Senior Medical Officer | Emerald Hospital and Emerald Community Service

General Practitioner | Emerald Medical Group

Dr Nichole Harch is a Rural Generalist in Emerald with advanced skills in mental health. Nichole is passionate about providing the best possible care to her local community and utilises her skills across the hospital, community, and primary care setting, providing continuity of care to her patients.

Nichole is a self-confessed dreamer who has always wanted to make a difference, but becoming a doctor wasn’t always the plan.

“Throughout high school I wanted to become a lawyer, more specifically Australia’s own Judge Judy (there was something intriguing about holding a gavel!). When the time came to apply for university, my community was in a quandary. The three doctors in our rural town decided to retire, all within months of one another. To see my community rally together was inspiring. The founding Rural Generalists had such a large impact on the people around me. Next thing you know, I was enrolled in medical school”.

Nichole’s interest in mental health started on a rural placement in her second year of medicine.

“My first forays into mental health care were quite confronting. I was at a small hospital on a second-year rural placement when mother nature unleashed, causing major flooding. I was assisting with an acutely psychotic patient who required a transfer, but due to flooding they were unable to be moved. Although this experience was challenging at the time, I later realised the impact Rural Generalists could have in their local community by supporting and managing patients with mental illness, and caring for them through some truly horrible times in their lives”.

Commencing Advanced Skills Training (AST) can be a big learning curve for any trainee. It may require a move to a new facility, comes with the responsibility of stepping up into a Principal House Officer (PHO) role, and there is lots to learn in 12 months. Nichole went into her placement with the end in mind and successfully navigated the demands of the position.

“I was incredibly lucky to have supervisors who understood that my learning objectives and needs weren’t the same as regular trainees. They knew adjustments were required to ensure the experience I received would prepare me for rural practice. I worked between the acute inpatient unit, the acute care team, older person’s mental health and the community outreach team. The combination of practise exposed me to a wide variety of experiences. By focusing on the bread and butter of psychiatry and acute emergencies, I was able to enter my rural community with confidence in my skills and abilities to provide valuable expertise”.

The local Emerald community is the real beneficiary of Nichole’s training.

“In a rural area there are so many who suffer from mental illness or who are in crisis. My skill set enables me to create management plans and formulate a way forward within an acute, subacute, maintenance or relapsing phase. I am very fortunate to be part of each patient’s journey during all stages, within the hospital emergency department, the community mental health team (led by a psychiatrist), or in primary care. That’s not to say I don’t enjoy the other parts of being a Rural Generalist. I love working in the emergency department and the adrenaline that comes along with it. I get great satisfaction being able to treat people in all stages of life, from babies through to the elderly, and thrive on the variety each day brings”.

Keeping work and private life separate in a small community can be challenging. By creating healthy boundaries and practising self-care, Nichole has managed to create a sustainable work-life balance.

“Creating separation isn’t always easy. I have been chased through the supermarket by patients because they ‘couldn’t get a review appointment until six weeks’ time!’ There is a consistently large quantity of work. I have found the best way to prevent myself drowning in the workload is to have things you either can’t, or don’t want to go without. That could be a sports team you don’t want to let down, a hobby you can’t go without, or friends that fill your wellbeing cup to the brim”.

“I surround myself with supportive friends and family who do their best to understand what I go through, and book holidays when I need a break. All these things can help ensure longevity in my career and hopefully avoid burnout. It’s important to prioritise time for reflection, to step back and set boundaries. It’s ok to remind your patients that your doctor hat gets left at the hospital, and if they bump into you at the grocery store, you are simply another customer”.

Nichole believes there are misconstrued views around the worth of a Rural Generalist with a non-procedural advanced skill and it’s something she’s keen to address.

“You are beyond valuable with an advanced skill like mental health in a rural community. In addition to the vital support and care you provide for patients with mental illness, you’re also a valuable member of the broader team who contributes across the spectrum of generalist patient care in your community. While you might not be the person intubating a patient in a resuscitation setting, you might use your amazing communication skills as a team leader during the event, or support your colleagues in a hot/cold debrief afterwards. You are highly employable and highly valued as a Rural Generalist, don’t ever forget that!”

Nichole has some final words for trainees interested in undertaking an AST in mental health.

“Take the time and think about where you want to work post-fellowship and attempt to complete your AST in that catchment. This will enable you to build relationships with your referring hospital and local team. Having these support systems around you is invaluable, especially if something more unusual or complicated comes up. There is nothing quite like being able to ‘phone a friend’ and have someone who you know (and knows you) on the other end of the line”.