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Working as a Doctor i the Australian Army Corps has brought Captain Andrew Challen a wealth of experience...Read more on pages 8,9 and 10.

Working as a Doctor i the Australian Army Corps has brought Captain Andrew Challen a wealth of experience...Read more on pages 8,9 and 10.

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    Gp July 2012 Gp July 2012 Document Transcript

    • AndrewSouthcotton primary healthcareISSUE 5: JULY 2012 04 Dr Andrew Southcott 08 GP Profile 12 Dr Kathryn Fox 16 Exploring the medical museum
    • THIS MONTH IN CANBERRAParliament rests, but it’s a busymonth for healthcare changesJuly is an eventful With the launch of the Personally previously raised by the RACGP – ‘that Controlled Electronic Health Record unanimous concern still remained ... thatmonth for the (PCEHR) system and amendments to the agreement still did not provide clarityhealth sector. the private health insurance rebate and relating to intellectual property clauses, Medicare levy surcharge, Australians are and the separation of responsibilitiesSharon Lapkin looks facing large changes in their healthcare. between HPOs and individual healthcareat the past month July – which also includes Pneumonia providers’. Awareness Week, Eye Health Awareness The College is continuing to work within Canberra. Month and World Hepatitis Day – is the government and medical defence actually a quiet month in Canberra with organisations to ensure adequate no parliamentary sittings. medicolegal protection for all users of the However, there are major concerns PCEHR system. being expressed by healthcare Meanwhile, patients will be able to professionals and medical indemnity sign up for a PCEHR from 1 July. The insurers about the implementation of the government’s e-health learning centre PCEHR. went live on 12 May, and from there President of the Medical Defence Australians will be able to register for Association (MDA), Associate Professor an e-health record online. A ‘Consumer Julian Rait told The Australian that the Portal’ can be accessed from the MDA ‘had serious concerns about the website as well, which will allow patients legal responsibilities doctors would face’ to access their e-health record after they if they used the PCEHR, and warned have registered. members ‘not to participate until these Similarly, a ‘Provider Portal’ is available problems are properly addressed’. for healthcare professionals to view It has also been reported recently e-health records once patients have in Australian Doctor that no insurers given them permission to do so. have, as yet, stated whether they The legislative changes to the private would consider raising premiums, and health insurance rebate and Medicare it remains unclear whether doctors’ Levy surcharge require that they be indemnity insurance would ‘cover them income-tested against three-income for claims arising from their use of the tier thresholds. According to the PCEHR’. Australian Medical Association Australian Taxation Office, ‘higher (AMA) President Dr Steve Hambleton income earners will receive less private has advised members not to sign up until health insurance rebate or, if they do the AMA ‘is happy with the regulations not have the appropriate level of private and that may not be before 1 July’. patient hospital cover, the Medicare levy The problem at the heart of the surcharge may increase.’ issue is a government draft requiring The government expects to raise GPs taking part in the PCEHR to sign $2.4 billion in revenue over 3 years a contract that states the government from means testing the rebate and has is not liable if patients’ records are promised to put it back into training breached. GPs and funding healthcare and The RACGP stated after viewing a hospitals. But the Opposition claims revision of the Participation Agreement the government will pump the money for use with Healthcare Provider back into consolidated revenue to help Organisations (HPOs) – which balance its budget. Like the rollout of the addressed a number of concerns PCEHR, only history will tell. Reprinted from Good Practice Issue 5 – July 2012 3
    • LEAD STORYAndrew Southcott ona doctor in parliameSHARON LAPKIN It was Harvard law graduate, sociologist and the way it has attempted to create an e-health educator David Reisman who said that ‘if system on a global scale over a 2-year time you want to get out of medicine the fullest frame. The Coalition, Southcott said, initially enjoyment, be students all your lives’. Ask explored the idea of a shared electronic healthGood Practice talks to Dr Andrew Southcott and he would probably record in 2004, and it supported the ideaDr Andrew Southcott agree because his medical training kicked off as a progressive step forward. Despite its 16 adventurous years of parliamentary service concerns, the Opposition is committed to theabout his role as as the federal member for Boothby in South concept of a PCEHR, Southcott said, becauseShadow Parliamentary Australia. Along the way he picked up an of the ‘potential benefits to patients and economics degree at Flinders University and practitioners alike’. He cited forecasts fromSecretary for Primary then returned to the University of Adelaide, the Booze and Co, showing that a comprehensiveHealthcare. site of his medical studies, to earn an MBA. As the Shadow Parliamentary Secretary and properly implemented e-health platform could save up to 5000 deaths annually. for Primary Healthcare, politics is Southcott’s The Rudd government, Southcott said, true love, but it’s his medical education ‘had a national e-health strategy prepared and experience that provides him with the for them in 2008, which laid out over 10 necessary insight and understanding of his years, an incremental way of implementing portfolio. ‘I know the space’, which makes it workable e-health solutions’. Instead of easier, he said. introducing it gradually as recommended, he After graduating in 1990, Southcott said, ‘In April 2010, Kevin Rudd decided to completed his internship at the Royal Adelaide go for the big bang approach’ and create a Hospital from 1992–93. Then in 1994, he ‘PCEHR for all Australians’. was a surgical registrar in vascular surgery at The latest estimate for the arrival of the GP the Repatriation General Hospital in Daw Park, software, Southcott said, is now September, and a surgical registrar at the Breast