Light and shade

Tairawhiti Police medical doctor and Three Rivers GP Tom James was profiled in the latest edition of NZ Doctor by Cliff Taylor — the article was headlined A tale of two cities: GP scratches shiny surface to treat unseen ills.

Tairawhiti Police medical doctor and Three Rivers GP Tom James was profiled in the latest edition of NZ Doctor by Cliff Taylor — the article was headlined A tale of two cities: GP scratches shiny surface to treat unseen ills.

Dr Tom James

Like many others before him, GP Tom James came to Gisborne for “blue skies, sunshine, beaches and lifestyle factors”.

That was in 1994, and he has been here ever since. But as a police medical officer, Dr James gets to see another side of Gisborne life, existing just beneath the postcard image.

It’s light and shade, he says.

“But I think a community that hasn’t got a dark surface is one that you don’t know very well.”

Dr James has helped build up the largest practice in the region, Three Rivers Medical Centre, which opened in 2012 in a modern, gleaming white building near the centre of the city.

Today, the practice employs about 17 GPs and has an enrolled population of 18,000 patients.

Dr James came to New Zealand from the UK, where he had worked in Bristol and Swindon, in what he describes as the remnants of the health system.

He found it frustrating to be doing lots of house calls, because patients couldn’t get GP appointments.

“More of my daily hours are directed at patient care here,” he says.

“Most of the doctors who come here from the UK realise we do more in-house. We do more procedures, particularly with the primary options, IV infusions for cellulitis, minor surgery, removing skin lesions.

“Visitors from the northern hemisphere are quite surprised by how many skin cancers and pre-cancers are around, and how you’ve got to get on and do something about them — you can’t refer them all on.”

Asked whether he feels isolated on the East Coast, he retorts: “Isolated from what?”

“The pictures of blue sky and blue sea and long, uncrowded beaches — they’re not doctored, they’re real. It’s just over there.

“For people who want that sort of thing, it’s a huge benefit, our biggest drawcard. I used to think I’d get a crappy car and get flights to the major cities for the weekend. I suppose your interests change — I’d be perfectly happy going around exploring different beaches, fishing and camping and stuff.

“If that fits in with people who want to work here, what would they miss about being stuck in traffic?”

Traffic jams are rare

It’s true, traffic jams are rare in Gisborne. But a lot of heavily-laden logging trucks rumble through town, to and from the port, evidence of the city and coast’s reliance on primary industries.

The work takes its toll on people’s health.

There are also areas of high deprivation and consequent social ills in the region.

“People are using heavy machinery, they’re working at heights, they’re driving on uneven, muddy roads, and there will be incidents there,” Dr James says.

“We see the results of injuries.”

As a police doctor, he is acutely aware of the fatal accidents that occur in these workplaces: a forestry contractor who fell and died; the top-dressing pilot and his passenger killed in a crash last December; and the Gisborne truck driver and his eight-year-old son who died in a crash in January.

“That was particularly tragic.”

Mortuary visits

Part of his role is to officially confirm deaths, which may involve visits to the mortuary. He also provides custodial care to police-cell prisoners with a medical condition, and examines victims of physical assault to assess injuries.

He is sometimes required to provide reports for the courts.

These must be unbiased and robust enough to be cross-examined.

“It’s important to note our evidence is just a part of a picture, it’s not the sole evidence presented to the courts. We need to play our part and not oversell it.”

He finds the police work interesting because it illuminates some of the hidden aspects of people’s lives.

“I can see gang members in the police cells, and it’s never really a problem as long as you treat everyone with respect.

“We see people from all walks of life so, if patients get in trouble with the law, it highlights . . . drug and alcohol problems, how widespread it is, how it actually causes family violence, how it causes altercations, street violence — or how there’s a drug bust, and suddenly you see some of your patients in the police cells with a different hat on.”

He’s also involved with sexual assault treatment services.

“There is a movement to try and acknowledge that, bring it into an area we can talk about rather than just having a special area with special doctors to deal with it and have it hermetically sealed from the rest of our activity.”

As a GP, such insights help him understand why patients don’t engage in ways they are expected to.

“Why aren’t you coming and getting your pills? ‘Because my whole life is crap.’ Needs are not met at many levels, which are deeper than the ones we’re dealing with on a day-to-day basis.

“You don’t have to scratch too hard and you find that a lot of reasons why people aren’t functioning are something to do with domestic violence or substance abuse. You see that.”

Dr James’ office is neatly situated, with a view of palm trees and Waikanae Beach, where Gisbornites can skive off for a lunchtime surf, but just two blocks from the large city police station.

Twenty-three years on, he has no regrets about moving here and accepts both the light and dark aspects of his work.

