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Posts Tagged ‘New Zealand’

A World Apart

It’s hard to believe that I have been practicing medicine in New Zealand for 7 months. The time has flown by.

 

There are so many differences between the medical system where I’m practicing in rural New Zealand and where I trained in America. In medical school I predominantly trained in inner-city hospitals, and in residency I largely worked in urban hospitals and clinics. I had occasional electives in rural settings, but the majority of my time in medical school and residency was spent in or near major medical centers. The clinic where I work in New Zealand is rural, but we’re also only 45 minutes from a major hospital in case of emergency. There are also 24-hour surgeries (which would be considered Urgent Care in the US) that will see our patients in town on nights and weekends. This means that my colleagues and I don’t have any night or weekend call, which is fantastic for having a life outside of work.

 

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Rural General Practitioners are not limited to one species…

 

I work in New Zealand as a GP- a “General Practitioner”. GPs are the entry-way into the medical system in New Zealand. Pregnant women can directly go to midwives, and patients can see physiotherapists without referral, but if you need non-urgent medical care in New Zealand you go to the GP who will refer you on to a specialist as needed. Being in a rural, farming, community I see some different medical issues than I did back home. In my first month of practice I joked that I could easily compile a book on 101-ways to be hurt by a cow (or a sheep for that matter), but while there are a few illnesses that people get in New Zealand that I never heard about in training (take Orf for example) the human body is remarkably consistent around the globe. Practicing medicine on this side of the world is the same as practicing anywhere else, just in a different medical system with slightly different practices and medications.

 

In America, healthcare is largely a for-profit industry that relies on individuals having insurance. In contrast, New Zealand has a robust public health care system funded largely by taxation. While some of my patients have private insurance, it is a luxury, not a necessity as it is in the United States. I have been blown away by the effectiveness and efficiency of the healthcare system here- when I have a patient that needs acute medical admission, I call the medical registrar (essentially a senior resident) who agrees to evaluate my patient in the acute assessment unit in the hospital and works-up, treats, and/or admits my patient to the hospital as appropriate. If I have an unwell child that I’m not comfortable managing in the community, I call pediatrics. If I’m not sure which specialty will admit the patient, and the patient needs further workup before that decision is made, patients will be evaluated in the emergency department. But we’re often able to bypass the emergency department, saving everyone’s time and money.

 

If you need non-urgent specialist care in New Zealand, and you don’t have private insurance, you will have a bit of a wait. When I ask a specialist to see a patient I give then triage information, and they may have to wait 4 months to see a specialist. But urgent matters get urgent care, and as a GP I can always call a specialist and ask for recommendations while my patient is waiting for formal specialist review.

 

One of my favorite aspects of the public medical system in New Zealand is Pharmac- the Pharmaceutical Management Agency- the government agency that buys and supplies pharmaceuticals for the New Zealand healthcare system. In brief: Pharmac negotiates and bulk-buys product and supplies all the pharmacists in New Zealand. If a medication can be prescribed by a GP and is a subsidized medication (something that Pharmac buys), patients can get a 3-month supply for $5. They can get a 3-month supply of a blood pressure medication for $5. They can get a 3-month supply of insulin, or a 3-month supply of a necessary inhaler, each for $5. On average, Americans who need insulin spend hundreds of dollars per month on insulin, and I had patients in this category. in New Zealand they pay $5 for 3 months (or maybe $10 if they have 2 types of insulin). I recently started one of my patients on Spiriva- an inhaled medication used for COPD (Chronic Obstructive Pulmonary Disorder). This is an expensive medication, but a General Practitioner can prescribe if they apply for a special authority number. In order to get this special authority I open up a tab on the electronic medical record, confirm that my patient has COPD, confirm that her pulmonary function warrants this treatment, confirm that her symptoms are not controlled on her other medications (and that she’s on other medications) and hit “submit”. In under 10 seconds I can now prescribe this medication for the patient. In the US getting “prior authorization” for specific drugs through insurance companies can take weeks…

 

On the other hand, routine drug prescriptions in the US can be for a year, potentially saving three visits to the clinic every year…

