Here, Patrick reflects on the challenges and adventure that has filled his 10 years in the Defence Force and shares how his training as a Rural Generalist provides the perfect fit for a life in pursuit of great stories. 

Tell us a little about your background and what attracted you to choosing a career in medicine... 

I had an interesting childhood - my mother was a successful equestrian rider and horse breeder and we moved around Europe a little bit. Eventually we ended up settling on a rural property west of Brisbane, and that’s where I did my schooling. 

The reason I got into medicine was accidental. My sister was born with a genetic condition similar to cerebral palsy. I had a lot of exposure to hospitals because of that, as my sister spent a lot of time in that environment. I wouldn't say that it made me want to be a doctor, but it gave me a lot of exposure to the hospital setting and to what it is that doctors do. 

After my undergraduate degree, I couldn’t decide if I wanted to join the Navy or study medicine, and they were kind enough to sponsor me so I could do both. Working in medicine in that kind of challenging environment appealed to me and I liked the kind of problem-solving that it required. It also offered a great way to support myself while I was in medical school.  

How did you know Fellowship with ACRRM and going down the rural generalism path was for you? 

The reason that I chose rural generalism was because I couldn't make a decision, because I enjoyed every rotation that I did. I'd be in hospital, and I'd be doing emergency and I’d think this is the best and could totally see myself being an emergency doctor and then I’d go and do general practice for a bit and that would be so much fun.  

Then I went and did mental health and thought I'd like to have some mental health in my practice. Likewise with orthopedics, because I really liked the operating theatre and I thought it would be nice to be able to stay involved in the operating theatre somehow. 

I just liked everything, the variety, and I could not see myself giving any of it up, so when there was an option to follow a training path that meant that I did not have to give any of it up, I took it. That was the one that made the most sense to me.  

I like doing medicine in that kind of MacGyver-like setting where you are outside the hospital and you don't have everything there you need, or you can’t just refer out to people. I really liked the idea of being able to be useful away from the tens of millions of dollars' worth of kit.  

I always thought, for example, if you came upon a roadside trauma, and you’re a plastic surgeon, how much help would you really be if there was someone in that situation who needed a doctor? How much help would you be if you were a surgeon, a psychiatrist or all the rest? But if you've got a bit of skill in all those areas, I think that you can be extremely useful.  

Do you ever stop and pinch yourself when you consider the knowledge and the skills you have to intervene so positively in someone's life, in a range of different scenarios? 

All the time, although I don't think that the skills that I've gained through the investment that's been made in me through medical school makes me any more special, but I think it is just my obligation now to have and maintain those abilities to help people in that way, particularly on a ship. 

On a ship, the engineer is the guy who can fix all of those engineering problems and I need him to be able to fix those things if something breaks. Just like we need the ship’s chef to be able to turn out healthy food every day. I can't do that, I can't fix stuff, but I need to be able to make sure with people's health that I can address pretty much any problem that comes to me. 

Just like the engineer can come up with all kinds of solutions to whatever breaks down. On a ship no one's more or less important, but I think you're obligated to be able to have that breadth of skill so that you can make the whole thing work. 

What is your AST and why did you choose it? 

I chose remote medicine because I wanted to really double down on that ‘no support, as far away as you can possibly be, jack of all trades’ approach to medicine. And when you're on a ship in the middle of the ocean there's nothing more remote than that.  

I've looked after patients who were six or seven days away from an operating theatre - if you needed anything to be done for them, and if you're floating around in the middle of the Pacific, then you are truly remote, whether you want to be or not. Getting exposure to that mindset has been daunting but also really cool - where you know there’ll be a knock on the cabin door and I'm the only person that they've got, and I better be prepared for it.   

You can't go get the counselor and you can't call for anesthetics to come and help you - you've got to back yourself to get it done, and it really sharpens you.  

Can you tell us a little more about your role, your position, in the Navy? 

Typically, I would see 10 to 15 patients a day most days, but it can be very different on different classes of ship. My most recent appointment, I was the sole medical officer on a ship of about 220 people, we were gone for about six months, and it was in the middle of COVID. 

So, that situation had its own issues. We were testing and swabbing and doing all those sorts of things, but my role on board is really in line with the remote medicine domain.  

You've got to be the person who can provide all care to all comers in all scenarios. And it depends on what you are up to at the time. For example, when we were doing lots of exercises and there are lots of people running around the ship and there is lots of physical activity, I would be getting heaps of orthopedic injuries come through the door. But then, as the tempo dropped, and we had been away for longer and we'd been on the ship for a longer period I started dealing a lot more with mental health. And that was as hard, if not harder, in that you've got people who still have lives back home and you've got to try and give them some pastoral support and talk them through what has been going on and see if there's any way that you can help them. 

One of the quirks of being the doctor on a Navy ship is that your patients can't miss follow up appointments. They live 20 metres away, and they can’t lie about their smoking status either. You live with them, and you see them smoking on the upper decks. Being part of the crew in that way is really cool. You are incorporated into the team, and you can really provide holistic care for them.  

Another situation that is specific to life on a ship is when we run exercises, where I would oversee mass casualty scenarios or where I would be a casualty myself and would assess how the rest of the team is able to take over my role and implement the succession plan that is in place for the medics.  

We do all sorts of scenarios - helicopter crashes on deck, fires and floods and all that sort of stuff and work through how we would respond to that. A lot of that is supported from back in Australia, where they give you advice and you can get some really good real-time advice from specialists, but you are still the person there, who must do it.  

