Jared Watts, like so many others now working in rural and remote medicine, has experienced the Rural Clinical School and its benefits from both sides – firstly, as a student, and now as a specialist Obstetrician Gynaecologist working in Broome and helping to mentor the class of 2016.
“The reason I am back here these days is because I get to work as a colleague with those who taught me,” he says.
“I think country doctors in general definitely have teaching and the patient’s interest at heart, so they want to train the next generation. Therefore, they are willing to teach and actually get you involved.
“And that’s the thing that makes RCS – you actually become part of the patient’s team, you are not just the 14th person at the end of a ward round. You get to see the patient sometimes first off in the Emergency Department, sit down and speak with them, and then work with the doctors.
“Quite often it is a ‘one on one’ learning experience with the doctor you work with; you learn so quickly because you are part of the patient’s treatment.
“And, you know, they would give you a phone call at like 2am and say, ‘look, there’s something really interesting, come in now.’ There are not the big egos and everything like that; I think most country doctors are there to make a difference, and so teaching is where they can perhaps make a difference for the next generation of patients.
“When I returned to the city I could definitely see from our year in the country that we were not behind our peers who had stayed in Perth; far from it.”
Jared’s initial disposition was towards becoming a rural GP, but in the process of broadening his skills in obstetrics and gynaecology, he was persuaded to take on the discipline as a specialty.
And that, too, was a turnaround from the young med student who when asked ‘what do you want to do’, always responded with ‘anything but obstetrics, gynae or geriatrics’. But the more he learned, the more he got the ‘rush’.
“There’s a lot of adrenalin in obstetrics and 98 percent of the time it is a very happy specialty; and then there’s the gynaecology and lots of gadgetry – gynaecology sort of invented laparoscopic surgery and have been leaders in the field. We are often operating on women who do not want a large scar, so we have a lot of laparoscopic gadgets and up-to-date minimally invasive surgical instruments.
The attraction, though, also set a path of several more years training in the specialty and PGPPP in the city and remote areas of Western Australia, the Northern Territory and overseas before Jared eventually returned to Broome in February 2016 … 12 years after he had done his RCS there.
“Some of the challenges are also some of the attractions – as the obstetrician gynaecologist, I am often here on my own and when things go wrong, they can go wrong quickly. But I can always be sure that other doctors will be available and more than willing to come and help. The team work is incredible and people are willing to step out of their comfort zone and their routine job to help each other out.
“Another challenge is the amount of pathology. Some of the conditions you see up here you don’t see outside of the Kimberley.
“People don’t realise that we still have conditions such as Hanson’s disease and rheumatic fever here; we still have massive issues with alcohol in pregnancy which is quite challenging because you can’t simply fix a lot of the social aspects of our patients’ lives and we need to change this as a society. It can be quite challenging and frustrating, just trying to change the patient’s home life.”
As is common for most rural and remote doctors, whether in general practice or specialisation, the days are never the same – and for Jared, that’s what he enjoys.
“Normally I meet with the DMO and Registrar to get a bit of an over-arching view about what is happening on labour ward. We go through any complicated patients who have come in to determine if anything needs to be done, and come up with a plan for their management.
“Then I would normally have a clinic in the morning, and that can be seeing an infertility patient one minute, someone with ovarian cancer the next, and then two minutes later seeing a pregnant lady.
“In between there are lots of phone calls from the entire Kimberley for advice – that can be accepting patients for Broome, talking to the RFDS and negotiating the safest place to take the patient, or I could be called into video conferences where a pregnant woman has gone into labour in a remote community and I help talk them through the delivery.
“Sometimes in the Emergency Department a gynaecology patient may present and I have to leave clinic to see them, or there may be a complication with an obstetric patient and I am call to theatre or labour ward urgently to assist with that.
“Outside of here, I go to Derby for a week a month where I also have a theatre list, and I fly out to Fitzroy (Crossing) for a day a month.
“The Kimberley has some of the worst obstetric outcomes seen in a developed country, and to be back and to using the skills I first started to learn as a 5th year medical student here in Broome, is actually quite a privilege and honour.”