Well, just got back from the excellent GP Anaesthetists conference held in Sydney under the auspices of the NSW Rural Doctors Network. Apparently it's an event they hold every other year (alternating with an obstetric workshop) and manage to do each workshop twice in each year - delivering quality education to approx 80 of the 150 or so rural GP proceduralists in NSW. It's an extensive event that would go down well back in South Australia...although I reckon we'll have to get Dr Minh Le Cong and Dr Casey Parker along to emphasise the 'rural connection'.
What makes this event stand out was a day spent in the simulation lab at the Royal North Shore Hospital, with hands on quality simulation training in a variety of anaesthesia-relevant emergencies, then a conference dinner and the next day spent with a variety of speakers pitching content to the rural audience.
It was good for me to meet with other rural doctors, mostly from NSW and a few from Victoria. Interestingly, once they knew I was from Kangaroo Island, all were interested in the events of 2009 and our stoush with Country Health SA and the ACCC debacle (details of which I really should blog one day, as I should about upcoming contract negotiations with Rural Doctors in South Australia).
What I found interesting was that many of us rural doctors have the same problems - such as ongoing skills maintenance, lack of funding for nurse training and essential equipment, ongoing threats of hospitals being downsized and procedural services cut, remuneration for on call hospital work, as well as poor relationships with health bureaucrats. Most worryingly, many said that they were having to find own solutions to these shared problems, rather than a 'top down' approach. Basically, we're all operating in our little silos, rather than solving problems and lobbying for changes en masse.
It was particularly illuminating to hear some of the speakers (mostly metro-based anaesthetists) talk about difficult scenarios and resources to cope. In a few instances the speakers seemed aghast that many of the rural GP anaesthetists did not have access to equipment that their metro counterparts considered essential - things like suggamadex, desflurane, remifentanil, FFP, fibre optic intubation, modern anaesthetic 'workstations' etc. Sure, some of the rural docs had some of this stuff. But by no means all, in fact more like fingers of one hand. Out of 40 doctors.
Why? Cost, as always I am afraid. But that's OK. I think the key to being a good rural doctor is to "adapt-improvise-overcome". Luckily we stand on the shoulders of giants and most of the hard work is already done - providing we are well-trained, and equipment is well-maintained, it's perfectly possible to deliver a safe service using tried-and-tested agents.
So...anyone still using nitrous? I've been told that 'no ANZCA trainee uses nitrous' yet it's been around for ages and remains on the anaesthetic machines in most places.