Nowhere in Dr. Leonard Bentch's CV does it mention his knack for writing, but his talents extend well beyond Internal Medicine. A retired physician, Dr. Bentch was sailing the Caribbean when he received a call that took him on a six-month locum adventure with his wife, Sue. He recently put his many remembrances to paper, and we're proud to present the second of three installments here. (If you missed the first installment, you can read it now).
Right off the bat, I noticed a few subtle differences between the way medicine is practiced in the States and the way it's done in New Zealand. Aside from the relaxed dress code - business casual and no lab coats - the Department of Medicine structure is a bit different. Altogether, there were approximately thirty full-time Physicians; however in the British system, Board Certified Internists are called "Doctor" and Surgeons are not Physicians, but "Mister or Ms." But hey, what's in a name?
As a Physician and Gastroenterologist, or "Mister" as I became known, my work included a combination of general and specialty medicine. I saw acute admissions with my team of House Officers every fourth day and night, made teaching rounds daily, supervised the newly reinvented Handover Conference, attended Journal Club, House Surgeon conferences, made presentations at M & M conference, and gave teaching conferences.
In addition, I saw GI outpatient consultations three afternoons per week, reorganized the Chronic Liver Disease clinic (which met twice weekly), performed 3 "lists" of general endoscopy per week and also participated in the ERCP list. I worked with the New Zealand Hepatitis Foundation, where we helped organize a treatment program for patients with chronic liver disease so they could be followed by their General Practitioners. Another highlight was a presentation I gave on Chronic Liver Disease to an area Medical Society. Put together, it was an active, fascinating, and mind-stretching experience.
The nursing staff was exceptional; wonderfully trained and competent. Several were originally from New Zealand, but many were traveling nurses trained in other British Commonwealth nations. They labored with minimal resources, by our standards, to provide continuity of care - especially necessary in a teaching hospital.
Patient care in New Zealand was decidedly different from the United States. Resources are in such limited supply that evidence-based approaches to patient care were much more important. I found this rigorous attention to literature very refreshing.
Not every person with COPD who was admitted with cough and respiratory insufficiency was automatically treated with antibiotics; not every person readmitted with CHF received an echocardiogram or even a Cardiologist; not every person with headache automatically received an MRI and not every person with abdominal pain had a CT scan. The formulary was barebones, but covered the bases. Specialty help was there, including radiology, pathology, surgery, and all the medical subspecialties, but one did not feel obligated to request consultation on every case.
Kiwis do not expect extraordinary care when the natural history of their disease process is clear. Futile and unnecessary care was minimal. End-of-life care was excellent.
Also, my office was fantastic. I was in a new building adjacent to the operating rooms; next door to the Cardiologists with views of the beautiful roof top gardens which provide a tranquil space for thinking, meeting house staff and colleagues, and enjoying lunch. My two office mates, a Rheumatologist and an ID physician, both full-time staff, offered a vast experience in medicine, an academic approach both to patient care and teaching, and a warm welcome. We were to become good friends.
Check back here often for more updates from Dr. Bentch. Or better yet, subscribe to this blog and receive a weekly update!