Bellingen’s Dr Trevor Cheney has generously kept our community informed and let’s be honest, entertained, on a weekly basis since the outset of the Covid-19 Pandemic in Australia. His weekly newsletter update (or as he likes to call it ‘meanderings’), have provided unbiased facts and sound advice with a sprinkling of humour, personal anecdotes and many asides.
This week Trevor was awarded with the Rural Doctors Association of NSW Bowman Cutter Award 2020 to acknowledge his exceptional services to RDANSW and his strong, ongoing advocacy for rural doctors and rural healthcare. This is an exceptional honour but very well-deserved, as many in our community will attest.
Trevor has been a practising GP in our community for the past 19 years. Despite an unflinching dedication to his patients, community and rural healthcare generally, he is not one to seek acknowledgement for his hard work. For those who know him, are lucky enough to call him their GP or who are even more fortunate to actually work with him, his dedication to health and his community is inspiring. Despite being very camera shy, we thought it was definitely time to reveal the doctor behind the PPE and stethoscope.
Trevor, what motivated you to become a doctor?
Curiosity. I had trained as a Nurse, then spent 6 years in Outdoor Education, logistics (including Medivac/wilderness first aid), and loved learning about everything. But then felt a need for a mental challenge and felt that medicine offered a chance to really understand the world, be forever useful, and make a difference – doesn’t that sound corny? Maybe I also just wondered if I could do it. “You never know if you never go”. I had to make a career direction decision and played a mind game of ‘what can I see in the next 10-20 years?’ and rural GP was the ultimate vision.
But then I was very lucky to have married Vicki who pinned me down and said –‘ok, here are the places you might do mature age entry’. She then prodded me to follow up, and accompanied me to a state and city she had never seen, worked to support us the whole 6 years I was in UNI (apart from having 2 babies), lived through the horror shifts as a junior Doctor. She got jobs in Perth in which she learnt the business of medicine. Then packed up the kids, dog and life to drive up to the dry, desolate and desperately exciting landscape of the WA Pilbara – Dampier and Karratha. There and here, if I was dealing with someone in hospital or in labour and it might interrupt a family event she would always say ”you go and look after those ladies, we’ll be OK!” So please forgive if I tend to say we rather than me. We have succeeded because of my devoted, quiet and clever partner.
What is it about rural medicine that keeps you so engaged?
I still love learning about everything! It is the best job in the world. I meet lots of lovely people, get to work every aspect of my brain, while being required to maintain a significant level of skills at the pointy end of emergency medicine.
Ultimately, despite what is often presumed in our system of silos in specialised medicine, I teach students -the “Buck stops here”! People still mostly have to come back to where they live. They bring their rare or complex illnesses and injuries with them, and as a rural GP one has to be ready to rapidly up skill and help them regardless of how rare or unexpected the health problem is. But in the end there are relationships with families and extended families that one sees through all the life phases and at times one has the ultimate honor of being allowed to help them when they need it. Sometimes even before they know they need it.
What does being honoured with the Bowman Cutter Award 2020 mean to you?
To be called out at all was a huge honour, and never, ever expected. Perhaps it will help add gravitas to our attempts to represent rural medicine as a great career choice for young doctors, but also in our dealings with decision makers to preserve or improve services outside urban environments.
In my heart I have always believed it has been easier to give better medical care in a rural setting than I ever could in my short stints in urban practice. I suspect most country doctors feel similar, but there are structural barriers that sometimes get in the way giving rural health a lot of published poor outcomes.
Hell, I don’t know – you do what you think is right and do it hard, then if others think that’s good then – beauty! Lets get on with doing good stuff.
You continue to serve our local community at the Bellingen District Hospital despite ongoing pressure to firstly close the hospital all together and now the ED. Why is it so important to you that the medical services are maintained at our local hospital?
I think there is a huge service that small hospitals provide that is not well recognised. Firstly the model of local doctors (and nurses), knowing the local resources, the families, the patients, then also sorting their emergencies is a brilliantly efficient way of dealing with community acute care. Almost universally, people who have to be in Hospital prefer to do so closer to home.
We also serve as a pressure fuse for Coffs Hospital. Patients with complex needs are able to get out of the hurly burly of big hospital acute wards to be managed by “generalists”. This is a term that is being resurrected in medicine. It refers to Doctors who look at the whole patient and milieu, working towards helping the whole person to the best health solutions. It can be very efficient and effective. Small rural hospitals are about the only place in which that model has been able to work.
