Going Places Magazine - Issue 5 by GPRA Publications

G oing P laces

ISSUE #5 – FREE

Taking a fresh look at General Practice An initiative of GPRA

G oing P laces Meet a new group of interesting GPs

Join the Going Places Network Taking a fresh look at General right now! Application

Practice Forms inside – pages 43-50 An initiative of GPRA

Get to know 29 new GP Ambassadors

S A MAGIRO IS R A M R D

A GP with three jobs An initiative of

GENERAL PRACTICE REGISTRARS AUSTRALIA

Must-read true stories from GPs

AGPT selection criteria details

The Future of General Practice

Adventures of a PGPPP doctor! What’s your diagnosis?

Financial Health Check, Dr Fairytale and lots more

An initiative of

GENERAL PRACTICE REGISTRARS AUSTRALIA

The future of General Practice

General Practice TRAINING 2012

Applications Open 13 May-17 June 2011 www.agpt.com.au

G oing P laces

In this edition:

Taking a fresh look at General Practice An initiative of GPRA Greetings fellow future GPs

It’s time for yet another edition of Going Places to promote the virtues – and pleasures – of General Practice. Can you believe we are already up to issue 5?! Every issue gets bigger … and better! I hope you all agree.

The Going Places Network is growing by leaps and bounds – we have added another 33 GP Ambassadors who all have an incredible passion and enthusiasm for General Practice … and want to meet you. Keep a look out for posters in your hospital about events they’ll be organising! And, if you haven’t already joined the Going Places Network – no excuses – do it now! We have included postage paid application forms at the rear of the magazine. The featured GP in this issue is Marisa Magiros, who is truly an inspiration as she holds down three jobs – and, even though she was seven months pregnant at the time of interviewing and photographing her, she wasn’t showing any signs of slowing down! Marisa really has done a bit of everything and is testimony to the fact about how diverse General Practice can be! We asked our GPs to provide us with some stories of patients who have touched them in some way – and the result is five “must read” stories that we feel will have an impact on you. Three of these illustrate how important listening skills are in General Practice – just as Dr Carmel O’Toole related in her story we featured in issue 3.

What’s your diagnosis? is a terrific, real life scenario contributed by Dr Heidi Spillane, who is now back in Australia after working overseas for MSF, most recently in China. We have a great selection of GPs for you to read about – Dr Ruth Stewart, Dr Tim Kelly, Dr Rohan Kerr, Dr Marlene Kong and Dr Jim Finn – all quite different in the variety of how they practice and their specific interests … from indigenous health to addiction medicine! And, talking about variety – you must read Dr Sarah McEwan’s story about variety … how she is pursuing her own interests as a fully fledged GP Obstetrician! You know we are great promoters of PGPPP – the real first-hand experience to learn what General Practice is all about. Our intrepid correspondent, Dr Heather Pascoe, reports about her first five action-packed days on her PGPPP in Camperdown. There’s lots to read, so I’ll let you get on with it. Enjoy! Yours in General Practice

Dr Lana Prout Hospital Registrar – Southern GP Training Latrobe Regional Hospital, Gippsland, Victoria GP Ambassador Gippsland GPRA Board Member (Prevocational)

Going Places! If you have a t We welcome your feedback on us an email and tell us wha few spare moments, please drop you’d like to read about and t wha you think of our magazine, goingpla ces@gpra.org.au even if you can contribute! Designed, managed and produced by wam Pty Ltd. Interviews with GPs by Fran Molloy, © GPRA 2011. No material contained within this publication may be reproduced in full or in part without the express permission of the publisher.

11 Dr Marisa Magiros A GP with three jobs 18 Dr Ruth Stewart Enjoying the quadrilogy of University, Clinic, Committee and Practice 22 Dr Tim Kelly The rural GP with a passion for Obstetrics and Anaesthetics 26 Dr Rohan Kerr Giving General Practice a volley 30 Dr Heather Pascoe PGPPP adventures in Camperdown 34 Dr Marlene Kong The Aboriginal GP making a difference in Indigenous health 38 Dr Sarah McEwan Variety – it’s what General Practice is all about 41 Dr Jim Finn The GP who’s made the change from country practice to addict medic in the city

We would like to acknowledge the help and support provided by Australian General Practice Training and Avant, which has made Going Places possible. Our sincere thanks to all the GPs who have generously given their time to be interviewed and photographed. Going Places is published by GPRA, Level 4, 517 Flinders Lane, MELBOURNE VIC 3000. Phone: 1300 131 198. www.gpra.org.au

Whats new in the Going Places Network

A Network of GP Ambassadors covering 40 hospitals throughout Australia We now have GP Ambassadors in 40 hospitals throughout Australia – they are junior doctors, just like yourself, who have volunteered to be champions of General Practice at hospitals around the country. The GP Ambassador at your hospital can help you with any information you require about General Practice careers. They can also connect you with other junior doctors who are considering General Practice as a specialisation. Have you met your GP Ambassador yet? If not, what are you waiting for? You’ll find they are helpful and friendly. Contact your GP Ambassador today … they are standing by, ready to meet you! To find out who your local GP Ambassador is, look out for GP Ambassador posters in your hospital or visit www.gpaustralia.org.au/goingplaces

Going Places E-news Have you seen the latest Going Places E-news that is sent out to all Going Places Network members? If you are thinking about, or considering, General Practice as a career choice, it’s an essential read – packed with all the latest information on everything that’s General Practice, information on the Going Places Network and other General Practice events plus interesting General Practice stories. If you want to receive this great newsletter, make sure you become a member of the Going Places Network. Complete an application form you’ll find on the last four pages of this issue of Going Places – or you can join online at www.gpaustralia.org.au/goingplaces

Going Places Events Have you been along to a Going Places event? Check out some of the cool events that have been put together by your GP Ambassadors over the past few months.

Help – my patient has a rash! South Australia – March An approach to common skin conditions for trainee medical educators.

GP Networking Dinner Hobart – April An opportunity to network with GPs and GP Registrars and find out first hand what a career in General Practice is really like!

GP Coffee Clubs Perth – throughout April and May The hospital environment can often be a lonely place for General Practice; the GP Coffee Club helps you connect with interns and Residents who are keen on General Practice. To find about events in your hospital – or near your hospital – join the Going Places Network! It’s really easy to become member – and it’s absolutely FREE.You’ll find application forms on the last four pages of this issue of Going Places – or you can join online at www.gpaustralia.org.au/goingplaces Your local GP Ambassadors will tell you all about the General Practice happenings near your hospital – so, don’t be shy …. make contact!

Meet your new GP Ambassadors Find out a little bit about our newly appointed GP Ambassadors! Remember – GP Ambassadors are the GP champions in your hospital and can help you with all your questions about careers in General Practice. Contact them today – they are waiting to hear from you! Profiles and information about all our GP Ambassadors can be found at www.gpaustralia.org.au/goingplaces

RYAN METCALFE, 26

HEATHER PASCOE, 24

HOSPITAL

Gosford Hospital, NSW

HOSPITAL

Barwon Health, VIC

gosfordgp@gpra.org.au

geelonggp@grpa.org.au

I’m originally from the Central Coast of NSW, where I’ve spent my whole life. I decided to pursue medicine halfway through my undergraduate course in Advanced Science at The University of Sydney. I realised it would be a perfect way to balance both science and the human element of caring for patients. I particularly like the flexibility and career options General Practice provides. I’m interested in Sports Medicine and General Practice can provide me with an avenue to pursue this. I’m also particularly interested in the small business aspect of General Practice. I decided to become a GP Ambassador to encourage junior doctors to consider General Practice training. The program is not only a great way to assist junior doctors to access information from peers and pursue General Practice training – it’s also a great way to socialise.

NICI WILKINSON, 31

I’m from Mildura, where I’ve lived all my life – so far! I was always interested in health, but coming from a rural area I never thought I would get into medicine. It wasn’t until my year 12 results came out that I realised “I can do this”. So I did. Now I can’t imagine doing anything else … and wouldn’t want to! General Practice is the ideal specialty for me to continue caring for the “whole” patient. I also really value forming relationships with my patients – not many other specialities enable doctors to form such close relationships with their patients. I would also like to work in a rural area … as a GP there aren’t many places I won’t be able to work. I became aware that Barwon Health was in need of a GP Ambassador and given that I was keen to find out all about GP training, I thought “Why not share this knowledge?”.

DARREN NG, 27

HOSPITAL

Westmead Hospital, NSW

HOSPITAL

Royal Adelaide Hospital, SA

westmeadgp@gpra.org.au

royaladelaidegp@gpra.org.au

I grew up in Johannesburg, South Africa. After finishing school, I travelled to Scotland to study International Relations at St Andrews University, finishing my Masters in 2002. I did a lot of travelling before finally deciding I wanted to be a doctor – so I returned to uni in Sydney. The flexibility of General Practice appeals to me. My dream is to expand my skill-set to a point where I can work as a GP in a rural area combined with secondments in humanitarian aid work. General Practice gives you the opportunity to shape your career around your own particular interests, while still being able to maintain a work-life balance. During orientation week there seemed to be a real need for someone to answer everyone’s questions about General Practice as a training and career pathway. Given my own goal of starting GP training, I put my hand up for the position! I am so excited to share my passion and enthusiasm for General Practice.

NATASHA VAVREK, 26 HOSPITAL

Launceston General Hospital, TAS

launcestongp@grpa.org.au

I am from Launceston and attended Larmenier Primary School – following that, I went to St Patrick’s College. It was towards the end of Year 10 that I realised medicine encompassed my passion to work with people and it suited me and my expectations in life … the perfect career for me! I have decided to pursue General Practice because the lifestyle suits me and I have an interest in all specialities. I particularly like the continuity of care and the importance of good communication. And I love the fact that I can also easily balance a great career with a family. I realised that I have already been doing the job of a GP Ambassador. I have a passion for encouraging people towards General Practice and I love to talk – so it makes perfect sense!

I’m Adelaide born and bred – I went to St. Peter’s College for my schooling. I’m actually from a medical background … my father is a GP – both of my younger brothers have finished medical school, too! I liked the challenge of a medical career, speaking to old scholars in the medical course helped, and also my father was able to give me the ups and downs of being a doctor. The thing I like most about General Practice is that you can make it whatever you want it to be. For myself, I would like to have a sports interest in my practice. I’m excited about being a GP Ambassador as I can help to spread the word about a career in General Practice and ensure that resources are readily available. I am really enthusiastic about General Practice and keen to let others know the wonders of being a GP.

SHELLEY DAVIES HOSPITAL

Fremantle Hospital, WA

fremantlegp@grpa.org.au

I’m from Western Australia – Geraldton (Midwest) and Perth. Initially I worked in public health. Then, after sitting the GAMSAT, I applied for a research position at General Practice, University of WA – in a multi-centred trial in General Practice in the use of dermoscopy and short-term digital monitoring in the diagnosis of pigmented skin lesions. This gave me an opportunity to visit 35 General Practice locations in the Perth Metro area in the process of promoting the trial and recruiting GPs. This helped me to decide if I could be a GP! I quickly understood General Practice is a specialty in its own right – it can be as broad or specialised as you want it to be. And that’s why I decided to become a GP Ambassador. It’s something I really believe in.

Going Places – ISSUE #5

Meet your new GP Ambassadors LUKE DWYER, 39 HOSPITAL

Toowoomba Base Hospital, QLD

toowoombagp@grpa.org.au

I moved to Brisbane at the age of seven and completed my schooling in Brisbane. I was actually an accountant in my previous life and, when I was 30, I had a career break and decided I wanted a change. I had time to reflect and was able to identify that I liked people, I liked solving problems and I liked science.

GERRY CONSIDINE, 27 HOSPITAL

Flinders Medical Centre, SA

flindersmedicalgp@grpa.org.au

I’m from Croydon – a suburb of Melbourne. I had thoughts of studying medicine during high school, but realised during my honours year working in a lab that I wanted more contact with patients. At the beginning of my final year I was keen to do General Practice, Paediatrics and Anaesthetics. I then had a rural placement and realised I could do all three and have a great lifestyle at the same time.

General Practice really suits me – I really enjoyed my GP rotations and got positive feedback from patients. To me, General Practice represents freedom and opportunity – wherever it may lead. It also provides the opportunities for preventative medicine, variety and working with a patient to achieve a better outcome.

I enjoy treating all the different types of patients that walk through the door, without knowing what will be next. You get a chance to know the person behind the medical condition and are therefore able to treat more specifically. Also the opportunity to gain some procedural and special skills appeals to me.

I volunteered to become a GP Ambassador to help dispel the myths that some students and junior doctors hold about General Practice – I also want to promote this specialty and encourage doctors to find out more.

I’m very passionate about the work GPs do – so, as GP Ambassador, I would like to try and dispel some of the mistruths about the specialty. I can help those still deciding if it is the right move for them and even reinforce it for those who have already decided.

MARY WYATT, 37 HOSPITAL

Royal Perth Hospital, WA

royalperthgp@grpa.org.au

I was born and raised in Wollongong, NSW. I went to St Mary’s College in Wollongong. I’m from a medical background – my father was an Orthopaedic Surgeon and my mother is a GP. I also have two older brothers who are GPs in Sydney. I don’t really remember a time when it wasn’t my dream career to be a doctor. However, I did take a roundabout way to medicine and had my family first (four kids) before I decided it was time to pursue this career. I was always interested in the medical conversations that we frequently had around the coffee table – they fascinated me. Many years later, my own children and my husband encouraged me to pursue my dream when Medicine was finally offered at my home town university. From the moment I entered Medical School I wanted to be a GP. I like the community focus, being an important part of so many people’s lives – plus the variety of conditions first found/suspected in primary care. I am interested in the area of Paediatrics and Adolescence Psychiatry – there are so many different avenues of working practice available to GPs.

MING LIN, 43 HOSPITAL

Redland Hospital, QLD

redlandgp@grpa.org.au

I was born and grew up in TianJin, China. I graduated from TianJin Medical University in 1989 and then did my 7 year training in Thoracic Surgery at TianJin Medical University Cancer Hospital before moving overseas. My grandfather was a Traditional Chinese Medicine Practitioner and I became fascinated with medicine. After I did my Thoracic Surgeon Training in China and had enough experience of performing difficult operations, I felt it was the right time for me to change my speciality. I found that General Practice suits me perfectly in terms of lifestyle and job satisfaction. I really enjoy being involved in the primary care of patients – there are day-today challenges, more opportunities to encounter difficult clinical scenarios and I can play a vital role in preventative medicine Being a GP Ambassador gives me an excellent opportunity to facilitate interaction between hospital doctors and GP training providers. I would like to use this network as a platform to deliver valuable information – I feel this will be an incredibly rewarding experience.