 

I could write about how much I love Pharmac for hours. I’ll admit there are some shortcomings, and in America there are a myriad reasons we can’t and won’t have a system like Pharmac, but I love being able to give a patient a prescription and know they can get a medication for 3 months for $5, and not having to worry if the patient’s insurance will cover a medication for a small copay, not cover the medication at all, or require pages of paperwork from my office to get the medication approved. Of course Kiwis pay for this in their taxes, but New Zealanders see this as a no-brainer…

 

Outside of medicine, life in New Zealand is grand. In the last 7 months I’ve read more books than in the last 3 years. I’ve racked up many Ks on my mountain bike, explored a lot of the south island, and made many new friends.  New Zealand is a great place to work and play, so it’s no suprise that I love it here!

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About 24 hours into the Old Ghost Road… You can see the trail climbing and traversing the mountain to my right. 

Till next time!

 

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Bell Birds Sing,

Are you listening?

Tuis ring,

Did you miss them?

The Sandflies may bite,

But the evenings are light,

Walking in a Kiwi Wonderland.

 

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Cathedral Gully on Christmas Day.

 

Merry Christmas!

 

The last three years in Utah we’ve had snowy Christmases (and they’ve had another this year!). Christmas in New Zealand this year was sunny and hot. With Jamie and Anastasia of AHSNZ I just spent a couple days in Kaikoura, a beautiful coastal town north of Christchurch. Kaikoura (Maori translation ‘Meal of Crayfish’), was struck by an Earthquake just over a year ago, and the main road that connects Kaikoura to Christchurch was only recently reopened.

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“Meal of Crayfish”

Kaikoura is a gem, with activities including scuba diving, fishing, whale watching flights and cruises, and opportunities to swim with dolphins or explore the coast on foot. We spent a great couple days camping, tramping (that’s hiking to many of your), kayaking, and wildlife spotting.

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Kayaking to visit one of the Seal colonies.

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Wildlife spotting: a Shag in the foreground and a Fur Seal in the background. Not pictured: the huge pod of Hector Dolphins we saw on our drive out of town.

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Tramping in the bush.

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The seabed rose up with the recent earthquake

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Exploring the raised seabed

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Not exactly roughing it- a delicious camp breakfast!

 

It’s not wintery, but New Zealand certainly is a wonderland…

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The beach at our campsite: a nice place for an evening drip after a hot day!

 

I’m not the first to rethink this Christmas classic. This Air New Zealand take is ‘Sweet As’.

 

 

I hope you all find some joy and fulfillment this holiday season, whatever season it is where you life!

 

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Post-Residency Update

5 months ago I finished my residency training in Family Medicine at the University of Utah in Salt Lake City. During my three years of residency training I posted to this blog three times- mea culpa! There definitely wasn’t a lack of things to write about in residency- and I regret not jotting down notes of stories to recount or emotions to unpack- but sadly my urge to write during residency faltered and was replaced with an urge to… survive.

 

Residency is hard. It’s wonderful, amazing, at times exhilarating and at times demoralizing, and it is definitely hard. There’s a reason people have written books (fact and fiction) about residency, and sadly there are also reasons why there is a deluge of mental health problems in residents [1-2]… I hope I’ll get back to writing about some of my experiences soon, but only time will tell!

 

In the 5 months since finishing residency I’ve done a lot! Historically, residency ends June 30th (or more precisely STARTS July 1st, so you finish X years later), and a few days into July I was winging off to Japan with my boyfriend to explore Japan. The motivation to visit Japan was the promise of a bike tour around Hokkaido, the northernmost island in Japan. For over a decade my brother has taken time every summer to tour Hokkaido by bike, and thanks to various academic obligations I’ve never been able to join him – until this year.

 

I’ll try and flesh out this adventure at some point in the future, but to cut a long story short, we biked and ate our way around 900km of Hokkaido in 10 days. It was exhausting (and as expected somewhat uncomfortable at times), but it was a wonderful adventure. We visited a historic soba house, took a tram up a mountain, visited a lavender farm, tasted expensive (and delicious) melons, feasted on delicious food, and ate more ice-cream than is probably reasonable…

 

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My trusty steed for our 900K adventure.

