Gp July 2012

Andrew Southcotton primary healthcare on primary healthcare

ISSUE 5: JULY 2012

04 Dr Andrew Southcott

08 GP Profi le

12 Dr Kathryn Fox

16 Exploring the medical museum

3

Parliament rests, but it’s a busy month for healthcare changes

THIS MONTH IN CANBERRA

July is an eventful month for the health sector. Sharon Lapkin looks at the past month in Canberra.

With the launch of the Personally

Controlled Electronic Health Record

(PCEHR) system and amendments to

the private health insurance rebate and

Medicare levy surcharge, Australians are

facing large changes in their healthcare.

July – which also includes Pneumonia

Awareness Week, Eye Health Awareness

Month and World Hepatitis Day – is

actually a quiet month in Canberra with

no parliamentary sittings.

However, there are major concerns

being expressed by healthcare

professionals and medical indemnity

insurers about the implementation of the

PCEHR.

President of the Medical Defence

Association (MDA), Associate Professor

Julian Rait told The Australian that the

MDA ‘had serious concerns about the

legal responsibilities doctors would face’

if they used the PCEHR, and warned

members ‘not to participate until these

problems are properly addressed’.

It has also been reported recently

in Australian Doctor that no insurers

have, as yet, stated whether they

would consider raising premiums, and

it remains unclear whether doctors’

indemnity insurance would ‘cover them

for claims arising from their use of the

PCEHR’. Australian Medical Association

(AMA) President Dr Steve Hambleton

has advised members not to sign up until

the AMA ‘is happy with the regulations

and that may not be before 1 July’.

The problem at the heart of the

issue is a government draft requiring

GPs taking part in the PCEHR to sign

a contract that states the government

is not liable if patients’ records are

breached.

The RACGP stated after viewing a

revision of the Participation Agreement

for use with Healthcare Provider

Organisations (HPOs) – which

addressed a number of concerns

previously raised by the RACGP – ‘that

unanimous concern still remained ... that

the agreement still did not provide clarity

relating to intellectual property clauses,

and the separation of responsibilities

between HPOs and individual healthcare

providers’.

The College is continuing to work with

the government and medical defence

organisations to ensure adequate

medicolegal protection for all users of the

PCEHR system.

Meanwhile, patients will be able to

sign up for a PCEHR from 1 July. The

government’s e-health learning centre

went live on 12 May, and from there

Australians will be able to register for

an e-health record online. A ‘Consumer

Portal’ can be accessed from the

website as well, which will allow patients

to access their e-health record after they

have registered.

Similarly, a ‘Provider Portal’ is available

for healthcare professionals to view

e-health records once patients have

given them permission to do so.

The legislative changes to the private

health insurance rebate and Medicare

Levy surcharge require that they be

income-tested against three-income

tier thresholds. According to the

Australian Taxation Offi ce, ‘higher

income earners will receive less private

health insurance rebate or, if they do

not have the appropriate level of private

patient hospital cover, the Medicare levy

surcharge may increase.’

The government expects to raise

$2.4 billion in revenue over 3 years

from means testing the rebate and has

promised to put it back into training

GPs and funding healthcare and

hospitals. But the Opposition claims

the government will pump the money

back into consolidated revenue to help

balance its budget. Like the rollout of the

PCEHR, only history will tell.

Reprinted from Good Practice Issue 5 – July 2012

4 Reprinted from Good Practice Issue 5 – July 2012

LEAD STORY

SHARON LAPKIN

Good Practice talks to Dr Andrew Southcott about his role as Shadow Parliamentary Secretary for Primary Healthcare.

It was Harvard law graduate, sociologist and

educator David Reisman who said that ‘if

you want to get out of medicine the fullest

enjoyment, be students all your lives’. Ask

Dr Andrew Southcott and he would probably

agree because his medical training kicked off

16 adventurous years of parliamentary service

as the federal member for Boothby in South

Australia. Along the way he picked up an

economics degree at Flinders University and

then returned to the University of Adelaide, the

site of his medical studies, to earn an MBA.

As the Shadow Parliamentary Secretary

for Primary Healthcare, politics is Southcott’s

true love, but it’s his medical education

and experience that provides him with the

necessary insight and understanding of his

portfolio. ‘I know the space’, which makes it

easier, he said.

After graduating in 1990, Southcott

completed his internship at the Royal Adelaide

Hospital from 1992–93. Then in 1994, he

was a surgical registrar in vascular surgery at

the Repatriation General Hospital in Daw Park,

and a surgical registrar at the Breast Cancer

Unit at Flinders Medical Centre. While he was

a political candidate, Southcott worked as a

locum medical practitioner and medical offi cer.

As an associate member of the RACGP, with a

non-practising medical registration, Southcott

said he has the prerequisite knowledge to ably

assist Shadow Minister for Health and Ageing

Peter Dutton in his portfolio.

Southcott has serious concerns about

the readiness of the Personally Controlled

Electronic Health Record system (PCEHR)

and describes its implementation as ‘nowhere

near ready’. ‘In principal’, he said, ‘an

electronic health record is a good idea’,

but he criticised the speed with which the

government has implemented the scheme and

the way it has attempted to create an e-health

system on a global scale over a 2-year time

frame. The Coalition, Southcott said, initially

explored the idea of a shared electronic health

record in 2004, and it supported the idea

as a progressive step forward. Despite its

concerns, the Opposition is committed to the

concept of a PCEHR, Southcott said, because

of the ‘potential benefi ts to patients and

practitioners alike’. He cited forecasts from

Booze and Co, showing that a comprehensive

and properly implemented e-health platform

could save up to 5000 deaths annually.

The Rudd government, Southcott said,

‘had a national e-health strategy prepared

for them in 2008, which laid out over 10

years, an incremental way of implementing

workable e-health solutions’. Instead of

introducing it gradually as recommended, he

said, ‘In April 2010, Kevin Rudd decided to

go for the big bang approach’ and create a

‘PCEHR for all Australians’.