Cancer and while GPs will be reimbursed for Unit at Flinders Medical Centre. While he was populating e-health records, it has to be done a political candidate, Southcott worked as a in the context of a patient consultation with locum medical practitioner and medical officer. some remuneration available under Medicare. As an associate member of the RACGP, with a Although it’s an opt-in system, Southcott non-practising medical registration, Southcott expects very few will sign up and there won’t said he has the prerequisite knowledge to ably be ‘a lot to see for it. Outside the wave assist Shadow Minister for Health and Ageing centres there will be nothing’, he added. Peter Dutton in his portfolio. Southcott said he believes there will be a Southcott has serious concerns about big difference between people registering the readiness of the Personally Controlled for the PCEHR and those who actually use Electronic Health Record system (PCEHR) the system. GPs and other practitioners and describes its implementation as ‘nowhere will only use it, he said, ‘if they find it near ready’. ‘In principal’, he said, ‘an useful’, and ‘nothing will replace taking a electronic health record is a good idea’, detailed history and a focused examination’. but he criticised the speed with which the However, the PCEHR will have its uses, he government has implemented the scheme and said, ‘principally for those people who have4 Reprinted from Good Practice Issue 5 – July 2012
    • beingnt 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 firstly, 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 find’, if they took office after the next federal election. >> Reprinted from Good Practice Issue 5 – July 2012 5
    • LEAD STORY >> Southcott said he was ‘very concerned Southcott said he welcomed the news fromabout a similar program’ to the PCEHR the Australian National Audit Office thatin the UK, where ‘they spent £12 billion it was now assessing ‘the effectivenessand really don’t have a lot to show for all of DoHA’s [Department of Health andthat money’. He said e-health is an area Ageing] administration of the GP Superthat can have enormous benefits, but also Clinics program, which is due to table inwhere a lot of money could be wasted and autumn 2013.‘poor planning and implementation’ over 10 Southcott appears pleased with hisyears on the summary care record in the career choice to move from medicine toUK proved to be ‘financially disastrous’. politics. ‘I enjoyed working in medicine An Abbott government would restore the very much’, he said, ‘but I also had anprivate health insurance rebate ‘as soon interest in politics and now I have a greatas we can, when we can’, Southcott said. job where I get to think about and discuss‘We think private health insurance plays a and make an impact in health policy acrossvery important role in taking pressure off the board’. In the future, Southcott saidthe public system and in providing choice of he’d like to work with Peter Dutton, thedoctor, and also in terms of all of the allied current Shadow Health Minister, in ahealth offering as well.’ The PIP was all about Coalition government to help implement In the area of Indigenous health, people incentives to be the Opposition’s health policy.Southcott praised aspects of the ‘Close For now he is working hard in a portfoliothe Gap’ initiative, and said he was immunised and now all that includes primary healthcare, e-healthimpressed with the way the RACGP was of the focus is on the stick and preventive health. Southcott, marriedworking to increase cultural awareness and instead of the carrot. with two school-aged children, also findsimprove primary healthcare for Indigenous time to complete the RACGP’s onlineAustralians. He also supports the way the QI&CPD and is a big fan of the College’sinitiative works through general practice, long way to go and a large gap in life professional development check Program,and said ‘we rely a lot on our 7000 general expectancy, mortality rates, complications which he receives in hard copy.practices and more than 20 000 GPs to do from diabetes and kidney disease in Southcott is passionate about medicalthese things. It’s just a matter of thinking Aborigines and Torres Strait Islanders. education and an advocate of generalthrough “what is the gold standard I can do The status of Labor’s GP Super Clinics practice as a ‘very strong career option’ forfor this patient”. Even if it’s through fairly program is also something that concerns medical students. ‘There’s a lot going on innon-subjective surveys,’ he said, ‘finding Southcott. He said the Opposition would that space’, he said, and ‘what’s happeningout who are the Aboriginal and Torres Strait rather have built on existing practices than in the medical schools, the GP studentIslander patients in their practices’ so they build super clinics, and added that ‘of the societies, GP registrars’ associations andcan provide the best healthcare available. 64 promised clinics, only 24 are open, at what the College does is making sure theyDespite advances and the College’s hard least three have required additional funding have a lot more exposure to general practice’work Southcott said there was still a and two have been scrapped completely’. and the rich rewards of a career as a GP.6 Reprinted from Good Practice Issue 5 – July 2012
    • HEALTHLooking after your own healthNICK JOHNS-WICKBERG Four wheels? Try two, or zeroBusy doctors spend their days taking Going to and from work provides an excellent opportunity to get some exercise, so consider ditching the car – andcare of their patients’ health, but we the traffic – for a bicycle. In 2010, Dutch researchersfound some simple ways for GPs to found that people who cycled short distances instead of driving had an estimated increased lifespan of betweenstay healthy too. 3–14 months. The risks of cycling, such as exposure to air pollution and traffic 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 office. If you live in the country, sans the smog, cycling can be even Enjoy a better for you. tropical smoothie Go for a walk between patients to cure the winter blues Taking a quick walk outside between patients can be beneficial 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 Ingredients exposure each day. Walking is also great for lowering 2 ripe bananas stress levels, so taking a brisk walk around the block can I cup coconut milk be exactly what a busy doctor needs. 1 cup low-fat milk 2 tablespoons natural nat or vanilla yoghurt 2 teaspoons Manuka honey Ma 1 teaspoon lin linseed meal Make work relaxed and more fun 4 ice cubes M Method Creating a relaxed and fun work environment is considered P Place all in ingredients into a a good way to keep workers happy and healthy. blender or food processor b o Researchers tend to divide this into two categories: and blend until smooth. a blen ‘organised fun’ and ‘organic fun’. The former refers to Serve immediately. S i events such as birthday celebrations and office 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 benefits felt by happy staff – such as less stress and increased productivity – are likely to flow on to GPs. Reprinted from Good Practice Issue 5 – July 2012 7
