Family doctor

WALKING into Peter Rich's waiting room comes very close to travelling through a time warp. The walls of the reception office bulge with handwritten patient notes.

"He's a technophobe," his long-serving staff share fondly with broad smiles. In our modern world, where doctors are surrounded by computers and are grouping together to share costs in sprawling offices, his surgery in the front room of a big old villa in New Plymouth's Powderham Street stands proudly alone.

There's no sign of a computer on the battered wooden desk that his GP dad purchased in 1945 for his Hawera family practice. Apparently he does own a computer, but it is hidden away in a cupboard.

"I can't type and I'd lose a lot of time if I used a computer," he explains.

The 66-year-old estimates there are about 2100 patients on his books, some of whom are now the third generation of the loyal patients who signed up with him 30 years back, when he hung up his first shingle in his rooms next door to the police station. The shingle, which reads Dr Peter Rich, MB ChB (Otago) FRNZCGP and Dip Obst (Auck), has now shifted with him and his patients three times around New Plymouth.

His great sorrow is that his Dip Obst (diploma in obstetrics) has become redundant. New Zealand now has a rare few GPs who continue to assist in the birth of babies.

He regrets that there's now a generation of GPs who have never witnessed the joy of a birth.

"It is a privilege to go to deliveries. I think it's a tragedy that GPs have been sidelined from obstetrics and working with midwives as our colleagues. Midwives do a great job but we can add an extra dimension."

As a result, GPs are now missing out on that special bonding with families when babies are born. He's also a fan of families being together during the birth just as he had done when he was young.



While computers might not be his thing, he is passionate about keeping up with health trends and drugs.

"People are living longer with the introduction of ace inhibitors (which lower blood pressure). They don't have that slow decline."

The ace inhibitors help your heart pump better and by lowering the blood pressure, you also protect your kidneys, Dr Rich says.

And he's already on the record supporting the use of cholesterol-lowering statins, which he describes as "wonderful".

In the interests of good bowel health and lowering the likelihood of putting yourself at risk of the ever-expanding diabetes epidemic, he believes white bread should be banned.

"I wish we could get people to eat less white bread and more wholemeal. All white bread should be ditched," he says with feeling.

The message about healthy eating is slowly getting through to adults, he says, but he fears for the young, a generation seemingly brought up on a surfeit of fast foods.

Some Taranaki practices are already being swamped with diabetics.

"On average, diabetes has added 8% to our workload. In 15 years in South Auckland, there won't be any money for anything but diabetes."

However, in Taranaki, patients are well served by GP diabetes checks used to identify those at risk.

"Poos" are a great diagnostic tool and the sure way to find out if you are getting enough roughage in your diet and what might ail you, Dr Rich says. It's a great icebreaker when you ask the kids in the surgery about their poos.

"Their faces light up. They love talking about their poos."

Dr Rich is a great supporter of the monthly GP peer review groups that were made compulsory at the beginning of the year.

His own group is a mini League of Nations, where they benefit from sharing their different methods of diagnosis and treatment.

His love of diversity and desire to keep up his skills means he enjoys taking his turn at the city's community medical and accident after-hours clinics the type of work that the 24/7 family GP would have taken care of in the past. "You never know what's going to walk through the door."

It's a message to the younger docs coming through that they, too, should hone their skills by doing the same.

"The younger ones do need to keep up their interest in emergency medicine."

Another of his fears for the future of general practice is that government restrictions, which stop GPs putting up their fees, is financially strangling them.

"Helen Clark froze the fees for the last two years. And John Key said they would continue to be frozen. They are allowed to go up with inflation only. The problem is it did not keep up with pay rises."

It was a painful blow when they were facing pay rises of 20% for their practice nurses and clerical staff pay. And there's another in the pipeline. There's no similar restrictions on any other business in New Zealand, he says.

"As a result, we're unable to do maintenance or buy new equipment. The result is a lot of unhappy younger doctors do not want to come into private practice because they don't want their prices frozen."

In the meantime, Dr Rich proudly remains computer illiterate. He is adamant he works faster, leaner and meaner without a computer.

And his patients love the fact that they get his full, undivided attention. There's a few on the books who have left the bigger practices in preference for the handful of sole-GP practices that remain in Taranaki, he says.

"Not everyone wants their GP to be part of a bigger practice. I think solo practices will continue to thrive."

By LYN HUMPHREYS lyn.humphreys@tnl.co.nz - Taranaki Daily News | Wednesday, 31 December 2008