The latest estimate for the arrival of the GP

software, Southcott said, is now September,

and while GPs will be reimbursed for

populating e-health records, it has to be done

in the context of a patient consultation with

some remuneration available under Medicare.

Although it’s an opt-in system, Southcott

expects very few will sign up and there won’t

be ‘a lot to see for it. Outside the wave

centres there will be nothing’, he added.

Southcott said he believes there will be a

big difference between people registering

for the PCEHR and those who actually use

the system. GPs and other practitioners

will only use it, he said, ‘if they fi nd it

useful’, and ‘nothing will replace taking a

detailed history and a focused examination’.

However, the PCEHR will have its uses, he

said, ‘principally for those people who have

Andrew Southcott on a doctor in parliame

being nt

5Reprinted from Good Practice Issue 5 – July 2012

chronic disease, who have multiple episodes

of care and multiple practitioners involved in

their care’. Southcott said the government

should have commenced its venture into

national electronic health records with

simple and inexpensive procedures within an

e-health context.

Regarding the reduction of the PIP

immunisation payments, Southcott said it

‘was very poor from a public health point of

view ... as we have seen large increases in

our immunisation levels of children’, due to

the institutional focus. The government is

becoming ‘complacent about immunisation,

and if we don’t maintain these high rates

it’s only a matter of time before we start

seeing preventable diseases of childhood

re-emerging’, he said. ‘The PIP was all

about people incentives to be immunised

and now all of the focus is on the stick

instead of the carrot.’

According to Southcott, ‘two of the

really big success stories of the Howard

government in the general practice space

were fi rstly, the computerisation of general

practice and secondly, immunisation

incentives’, which ‘we did through GPs and

we did it very successfully. It was a really

good model,’ he said.

An Abbott government, Southcott said,

‘would rebuild general practice’ because ‘we

want to see that general practice is at the

centre of the health system’. In terms of the

PCEHR, Southcott said a future Coalition

government would do a ‘stocktake of where

we’re at’, and ‘our approach would be to

look at practical things that we could achieve

such as electronic prescriptions and discharge

summaries’. He added that what they would

do depended on ‘what they fi nd’, if they took

offi ce after the next federal election. >>


LEAD STORY

>> Southcott said he was ‘very concerned

about a similar program’ to the PCEHR

in the UK, where ‘they spent £12 billion

and really don’t have a lot to show for all

that money’. He said e-health is an area

that can have enormous benefi ts, but also

where a lot of money could be wasted and

‘poor planning and implementation’ over 10

years on the summary care record in the

UK proved to be ‘fi nancially disastrous’.

An Abbott government would restore the

private health insurance rebate ‘as soon

as we can, when we can’, Southcott said.

‘We think private health insurance plays a

very important role in taking pressure off

the public system and in providing choice of

doctor, and also in terms of all of the allied

health offering as well.’

In the area of Indigenous health,

Southcott praised aspects of the ‘Close

the Gap’ initiative, and said he was

impressed with the way the RACGP was

working to increase cultural awareness and

improve primary healthcare for Indigenous

Australians. He also supports the way the

initiative works through general practice,

and said ‘we rely a lot on our 7000 general

practices and more than 20 000 GPs to do

these things. It’s just a matter of thinking

through “what is the gold standard I can do

for this patient”. Even if it’s through fairly

non-subjective surveys,’ he said, ‘fi nding

out who are the Aboriginal and Torres Strait

Islander patients in their practices’ so they

can provide the best healthcare available.

Despite advances and the College’s hard

work Southcott said there was still a

long way to go and a large gap in life

expectancy, mortality rates, complications

from diabetes and kidney disease in

Aborigines and Torres Strait Islanders.

The status of Labor’s GP Super Clinics

program is also something that concerns

Southcott. He said the Opposition would

rather have built on existing practices than

build super clinics, and added that ‘of the

64 promised clinics, only 24 are open, at

least three have required additional funding

and two have been scrapped completely’.

Southcott said he welcomed the news from

the Australian National Audit Offi ce that

it was now assessing ‘the effectiveness

of DoHA’s [Department of Health and

Ageing] administration of the GP Super

Clinics program, which is due to table in

autumn 2013.

Southcott appears pleased with his

career choice to move from medicine to

politics. ‘I enjoyed working in medicine

very much’, he said, ‘but I also had an

interest in politics and now I have a great

job where I get to think about and discuss

and make an impact in health policy across

the board’. In the future, Southcott said

he’d like to work with Peter Dutton, the

current Shadow Health Minister, in a

Coalition government to help implement

the Opposition’s health policy.

For now he is working hard in a portfolio

that includes primary healthcare, e-health

and preventive health. Southcott, married

with two school-aged children, also fi nds

time to complete the RACGP’s online

QI&CPD and is a big fan of the College’s

professional development check Program,

which he receives in hard copy.

Southcott is passionate about medical

education and an advocate of general

practice as a ‘very strong career option’ for

medical students. ‘There’s a lot going on in

that space’, he said, and ‘what’s happening

in the medical schools, the GP student

societies, GP registrars’ associations and

what the College does is making sure they

have a lot more exposure to general practice’

and the rich rewards of a career as a GP.

The PIP was all about people incentives to be immunised and now all of the focus is on the stick instead of the carrot.

Creating a relaxed and fun work environment is considered

a good way to keep workers happy and healthy.

Researchers tend to divide this into two categories:

‘organised fun’ and ‘organic fun’. The former refers to

events such as birthday celebrations and offi ce outings,

the latter to everyday activities such as telling jokes,

recounting stories and using nicknames. Encouraging

organic fun in particular can make workers feel supported,

which has been shown to improve psychological wellbeing

and reduce the risk of longterm absence from sickness.

In the context of a general practice, the benefi ts felt

by happy staff – such as less stress and increased

productivity – are likely to fl ow on to GPs.

