One of the most attractive (and enjoyable!) parts of GP work is the opportunity to experience a diversity of practice. And working in Indigenous health certainly fits that bill. Here Demitri Perera – a recently Fellowed registrar – shares his perspective on training and working in the area, along with reasons why you might like to consider working in Indigenous health.
Demitri’s road to Goolburri Aboriginal Health
Demitri gained his GP Fellowship in February 2020, and currently works four days a week at Goolburri Aboriginal Health in Toowoomba. He first became interested in Indigenous health during his training time as an intern and junior doctor at Mount Isa.
“I really enjoyed the interaction with patients, the complexity involved, as well as learning about some of the important issues in the sphere,” he says.
“When it came time to do my GP placements, I had the option of choosing from a few different practices in Toowoomba, and Goolburri happened to be one. I chose to work there for my first year, and in a mainstream practice after that. I came back to Goolburri after gaining my Fellowship to work permanently. ”
Why he loves working at an AMS
Demitri finds it hard to pinpoint the most rewarding part of working at an Aboriginal Medical Service (AMS) as he feels there are so many.
“We’re trying to address the gap by providing culturally sensitive care focused on building rapport and trust in the doctor-patient relationship. Through this, we can raise health literacy and health outcomes for a whole population. It’s such an important field and I’m so happy I can be a part of it,” he smiles.
He also enjoys the chance to learn about ‘all of the different facets of a culture’. This helps him appreciate the issues that arise.
“Family is very important in Aboriginal culture and sometimes patients put family obligations before themselves. This might be why they might fail to follow up with a health issue, and a small problem can become a much bigger one,” he explains.
Demitri shares a patient example from his time as a registrar at Goolburri, illustrating how a reluctance to seek treatment exacerbated the issue.
“We had a new patient come in with a horrible diabetic lower limb ulcer. She was basically managing it on her own as she didn’t want to go to hospital. During that first consult, there was a lot of hesitancy on her part, as I don’t think she’d had a good experience with previous medical providers,” he says.
“It took us quite a few consults to slowly build the relationship to the point where she really did trust coming into the clinic. And then the onion opened up and we uncovered so many other layers of medical and social issues.”
While Demitri says ‘she probably should have been in hospital for treatment’, she refused. But the team at Goolburri were able to achieve much success through building that rapport.
“We worked on each individual concern and by the end of it, we’d mostly fixed her ulcer. She stopped smoking and was regularly attending clinic appointments. She’d even have a laugh with us!” he smiles.
“It’s just so rewarding to know you’ve actually made a real difference to someone who may have otherwise ended up in a much worse situation.”
Differences between working at a mainstream GP clinic and an AMS
As Demitri has had experience working in both a mainstream general practice and an AMS, he’s well positioned to highlight the differences.
“It’s mainly the level of complexity you see at an AMS as it’s often multifactorial,” he says.
He also says cultural or socioeconomic issues can change the way the consult needs to run.
“For instance, there’s cultural variation even from location to location. When working in Mount Isa, I found some patients didn’t feel as comfortable looking directly at me. But in the Toowoomba population, I don’t seem to face that as much.”
“For most consults at an AMS, you need to take a bit more time to establish rapport and take the history, which may not be straightforward or be told to you as a story. Another challenge is you often need to try and get things done in fewer consults as people may not always re-present for follow up.”
This is where working in an AMS is advantageous.
“We have a 20 minute standard consult time to account for the complexity. It also helps being a service tailored specifically for the Aboriginal population in the Toowoomba region. People automatically feel a little more at ease when they come in.”
Experience really is the best form of training
Demitri feels not enough registrars consider a training term in Indigenous health, opting instead to train in one or two mainstream practices. But he thinks experiencing Indigenous health first hand is the ideal way to determine if it’s the right fit for you.
“At various points throughout your medical training, you get a lecture about Aboriginal health and cultural differences. Sometimes they’re delivered really well, but other times they’re a little lacking. It’s hard to encompass all of the history and cultural experience in one or two lectures,” he says.
“That’s where on-the-job experience is the most beneficial. It wasn’t until I was up in Mount Isa as an intern that I really started to get it. I remember thinking ‘Oh okay. Now I understand what we were talking about during those lectures.’”
Demitri feels training in Indigenous health can also quickly expand your clinical knowledge base.
“You’ll see a number of multimorbid and comorbid presentations. This is very helpful in other areas of practice, as you have to think outside of the box,” he says.
“Even if you decide Indigenous health is not your career path, you’ll still inevitably end up seeing Aboriginal and Torres Strait Islander patients in your clinic. Understanding how to treat that consult differently and treat that patient appropriately ensures you get the best outcome for them.”