“I guess if you work at it, you can actually see you are making a difference. It may take a while, you may have to look very carefully, but you can see you are making headway in some things, whereas in a lot of places you are just processing a queue of patients and you’re not sure you are making a difference or not. So that’s appealing.”

■ Cliff Taylor can be contacted at ctaylor@nzdoctor.co.nz

Like many others before him, GP Tom James came to Gisborne for “blue skies, sunshine, beaches and lifestyle factors”.

That was in 1994, and he has been here ever since. But as a police medical officer, Dr James gets to see another side of Gisborne life, existing just beneath the postcard image.

It’s light and shade, he says.

“But I think a community that hasn’t got a dark surface is one that you don’t know very well.”

Dr James has helped build up the largest practice in the region, Three Rivers Medical Centre, which opened in 2012 in a modern, gleaming white building near the centre of the city.

Today, the practice employs about 17 GPs and has an enrolled population of 18,000 patients.

Dr James came to New Zealand from the UK, where he had worked in Bristol and Swindon, in what he describes as the remnants of the health system.

He found it frustrating to be doing lots of house calls, because patients couldn’t get GP appointments.

“More of my daily hours are directed at patient care here,” he says.

“Most of the doctors who come here from the UK realise we do more in-house. We do more procedures, particularly with the primary options, IV infusions for cellulitis, minor surgery, removing skin lesions.

“Visitors from the northern hemisphere are quite surprised by how many skin cancers and pre-cancers are around, and how you’ve got to get on and do something about them — you can’t refer them all on.”

Asked whether he feels isolated on the East Coast, he retorts: “Isolated from what?”

“The pictures of blue sky and blue sea and long, uncrowded beaches — they’re not doctored, they’re real. It’s just over there.

“For people who want that sort of thing, it’s a huge benefit, our biggest drawcard. I used to think I’d get a crappy car and get flights to the major cities for the weekend. I suppose your interests change — I’d be perfectly happy going around exploring different beaches, fishing and camping and stuff.

“If that fits in with people who want to work here, what would they miss about being stuck in traffic?”

Traffic jams are rare

It’s true, traffic jams are rare in Gisborne. But a lot of heavily-laden logging trucks rumble through town, to and from the port, evidence of the city and coast’s reliance on primary industries.

The work takes its toll on people’s health.

There are also areas of high deprivation and consequent social ills in the region.

“People are using heavy machinery, they’re working at heights, they’re driving on uneven, muddy roads, and there will be incidents there,” Dr James says.

“We see the results of injuries.”

As a police doctor, he is acutely aware of the fatal accidents that occur in these workplaces: a forestry contractor who fell and died; the top-dressing pilot and his passenger killed in a crash last December; and the Gisborne truck driver and his eight-year-old son who died in a crash in January.

“That was particularly tragic.”

Mortuary visits

Part of his role is to officially confirm deaths, which may involve visits to the mortuary. He also provides custodial care to police-cell prisoners with a medical condition, and examines victims of physical assault to assess injuries.

He is sometimes required to provide reports for the courts.

These must be unbiased and robust enough to be cross-examined.

“It’s important to note our evidence is just a part of a picture, it’s not the sole evidence presented to the courts. We need to play our part and not oversell it.”

He finds the police work interesting because it illuminates some of the hidden aspects of people’s lives.

“I can see gang members in the police cells, and it’s never really a problem as long as you treat everyone with respect.

“We see people from all walks of life so, if patients get in trouble with the law, it highlights . . . drug and alcohol problems, how widespread it is, how it actually causes family violence, how it causes altercations, street violence — or how there’s a drug bust, and suddenly you see some of your patients in the police cells with a different hat on.”

He’s also involved with sexual assault treatment services.

“There is a movement to try and acknowledge that, bring it into an area we can talk about rather than just having a special area with special doctors to deal with it and have it hermetically sealed from the rest of our activity.”

As a GP, such insights help him understand why patients don’t engage in ways they are expected to.

“Why aren’t you coming and getting your pills? ‘Because my whole life is crap.’ Needs are not met at many levels, which are deeper than the ones we’re dealing with on a day-to-day basis.

“You don’t have to scratch too hard and you find that a lot of reasons why people aren’t functioning are something to do with domestic violence or substance abuse. You see that.”

Dr James’ office is neatly situated, with a view of palm trees and Waikanae Beach, where Gisbornites can skive off for a lunchtime surf, but just two blocks from the large city police station.

Twenty-three years on, he has no regrets about moving here and accepts both the light and dark aspects of his work.

“I guess if you work at it, you can actually see you are making a difference. It may take a while, you may have to look very carefully, but you can see you are making headway in some things, whereas in a lot of places you are just processing a queue of patients and you’re not sure you are making a difference or not. So that’s appealing.”

■ Cliff Taylor can be contacted at ctaylor@nzdoctor.co.nz

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