Make work relaxed and more fun

NICK JOHNS-WICKBERG

Busy doctors spend their days taking care of their patients’ health, but we found some simple ways for GPs to stay healthy too.

Taking a quick walk outside between patients can be

benefi cial for body and mind. Even a few minutes of

fresh air every hour provides exercise, breaks up your

day and helps you to maintain the necessary levels of

vitamin D. This is especially important in winter, when

many Australians require up to half-an-hour of sun

exposure each day. Walking is also great for lowering

stress levels, so taking a brisk walk around the block can

be exactly what a busy doctor needs.

Go for a walk between patients

Going to and from work provides an excellent opportunity

to get some exercise, so consider ditching the car – and

the traffi c – for a bicycle. In 2010, Dutch researchers

found that people who cycled short distances instead of

driving had an estimated increased lifespan of between

3–14 months. The risks of cycling, such as exposure

to air pollution and traffi c accidents, were shown to be

minor in comparison. If you live far from work, think about

cycling or walking to the train station instead of driving. At

the other end, walk from the station to the offi ce. If you

live in the country, sans the smog, cycling can be even

better for you.

Four wheels? Try two, or zero

Looking after your own health

Enjoy a tropical smoothie to cure the winter blues

HEALTH


Ingredients

2 ripe bananas

I cup coconut milk

1 cup low-fat milk

2 tablespoons natural

or vanilla yoghurt

2 teaspoons Manuka honey

1 teaspoon linseed meal

4 ice cubes

Method

Place all ingredients into a

blender or food processor

and blend until smooth.

Serve immediately.

tropical smoothie to cure the winter blues

Ingredients

2 ripe bananas

I cup coconut milk

1 cup low-fat milk

2 tablespoons nat

or vanilla yoghurt

2 teaspoons Ma

teaspoon lin

4 ice cubes

Method

Place all in

blender o

and blen

Serve i

1

4

M

P

b

a

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Captain

Andrew Challen NICK JOHNS-WICKBERG

Working as a doctor in the Australian Army Medical Corps has brought Captain Andrew Challen a wealth of experiences.

GP PROFILE

As an Australian Army Medical Offi cer,

Captain Andrew Challen has been deployed

to Iraq, East Timor and Afghanistan, but

his service in Australia has also provided

valuable medical experience.

When Challen joined the Army as

a medical student in 2001, he looked

forward to the opportunity to work overseas

in a range of challenging environments. His

experiences to date include working in an

Afghan summer in temperatures of more

than 50 degrees Celsius, providing forward

resuscitation support from an armoured

ambulance in Iraq and performing medical

retrievals in a helicopter in low visibility

during East Timor’s wet season.

One of the incentives for Challen to

join the Army was a Defence University

Sponsorship, which paid him a salary while

he studied and took care of his remaining

HECS fees. The freedom to study

without worrying about

part-time work, as well

as the opportunity

to do medical work

overseas meant the

Photos

L to R:

Captain Andrew

Challen; outside the

medical centre in Afghanistan;

performing minor surgery in

Afghanistan.

ambulance in Iraq and performing med

retrievals in a helicopter in low visibility

during East Timor’s wet season.

One of the incentives for Challen to

join the Army was a Defence University

Sponsorship, which paid him a salary w

he studied and took care of his remain

HECS fees. The freedom to stud

without worrying about

part-time work, as w

as the opportunity

to do medical wo

overseas meant


Army was an attractive option for Challen.

He has also enjoyed and was inspired by

the mentorship offered by doctors within

the Army, who assisted him to prepare for

his medical career both in the Defence

Force and civilian life.

As part of the medical corps, Challen has

worked at Holsworthy Barracks in Sydney,

and Lavarack Barracks in Townsville. He

completed a Navy diving and submarine

medicine course in Sydney and has worked

extensively with soldiers’ training-related

injuries. However, it’s Challen’s overseas

work that has been the focal point of

his military career and given him with

far-reaching experiences.

As well as providing medical support

to ASLAV ambulances in Iraq, Challen

helped instruct Iraqi civilians in paramedics

and worked in a trauma bay attached to

the United States Forward Surgical Team.

As an aero-medical evacuation doctor

attached to the Timor Leste Aviation Group,

he completed more than 80 aero-medical

retrieval missions with the Australian Army

and the New Zealand Air Force.

And in 2009, in Afghanistan, Challen

provided primary healthcare to deployed

Australian soldiers, assisted in clinics for

Afghanistan locals and was team leader in

a Dutch-led hospital.

‘Every deployment has been rewarding

and challenging,’ Challen said. ‘It has also

provided me with an opportunity to grow

clinically and personally.’

The knowledge Challen has gained

during his deployments has also proven

useful in his civilian work in Australia,

especially when it comes to trauma cases.

‘Fortunately, in Australia the incidence of

major trauma is small,’ he said. ‘However,

for medical teams it often means that they

lack the depth of experience when dealing

with these patients.

‘My military experience has given me an

advanced understanding of the challenges

that these patients can pose to unwary or

inexperienced clinicians and has allowed

me to pass on my experience to junior

doctors.’

It is diffi cult to be prepared in a job that

can be unpredictable, but Challen said

military training had provided the best

possible preparation for medical offi cers.

‘The training the military provides to

medical personnel is increasingly more

realistic and is helping to better prepare our

doctors, nurses and medics for the rigours of

deployment,’ he said.

Now 32 years of age, Challen has

completed his fulltime military service and

commenced work in Fremantle Hospital’s

anaesthetics department. He remains an

Army Reservist, and is part of the 2nd

Health Support Battalion where one of

his roles is to educate new Army doctors

about advanced trauma life support in

battlefi eld situations.

Challen’s military experience has fostered

other professional interests in sports and

underwater medicine, which he has turned

into an impressive set of qualifi cations.

He has completed a Masters of Sports

Medicine, a Medical Offi cer’s course in

Underwater and Submarine Medicine, a

Certifi cate of Ultrasonography in Emergency

Medicine and is now undertaking a Diploma

in Hyperbaric Medicine.