As a GP Ambassador, I would like to start the conversation about General Practice within my hospital and build a supportive network of other interested doctors who I can continue to work with, and socialise with, in my future career.

SUMIT CHADHA ANNA RYAN, 36 HOSPITAL

Austin Hospital, VIC

austingp@grpa.org.au

I’m from a tiny little place called Grasmere – near Warrnambool in South Western Victoria. I went to Grasmere Primary School (there were about 50 kids in the entire school) and then to St Ann’s in Warrnambool for High School. I didn’t want to study medicine initially – straight from year 12 I studied to be a Chiropractor and I applied to do Grad Entry Medicine after 7 years in that profession. It was a pretty gradual process, but after considering other specialities, I felt General Practice would give me the best combination of interest, variety, scope of practice, flexibility and it also allows me to continue my work in academic medicine by training part-time. Another real attraction is the opportunity to work with patients over a lifetime – that continuity of care can be a really important way to have a positive influence on a patient’s health. I decided to become a GP Ambassador as a friend who was already a GP Ambassador recommended it to me – the idea of being able to increase visibility and representation of General Practice within the hospital environment really appealed.

HOSPITAL

Royal North Shore Hospital, NSW

royalnorthshoregp@gpra.org.au

I grew up in Sydney and went to Epping Boys High. I decided I wanted to be a GP from a very early age. I chose General Practice because it’s not a partial specialty – it encompasses many areas of medicine. It also provides the opportunity to meet different people from various backgrounds, and to be responsible for the complete care of a patient. I volunteered to become a GP Ambassador as the Going Places Network offers a fun environment and meeting other like minded people seemed a fantastic option. I’d like to be able to promote General Practice by using innovative and fun activities and by organising events, which would enhance junior doctors’ skill and knowledge base.

STACEY SEAKINS, 25 HOSPITAL

Royal Adelaide Hospital, SA

royaladelaidegp@grpa.org.au

I’m originally from Victoria – I grew up in Rye on the Mornington Peninsula where i also went to Primary School and attended High School at Toorak College in Mount Eliza. I always loved sciences and, as I’m a people person, medicine seemed like the best fit for me. In my final year of Medical School I felt as if I’d tried lots of Specialties but, for various reasons the cons always seem to outweigh the pros … except for General Practice. I love the continuity of care involved in General Practice and the idea of family medicine – particularly that you treat a variety of people and age groups as well as the whole patient, not just a specific illness or organ. I became a GP Ambassador because many people don’t really understand what General Practice is all about or the opportunities that General Practice can offer. I want to help rectify this. You just won’t know if General Practice is for you, and about all the opportunities available, unless you get involved and give everything a go. That’s why the Going Places Network is a great place to start.

SCOTT HAHN, 48 HOSPITAL

Logan General Hospital, QLD

logangp@grpa.org.au

I’m originally from San Diego, California, USA; my education covers Bonita Vista High School, UCSD, UQ, QUT & Newcastle University. I started with Biomedical Science then I had the opportunity to change career from Academia to Medicine with Defence support. I participated in the AMAQ GP Mentor Scheme from year one of the MBBS. I saw huge opportunities in General Practice: variety, independence, connection with the community, the nature of the doctor-patient relationship, plus the flexibility and diversity of General Practice. In addition to all of these, I saw the opportunity to practice holistic medicine, and the vital role a GP plays in the Australian system of medicine. I plan to retire from Army after serving as a Medical Officer with Rural GP Qualifications and advance-skills-training, to work in a rural practice as a ‘family’ doctor – possibly a rural hospital SMO/Superintendent. I wanted to become a GP Ambassador as I committed to GP training early – I have a great deal of confidence and enthusiasm in my decision to do so. I look forward to discussing the benefits of General Practice with prospective trainees against the backdrop of the State and Federal initiatives to promote and facilitate GP specialisation.

SEBASTIAN REES, 25 HOSPITAL

The Queen Elizabeth Hospital/ WCH, SA

queenelizabethgp@grpa.org.au

I was born in England and moved to New Zealand when I was young. My father was working as a rural GP at this time – about an hour south of Auckland. I went on to high school in Auckland and later the University of Auckland where I gained my MBCHB. Last year I underwent my internship in Adelaide at The Queen Elizabeth Hospital. Having a medical family certainly encouraged my initial interest. Around year 3 or 4 of university I was actually determined to be a surgeon and was starting to select my electives based on this preference. After a short elective in Plastics, I soon realised it really wasn’t for me and I tried to think about the type of medicine I wanted to be involved in. Around this time I began to see all the positives of General Practice as a Specialty. What really caught my interest was the interaction with patients and the diversity of the job as a GP. There is also endless opportunity for specialisation at any stage in your career. As a GP Ambassador I saw an opportunity to talk to junior doctors and medical students about the great aspects of General Practice. It is a growing and increasingly diverse Speciality and I hope to let people know about the opportunities available to them.

SARAH FAIRHALL, 25 HOSPITAL

Cairns Base Hospital, QLD

cairnsgp@grpa.org.au

I was born in Brisbane but grew up in Townsville. I went to multiple primary schools and Saint Patrick’s College and Pimlico State for High School. When I was four years old, after my father died, I thought about becoming a doctor – but it wasn’t really until my second year of Medical School that I knew I had made the right decision. I always loved science and knew I wanted to pursue something in that field. I liked the idea of helping people and knew that there were so many facets within the study of medicine that I would find something I loved. I was on the Queensland health rural scholarship scheme as a student and also attended JCU. The extra rural placements really showed me what being a rural GP was going to be like and I just loved it!!! It’s the diversity of General Practice work and that you are the centre for co-ordination between other specialists and your patient.

SARAH HANDLEY, 28 HOSPITAL

Mackay Base Hospital, QLD

mackaygp@grpa.org.au

I was born and bred in Brisbane, with 6 years spent on the Sunshine Coast during my adolescence. I always wanted to study medicine, but also did another degree in Science & Psychology beforehand to make sure I had something to fall back on if it all didn’t work out. I am on the Rural Generalist pathway, as I have a QLD Health rural scholarship – but even before this I was always interested in the continuity of care and generalised scope of General Practice. I really feel strongly about the relationships you can foster with each and every patient, which is a unique aspect of General Practice. As a GP Ambassador, I am interested in promoting General Practice, as I believe it’s not usually seen as a specialty and yet has the potential to be such a rewarding and interesting career. I also believe that, in the hospital system, those interested in General Practice don’t get enough information or exposure to General Practice in the pre-vocational years and that this can lead to them starting down the path of another specialty.

SIMON TING, 24 HOSPITAL

Princess Alexandra Hospital, QLD

princessalexandragp@grpa.org.au

I grew up and went to school in Brisbane. I did Med School at James Cook University in Townsville. My Dad, brother and sister are all GPs – I’ve always had an interest in doing medicine, influenced fairly heavily by seeing my Dad work and helping him out as a receptionist during my school holidays. I saw how rewarding it was working as a GP. I like the diagnostic side of General Practice, along with the ability to develop a proper relationship with patients and being able to be a part of someone’s life for longer than a few days of admission in hospital. Because there isn’t a whole of lot exposure of General Practice as a medical student, or as an intern working in a busy hospital, I decided to become a GP Ambassador. I hope I’ll be able to better serve the need of those interested in General Practice as well as increase the awareness amongst junior doctors of what it is all about.

I was approached and asked to become a GP Ambassador and thought I should, as I am committed to becoming a GP, I like helping people and I love rural practice. I can help people by answering their questions from either personal experience or by putting them in touch with someone more qualified.

Going Places – ISSUE #5

Meet your new GP Ambassadors ANNA ELDER, 26

YVETTE BRUCE, 47

HOSPITAL

Royal Prince Alfred, NSW

HOSPITAL

Joondalup Health Campus, WA

royalprincealfredgp@grpa.org.au

joondalupgp@grpa.org.au

I am a Sydneysider – I went to school at Barker College in Hornsby. I decided to study medicine within the last few years of high school and this decision was reinforced when my boyfriend (now husband) decided to do medicine. I love the variety of people you get to see as a GP – especially the large proportion of children. Whilst doing my GP rotation I was able to see the variety of people and presentations that a GP gets each day. As a GP Ambassador, I know I can make a difference promoting GP as a career and answering questions for people who might be interested in General Practice. I can provide basic answers on GP training and direct them to the right people to find out more information … and I can help organise lots of social events.

AMY O’BRIEN, 28 HOSPITAL

Wollongong Hospital, NSW

wollongonggp@grpa.org.au

I’m from Bronte, Sydney – for high school I went to St Catherine’s in Waverley. I had always been interested in the biological sciences, so when it came time to apply to uni courses in year 12 I had very little idea what I wanted to do, but a friend suggested Medical Science. I ended up at UNSW doing exactly that. I loved the subject matter, but wanted to be more clinical/people based. Still unsure about medicine I finished med science and went travelling for a bit. A little while later, I started working as a ward clerk at Prince of Wales Emergency Department – the combination of being a bit older plus the ward clerk job helped me gradually realise that I really wanted to be a doctor. General Practice has always been high up on my list of career possibilities, but I firmly decided on GP training towards the end of uni. I did two excellent GP terms as a student – Coogee (Eastern Sydney) and Warren (Central West NSW). The difference between the two terms demonstrated the diversity within General Practice. I loved them both which just confirmed that General Practice was for me.

I spent my childhood in Melbourne – my Dad is a doctor. I always wanted to be a doctor. I left home at 14 and never finished high school. I thought I was of average intelligence and had no hope of ever being a doctor. However, in 2000 I did the National IQ test on channel 9 and discovered I had a high IQ. I sat a STAT test and started nursing training at university in 2003. I applied for medicine in 2005, starting in 2006. I decided to become a GP after watching Dad, as a country doctor, sharing people’s lives from birth through until death. I love the variety of General Practice. You never know what will walk through the door. I also like the idea of becoming involved in ongoing patient care at every level. My passion for General Practice made being a GP Ambassador an obvious choice. I love to talk about GP training. I am still learning all the ins and outs but I am keen to encourage others to get involved.

NICOLE HALL, 24 HOSPITAL

Bankstown and Campbelltown Hospital, NSW

bankstowngp@grpa.org.au

I’ve always lived in Sydney – the Sutherland shire in particular – and I went to school at St Vincent’s, Potts Point. I was keen to be a lawyer, but I’m glad I changed my mind – it was the thought of learning about an interesting area, facing ongoing challenges and meeting different people every day, knowing that you can have an impact on their lives. I worked in GP Practices throughout medical school and I love the dedication and passion GPs have, the continuity of care and the diversity of patients. I have known from early on that becoming a GP was the perfect career for me. It’s the opportunity to help patients with a wide range of problems, to follow them over many years and continue to build rapport, and the value GPs have in the community. I would love to own/run my own practice one day! I really want to share my energy and passion for General Practice with other junior doctors. I have lots of information for those considering General Practice as a career option.

I am very excited about the beginning of my career in General Practice. I would like to be able to share this with other junior doctors who are also interested in General Practice and help them with the application process and career planning.

TOM QUIGLEY, 26

ANN ARLOTT, 38 HOSPITAL

Rockhampton Hospital, QLD

rockhamptongp@grpa.org.au

I’m from Rockhampton, but much of my adult life has been spent away or overseas. I decided to study medicine ten years ago – I was in a hill village in Nepal, having travelled there with a Canadian friend who was donating money to set up a woman’s health centre. I like the idea of being a rural generalist – it is the old fashioned idea of medical practice – looking after people from cradle to grave … that really appeals to me. It’s also the acknowledgment that knowing a little bit about almost everything is the most important step in looking after the health needs of your community – making sure nothing is overlooked or missed. I decided to become a GP Ambassador because so many people in the hospital talk to me about my GP training already that I thought it might be good to formalise the role.

HOSPITAL

Modbury Hospital, SA

modburygp@grpa.org.au

I was born and raised in Adelaide suburbs – Dad’s a dentist, Mum’s a nurse and three uncles are doctors – two of them are rural GPs. For me, medicine had been a long term possibility since high school. I undertook the third year of my medical degree with a rural focus and, like most students training in General Practice, really enjoyed the more ‘master/ apprentice’ model of studying in the community. It dawned on me that as a rural GP I could enjoy all my own particular areas of interest – preventative/ maintenance health with an internal medicine emphasis, emergency, and Anaesthesia. I wanted to become a GP Ambassador because many junior doctors are unlikely to be exposed to the General Practice experience or inspiring GP mentors, so I can help address this. The Ambassador program – in addition to experiences now available with PGPPP – is an important way to put hospital-based junior doctors in touch with GP mentors. As an approachable advocate for taking up the profession, I can help create awareness.

SARA LE, 24

JOSHUA CRASE, 31

HOSPITAL

Lyell McEwin Hospital, SA

HOSPITAL

Ballarat Base Hospital, VIC

lyellmcewingp@grpa.org.au

ballaratgp@grpa.org.au

I’m from Adelaide and decided I wanted to study medicine when I went to the Women’s and Children’s Hospital on work experience – I thought being a doctor looked terrific. I spent a significant amount of my clinical years in the country, and those were some of the happiest times of my medical student life. I like the idea of not doing the same thing for the rest of my life, and never knowing what will walk through the door. Then there’s the opportunity to provide long term care for your patients and (especially in the country) develop good relationships. As a GP Ambassador, I thought it would be a good chance to find out more about GP and the program myself, and also network with other people who are interested in General Practice. I can offer some personal experience as far as what it is like in a GP setting, and also information about the training itself.

