Senior Medical Officer | Barcaldine Multi-purpose Health Service
Dr Priscilla Aw-Yong is a Senior Medical Officer at Barcaldine Multi-purpose Health Centre in Central West Queensland. Her love for Rural Generalism and cognitive medicine led her to pursue a career as a Rural Generalist with advanced skills in adult internal medicine.
“I fell in love with the community feel of a rural hospital, where all staff had a close working relationship. I was amazed at how Rural Generalists had a laid-back demeaner, whilst being very good at what they did. Working in a rural community was appealing and they were so grateful to have another much-needed doctor working in their town”.
“My second love of medicine has always been the problem-solving part. Having placements and rotations with General Physicians made me feel like a detective; trying to piece together an array of complex medical problems and investigation results. The gratification one gets from getting a difficult diagnosis correct is only surpassed by the moment you are able to help a person who has been suffering from a previously unknown / unmanaged medical condition”.
Adult internal medicine Advanced Skills Training has a unique set of challenges.
“There is significant breadth of knowledge involved in adult internal medicine. It can feel overwhelming studying due to the sheer quantity of information that is expected to be known. Once you finish Advanced Skills Training, the challenge then becomes maintaining that knowledge. As always, we want to do our best for our patients, which means a constant internal pressure to ensure we continually build on our expertise”.
“There are over 20 sub-disciplines in internal medicine. Within each individual Advanced Skills Training post, a balance is usually struck between the training needs of the individual versus the service needs of the community. Some posts provide greater depth in a particular sub-specialty, and others provide greater depth of experience across many sub-specialities. Therefore, depending on where you work and your advanced skills background, some Rural Generalists with adult internal medicine advanced skills will be more comfortable in certain sub-specialities than others. This can create a bit of uncertainty from colleagues (both Rural Generalists and partialists) and at times self-uncertainty, around what our role looks like”.
Priscilla thrives on managing complex medical patients locally, enabling them to stay home for treatment and prevent the extra strain of travelling to tertiary hospitals.
“I see our role as the in-between for GP and Physician care, allowing more complex care into rural medicine. Being able to do a thorough work-up, organise appropriate investigations and potentially commence initial treatment is so beneficial to our community. I have been able to fully manage complex medical patients with the help of a Physician over telehealth. Allowing patients to stay in their town to be managed by their own GP is a wonderful and fulfilling opportunity. This also creates a stronger bond between tertiary based Physicians and rural sites”.
As a Rural Generalist with advanced skills in internal medicine, there is a seamless transition between hospital and General Practice. This enables patients to see the same doctor throughout the entirety of care.
“Adult internal medicine is a very broad advanced skill, which means I can confidently manage difficult patients in both settings. I can confidently mange difficult exacerbations of chronic obstructive pulmonary disease (COPD) with bilevel positive airway pressure (BiPAP) in the hospital, then care for the same patient in General Practice with chronic COPD management and optimisation, and potentially identify a rarer cause for this patient’s COPD. In General Practice I have ended up caring for many complex medical and geriatric patients, largely due to my advanced skill
“Other skills that I have learnt through my advanced skill, such as running family meetings, complex Advanced Care Planning and delivering bad news, have really enhanced my abilities in General Practice as well. I get great satisfaction being able to discuss a colleague’s patient with them and point them to resources or teach them about a certain topic”.
With a broad scope of practice, Priscilla cares for a diverse range of medical problems and demographics, creating variety in her work week.
“My daily activities normally start with a handover; all the doctors come together and discuss admitted patients and overnight discharges. We work through ward patients and develop management plans, then commence ward rounds which are shared between the Senior Medical Officers. We do one week of acute hospital patient rounds and rotate. Most of these patients are medical cases, which is where I utilise my advanced skills in internal medicine the most”.
“I spend the rest of the day in General Practice, where I am also on-call at the hospital if they have questions or need help with patient management. I am rostered on-call at least one night per week and every second weekend. This covers the ward, emergency presentations, as well as our three outreach facilities”.
Priscilla’s desire for knowledge is fuelled by her clinical and educator roles, providing the perfect mix of practice.
“I love working in both a clinical and educator role as it provides great variety and allows me keep up to date in medicine. I enjoy being around Registrars during exam preparation as they have an amazing knowledge base. This ignites my desire to be as knowledgeable as possible in my clinical role, to ensure I provide patients with the best possible care. Conversely, working in my clinical role and continuing to build on my medical expertise and experience helps me be a better educator. It is an amazing pleasure and honour to be involved in another doctors’ education – both the highs and the lows”.