    • GP PROFILE As an Australian Army Medical Officer, Captain Andrew Challen has been deployed to Iraq, East Timor and Afghanistan, but his service in Australia has also provided valuable medical experience.Captain When Challen joined the Army as a medical student in 2001, he lookedAndrew Challen forward to the opportunity to work overseas in a range of challenging environments. His experiences to date include working in an NICK JOHNS-WICKBERG Afghan summer in temperatures of more than 50 degrees Celsius, providing forward resuscitation support from an armouredWorking as a doctor ambulance in Iraq and performing med medical retrievals in a helicopter in low visibilityin the Australian Army during East Timor’s wet season. One of the incentives for Challen toMedical Corps has join the Army was a Defence Universitybrought Captain Andrew Sponsorship, which paid him a salary w while he studied and took care of his remaining remainChallen a wealth of HECS fees. The freedom to study studexperiences. without worrying about part-time work, as w well as the opportunity to do medical wo work overseas meant thePhotosL to R:Captain AndrewChallen; outside themedical centre in Afghanistan;performing minor surgery inAfghanistan.8 Reprinted from Good Practice Issue 5 – July 2012
    • Army was an attractive option for Challen. And in 2009, in Afghanistan, Challen military training had provided the bestHe has also enjoyed and was inspired by provided primary healthcare to deployed possible preparation for medical officers.the mentorship offered by doctors within Australian soldiers, assisted in clinics for ‘The training the military provides tothe Army, who assisted him to prepare for Afghanistan locals and was team leader in medical personnel is increasingly morehis medical career both in the Defence a Dutch-led hospital. realistic and is helping to better prepare ourForce and civilian life. ‘Every deployment has been rewarding doctors, nurses and medics for the rigours of As part of the medical corps, Challen has and challenging,’ Challen said. ‘It has also deployment,’ he said.worked at Holsworthy Barracks in Sydney, provided me with an opportunity to grow Now 32 years of age, Challen hasand Lavarack Barracks in Townsville. He clinically and personally.’ completed his fulltime military service andcompleted a Navy diving and submarine The knowledge Challen has gained commenced work in Fremantle Hospital’smedicine course in Sydney and has worked during his deployments has also proven anaesthetics department. He remains anextensively with soldiers’ training-related useful in his civilian work in Australia, Army Reservist, and is part of the 2ndinjuries. However, it’s Challen’s overseas especially when it comes to trauma cases. Health Support Battalion where one ofwork that has been the focal point of ‘Fortunately, in Australia the incidence of his roles is to educate new Army doctorshis military career and given him with major trauma is small,’ he said. ‘However, about advanced trauma life support infar-reaching experiences. for medical teams it often means that they battlefield situations. As well as providing medical support lack the depth of experience when dealing Challen’s military experience has fosteredto ASLAV ambulances in Iraq, Challen with these patients. other professional interests in sports andhelped instruct Iraqi civilians in paramedics ‘My military experience has given me an underwater medicine, which he has turnedand worked in a trauma bay attached to advanced understanding of the challenges into an impressive set of qualifications.the United States Forward Surgical Team. that these patients can pose to unwary or He has completed a Masters of SportsAs an aero-medical evacuation doctor inexperienced clinicians and has allowed Medicine, a Medical Officer’s course inattached to the Timor Leste Aviation Group, me to pass on my experience to junior Underwater and Submarine Medicine, ahe completed more than 80 aero-medical doctors.’ Certificate of Ultrasonography in Emergencyretrieval missions with the Australian Army It is difficult to be prepared in a job that Medicine and is now undertaking a Diplomaand the New Zealand Air Force. can be unpredictable, but Challen said in Hyperbaric Medicine. Reprinted from Good Practice Issue 5 – July 2012 9
    • MEDICAL EDUCATIONStudying with a littlehelp from the ADF NICK JOHNS-WICKBERGThe AustralianDefence Forcesponsors bothundergraduate andgraduate medicalstudents. The Defence University Sponsorship is of up to $43 266. Graduates must have a program developed by the Australian completed a relevant undergraduate degree Defence Force (ADF) for undergraduate and and can receive a salary of up to $64 437 graduate students studying an accredited per year. All students in the program receive degree at any recognised university in 18% superannuation. As soon as the student Australia. It offers the following benefits: is accepted into the ADF sponsorship • a salary while studying program, their remaining HELP fees are paid • Higher Education Loan Program (HELP) by the ADF. and student fees paid Once students have graduated they are • superannuation contribution of 18% required to commit the same number of yearsPhoto • subsidised accommodation they were in a sponsorship, plus one year. SoIsabella Todd, a medical student studying at • free healthcare (dental and medical) if a student was sponsored for three yearsthe University of Queensland on a Defence • a rewarding career as an officer in the they would need to serve four years in theUniversity Sponsorship. Navy, Army or Air Force. Navy, Army or Air Force. There is a minimum‘Many students are yet to realise that they Undergraduate students must have requirement of three years.can be sponsored later in their degree. If youget to third year and decide Defence is really completed one year of a three or four yearwhere you want to be, you can apply for a degree, or two years of a five or six year Further informationDefence University Sponsorship,’ she said. degree. They receive a salary while studying, www.defencejobs.gov.au/unisponsorship10 Reprinted from Good Practice Issue 5 – July 2012