I’m originally from Broken Hill, NSW. My journey into medicine is quite a story. I was working as a computer engineer for a pharmaceutical company and my mother was having health problems with her diabetes at the time. I was reading medical information and was finding it far more interesting than anything I was doing as an engineer. My boss was a doctor and my mentor. I decided to take the plunge after much deliberation to change career and I haven’t looked back. I was lucky enough to be a recipient of a John Flynn scholarship to work with a GP in Mareeba, Far North Queensland. I soon realised after one or two placements with him that I was more cut out to be a GP than a specialist – I think it is a privilege to be able to treat a whole family from birth through to old age. There aren’t many professions that offer such gifts as General Practice. I like the variety of patients and work – the fact that you don’t necessarily know from day-to-day what each patient encounter will entail. I also like the career flexibility that allows you to retrain and subspecialise as your career progresses – from Aboriginal health, to Dermatology, to Anaesthetics, to Obstetrics and so on …

RILEY SAVAGE, 25 HOSPITAL

The Townsville Hospital, QLD

townsvillegp@grpa.org.au

I was born in Sydney, then travelled around Australia with the family in a caravan when I was young. I settled in WA, lived in Dampier, a small coastal town in North WA, until I was 16, then I moved to Townsville. I actually grew up believing I would be a Vet. When I was 14 I lived in Japan for a year and realised that I really like people as well as animals. I believed I could make a significant contribution to society as a doctor. My rural background has left me passionate about rural, remote, Indigenous and tropical medicine, and so decided to take the Rural Generalist pathway. General Practice as a specialty provides the ability to gain advanced skills and work in challenging yet rewarding settings – however, you stlll stay general enough to be useful in rural communities. I am passionate about rural medicine, and often find myself talking to junior doctors or medical students about the possibilities of a career in rural medicine or General Practice. With the GP Ambassador program I will have resources to support these discussions.

As a GP Ambassador, I hope I can be a port of call for anyone interested in considering General Practice as a career in medicine and to help channel information as needed on their journey.

BRENDAN THOMPSON, 28 HOSPITAL

Ipswich Hospital, QLD

ipswichgp@grpa.org.au

I’m from Ipswich – educated at Brassall Primary School and Ipswich Grammar. I decided that I wanted to pursue a career in medicine when I was very young. I instinctively felt General Practice was right for me because of the flexibility, being your own boss, getting out what you put in and making a difference in families’ lives. I wanted to become a GP Ambassador to dispel the myth of being ‘just a GP’.

PHIL DEACON, 28 HOSPITAL

Flinders Health, SA

findersmedicalgp@grpa.org.au

I’m originally from Canada – I traded in my snowboard for a surfboard! I first decided I wanted to study medicine when I was hunched over at my Immunology lab bench pipeting dilutions of infected murine vaginal washes ... maybe a bit earlier … but that was definitely a clincher. One of the main influences that persuaded me to study medicine was the opportunity to talk to people instead of mice! I really wanted to pursue General Practice because it’s got everything and anything. Really, absolutely whatever you want! I’m a GP Ambassador because I feel I can contribute to the Going Places Network – PGPPP and student placements are a great opportunity – and maybe the only chance you’ll get to ‘think’ as an intern! The Going Places Network is ideal for people interested in General Practice but especially for people who aren’t sure yet – it’s the perfect opportunity to see what’s out there and what GP is (and can be) all about.

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Going Places – ISSUE #5

COVER STORY

DR MARISA MAGIROS

A GP with three jobs

At the moment, I have three jobs. I work two days a week at a private General Practice in Sydney’s south, one day a week in Family Planning and another day and a half as a Registrar Liaison Officer and Registrar Medical Educator.

Going Places – ISSUE #5

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Photography: Mel Koutchavlis

COVER STORY There’s quite a stark contrast in the patient profiles for my clinical work. The private practice is in an affluent area, with private billing and people who take an active role in caring for their health. My family planning work involves half a day each at the Ashfield and Fairfield clinics. Fairfield has a high migrant population and I often need an interpreter for my patients. I did a Certificate in Sexual and Reproductive Health in my first year of GP training and I like the Family Planning work – it’s really interesting. Half hour appointments are standard and they involve a lot of patient education. As a female doctor, it’s good to upskill in that area, and the clinics are also another family-friendly work option for me, down the track. I really love the variety of work I have in General Practice. Every day is completely different and offers new challenges. A little while ago I picked up possible testicular torsion in a 14 year old boy at 8pm. I immediately referred him for surgical review and he was taken to theatre that night. It ended up being Torsion of Morgani – the appendix rather than the testicle itself, less serious – but he had bilateral repair. The continuity of care is very satisfying, especially when I’m recommended to new patients by current patients. A good example is one of my patients – a 60 year old lady who I treated for colon cancer. Despite the stressful diagnosis, she was very happy with the care I provided and my thoroughness – so she recommended me to her son.

better doctor. Running case discussions as part of formal training really helps develop your diagnostic reasoning. Preparing a formal session for training on a topic also gives you the scope to explore something in more depth. I ran a session on dizziness recently. It was something I wasn’t completely on top of beforehand, so doing a presentation on this was also useful for my own development. How did I start in Medicine? After doing a medical science degree with honours at the University of Sydney straight from school, I went on to be part of the first year of the postgraduate medicine program, graduating ten years ago. I did my internship and both RMO years at Orange Base Hospital – Orange is a big country town west of Sydney. There were four of us sharing a house just across the road from the hospital and it was a really fantastic time. I made lifelong friends there. Even though we spent a lot of time in hospitals as students, it was a really steep learning curve when you actually started to work there. I found the workload and the responsibility a huge challenge from day one when I walked onto a general medical ward of about forty patients. I had always wanted to travel – so, after three years in Orange, when I’d completed my basic training, I took five months off and travelled through Africa, the Middle East and Eastern Europe and then arrived in London where I stayed with an English doctor I had actually worked with in Orange. I worked in various medical locum

as a doctor on cruise ships, so I decided to apply. Ship-board medicine is a mixture of General Practice, accident and emergency and public health care, plus a range of ship’s officer responsibilities. The medical side of the job was actually really interesting and far more challenging than I had initially expected. The ship’s doctor was really the GP for the crew, as some of them are on board for up to twelve months … so you do have some continuity of care and occasionally chronic disease management. Conversely, treating passengers was more like Accident and Emergency work, stabilising them until you could get them safely to shore. I started my GP training when I returned to Australia, after spending about two and a half years working as a ship’s doctor on several cruise ships. It was that experience with such a variety of medical work on ships that led me to choose General Practice. It was great to be able to combine work and travel, but one downside of the cruise ships was that I was often on-call 24 hours. I worked for four months straight then had two months off. It could be quite unrelenting. That ship-board experience plus years of shift work in hospitals makes me really appreciate the work-life balance that you get in General Practice. I’m very happy to be working in General Practice in Sydney now and having the variety of practice that I enjoy at the moment. I don’t think I could ever work as a five-day a week GP in just the one office!

Getting into medical education came by chance, really. As a doctor, you find yourself naturally involved in some teaching, whether through supervising staff or medical students – or even educating your patients about preventative health or management of chronic disease. I found I really enjoyed teaching and taking on the Registrar Liaison role gave me the scope to get involved further. I think teaching others helps me to become a

positions in hospitals in London and the UK for the next year, mainly in medical and Accident and Emergency roles. Then I spent about a year working in Ireland as an Accident and Emergency Registrar, because Jason (now my husband) is from Ireland. I still didn’t really know what I wanted to do medically, although by that stage I had worked out what I didn’t want to do! A friend had told me about his experiences working

Jason and I are expecting our first child soon, which will be our next big adventure. We both like the country so I’m not sure if we will stay in Sydney. I’m really glad I am doing General Practice. It’s a job that can take me anywhere … as well as give me plenty of medical challenges!

Going Places – ISSUE #5

G oing P laces NETWORK

Taking a fresh look at General Practice An initiative of GPRA

Are you curious about General Practice? Could it be the right specialty for you? Find out more by joining the Going Places Network and explore the world of General Practice.

JOIN TODAY Visit www.gpaustralia.org.au/goingplaces or contact your GP Ambassador

BECOME A MEMBER TODAY – IT Application ’S FREE! forms back of this at the issue

It happened this way … We asked some of our GPs to tell us stories about patients or situations they’ve encountered. Here are some interesting, amusing and poignant stories that are a “must read”. Please put your feet up, take a few minutes to read them and prepare to be moved. Please note that patients’ names have been changed.

Listening makes the difference. Every three months Ron drives several hours to see me for his diabetes check. He always arrives an hour early and sits patiently in the waiting room. Whenever I come to my door to call a patient, he smiles and looks up hopefully at me. No matter how long he has to wait, he never complains and is always so thrilled when I finally call his name. He leaps to his feet and hurries to my room, so as not to take up my time. He then proudly shows me his carefully documented and well-controlled blood sugar levels. After this, he gets down to the most important business of showing me photos of his truck and telling me stories about the latest jobs he has done. To anyone else, Ron looks like a scruffy, overweight 74 year old trucker. He is always in need of a shave and a fresh change of clothes. But I don’t mind. I know that he has usually slept in his truck the night before he comes to see me, to try and break up the very long drive. He also doesn’t look very fit or particularly healthy. But I know better … I first met Ron two years ago. I remember the day he first came to see me. He was morbidly obese and struggled to walk the short distance to my room on his walker. When he finally made it, he sat down heavily on the chair with a thud – out of breath and wheezing. He presented me with a pile of crumpled papers detailing his long list of medical problems and medications. He had very poorly controlled diabetes and extremely high blood pressure. He had recently been discharged from a country hospital where he had been an inpatient for six months – they had been trying to heal a huge ulcer on his left lower leg. The ulcer was proving very resistant to all of their efforts and when I examined it, I was horrified to find that it measured 5cm in length and 7cm in width. I arranged regular dressings for his ulcer. He was to see our Practice Nurse several times per week for this. I also arranged a weekly appointment with myself to try and get his myriad of medical issues under control. At each appointment, I would talk to him about diet and exercise. I adjusted his medications. I walked the fine line between managing his blood pressure, his peripheral oedema and his renal failure. I pored over his blood sugars and tried to encourage him to follow a low GI diet. It was all in vain. Ron was completely disinterested in his health. Every time he was in the practice I would pop out to the treatment room between patients, hoping to quickly see his ulcer. I was always pressed for time and he would try to keep me talking forever … but never about his health! He was always miserable, with a sad story to tell. He moaned to me about being ripped off by his landlord who was charging him an exorbitant amount of money for room and board – but he was not receiving meals. He couldn’t afford to buy decent food with the small amount of his pension he

had left over. He was in a huge amount of debt and he threatened he might have to skip town. I talked to him about the importance of staying for his treatment but he didn’t seem to care. I thought to myself on many occasions “this man is going to die before I get a chance to heal this ulcer”. I just couldn’t seem to get through to him. It was so frustrating and I felt I was fighting a losing battle – I was exasperated. I’m not quite sure when, but at some point I stopped trying to get in and out of the treatment room to see him as quickly as I could. I gave up trying to talk to him about his diet and exercise. Instead, I sat patiently and listened to what he had to say. It’s then I realised that he had no friends or family – and nobody to talk to. Except me. With the help of one of my nurses, we arranged food vouchers for him. We also helped him to get in touch with an advocacy service so he was able to break the lease on his lodgings. After that everything changed. When I told him he needed to lose weight, he actually listened to me. He started to drop the kilos. He was also paying attention to his diet. His blood sugar readings improved. With the weight loss, his arthritis settled down and he was able to stop using his walker. Then, gradually, his ulcer healed! Then he decided he was sick of being retired and started driving his friend’s truck – doing some delivery jobs. He had soon paid off all of his debt and saved enough to invest in his own truck. Now he has a whole lot of trucker friends and he endlessly nags them about “eating healthy”, not drinking alcohol and quitting “those evil cigarettes”. Ron has come such a long way in the past two years. I am always happy to see him and he is always happy to see me. We both know what we have managed to achieve together and I am thrilled to be able to say that I have really changed his life. It just goes to show that in this profession we have the opportunity to apply our listening skills, as well as our medical experience and expertise, to heal our patients.

Going Places – ISSUE #5

Sparkle in her eye.

Till death do us part.

By Dr Heidi Spillane

From Dr Liz Wearne

You had a friendly smile as you walked into the room and I instantly warmed to you. A bit of background history was taken, and the usual questions around the purpose of the visit were asked – the request for a PAP smear.

I hope you don’t think this sounds macabre, but I find working with people who are dying – and their families – one of the most satisfying parts of General Practice.

Previously married, two grown-up kids, now in your 60s and ready for something new in your life. No new sexual partners … but there may possibly be someone new on the horizon. You ask for an update on STIs and condom use. Conversation flows easily. The following week you return for your results – all clear – and we engage in more conversation about the potential new partner. I notice the sparkle in your eye as you coyly tell me about the highschool sweetheart you were hopelessly in love with. How it ended in heartbreak when, after one explosive argument, you went your separate ways. Both as stubborn as each other and never looking back. You lived your life – and 40 years later, your kids have left home, your marriage has ended, and you have disentangled yourself from an identity that has defined you so many years. So you are free and ready to start afresh. Then, one day you return home from work and play your answer phone messages. You hear a familiar voice, cloaked with a maturity you do not quite recognise, leaving you momentarily confused. Slowly, as the name, face, and memories come flooding back to you, your heartbeat quickens and a swell of emotion rises from somewhere deep inside. The voice explains the story of how he didn’t look back that day he left you, but has been looking back every day since. He has led a colourful life. He has chosen a flight back to Australia as a gift to himself on his retirement. He has travelled from his home in the US to the home of his youth, and the home of the lover he never quite managed to quench the flame for, all those years ago. He is flying back to the US in two days, and apologises for the urgency of the request to meet you for coffee … but nerves had got the better of him. With emotion in your voice, you recount the story of your meeting, and of your approaching visit to the States. The details are lost, and all I see is a radiance and glow that emanates from you. And – again – that sparkle in your eye. As you leave the room and I wish you well on your trip, I feel your joy and see the spring in your step. I am left with a smile on my face as I am reminded of the beauty of living. Later that evening, I reflect on the privilege of being told countless, deeply personal stories; of life, of death and all that lies between. As a GP, I am afforded momentary insights into the complex lives of my patients, and feel wiser, enriched and sometimes enlightened by our common humanity.