One scenario I had was managing a patient with an orthopedic injury, that needed to be moved off the ship. I was able to get in touch with an orthopedic surgeon immediately to say this is what I'm seeing, this is what I'm feeling, and to organise the handover of that patient and get a plan from them.  

But you have no X Ray and you have no way of really telling them what is happening - just your examination findings. It's really pure clinical medicine.  

What is your day-to-day schedule on board a ship? 

As the doctor on board, you are kind of always ‘on’. I want my medics to feel comfortable to come and wake me up at any time for any patient if needed. And they do. There isn't a lot of occasions where that is necessary, but I would always expect them to come and get me for anything that is serious. 

So, the routine every day and each morning, I would see what's called sick parade, which is the people who have woken up that morning and feel like they cannot go to work that day, or they have got an issue that they need to see me about. 

That would typically go for a few hours in the morning and then I try and run a regular sort of GP schedule until the afternoon when we will usually do some training exercises. For example, we'll run a mass casualty scenario, a combat scenario, or we’ll run a damage control scenario - whatever it might be on that day, and then I’ll do another sick parade again in the afternoon and try and do one at about 1800 for the people who are asleep during the day because they work the night shift. 

So, typically, you are the only doctor on board, and you have a team of medics? 

I've been the only doctor on two ships I’ve served on and then I was on what's called an LHD (Landing Helicopter Dock) which had several doctors on it - we were going to Fiji, to provide aid there. 

But the other ships I've been on I've been the only doctor on board, along with a senior medic and one or two junior medics. The medics’ skill set is really different to what you see in the civilian space, they're trained really heavily in the trauma and battlefield casualty side by army and then on the ship they predominantly do primary care because that's what we see most of the time, and even though we're geared up and ready for something to happen to the ship and for there to be lots of casualties, the things we deal with every day are still coughs, colds, runny noses, orthopedic injuries, mental health and women's health. 

The medics I work with are amazing. They know the ship better than I ever will as they’ve usually been on there for years. I come on when deployed and I'm very aware that I am joining their sick bay. I'm just plugging into that - I'm an asset that will get taken off the ship and sent to the next one when we get home whereas they'll stay with the ship and look after those same guys, for a very long time.  

If you weren't in the Defence Force, do you have a sense of where else your Rural Generalist skills might take you?  

The remote and expedition space is where I want to stay. The Navy gives me great opportunities to do that, and as long as they keep giving me these cool trips and fun stories and things that make life more interesting and let me write an interesting memoir at the end of it all I'll keep doing it. 

But if I find that I can get an amazing opportunity to do that in a civilian space, then I'd consider that. There are heaps of opportunities for that in remote medicine, some of my mentors are in civilian land. Doctors that go on polar expeditions for example, or guys that go down with the Australian Antarctic division - that's all stuff that I would love to do. 

I’d also love to work on a submarine which I'm hoping to do with the Navy at some point.  

I would love to go and practice medicine in as far-flung places as you can imagine, in some seriously austere conditions - at the moment the Navy looks like my best bet to do that. 

How does it work for you, managing your pathway to Fellowship while working in the Navy and working remotely? How do you study and sit your exams, for example? 

It’s been great with ACRRM being able to make it all happen. I'm very glad that I went the way that I did as far as having someone facilitate and just say yes to all of the things that I'm trying to do in finishing my training. 

I put a case forward for being on a ship, being remote, and for that time to count towards training time and ACRRM came back straight away and said absolutely, of course, that makes perfect sense, you’ve put a decent case forward and we're happy to approve it. 

I also asked to be able to do my MCQ assessment on a ship and that posed its own issues because often there is no internet and I didn't have any internet for studying for that exam for a long time. I just looked like a crazy person with all these pins and scribblings all over the walls of my cabin. 

I was able to ask ACRRM if I could do that, and it was no trouble at all. They said, 'Of course, people do our exams in the middle of the bush all the time, people do our exams in Antarctica, people do our exams on ships, absolutely we can make that work.’ It was just that willingness and a flexibility to make it work that made it all possible. 

I think I had the most individualized exam ever because I had a member of the military police invigilating my exam. I was in the Captain's cabin on a warship - I was sitting there with this guy several feet away just watching me do the paper for about three and a half hours. The exam was sealed up and sent off, thankfully I passed and there was no issue. That has been the theme with ACRRM the whole time - if you're willing to put in the work and you are willing to do it, then they will make it work for you and they are not going to let the bureaucracy of this form, that form, get in the way of getting it done. 

What’s your advice for any prospective registrar who is considering a Rural Generalist pathway and a career in the Defence Force? 

I have a test that I apply to everything that I do in terms of medicine and life experience, which is... would this make a good story that I'd like to tell people down the line? And if you think it's going to make a good story and it's not going to stop you from telling other better stories than I don't see why you wouldn't do it. 

I've kind of chosen all my pathways based on that. 

There's nothing wrong with being a GP in a clinic who sees plenty of patients, and you can do that, but do you want to also tell some other interesting stories? The deployments that I've done definitely tick that box. 

That would be my advice - if you are going to make a decision based on where you're going to go, do you want to be a surgeon, for example, and do the same surgery hundreds and hundreds of times until you're perfect at it, which is an amazing skill, or do you want to do that and also tell some cool story about that time that you did that surgery in the back of a flatbed truck in a Pacific island country and really helped someone out. If you are after the exciting stories, then the Defence Force and a Rural Generalist pathway is worth considering.