    • MED BITESStem cells can survive morethan 2 weeks after deathExciting new research from France in culture, they retained their ability tohas found skeletal muscle stem cells in develop into muscle cells despite havinghumans can maintain their regenerative been dormant for so long. It had previouslycapacities for up to 17 days after death. been thought stem cells could notThe study, published in the journal, Nature survive more than 1–2 days after death.Communication, found stem cells are Researchers acknowledged that furthercapable of slowing their metabolism by research was needed before clinical trialsadopting a ‘reversible dormant state’, began, but said their work cleared the waywhich allows them to survive without for similar studies on stem cells from otheroxygen for an extended time. When placed organs and tissues in the body.Antipsychotic drugs reducerelapse in schizophrenicsA systematic review and meta- given placebos. Depot haloperidolanalysis published in The Lancet was found to be the most effectivefound keeping schizophrenia patients treatment at preventing a relapse.on ‘maintenance treatment’ with There were adverse side effects,antipsychotic drugs after stabilisation however, with patients on the drugsreduced the likelihood of relapse. 4% more likely (10% vs 6%) to gainResearchers examined data from weight, 7% more likely (16% vs 9%)116 appropriate reports with to suffer movement disorders and 4%information on 6493 patients. They more likely (13% vs 9%) to experiencefound that the rate of relapse within sedation. The authors advised that ‘thea year of initial stabilisation was 27% advantages of these drugs must befor patients given antipsychotic drugs, weighed against their side-effects’.compared with 64% for thoseWHO issues diesel fume warningThe World Health Organization (WHO) WHO also found ‘limited evidence’has declared diesel fumes to be to suggest a positive associationcarcinogenic. A committee from WHO’s between diesel exposure and bladderInternational Agency for Research on cancer. However, it acknowledged theCancer (IARC) upgraded diesel exhaust’s classification was based primarily onrating from ‘probable carcinogen’ to studies involving workers with longterm‘carcinogen’ on the back of evidence exposure, and health warnings forshowing an increased risk of lung cancer the general population were just anin heavily exposed workers. extension of those findings. Reprinted from Good Practice Issue 5 – July 2012 11
    • GP AUTHOR FEATUREKathryn Fox on being ainternationally acclaim SHARON LAPKIN She describes herself as a medical age Fox couldn’t imagine not being able escapee, but Dr Kathryn Fox’s 12 years in to communicate with her mother and general practice play such an integral role in father, and them, equally, not being able her career as an internationally best-selling to hug her. She was drawn as a child toKathryn Fox has been crime writer that her medical training is non-verbal cues of communication suchcompared to best- as relevant as it ever was. And indeed it as eye contact, and couldn’t perceive not shows, for her latest novel Cold grave is a feeling that ‘warm, fuzzy love you get whenselling crime authors gripping tale about forensic physician Dr you connect and smile with someone’. As aPatricia Cornwell and Anya Crichton’s attempt to uncover a series of sexual assaults on board a luxury cruise child, she said, ‘for me the worst possible thing that could have happened in life wasKathy Reichs, and her liner sailing a mysterious and lawless sea. to not be able to communicate’. Despite her busy life as a successful About the same time, Fox said, shestudy of medicine is novelist, Fox said she missed some aspects started hearing and reading about Helenan integral part of of general practice. ‘I do miss the contact Keller. ‘I’m still fascinated with how with people,’ and ‘the privilege of hearing Helen Keller learnt,’ she said, referringthat success. intricate details of people’s lives and trying to help them through crises’, she said. However, it’s clear Fox loves what she As a doctor you discover does. Writing, she said, ‘took over’ her there’s no black and white, life some years ago and due to the nature everything is very grey. of crime and thriller publishing, she has needed to establish a readership and work fulltime to maintain it. This means Fox to the woman who earned a bachelor of researches and writes 100 000 words arts degree in 1904, despite being deaf a year. ‘It’s like doing a masters every and blind. While Fox wanted to study year,’ she said. ‘A year sounds like a lot medicine to enable her to cure other for a book, but it’s not’, she added, when people’s communication difficulties, she you count touring and interviewing and also wanted to write so that she could everything that goes with promoting a book. tell stories that connected people. This Fox topped the Australian Capital is a theme that runs through her work as Territory in English in high school, and a writer. She aims to entertain, but also she realised in years 11 and 12 that she to present her readers with challenging wanted to write, but in her early years moral dilemmas. The joy of fiction’, she she didn’t know what she wanted to write explained, is that it can raise topical about. From the age of 5 years, she said, and controversial issues and present she ‘was obsessed’ with finding a cure different sides to the story and readers for autism, hence her determination to go can be educated and informed while being into medicine. ‘I had a lot of empathy as entertained – if they’d like to be.’ a child,’ she remembers, and can recall While writing books that challenge watching a movie where the parents readers’ preconceptions and values, Fox of an autistic child removed all stimuli emphasised the importance of balance.Photo and focused one-on-one with him and ‘Medicine especially is full of moralOpposite page: Dr Kathryn Fox ‘brought him out of his autism’. At that dilemmas,’ she said. ‘As a doctor you12 Reprinted from Good Practice Issue 5 – July 2012
