General practice in the outback

The Queensland outback has been a place to grow for Dr Rachael Yin Foo, a dual RACGP-ACRRM registrar. As Winton’s only permanent doctor, Dr Yin Foo divides her time between general practice and her role as provisional Senior Medical Officer, running the local hospital.

"I love my job. I love the variety that I get mixing both general practice and on-call emergency hospital care for patients. I see it as a continuum of chronic or general screening health care for patients through to emergency presentations and hospital care, and then returning to the community. You just get to see absolutely everyone and have connections.

Having had my advanced skills training in emergency, it’s good to be able to walk into most situations and be able to manage it, to at least to stabilise things before we can arrange further treatment.

Playing a part in everyone's lives is probably what I see is the biggest difference between city and remote general practice. It's the holistic care of a person, not just a patient. You get to see the whole picture. You see not just a condition or a presentation, but the effects of isolation, medication restrictions or resource availability, and you get to make decisions that help manage all of those situations. You also get the benefit of seeing them in general practice in a non-emergency sense and then also managing them in an emergency, and then also the follow-up. That's sometimes what's missing, particularly in tertiary care – you just don't get to follow up these patients or see the effects that flow on to the families and the community. In remote areas that's your day-to-day life and work. There's always a connection to the town.

I took on the dual pathway because I wanted to prove to myself that I could do it. RACGP had a GP focus and ACRRM has a strong rural and remote training pathway, so I wanted to combine both. I want to be a medical educator and be able to provide the registrars who come through with the experience of a person who's been through both pathways. Remote supervision has taught me to be a lot more independent, quite early, and to feel confident calling consultants for advice and building my own networks with the specialists. It's definitely challenging with an on-call roster that is quite heavy. But out of that comes the joy of knowing that you will be able to help people you know, as a remote doctor.

This past year, particularly with COVID, has been an interesting time for me as a GP registrar and helping to run a hospital. It's been quite a learning experience to plan for testing, containment, managing the isolation and the acute presentations that require hospitalisation, and ensuring you provide the best of care in the most comprehensive way.

You become an access point to the community to getting information and getting it explained in the way that they can understand. So it's been a challenge as well as a positive in learning how to plan to manage a pandemic, and the impacts that can have beyond just health care, the effects it can have on to a small community that relies on tourism.  The increased access to telehealth and more people knowing that that's a possibility has been very helpful in not just COVID, but in general healthcare as well.

It's lovely to be known in a town, and to walk around and people know your names. I'm gradually learning everyone's names and everyone's family connections. It's just nice to have smiling faces say hello to you down the street and have an interest in you, because you are here doing a critical job. I really do love the town, the people, the location. There's a beauty to our isolation. There's a beauty to the flat, red dirt. They're just a very welcoming community and so feeling like I was a part of a community as soon as I arrived was wonderful. You can truly feel that you make a difference."