Orientation in Wellington, New Zealand I: jellyfish stings, rheumatic fever, and electronic health records.


When it comes to a medical fee,

There’s a co-pay, there’s nothing for free.

     The discomfort that lingers

     From jelly fish stingers

Is cured with hot water or pee.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, we’re in New Zealand, getting ready to go to work.

New Zealand knows its capitol city as “Windy Wellington.”  Bethany and I haven’t been able to sleep in because our bodies haven’t accommodated to the time difference yet, and we went out before dawn, in the cloudy, breezy early morning, looking for a hot breakfast place, then went to the offices of NZLocums for orientation.

The first speaker, an erudite General Practitioner with a long and distinguished career talked to us, doctors from Holland, Singapore, Oregon, and Iowa, physician to physician, about what it means to be a GP in New Zealand.    The country has twenty-one health care areas, and each one has a Community Management Board, which has a budget and sets priorities.    About 30% of the population has health insurance, and the private sector does well here.  The public sector supplies the rest, and patients have a significant co-pay at time of service.  The Community Management Board keeps pharmacy costs down by maintaining formulary control.  Most prescriptions are filled for 90 days unless they’re addictive or the practitioner puts in a limit.  Watch out for drug seekers, he warned us.  Many of them will try to get a prescription for pseudoephedrine, the key ingredient for making crystal meth. 

I regret my lack of surprise at hearing that the white plague of crank has reach here.  I have never recommended pseudoephedrine.  In the US, it remains a non-prescription item, though some states keep it “behind the counter” and limit the amount that one person can buy.  If you fear for your safety from a drug seeker, he said, prescribe a small number and notify the police. 

The average New Zealander with medical coverage sees the doctor 6.6 times per year, the average visit runs 15 minutes, and 20% of the visits consist of filling out forms.  New Zealand has a no-fault law that covers injuries from all accidents, including “therapeutic misadventure,” which would be called medical malpractice in the US.  For unknown reasons, this country has a disproportionately high rate of asthma and asthma death.  Common problems here include red tide shell-fish poisoning, a neurotoxin without antidote.  Jelly fish stings deserve treatment with warm water, with urine as a good substitute.  The red back spider, an accidental import from Australia, has a poisonous bite for which treatment exists.  The Maori’s genetic predisposition to rheumatic fever sways the treatment algorithm for sore throat towards presumptive penicillin prescription.  An epidemic of meningococcal disease is starting to abate.

When he finished speaking I could tell much remained to be said, and I could have listened to him for days.

The recruiter walked us, like a tour guide with tourists, to the bank.  We all set up accounts so that we could receive payment via direct deposit and for the first time I considered the problem of getting my hard-earned money back into the country. 

We lunched on curry with the doctor from Holland; I talked about the tradeoffs faced by working people with families.  His father, like mine, was a physician.

After lunch we spent three hours in front of computers learning to use the most common electronic health record system in the country.  New Zealand embraced the Information Age early, and a few years ago attained the world’s highest number of laptops per household.  Sunshine came in bright through the blinds, and wind gusts rattled windows as the afternoon wore on.  The system has a reasonable learning curve, and I finished with confidence.

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2 Responses to “Orientation in Wellington, New Zealand I: jellyfish stings, rheumatic fever, and electronic health records.”

  1. Pale Says:

    I am enjoying following your adventures in LTland. I should have said so before now. I could, as you say of your NZ GP, “listen to you for days.” I am looking forward to hearing more about New Zealand.

    Cheers.

  2. Rheumatic fevert | AltaVersion Says:

    […] Orientation in Wellington, New Zealand I: jellyfish stings … […]

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