Helping someone to travel that journey well is so important – both to them and their family. Late last year I helped to look after an Aboriginal lady who was dying from end-stage COPD. I’d known her for some time and I really loved how feisty and strong-willed she was. Her physical decline was painfully slow but she battled on – ever the matriarch. I’d often see her with a legion of grandchildren and great-grandchildren all in tow. She was a well-respected elder with a large, loving family – and although they all struggled to let her go, she was very firm about her wishes, right up until the very end. Working together with the whole family, we helped her die peacefully at home, with everybody around her. I arrived at the house about an hour after she’d died and there were literally hundreds of people there to mourn. To have her children and husband hug and thank me was the most humbling experience – all that I’d done was sit with her, manage her symptoms and focus on her comfort. Sometimes the most powerful tool we have as GPs is the ability to listen and have compassion. To hear what people fear, expect, value and want in their lives. I feel immensely privileged to be able to listen to people’s stories and – in however small way – help them to live, and die well.

A pain in the neck. From Dr Rohan Kerr While working with the Royal Flying Doctor Service in Western Australia, I was called to an accident at a mine site hundreds of kilometres from anywhere that represented civilisation as we know it. In the mine, a 300kg object had fallen, landing on the upper back, neck and shoulders of a mine worker … which (perhaps not surprisingly) left him in considerable discomfort. Within a few hours we’d arrived at the mine and were immediately taken to see this worker. Without resorting to expletives, he was a “very large” man with a very short, thick neck. We quickly determined he had a neck injury that required radiological assessment. Due to the remote location of the mine site and the likelihood that this man would require a CT scan, we decided he needed to be flown to Perth where the closest CT machine was. After a huge amount of effort – struggling, gentle pushing, shoving and pulling, we managed to get him into the RFDS plane and take him to Perth. We arrived in Perth and did a cervical spine x-ray straight away – however, as predicted, this did not satisfactorily show the cervical spine, so – as we’d anticipated – a CT scan was needed. We arranged a scan and took him down for this. Unfortunately, due to his body habitus, no matter what we tried, he just would not fit into the CT machine. After a discussion and a few quick phone calls, we arranged a CT …. at Perth Zoo. So he was sent off to the zoo where he had his neck scanned by the CT machine used for elephants.

Thankfully there was no bony injury.

“While I’m here Doc…” By Dr Genevieve Yates “I know this appointment is for my son, but while I’m here, could I get you to have a quick look at my rash?” A fit-in-a-family-member appointment. A while-I’m-here-it-won’ttake-long request. Always on a day when you’re already running late. Josie was a repeat offender – forever trying to get herself or one of her brood “squeezed in” with trivial ailments. A worrier by nature, she’d race in to see me at the first sign of a sniffle, and then think of something else while she’s at it. If the surgery offered frequent flyer points, she’d have had free air travel for years! I gritted my teeth. “We’ve talked about this before, Josie. If you wish to be seen along with your son, please let the receptionists know when you ring and they can book you … wow, how long have you had that rash?” “About a week. It doesn’t hurt and it’s not itchy but it’s spreading, though.” The purpuric rash was classic. The petechiae unmistakable. This was no trivial ailment. I saw her again that evening after the preliminary blood results came back. She took the news surprisingly well. “We don’t have the full results yet, Josie, but we do know that your white cells are extremely high:140 – that’s over ten times what they should be. Most of these are immature and abnormal looking cells. Also, your platelets are dangerously low at 20. This is why you are bruising and bleeding so easily.”

“So what’s caused this?” she asked calmly. “Based on these findings and the fact that your blood count was totally normal six weeks ago, it appears you have some kind of acute leukaemia.” She smiled and shook her head. “Cute leukaemia? Thanks for trying to break the news to me gently, but I’m not stupid. I know there is no such thing as cute leukaemia – they’re all nasty.” Josie discovered just how nasty leukaemia could be over the next year. Her in-patient treatment was protracted and complicated, and on several occasions her family expected that she wouldn’t pull through. Now, two years after the initial diagnosis, she is in remission and feeling well. Travelling with her and her family through this difficult journey has been both challenging and rewarding. Interestingly, her anxiety levels regarding her health and that of her offspring have decreased significantly. “After what I’ve been through with the cancer, nothing else seems worth worrying about,” she comments cheerfully. She still pulls the while-I’m-here-Doc trick fairly regularly, but I happily let it slide. It doesn’t seem worth worrying about, either.

Dr Ruth Stewart

Enjoying the quadrilogy of University, Clinic, Committee and Practice

I’m currently working four days a week at Deakin University as the Director of Clinical Studies for the IMMERSE program – which stands for Integrated Model Medical Education in Rural Settings. My role involves finding appropriate placements for our postgraduate medical students, who spend third year – their core clinical year – on a one-year rotation in a rural Practice, where they study all the disciplines concurrently: medicine, surgery, musculoskeletal medicine, women’s health, children’s health, and mental health. As a result, I’m on the road quite a lot, building relationships between the School of Medicine and the various Practices who host our students. I’m also on the Board of the College of Rural and Remote Medicine, where I’m the Director for Women in Rural Practice.

Although I have a very busy schedule, I manage to retain one day a week in clinical practice as a rural GP Obstetrician. And, as well as this, I still work each Wednesday in my practice in Camperdown, south-west Victoria, where my husband Tony is also a rural doctor. I’ve only ever worked part-time as a GP because Tony and I have four children – so until around 2001, I spent much of my time looking after children. I grew up in Tatura near Shepparton, a small town in northeastern Victoria with a population of about 2,500. I was one of five children and I was always getting sick. I was born at 32 weeks and delivered by my local GP Obstetrician. The whole family were expertly cared for by our local GPs; I had earaches, had my tonsils out … even had an emergency appendectomy at the age of eight. Our family doctor saved my life and became my instant hero, which must have been about the time that I decided I wanted to be a doctor! From school, I went straight to Melbourne Uni to do medicine. But, unfortunately, I didn’t enjoy the course at all. By the fourth year, I was well and truly sick of the course and started doing a writing course at night. To be honest, I really wasn’t doing very well in medicine, and I was also waitressing three nights a week to support myself. I was seriously contemplating dropping out of medicine and went home to visit my family. When I was there, my mum suggested I should spend a couple of days with the young GP Registrar in town. Looking back, I’m so glad I did spend time with that GP! Because I realised straight away, this was really what I wanted to do. Back at med school, I returned with new enthusiasm – I knuckled down and, once I got into the clinical years, I found it much more enjoyable and interesting. I did my internship at Geelong Hospital and stayed for another year as a resident. I really enjoyed it there – it was a really friendly and supportive place. Tony and I were married towards the end of our second year in Geelong and I then decided on Glasgow to do six months of Obstetrics. We planned to backpack around South America for six months straight after that. We were both keen to do rural General Practice when we returned. But six weeks after the wedding, I found I was pregnant with our first child, Hamish, who arrived when we were in Glasgow doing the six month Obstetrics term. So there was no South American adventure – instead, we returned to Australia, where vocational registration had just come in – and we both did Family Medicine. Luckily, we managed to arrange a dual locum placement here at Camperdown shortly afterwards and loved it. We only intended to stay for two years to get accredited, but ended up buying a house in town …. and so far we have been here for 21 years! Our second child, Duncan, arrived in 1990, then came Grace and finally Lachlan, our fourth, born in 1996. It took me a while to complete my training, with all the other commitments, but I finally finished in 1998, when Lachlan was about two. You do have to give up some level of control over your life to be able to have a career with a large family, but and Tony and I are very fortunate as we have a whole team of people who have helped with cleaning, babysitting, and so on – allowing us to do our GP work. I’ve always worked part-time in General Practice, initially because we were raising a family – but as the children got older,

I’ve also worked in a number of other roles, like VMO at South Western Health Camperdown Campus and at Toorang and Mortlake Hospitals, as well as Timboon District Health Services. I’ve also been actively involved on various medical and community boards and committees. I was lucky to work in both Ethiopia and Arnhem Land and then in 2005, undertook a Rotary International Study Exchange to Argentina. I have been privileged in that my colleagues have always valued what I do and have enabled me to come and go from the practice over the years. Something I have valued greatly is the involvement with teaching in the practice, which led me to being on the Board of the Greater Green Triangle General Practice Education and Training. (On 1 November 2010, Greater Green Triangle GP Education & Training – GGT – merged with the Gippsland-based training provider, getGP, to become Southern GP Training.) I’ve also been able to be involved in the medico-political side of General Practice, becoming the Vice President of the Australian College of Rural and Remote Medicine and then the Director for Women in Rural Practice. General Practice has enabled me to lead a huge and interesting life, combining the roles of rural procedural doctor, wife, mother, medico-politician and an academic. It’s quite a handful but it’s wonderful and I love it! Just to demonstrate the myriad of different paths you can take with General Practice, the major focus right now is my PhD Thesis: “Barriers and Facilitators to the Establishment of a Maternity Managed Clinical Network in a Low Volume Rural Context”. This is about the development of the Corangamite Managed Clinical Network – an organisation which spans three small hospitals with responsibility for coordinating quality assurance practices, professional development activities and workforce modelling in the maternity services. It’s a way of doing the things in small facilities that are typical of what’s found in a large centre.

Photography: Rod Clarke

Going Places – ISSUE #5

What’s your with Dr Heidi Spillane It’s Thursday afternoon and I’ve had quite a busy surgery – a real mixed bag of patients who all look at me, hoping I can provide a miracle cure or an instant solution! I do my best to satisfy their hopes. They include a 26 year old woman who returns with fevers and otitis externa plus cellulitis after three days of Soframycin ear drops, then a mother who brings in her three year old who has impetigo, followed by a 56 year old male who has suffered a syncopal episode and a 30 year old female with chronic pelvic pain and irregular bleeding. Another two hours of surgery this evening – so there’s time for another few patients and to check over some X-rays and results from the lab. I give a flu shot, examine a 26 year old male who is back from Indonesia with fevers and headaches, do a pap smear and talk through options with a 19 year old female who has impaired glucose tolerance and has come in with her 24 hour BP record.

I asked Jack to provide a urine sample for me and performed a dipstick. I didn’t detect any abnormality. I explained to him I was going to prescribe Tamsulosin – an effective drug used in the syptomatic treatment of BPH, which is what would cause him to have the need to urinate several times during the night. I asked him to arrange to have blood samples taken at one of the local pathology labs, so I provided the referral for the Bloods: FBC, ESR, CRP, E/LFTs, PSA, TSH, Ross River Fever and Barmah Forest serology (mosquito-borne illnesses that are prevalent in the area), Iron studies, and an MSU.

The last patient of the day is a 79 year old male – a very pleasant and affable elderly gentleman. He introduces himself and asks me to call him Jack. He tells me that he feels depressed and in poor spirits – he just doesn’t feel like doing anything anymore. The way he explains, it’s a mixture of lethargy, aching and fatigue. He’s not sleeping well and he has lost weight. This has all happened fairly recently, so he tells me he feels he is “falling to pieces”.

I discussed the differentials and suggested that he could probably benefit from some counselling if nothing showed up on his investigations. I told him the results should be back in a few days and I’d see him again then.

I probe him about this and how long he’s been suffering from weight loss. He feels it has been a couple of months, but it has certainly been getting worse over the past two or three weeks.

• Hb 120 (MCV 85)

In response to my questions, I gather he’s not a big drinker, he and his wife have a good relationship, there don’t appear to be any financial stresses that are worrying him, and he doesn’t have any suicidal tendencies. However, he is tearful and really quite emotional throughout the consult. He tells me he has to get up four or five times a night to pass urine – so I’m alerted to the fact that there could be some prostate trouble. From his PMH, I see that he had a CVA in 2002 and he still suffers from slight residual ataxia. From his entrance into the surgery, I could tell that his co-ordination and movement was just slightly impaired. He has AF, which is controlled with Digoxin and is Warfarinised. He also has Fe deficiency – the colonoscopy/endoscopy five years ago was normal. We then move on to an examination – RS/CVA and Abdo are unremarkable and I can feel a moderately enlarged prostate on PR, but I don’t detect any masses.

At this point what would you consider?

It’s now Wednesday morning and I see Jack has made an appointment for 11am. I’ve received the results of the bloods and everything is normal except:

• Ferritin 90 • ESR 105 The ESR interested me, as it was very high – three or four times what would have been normal. It’s a useful test that indirectly measures inflammation in the body, although it’s not specific as to where it is, and doesn’t allow for an accurate diagnosis. ESR is helpful in diagnosing two specific inflammatory diseases: temporal arteritis and polymyalgia rheumatica (PMR). A high ESR in one of the main test results is often used to support the diagnosis. It is also used to monitor disease activity and response to therapy in both of these diseases. Jack comes into the surgery and this time he’s accompanied by his wife, who is very concerned about her husband – she insisted on coming with him.

I probe more specifically about the aching he described in his initial consult, as with the high ESR this could be very relevant. He tells me he suffers from a painful aching in his thighs and his shoulders – he feels really stiff in the morning, and particularly when he gets up from sitting. The diagnostic picture suddenly becomes obvious as symptoms of shoulder and hip girdle stiffness with an elevated ESR in an elderly person being classic for polymyalgia rheumatica. PMR will certainly be more straightforward to deal with than the one of depression that was high on my list of differentials. I question him about eye symptoms or symptoms of jaw claudication, and examine his temporal arteries, which show no signs of tenderness – often a tell-take sign of giant cell arteritis. I look for this, as in a quarter of cases it co-exists with PMR. In fact, GCA and PMR are so closely linked that they are often considered to be different manifestations of the same disease process.

At this stage what do you think the problem is?

Well, I’m not disappointed. Jack comes in with his wife. His demeanour has changed substantially – he’s brighter, happier and appears far more sprightly than I’d observed on the last two occasions. He tells me he feels 100% better …. “marvellous, much better than he has felt in years … on top of the world”. He is so grateful for my miracle cure! His wife is equally delighted and they leave the surgery thanking me and telling me what a wonderful doctor I am. It’s at times like these it is so satisfying to be able to do this job and make such a difference to people’s lives. That’s why it’s motivating to know you can use your skills, experience and expertise to achieve what patients perceive as miracles!