MEDICAL EDUCATION

Studying with a little help from the ADF

NICK JOHNS-WICKBERG

The Australian Defence Force sponsors both undergraduate and graduate medical students.

The Defence University Sponsorship is

a program developed by the Australian

Defence Force (ADF) for undergraduate and

graduate students studying an accredited

degree at any recognised university in

Australia. It offers the following benefi ts:

• a salary while studying

• Higher Education Loan Program (HELP)

and student fees paid

• superannuation contribution of 18%

• subsidised accommodation

• free healthcare (dental and medical)

• a rewarding career as an offi cer in the

Navy, Army or Air Force.

Undergraduate students must have

completed one year of a three or four year

degree, or two years of a fi ve or six year

degree. They receive a salary while studying,

of up to $43 266. Graduates must have

completed a relevant undergraduate degree

and can receive a salary of up to $64 437

per year. All students in the program receive

18% superannuation. As soon as the student

is accepted into the ADF sponsorship

program, their remaining HELP fees are paid

by the ADF.

Once students have graduated they are

required to commit the same number of years

they were in a sponsorship, plus one year. So

if a student was sponsored for three years

they would need to serve four years in the

Navy, Army or Air Force. There is a minimum

requirement of three years.

Further information

www.defencejobs.gov.au/unisponsorship

Photo

Isabella Todd, a medical student studying at

the University of Queensland on a Defence

University Sponsorship.

‘Many students are yet to realise that they

can be sponsored later in their degree. If you

get to third year and decide Defence is really

where you want to be, you can apply for a

Defence University Sponsorship,’ she said.

MED BITES


WHO issues diesel fume warning

The World Health Organization (WHO)

has declared diesel fumes to be

carcinogenic. A committee from WHO’s

International Agency for Research on

Cancer (IARC) upgraded diesel exhaust’s

rating from ‘probable carcinogen’ to

‘carcinogen’ on the back of evidence

showing an increased risk of lung cancer

in heavily exposed workers.

WHO also found ‘limited evidence’

to suggest a positive association

between diesel exposure and bladder

cancer. However, it acknowledged the

classifi cation was based primarily on

studies involving workers with longterm

exposure, and health warnings for

the general population were just an

extension of those fi ndings.

Antipsychotic drugs reduce relapse in schizophrenicsA systematic review and meta-

analysis published in The Lancet

found keeping schizophrenia patients

on ‘maintenance treatment’ with

antipsychotic drugs after stabilisation

reduced the likelihood of relapse.

Researchers examined data from

116 appropriate reports with

information on 6493 patients. They

found that the rate of relapse within

a year of initial stabilisation was 27%

for patients given antipsychotic drugs,

compared with 64% for those

given placebos. Depot haloperidol

was found to be the most effective

treatment at preventing a relapse.

There were adverse side effects,

however, with patients on the drugs

4% more likely (10% vs 6%) to gain

weight, 7% more likely (16% vs 9%)

to suffer movement disorders and 4%

more likely (13% vs 9%) to experience

sedation. The authors advised that ‘the

advantages of these drugs must be

weighed against their side-effects’.

Stem cells can survive more than 2 weeks after death

Exciting new research from France

has found skeletal muscle stem cells in

humans can maintain their regenerative

capacities for up to 17 days after death.

The study, published in the journal, Nature

Communication, found stem cells are

capable of slowing their metabolism by

adopting a ‘reversible dormant state’,

which allows them to survive without

oxygen for an extended time. When placed

in culture, they retained their ability to

develop into muscle cells despite having

been dormant for so long. It had previously

been thought stem cells could not

survive more than 1–2 days after death.

Researchers acknowledged that further

research was needed before clinical trials

began, but said their work cleared the way

for similar studies on stem cells from other

organs and tissues in the body.

SHARON LAPKIN

Kathryn Fox has been compared to best-selling crime authors Patricia Cornwell and Kathy Reichs, and her study of medicine is an integral part of that success.

She describes herself as a medical

escapee, but Dr Kathryn Fox’s 12 years in

general practice play such an integral role in

her career as an internationally best-selling

crime writer that her medical training is

as relevant as it ever was. And indeed it

shows, for her latest novel Cold grave is a

gripping tale about forensic physician Dr

Anya Crichton’s attempt to uncover a series

of sexual assaults on board a luxury cruise

liner sailing a mysterious and lawless sea.

Despite her busy life as a successful

novelist, Fox said she missed some aspects

of general practice. ‘I do miss the contact

with people,’ and ‘the privilege of hearing

intricate details of people’s lives and trying

to help them through crises’, she said.

However, it’s clear Fox loves what she

does. Writing, she said, ‘took over’ her

life some years ago and due to the nature

of crime and thriller publishing, she has

needed to establish a readership and work

fulltime to maintain it. This means Fox

researches and writes 100 000 words

a year. ‘It’s like doing a masters every

year,’ she said. ‘A year sounds like a lot

for a book, but it’s not’, she added, when

you count touring and interviewing and

everything that goes with promoting a book.

Fox topped the Australian Capital

Territory in English in high school, and

she realised in years 11 and 12 that she

wanted to write, but in her early years

she didn’t know what she wanted to write

about. From the age of 5 years, she said,

she ‘was obsessed’ with fi nding a cure

for autism, hence her determination to go

into medicine. ‘I had a lot of empathy as

a child,’ she remembers, and can recall

watching a movie where the parents

of an autistic child removed all stimuli

and focused one-on-one with him and

‘brought him out of his autism’. At that

age Fox couldn’t imagine not being able

to communicate with her mother and

father, and them, equally, not being able

to hug her. She was drawn as a child to

non-verbal cues of communication such

as eye contact, and couldn’t perceive not

feeling that ‘warm, fuzzy love you get when

you connect and smile with someone’. As a

child, she said, ‘for me the worst possible

thing that could have happened in life was

to not be able to communicate’.

