Ellingtons in New Zealand: Good as Gold

Well I have spent the past year working in the Emergency Department at Taranaki Base Hospital here in New Zealand and I thought I would convey some of my observations and experiences through some of my favorite Kiwi expressions.

1)
Me: "Well I am afraid the x ray shows that you have broken your humerus (upper arm bone). We will put you in a sling, have you follow up with orthopedics and here is a prescription for Panadol (tylenol), and Ibuprofen which should control the pain."

Kiwi patient: "Sweet as!"

Kiwis are generally quite appreciative of what you do for them. While there is certainly some abuse of social well fare in this country there isn't this sense of entitlement where patients feel they should get whatever they want including narcotics when ever they want. They understand that in many cases they are not going to get certain tests done right away or may have to wait several months to get things like colonoscopys done. I have not once been told I was racist, didn't care about the patient because they did not have health insurance, or was going to be sued for not ordering a CT scan, or an MRI after explaining why they aren't necessary at the moment. Most shocking, I have discovered that not one Kiwi has an allergy to tylenol, ibuprofen, aspirin, tramadol, toradol, acupuncture, the north wind or any other non opiod pain medication as so many Americans do. I have written exactly 0 scripts for vicodin or percocet since I have been here and not once has someone required IV dilaudid for pain control. A bit of morphine or fentanyl usually works just fine. No one has requested IV benadryl or phenergan which seem to enhance the euphoria associated with IV narcotics either. I have sent less than 10 people home with a script for oral morphine and only for well documented reasons. There are without a doubt people here who abuse drugs, and perhaps they are just not quite as savy as your typical American drug seeker, but the ED has yet to become the source for peoples recreational substances. In the States we are on occasion dope dealers. Patients come in with a myriad of pain complaints, complicated lists of allergies and have been conditioned to expect a bottle of vicodin or percocet as a parting gift for the ED visit. The abuse of prescription drugs in America is astonishingly prevalent and a very real, often under appreciated problem. There are multiple contributing factors but the medical community has to shoulder most of the blame. Part of it is trying to move as many patients as possible through overburdened EDs with minimal amount of drama. A forsaken drug seeker can get very belligerent, be physically threatening and even worse can complain to hospital administration. Too many complaints, even from dirt balls can threaten a physicians employment. "The patient will continue presenting until they get what they want any way, so what difference does it make if I give them 5 or 10 vicodin" is how we justify it.

Whatever you do for patients here, even if it is nothing you often get a "sweet as". It makes me smile and feel appreciated for a bit.

2)
Me: "Well sir it looks as if you have suffered a major stroke and may not be able to use your right arm and leg again.

Kiwi patient: "Aw doc, she'll be right!"

There is very little wallowing in self pity among New Zealanders. They seem to me to be a fairly optimistic people and when bad things happen they are confident they will overcome the consequences.

3)
Me: "ma'm, I can see that you are breathing 40 times a minute, have an oxygen saturation of 82% and your heart is beating 130 times a minute, but tell me how are you feeling?"

Kiwi emphysema patient through forced smile: "Good as gold!"

This kind of goes in the same category as above but patients here would generally be happier if we sent them home and I think they often feel as if their illness is a burden to others. I have to reassure multiple patients every day that they or their family member did the right thing by calling the ambulance and that in no way are they an inconvenience to me and the rest of the staff.

4)
Me: "Well you can tell by this repeat x ray that we were able to put your son's arm back in the correct position."
Grateful father: "Good on ya mate!"

Usually directed at the son for sustaining his first fracture as much as at us for straightening it.
Kiwis as well as Australians use this term a lot. It shows to me that people are generally impressed with and acknowledge others success in life. There is very little jealousy and very little self promotion in Kiwi society. One's worth in life is not tied to what you have or how you look, it is what you do to contribute and how much effort you put forth that matters. People here don't care at all about what kind of car one drives or what clothes they wear. There is no pressure come summer to get your body in swimsuit condition and very little, if any cosmetic surgery here. Getting a "good on ya mate" makes me feel as if I have done something worthwhile.

Other favorites:

After breathing treatments the asthmatic reports that he "is feeling heaps better. Our kids use this term frequently as in "there was heaps of candy at the party" or "I scored heaps of goals today in soccer".

Overheard at one of Owen's rugby games from a father of one of his teammates describing one of the larger kids on the opposing side. "he is a nuggety little chap!"

As a disclaimer I will point out that I am not trying to be derogatory towards Americans, I am just trying to convey some nuances of life here that I hope to better myself with. All Americans are not unappreciative, fat, demanding, drug seeking dirt bags and some Kiwis are exactly that but I find in general that people are a bit more sensible here.

I have found that the practice of Emergency Medicine in NZ, for me personally, includes all the great things about being a doctor any where without all the extraneous crapoola which can make practicing in America less satisfying. The business side of medicine in the US means as a physician, you are constantly being hounded by billing personnel to have complete charts so that they can bill patients and insurers at the optimal coding level. What this means is that you have to document that you listened to the heart of a patient with a sprained ankle, that they are not having headaches, and they have no significant family medical history so it can be billed at a higher level. Seems almost criminal to me but it is really just a complicated game. Here my charting is fine as followed.

Diagnosis: Ankle sprain

presentation: Twisted ankle

Hospital Course: x-ray shows no fracture

Not too time consuming.

Also EMTALA legislation in America has no jurisdiction here. EMTALA in a nutshell requires anyone who presents to a hospital ED is entitled to a screening exam by a health care practitioner. While this makes sense in a responsible community, in effect it means that patients are entitled to call an ambulance for a tooth ache, get transferred to an ED and be seen by a doctor. Here the ambulance can refuse such transfers and the nurse at triage can in effect tell a patient that the doctor is unlikely to do anything for their tooth pain so they might as well not wait for 3 hours. In the US such activity would open up the hospital to $50,000 in fines for failure to meet the EMTALA mandate.

All that and the fact that you can't be sued in this country make for an enjoyable practice environment.

Lots of snow on Taranaki.
A good friend of ours was just recently carried 1700 meters down Taranaki in an avalanche. He was completely buried save for 1 hand. His mate who fortunately was not buried and miraculously ended up a mere 3 meters from him was able to dig him out. He amazingly only ended up with a dislocated ankle and several bruises.

A big "good on ya mate" to Jenny and her mates for competing in the Naki Mud Run in Urenui a couple of weeks ago. Five km through mud and rivers, under cargo nets and up a mud slide using a rope. A funny event with all kinds of costumes and crazy people. I would have done it too but someone had to watch the kids and take pictures, right.