VIEWPOINT
Managing Editor’s Note: Dr. Michelle Miller took a one year locums primary care position in New Zealand in June 2021. She will be returning to Tallahassee in July 2022.
HALF A YEAR HALF-WAY AROUND THE WORLD By Michelle Miller, M.D. Hi everyone!!! Time sure does fly when you are having fun. I can’t believe I have been in New Zealand for seven months (with six more to go.) I would recommend anyone having major burnout to consider coming here - or consider locums somewhere else. Just in my short time here, I feel better, and I doubt I will fully retire any time soon if my health continues to be stable. Yes, I will be coming back to the States. Immigration denied my visa extension due to my Multiple Sclerosis, so in order to not be banned for life, my family will be heading back in July. We may try to visit Australia for a week or so prior to coming back, depending on the pandemic situation at that time. During my time here, a lot has changed. I started with little to no COVID-19 in the country and not having to wear masks in the office, to getting put in lock-down due to the delta variant and wearing N-95s daily and 70% of visits by video or telephone for a few weeks, to now a combination of telemedicine and in-person visits but still wearing N-95s daily. I now have more than just a few patients refusing the COVID-19 jab or asking for exemptions, but the local community has > 90% vaccination rates (age 12+). The country has moved from only having the Pfizer vaccine to also the AstraZeneca vaccine, and now giving boosters to everyone 18+. We luckily haven’t seen much of the Omicron variant, but everyone is on edge awaiting to see it come into the community. Luckily, COVID-19 passes (proof of immunization) are mandatory at most establishments and the COVID-19 tracker app makes contact tracing so much easier. My family moved out of an apartment downtown (small town with no traffic lights so not too busy) to a nice house that is a 15-minute walk from the office, so with going home at lunch, I am walking an hour most days. We were walking to nearby restaurants, but I must admit that we really miss the food back home - the food here is very bland with lots of french fries (or chips as they call it) for sides. Therefore, my husband has become a great cook at home. I have gotten more comfortable with finding information on the New Zealand formulary or Pathways and calling specialists to get approvals for imaging or medications. It is no longer strange to hear “Michelle” instead of “Dr. Miller.” The patients are a joy for the most part - usually not entitled and understand that their appointment is
only 15 minutes so they will let me know that they plan on making future appointments for anything that we don’t cover. They also apologize if they are late! Also, new to me, any patient over 79 wanting to renew their license must have a visit with a GP to review their conditions, medications, vision, strength, balance, and memory to determine if they are safe to drive or need more assessments or restrictions. Also new to me, if a patient dies, you must visit their body to confirm death, and if for cremation, it must be within 24 hours to make sure no medical equipment (specifically pacemakers) that need to be known to the funeral home. Jargon that I’ve learned while here: glandular fever (mono), grommets (tympanostomy tubes), giddy (dizzy), jabs (vaccines), seeing extra ‘o’s added to words like oedema, oesophagus, etc. I’ve also seen a lot of melanomas (very common due to low ozone). I don’t see nearly as much Vitamin D deficiency - likely due to it being a lab test that isn’t covered, so most patients don’t want to pay to see their level. I see a lot of GI disturbances - likely from all the milk that people add to their 6+ cups of teas a day. So far, my family has really enjoyed our stay here. The country is beautiful, and most of the people are very nice. We have taken some weekend trips to explore a little of the country. However, we mostly rest at home with nearby hikes and are enjoying living in a small town. During these treks, it’s not unusual to see people not wearing shoes (my toddler points this out every time we walk to the local park). I don’t bring my work home with me - it is frowned upon, and I have an excuse that it would cost the group to pay me overtime. I have plenty of breaks built into my schedule to finish paperwork or take breaks (most of which I don’t work through). When I return to the States, I hope to keep up a good worklife balance. I plan to start with setting boundaries to keep work at work and learn to delegate. It’s amazing what the nurses can do here that I don’t have to worry about besides sending in medications based on standing orders for nursing visits. It’s unlikely most of the life-balance measures can be implemented in the States. Teatime and paperwork breaks would likely be frowned upon. However, I plan to make small changes, such as saying no to overbooking and not replying with free medical advice when a patient should make a visit instead of sending messages on the EHR. Kia Ora from New Zealand! I hope to see you all at CMS meetings after July. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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