About the same time, Fox said, she

started hearing and reading about Helen

Keller. ‘I’m still fascinated with how

Helen Keller learnt,’ she said, referring

to the woman who earned a bachelor of

arts degree in 1904, despite being deaf

and blind. While Fox wanted to study

medicine to enable her to cure other

people’s communication diffi culties, she

also wanted to write so that she could

tell stories that connected people. This

is a theme that runs through her work as

a writer. She aims to entertain, but also

to present her readers with challenging

moral dilemmas. The joy of fi ction’, she

explained, is that it can raise topical

and controversial issues and present

different sides to the story and readers

can be educated and informed while being

entertained – if they’d like to be.’

While writing books that challenge

readers’ preconceptions and values, Fox

emphasised the importance of balance.

‘Medicine especially is full of moral

dilemmas,’ she said. ‘As a doctor you

Kathryn Fox on being a internationally acclaim

GP AUTHOR FEATURE

As a doctor you discover there’s no black and white, everything is very grey.

Photo

Opposite page: Dr Kathryn Fox


XXXXXXX XXXXXX > article by xxxxxxxxxxxxx

GP and an ed crime writer

discover there’s no black and white,

everything is very grey. That’s why you

can’t judge patients because you’re never

quite in their shoes, and you’re not there

to pass judgement.’ This understanding

is refl ected in Fox’s writing, which can be

read purely as the crime thriller genre,

or as a tale that challenges dominant

narratives and asks uncomfortable

questions. To get the most out of reading

Fox, however, the reader should enjoy

the adventure, but also contemplate the

moral dilemmas contained within it. On

her writing, she said: ‘I’m hoping I’m

not passing judgement. I’m presenting

information and I’m telling a story.

Primarily, I love to tell stories.’

Fox also likes to raise awareness and

bring subjects into mainstream media

that people may have not thought about

before. Her last novel, Death mask,

explored footballers and head injuries,

and footballers and bad behaviour. It

examined the culture of football and

the physical problems associated

with repetitive concussions. Fox also

noted a recent study had identifi ed a

correlation between chronic traumatic

encephalopathy (CTE), found on post

mortem, in Iraq and Afghanistan war

veterans who had committed suicide after

being close to repeated explosions during

their military service. The explosions

were thought to cause the same type

of damage as suffering repeated blows

to the head. CTE causes ‘impaired

judgement, poor impulse control, poor

memory, depression, addictive behaviours

and sexual inappropriateness’, Fox said.

‘I just try to open it up ... I ask why?’

she added, and agreed that her writing

was a mechanism to explore sometimes

disturbing topics and social issues. >>



BOOK GIVE-AWAY

Letters

Interested in providing feedback on Good

Practice? Please email your letters, including

your name, title, address and offi ce-hours phone

number, to [email protected] or post

to Editor, Good Practice, The RACGP,1 Palmerston

Crescent, South Melbourne, VIC 3025.

Note: letters must be under 200 words

and may be edited for clarity and space.

Good Practice free book give-away: Cold grave

by Kathryn Fox If you’d like a copy of Kathryn Fox’s new crime thriller, email your name and address to [email protected]. The fi rst 20 people will receive a free copy in the post.Title: Cold grave

Author: Kathryn Fox

Publisher: Pan Macmillan Australia:

www.panmacmillan.com.au

RRP: $27.99

Forensic physician Dr Anya Crichton needs a break. Cocooned

from the world aboard a luxury cruise ship, nothing can interrupt

time with her precious 6-year-old son.

Peace is shattered when the body of a teenage girl is discovered

shoved in a cupboard, dripping wet. With no obvious cause of

death and the nearest port days away, Crichton volunteers her

forensic expertise.

She quickly uncovers a sordid pattern of sexual assaults,

unchecked drug use and mysterious disappearances. With the

crew too afraid to talk, she is drawn into the underbelly of the

cruise line, its dangerous secrets and the murky waters of legal

accountabilities.

Book give-away closes 20 July 2012. All winners’ names will be published in the

August issue of Good Practice.

>> When she was a child Fox said she believed that ‘evil

did not exist as an entity, that it was merely a lesser degree

of good and conscience’, however, she has since changed

her mind. ‘Now I believe that evil really does exist – as an

absolute.’ The turning point for Fox was reading In cold

blood by Truman Capote, a fi ctionalised account of the

factual brutal murder of a family of four in Kansas in 1959,

for no apparent reason. She began to question whether the

common assumption that there was always a reason for an

evil act – that it could always be explained by something that

had happened to the perpetrator, or by a medical condition,

was correct. Sometimes, she said, ‘people are cruel and

destructive just because they can be’.

The treatment of women is an issue Fox takes

seriously, and she has studied world religions and the

cultural executions of those religions in relation to

women’s roles. Along with two friends – Linda Fairstein,

the United States’ foremost legal expert on domestic

and sexual violence and author; and Dr Kathy Reichs,

professor of forensic anthropology and an author – Fox

shares similar views on the way sexual assaults are

handled around the world. The trio support each other’s

writing and mutual concern about the disempowering

of women. They aim to raise awareness through public

speaking and through their writing and work to ‘give

voiceless people a voice in fi ction’.

The prevalence of domestic violence particularly

concerns Fox, and she works with female victims of

male violence to help them understand that ‘just because

someone assaults you and says I’m sorry I love you

doesn’t make it all right.’ ‘One of the things I’m really

passionate about’, she said, ‘is giving girls enough self-

esteem to know that love is an action not a word – love is

a series of actions’.

For Fox, ‘writing is like breathing’, and ‘once you

start exercising the right side of your brain it’s like a

fl oodgate’, she said. As a writer and a doctor, she fi nds

many similarities between the two. ‘When a patient comes

to you they are telling you a clue’, she said, ‘they don’t

necessarily know what is going on; you have to interview

and elicit, and then you do your investigation and then

come up with an hypothesis’ – the same as in a crime.

