Using brown snakes to organise patient free days

Abstract

External clinical teaching visits are an important component of general practitioner training in Australia. During these sessions, a senior general practitioner observes a registrar's consultations and reviews the surgery's equipment, policies, and procedures. Structured feedback is given to assist registrar learning. Visiting remote regions to perform external clinical teaching has its challenges. I recount here a story of when I visited a solo general practitioner registrar who worked in a small rural village in the rugged forested hinterland of the coast of New South Wales. I was impressed by the surgery's peaceful character. It was an old converted post office with aged cypress pine floors. The registrar was busy, with a clientele consisting mainly of elderly farmers from the valley. The waiting room was full, and the patients extended out on to the veranda. In a quieter moment, I asked about the new piece of wood that looked out of place nailed to the floor next to the registrar's desk. I was concerned that it might be a trip hazard for his patients. In explanation, the registrar recounted the tale of a farmer who had probably saved his life. A 70 year old farmer, "Joe," had come in for his blood pressure check and a chat. As they chatted about the weather and cattle markets, his patient had turned pale. "Hey, Doc," said the patient quietly. "Yes, Joe," said the registrar. "Don't move," said Joe. "Why?" "There's a brown next to your toe." A brown snake's head had slithered out of a knothole in the floorboards. Its head lay next to the registrar's now sweating sandalled foot as metres of snake body kept emerging. A long silence descended, as snake eyed registrar and registrar eyed snake. To everyone's relief, discretion over valour was decided as the better course of action by all. The snake returned to its subterranean environment beneath the surgery and the registrar to his desktop. As the registrar nailed the hole closed with a piece of wood, Joe's condition improved and he yelled to the waiting room, "Six foot brown!" Remarkably, all of the waiting patients improved and they ran off. This brown snake was useful in organising a patient­free day for the registrar. A stethoscope applied to the floorboards periodically during the day failed to locate its whereabouts. The brown snake elected to migrate that night to find another, safer habitat.