Going all-in on life as a rural GP

Some people get a taste for country living and want another bite. After just one week holidaying in the beautiful Atherton Tablelands, GP Dr Catriona Arnold-Nott came straight back for the full meal. In a recent interview, she shares how satisfying and enriching the life of a rural GP can be…

So firstly Catriona, set the scene for us on how you came to be living in the Tablelands. We hear you went ‘all-in’ on country living straight away?

It sounds crazy. We never planned to live here! We were living on Thursday Island and came through the area on a holiday with our three young children. A week later, we had bought ourselves a 120-acre farm! It was a totally impulsive decision. We had never talked about living in this part of the world. We had never talked about owning land. We had never, ever talked about being farmers!

When we moved here, it was like finding home for the first time in my adult life. Up until then, I had thought where I had grown up was home and that I would probably end up back there one day. Then we moved here, and straight away I thought ‘My bones are going to be in the cemetery here’. I grew roots so quickly and so deeply.

It sounds like it was love at first sight for the region! You’ve been in the town for 10 years now. How would you describe your role as GP in the community?

I think most people think GPs are just doctors so our role is to provide medical care to patients. It’s entirely true, of course, we do do that. But what I’ve learned from being here 10 years is that my role is much more than medical care. My role is counsellor, support and general advice, community engagement.

We're community members, but we are always identified as the doctors as well. When I walk into our local shops, people say, ‘Hey, Doc, how you going?’. I think that's the pivotal bit about being a doctor in the community. Although we are fully enmeshed as community members in all these other different aspects, to the people around us we’re the doctors. It's not about respect and it's not about being on a pedestal, it's about our role and the fact that people know they can come to us and we will always try to help them, no matter what it's about.

How does being a GP in a regional setting like the Tablelands compare to the big smoke?

Well, I certainly don't want to diss my city colleagues, because they do very important and challenging jobs. But working as a rural GP, I think we do have to think on our feet a little more. I know we're only an hour and a half or two hours away from the nearest tertiary hospital, but many of our patients don't want to drive that far. That means I do much more procedural work than I would if I was in a city. When I see a tricky skin cancer, I say to the patient, ‘well, you know, we should send you down to a surgeon to get this chopped off’. They say to me ‘Catriona, you do it for me, I trust you’. My skills grow and I get better at doing that sort of stuff. I feel more confident to offer those kinds of services to our patients here locally, so they don't have to travel.

What gets you out of bed every morning and excited to do this job?

You know, I cannot imagine a job I could possibly enjoy more. I love relationships and I love people. I get to sit all day long and hear people’s stories, and then I get to walk those stories with people. I walk the journey of life with people from so many different backgrounds, from every age, every culture, every socioeconomic group. I hear stories and I am part of their stories.

Those relationships for me are so strong. That’s what makes me love my job. I think I had a sense of it before I settled here, but I’d never worked anywhere for more than four years before we moved here. There is a real depth gained from being in this place for over a decade now. I'm looking after pregnant women who were childhood friends of my kids. This experience of walking through life with my patients is incredibly enriching.

Is your role as a GP what you thought it would be when you decided to become a doctor?

Perhaps when I was younger, I thought there was a bigger picture about being a doctor and that I might be able to save the world or cure all the poor people or something like that. But what I love about what I do is, every single day I'm connecting with people and every single day I'm sitting there with people and saying, ‘It's okay, I can help you’. And I'm not changing the world; I'm not saving millions of people. There are good public health doctors out there who might be doing that. But every single day, I help people one by one. Sometimes there are people who I just can't help, but nearly everyone I see is someone who I can tell, ‘I'm going to be able to help you. It's okay, this is all going to be okay, I can help you’. That is such a powerful thing to be able to offer my fellow humans as they journey through life. ‘It's okay, I'm here to help you. I'm on your side’. That's why I love being a GP.

You also play an important role in the training of medical students, taking on placements in your practice. What has been their perception of working as a rural GP and what would you say to someone who might be on the fence about this career path?

