Vivienne Cebola, Registrar

Vivienne is currently completing her basic term with SIGPET. She is working at the Balmoral Street Medical Centre in Hornsby, a very busy bulk-billing practice with the facilities to undertake small surgical procedures. Vivienne has more general experience than many of the registrars who are doing their basic terms because she took time off from her studies to travel the world and apply some of her medical knowledge before undertaking GP training.

Vivienne graduated from the University of NSW in 1998. She also completed a Masters of Public Health in Tropical Medicine at James Cook University. Since completing her intern and resident years on the Central and North Coasts, she has worked for Medecins Sans Frontiers in Angola, South Sudan and Mozambique. Vivienne has also worked as a District Medical Officer for NT Aboriginal Health Services. Describing herself as a "people person who is interested in the wellbeing of others", she wants to specialise in General Practice in order to continue to pursue a flexible and mobile career.

Here is a part of her story:

Why did you choose to train with SIGPET?
I was born and bred in the inner City - I have family here. I could go rural, and I love rural, but nobody's pushing me into the rural areas. At this stage, it suits me to be able to see my family. Later on, I'll move where I choose.

Being in the city is great. I was lucky. It was very hard to get into SIGPET back at the time I did my interview, in 1999 or 2000. To get into any non-rural stream was hard. It was a long interview and I was very relieved when I found out I was successful.

What made you decide to become a GP?
I guess I was always interested in roots medicine or getting back to basics - whether that's working in the rural communities or working in my favourite area, which is humanitarian aid.

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Did you have a plan?
Oh yeah! I always knew I was going to be a humanitarian worker. We've got so much public health to do here, not only with the aboriginal people, but with refugees and all sorts of other things. Somebody's got to care about the public matters and not do it for the money.

My internship was in Taree - it was my first hospital and was quite good because it gave me a lot of experience in a fast-paced environment. I did anything that could help me - obstetrics, gynaecology, psychiatry, bits of surgery because I was interested in that, and lots of emergency medicine. I used to fill in wherever they needed me, so I was quite flexible. Then I went out and did work over in the Northern Territory and other emergency departments through NSW.

That was all while I was doing my Masters of Public Health in Tropical Medicine, to be ready to go on my mission with Medecins Sans Frontiers. First I did my mission in South Sudan for over a year, and then I spent time traveling around and worked with some Italians in Mozambique. I then did another mission the following year, a couple of years after the first one, where I spent about a year in Angola. And now I'm back here to complete my GP training - because actually it's very flexible and you can make what you want out of it.

What do you perceive as the flexibility?
You can work in a medical centre and cut things out or you can sit in a practice and do a lot of psychological medicine. You can really do what you like. And it's roots medicine!

Vivienne at Hornsby GP Unit

What's it like to be training as a GP registrar?
Well - I guess training as a GP registrar is different depending on where you come from and where you are in your training. I mean, if you've done only hospital medicine for a couple of years, the first time you're exposed to this it's completely different.

In what way different?
You have to look at your patients in a different light - they're not just coming to see you for one day. You've got to look after them, and maybe their family, in the future, and you have to follow them up. It's a whole different scenario. You get a lot of things that may not seem so urgent, but you have to always remember the importance of the patient. If you haven't been doing this before, this is a shock! And there are a lot of areas which you might not have thought about because they're very low key in comparison with the emergency setting, but they're important in terms of the general public's perceptions of problems.

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Such as?
Hair loss, menopausal symptoms, basic screening and preventative activities. The well person's check. A lot of this you just don't see when you're going through the hospital system.

Do you enjoy these low key areas?
These areas will always open new doors to find new information, and even if you have been working in a lot of areas, there's always a new door opening every day. Something you could know more about, something you haven't seen in a while, something you're seeing for the first time. I guess I've been working in sort of a general practice area for some years - but most days I find something totally new. Or if not totally new, something I have questions about. As a registrar, you have the capacity to ask somebody, you've always got someone nearby, and you've got courses and lecture days.

How closely do you work with your Supervisor?
My supervisor here at Hornsby is Karen Oswald - and she's great. She's very informed, open-minded, easy to get on with and, although I don't need to access her every day with every patient, I'd always know that I could. Often I'll just leave it until our weekly meeting.

How does that work - with supervisors?
Depending on where you work and your supervisor, you can do different things. In some practices, the registrar sits in with the supervisor or the supervisor sits in with the registrar. Sometimes you can videotape a session and analyse it afterwards. Sometimes you just have quick corridor consultations about the day to day functioning - although there's not much time for corridor consultations here!

Sometimes Karen will see the patient I've just seen, sometimes I'll bring in notes if there's a query I want to discuss about the management of a patient. She's basically there for any trouble that I have and if anything comes to the attention of - anybody I guess, then she will get back to me on it. What Karen's taught me is an appreciation for what general practice is, I guess, and to realize that it can be anything.

And this practice is really suitable for a person like me because it's action packed! It's a medicare centre and it's got a good surgical capability where you can do minor procedures. You have old people, young people, middle-aged people, drop-ins as well as regular patients. There's so much in this practice that you never get bored.

But then if you're a person who prefers a sedate sort of environment, you could have only your pre-booked appointments and no procedures, you can do what you like. You can be a locum, go around the country, work in the Aboriginal Health Services, open up a practice anywhere in Australia. There's probably a need for GPs everywhere.

Did you get to choose this practice?
No. I was in Angola and we only had satellite phones - I just happened to get it because it's quite a busy practice for basic registrars. Usually you don't get a basic registrar here. It's really busy - I had 97 patients in four days last week.

Do you count?
As a GP registrar it's a requirement that you fill in a log book - which is useful. At a glance you can see what you've done - how many men, how many women, what kinds of cases, medications prescribed. It's helpful to reflect upon your job and what you're doing.

Tell me about your contact with SIGPET?
Louise Stone is my medical educator at SIGPET. I don't have to contact her often, but I know she's always there for me if I do need help or advice. My main contact with SIGPET is through the day releases or workshops - which are always interesting. Good to catch up with other registrars too.

How do you find the formal training program?
It's always good to recap on knowledge and bring it up to speed with the current treatments. You also need to give yourself time out to consolidate knowledge that you may have, but have been too busy to integrate with your practice. You have to make the time to sit and think about these things, or listen to someone who knows.

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