    • XXXXXXX XXXXXX > article by xxxxxxxxxxxxxGP and aned 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 reflected 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 identified 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. > > Reprinted from Good Practice Issue 5 – July 2012 13
    • BOOK GIVE-AWAY >> When she was a child Fox said she believed that ‘evil did not exist as an entity, that it was merely a lesser degree Good Practice free book 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 give-away: Cold grave blood by Truman Capote, a fictionalised 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 by Kathryn Fox 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, If you’d like a copy was correct. Sometimes, she said, ‘people are cruel and destructive just because they can be’. of Kathryn Fox’s new The treatment of women is an issue Fox takes crime thriller, email seriously, and she has studied world religions and the cultural executions of those religions in relation to your name and address women’s roles. Along with two friends – Linda Fairstein, the United States’ foremost legal expert on domestic to goodpractice@ and sexual violence and author; and Dr Kathy Reichs, racgp.org.au. The first professor of forensic anthropology and an author – Fox shares similar views on the way sexual assaults are 20 people will receive handled around the world. The trio support each other’s a free copy in the post. writing and mutual concern about the disempowering of women. They aim to raise awareness through public Title: Cold grave Author: Kathryn Fox speaking and through their writing and work to ‘give Publisher: Pan Macmillan Australia: voiceless people a voice in fiction’. www.panmacmillan.com.au The prevalence of domestic violence particularly RRP: $27.99 concerns Fox, and she works with female victims of male violence to help them understand that ‘just because Forensic physician Dr Anya Crichton needs a break. Cocooned someone assaults you and says I’m sorry I love you from the world aboard a luxury cruise ship, nothing can interrupt doesn’t make it all right.’ ‘One of the things I’m really time with her precious 6-year-old son. passionate about’, she said, ‘is giving girls enough self- Peace is shattered when the body of a teenage girl is discovered esteem to know that love is an action not a word – love is shoved in a cupboard, dripping wet. With no obvious cause of a series of actions’. death and the nearest port days away, Crichton volunteers her For Fox, ‘writing is like breathing’, and ‘once you forensic expertise. start exercising the right side of your brain it’s like a She quickly uncovers a sordid pattern of sexual assaults, floodgate’, she said. As a writer and a doctor, she finds unchecked drug use and mysterious disappearances. With the many similarities between the two. ‘When a patient comes crew too afraid to talk, she is drawn into the underbelly of the to you they are telling you a clue’, she said, ‘they don’t cruise line, its dangerous secrets and the murky waters of legal necessarily know what is going on; you have to interview accountabilities. and elicit, and then you do your investigation and then Book give-away closes 20 July 2012. All winners’ names will be published in the come up with an hypothesis’ – the same as in a crime. August issue of Good Practice. Fox is a linguistic thinker who thinks in words rather than pictures. She writes the dialogue first, almost like a play. ‘Then I have to go in and put in the direction and the description,’ she said. Prior to writing her first novel, Fox wrote freelance articles where she learnt the discipline of Letters writing everyday and the importance of word counts. She also learnt, she said, that part of learning to be a writer Interested in providing feedback on Good was being able to accept criticism and critique. ‘Writing is Practice? Please email your letters, including about rewriting,’ she added, and ‘you have to read’. your name, title, address and office-hours phone When Fox was 16 years old, the Dalai Lama visited number, to goodpractice@racgp.org.au or post Australia and she was lucky enough to meet him. As he to Editor, Good Practice, The RACGP,1 Palmerston shook her hand he said: ‘I’m so glad to have finally met Crescent, South Melbourne, VIC 3025. you.’ It was a ‘static electricity handshake’ she said, and Note: letters must be under 200 words for many years remained puzzled by his choice of words. and may be edited for clarity and space. Eventually, that experience became the unlikely genesis for her debut novel and the rest, as they say, is history.14 Reprinted from Good Practice Issue 5 – July 2012
    • A place for livingNICK JOHNS-WICKBERG The Think Pink Foundation’s Living Centre (TLC) in Melbourne offers free support services for men and women diagnosed withA breast cancer centre breast cancer and those who care for them. One of the centre’s most importantin Melbourne offers functions is providing a two-bedroompatients a range of apartment for patients who cannot afford to stay in Melbourne for treatment.free support services, Manager of operations at TLC Danielleincluding emergency Spence, who has more than 10 years’ experience as a breast care nurse, said theaccommodation. apartment has been a lifesaver for people who would otherwise have to commute several Spence said it relies on money from corporate hours each day for radiotherapy courses sponsors and private donors, and has no lasting up to 6 weeks. political or religious affiliations. Fulltime breast The apartment is for people who live more care nurses and administration staff are paid, than 100 km from their treatment centre, but all other employees volunteer. and they must be accompanied by a carer. Spence said TLC has ‘purposely tried to The apartment has proved to be very popular not affiliate directly with a particular hospital,’ and Spence and her colleagues rely on and ‘kept our independence by not taking referrals from rural GPs and other healthcare government funding’. professionals to select eligible patients. Although most services can be accessed ‘It is pretty popular and we really leave it to without a formal referral, Spence would like our rural breast care nurse colleagues to refer to see more GPs recommending TLC to their people to us, because we try and base it on patients. needs,’ Spence said. ‘I think we are a great referral source,’ she The centre’s other services include said. ‘This living centre is quite unique in that counselling from breast care nurses, everything we offer is free, and we do have professional massages, art therapy classes, professional support in our breast care nurse a wig salon and support groups for both counsellors.’ sufferers of cancer and their partners. It does Since opening in 2010, TLC has had not offer treatment advice, instead focusing contact with more than 2000 patients and on overall wellbeing. carers. Think Pink hopes to increase this Operated by the Think Pink Foundation, number and is looking to open living centres in TLC receives no government funding. other Australian cities. Promoting quality general practice education and training www.agpt.com.au Reprinted from Good Practice Issue 5 – July 2012 15