The thing about the journey of a doctor, from medical student through to hospital doctor and onto a GP or specialist, that different things along the journey will feel different. For a lot of students, it’s very exciting learning medicine. You learn lots of really clever things and you learn how to save lives. You do a term in emergency, where you have a few wins and might think, ‘I saved that person’s life’. It’s all very exciting and quite dramatic. But I think as people go through the journey, once you've learned the skills, the excitement of using those skills can wear off.

One of the problems is that medical students may think ‘GPs don't get to do anything exciting’. What I would say to any medical student who thought being a GP wasn't exciting or interesting, was to remember that everyone who ends up seeing a specialist has likely seen a GP first. So lots of the tricky diagnostics and investigations have come through GP land first. When I get medical students training with me, they always leave saying, ‘I had no idea what you did was so interesting, and that you saw so much interesting medicine’.

For me, the most interesting and exciting part of being a GP is the ongoing relationships I have with my patients throughout their life journey. But the medicine is also exciting, extremely interesting, and varied. Every day is different. You have no idea what is going to come through the door. We do lots of procedures, lots of interesting diagnostics, lots of interesting thinking about problems. I've got a patient at the moment, who is very unwell, but she doesn't quite fit into any specialist bracket. I've been ringing three or four different specialists asking for their help to try and solve this very complex diagnostic riddle. Each one of those specialists is like, ‘It’s not cancer. It’s not the heart’. And it all gets left with me; I'm the one who must solve the puzzle. For me, that's really intriguing and interesting.”

What’s special about the country community mindset?

So, our community is a farming community. Most people here grew up on farms, still run farms or are new to farming like us. We were still living in our caravan, building our house when Cyclone Yasi hit. What the community means, you saw in action when this enormous terrifying cyclone came bearing down on us. Although we weren't hit as badly as feared, there certainly was a lot of damage done to the farms and the town. The minute the wind stopped, people were on the move. There was no communication - the phones were down and there was no signal - so people were walking, or riding horses, or driving buggies, from one farm to the next. Everybody was checking on each other, checking on anyone who might have been more vulnerable.

Our local school was quite badly damaged in the cyclone. There were a dozen teams of people chain-sawing the trees that had come down onto the building and everyone was helping each other through the site. It all happened without anyone asking or organising anything, or without any kind of coordination. This was just a bunch of people who care about each other, and who know how to fix things. This is not contrived. It's not organised from above. It's a real living, heart-beating community where people care for each other, and look out for each other, and work for each other.

How does the sense of community make you feel? Does it shape the role you perform as a GP?

I feel completely connected. The weirdest thing is that I felt like I belonged here from the day we arrived. It was like finding a spiritual home. The sense of belonging is really key. It's been great for our family; it's been great for our kids to grow up in a place where they belong. And, crucially, it's great for our community to know that we belong, because small rural communities are forever having doctors who come and go come and go. I think that's very tiring for communities.

It's also about trust. In communities where the doctors are frequently turning over, it's very difficult for people to build long-term relationships with doctors, because they always assume they're not going to last very long. It’s the fact that we bought our farm, we built our house, our kids went to local schools, and we clearly feel that we belong. That makes it much easier for the community to trust us. We're always going to be here. When I talk about long term cradle to grave relationships, it's real. It means something because the people here know we're invested in this community.

What’s been your experience with JCU students and graduates at your practice? How would you rate their level of training, communication and attitude to working out in a regional setting?

At Malanda Medical Care we take JCU students and registrars at various stages of their training journey.  We are always impressed with the quality of the training the students and registrars receive.  They bring with them great energy and enthusiasm for rural practice and excellent training in communication skills.  Our overwhelming experience of these young doctors-in-training is of their high level of commitment and professionalism. 

Thank you Dr Arnold-Nott for sharing your story as a rural GP. Here at JCU we know regional areas like the Tablelands are impacted by the health care maldistribution. We believe everybody deserves access to a doctor, no matter their postcode.