Symptoms of Polymyalgia Rheumatica (PMR) Symptoms can offer appear quite suddenly:

My diagnosis was Polymyalgia Rheumatica (PMR), and while Jack had a myriad of non-specific symptoms at initial presentation that could have been consistent with a diagnosis of depression, the high ESR prompted me to believe something else was going on. It’s a disorder that almost always occurs in people over 50 years old. The cause is unknown – although symptoms are located mainly in the muscles and there are no outward signs of arthritis; however, in some cases there is evidence of inflammatory arthritis. I prescribed Prednisone 25mg and asked Jack to return to see me in three days so I could monitor the INR, which is necessary for anybody on this drug and Warfarinised. It’s now Monday and Jack has another appointment, so I’m hoping he’s experiencing some immediate benefits from Prednisone, as I’ve read occurs rapidly

• Anaemia • Face pain • Fatigue/excessive tiredness • Fever • Hip pain and stiffness • Malaise/general ill feeling • Muscle pain – sometimes minimal, more commonly aching • Neck pain and stiffness • Other joint pain • Shoulder pain and stiffness • Unintentional/unexpected weight loss

Going Places – ISSUE #5

Dr TIM KELLY

The rural GP with a passion for Obstetrics and Anaesthetics I realised Iâ&#x20AC;&#x2122;d actually like to be a rural GP and from then on, everything fell into place for me.

Photography: Clive Palmer

“I got frustrated at seeing the silos that get built, because Dr Tim Kelly is a rural GP with additional qualifications in as a generalist, you are really versatile and can do a wide range Obstetrics and Anaesthetics, who works in a three doctor practice of things. Conversely, in the larger hospitals, you see so many in Crystal Brook, which is a couple of hundred kilometres north of inefficiencies, because nobody is taking on the broad responsibility Adelaide. as a generalist. I loved the experience, but I found that part of it When he spoke to Going Places, Tim had just come out of theatre truly frustrating.” in the Crystal Brook hospital, adjacent to his practice, where he While Kangaroo Island has a similar sized practice to his had looked after the anaesthetics for a visiting gastroenterologist. current one and most of his family are still there, Tim says he feels “On average, I’m in theatre about once a week. There’s two he has the capacity to be a better doctor somewhere else – where days a month at Port Pirie, which is a bigger regional centre about the population don’t know him predominantly as a friend and local! 30kms away, and a couple of days here at Crystal Brook.” Tim has also been involved in Registrar training over the years Both Tim and another partner in the practice are able to switch – employed part-time to do rural medical education work for between Anaesthetics and Obstetrics, giving them quite a lot of the Adelaide to Outback GP Training Program. He is now a rural flexibility, he says. “We do about 60 to 70 deliveries each year, education coordinator, running rural-based with people coming from outside the district training days for Registrars. because we’ve got good midwives and have “Half of my day-to-day “I really enjoy the Registrar training – it’s developed a good reputation as a baby good to get to know the Registrars and also hospital.” work is hospital work – it’s to see people working in different Practices. Tim grew up on a farm on Kangaroo procedural work – and It gets me out of my practice and makes me Island, the youngest of three sons. Initially keen on becoming a rural vet, he was there is a real difference.” think with a different part of my brain when I get to see how they operate.” accepted into undergraduate medicine at Tim believes there needs to be a far the University of Adelaide. “Part way through greater distinction between metropolitan General Practice and the the course, I wasn’t all that sure that I wanted to do medicine – sort of work he is doing. so I was about to take a year off and consider my options. But “I’m a committed rural generalist, so in reality only about half then I realised I’d actually like to be a rural GP and from then on, my work is the kind that we get assessed on in General Practice everything fell into place for me.” exams. Half of my day-to-day work is hospital work – it’s procedural Tim did his internship at Modbury, a smaller peripheral work – and there is a real difference.” hospital that’s really geared up for rural training. “I got out of the That’s not to say that he’s not a fan of regular GPs. “I’m big tertiary hospitals as soon as I could – partly because I didn’t passionate about General Practice, full stop. City GPs do a fantastic like the hierarchy – but also, because I knew they wouldn’t serve job, often under difficult circumstances, but as a rural generalist my own, personal training purposes and ambitions. you cross over into hospital-based practice, too.” At that time, there were no Regional Training Providers He’s keen to keep a rural generalist perspective in his practice, established, so Tim did his GP training via the RACGP, mostly in wherever he ultimately ends up. “I’m just not sure that I could Adelaide. work in the city. I like the city – and I’m aware it can be isolating if Ironically, his first post as a GP Registrar was at Crystal Brook you stay in the country – but I’m involved in activities outside the – where he is now! “I loved it here, it was great. I had such good practice, like the training program … and that means I get to meet experiences.” he says. a lot of people and keep up all my networks.” Tim spent six months doing locum work all around South After ten years at Crystal Brook, Tim and his family (wife Jane Australia with the Rural Doctors Workforce Agency. “I worked in and children aged ten and seven) are still loving the work, the 12 or 15 different Practices for a week or two each. That gave me a lifestyle and the locality. huge amount of hands-on rural practice experience.” “The longer I’m here, the more I enjoy it. If a student sits in and When he’d finished his General Practice training, Tim and his watches a consult, for them it’s just like seeing a snapshot. But wife took six months off to travel, then – when they returned – in my mind, and hopefully in the patients’ minds, it’s something he spent a year at Cairns Base hospital doing further training in quite different. It’s about shared experiences with the community Obstetrics. over the last nine or ten years that have got us to that point. It’s “I had already done a Diploma of Obstetrics, but needed more about the relationships and the history – for example, it could training to be able to do caesareans.” He says that the training was involve looking after their spouse who died of terminal cancer or wonderful and there were great opportunities – but he found the delivering their child. That’s why it’s so incredibly satisfying.” hospital system frustrating, even in a regional centre like Cairns.

Going Places – ISSUE #5

Tech Talk • Review

We’ve all seen Dr McCoy use the high-tech needle-less syringe on Star Trek all those years ago and thought it was futuristic. But it’s not. The needle-less syringe is a reality and in use throughout the world – especially by diabetics, many of whom need to inject themselves several times daily. But let’s start at the beginning to understand how and why the needle-less syringe can make a huge difference. It’s a quantum leap from the first hypodermic needles developed by Alexander Wood in 1853 to administer morphine …

Injections and needlestick injuries

The development of the technology

It’s estimated that, worldwide, over 10 billion needle injections are given each year by medical professionals – this doesn’t take into account those who self-inject. As you’d be aware, giving injections successfully (and relatively painlessly) with a syringe requires training and experience.

It may surprise you that needle-less technology is not that new – jet injectors were developed by the US military and used during the Second World War for mass administration of vaccines to soldiers. These first injectors used compressed gas to propel milliliters of liquid into the skin … even into muscle. The overall thinking was that “as long as you inject enough vaccine somewhere, you’ll get a result”.

The needle needs to be inserted properly to reach the correct depth, making sure it’s not in a blood vessel. Research has shown, in many cases, incorrect technique with needle-based injections can deliver medication to the wrong depth, leading to wastage and poor medical outcomes. More significantly, there’s the potential for needlestick injuries – high risk when treating HIV and Hepatitis patients. It’s reported that there are well over 800,000 needlestick injuries to healthcare professionals every year – and that is just in the US. It is estimated that this annual figure is probably as high as 3.5 million worldwide.

Benefits and advantages The potential for needle-less syringes is huge and addresses some of the disadvantages of using needles: the relatively high cost of the disposable needles, the inability to reuse, the potential for needlestick injuries … and the pain inflicted on patients! Needle-less syringes are easier and safer to use, they require less training and technique – and consistently deliver injections to the correct depth. They also put an end to sharps bins/containers and hazardous waste. Importantly, there is considerably less pain for patients! From an economic perspective, the latest units keep costs down, so that safe needle-less injections are well within the scope of healthcare budgets.

In the decades following this, traditional jetinjectors were actually shown to be responsible for the spread of disease, and were banned by the World Health Organization. This was due to wide injection streams that caused a significant amount of splashback onto the injector, resulting in contamination, which was not thoroughly cleaned. Thankfully, there has been considerable progress in the development of the technology over the past decade. There are now various types of needle-less syringes available – including the PenJet, Biojector, Medi-Jector and Injex.

How do they work?

Will you be using needle-less syringes?

There are different technologies, but we can generalise about the way they work and how they deliver medication to patients.

Using needle-less syringes makes a great deal of sense – particularly the contribution they can make to a safe and hazard-free medical environment. They offer the benefit of speed and simplicity – and also eliminate many of the dangers and drawbacks of using needle-syringe delivery, such as intentional or inadvertent unsterile reuse, needle-stick injuries to healthcare workers, and improper disposal of sharps waste.

To administer a needle-less injection, the nozzle of the unit is placed against a suitable injection site, such as the upper arm, thigh or stomach. The unit is gently pressed like a conventional syringe and the injection is administered. Instead of a needle piercing the skin, a burst of gas (most commonly CO2 or nitrogen) – or spring-power – is used to propel a very fine jet of the required drug through a hole barely a 0.1mm wide (smaller than the diameter of a human hair – less than half the size of a 0.25mm syringe needle). This travels through the skin to the underlying tissue in less than 60 milliseconds. Compared to needle syringes, this technology has a substantial benefit – it improves the dispersion of the drug throughout the tissue. As the fluid stream forces its way through the tissue, it follows the path of least resistance, resulting in a widely dispersed, homogenious, spider web-like distribution of the drug. That means it does not enter blood vessels, nerve fibres or even osseous tissue. Some units can deliver subcutaneous, intradermal and even intramuscular injections. Dosage size can be as large as 0.5mL or as small as 0.1mL.

Needle-less syringes are perfect for the needle-phobic! They can be used for subcutaneous injections of medications, including Insulin for diabetics, Heparin for Thrombosis prophylaxes, local anaesthetics, as well as for the delivery of other drugs. Trials have indicated that the effectiveness of needle-free injection with the Biojector unit is equal to needle and syringe for some anaesthesia blocks. The technology continues to be developed and the increasing volume of manufacture is resulting in lowered unit costs – so it’s possible that you may be using needle-less technology to administer injections to your patients within the next few years!

In addition to conventional liquid medications and vaccines, some of the units can deliver needle-less injections of freeze-dried (lyophilised) drugs. This is particularly useful for the increasing number of highly potent, biotechnologically derived proteins that require lyophilisation to maintain shelf life. The units are ergonomically designed – feeling and functioning like an ordinary syringe. Because of the similarities, users intuitively know how to use them and therefore have complete control over the administration of a needle-less injection. For those who need to self-administer injections, it reduces the amount of dexterity required – a real benefit for the young or the old – or those who find traditional syringes difficult to use.

Going Places – ISSUE #5

Dr Rohan Kerr

Giving General Practice a volley 26

I have a really nice mix of work at the moment, divided between clinical work and medical education. I spend three days a week as a GP in a practice in Claremont, which is an outer suburb of Hobart. There are eleven doctors in the practice – most of us are there part-time as we have other medical commitments. I ride my bike to work and our afterhours on-call work is outsourced, so it’s all very civilised. I spend one morning a week looking after my son, who is nearly two, and the rest of the time I work as a medical educator with General Practice Training Tasmania (GPTT). I run the GPTT Approach to Emergency Medicine (AMR) training for GP registrars, GP Supervisors and Medical Educators. My main role in medical education is coordinating emergency and simulation training. I set up the Advanced Life Support (ALS) course in Tasmania, which is badged by the Australian Resuscitation Council. It was initially set up in the UK and then started a few years back in Western Australia – this year I brought it to Tasmania. It’s not just for GPs, as we run it for the wider Tasmanian medical community. People who attend these courses include paramedics, advanced nurses, physicians, emergency doctors, overseas trained doctors and hospital doctors. Running the courses often takes up time on weekends and after work, but I’m not doing any on-call work, so it’s very manageable. I’ve always been a keen tennis player and wanted to pursue this after school, but also wanted to have a career in medicine … fortunately, I’ve been able to combine the two. I graduated in 1996 after doing an undergraduate medical degree at Monash University. After third year medicine, I deferred to travel to Europe and play tennis for a year. The university was really supportive and the Dean actually encouraged me to take that year out. When I came back, I was very interested in working for the Royal Flying Doctor Service, so I contacted them and was able to arrange for a six-week placement in my fifth year, which was one of the most enjoyable times during my medical education. I did my intern year and my first resident year in Geelong hospital, as I was keen to get out of the city. I guess, like most new doctors, I found the intern year really challenging. You’re making that transition from student to doctor, trying to establish yourself and, at the same time, coping with the excessively long hours. After two years in Geelong, I took another year out to once again play professional tennis in Europe and by the time I returned, I had decided I wanted to become a rural GP so I moved to Tasmania and entered the rural GP training pathway. If there was anything that clinched General Practice for me, it was the variety and the flexibility of things I would be able to do. I did a resident year at the Royal Hobart Hospital doing rotations that I knew would be useful in General Practice – paediatrics, obstetrics, emergency and palliative care. Then I worked in four different practices, six months apiece, on the north-west coast of Tasmania. I wanted to get really good exposure to the way that different practices run. One of them, Smithton, was very much a true country practice, where the GPs admitted their own patients into the district hospital and would do their own daily round there.

There were a lot of farm injuries and things that – in a big city – would first present to the emergency department, but in Smithton the GPs were the first to attend. Then I went to WA and after a little time travelling, I joined the Royal Flying Doctor Service in WA. I absolutely loved it, working as a team with a pilot and a nurse, doing a mixture of emergency work, retrieval work and clinic work. Sometimes we would fly off to mine sites or aboriginal communities to run routine clinics. Other times we would service the phone calls, triage calls and making decision plans – things like the practicalities of the closest spot we could land a plane; how somebody in a really remote location was going to get to that landing spot and what medical help they could get in the meantime. My time in the RFDS was cut short when I returned to Tasmania following the tragic death of a friend who was killed in an avalanche while mountaineering in New Zealand. After that I moved Gippsland in Victoria to do GP anaesthetics training, mostly at Sale Hospital, so I’d get more experience in airway management to complement my Flying Doctor work. Then I moved to Melbourne in 2006. I took a few months off to captain the Australian over-35 tennis team to play in the World Championships in South Africa. After that I did about 18 months in General Practice in the city before my wife and I were married. We decided to move back to Tasmania, and I took up the position I have now in General Practice here in Claremont in conjunction with the medical educator role. What I love most about General Practice is the variety and flexibility along with the continuity of care. After four years in the same clinic, I have my own patient base and I really like that. I enjoy the teaching aspect, so I am enrolling in the Graduate Certificate in Teaching and Learning at University of Tasmania this year – something I’m looking forward to! One specific aspect that makes General Practice so appealing is that I don’t know what my future plans are … but I do know that, as a GP, there’s a world of opportunity out there for me.