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Part way through a 76K day along the northern coast of Hokkaido.

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Quite a bit of our cycling was on nice bike paths.

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Stunning flower farm in Bie.

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One of our many traditional dinners.

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One of many not-traditional icecreams. Lavender flavored at the Lavender farm, of course!

 

In August I invited myself up to Canada to spend time with my friend and fellow ancestrally-minded MD, Don Wilson. He graciously put me up in Calgary, Vancouver Island, and his home reservation of Bella Bella. Not only did I get to tour Calgary, visit Banff, and see Vancouver Island, but I got to drive up to Port Hardy and take the ferry up to Bella Bella where I got to experience a bit of rez-life and the wonderful hospitality (and traditional foods) of the Heiltsuk people. The experience, and the wildlife, were incredibly memorable.

 

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Don and I enjoyed a great hike up Sulphur Mountain in Banff.

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They were all over in Bella Bella.

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I had the privilege of being invited out salmon fishing with a couple of the locals and helped the pull in hundreds of pounds of Silver, Chum, and Coho Salmon that was eaten, frozen, and smoked. Yum!

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“Old Sam” or “The Watcher”. Whatever you call him, he is striking. The men who took my out fishing also brought me to this island for a visit.

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Great Blue Heron

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A reason not to hike alone… This bear was out with her two cubs.

 

In September I took some time to travel back to New Jersey where I caught up with friends and family. I have loved my 3+ years in Utah, and think there’s a good chance I’ll be back in the Bee Hive State in the future, but New Jersey will always hold a place in my heart and may one day call me home.

 

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Cow and calf at my parents farm.

 

In between all these trips I would head back to Utah, a state which I love to call home. I have never regretted my choice of residency programs: I had wonderful mentors and a great education in a place that allowed me to savor every free moment I had. It’s the place where I learned to love mountain biking, the place where I rediscovered alpine skiing after a 13-year hiatus, the place where I learned that rock-climbing doesn’t play to my strengths but is worth a go anyway. The people are friendly, the academics are excellent, and the wilderness is world class.

 

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Cartwheels over Canyones… Capitol Reef is one of the “Big 5” National Parks in Utah. Definitely worth saving.

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Canyoneering in Arches National Park (Spot the person on rappel!). Another great adventure in another great Utah Park.

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Mountain biking in the Wasatch- one of the new hobbies I took up while a resident is slowly peddling uphill and then speeding down through single track faster than is probably advisable…

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It may just be marketing, but sometimes it certainly seems like Utah has “The Best Snow on Earth”.

 

So where am I now?

 

After a brief stint moonlighting in some Urgent Care clinics in Salt Lake City, I’ve moved onto the next chapter in my life as a GP (General Practitioner) in the South Island of New Zealand, not far from Christchurch. I’ve been interested in practicing medicine in New Zealand since early in residency, having had a great trip here before starting residency and then hearing from a couple of physicians who enjoyed their time as GPs in the New Zealand system. I’ve signed on for a year and will see where the future takes me!

 

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Mt Cook from the Hooker Valley Track.

 

I arrived in New Zealand mid-October and shortly thereafter spoke about Ancestral Health in Academic Medicine at the Ancestral Health Symposium New Zealand in Queenstown. I started practicing at the beginning of November and am just rounding out my first month of practice in New Zealand.  It’s exhilarating, interesting, and at times a little intimidating (as I imagine all new-graduates find their post-residency jobs).

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A bit of lunch-time exploration at AHSNZ

 

So that’s a quick update from me- I hope to get back into a swing of writing about life, medicine, and ancestral health. Watch this space!

 

  1. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015 Dec 8;314(22):2373.
  2. Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC, et al. Causes of Death of Residents in ACGME-Accredited Programs 2000 Through 2014: Implications for the Learning Environment. Acad Med. 2017 Jul;92(7):976–83.

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