From sickly child to community doctor

 

Townsville GP and National Home Doctor Service Medical Director Dr Vicki Stonehouse talks about her role as a community doctor in far north Queensland.                                                                                                

Dr Vicki Stonehouse is a very busy woman. General Practitioner, Palm Island community doctor, National Home Doctor, Medical Director, teacher, mentor, touch football player, student of French, and last but not least, mother to a four-year-old. How does she do it?

“It is a juggle! I keep a pretty tight diary and I try and roster myself at least a month in advance. I find the older I get, the more experienced I am, I know what I can and can’t do.”

Dr Stonehouse’s love affair with medicine began when she was a little girl. “I was quite a sickly kid and I had a lot of respiratory tract infections. So I was always at the doctor’s with my mum. I really liked that profession, just the looking after people, getting to know people and caring for people. I really liked that aspect.”

Beginning with a degree in biomedical science, Stonehouse realised her dream of being a doctor when James Cook University established a medical school. Since finishing her medical degree at JCU, and completing her ACRRM and RACGP training, Dr Stonehouse has been flying to Palm Island four days a week to a dedicated primary health care centre (run by Palm Island Community Company) she helped to establish with colleague, Dr Raymond Blackman.

Previously there was not a primary health care centre on the island, so this new centre has made a huge difference for the community of Palm Island.

“Even though we work on Palm Island, which is classified as ‘remote’, we like to offer everything that you would get in a GP Practice in Townsville. If a patient needs anything like imaging, or specialists, we can refer them and provide the transport.

“We see everyone from newborns to the elderly, primarily Aboriginal and Torres Strait islander, because Palm Island is one of the biggest Aboriginal communities in Australia. We do everything here – there is so much pathology, it’s a really great learning environment. We treat everything from basic coughs and colds, migraines, run-of the-mill things, through to chronic disease – heart disease, kidney disease, diabetes, strokes, osteoporosis, everything you can think of - we see it here!”

“Palm Island hasn’t always had a great name in the media, but it’s easy to judge a place when you haven’t been there. When I came here I fell in love with the community. I wasn’t experienced in indigenous health at all, but it’s a really beautiful place and the people are really beautiful as well. If you give people a chance, and you get to know them and you respect their culture and their community, then the people embrace you - it’s a really nice place to work.”

After hours - another piece of the puzzle

Dr Stonehouse combines her work on Palm Island with working in Townsville with National Home Doctor Service as a Medical Director, mentor and after hours doctor. “My special skill is emergency medicine, so I’ve always like the acute side of things. I really like being at the coal face, helping people in their homes. I like that side of things I don’t always get in my GP Practice. It’s another piece of the puzzle that makes my career satisfying.

“There’s a massive difference between seeing patients in a Practice and doing home visits. When you’re in someone’s house, the social determinants of their health are right in front of you. We see from affluent backgrounds right down to families on the poverty line. If someone comes in to your GP Practice and sits down in front of you, well, you get to know them, but that’s nothing like being in their home with them, seeing how they interact with their family or their surroundings. It’s a great advantage to have.

“To give you some examples, at one extreme – a patient might not have a fridge, so how are they keeping their thyroid medication cool? Or there are 14 steps to get up to the front door and you’re 84 and short of breath. There are some things that just make sense when you see them at home.”

Out of your comfort zone

Dr Stonehouse believes home visiting is good for a doctor’s practice. “It forces you to be more clinically astute. With home visits you don’t have all the fancy things that you have in a GP clinic. Sure we’ve got our blood pressure machine, our glucometer, and our stethoscope, but we don’t have a clinic nurse, we don’t have an ECG machine, we don’t have easy access to imaging and pathology and all of those things. So you have to rely on your history taking and your examination to be actually able to work out what’s going wrong with someone, rather than just sitting in the GP Clinic and having all the bits and pieces at your fingertips. It’s good because in a way you’re out of your comfort zone, and working in these environments can really help your growth as a doctor.

“I’m really big on taking a good history because patients will tell you what’s wrong if you just give them time to talk and you listen to them.”

A mother and a doctor

Dr Stonehouse says she has special sympathy for mothers with small children, as she has been in that anxious phase herself. “Being a doctor and being a mother are two completely different things even when you’re the same person. I’ve been there, I know exactly what it’s like, being a new mum, having a baby or child who is crying, has a fever, or is unsettled for whatever reason. It’s late at night, and when you go there, even if there’s no treatment required at that stage, just giving some reassurance, some education, and you see the relief on the mum’s face…it’s really nice that you can provide that for people.”

Listening to patients

Asked what her best advice to young doctors would be, Dr Stonehouse does not hesitate. “Listen to your patients. In my teaching, I come across doctors who are a little more reserved, you know, they say, because I’ve got 40 patients to see, I need to get in and get out. But I think, well, if you just spend another five minutes there, and listen to that patient, you’ll actually save a lot of time, make fewer mistakes, and the patient will be so much happier as well.”

                                                            

 “I like sitting down, taking time with people, and if you listen to them, it actually makes diagnosis so much easier.”

“Having worked in Emergency as well, I know how hard it is when you’re under pressure and you don’t have time to spend with patients. You’ve just got to ‘push ’em in and push ’em out’. With home visits, it’s nice to be able take the time, give some reassurance, make a diagnosis and start treatment early. You feel like you’ve actually made a bit of a difference to people.”

After hours gives you a different perspective

Dr Stonehouse believes doctors have a lot to gain from working in the after hours space. “It’s definitely worth trying it – it’s really rewarding. It’s not necessarily for everyone, but I really like the social side of medicine, getting to know people, and how they work. Even if that’s not the kind of person you are, it’s a good thing to do. You learn more about patients and more about yourself. And it can complement whatever you do. Whether you’re a GP Registrar, or an Emergency doctor, a surgical doctor or whatever, it’s good because you learn to become a jack-of-all-trades. I think it’s easy in medicine to become sub-specialised, and forget certain things, like how to assess a child for example. Home visiting is a way of making sure you keep your hand in everything.

“Home visiting gives you a different perspective on a lot of things. Even though you don’t get a lot of continuity of care, it’s that ten or twenty minutes that you spend with people can make a difference. It’s nice to know that.”

Dr Vicki Stonehouse BBiomed Sc,MBBS, FRACGP, FACRRM

     
 Dr Stonehouse is involved in all aspects of indigenous health in her role as GP at the clinic on Palm Island. Here she appears in a poster to encourage shingles vaccinations.