Photography: Fluid Photography

Going Places – ISSUE #5

General Practice Training in Indigenous Health Victoria It is important

Is it for YOU?

It is challenging It is inspiring

What are you doing about Indigenous Health? Indigenous health is a national priority, with Aboriginal and Torres Strait Islander Australians still dying years earlier than other Australians and suffering from a wide range of preventable diseases and treatable illnesses. As a GP working in Indigenous health, you are likely to make a bigger difference to health outcomes than in any other area of medicine in Australia today! • Practice a holistic approach to primary health care in a cultural context by training at an Aboriginal Community Controlled Health Service (ACCHS). • Get an appetite for Indigenous health by negotiating part-time or sessional arrangements whilst doing your GP training. • Experience complex medicine including chronic disease, preventive health care, health promotion and public health management. • Train under inspirational GP Supervisors, who are ACRRM and/or RACGP Fellows with years of experience and in depth knowledge of the clinical status and cultural aspects of the community. • Enjoy complete flexibility with 9-5 daily hours, leave for release sessions, conferences, study and personal life.

Are you interested in Indigenous Health? Contact the GP Education and Training Officer at VACCHO.

5-7 Smith St, Fitzroy VIC 3065 P: (03) 9419 3350 E: enquiries@vaccho.com.au W: www.vaccho.com.au

Victorian Aboriginal Community Controlled Health Organisation

Applying for GP Training Decided general practice is your career choice? This guide will tell you what you need to know about the application process for general practice. How do I become a GP?

Who delivers the training?

What is the AGPT?

Where do I do my training?

One pathway into general practice in Australia is through the Australian General Practice Training (AGPT) program. Successful completion of all elements of this training program will result in Fellowship of one of two Australian GP Colleges – the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine – depending upon which curriculum is selected. Both Fellowships are vocationally recognised under Medicare and enable work anywhere in Australia. The Australian General Practice Training (AGPT) program is a worldclass vocational training program for medical graduates wishing to pursue a career in general practice in Australia. The AGPT program is fully funded by the Australian Government.

What is involved?

The training is delivered by 17 training providers throughout Australia. Eligible applicants will be allocated to RTPs based on their application and assessment ranking, training preferences and availability of training places. Training is conducted within accredited medical practices and hospitals and is supervised and assessed by experienced medical educators. The training includes self-directed learning, regular faceto-face educational activities and in-practice education. Visit www.agpt. com.au to see who the training providers are in your State or Territory. The AGPT program is based on an apprenticeship model. During training, registrars gain valuable practical experience in teaching hospitals, in rural and urban practices, in extended skills, procedural and academic posts. Registrars in general practices are supervised by experienced GPs.

The program involves a three- or four-year full-time (or part-time equivalent) commitment, which can be reduced with recognition of prior learning (RPL).

How do I apply?

What is involved in the AGPT selection process?

What do I need to do to prepare my application?

Selection into the AGPT program is a merit-based, competitive and multi-phased process used to determine which applicants are best suited to general practice. The selection process consists of four key steps:

Applications for the 2012 AGPT program will open on Friday 13 May. There are a number of things you can do now to prepare for your application.

Step 1: Apply for AGPT

All applicants must provide the details of two referees in their online application. On submission of their application, an email will be automatically generated and sent to the two nominated referees with instructions on how to complete the report. Referees ideally should be a medical practitioner who has directly supervised the applicant for at least a period of 10 weeks within the past three years. Applicants need to select referees who are able to confidently make judgments about the applicant’s professional capabilities and suitability for general practice; and who can complete and submit the referee reports by 10.00am AEST 24 June 2011.

Applicants apply online at the AGPT website. Applicants will receive a PDF of their application upon submission and are required to send a hard copy of this along with required supporting documentation and passport-sized photographs to GPET. Applicants are also required to supply two referee reports to support their application.

Step 2: Eligibility determination

Applicants are assessed by GPET for eligibility to join the AGPT program and, if eligible, the pathway through which they may train (general or rural) using established eligibility criteria.

Step 3: Suitability assessment and allocation

Applicants will be invited to attend an AGPT Selection Centre to be held from 7 to 28 July 2011. The Selection Centres will consist of Multiple Mini Interviews (MMIs) and a 50-question Situational Judgement Test (SJT). The results from the Selection Centre and the score of the structured referee reports supplied will form the basis of a competitive, merit-based applicant allocation to an RTP. Selection Centres will be run in all capital cities, as well as Newcastle and Townsville. A full list of Selection Centres, locations and dates is available on the AGPT website.

Step 4: Allocation and RTP placement assessment

Applicants who have completed the above steps will be included in the allocation process. Based on rank and availability of places at their preferred RTP, applicants will be allocated to their highest available preference.

General Practice Education and Training Ltd manages the selection of applicants into the AGPT program. Applications open on Friday 13 May 2011 and close on Friday 17 June 2011 for 2012 entry. Applications are made online at www.agpt.com.au

Referee Reports:

Supporting documentation:

Certified true copies of various official documents (for example residency/citizenship proof) must be included with your application in order to meet a number of legislative requirements. You can prepare this documentation prior to applications opening.

AGPT Selection Centre preparation:

Selection Centres consist of Multiple Mini Interviews (MMIs) and a Situational Judgement Test (SJT). What is an MMI? MMIs involve applicants being rotated between interview stations with each interviewer asking the same question to each applicant individually. Applicants will have two minutes to read the question before entering the interview room, then eight minutes to answer the question from the interviewer. The applicant is then rotated to the next interview station and the same procedure applies for the next question.

RTPs will be provided with individual performance information from the AGPT Selection Centres. Based on this information (and any further requested information such as a placement assessment), applicants are advised of the outcomes of the allocation, and suitable applicants are offered training places.

What is an SJT? SJTs consist of a number of scenarios that applicants are asked to assess and answer based on answers of varying degrees of correctness being made available to the applicant. Applicants are asked to choose the answer they consider best fits the given scenario.

To find out more about the selection process visit the New Applicants page of the AGPT website and download the 2012 AGPT Applicant Guide. http://www.agpt.com.au/ApplyforAGPT/NewApplicants/

Examples of SJT scenarios can be found on page 19 of the 2012 AGPT Handbook, downloadable at http://www.agpt.com.au/ ApplyforAGPT/NewApplicants/

Find out more at www.agpt.com.au

Heather Pascoe’s It’s only the first week and so much has happened! At last, the day has come for me to set out for Camperdown. I have been in contact with the intern who’s currently there and she can’t speak highly enough of the PGPPP (Prevocational General Practice Placements Program) rotation. She has enthusiastically told me all about the fantastic teaching – how involved we get in the clinic and hospital – the independence but total support we get and the friendliness of the staff. The regular dinners and murder mystery nights sound great, too. It’s Sunday and I’m driving into Camperdown. It looks and feels like a really friendly country town. There are luscious gardens everywhere, beautiful old homes and people riding bicycles down the main street. There’s a delicious looking bakery and patisserie that instantly attracts my attention. I meet the Practice Manager at my flat and he apologises for being late – his tractor ran out of diesel. He tells me that he is there for me anytime, day or night … even if I need to call him at midnight, it’s not a problem. Standing at the front door of my flat, he points out a tree just across the main road – and just behind that is the clinic. And then there’s the hospital a little way up that road. Nothing is more than 5 minutes walk away … including the yummy bakery (which is going to get me into serious trouble!). There’s no need for a car over the next 11 weeks!

What a start to the day. Just walking outside and smelling the fresh country air sets the scene. Plenty DAY of time for a morning run then a leisurely bike ride to the hospital. Unfortunately, the two senior GPs are away at an all-day meeting and the two senior Registrars are off overseas. So, this morning, the round consists of me, the junior Registrar and the medical student. Together we run around and visit all the patients – afterwards, I stay back and finish up ordering tests and reviewing results. I feel completely out of my depth, but the nurses are so friendly and reassuring – they answer any questions I have. Then it’s back on to the clinic on my bike … I couldn’t be made to feel more welcome at the clinic. The Practice Manager spends over an hour and a half taking me through the workings of the clinic. I have my own consulting room with my name already on the door … how cool is that?! He has contacted all the pathology and radiology services and all the chemists in the area to inform them I am here and will be ordering/prescribing. I will be seeing my own patients under the guidance of the two senior GPs... Phew – that’s a relief! I think to myself. Everything I do will be checked and I will have ample time to ask questions. To start off, I will sit in with the GPs for a few consults to see how they like things done. And that’s not all! Not only will I get to consult – they’ll also arrange for me to go out with the RDNS and I’ll be able to see for myself whether the plans for patients I make are actually working … or not!!!

A visit to some surrounding dairy farms is also on the cards. I am told how tough the farmers are out here. Just a few weeks ago, a farmer came in three days after an injury because he didn’t think it was urgent – on examination they discovered he had broken fibulas and bilateral haemopneumothoraces! But the cows must come first. There’s a sort of rural etiquette – if a farmer is in the waiting room and it comes to milking time, there is no question about what is more important, so he (or she) gets priority attention. I look at my watch and it’s 12.30 already! Lunchtime? I actually get a lunch break? What a change from the hospital. I’m assured I will get one every day from 12.30 to 2pm! This whole PGPPP rotation will be a fantastic learning experience, especially as I get two full hours each week – one-onone – with a senior GP. I will definitely make the best use of this valuable time and pick their brains to find out all about how to be a successful rural GP. This weekly session will depend on the patients we’ve seen and on my goals. As well as this, there is teaching for an hour on a Friday; all the Registrars at my clinic – and the other clinic in Camperdown – get together and hold a teaching session. Being willing and enthusiastic gets you lots of experiences. I was intending to be at the clinic all afternoon and planned to find my way around the computer system, however we receive a call from the hospital telling us that one of our patients was going to self-discharge. I volunteer to go up and sort out his discharge. So I hop onto my bike and sort him out … followed by attending one of our other patients who had a fall. Later that afternoon, the clinic is called about one of the patients at the nursing home who needs to be seen – so, I drop in to see what I can do to help.

PGPPP

adventures in Camperdown. The nurses are very proud of the care they give to the elderly in the nursing home. I can see that they take a lot of pride in being able to show the residents in their care are given the best quality of life possible. When they tell me about the activity programs they have, I offer to go along on some of the outings – they couldn’t have been more delighted. I think this made them really see that I genuinely value everything they are doing. Tomorrow morning I’m starting the day with a walk up the local mountain with a few of the clinic staff and their dogs. It’s only the first day and I already feel part of this close-knit community. I am really looking forward to the next 11 weeks. I know it’s going to fly by, so I want to get as much out of it as I can In the country, whenever a specialist opinion is needed, it pretty much means shipping patients out. Having done my first rotation in DAY ED in Geelong, I was aware how often patients are transferred from surrounding towns, such as Colac and Camperdown. I think it was really good to see this side of things before coming to Camperdown, as I know that the bigger hospitals regularly receive calls for either a pending transfer or simply for advice. This experience gave me a good idea of who I have to ring today to transfer two patients out – the person who I want to accept the patient: the ED – the bed manager. However, it takes a lot of phone calls today to eventually get the patients transferred out, but everyone is very helpful – from the nurses in Camperdown to the accepting consultants. It’s 5.15pm according to the clock in the office and I say to the girls “I think your clock is fast”. They reassure me it’s not. Time really flies when you are enjoying every moment … and learning so much at the same time. Next week I am looking forward to attending the GP release days in Colac for two days. This occurs every month for the 1st year GP Registrars and it has been organised so the PGPPP interns are also included. There is absolutely no better way of finding out what life as a GP is like through this training process – living it 24 hours a day for three months.

Photography: Rod Clarke

Things are starting to fall into place now and I’m gradually learning how things run. At this stage, my days consist of hospital work in the morning DAY and clinic work late morning and all afternoon. I really enjoy this set up. I think as time goes by, I should get quicker at the hospital jobs and that means I’ll be able to return to clinic earlier. Today we discharge two patients for the first time since I have been here. I like the fact that when I discharge them I could say in my best GP tone of voice “now you need to reivew with your GP next week, and I’m a doctor at the clinic, so you are welcome to review with me”. The aspect I really love is being able to provide such continuity of care and it’s obvious that the patients feel exactly the same way. Continued over

Photography: Lachlan Moore

Going Places – ISSUE #4

But talk about multiple roles – a retired farmer comes into the clinic with left arm and chest pain which he’s had, on and off, for the past two days along with associated sweatiness and nausea: “Hello my name is Heather and I am one of the junior GPs at the clinic….” I take a history, ECGs, bloods, aspirin and all the usual emergency things for chest. Then I tell him we need to get him into hospital as soon as possible, so we call the ambulance. So, off he goes in the ambulance. Then I hop on my bike and ride up to the hospital. “Hello, my name is Heather and I am the doctor who will be admitting you. Let’s fully examine you and run over your history.” Tomorrow morning I’ll be saying: “Hello, my name is Heather and I am one of the doctors who will be looking after you while you are in hospital.” Ultimately I’ll finish with: “Goodbye. We would like to review you at the clinic in a week. I will be at the clinic so you can come along and ask for me.” It’s only the fourth day but I actually feel like a doctor. The morning starts off very nicely, having DAY discharged lots of patients yesterday. And then just as I’m about to leave the hospital at a reasonable 10am, a patient dies. We have been expecting it very soon but it’s still a shock as this is the first person that has died under my care. The nurses are absolutely fantastic and take me through every step. They help me deal with the family. I think I handle it really well. Then back at the clinic I have two hours of excellent teaching with one of the GPs followed by seeing eight patients. I’m overjoyed because I feel confident making a diagnosis and giving advice to almost all of the patients. And tonight I have volunteered to be first on call for the hospital. This means that I will be called for anything that comes into the hospital tonight. I will go in and see the patient and then call one of the GPs to come in and review the patient. Might it be an exciting night? I have no idea what might happen! It’s a great experience. And it’s wonderful because I know help is there when I need it – but I still have to make some important decisions. Really the best of both worlds.