Fox is a linguistic thinker who thinks in words rather

than pictures. She writes the dialogue fi rst, almost like a

play. ‘Then I have to go in and put in the direction and the

description,’ she said. Prior to writing her fi rst novel, Fox

wrote freelance articles where she learnt the discipline of

writing everyday and the importance of word counts. She

also learnt, she said, that part of learning to be a writer

was being able to accept criticism and critique. ‘Writing is

about rewriting,’ she added, and ‘you have to read’.

When Fox was 16 years old, the Dalai Lama visited

Australia and she was lucky enough to meet him. As he

shook her hand he said: ‘I’m so glad to have fi nally met

you.’ It was a ‘static electricity handshake’ she said, and

for many years remained puzzled by his choice of words.

Eventually, that experience became the unlikely genesis for

her debut novel and the rest, as they say, is history.


www.agpt.com.au

Promoting quality general practice

education and training

A place for livingNICK JOHNS-WICKBERG

A breast cancer centre in Melbourne offers patients a range of free support services, including emergency accommodation.

The Think Pink Foundation’s Living Centre

(TLC) in Melbourne offers free support

services for men and women diagnosed with

breast cancer and those who care for them.

One of the centre’s most important

functions is providing a two-bedroom

apartment for patients who cannot afford to

stay in Melbourne for treatment.

Manager of operations at TLC Danielle

Spence, who has more than 10 years’

experience as a breast care nurse, said the

apartment has been a lifesaver for people who

would otherwise have to commute several

hours each day for radiotherapy courses

lasting up to 6 weeks.

The apartment is for people who live more

than 100 km from their treatment centre,

and they must be accompanied by a carer.

The apartment has proved to be very popular

and Spence and her colleagues rely on

referrals from rural GPs and other healthcare

professionals to select eligible patients.

‘It is pretty popular and we really leave it to

our rural breast care nurse colleagues to refer

people to us, because we try and base it on

needs,’ Spence said.

The centre’s other services include

counselling from breast care nurses,

professional massages, art therapy classes,

a wig salon and support groups for both

sufferers of cancer and their partners. It does

not offer treatment advice, instead focusing

on overall wellbeing.

Operated by the Think Pink Foundation,

TLC receives no government funding.

Spence said it relies on money from corporate

sponsors and private donors, and has no

political or religious affi liations. Fulltime breast

care nurses and administration staff are paid,

but all other employees volunteer.

Spence said TLC has ‘purposely tried to

not affi liate directly with a particular hospital,’

and ‘kept our independence by not taking

government funding’.

Although most services can be accessed

without a formal referral, Spence would like

to see more GPs recommending TLC to their

patients.

‘I think we are a great referral source,’ she

said. ‘This living centre is quite unique in that

everything we offer is free, and we do have

professional support in our breast care nurse

counsellors.’

Since opening in 2010, TLC has had

contact with more than 2000 patients and

carers. Think Pink hopes to increase this

number and is looking to open living centres in

other Australian cities.

NICK JOHNS-WICKBERG

Explore medical history at The University of Melbourne’s Medical History Museum.

In the late 19th century Australian GPs

had an important and wide-ranging role

in their communities. As well as treating

common injuries and ailments they would

perform surgery, deal with accidents,

practise obstetrics and administer

anaesthesia. They were mobile medical

saviours who would often make house

calls, carrying their livelihood in a large

wooden chest full of strange and

wonderful substances. Also playing

the role of pharmacist, they would use

these ingredients to make all manner of

medicines, many of which were low in

scientifi c value but high in hope.

Dr James Napthine worked during

the 19th century as a GP in Port Fairy

and Stawell. His medicine chest and its

contents are on display, along with more

than 6000 other interesting pieces, at

the University of Melbourne’s Museum of

Medical History.

The museum’s collection chronicles

the development of medical technology

in Australia and around the world, while

also celebrating the camaraderie and

quirkiness of life as a medical student.

Curator Dr Jacqueline Healy gives

free tours of the museum to doctors,

students and members of the public.

She said that ‘looking through the prism

of medical history’ could provide valuable

perspective for people in medical

careers.

‘I think by analysing past practice

it actually informs current practice,’

Healy said.

Fascinating exhibits are everywhere

at the museum. The most striking is

the transplanted Savory and Moore’s

pharmacy, which opened in 1849 in

London’s Belgrave Square and was

moved to the museum in 1971. The

pharmacy is a replica of its 19th century

original and similar in style to Australian

pharmacies of the time. Its shelves are

lined with scores of different medicines,

which would have been made onsite

by pharmacists when the store was

functional.

Hanging in the museum’s far right

corner is a photograph of an early

dissection class taken in 1864. Due to

complaints about the smell of cadavers,

the class was originally forced into

stables at the most remote corner of

Melbourne University, which Healy said

refl ected the view that medicine was

considered a ‘dirty’ profession at the

time. The photograph shows the full

cohort of medical students – all eight of

them – dissecting cadavers in their basic

facility.

Some of Australian medicine’s

more colourful characters also have

their stories told at the museum. Dr

James Beaney – affectionately known

as ‘Champagne Jimmy’ thanks to his

Explore medical his

MEDICAL HISTORY


Photo

L to R: Statue of Dr

James Beaney, the

Savory and Moore

pharmacy, Dr James

Naphine’s medicine

chest.

tory at the museum tendency to celebrate medical successes

with a bottle or two of the bubbly

beverage – was a senior surgeon at

the Melbourne Hospital. He achieved

notoriety in 1866, when he was accused

of murdering barmaid Mary Lewis by

performing an illegal abortion, but he was

acquitted after two trials. Champagne

Jimmy’s quirks are remembered in

a statuette, with his hair shaped into

devil’s horns and an empty bottle of his

favourite drink at his feet.