    • MEDICAL HISTORY Explore medical his NICK JOHNS-WICKBERG In the late 19th century Australian GPs ‘I think by analysing past practice had an important and wide-ranging role it actually informs current practice,’ in their communities. As well as treating Healy said. common injuries and ailments they would Fascinating exhibits are everywhere Explore medical perform surgery, deal with accidents, at the museum. The most striking is history at The practise obstetrics and administer the transplanted Savory and Moore’s anaesthesia. They were mobile medical pharmacy, which opened in 1849 in University of saviours who would often make house London’s Belgrave Square and was Melbourne’s Medical calls, carrying their livelihood in a large moved to the museum in 1971. The wooden chest full of strange and pharmacy is a replica of its 19th century History Museum. wonderful substances. Also playing original and similar in style to Australian the role of pharmacist, they would use pharmacies of the time. Its shelves are these ingredients to make all manner of lined with scores of different medicines, medicines, many of which were low in which would have been made onsite scientific value but high in hope. by pharmacists when the store was Dr James Napthine worked during functional. the 19th century as a GP in Port Fairy Hanging in the museum’s far right and Stawell. His medicine chest and its corner is a photograph of an early contents are on display, along with more dissection class taken in 1864. Due to than 6000 other interesting pieces, at complaints about the smell of cadavers, the University of Melbourne’s Museum of the class was originally forced into Medical History. stables at the most remote corner of The museum’s collection chronicles Melbourne University, which Healy said the development of medical technology reflected the view that medicine was in Australia and around the world, while considered a ‘dirty’ profession at the also celebrating the camaraderie and time. The photograph shows the full quirkiness of life as a medical student. cohort of medical students – all eight of Curator Dr Jacqueline Healy gives them – dissecting cadavers in their basic Photo free tours of the museum to doctors, facility. L to R: Statue of Dr students and members of the public. Some of Australian medicine’s James Beaney, the She said that ‘looking through the prism more colourful characters also have Savory and Moore pharmacy, Dr James of medical history’ could provide valuable their stories told at the museum. Dr Naphine’s medicine perspective for people in medical James Beaney – affectionately known chest. careers. as ‘Champagne Jimmy’ thanks to his16 Reprinted from Good Practice Issue 5 – July 2012
    • tory at the museum tendency to celebrate medical successes lessons of medical history, with a bottle or two of the bubbly which is that the most important beverage – was a senior surgeon at discoveries are often initially the Melbourne Hospital. He achieved dismissed. notoriety in 1866, when he was accused According to Healy, of murdering barmaid Mary Lewis by examining medical history can performing an illegal abortion, but he was help identify areas in which acquitted after two trials. Champagne the field has not advanced Jimmy’s quirks are remembered in as it should. She nominated a statuette, with his hair shaped into an 1887 photograph of the devil’s horns and an empty bottle of his Melbourne Medical School’s favourite drink at his feet. first female students as an It’s easy to miss and doesn’t look example. The seven women anything like its modern equivalent, but in the picture fought hard for one of the museum’s most interesting their right to study medicine, artefacts is a hollow wooden tube with and in the decades following an earpiece, which is actually an early the photo many women had to stethoscope. Invented by Frenchman work harder than men for the René Laënnec in 1816, the device, opportunity to study medicine. which has become the medical Healy said she had noticed an profession’s most recognisable symbol, extraordinary interest in the history was initially ridiculed by doctors – who of medicine. She meets doctors instead preferred to press their ear of all ages pondering what their against the patient’s chest. As late as profession would have been like in 1885, medical professionals continued previous generations. ‘You have the to shun the device, with one professor senior doctors who are coming in saying ‘He that has ears to hear, let him and looking at instruments like the use his ears and not a stethoscope.’ The amputation kit and musing on the design was later improved by replacing difference that makes,’ she said. the wood with rubber tubing and adding a second earpiece, and the rest is Further information history. Medical History Museum The story of the stethoscope, Healy The University of Melbourne said, sums up one of the most valuable www.medicine.unimelb.edu.au Reprinted from Good Practice Issue 5 – July 2012 17
    • 25 – 27 October 2012 Gold Coast Convention and Exhibition CentreLeading primary care 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 Men, women and children’s health Clinical skills Skin and bones Education and training Telehealth/Business e-health and the PCEHR innovations. 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.Register by 10 August 2012and save up to $100 with early bird rates* * Conditions apply. Visit www.gpconference.com.au for details.
