Rural medicine was not on Davina Oates horizon.
Nor was the Rural Clinical School front of mind – yet it became the year that would transform her thinking and shape a career which now sees her practise in a town just about as far away from Perth as you can get in Western Australia.
“It wasn’t really something that I had a burning desire to do,” she says.
“Someone told me that 5th Year was really, really hard – the hardest year of medicine – and someone else had said, ‘do RCS, it’s much easier.’ I hadn’t ever really thought about doing rural medicine at all, but I thought RCS would be something a bit different.
“Everyone else made it sound really fun, and I remember as a 4th Year working alongside the 6th Years – because we did a lot of rotations that had maybe one 6th Year and two or three 4th Years in a group – and I really noticed that the clinical skills and the practical skills and the knowledge of the people who had done RCS were just leaps and bounds ahead of the ones who hadn’t.
“That’s the way it seemed to me, so I thought, ‘yeah, I would like to be like that.’
“When I went into 6th Year I noticed that I was a lot more confident and found my exams pretty easy because you get treated, especially on a small site, like one of the other doctors and you get a lot more autonomy.
“You get to make decisions – there is always someone to run it by, and you’re meant to – but there is just feeling a being a lot more involved in the process.
“And I think that is far more so than in a Perth tertiary-based hospital or even a Perth GP situation, because you have to be good at everything because you are the only option and your specialists come and visit rarely.”
Davina also came to appreciate that she could pursue her preference for obstetrics and gynaecology.
After graduating and doing her intern year at ‘Charlies’, followed by a couple of years backpacking through Central and South America and Asia, she returned home to take up training for Advanced DRANZCOG over the next three years.
“Early 2015 I had the opportunity to locum as a GP Ob in Port Hedland for a good friend who was taking mat leave. I was only able to cover her for four months because I was off to have my own baby, but that taste of rural GP Obs really cemented my decision to do it as a career.
“I had the rest of the year off and started in Kununurra as an ACRRM Registrar in Kununurra which is where I had been aiming for. I had done my rural GP placement as a 6th Year in Kununurra and just fell in love with the place and was desperate to get back.”
An age-old function of the country doctor is at the heart of Davina’s enjoyment of medicine – the “privilege” of being involved in a major life event: being the first to confirm a pregnancy, guide the mother through ante-natal care, deliver the baby and then provide post-natal support
“Equally, I have had a really phenomenal experience here guiding families through the other end of life with palliation – someone who has advanced cancer that becomes terminal, and going through the process of not only providing comfort to the patient, but also their family.
“You are in such a privileged position in that you get to look after people from start to finish.”
Davina enjoys the variation and the challenge of rural medicine as she practises it more than 3,000 kilometres from Perth, and sees advances in tele-medicine continuing to reduce the disparity in health care between city and country.
“I do two weeks on, two weeks off at the general practice in at the hospital. I do a morning in ‘sick kids’ clinic where we have a drop-in clinic for parents to bring in their children without appointments if they are worried about something that’s happened overnight, or if they need an assessment to see if they can go to school that day.
“We have a good mix of chronic disease management and acute stuff, and I see a lot of women’s health and fertility and ante-natal patients because of my post-graduate training in obstetrics and gynaecology.
“In its essence, rural medicine is challenging because there is the tyranny of distance as well as that feeling of isolation, both professionally and personally; then you add in the complex disease processes that happen in some of our indigenous population and the non-indigenous population, and that just makes medicine that much more complex out here.
“But you have specialists on the other end of the phone, so you have lots of resources to tap into.
“They really try to understand and make things work for you so your patients don’t face a three-and-a-half hour flight each way, that only flies a couple of days a week, for just a single clinic appointment. They try to make it work, which is nice.
“You do try to do as much for your patients as possible, but if they if they really need to have specialist treatment you send them.
“However, with advances in tele health and tele medicine, increasingly, your patients don’t need to go down to Perth for their dermatologist review, or they can have their follow up cancer care co-ordinated by you as the GP under the guidance of the specialist without them being in the same room, or very rarely in the same room as the specialist.
“It means that GPs, and rural GPs particularly, are playing an increasingly important role in all aspects of patient care, and I think that’s exciting in the way all of that is happening.