It’s easy to miss and doesn’t look

anything like its modern equivalent, but

one of the museum’s most interesting

artefacts is a hollow wooden tube with

an earpiece, which is actually an early

stethoscope. Invented by Frenchman

René Laënnec in 1816, the device,

which has become the medical

profession’s most recognisable symbol,

was initially ridiculed by doctors – who

instead preferred to press their ear

against the patient’s chest. As late as

1885, medical professionals continued

to shun the device, with one professor

saying ‘He that has ears to hear, let him

use his ears and not a stethoscope.’ The

design was later improved by replacing

the wood with rubber tubing and adding

a second earpiece, and the rest is

history.

The story of the stethoscope, Healy

said, sums up one of the most valuable

lessons of medical history,

which is that the most important

discoveries are often initially

dismissed.

According to Healy,

examining medical history can

help identify areas in which

the fi eld has not advanced

as it should. She nominated

an 1887 photograph of the

Melbourne Medical School’s

fi rst female students as an

example. The seven women

in the picture fought hard for

their right to study medicine,

and in the decades following

the photo many women had to

work harder than men for the

opportunity to study medicine.

Healy said she had noticed an

extraordinary interest in the history

of medicine. She meets doctors

of all ages pondering what their

profession would have been like in

previous generations. ‘You have the

senior doctors who are coming in

and looking at instruments like the

amputation kit and musing on the

difference that makes,’ she said.

Further information

Medical History Museum

The University of Melbourne

www.medicine.unimelb.edu.au

17Reprinted from Good Practice Issue 5 – July 2012 17

Leading primary care

25 – 27 October 2012Gold Coast

Convention and Exhibition Centre

Leading primary care is the overarching theme of The Royal Australian College of General Practitioners (RACGP) annual conference, focusing on practical skills to support your daily practice.

The program will explore the following key streams:

Chronic disease

Clinical skills

Education and training

e-health and the PCEHR

Men, women and children’s health

Skin and bones

Telehealth/Business innovations.

Register by 10 August 2012 and save up to $100 with early bird rates*

* Conditions apply. Visit www.gpconference.com.au for details.

View the conference program via your mobile, tablet or desktop computer. Visit www.gpconference.com.au/gp12program to:

Create your own program schedule

View session details

Take notes on sessions and workshops

Access speaker profiles.

For more information and to register go to www.gpconference.com.au

Guest speaker program

More guest speaker details to be confirmed.

Health reform: a citizen’s jury Saturday 27 October 9.00 am – 10.30 am

General practice leading primary care: showcasing the evidence Friday 26 October 3.45 pm – 5.00 pm

Stuart Patterson Lecture Leading primary care: health reforms, the UK perspective Thursday 25 October 11.30 am – 12.30 pm

What still has to be done to close the gap? Thursday 25 October 4.45 pm – 5.45 pm

Leaders in primary care Friday 26 October 9.00 am – 10.30 am

Professor Clare GeradaInternational keynote

Dr Harry PertInternational keynote

Dr John Buckley Facilitator

Dr Steve Hambleton

Professor Claire Jackson

Mr Mick Gooda Ms Mary Martin Associate Professor Brad Murphy

Ms Melissa Sweet Facilitator

Associate Professor Mark Wenitong

Dr Justin Coleman Professor Michael Kidd

Dr Malcolm Parmenter

Professor Jane Gunn

Dr Eleanor Chew Facilitator

Professor John Murtagh

Associate Professor Marie Pirotta

Dr Jeanette Ward


Most people travel to San Antonio in

Texas to see its most famous attraction,

the Alamo. The former Catholic mission

and its impressive fortress grounds were

the site of the Battle of Alamo in 1836.

And it was this setting that inspired John

Wayne to make a movie in 1960 about the

historic standoff between the Mexicans

and the Texans. The legendary actor

starred in it, along with a number of other

Hollywood heavyweights, and despite a

few historical inaccuracies it went on to

win an Academy Award and be nominated

for several others.

But it’s not the historic battles or the

famous buildings that attract some people to

San Antonio. It’s something far gentler. The

San Antonio Riverwalk, also known as Paseo

del Rio, is a charming network of pedestrian-

only pathways along the San Antonio River,

one story beneath the city proper. Like a

mini-Venice the narrow pea-green river winds

and loops around cafes, restaurants, hotels,

shops, gardens and historical sights. Built in

1929, the Riverwalk hugs the banks of the

river for almost 13 kilometres, and by 2013

local authorities hope to have lengthened it to

24 kilometres.

Arched fairytale-book footbridges allow

visitors to cross the river and explore the

Riverwalk from both sides. The famous

Arneson River Theatre sits snuggly on one

side of the river while the audience enjoys the

performance from grass-covered steps on

the other. Built in 1939, the unique theatre

was featured in the movie Miss Congeniality

starring Sandra Bullock and Michael Caine.

The colourful restaurants and cafes

dotted along the Riverwalk offer fi rst-

class Mexican food and margaritas, and

consuming such local delights requires

that you sit by the river and be serenaded

The San Antonio Riverwalk Sharon Lapkin

recalls the charm of San Antonio’s famous Riverwalk.


GET LOST

by charming Mexican mariachis. The Iron

Cactus Mexican Grill and Margarita Bar

serves a renowned signature margarita ‘El

Agave’, which is one of the best in Texas. It

can be enjoyed from the restaurant’s private

patio beside the river, although with more

than 100 tequilas to choose from the Iron

Cactus keeps some of its customers around

a bit longer than they intended.

The best accommodation near the Riverwalk

is the exquisite Victorian-era Menger Hotel.

Built in 1859 on the site of the fi rst brewery

in Texas, it sits a stone’s throw from the

Riverwalk and offers three levels of elegant

vintage architecture. The oldest continuously

operating hotel west of the Mississippi,

the Menger has played host to American

luminaries such as President Theodore

Roosevelt and baseball great Babe Ruth.

The main hall of the hotel’s lobby features

photographs of many of its famous guests,

along with antiques, artifacts and paintings

from the early days of United States’ history.