    • Guest speaker programStuart Patterson Lecture Leading primary care: General practice leading primary care:health reforms, the UK perspective showcasing the evidenceThursday 25 October 11.30 am – 12.30 pm Friday 26 October 3.45 pm – 5.00 pm Professor Clare Gerada International keynote Dr Eleanor Chew Professor Facilitator John MurtaghWhat still has to be done to close the gap?Thursday 25 October 4.45 pm – 5.45 pm Associate Professor Dr Jeanette Ward Marie PirottaMr Mick Gooda Ms Mary Martin Associate Professor Brad Murphy Health reform: a citizen’s jury Saturday 27 October 9.00 am – 10.30 amMs Melissa Sweet Associate ProfessorFacilitator Mark WenitongLeaders in primary careFriday 26 October 9.00 am – 10.30 am Dr Harry Pert Dr John Buckley International keynote FacilitatorDr Justin Coleman Professor Dr Malcolm Professor Dr Steve Michael Kidd Parmenter Claire Jackson Hambleton More guest speaker details to be confirmed.ProfessorJane GunnFor more information and to register go towww.gpconference.com.au
    • The San Antonio Riverwalk Sharon Lapkin recalls the charm of San Antonio’s famous Riverwalk. Most people travel to San Antonio in But it’s not the historic battles or the Arched fairytale-book footbridges allow Texas to see its most famous attraction, famous buildings that attract some people to visitors to cross the river and explore the the Alamo. The former Catholic mission San Antonio. It’s something far gentler. The Riverwalk from both sides. The famous and its impressive fortress grounds were San Antonio Riverwalk, also known as Paseo Arneson River Theatre sits snuggly on one the site of the Battle of Alamo in 1836. del Rio, is a charming network of pedestrian- side of the river while the audience enjoys the And it was this setting that inspired John only pathways along the San Antonio River, performance from grass-covered steps on Wayne to make a movie in 1960 about the one story beneath the city proper. Like a the other. Built in 1939, the unique theatre historic standoff between the Mexicans mini-Venice the narrow pea-green river winds was featured in the movie Miss Congeniality and the Texans. The legendary actor and loops around cafes, restaurants, hotels, starring Sandra Bullock and Michael Caine. starred in it, along with a number of other shops, gardens and historical sights. Built in The colourful restaurants and cafes Hollywood heavyweights, and despite a 1929, the Riverwalk hugs the banks of the dotted along the Riverwalk offer first- few historical inaccuracies it went on to river for almost 13 kilometres, and by 2013 class Mexican food and margaritas, and win an Academy Award and be nominated local authorities hope to have lengthened it to consuming such local delights requires for several others. 24 kilometres. that you sit by the river and be serenaded20 Reprinted from Good Practice Issue 5 – July 2012
    • GET LOSTby charming Mexican mariachis. The Iron vintage architecture. The oldest continuously There are other more modern hotels inCactus Mexican Grill and Margarita Bar operating hotel west of the Mississippi, San Antonio, and venturing into the cityserves a renowned signature margarita ‘El the Menger has played host to American proper reveals the seventh largest city inAgave’, which is one of the best in Texas. It luminaries such as President Theodore the United States. There’s a fantastic zoo,can be enjoyed from the restaurant’s private Roosevelt and baseball great Babe Ruth. beautiful botanical gardens, the ornatepatio beside the river, although with more The main hall of the hotel’s lobby features Majestic Theatre, which features a domedthan 100 tequilas to choose from the Iron photographs of many of its famous guests, theatre painted with clouds and stars, and fourCactus keeps some of its customers around along with antiques, artifacts and paintings 18th-century missions to visit. But whatevera bit longer than they intended. from the early days of United States’ history. you do in San Antonio, be sure to linger along The best accommodation near the Riverwalk The Menger Bar, voted one of the most the Riverwalk for as long as possible.is the exquisite Victorian-era Menger Hotel. historic bars in the United States, is theBuilt in 1859 on the site of the first brewery legendary bar where Teddy Roosevelt recruited More informationin Texas, it sits a stone’s throw from the his rough riders and, evidently, the site of more San Antonio Convention and Visitors BureauRiverwalk and offers three levels of elegant cattle deals that any other location in Texas. http://www.visitsanantonio.com/index.aspx Reprinted from Good Practice Issue 5 – July 2012 21
