GPs working closely with Specialists in Primary Care

This year, we started having a visiting General Physician to our medical centre once a fortnight to discuss cases and see patients in the practice. I had always worked closely with this specialist and had a great working relationship with him. 

Since coming to our practice, I have found the time spent with him to be hugely rewarding for me, in terms of upskilling and learning how to manage some of my patients without having to refer them to the hospital for an outpatient appointment. But the biggest benefits are for the patient of course. Because I don’t have to refer the patients to the hospital, they do not have to wait for an outpatient appointment or travel 45 minutes to Wairarapa Hospital. Any initiative that reduces the burden on specialists’ appointments in the hospital is a benefit to the community as a whole. 

I had a patient with severe COPD and lives 45 minutes from the medical centre completely isolated in a rural community. His symptoms were become worse and he complained of worsening fatigue. On examination, I noticed a large, prominent supraclavicular node. A CT scan revealed wide spread nodes throughout his chest and upper abdomen. His Serum ACE is normal and after discussion with the Physician, we have ordered a fine needle aspiration of this node.

All of this has occurred over the past two weeks and we expect to have a diagnosis and treatment soon. With regular and direct access to the Physician, this patient was attended too and didn’t have to wait for an outpatient appointment.

For us to provide timely and effective care to the patient and close to home is the standard with all aspire to achieve.

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In My Blood, by Aruni. A true story.

What does it mean, to me, to support GPs moving to NZ?

My dad was a doctor in Sri Lanka and he moved our family to NZ in the early 70s to get a better life.

Dad escaped political uncertainty and looming civil war in Sri Lanka, worried about his future and the future of his children.  He wanted us to have all the benefits of citizenship and education that NZ has to offer. He knew that we would grow up in a safe, beautiful and peaceful country and we would enjoy total freedom, freedom from corruption, tyranny and oppression. He wanted to have a balanced lifestyle, including time with his kids and his hobbies. He wanted us to attend university in NZ and gain internationally recognized qualifications. He wanted us to travel around the world with ease on a NZ passport. He wanted us to have a family of our own in NZ and that’s why he moved here. He made that brave decision, on my behalf, and I wasn’t even born yet.

My parents, Don and Nirmali, left Sri Lanka with very little, leaving behind a whole lot. They had lots of family and friends and a support system. They had a home, full of possessions and childhood memories. They had elderly parents they worried about and others who relied on them. They left all of that behind in search of a better life and opportunity.

I think about how brave they were to get on a plane for the first time in their lives and travel halfway around the world to arrive in Invercargill, New Zealand. It’s not like they had the internet or could google where they were going too. But they had each other and they had hope.

On arrival, they were welcomed by hospital staff who arranged a home and car for them. Mum says that she wore a sari and quickly realized as she disembarked the plane, down the staircase into the snow, that she would have to change her wardrobe pretty quickly. They spoke about how they were taken to their new home, fully furnished, beds made and a full pantry and fridge.  My dad didn’t work long hours so he had plenty of time to settle the family into their new life. It was with this support and care that they knew everything would be ok.

I often think about their journey, their courage and what they would have been feeling the first few days after they arrived. And that is what I think about when I’m talking to doctors about moving to NZ now. I’m so grateful for the support that my parents had when they moved to NZ and I can now support another family, just like mine.

I truly understand what it means to migrate your family to another country, all the hopes and fears. We’re not like other GP recruitment agencies, just looking to fill vacancies. We want to support your whole family to make the move and get a better life, to have time together to discover and explore beautiful NZ, just like my family did.

Email me, Aruni at info@doctorsnz.com to find out more about how I can support you.

