as it should. Firstly, you are paid fortnightly (hooray). The pay you receive varies depending on how many out of hours shifts you have worked that week. As such, weeks where you have worked weekends/nights provide you with a noticeable increase in your take-home pay. I know it supposedly works this way in the UK too – your annual salary is calculated to include your out of hours work, but you never see it directly. Seeing those extra dollars in your bank account after a weekend shift makes it exponentially easier to cope with.

Additionally, the workload is so much less. There is constantly more than adequate staffing, with time to make a cup of tea and have a little chat with your colleagues even during the “busiest” of shifts. I no longer feel as if I am continually chasing my tail and getting nowhere. There is time to properly assess, investigate and treat patients, instead of feeling as if you are providing a triage service where people are either referred or discharged without so much as a diagnosis considered or a brain engaged. People are less overworked, and as such more amenable to being contacted about patients for advice, even if you are not referring. There is more of a culture of friendliness and openness.

We are all used to the post night shifts breakfast where you get boozed and form the best bonds with your colleagues, dissecting the previous shifts and getting increasingly tiddly on espresso martinis, but in my hospital here, the Consultants foot the bill for these social engagements. There is a cap of $100, but it definitely shows appreciation for the night work. They can do this comfortably, and claim it back on expenses. Which leads me nicely to the next point:

 

Salary packaging. For those working in healthcare, you can set up a system whereby you can pay for certain expenditures such as rent/entertainment from your gross salary, prior to taxation. There is a cap of around $9000 per year, which gives your take-home money a significant boost, and again adds to the feeling of appreciation of your hard work.

 

I have left a training programme in a major teaching hospital, where there was a commitment to providing me with teaching and training experience, and am now working as a trust doctor in a smaller unit. One would assume that the teaching and training opportunities would have decreased. This could not be farther from the truth.

Despite the fact that I do not have a college affiliation, I have access to 5 hours of protected, PAID FOR, teaching on a weekly basis. What is more, the sessions are actually useful. Additionally, the ED registrars are all rostered to spend time in theatres, ensuring we keep our intubation skills up to date. It makes sense that you would want to keep practicing a skill that you rely on in an emergency, and I can’t believe we don’t do that in the UK.

 

You are much more responsible for your patient here. While the patient is in ED, regardless of the team they are under, you continue to make all the management decisions for them, obviously with consultation as required. If someone needs intubating, you do it. You put the lines in, initiate the treatment, and then call ICU for admission. It is so much more hands on, and exactly what we all signed up for when we wanted to become emergency doctors. It feels so good.

In addition to the above point, you can also do so much more for your patients here. Due to a combination of everyone being much less overworked, and funding being distributed differently, I have had none of the old frustration of knowing someone needs an outpatient review/further investigations and being unable to arrange them. Need to see a cardiologist? No worries. Need outpatient investigations ordered? Easy. Need an MRI for your ligamentous knee injury? No dramas.

 

I haven’t quite worked out how I feel about the public/private healthcare system. Honestly I don’t quite understand it. Perhaps it will become clearer the longer I am here. The private system definitely takes the strain off of the public hospitals, and provides fast and easy access to investigations, and prompt treatment for those able to pursue it, however, there are also negatives. Unnecessary admissions and investigations being one. I have had several conversations along the vein of “well, they don’t really need admission but if they are private we can bring them in for a few days and investigate.” And I am uncertain how I feel about that. You are obliged to encourage people to use their private insurance instead of taking a place in a public hospital. I understand the logic of that, but I am not used to feeling like a healthcare saleswoman, and I feel that it damages my integrity a little, especially if I do not feel the admission would be any different for the patient, or that the tests are unnecessary. I have had so many ridiculous conversations with extremely twattish private Consultants who clearly don’t care either way about their patients as long as they are being paid. Watch this space for more thoughts as I come to understand the process better.

 

Brand names. Dear God, Australia, learn what paracetamol is. Every drug is exclusively referred to by the brand. Not just by the public, but in healthcare too. The electronic prescription system requires the brand name to prescribe. You type Panadol, Voltaren, Lyrica etc. It drives me nuts that nobody knows what drugs they are taking and it’s even worse that the brands are so prevalent within the ED. I needed some metaraminol the other day and got nowhere until finally someone told me they call it Aramine here. It is a daily struggle.

 

Inherent racism/homophobia/intolerance of difference. This is a BIG factor for me. Australia is a developed country, with tons of educated people, and a net immigration per inhabitant of 4.5% (for reference the UK and US are roughly 1.5-2%). One in five Aussies were born abroad. It is therefore completely baffling to me that there is this degree of intolerance. People who I socialise with, who I consider to be well educated, largely with left-leaning politics, and a similar worldview to my own, have no problem voicing incredibly racist and offensive terminology. I have heard the word ‘wog’ in casual conversation more here in the last month than ever before in my life. I am not sure that I will be able to make my peace with that. I am told it is much worse in other parts of Aus, and that Melbourne is relatively tame in this regard, and that makes me feel sick. I am sure that their most recent Prime Minister and his anti-immigration, anti-marriage equality, extreme religious views is not about to improve the situation any time soon.

 

On a lighter note, it is VITAL that I pick my AFL team. I didn’t care much about footie teams back home, and assumed the same would be true here. But AFL here is life. It permeates every conversation, people form impressions of you based on your affiliation. Pretty much every conversation includes references to the players/games. It probably doesn’t help that I have arrived around finals season, but I clearly need to pick a team.

 

That’s it for now. I will keep you posted on further impressions as we go, but now I need to go out for coffee. Peace out.

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