A Fortnight in Christchurch

By the end of my second week at Christchurch Hospital I was beginning to feel acclimated to the hospital, the town, and the system. The physical plant is intimidating enough by itself. The main complex consists of seven separate buildings stuck together in a haphazard fashion with no obvious evidence of a higher intelligence at work. They only connect on the ground floor, and the path from one ward to the clinic or cafeteria can be quite a maze. Also, there was no formal approach to my “orientation”. Dr. Lutz Beckert

did his best, but even he wasn’t sure what to do with me. When I was introduced to people, I got the distinct impression that while doctors from other areas had been sent to Christchurch for orientation, it was not routine. It did not seem clear to anyone whether I was there as a colleague or someone who was supposed to either observe or be observed. The overall impression I got was “nice to meet you; I’ve got work to do“. Don’t get me wrong, people were polite enough, but my role was ill-defined, and I sensed it made everyone just a little bit uncomfortable (perhaps I’m over-reading that). It may not have helped me to realize my age was about equal to three of my junior associates combined.

What did I learn that will help me with my work in Timaru? That’s a difficult question to answer because “you don’t know what you don’t know“. However, I was able to observe the social structure of the medical system. It is more complex In Christchurch because they have more levels of doctors. The system is quite hierarchical. There are medical students (who seem to be similar around the world), house physicians (roughly the equivalent of an Intern or junior resident), registrars (approximately senior residents or young doctors-one can hold this position for several years), and attending physicians (my rank). Professors or emeritus positions would be above that. Timaru only has house physicians and attending physicians. When you make rounds on patients, the most senior doctor will talk with the patient and examine them, and the doctor immediately below them in rank will transcribe the events. The system has some interesting consequences. I saw cases where the night-coverage physician described the patient briefly to the registrar, and shortly thereafter the registrar described the patient to the attending physician using recall of the verbal check-out as well as reading from the written notes. The attending will then go in and briefly talked to and examine the patient, and then announce a plan of action. It seems to me that there’s a fair amount of “performance” in these bedside rounds and it encourages one to “shoot from the hip”. Overall, the system seems to work fairly well, especially since some of the time none of the physicians in charge has really done a complete history and physical.
The patients seem quite familiar to me, with the same types of medical problems I’m used to dealing with a daily basis. They also seem to be “salt of the earth” type people, straightforward and down-to-earth, like the folks around Fort Bragg. Some of the medical terms are different, as are some of the “vocal tics” or shortcuts the doctors use. For instance in describing heart sounds, I am used to routinely saying something like “S1 S2 within normal limits”, whereas here they are always described as “dual”. A notation “2/12” or “15/52” is used to mean 2 out of 12 months or 15 weeks in the last year. I believe it is meant to imply the most recent period of time consecutively, i.e. the last two months, but I’m not completely sure. With the health system here, they do try to get the patient in and out of the hospital as efficiently as possible, but I am a very used to that from my work at MCDH especially with the critical access designation. In fact even a hospital the size of Christchurch seems to have skeleton services available over the weekend, so if you’re not discharged by Friday you will be in until Monday at least. Senior physicians such as myself seem to have to do much less documentation that I’m used to. The admitting and discharge notes are done by the house officer, as are the daily progress notes. I believe I will be expected to enter notes primarily for consultations in the hospital and clinic. Like in the states, coordinating care with the primary care doctor is an important part of the job, and a place where it is easy to drop the ball.
Doctors and students are here from all over the world; any place you can imagine in the old British Empire and Europe and throughout Asia, in particular China. Most people talk rapidly, and I am impressed how the medical personnel and the patients seem to have no trouble with the various accents, which are at times quite thick. Almost all of the doctors here have trained and/or worked outside of the country, although not too many in the United States. Many people both foreign and domestic have decided to live and work here in large part because of lifestyle choices. In particular, parents have chosen to raise their families in the environment that appears simpler, safer, and perhaps with a better educational system. The doctors I’ve met have been bright and well-trained. They seem to value and possess a good sense of humor, and have interests outside of the hospital. For example, Dr. Beckert missed one 8 AM session of lung cancer rounds because his son’s school was having an ethnic heritage day, and he spent the morning preparing the tray of sausage, cheese, and German bread in the shape of the German flag. (I wish I had a photo of that). People are very interested in the outdoors here, and pretty much everyone seems to “tramp” (hike) regularly and many bicycle to work. One nice thing about the hospitals in Christchurch and in Timaru is that both abut Botanical Gardens; many rooms in the hospital have lovely views, and the patients are encouraged to get outside when possible to enjoy the flora and fauna.

Overall, I think it’s been a useful two weeks here, a time to allow me to see a different way of doing things. I also met physicians with whom I will be dealing on a consultative or referral basis, and have a better idea of how the system handles things like strokes, MRI’s, cancer screening, and sleep disorders. We were also made to feel very welcome by Michelle Dhanak and her family.

She is the ex-patriot East Bay physician now working as an elder care physician at The Princess Margaret Hospital, a rehab hospital here in Christchurch, as I mentioned in a previous post. I was fortunate enough to run into her a few times this week at educational rounds. And we had two lovely meals with David and Susan Cohen (also previously mentioned in a post), including a wonderful meal at their house Thursday night. David has become quite the oenophile, we had some wonderful wine to accompany fine food and conversation. Thank you David and Susan, and to Paula for putting us in touch with them.

Fayne and I also had time to enjoy more of Christchurch over the last week. The location of our apartment could not have been better, rightl in the center of what is considered the Cultural Precinct. We were able to visit some of the less obvious sites. There is a small but creative dyslexia discovery exhibit.(http://www.cmct.org.nz/dde/exhibit.html)

The COCA (Centre Of Contemporary Art) had some provocative exhibits, we saw more films, and a very entertaining play entitled “Glorious”. It is contemporary play, but written in the style of the screwball comedies of the 1930s, quite witty and fast-paced and well-performed. On Friday night we capped off our visit to Christchurch with an excellent dinner and nighttime tour at Willowbank Wildlife Reserve on the outskirts of town. we got to see several natives New Zealand creatures, including a swarm of freshwater eels

(which can grow to be over 3 m long), the kea mountain parrot, the kereru pigeon, an ugly kunekune pig, and the highlight: the brown kiwis. Unfortunately for my blog fans the kiwi is a nocturnal animal and we were not allowed to use flash photography as it could frighten the animal and damage his eyesight. If you can see a bird in this photograph, your eyesight is better than mine.