    • BOOK REVIEWS How doctors think Written for patients and physicians alike, diagnoses – the doctor’s mood on the day, Dr Jerome Groopman’s How doctors whether or not they like the patient, what think is a fascinating insight into why conditions the doctor is more accustomed doctors make certain decisions, and why to seeing – and that an original they may not always get it right. Three misdiagnosis can gain momentum, which decades into an illustrious medical career, leads doctors further down the wrong path. including being a successful author and a A staff writer at The New Yorker, chair at the Harvard School of Medicine, Groopman expresses complex medical Groopman comes to the realisation that situations in a way ordinary people can doctors can miss crucial information understand and enjoy. He encourages because they aren’t taught to listen to patients to be active in their treatment what patients say and reflect and think and ask questions if they are unsure of deeply about it. He also notices flaws in anything. algorithmic thinking methods being taught This book reveals an illuminating view to young doctors, which he says can be of current medical practice and providesAuthor: Jerome Groopman useful in simple diagnoses but otherwise patients, and doctors alike, with usefulFormat: softcover ‘constrain’ the mind. information to make better judgementsPublisher: Scribe Groopman explores these issues and together. Groopman draws on his extensiveRRP: $29.95 other aspects of the doctor’s psyche experience, including his own as a patient, through a combination of firsthand to encourage his colleagues and patients accounts and case studies. He writes to develop more informed patient-doctor that seemingly small factors can influence relationships. Seize the day: How the dying teach us to live Marie de Hennezel is a psychologist become what he or she was called to working in a French hospital for the become: it can be, in the fullest sense of terminally ill. Her writing is well known the word, an accomplishment.’ internationally and Princess Diana once The author writes that ‘After years of invited her to tea and told her she was so accompanying people through the living moved by her book Intimate death, (this of their final moments, I do not know book’s former title) she had read it ‘twice anymore about death itself, but my trust running’. in life has only increased.’ She describes, In the foreword of this second edition throughout the pages of her book, the written by former French president various patients she has assisted to die Francois Mitterrand, he laments the with dignity. Some arrive at the hospital inadequacy of the ‘modern spiritual desert’ with no knowledge of their impending to embrace the final journey and says death, due to their close relatives’ inability that previous generations looked squarely to accept their medical conditions rather at death and ‘mapped the passage for than any indication they cannot accept both the community and the individual’. their fate themselves. These people, The author, he says, presents ‘a lesson de Hennezel writes often think they’re in living’, and ‘perhaps the most beautiful protecting the person who is dying, butAuthor: Marie de Hennezel lesson’, he adds, of this book is that they are really trying to protect themselves.Format: softcover ‘Death can cause a human being to This is a profound and unforgettable book.Publisher: Scribe 2012RRP: $24.9522 Reprinted from Good Practice Issue 5 – July 2012
    • PUBLISHED BY ADVERTISING ENQUIRIESThe Royal Australian College of General Practitioners Kate Marie – T 0414 517122 E kate.marie@racgp.org.au1 Palmerston Crescent, South Melbourne,Victoria 3205 PHOTOST 03 8699 0414 Cover photo, pp5,6 © Andrew Southcott; pp8–10 © ADF; p13 © KathrynE goodpractice@racgp.org.au Fox; p15 © Think Pink Foundation; pp15,16,17 © Nick Johns-Wickberg;www.racgp.org.au/goodpractice pp16,17 © University of Melbourne; pp20,21 © Sharon Lapkin. All otherACN 000 223 807 ABN 34 000 223 807 photos by shutterstock.ISSN 1837-7769 EDITORIAL NOTESSTAFF © The Royal Australian College of General Practitioners 2012. All rightsPublications Manager Helen Barry reserved. Requests for permission to reprint articles must be made to the editor.Editor Sharon Lapkin The views contained herein are not necessarily the views of the RACGP,Writers Nick Johns-Wickberg, Sharon Lapkin its council, its members or its staff. The content of any advertising orGraphic Designer Beverly Jongue promotional material contained within Good Practice is not necessarilyProduction Coordinator Morgan Liotta endorsed by the publisher. Reprinted from Good Practice Issue 5 – July 2012 23
    • RESTORE SIGHT FOR JUST $25Photo courtesy of www.michaelamendolia.com PUBLISHED BY ADVERTISING ENQUIRIES We need to perform 12,000 operations each month The Royal Australian College of General Practitioners 1 Palmerston Crescent, South Melbourne, Victoria 3205 Kate Marie T 0414 517122 E kate.marie@racgp.org.au Three out of four people PHOTOS blind T 03 8699 0414 who are only 20 minutes and cost just $25. E goodpractice@racgp.org.au can have their sight saved or restored. www.racgp.org.au/goodpractice Cover photo p.20–21 © Gregory Watson. All other photos by shutterstock.goal is to restore sight Each month, our ACN 000 223 807 ABN 34 000 223 807 ISSN 1837-7769 some developing countries the operation In to 12,000 people. Donate now to help EDITORIAL NOTES © The Royal Australian College of General Practitioners 2012 STAFF to overcome cataract blindness can takefor permissionusreprint articles mustFred’s work. All rights reserved. Requests to continue be Managing Editor Denese Warmington made to the editor. Editor Sharon Lapkin The views contained herein are not necessarily the views of the RACGP, Journalist Nick Johns-Wickberg its council, its members or its staff. The content of any advertising or DONATE NOW Graphic Designer Beverly Jongue Production Coordinator Morgan Liotta promotional material contained within Good Practice is not necessarily endorsed by the publisher. 1800 352 352 www.hollows.org.au