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How we’re reversing Type 2 diabetes

FROM THE START

I few years ago, I attended a GP conference andlistened to Dr Glen Davies (awarded GP of the Year) for his work reversing type2 diabetes in his patients through a low carb, healthy fat diet. Dr Davies established Reverse Type 2 DiabetesTaupō (RT2DT) group to promote a lifestyle that includes nutrient-rich wholeunprocessed foods and natural fats, and avoids processed carbohydrates,industrial seed oils and sugar. He had results showing over 120 of his patientshad reversed either pre or type 2 diabetes with this approach and he had over3,000 members in the RT2DT group, inspiring a wholecommunity to take better care of their health.

After hearing what hehad to say and the results and the debate amongst the panel of experts aroundthe effectiveness of his approach, I was compelled to look into it further formy patients.

EVIDENCE BASED

I started looking forevidence based research and found the following information in a COHORT STUDY.LANCET 2017;390:2050-62

•       Three high income countries & 11 middle incomecountries

•       Dietary intake 135,335 individuals

•       5,796 individuals died, 4,784 had major cardiovascularevents

•       Higher carbohydrate intake; higher totalmortality

•       Total fat intake; lower risk of mortality

•       Total protein intake; inversely associated with riskof total mortality/non cardiovascular disease mortality

•       Animal protein; lower risk of total mortality

•       Replacing carbs with fat or protein was not associatedwith cardiovascular disease

OUR PROGRAM

The first line in treatment of diabetes is providing  education and diet advice to our diabeticpatients. We have expanded on this pathway

Empowering patients to make healthy choices  

Stick with it

Nurse Anna Boyce (Registered Nurse) works one day/week as a healthcoach, working with patients with Diabetic patients who are aiming to reversetype 2 diabetes and reduce their medications by having a Low Carb, healthy fat(LCHF) diet.

 Nurse Anna provides coaching, working with patients on lifestylechanges and adjustments to a patient’s food intake with advice, recipes andhelpful resources and on-going support with weight, BP and blood sugar checks.

RESULTS

Since August 2021, our Practice has been enrolling diabeticpatients in this program. We have seen positive results through this approachwith 45% of all patients experiencing improvement in their diabetic controlalong with a reduction in their diabetic medications, some even coming offInsulin. The practice collected data on each patient enrolled in the programmeto monitor a reduction in blood sugar levels but also qualitative dataincluding how patient’s have improved their sleep and their overall health andwellbeing and that of their family. In addition, patients reported weight loss,improved mood, increased energy levels, improved agility, and reduced hunger.  

But the biggest achievement was the individual stories of which Inow have many. I had one patient, Male, 68 years old, Māori and Non-compliantdiabetic with HbA1C of 102. This patient was not engaging with the medicalcentre. I had a long chat with him about diabetes and what it will mean forhim. He refused to take any medication but he did agree to see Anna for dietadvice and made regular appointments to follow up with her. Within four months,he dropped his HbA1C to 41. The patient was thrilled with this result but alsoaware that this required a complete lifestyle change and it wasn’t just a quickfix. The biggest motivation to the patient was his increased energy levels andthat he now had energy to go hunting with this grandson that he couldn’t dothis before. Is spoke to the patient this week and This approach gives patients a clear and definitive structureon their diet. 

I feel that this approach gives patients an alternative to thetraditional pathway of increasing amounts of medication for diabetic patients. Somepatient will do really well but those who don’t stick with it still benefitfrom the education and increased awareness of the effects of carbohydrates ontheir diabetes.

For us as GP’s, it’s a great tool to have in your toolkit for themanagement and treatment of patients with diabetes.

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Patients or Friends?

We all have patients who we get to know, quite closely, who then invite us to spend time with them outside the medical centre. Some of my patients have interesting hobbies and have lots of fun doing different things that I have wanted to try myself. So, what do you do?

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This year, I had a couple of patients invite me to join them on an overnight tramp in the wilderness about one hour from Featherston. Immediately I was intrigued! The tramp sounded amazing – covering rugged bushland that hadn’t been walked on before, with no marked track and the promise of stunning views. They talked vaguely about a tarn (high mountain lake) they had seen on google maps and had heard about from others, but they weren’t sure where it was. I knew I would have fun but a little part of me was concerned – a lot could go wrong!

