Thursday, 27 March 2014

Working on Orkney

We are currently in the process of finalising what rotations we will be offering in Round 2. One thing that is certain that we will be offering 4 rural track rotations, 1 in Shetland, 1 in the Western Isles and 2 in Orkney.

David Lovell is a trainee on the Grampian four year program. He spent 6 months on Orkney during the first year of his 4 year program. Here is his take on what it is like to be a part of the community on Orkney.

"Working as a GP trainee in Orkney was one of the most fun and interesting periods of my life. Some of my favourite experiences are from that time and I would recommend working there to anyone.

I first went to Orkney as a medical student. Having done my medical degree at the University of Aberdeen I had been quite used to the idea of rural placements but I was very anxious about coming so far north. I was worried about the prospect of feeling totally isolated from everyone I knew and loved with little chance of returning home until my placement was over.

What I found was not isolation but a fantastic feeling of community. Paradoxically, it felt like one of the least isolated place I had ever been. Needless to say, I had a lot of fun.

When selecting my GP training preferences, one of the main reasons for choosing the four year programme was the opportunity to return to Orkney. It wasn’t because I am a particularly outdoorsy person (a reason often cited by trainees who opt for rural placements) but more that I had become fascinated by the place, its history and its people.

Getting there is actually reasonably straightforward. If you are taking a car you can get the ferry

from Aberdeen, which takes about seven hours. You can also catch ferries from near Thurso, one of which takes you past the magnificent Old Man of Hoy; an enormous sea stack off one of the islands. Flying there is a bit more expensive but significantly quicker than the ferries.

So, on to the job itself. You work as an SHO in the Balfour Hospital; a small hospital in Kirkwall with about three wards. Patients are looked after by both medical and surgical teams. When I was there the medical team was run entirely by GPs with a specialist interest in acute medicine. Since then there has been a shift towards employing consultant physicians in addition to the GPs.

The fact you work with GPs allows you to gain fantastic experience as they actually understand what is required of you in the GP training programme. There is a real focus on holistic care and the fact the GPs often know the patients from working in their surgeries really helps you to put the patients’ problems in context.

The surgical team is made up of some really dedicated rural surgeons who can do everything from bowel surgery to repair of hip fractures. When working with this team you cover the small casualty department and you see a fantastic variety of things from minor injuries to major trauma. It’s all really well supported and everyone is very friendly. I never really had any qualms about asking for help whenever I needed it.

There are strong links with Aberdeen Royal Infirmary and the various specialties are usually very good at providing help from afar via telephone, email and video link. The hospital also has links with the emergency medical retrieval team who can help with transfer of sick patients to tertiary centres.

Rural medicine is fascinating not because of what you have at your disposal, but because of what you lack. Good history taking and clinical skills therefore become indispensable when many tests and investigations aren’t readily accessible.

The winter I was there the hospital very nearly ran out of troponin assays when bad weather had delayed their shipment. As you can imagine this was a significant problem! We ended up having detailed discussions with the cardiologists in Aberdeen who recommended using the more old fashioned tests of CK and AST to help diagnose myocardial infarction.

There was a lot of debate at the time about when to use the remaining troponin assays. One school of thought suggested that we only use them on chest pains that definitely sounded cardiac in order to confirm MI. The other side of the argument was that we should use them in less clear cut cases in order to rule out MI. It was very interesting to be involved in these discussions, but fortunately the next batch of assays arrived and we were able to resume practice of more conventional medicine!

The accommodation there is basic but decent. There is a common room with a big TV and there was WiFi in the doctors’ flat. I shared the building with quite a few medical students who come tended to come from the University of Aberdeen on placement. There were also a few who came from much further afield on their medical electives from places such as Germany and Australia.

The best thing for me about the students being there was that I somehow managed to have my meals cooked by them every night! I’m not quite sure how this happened and I can’t guarantee it will happen for anyone else who ends up working there. Anyway, we all became really good friends and, along with the other GP trainees there, had a really great social life too.

There were several weekends where we all went to visit various islands where we would explore the stunning landscapes, the endlessly interesting archeological sites and the lovely pubs. I also had the opportunity to have nights out in Fusion, the local nightclub, which claims to be “the best nightclub north of Edinburgh”. I can honestly vouch for this fact*.

So, in summary I recommend you all go to Orkney as part of your GP training. It has been one of my favourite jobs since starting work and has been formative in my experience as a doctor. Above all, the nurses there are a hoot!"

*I can’t honestly vouch for this fact. But who cares!
David Lovell


So why not take that life canging leap of faith and apply for one of our rural Track ritations on Orkney and experience what it is like to be part of this thriving friendly community.

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