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Home  Orientation Visiting services
With a widely spread population and a shortage of health services, it is often necessary for doctors in rural areas to travel as a regular part of their work. This may affect your work in a number of ways.
 1. Local travel
It may be necessary to carry out more home visits than you ordinarily would in a city environment, especially if clients are not very mobile. Check with your Director of Training or placement supervisor to find out whether you require a current driver’s license.
2. Outreach services
You may also need to travel further afield, to provide services to smaller outlying regions. For example, you may work at the hospital four days a week and do a clinic in an outlying town one day a week. Due to the large distances in Australia, working in regional clinics may involve more driving than you are used to. Take care of your health and safety if travelling regularly, with particular attention to avoiding fatigue. If travelling in remote areas, you may need to familiarise yourself with off-road four wheel driving.
Many outreach services to remote areas are “flying doctor” style. Also referred to as “fly-in fly-out” services, these involve travelling to the region by plane, usually as part of a multidisciplinary team. Check with your DoT or placement supervisor to find out what the travel requirements will include.
3. Transfer patients
Some fly-out or other visiting services will transfer patients from their home to a larger regional hospital for further treatment. Even if you do not work with the visiting service, you may see patients who have been transferred from remote areas. In serious cases, patients may be transferred as inpatients, other times they may be brought in as day patients. A transferred inpatient will be the same as any other hospital admission, except that you may need to liaise with people in the town of origin. Day patient consultations are longer than usual, because within a single session you will need to complete your assessment and arrange a management plan.
 4. Patients who travel
Some patients may have to travel a considerable distance to reach their consultations with you. When seeing patients from a remote area, find out how far they are travelling and make allowances for this when structuring your appointments. It can be more productive to arrange longer appointments, both to allow for difficulties with travel and to ensure maximum benefit. You may also schedule multiple appointments for the same trip (e.g. assessment one day, with follow-up and management plan the next morning).
Ongoing management
Outreach visits may be infrequent and it is likely that patients will need attention between visits. This requires visiting specialists to liaise closely with local health professionals (e.g. nurses) and case workers, who will provide care in the meantime. Communication technology, from videoconference consultations to telephone follow-up, is a good way of maintaining contact with workers and patients in distant areas.
If working with a remote team, it is important to be familiar with writing a management plan, and the roles of other mental health workers.
Clinical Responsibility
In any visiting service scenario, an important consideration is clinical responsibility. If you are managing the patient from a distance, through local health services, all workers involved need to know who is responsible in the event that something goes wrong. Before involving yourself in any kind of outreach service or service involving transferred patients, you should discuss clinical responsibility with your supervisor and be clear about where that responsibility lies
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