The final day of my first week and what a fantastic week I have had. I think to myself “I’ll be really efficient this morning so I make sure DAY I get back to the clinic on time to see all of my morning patients”. I arrive at the hospital early, do all the jobs I could before the rounds (which go very quickly) … “yes, I’m on track!” I get back to the clinic and even have ten minutes for a coffee before my first patient. …. And then I get a call. Heather – a jockey – has just fallen off her horse and is up at the hospital. Of course I’d love to go back to the hospital, so I’m back on my bike and up to the hospital. I’m so pleased that the GPs at the clinic are involving me in all these sorts of things. Because I’m over at the hospital, they see my first patient, but I’m back in enough time to see the rest of my morning patients. I learn that planning your day as a GP is really quite impossible – but that is one of the things I love about it!

Want a taste of general practice while training in hospital? The Prevocational General Practice Placements Program (PGPPP) provides professional, well-supervised and educational general practice placements as part of your training. The aims of the program are to build your confidence, exposure and interest in working in urban, regional, rural and remote areas through supervised general practice placements of varying duration – approximately 10–12 weeks. You’ll continue to be paid while you’re on your PGPPP rotation. You’ll gain an increased understanding of the integration between primary and secondary health care – this practical experience will allow you to make an informed decision about considering a career in general practice.

What will you gain on the PGPPP? You’ll have a unique insight into general practice through this opportunity to work in general practice. Your placements will be well supported, providing you with these great benefits:

3 A real life experience in general practice over and above that of undergraduate training

3 Exposure to a variety of health services from migrant to aged care health services

3 Ongoing and personal mentoring by respected and dedicated GPs in the field

3 Direct patient contact in a range of primary care settings such as general practice, Aboriginal medical services, drug and alcohol services and community-based facilities

3 Enhanced understanding of the Australian health care system

3 Great networking opportunities 3 Increased confidence and independence to take into future training and work environments

Eligibility for the PGPPP To be eligible to participate in the PGPPP, you must work at an Australian hospital. For complete eligibility requirements, please contact the junior doctor manager at your hospital.

The PGPPP is managed by General Practice Education and Training (GPET) on behalf of the Australian Government. It is facilitated through providers and delivered by accredited practices and medical services throughout Australia.

BOOK Review

Silver Linings

Dr Fairytale General Practitioner to the Stars

As a medical student at NeverNeverLand Hospital, I was always told that most diagnoses can be made on history alone. However, when your patient is asleep that doesn’t help very much. It is fair to say that Sleeping Beauty [SB] didn’t contribute much to the diagnostic sieve.

Silver Linings is the first novel by Dr Genevieve Yates – one of the GPs we featured in issue 2 of Going Places. As well as being a GP in a small practice on the Sunshine Coast Hinterland in Queensland, Genevieve is also the Sunshine Coast Node Coordinator for CSQTC. In addition to all this, she keeps herself fully occupied pursuing a vast range of creative pursuits. She is a regular columnist for Australian Doctor, has had several short stories published, a short film produced and three plays staged. She has also worked in film and TV, and performed on stage in plays, musicals and stand-up comedy. Genevieve teaches violin, plays piano, sings and plays in orchestras. Silver Linings is set in modern-day regional Australia and explores the universal themes of loss, trauma, love and redemption. Its fast-paced plot – and numerous twists and turns – will keep you engrossed until the final page. Silver Linings tells the story of Dr. John Peterson, and his pregnant wife, Sarah, who move nearly 2000km across the country, hoping for a fresh start. They soon discover that it’s not so easy to run away from established behaviour patterns and past hurts. John’s patient, Taryn, and her two children make the move, too – escaping a violent home life. John’s new boss and Taryn’s landlord, Dr. Eloise Sutherland, doesn’t know what to make of the relationship between John and Taryn. Eloise is trying to come to terms with traumatic events in her past – her emerging feelings about John and the presence of Taryn complicate matters considerably. However, Taryn’s seven-year-old son, Oscar, brings immense joy into Eloise’s life. Precocious and highly sensitive, Oscar is bullied at his new school, but finds solace in classical music when Eloise starts giving him piano lessons. As their lives become increasingly intertwined and their pasts intrude in unexpected ways, all five main characters find themselves facing difficult decisions and enormous challenges. Not everyone will make it through unscathed … or, indeed, at all.

Sleeping Beauty While there was the occasional snore, I didn’t feel that these occurred with enough regularity to warrant them being classed as an ‘interaction’. As you can see, I have pruned the differentials to a short list. I am hoping that a good night’s rest will leave me refreshed and ready to tackle the problem tomorrow. Goodnight. Catalepsy Catalepsy is a nervous condition characterised by muscular rigidity and fixed posture, regardless of external surrounding and stimuli. Sufferers show waxy flexibility (limbs staying in position when moved), slowing down of bodily functions – such as breathing and a decreased sensitivity to pain. This would explain why this morning’s accidental miscalculation between the trolley and our examination bed, which resulted in SB ending up on the floor, was not enough to wake her. I see this as an important clinical finding rather than a medico-legal risk. There are many nervous disorders, which can cause a state of catalepsy including Parkinson’s disease or epilepsy or, in some cases, extreme emotional shock. Catalepsy is also a characteristic symptom of cocaine withdrawal. It is my understanding that SB is “a close friend of Snow White”, which may mean she dabbled with recreational drugs.

Anorexia Nervosa I won’t go into a detailed list of the signs, symptoms and presentation of anorexia nervosa but it is safe to say that a lack of food will leave anyone feeling tired and weak. As the body begins to shut down, a coma-like state can be reached. Something not as well known is the association of anorexia nervosa with Narcissistic Personality Disorder. The essential feature of NPD is a pervasive pattern of grandiosity, need for admiration and lack of empathy that begins by early adulthood. I mean, who calls themselves Sleeping Beauty? That shows a certain level of selfbelief that most people don’t share. Fibrodysplasia Ossificans Progressive (FOP) This is an extremely rare disease of the connective tissue. When damaged, soft tissues are transformed permanently into bone. Injuries can cause joints to become permanently frozen in place, but I hypothesise that in SB’s case, the whole body was affected. Unfortunately, there is no known cure for FOP and so my advice is to avoid activities that increase the risk of falling. Clearly living at the top of a tall tower is a recipe for trouble. By Dr Gil Myers. This article first appeared in JuniorDr.

The easiest way to purchase Silver Linings is online – there are many outlets selling the novel, including www.blurb.com

Going Places – ISSUE #5

Dr Marlene Kong

The Aboriginal GP making a difference in Indigenous health Marlene Kong and her twin sister Marilyn made history over a decade ago as the first Indigenous women to graduate from medicine at the University of Sydney. Now working all over Australia as a locum GP, Marlene says she loves the work she does. Her twin is Australia’s first Indigenous Obstetrician, and their younger brother Kelvin is Australia’s only Indigenous surgeon. All three were greatly influenced by their mother, Grace Kinsella, a registered nurse who raised the three children as a single mother, with the help of her extended family. “My grandfather was a Worimi man and my grandmother was from the Dunghutti people of Kempsie. We grew up in Port Stephens among our extended family, the Worimi people.” Marlene’s parents met when working at Prince of Wales Hospital in Sydney – she and her sister were born in Malaysia, moving back to Australia as toddlers when their mother, Grace, separated from their father, Tony, a Chinese-born GP whose family migrated to Malaysia during World War II. “My father’s parents were struggling Chinese who worked hard to send my dad to Australia to study medicine,” Marlene says. “I feel that I actually have four cultures now – and I appreciate all of them. I have my Aboriginal culture, my Chinese culture, my Australian culture – and my medical culture. It’s like being multilingual, as I can move between these different cultures. And, in my role as an Aboriginal doctor, I feel that moving between these worlds is a key to help close the gap in Aboriginal health.” Growing up among relatives with poor health outcomes and seeing the trauma affecting families was a big incentive for Marlene to become a doctor. “My grandfather died from heart failure at 50, one of my aunts died of acute asthma at the age of 31 and another uncle died at 36 from pneumonia.” Following their graduation from medicine, Marlene and her sister went to different hospitals to do their internship – probably the first time the pair had been separated for any length of time. “My intern year was one of the toughest years I have ever had as a doctor. There were many challenges of being a young doctor in the hospital system. I worked a great many hours – I found it tiring and really hard.” she says. After nearly four years as a resident, doing a lot of Pediatrics, Marlene says she didn’t want to continue working in hospitals. “I made the decision that General Practice was the best way for me to go out and work in the community – giving me the opportunity to do what I really love, especially in Aboriginal health.” After completing her GP training, Marlene went to Lismore Base Hospital in NSW, where she met then-president of Médecins Sans Frontières in Australia, Rohan Gillies, who inspired her to apply to do a diploma in Obstetrics. “I realised it would give me a better international perspective of Indigenous health.” In 2003, Marlene spent six months in South Sudan working in a hospital treating sleeping sickness, returning to Australia for a few months break. She

then worked in Sierra Leone for six months where she looked after two primary-care clinics in refugee camps with up to 7,000 Liberian refugees. “My experiences in Africa were fantastic – and made it even more apparent to me what a dichotomy we have in Australia. Indigenous people live in developing world conditions in one of the world’s top five health-providing countries.” MSF employ local translators in clinics, but in Australian hospitals, few Indigenous interpreters are made available, with a family member accompanying an Aboriginal patient usually asked to translate. “Even small things would get blocked, like the failure of the lobby for murals on the wall of the delivery rooms where Aboriginal women often delivered far from their homes – feeling

General Practice was the best way for me to go out and work in the community

Photography: Ric Woods

frightened and uncomfortable.” Returning from Africa, Marlene settled close to her family in Newcastle and moved back into Aboriginal health. After working part-time in several nearby GP clinics, she gained a scholarship to do an international degree in Public Health in Israel. After returning to Australia in 2006, she spent 18 months as the Medical Officer for the Australian Indigenous Doctors Association, a lobbying role based in Canberra. However, she missed clinical work and returned to Newcastle to work as a locum. “I remain on a number of committees and have a role in influencing Indigenous health, while taking jobs for anything from one week to six weeks, choosing a mix of

Aboriginal health services across Australia. I can work as much as I want, and take time off when I need to … I really feel that I am making a small difference.” “I have recently been accepted into the Australasian Faculty of Public Health Medicine as a new trainee. Commencing in July, I have a three year contract working for NSW Health through which I will complete my training for Fellowship of the faculty. It is very exciting for me as I truly believe that Public Health Medicine is the future – being able to affect a whole population through public health measures is a huge responsibility, as well as being so much more effective than simply working as an individual on a case-by-case basis.”

Going Places – ISSUE #5

Financial Health Check Brought to you by McMasters’

This is the second part of the feature for GPs on buying a property.

Co-ownership with parents Some doctors decide to buy homes with their parents as co-owners. In this situation, the parents usually pay 100% of the deposit, guarantee the loan and generally make the project a workable proposition. This strategy has worked for some doctors, but – on balance – it may not always prove to be the ideal solution. The reason is simple: you end up only owning half a home – ie: only having 50% of the equity in the property. We also think, in the real world, that owning half your home with mum and dad is a little uncool. Let’s face it – if a doctor being paid a reasonable annual salary cannot own all his or her own home, something is wrong, somewhere.

Co-ownership with friends or siblings It’s different if you are talking about co-owning a home with friends or siblings. It can make good sense to team up with someone and buy a $1,000,000 home in a great location close to work and all amenities that offers plenty of living space and privacy … Of course, each case is different, and co-ownership is not for everyone. But, we have found it can work out beautifully. However, a written co-ownership agreement, prepared by a solicitor as a legal document/contract, is essential. It gives everyone peace of mind and makes sure you will not lose a best friend – or a close relationship with a sibling – if circumstances change. And, over time, your circumstances will definitely change.

Parental guarantees Anecdotally, more than two thirds of new homes are bought with significant parental assistance, usually in the form of deposit gifts, co-ownership, repayment subsidies, extra security and guarantees. We expect this is probably lower for doctors, as they have higher incomes and tend to be financially independent. As we’ve mentioned at the start of this article, we confess to not being in favour of significant parental assistance when a doctor decides to buy a home. The exception is parental loan guarantees. Parents are only exposed to the possible drop in value of the property, and (worst case scenario) this is probably not a great amount, if a property has been purchased at the appropriate market value. After a few years have passed, any risk or exposure usually disappears, as the property increases in value and the equity builds. From our experience of working with doctors, they virtually never default on loans, and can always earn additional money by working weekends or nights if they need to. For young doctors, we think parental loan guarantees make a lot of sense. They mean the doctor can buy a property sooner – and this usually means more capital gain for less effort. Realistically, there is not much risk for the parents. Common sense is needed – but we believe, within reasonable limits, parental guarantees are a great idea.

Positive gearing Positive gearing is the opposite of negative gearing, and is jargon for borrowing to invest where the expected assessable income exceeds the

expected deductible interest cost, with a resultant increase in assessable income. OK, so let’s try and make that understandable! In the context of housing prices, this means buying a property with a rental yield of 6% or more … which is an unusual phenomenon. Most houses do not generate rents of more than about 3% or maybe 4% of the cost or value of the property. This means it’s very hard to positively gear houses. For example, if a property was bought for $650,000 and the rental is $500 a week, this equates to $26,000 or 4%. Sometimes, positive gearing works well enough, but it’s usually a sign the house is not that good and either needs a lot of work or is falling in value and was not worth buying. So, take great care if you encounter claims of positively geared houses! But – positive gearing of other types of investments is a different proposition. For example, a few years ago, we recommended to our clients that they should borrow to buy bank shares, which – at the time – were selling with after-tax yields of as much as 13%. This means if a client borrowed, say, $100,000 to buy ANZ shares, they received $13,000 of assessable income, paid $6,000 of interest and made $7,000 pre-tax profit on the deal. Of course tax is not paid at the full rate, as the income from the shares has a tax-paid element (franking credit offset). And there’s the capital gains aspect of the shares increasing in value. It can make a lot of sense for a young GP to adopt a strategy like this as an alternative to buying a home. However, you need to do it to the tune of at least $400,000 before it becomes a comparable strategy. Here’s an interesting fact – if you also borrow $400,000 to buy a home – ie: on top of the $400,000 to buy the shares – the net dividends from the shares more than cover the interest on the home loan. Plus you do not have to pay rent – and you enjoy capital gains on both the home and the shares. Just a thought ….

