I really felt GP Simon Willcock’s pain, frustration and impotence when faced with a man in his clinic whose attempts to get his life together were frustrated by the various government institutions which should be helping him (see Wednesday’s Crikey article).

I know, Simon. I have been there, done that. Thought, why am I here, this is not a clinical problem, but a social one. As with many people with complex social needs which impinge on their health this man needed a case manager rather than a GP.

Someone who knows how to negotiate the complex web of government institutions which will provide him with food and shelter so he can then get back to you who can provide him with the type of help you are trained to deliver.

So what did I do, Simon? Left NSW, left frustrations of working within a system which has not worked out how to provide health care to an enormous diversity of groups, and defected to the NT, whose health system was established for and is geared towards providing health care to a mostly marginalised group, a large proportion of whom live in remote areas.

When in remote communities, we are not faced with problems like the example you gave. Everyone has free health care, free medicines, and it’s not really considered a problem if someone has to kip down under the stars. But when we do have a medical problem which can not be dealt with in the community, we just ring the district medical officer on call, and he or she helps us solve the problem, often consulting other professional people for advice and help. No matter what the bed capacity of the hospital, if a person needs to be medivaced, he/she is. The plane arrives, and whisks him away.

In smaller communities, there tend not to be allied health professionals or social workers who could help us with your man, but we have designated specialists in paediatrics, mental health, O and G, aged care and disability, physician and sometimes surgeon, who are always happy to help on the end of the phone, giving advice to tide you over till their next visit.

In Tennant Creek, where I am shortly to take up a full-time position as senior (it’s not my fault that I turn 60 this year!) GP, the AMS has a huge network of organisations such as social and emotional wellbeing, men’s health, s-xual health, public health, and of course the invaluable Aboriginal health workers who often act as social worker, interpreter and clinician rolled into one.

It’s not all perfect. Far from it. We can never get enough staff, but the wonderful thing is that the positions at least are there, waiting to be filled.

I’d like to address your point number 5, that of burn out. I worked mostly in remote Aboriginal communities for the last five years and at Christmas, realised I was seriously burnt out. There was no way and nowhere to escape the petty whitefella politics that bug remote Aboriginal communities. No coffee shops, no book shops or cinemas in which to immerse yourself in darkness, absorbed in someone else’s story.

For me, it is not about balancing my working life in a salaried position supporting marginalised people with another role in a more profit-orientated sector. There is no need for that. As you pointed out, AMSs are mostly structured to involve a large multidisciplinary team who help each other out. In Tennant Creek, even Centrelink and the Dept of Housing are people orientated, approachable and helpful. But I face a lesser chance of burn out in the town as one can build a life other than work.

Your model is a good one. Fight for it. Everyone deserves a good life, both your patient and yourself. It’s only a different model of health care which will ultimately make both of you healthy and happy.