The small rural ED is a great training ground for young doctors – especially reflecting back on this year where we have been forced to do a lot of telemedicine. This will be debated in health care now for an eternity. Telehealth has served us well where rural areas have access to good internet (????), and where it is difficult to get to specialist services. But that is still predicated on having a GP in the flesh holding it together and recognising important signs. There is nothing that replaces taking a real live pulse and listening to a real heart to pick up important signs, and help one learn medicine in all its unpredictable faces.
I am aware that it can take half an hour or more to get from the ends of the valleys, or some of the MOs, just to Bellingen town. In an emergency the first hour is a critical life saving period – It is even called “The Golden Hour”! To remove access to people not on the highway is to further imperil the ability to save life and limb. Rural colleagues around the country share with us that once you start to cut back acute services from your local health campus, then starts a spiral of deskilling of medical and nursing staff, precipitating the creep of further service restrictions.
It has become increasingly difficult to staff the local hospital with doctors. Why is this the case and how would you encourage local medicos to continue to serve the hospital?
I see it a bit like the problem with informing people about good food. It’s a marketing issue. The good message has had too little airplay. Doctors have been barraged over the last 2 decades by corporatism and devaluing the intangible rewards of this career. We are looking at ramping up how we present the joys and satisfaction, and perhaps more importantly the intellectual stimulation of rural practice with maintained hospital visiting/emergency care.
I still remember with horror the old way of doctors working – I can remember doing a 100 hour week in my training days. That was nuts. It was dangerous. I’m glad we don’t do that anymore. But health needs do not confine themselves to neat shifts and business hours. We need to help colleagues relearn flexibility, to reclaim a sense of “vocation”. There is just a little light on the horizon as we have been informed by the RACGP that there may be a wave of urban doctors starting to ask about tree changing. And, it looks like we have some great keen young doctors heading our way next year with all the above in mind.
You and your colleagues moved very quickly to establish a drive through Covid testing clinic once the realities of the pandemic became known. Our district acted before many others. Why did you see this as being so important? What does this say about our local medical/health workers?
I don’t know what it says about our local health workers except that it has been a unique joy to work as a collective with all the wonderful caring GP practices in the Shire. As GPs we work in the interface of many systems. I take great pride in calling myself a public servant. But then also we run real small businesses and must manage the realities thereof. Agility is vital in the private arena, and as GPs, remember, our professional focus is seeing the little patient in the big picture.
As colleagues we were discussing the evolving Covid news, and to be honest, many of us thought that we had enough of the information we needed to take action by February. A viral pandemic has been heralded as long as I have been in health care – that is over 40 years. We just missed it in the 90s, it came close with SARS and MERS, then Ebola made the mistake of being too deadly, and the rest of the world got off lightly. Dr Bell called a meeting and the Principal GPs of all the practices agreed swift action was needed. And, we wanted to preserve our health services – the pharmacies, our GP practices, the aged Care Facilities, and the Hospital.
The Ruby Princess was exploding into Sydney, demonstrating how infectious the virus was and how spectacularly services could be overwhelmed and shut down. We were very lucky to have an infectious diseases specialist – Dr Richard Lawrence, living in the shire on sabbatical. So we decided we needed a clinic to assess and test, away from other health services. We needed it immediately, not when our federal and state leaders in politics and medicine got around to it. Bellorana was very generous providing the facility. Ironically we saw our first and only cases in the first 2 weeks, so I would like to think that was just in time to avert a break out in the Shire.
You take a strong interest in a wide variety of medical services/practices, including obstetric health, nutritional health, tick borne diseases. Do you believe that rurally based medical practitioners need to provide a broader scope of practice than urban colleagues or is there another motivator for you?
I would turn that around to say that rural practitioners CAN take a broader perspective and scope. This is one of the joys. One can follow the need as far as is safe and within one’s skills. Then we go off and learn more skills. Our communities need us to provide as much local facility as we can to reduce their need for expensive and fraught long travel to health care. I absolutely respect, celebrate and am very grateful to my specialist colleagues who will be brilliantly up to date in their field and offer our patients the best of specialist diagnosis and treatment. But they will still need to come home. I don’t pretend, or even aspire to be a specialist, except in life, and there is still SOOOO much of that to learn.