I have spent a couple of weeks floating between the medical team and emergency room here at Balfour hospital. Being a small hospital, there are no sub-specialties. So the general medicine is very general. There are two full time physicians at the Balfour and technically they each work on call once every four weeks with the other weeks covered by locum physicians. But the reality is that the full-time physicians here take on much more than the one week in four they are on call. Given the transient nature of locum placements, all outpatient clinics and follow ups on tests, biopsies etc are left up to the doctors based here in Orkney. They do a spectacular job.The emergency room here is always rather interesting. The Orkney Isles get a fair few cruise ships coming through so plenty of patients come in from that with complaints that can’t be sorted by the ship’s doctor. The other subset of population that comes into the emergency room is the local population. The local population are rather stoical. So it tends to be rather late that we see people, relative to what I saw coming through the door in Dunedin emergency rooms.

I do wonder whether if we spent the majority of medical school clinical time in GP practices and emergency rooms, would we all be set up for a better life as a junior doctor? We would see every presenting complaint there is, see a representative proportion of every specialty, and start with a wider base of general knowledge rather than a more confined knowledge of the few specialist runs you have done. Sure there needs to be time spent on wards. But ward management skills are mostly generic skills and an ability to understand how your seniors prefer things done is probably the most important skill to learn. By making everyone do sub-specialties as medical students are we narrowing our potential early? These are probably idealistic musings. Arguments can be made for improving error rates by consolidating your knowledge in one area. But as a soon to be junior doctor who will rotate around everything for a couple of years I don’t think a week learning about the finer details of the genetic background of paediatric syncope will be helpful until about 10 years down the track. Are we being educated to be partialists before we learn to be generalists….?

The weather has been pretty sharp here this last week so have managed to get out exploring a bit. Headed away to a local blues festival in Stromness with the other medical students here and then spent some time on the Isle of Hoy which is quite stunning.