The Menger Bar, voted one of the most

historic bars in the United States, is the

legendary bar where Teddy Roosevelt recruited

his rough riders and, evidently, the site of more

cattle deals that any other location in Texas.

There are other more modern hotels in

San Antonio, and venturing into the city

proper reveals the seventh largest city in

the United States. There’s a fantastic zoo,

beautiful botanical gardens, the ornate

Majestic Theatre, which features a domed

theatre painted with clouds and stars, and four

18th-century missions to visit. But whatever

you do in San Antonio, be sure to linger along

the Riverwalk for as long as possible.

More information

San Antonio Convention and Visitors Bureau

http://www.visitsanantonio.com/index.aspx


BOOK REVIEWS

Seize the day: How the dying teach us to liveMarie de Hennezel is a psychologist

working in a French hospital for the

terminally ill. Her writing is well known

internationally and Princess Diana once

invited her to tea and told her she was so

moved by her book Intimate death, (this

book’s former title) she had read it ‘twice

running’.

In the foreword of this second edition

written by former French president

Francois Mitterrand, he laments the

inadequacy of the ‘modern spiritual desert’

to embrace the fi nal journey and says

that previous generations looked squarely

at death and ‘mapped the passage for

both the community and the individual’.

The author, he says, presents ‘a lesson

in living’, and ‘perhaps the most beautiful

lesson’, he adds, of this book is that

‘Death can cause a human being to

become what he or she was called to

become: it can be, in the fullest sense of

the word, an accomplishment.’

The author writes that ‘After years of

accompanying people through the living

of their fi nal moments, I do not know

anymore about death itself, but my trust

in life has only increased.’ She describes,

throughout the pages of her book, the

various patients she has assisted to die

with dignity. Some arrive at the hospital

with no knowledge of their impending

death, due to their close relatives’ inability

to accept their medical conditions rather

than any indication they cannot accept

their fate themselves. These people,

de Hennezel writes often think they’re

protecting the person who is dying, but

they are really trying to protect themselves.

This is a profound and unforgettable book.

Author: Marie de Hennezel

Format: softcover

Publisher: Scribe 2012

RRP: $24.95

How doctors thinkWritten for patients and physicians alike,

Dr Jerome Groopman’s How doctors

think is a fascinating insight into why

doctors make certain decisions, and why

they may not always get it right. Three

decades into an illustrious medical career,

including being a successful author and a

chair at the Harvard School of Medicine,

Groopman comes to the realisation that

doctors can miss crucial information

because they aren’t taught to listen to

what patients say and refl ect and think

deeply about it. He also notices fl aws in

algorithmic thinking methods being taught

to young doctors, which he says can be

useful in simple diagnoses but otherwise

‘constrain’ the mind.

Groopman explores these issues and

other aspects of the doctor’s psyche

through a combination of fi rsthand

accounts and case studies. He writes

that seemingly small factors can infl uence

diagnoses – the doctor’s mood on the day,

whether or not they like the patient, what

conditions the doctor is more accustomed

to seeing – and that an original

misdiagnosis can gain momentum, which

leads doctors further down the wrong path.

A staff writer at The New Yorker,

Groopman expresses complex medical

situations in a way ordinary people can

understand and enjoy. He encourages

patients to be active in their treatment

and ask questions if they are unsure of

anything.

This book reveals an illuminating view

of current medical practice and provides

patients, and doctors alike, with useful

information to make better judgements

together. Groopman draws on his extensive

experience, including his own as a patient,

to encourage his colleagues and patients

to develop more informed patient-doctor

relationships.

Author: Jerome Groopman

Format: softcover

Publisher: Scribe

RRP: $29.95


ADVERTISING ENQUIRIES

Kate Marie – T 0414 517122 E [email protected]

PHOTOS

Cover photo, pp5,6 © Andrew Southcott; pp8–10 © ADF; p13 © Kathryn

Fox; p15 © Think Pink Foundation; pp15,16,17 © Nick Johns-Wickberg;

pp16,17 © University of Melbourne; pp20,21 © Sharon Lapkin. All other

photos by shutterstock.

EDITORIAL NOTES

© The Royal Australian College of General Practitioners 2012. All rights

reserved. Requests for permission to reprint articles must be made to the editor.

The views contained herein are not necessarily the views of the RACGP,

its council, its members or its staff. The content of any advertising or

promotional material contained within Good Practice is not necessarily

endorsed by the publisher.

PUBLISHED BYThe Royal Australian College of General Practitioners

1 Palmerston Crescent, South Melbourne,

Victoria 3205

T 03 8699 0414

E [email protected]

www.racgp.org.au/goodpractice

ACN 000 223 807 ABN 34 000 223 807

ISSN 1837-7769

STAFFPublications Manager Helen Barry

Editor Sharon Lapkin

Writers Nick Johns-Wickberg, Sharon Lapkin

Graphic Designer Beverly Jongue

Production Coordinator Morgan Liotta

ADVERTISING ENQUIRIESKate Marie

T 0414 517122 E [email protected]

PHOTOSCover photo p.20–21 © Gregory Watson. All other photos by shutterstock.

EDITORIAL NOTES© The Royal Australian College of General Practitioners 2012

All rights reserved. Requests for permission to reprint articles must be

made to the editor.

The views contained herein are not necessarily the views of the RACGP,

its council, its members or its staff. The content of any advertising or

promotional material contained within Good Practice is not necessarily

endorsed by the publisher.

PUBLISHED BYThe Royal Australian College of General Practitioners

1 Palmerston Crescent, South Melbourne, Victoria 3205

T 03 8699 0414

E [email protected]

www.racgp.org.au/goodpractice

ACN 000 223 807 ABN 34 000 223 807

ISSN 1837-7769

STAFFManaging Editor Denese Warmington

Editor Sharon Lapkin

Journalist Nick Johns-Wickberg

Graphic Designer Beverly Jongue

Production Coordinator Morgan Liotta

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