Note: This is the third installment in a seven-part series Brian Doyle prepared to help colleagues make the most of an emergency medicine rotation Down Under.
Part III:
Relaxed Working Environment
Australians do not define themselves by their work. In general they do not look up to or emulate the worker who puts in a lot of extra time or hours. They think of this person as a bit misguided. This is not to say that the Australians don’t have a pretty good work ethic, rather they have what I perceive to be a better understanding of the priorities in life. It is understood that one should have a life outside of the Emergency Department.
The “sickie” should be a question on the exam to become an Australian Citizen. Australians think of sick-days as a “right” rather than some extreme notion that we have in the USA. If an Australian has a bad cold, he or she will call in sick. This is expected. If you show up to work with a bad cold, they wonder what the hell you are doing going to work. I have told many an Australian about American doctors walking around with their own IV pole to keep hydrated during an illness… and they think we are nuts. Perhaps we are!??! However, there are times that sick days are abused a bit, but many supervisors do not cry foul since they are as likely to be as guilty at times.. While I was working at a moderate size ED in Victoria, we once had five nurses call in sick the day after “Ken’s famous cocktail party.” But this is an exception. Most “casual sickies” would not be expected to inconvenience the other staff that has to work.
More on relaxed working environment…
You will notice the pace to be a lot more relaxed compared to the typical American ED. Doctors are expected to be able to leave the department for a quick bite to eat and to use the bathroom when needed. I generally see just less than two patients an hour (depending on the acuity). You will notice that the ED seems to have more doctor coverage than what you would see in the USA. There is definitely less running around than you are probably accustomed to… enjoy it… But obviously step up the pace when things get busy or if you have multiple sick patients. You will need to be careful in the beginning about seeing “too many” patients while the junior doctors sit back and watch you run around. You will be supervising the junior doctors and may need to very politely ask if they were going to see the next patient, etc. Don’t be surprised when the other doctors take a lunch break and return 20 or 30 minutes later… but 30 minutes is a bit long. I usually leave for 10 minutes maximum, but this is me…
There are only 38 Emergency Nurse Practioners in the whole of Australia… They seem to be about 20 years behind the US on this one… As far as I am aware, there are no Physician Assistants. Osteopathic doctors are not really recognized as traditional medical practioners (like the USA) in Australia. They seem to operate more like chiropractors down here.
Documentation
Hand-written and short! You are not billing based on your documentation in Australia. There are no templated or dictated charts either… thought to be too expensive. Therefore, the documentation is probably what existed in the USA 20 years ago. Notes are very short, problem focused (don’t have to worry about 15 aspects of the review of systems etc…) Put enough to convey the encounter to maximize communication and patient care. Forget all of the silly things that we do for billing in the USA. Are you relieved?!?!
