I kept track of one day in the office at DAHS recently. Like the Gibb, it is run on the "British" model of consultation. I have my own room to see patients, with a computer and basic equipment. The staff put the charts in the box on the door and I see the patients in order. There are no appointments. I call my own patients, and do all their vitals. However, at DAHS if I get really busy I can often talk an Aboriginal Health worker into drawing some bloods or finishing the opportunistic screening, which helps.

Here is list of one busy day:

· I start the day with two little kids, 10 months and 4 years, with acute conjunctivitis. We use cholamphenicol eye drops here, a drug that has been virtually banned in the U.S. due to a rare risk of bone marrow damage. However, I looked it up, and its never been associated with eye drops. Here in the Kimberley, bacterial infection is so rampant that we use antibiotics much more aggressively.

· Next is a bearded dude in his 40s who needs refills of his BP meds. I saw him a few months ago and tried to get him to quit smoking with patches. He’s down to 5 a day, and would like to have a go with the Zyban, which I prescribe.

· A 10 month old has nocturnal cough for a month. There is a family history of ?asthma and lots of smoke exposure. We’ll try a short burst of Prednisolone for reactive airways disease.

· A very obese (150+ kg) diabetic comes in with a second attack of ankle gout in a month. I put him on recall to try to get Allopurinol started once we get it settled.

· A young man comes in right behind him ALSO with a sore ankle. I think, “It can’t be two cases of gout in a row!” but it turns out it might be. He was told he had gout before. I’m not so sure on exam what it is, except the spot anterior to his fibula is sore and swollen. We decide to settle it with ibuprofen and see what happens.

· 5 year old brought in by mum who notices “his head stinks”. I smell the fuzzy-grape odor of Pseudomonas. When I take off his cap, his hair is matted with a solid, thick skullcap of dried pus and he is covered in head lice. Mum says this only started last Thursday but nobody believes it. The kid has swollen glands and a little bit of fever. I start oral Augmentin and get the Health Worker to shampoo him in the office and remove as much crud as she can. We will rewash his hair daily this week until he is better.

· A one-eyed old man comes in wanting copies of his records for when he travels. I notice he is very short of breath, and find his COPD is really flared up badly. He hasn’t really noticed it much- he always runs an O2 sat of about 90 and refuses to use home oxygen. I give him his 3rd Prednisolone burst in 3 months and flag the drivers to drag him back to DAHS in 2 weeks.

· 30-something local woman who drinks a lot brings in a huge abcess under her arm. I take 45 minutes to set everything up myself, I&D it to drain the pus out, pack it, start her antibiotics and pain meds and arrange another call back. I get to clean up the mess myself and sanitize the room after each patient, which I tell myself is a good Buddhist exercise in humility and being in the moment.

· A break for lunch. I do a few admin things and run home. Vicki has painted the living room this morning. White of course. We sit outside and have avocado and salami sandwiches in the beautiful garden. She enjoys the little water fountain we placed in the pond this weekend.

· After lunch an intoxicated fella has the drip from not using condoms. He tells me his contact, and I have him take a ZAP pack (Zithromycin 1 gram/Amoxycillin 3 grams/Probenecid 1 gram) in front of me. Cultures to the lab and instructions to go and, if not “sin no more”, at least wear protection.

· Pregnant European woman has headaches at 16 weeks. Seen at hospital twice but not happy about explanations. Multifactorial but we sort it out and start exercises and sleep hygiene. She hasn’t started Antenatal Care, and we try to get that organized.

· Middle aged man with previous sinus surgery has congestion and drip for 5 weeks.
An x-ray taken at beginning of month was filed without being seen by the ordering doctor. I apologize for this. He is understanding, I explain my concerns, start antibiotics and urge him to keep his ENT appointment.

· Young guy working “out bush” comes in with men’s business concerns. We discuss that a circumcision won’t solve his sexual dysfunction problems. But reviewing a handout from the Internet and starting some medicine might help a lot. Finally a chance to practice medicine on a 21st century problem, and not an infection from the 1920s or earlier…