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13 Feb 2018

BY DR SANDRA HIROWATARI, CHAIR, COUNCIL OF RURAL DOCTORS

Hey doc, you look tired.

As I get older and more wrinkly, this comment seems to be a more frequent bugbear.

But you know, no matter how tired, it isn’t pleasant to be given that feedback – a mirror that states the haggard obvious.

But on the other hand, it touches me that the doctor-patient relationship has flipped a bit where my patient looks at me as someone that needs care.  For a moment, they care enough to see tiredness on my face.

Let’s unpack this tiredness.

Rural doctors on average work longer than their urban counterparts. This means less leisure time, less sleep time and less family time.

Forty per cent of rural doctors are international medical graduates (IMGs – overseas trained), like me, a duck out of water.  The tiredness for us is the added task of “fitting in”.  Generally, our nuclear family lives overseas.  Australian-based friends have yet to be fostered.

Rural doctors in general do more.  This means more to learn, more procedures to become comfortable with, more tasks that simultaneously need to be done with our octopus arms. 

Our urban colleagues have a wealth of alternatives to distract, entertain, and rejuvenate themselves.  Recently while in Brisbane, I was amazed at the choices of fitness clubs, cinemas, swimming pools, yoga studios, theatre, bike paths.  We don’t have these energising resources.

Rural doctors generally have less family and friend support.  Those luxurious relationships are fostered on a Skype call (if we have internet) or on our rare visits to family over 500 km away.  Tired is one thing. Tired and alone makes you want to cry, to give up.  Especially after a tough event in the clinic or in the ED.

When we plan a holiday, there is a dread of finding a replacement, a locum.  A weekend break is not a break when it takes one day to leave the Outback, one day to return (if the roads are not flooded).  I calculate that it is an investment of over 24 hours to achieve an 18 hour break.  Having said that, I did do that long trip to Broome, a trip of 700 km, killing my first kangaroo, saw a movie at the famous cinema there, then went back on Sunday night.

So, what can be done?  Well, doctor, I needn’t teach you what you counsel your patients daily. In my mind, when we are running on empty the first step is NOT to fill the tank. Why?  Because the cycle continues, the problems are not solved.

Here is a different perspective – an age old sequence reworded that some of you will recognise.

The first step is to recognise tiredness, despair, loneliness, heart break, depression, unrelieved stress as conditions that need to be addressed. Now. Admission of a weakness is the first step to strength. Admit that there is a helplessness to solving this by yourself.

Next find someone to help you, someone you can trust.  Let this someone not be yourself. Get a GP. Meditation, church, prayer and pastors all are another form of support outside of yourself. Doctors’ support programs exist now in all States. In the Outback you have a support that is rare in the cities – the local indigenous Elder, the wise woman or man. Even two States away, I still contact my two “sista-mothers” when I am particularly low.

Then follow the advice given. Let it go, you do not need to be in the driver’s seat always. Talk about it. The advice may be difficult, like “say no, or move on”. Or the comment may be “you cannot meditate this away”. Doctors used to being in control find this step difficult. But remember that you have taken the first step of admitting a need for help.

Hey doc, are you looking tired?  Wishing you health and recovery, we need you.


Published: 13 Feb 2018