I described it as an educational opportunity in my personal learning plan. The cultural differences in the understanding and delivery of healthcare in New Zealand made a good sound bite, but the reality was quite a challenge.
In spite of an induction session on the very different computer set-up, I wanted half an hour for all appointments.
The standard consultation
Picture the scenario: I struggle to read patient’s records, call them from the waiting room… nobody comes. Shout louder, still no response. Receptionist tells me to use only the first part of a Maori name and explains the correct pronunciation.
Patient realises I am not the usual GP, and reluctantly concedes to consultation. Decide to prescribe chloramphenicol for conjunctivitis.
From a very limited prescribing list, the drugs available change quickly. Chloramphenicol only appears as individual minims drops so I ask a pharmacist. He suggests chlorsig – magically this can be converted to generic 0.5% chloramphenicol. But I have prescribed it in the wrong encounter page so it won’t print. Help.
Only certain drugs are fully subsidised with the patient paying $3 per scrip; others are partially subsidised, not subsidised at all, or fully subsidised if recommended by a specialist.
Thirty minutes later, the patient emerges. I’m exhausted.
I did not come across an Accident Claims Compensation consultation, but lived in fear of determining if the problem was covered and which forms to fill out. However, I was still beset with queries about which treatments were free, such as the physio, or if the physio could make a supplementary charge as a specialist… and what the charges were.
Home from home?
We had holidayed in New Zealand before and discovered what a fabulously beautiful and unspoilt place it is. I applied to the general practice group that was advertising in our LMC newsletter, and that was it.
We rented a house on the lakefront and the three children went to the village Maori school, which they loved.
Back home again, I really miss the unspoilt beauty and quiet solitude (a population of 4 million), but do not miss the work. It was similar to working in the UK over a decade ago.
The delivery of healthcare, while very consumer-friendly, is not particularly well-organised and fails to meet the health needs of the most vulnerable members of society, such as the indigenous Maori population and the Pacific Islanders.
Their average life expectancy is 10 years less than that of the white immigrants. There is much kudos to being ill in a Maori culture too; only about half of the items prescribed are dispensed. Maoris cannot always afford them.
With the greater financial remuneration on offer in the UK, and having taken 15 years to develop many new initiatives and quality standards in my practice here, I would have to have compelling reasons to work in New Zealand.
But we did find several plots of land for sale with stunning coastal views: I could always pass my twilight years on a sun deck sipping a nice cool beer.
Dr Williams is a GP in Exeter, Devon