Dr Lachlan McIver — The island-hopping GP

No such thing as a typical day

There’s no such thing as a typical “Day in the Life of Dr McIver” on Thursday Island, he says, but these are the events of a recent day that illustrate the diversity he encounters.

He was rostered on emergency for the day. It was a busy morning with sick kids, some orthopaedic patients and a hip fracture to sort out, plus a patient with a stomach abscess that had turned septic had to be flown by the Royal Flying Doctor Service (RFDS) to Cairns for emergency surgery.

Then a woman came in with a complete heart block – her pulse was 30.

“I had to try and increase her heart rate with various mechanical means, then I called the RFDS plane and said, ‘Stop! Don’t go anywhere – we’ve got another patient for you!’. She had to go to Cairns urgently for a pacemaker insertion,” Lachie says.

However, the RFDS plane was a nurse-only flight, so he flew down with the two critically ill patients and had them admitted at Cairns Hospital just after 5pm.

“I guess that’s not really a typical day, but it’s one where I’ve got to the end and thought, yes, this is why I do this job. I’ve since seen both patients … they’re back here and doing just fine.”

In his current position, there’s a lot of overlap between clinical and hospital work, and with the position’s salary funded by the State health system, that’s not difficult to manage. Other rural positions often involve employment by indigenous community-controlled health organisations. The work is hard and the hours are long – more like that of a hospital registrar than a GP registrar – and he admits that most doctors are proceduralists, on-call for emergencies and for other skills – usually anaesthetics or obstetrics.

“It’s not everyone’s cup of tea, but for those of us that do it, we think it’s the country’s best kept secret. We live in paradise and work with some very interesting communities that have health problems shared more by developing world communities than by other Australians. We have a wonderful lifestyle where we live in the islands, muck around in boats and go water skiing and fishing and camping on the weekends. It’s great.”

Rural generalist — the perfect combination

For Lachie, training as a rural generalist with the Australian College of Rural and Remote Medicine ticked all the boxes. “I could combine all the things that I was interested in – emergency medicine, public health, indigenous health, chronic disease management and tropical medicine in the one vocation, with the outcome being registration as a GP.”

“As a rural generalist, I don’t do much in the way of the office-based or business side of general practice – there’s a lot more emergency, ward work and either anaesthetics, obstetrics or surgery than most GPs. Nevertheless, a significant part of our training is still chronic disease management and primary health care.”