Auckland Pediatric Surgery Journal

Transcription

1 Auckland Pediatric Surgery Journal Journal 2/9/2017: I ve been at the hospital for over a week now and continue to be surprised by the familiarity of it all. The day to day workings of the hospital are remarkably similar to my experiences in the states. I ve remarked on several occasions during conversations with house staff that if I were to have been blindly teleported straight into the hospital, I would probably still think I m in the states, until I heard someone speak at least. The most noticeable difference thus far has to be the calm, laid back nature of all the people, particularly in the operating rooms, known here as theatres. In the states there have been numerous occasions where there was yelling, cursing, and/or some degree of ridiculing. Though I ve never personally been bothered by such instances, it does tense up everyone in the room and leads to a stressful working environment for the future. Here, they actively campaign against any and all forms of a harsh hospital environment. I have seen no instances of the pimping widely present in American hospitals. Though I personally find pimping to be helpful, I certainly understand the negative impact it can have on one s emotional state, even when done with a welcoming and warm tone. 2/23/2017: I ve heard the term undergraduate medical student, but didn t really understand it until now. The difference in the format of medical training is interesting. Medical school is quite literally an undergraduate degree one pursues directly after high school. An application to the medical school within university is typically done after one year of undergraduate basic coursework, but if accepted that year counts towards the medical degree. Essentially, it is a six year degree (three pre-clinical, three clinical) that focuses only on medicine and its related topics. These six years are followed by at least a couple years of house officer training, which is essentially an extended internship in medicine involving a rotation on all the various wards. Once decided upon a field, a house officer applies to become a registrar in their chosen field, medicine or surgery, with the option of pursuing fellowship afterwards. In

2 the end, it amounts to hitting the same landmarks around the same points in life. After 6 years of undergraduate medical education and two years of house officering, one has completed the same years of training as most US medical students, yet with much more focus on only studying medicine and with more years of clinical experience. The effects of this are evident in the workload difference. A student I m working with doing his surgery clerkship is expected in the hospital from 7:30 am to 4:00 pm Monday through Friday. With the occasional weekend working in the emergency department. Hard work is definitely appreciated here, but overworking appears to be frowned upon. The quality of life for physicians and physicians in training, appears to be much better compared to the states, and patients don t seem to expect inhuman hours from their providers. They tend to not be concerned with having to stay an extra day or night, I presume to be due to not having to pick up the bill at the end of their visit. Cultural Reflections It was my second or third morning during morning report that it happened for the first time, one of the residents sneezed. My instinct was to immediately say bless you, but I held my tongue having a shy nature and being around new faces. After a few seconds I began to wonder if I imagined her sneeze as everyone else seemed to have just ignored the event completely. My hallucination concerns faded after seeing a third person sneeze, but this time she acknowledged it with a simple excuse me ; there was still no bless you was to be heard. I knew this tradition had pagan origins and it made me wonder if people in New Zealand weren t religious or at least didn t have Christian founding during their settlement, though I generally assume most places I visit are less Christian than where I m from in the Bible Belt of the United States. About halfway through my rotation, I made an unfortunate mistake of half sitting, half leaning on a counter. I see and do this not uncommonly in the states and never would have thought it would offend someone. Once I was informed of the rudeness of my actions and how locals see it no differently

3 than sitting on their kitchen table, I was surprised, but understand where it was coming from and quickly apologized. Both of these experiences caught me off guard. After spending a total of 6 weeks in New Zealand, I felt rather comfortable interacting with locals and assimilating to their slang and culture. Those two experiences though, still make me wonder what other subtle, small differences exist between two cultures who have so much in common and so much interaction. While I was there I learned that American politics are a hotter topic of discussion than New Zealand politics, and that was according to my multiple AirBnB hosts. It s interesting to me that despite all of the connections to one another, there remains many defined differences between the two cultures. Clinical Reflections and Future Impact The most profound difference I experienced during my rotation was the operating room (or theatre) atmosphere. I have heard of stories of classmates of mine nearly being brought to tears due to demeaning comments made by surgeons during a case. I have also personally experienced a surgeon being condescending to me and yelling at other staff members if they make a mistake. None of this ever seems to be an issue in New Zealand though. There are active campaigns to prevent bullying with signs and reminders posted all over the surgical floor. There was one instance in particular where a scrub tech accidentally touched a sterile drape with a non-sterile tool. I saw it happen and almost froze in anticipation of someone loudly calling her out on it, but, to my surprise, the surgeon calmly shrugged and just simply said, Alright, let s get a new drape in here like he was planning on asking for a new drape anyways. No one (but me) got tense when it happened, no one yelled, no one seemed worried or bothered at all that they had to spend an extra few minutes re-prepping and re-draping. It was obvious that this anti-bullying mentality made for a much less stressful environment that is better for everyone. And it is this mentality that I want to always keep in mind once I become an attending who sets the tone for the room.

4 Topic of Interest and Interview The government run, socialist healthcare system in New Zealand works quite well according to Dr. Neil Price, a pediatric surgeon at Starship Children s Hospital. It is difficult to argue against this perspective when compared to the United States, New Zealand has better outcomes, yet manages to spend less than half as much per capita on healthcare. This is likely due to a number of reasons. Of particular interest is the government control on medication use and operation availability. The Ministry of Health determines which medications are the most effective and affordable and will only subsidize certain ones. This leads to a tremendous lack of over-prescribing medications, particularly antibiotics. Many operations are limited in their availability due to quotas placed on each hospital on the number of certain operations that can be performed each year. This lends to waiting lists being developed and allocating open spots to those with the most need for an operation. Some patients have frustrations with this process and opt to purchase private insurance which can cover some of these medications and procedures, but not everyone can afford private insurance. From a physician standpoint, Dr. Price is rather happy with work and quality of life. He cites having greater flexibility in his scope of practice, being able to perform whichever procedures he is comfortable with and are needed. There has never been a time where Dr. Price felt he needed to perform an operation or procedure or needed to get a medication for a patient, but was unable to. He strongly believes in the New Zealand system, citing how often new medications and equipment come at significantly increased expense, with often unproven benefits and/or unclear risks. In addition, he feels fairly compensated and enjoys being on a salary rather than being part of a fee for service system. Similar to the US, there are some long hours involved and physicians can be known to be married to the job or end up experiencing burn out. Physicians that work at public hospitals are part of a union which works to improve physician satisfaction and is currently combating this burnout issue.

5 General thoughts on system? Quality? works well, bulk pay but underfunded, better than fee for service thinks performance based may help very high, SES factors are a challenge, more stable Restrictions on level of care provided? new meds harder to get, never issues with operations less flexibility with practice certification/freedom to practice is better Training/schooling? less academic/research, more clinical. research opportunities exist and are high quality but there are few What does work entail? less emphasis on administration, but opportunity exists, protected time for duties enjoys day to day Stress/hours/holiday burn out? 6 wks leave/year little overworked hard to make business case some increased levels of family stress/divorce some, union work see booklet compassion, empathy fatigue fairly compensated? yes compared to public, less so relative to other physicians (private practice) Public vs private? Lawsuits? all patients covered by public, but if have money can go to private private insurance excludes congenital diseases, but private hospitals will do robotic surgeries, cosmetic procedures, varicose veins, elective operations (lap chole, joint replacement, etc.)

6 disability care focused on rehabilitation provides for injured/diabled no personal injury suits neil price copy of paper when done: