Locum Earls and the Four-Hour Job

In 1992, towards the end of my short career in general practice, I found myself doing sessions in a clinic built mostly on tax evasion and medifraud. I was one of the new brooms brought in by new owners who played it totally straight, serviced patients instead of their hoarded Medicare cards and, soon enough, we realised viability was an issue.

As the practice limped along, I picked up one-off sessional work elsewhere through one of Brisbane’s bigger locum agencies, with the agency knowing I was up for a new permanent part-time job if the right opportunity arose. Soon enough, the ideal opportunity seemed to present itself. These were the days when general practice had recently been freed from the old rules that said a doctor or doctors always had to own the place, so entrepreneurs were trying their luck. The job was to be half-time – exactly what I wanted – in a brand new clinic on a main road on Brisbane’s inner southside. There were a couple of well-established practices right nearby – places with veteran GPs with good reputations – but in those days the entrepreneurs were deafened by the seductive ca-chunk of Medicare cards being processed and always felt we could grow the pie and bag our slice of it.

The new place, my workplace, was in a building that had been a real estate agency until a few weeks before, but it had been kitted out pretty well and seemed to have what I would need. The receptionist was ready to make appointments and set up files, had been trained to use the autoclave and was keen for me to dirty an instrument or two so that she could put it to use. The owner called around 8.32, two minutes into the job, and said, warmly, ‘Treat this as your own practice. We want this to be a long-term thing. We want people to feel you’re their GP.’

For the first two hours nothing happened. Down the road in both directions, at the established clinics, turnover was no doubt steady. The neighbourhood had already found its GPs. I sat at my desk editing the short story I had brought with exactly these circumstances in mind. I resisted the urge to make personal phone calls.

At 10.30, my first patient fronted up. I could hear mild excitement in the receptionist’s voice through the wall as she got the paperwork together. I opened my door, accepted the file optimistically numbered 000001 and asked him to come in.

He had heartburn, pure and simple. A mild case of it, typically at night. Nothing to find on examination. Job done in pretty quick time, no matter how thoroughly I did it. I gave him advice about weight loss, elevating the head of his bed and some over-the-counter antacids, and I advised him to return in a couple of weeks if he wasn’t noticing progress. He checked that I’d still be there and I assured him I would be. This was to be a long-term thing.

By the time I opened the door, I had legitimately had him with me just long enough to bill a standard consultation.

As I settled back into my editing, I wasn’t really paying attention when the receptionist made a phone call. I could hear her voice through the wall, but muffled. Then my phone buzzed. She said the owner was on the line and wanted to speak to me.

‘First patient, then,’ he said, as if I’d take the conversation from there.

I had no idea where it was supposed to go, so I just said, ‘Yes.’

‘But you didn’t make a follow-up appointment.’ That warm welcoming tone seemed to have gone missing.

‘No. It wasn’t indicated.’

‘But I thought you’d always do a follow-up appointment.’

‘Actually, you only do that if there’s a medical reason.’ This was the downside of working for the person who owned the building, rather than someone who knew the score. ‘If you did it routinely, it would be over-servicing, and the Medicare people would be onto that pretty quickly.’ Or not so quickly, if the fraud-based practice I was working for across town was any guide, but that was beside the point.

‘But what was wrong with him?’

At first, I thought I couldn’t have heard him properly. I got him to say it again. I asked him, quite sincerely, if this was doctor-to-doctor, and he actually had a medical degree I hadn’t been aware of. Red rag, meet bull.

‘But I’m the owner,’ he said, as if owner trumps all.

The call ended in the stand-off it was always going to. I explained confidentiality, he explained ownership. I told him the files were his property but not his business. He was outraged. He hung up on me.

Five minutes later, as I sat weighing up my options and wondering what quasi-medical hell I had got myself into, the phone rang outside. The receptionist put the call through to me. It was the agency, saying they’d just copped an earful from guess who about Locum Earls and his insubordination, lack of respect, etc, and that Locum Earls would be leaving at lunchtime and not coming back. My new name cranked the surreal feel of it up one more notch I didn’t need.

I set the agency manager straight. She got it, of course. Which immediately led to more outrage, but all on my side.

‘I’ll make him pay you for at least the whole day,’ she said. ‘Maybe the week. And I’ll be telling him why I’m not sending him anyone else. And then I’ll let the other agencies know.’

At precisely 12.30, with file 000002 still on the receptionist’s desk optimistically awaiting a name, I left and never went back.

I’ll never know how patient 000001 went with his reflux. But I do know that, if he returned a couple of months later, he would have found a real estate agency where a medical clinic had once, fleetingly, been.

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