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I decided to go for it!

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We had an informal planning meeting one night over lots of alcohol but still I wasn’t too concerned. These guys were experienced trampers, and I knew I was in good hands.

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On the day of the tramp, we were blessed with great weather. It started with a drive out to end of White Rock Road past the sheep station where we parked the car and started the walk. From there, it was a steep climb, straight up the ridgeline amongst the rugged bush.
The experienced trampers cut branches to clear our path and tie knots in the flax and notches in the trees to mark our way back. In the first couple of hours, we climbed 300 meters.

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Once we got above the tree line, we found ourselves on bare rocks, tussock and exposed winds. But the view was stunning, as promised. I could see the South Island and had 360-degree views of the stunning Wairarapa region. Already, I was having fun and glad that I came.
We kept walking for another 5 hours till we reached the plateau. There we began to search for the tarn. Without any reference point or idea of where we were going, we scrambled through the bush, trying not to lose each other and searched for a low point. Finally, we came across a swamp that led us to a small lake and an area that looked like it might have been used as a campsite at some time. We found a bit of dry bush, cut some wood, and pitched our tents.
The experienced trampers braved it with a fly only while I used my tent. We made camp for the night and boiled up the billy for a cup of tea and rehydrated. At night, we made dinner, told camp stories, played the harmonica, and sang songs. Exhausted by the day’s activity, we had a great sleep and woke the next morning to tramp back down the mountain and return home.

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On this tramp, I was reminded of the joy in meeting new people and trying something new. It was great to push myself to do the “unknown” and trust those around me to keep me safe.

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Being a GP in a small community can be so rewarding, especially in the relationships we have with our community and our patients. I enjoy talking to my patients about their interests and what makes them happy.

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Accepting the invitation from my patients has opened more opportunities for me and I wouldn’t have wanted to miss out on this experience. We’re now planning our next tramp.

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The Good Doctor -Dr Harsha Dias

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Who are The Good Doctors?

We’re Mr. and Mrs. Dias, living and working in the lovely Wairarapa. We’re thrilled to share our story with you, and some inspiration behind our vision for Doctors NZ. We decided to move to the Wairarapa from Melbourne ten years ago, and never looked back!

The decision to move here was rooted in our desire for a better life. Once we realised how much we loved living and working here, we wanted to help other GP’s and their families make the move too. Our Vision & Inspiration Finding the balance was paramount.

Here, we’ve discovered a pace of life that allows us to enjoy the balance between work and life. Harsha, with his patients, and cherished garden time, and myself, Aruni, able to pursue my passions throughout the week, not just on weekends - It’s been a game-changer for our family.

Shifting gears comparing life here to our bustling days in Melbourne is like night and day. In a city teeming with millions, we found a unique sense of isolation. Now, in the Wairarapa, we’re part of the community. We’re not just the doctors, we're an important part of our neighbours' health and well-being. Favourite aspects of life in the Wairarapa The slower pace of life has been one of our favourite aspects. The absence of traffic, the warmth of our neighbours and the sense of community here is priceless. And when we are in the mood for a change of scenery, Wellington is just a short trip away. Affordable living has given us the opportunity to call a sprawling ten-acres property home, complete with a lush garden filled with flowers, fruits and vegetables. The outdoor experiences are unparalleled; a playground full of golf, hikes and the occasional hunting, fishing and diving adventures.

Lessons we’ve learnt looking back, one thing we wish we’d realised sooner is the significance of a balanced work life. It's not just about our personal health and well-being - it affects the whole family dynamic. And how important it is to get the right work life balance for your own health and well being and our whole family.

We look forward to using this series of posts to introduce ourselves more and give some insights into the work we are doing here in the Wairarapa!

Are you a talented General Practitioner with dreams of practicing in the stunning Wairarapa, New Zealand? We specialize in making those dreams a reality. Join us on this incredible journey of healthcare and adventure.

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