When you live rurally, you expect to travel a bit and don’t often get to the big shops or a supermarket, but you still expect the basics, Ms Steiner says. However, a critical shortage of GPs in the region and, to a lesser extent, New Zealand means doctors can pick and choose where they work. And Patea is not being picked or chosen.
A critical shortage of GPs in the region and, to a lesser extent, New Zealand, means doctors can pick and choose where they work. And Patea is not being picked or chosen
The nearest general practices to Patea are in Hawera, 20 minutes away via State Highway 3, but they don’t have capacity for 2300 patients and, as Mr Honeyfield says, some Patea locals don’t have the means to travel out of town.
As a stopgap, Patea Doctors’ three nurses were working under standing orders, managing uncomplicated urinary tract infections, impetigo, sore throats, earache and chest infections. The PHO, Pinnacle Midlands Health Network, arranged for a GP to visit the practice, albeit sporadically, to see patients with ailments that couldn’t be treated by a nurse.
The trust also managed to sign a contract with two locum GPs, a couple from the UK, to work from 9 October until Christmas, but that didn’t alleviate the need for an immediate solution.
It came in the form of a videoconference system set up by Pinnacle Midlands. The technology allows GPs from Taupo Medical Centre, another of the PHO’s clinics, to have virtual consultations with patients in the Patea surgery.
It’s essentially a secure version of Skype and, in the last week of July, Patea Doctors became the first Pinnacle Midlands practice to use it.
Consultations take place between 9.45am and 11.45am four days a week.
Patients have long depended on the clinic’s nurses, especially for continuity of care when locum GPs move on, and this solution relies on their input, too.
They work in rotation during the virtual consultation sessions, bringing in patients 15 minutes before their doctor’s appointment to take their height, weight and blood pressure, and assess their symptoms.
This means the Taupo-based doctor is briefed before the consultation begins. The GP also has access to patients’ electronic health records.
The nurses sit in on the consultations, taking further observations on behalf of the doctor, such as looking at a sore throat or moving the camera around so the GP can make an examination.
Taupo Medical Centre GP John Chico finds it’s not all plain sailing, “because I’m a hands-on doctor and rely on listening to a person’s heartbeat or looking inside their ear”.
Dr Chico trained and practised in the US before taking on a locum assignment in New Zealand.
Despite his reservations about telehealth, he welcomed the chance to try it. “Whether I like it or not, I think this is going to be part of medicine in the future, and I’m going to have to get used to it sooner or later.”
Videoconferencing had been in use at Patea Doctors for only a couple of weeks when New Zealand Doctor visited, but Dr Chico said the technology had been functioning well.
“I would say we can actually treat more than 50 per cent of the patients who come for a virtual consult, but there’s a lot more that comes from a medical evaluation than just treating a patient,” he says.
“Sure, I can manage and treat someone’s diabetes, but when someone comes in with chest pain, I would not be able to treat that.”
Those patients are sent to the emergency department at Hawera Hospital – “which is what I would have to do if they came to see me face-to-face anyway”, Dr Chico says.
He has not found virtual consultations more time-consuming than regular appointments, although the patients in Patea are new to him, so he spends more time reviewing their notes.
Because of his hands-on approach, Dr Chico looks forward to digital stethoscopes and otoscopes becoming part and parcel of telehealth, so he can listen to a patient’s heartbeat or examine their ear canal, remotely. He says the resolution of the images captured by the webcam at Patea Doctors makes thorough visual examinations difficult.
Asked how patients have taken to virtual consultations, Trudy Young, one of nurses who sits in on the appointments, says: “Some will talk to me instead of looking at the doctor, but some are really good with it.”
Quite a few teenage patients have seemed wary of the videoconference appointments, Ms Young says. She thinks that might be because they’re more nervous about seeing a doctor in the first place and have been taught to be cautious of sharing personal information over the internet.