Buying purely for investment purposes Buying a home hits a psychological sweet spot with most of us – it’s an emotional purchase. Often, it’s an indicative sign of the nesting instinct. The idea of always having our own roof over our heads intuitively appeals. It would be an amazing statistical coincidence if the most suitable home is also the best possible investment option. But it almost certainly isn’t. There’s a great deal to be said for the idea of buying a property purely for investment purposes and renting/leasing a house that suits your needs at each stage of your life. One proponent of this view is Phil Ruthven, CEO of Access Economics, and a well-known and respected commentator on financial matters. Mr Ruthven argues that, over time, most people will be better off renting – thereby paying the difference between their rent and the home loan interest otherwise payable into superannuation and shares. Mr Ruthven may be right, if things unfold in line with his assumptions (which seem to ignore the historical out-performance of property over shares) and one has the discipline to invest regularly through shares and superannuation. But, we expect for most GPs, home ownership and eventually owning your own practice, your own practice premises and your own superannuation fund will be the best way to go.

About McMasters’ McMasters’ is a multi-disciplinary Practice with offices Australia-wide, specialising in doctors, dentists and other professionals. A complimentary initial meeting is offered to all medical Registrars. For more details, call 03 9583 6533 or email berivan@mcmasters.com.au or visit www.mcmasters.com.au 36

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It is important for all medical practitioners to learn how to Getting stuck in one phase It is important for all medical practitioners to learn howWhat to Getting stuck in one phase By Prof GregasWhelan should you do? break bad news; it is an integral and frequent part of our job. break bad news; as it is an integral and frequent part of our job. • P ersistent denial – e.g. demand for more and more tests 1 AM MD MBBS MSc FRACP FAFPHM FAChAM Research suggests that breaking bad news is often done poorly , • Persistent denial – e.g. demand for more and more tests 1 Research suggests that breaking newstoisor often doneApoorly , response good often toit say ‘I think It improved is Explore important all medical practitioners to learnbad how opinions. This can be common because seems more it would be best if you thefor patient’s understanding References Getting stuck inis one phase so3. knowledge and insight can help reduce any stress or or opinions. This can be common because it seems more Senior Medical Adviser, Avant so improved knowledge and insight can help reduce any stress or culturally acceptable than anger. take this up with your own GP.’ You may be able to assist them in break bad news; as it is an integral and frequent part of our job. 1 E Kübler-Ross, On Death and Dying, Macmillan, NY, 1969. anxiety associated with breaking bad news. culturally acceptable than anger. anxietymedical associated with breaking baddepict news. • Before we break the bad news, it is important to know what the • 2 ibid. Persistent denial – e.g. demand for more and more tests 1 With the exception of House, television shows obtaining a GP if they do not already have one. • Persistent anger – e.g. suing for delayed diagnosis. Research suggests that breaking bad news is often done poorly , • Persistent anger – e.g. suing for delayed diagnosis. patient understands atWhat this stage. This willdiagnoses allow uswith to reinforce or opinions. This can be common because it seems more What is badwhere news? situations a bright young doctor makes very 3 D r. R Temes, Living With An Empty Chair - a guide through grief’ New Horizon Press; is bad news? so improved knowledge and insight can help reduce any • stress or Persistent depression – this is the most common form of • Persistent depression – this is the most common form of Enlarged ed 1992. accurate information, correct andlives. ‘Bad news’ can be determined and by the: culturally acceptable than anger. Good advice little clinical information rapidly treats the knowledge patient to save ‘Bad news’inaccurate can benews. determined by the: sticking. anxiety associated with breaking bad sticking. understand what patient is expecting to hear. shows give thethe impression that most of what we do is ‘spot • These patient’s or carer’s perception, or • patient’s or carer’s perception, or I did locum for a solo GP in a country practice as a young doctor. • aPersistent anger – e.g. suing for delayed diagnosis.

diagnoses’.

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is bad news? by our own clinical knowledge and insight. • What by our own clinical knowledge and insight. At handover – apart from showing me the clinic and introducing me • Moving backwards in cyclic loops and repeating previous 4. Confirm or break the• bad news • Persistent depression – this is the most common form of • Moving backwards in cyclic loops and repeating previous to the patients in theorhospital – the GP gave me two good pieces of Informal ‘corridor’ consultations occur in hospitals. This is part of news’ can be determined the:may differ from our – e.g. to anger denial. A‘Bad patient’s or carer's perspective of badby news emotions – e.g. reverting to anger or denial. A patient’s or carer's perspective of bad newsemotions may differ fromreverting our sticking. advice: learning and peer support. However ‘kerbside’ consultations by • Avoid medical jargon. own. Their perspective may be own. affected Theirby: perspective may be affected by: • Cycling is a form of avoidance – going backwards is a strategy • patient’s or carer’s perception, or • Cycling is a form of avoidance – going backwards is a strategy

friends or family that are often requested at parties or elsewhere through TConstant o avoidneed being disturbed at all hours of acceptance. the night, do not live in to delay the1.inevitable for acceptance. tocycling delay the inevitable needstages for carry a higher risk. • by our own clinical knowledge and insight. the house attached to the clinic! • limited clinical understanding • limited clinical understanding The patient’s behavioural responses will likely resemble one of The patient’s behavioural responsesthe will likely resemble one of the • Moving backwards in cyclic loops and repeating previous • Show empathy. 3 a qualified registered medical practitioner, once you respond : three types of behaviour associated withofgrief and loss three types behaviour associated with grief and loss3: • As the impact of the news on their lifestyle • the impact of the news on their lifestyle stopped thereverting street and asked adenial. medical opinion, emotions –ine.g. to angerfor or A patient’s or carer's perspective of bad news may differ from our 2. When to such requests, you are • legally and ethically responsible for the the impact of the news on their career. • • Encourage the patient to ask questions. the impact of the news on their career. • Numbness – mechanical functioning/social insulation • Numbness – mechanical functioning/social insulation suggest the person should make an appointment to see you at own. Their be affected by: advice youperspective give, whethermay or not the ‘consultation’ generates a fee. • Cycling is a form of avoidance – going backwards is a strategy your clinic. If they persist and say this won’t take long, the tactic • Disorganisation – intensely painful feelings of loss perception of bad be affected by:– intensely painful feelings of loss Disorganisation Whereas our perception of badWhereas news willour likely be affected by:news will• likely to delay the inevitable needask forthem acceptance. • • Allow the patient to express emotions. individual fears he suggested was to humorously to strip off in the Reorganisation re-entry • Reorganisation – re-entry• into more normal–social life.into more normal social life. to decline• clinical knowledge and insight • Reasons clinical knowledge and insight sk the patient what they are thinking and how they are street for an examination. While this light-hearted humour • • Alimited clinical understanding The patient’s behavioural responses will likely resemblemay one of the • the diagnosis • the diagnosis Steps in breaking bad news • feeling. It is difficult to perform a comprehensive assessment on aSteps friendin breaking bad news not suit all, it of highlights the serious and with private nature ofloss medical 3 : three types behaviour associated grief and • the impact of the news on their lifestyle • the prognosis • the prognosis or family member following an informal request for diagnosis or for the consultations. 1. Prepare discussion1. Prepare for the discussion • the treatment • • • Anticipate denial and anger. the treatment the impact of the news on their career. • Numbness – mechanical functioning/social insulation treatment. onsider which other practitioners, if any, should be involved in As part of my• Cwork, I take groups for therapy. The participants • Consider which other practitioners, if any, should be involved in • empathy for the patient. • empathy for the patient. the discussion. • P atients may often forget or not understand the bad news, so discussion. • Disorganisation – intensely painfulI commence feelings of aloss • It may our difficult to devote a comprehensive frequently ask about their health problems. session Whereas perception ofadequate bad newstime willfor likely be affectedtheby: Patient reactions bad news strategies should be used to help themto understand. • S elect a meeting space that provides both auditory and visual Patient reactions toinformal bad news assessment in an setting. by indicating that I am not their treating GP and that any responses • Select a meeting space that provides both auditory and visual • ability Reorganisation – re-entry into more normal social life. • clinical knowledge and insight Perhaps the most vital aspect of delivering privacy. bad news is our I give are part privacy. of general information and not specific to the person Perhaps the most vital aspect of delivering bad news is our ability •5. ItPresent may difficult to perform an adequate physical examination in an to anticipate the patient’s reaction. While each patient will options • Squestion. et a mutually agreed to time; do not inconvenience the • anticipate the diagnosis to thetreatment patient’s reaction. While each patient will who asked the I usually have at least 12 • S et a mutually agreed to time; do not inconvenience the Steps in patient. breakingFortunately, bad news react differently, there are common emotional and behavioural informal setting. react differently, there are common emotional and behavioural witnesses to my explanation. patient. • • the prognosis responses that we might encounter. I deally options should be discussed over more than one responses that we might encounter. • Contemporaneous notes are almost never written to document • Allow ample time so as not to appear rushed or impatient. 1. Prepare for the discussion • Allow ample time so as not to appear rushed or impatient. consultation to allowThe for'grief greater understanding by the patient. At the end of the day • the treatment cycle' the encounter. The 'grief cycle' • Consider if the patient should have friends, family and/or an • • Allow silences – they don’t have to be filled. individual fears • individual fears

• Consider if the patient should have friends, family and/or an After receiving bad news, the patient’s emotional response • Consider which other practitioners, if any, should be involved in • • empathy for the patient. Uisse simple language and avoid using medical jargon. interpreter present. Diagnosing and/or treating family or friends is not recommended. It After badto news, the patient’s emotional response • Itreceiving difficult be objective when responding family or friends. interpreter will typically resemble one to of the following five phasespresent. of thethe discussion. will typically resemble one of the following may do more harm than good both for the patient and for you. • C ollate contact details and information about relevant support 2 five phases of the ‘grief cycle’ and move through the cycle • until the final point of • • The Ensure this is a two-way conversation where you present the Patient bad Collate contact details and information about relevant support 2 reactions request maythrough notto relate tonews your of expertise and move the cycle untilarea the final point of – a common ‘grief cycle’ groups. • Select a meeting space that provides both auditory and visual acceptance: treatment patient considers, discussesgroups. and situation foroptions, students and and the junior doctors. Please contact Avant for more information acceptance: privacy. 2. Open the discussion Perhaps the most vital aspect of delivering bad news is our ability 1. Denial: ‘It’s not true. I want more tests, and a second opinion.’ asks questions about each option. on 1800 128 268 or visit www.avant.org.au 2. Open the discussion 1.to•Denial: ‘It’s not true. I want more tests, andinformation a second opinion.’ You may mistakenly assume certain about anticipate the patient’s each patient willfriend • We should always be sure we are speaking with the correct 2. reaction. Anger: ‘WhyWhile me? Why wasn’t this your detected earlier?’ • Set a mutually agreed to time; do not inconvenience the • We should always be sure we are speaking with the correct • Anger: Provide written material with diagrams to facilitate the 2. ‘Why–me? wasn’t this detected earlier?’ and behavioural or family or Why avoid asking any uncomfortable questions, patient. react differently, there are emotional 3. common Bargaining: perhaps withpersonal you – ‘What if I stop smoking now?’ patient. patient. so you won’t get the full picture. 3. Bargaining: perhaps with you – ‘What if I stop smoking now?’ patient’s understanding. • It is important to introduce ourselves if the patient Or perhaps with God – prayer, pilgrimages… responses that we might encounter. It is important to introduce ourselves if the patient Or perhaps with God – prayer, relationship is not already well established – particularly if 4. pilgrimages… Depression: grieving realisation of the• inevitable • Allow ample time so as not to appear rushed or impatient. •Depression: Often all they want is a prescription for their symptoms andrelationship you is not already well established particularly if we have not met before. there are family–or friends who 4. grieving realisation of the inevitable consequences. The 'grief cycle' 6. Close the discussion may feel pressured or obliged to write one. there are family or friends who we have not met before. consequences. • C onsider if the patient should have friends, family and/or an 5. Acceptance: emotional relaxation, and objectivity. • Introduce the purpose of the discussion. • Encourage the patient to contact you directly with further After receiving bad news, the patient’s emotional response 5. emotional relaxation, and objectivity. interpreter present. • Introduce the purpose of the discussion. •Acceptance: Diagnosing and/or treating family or friends is risky! © Avant Mutual Group Limited Disclaimer will questions. typically resemble one of the following five phases of the © Avant Mutual Group Limited • Collate contact details and information about relevant support • Provide appropriate contact details. ‘grief cycle’2 and move through the cycle until the final point of This is general information relating to legal and/or clinical issues within Australia. Itgroups. is not intended to be legal advice, nor and should not be considered as a acceptance: • Make follow up appointment(s). substitute for obtaining personal and specific legal and/or other professional 2.advice. Open thewe discussion Whilst endeavour to ensure that professional documents are as current 1.• Denial: ‘It’s not true. I want more tests, and a second opinion.’ Offer other support services such as a support group. as possible at the time of their preparation, we take no responsibility for matters • We should always be sure we are speaking with the correct 2. Anger: ‘Why me? Why wasn’t this detected earlier?’ arising from changed circumstances or information or material which may have For further information on Avant’s Clinical Risk Management patient. become available subsequently. Avant Mutual Group Limited and its subsidiaries 3.resources Bargaining: perhaps with you – ‘What if I stop smoking now?’ visit www.avant.org.au or email Disclaimer: The information in this publication is general information relating to legal and/or clinical will not be liable for any loss or damage, however, caused (including through issues Australia (unless otherwise stated). It is not intended to be legal advice and should not be • Iwithin t is important to introduce ourselves if the patient Or perhaps with God – prayer, pilgrimages… clinical.risk@avant.org.au. considered as a substitute for obtaining personal legal or other professional advice or proper clinical negligence) that may be directly or indirectly suffered by you or anyone else in decision-making having regard to the already particular circumstances of the situation.–While we endeavour if to relationship is not well provided established particularly 4. 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5. Acceptance: emotional relaxation, and objectivity.

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• Introduce the purpose of the discussion.

Going Places – ISSUE #5

y t e i r a V t a h w itâ&#x20AC;&#x2122;s l a r e n Ge e c i t c a r P . t u o b a is all

e spice of th is ty ie r a GPs aid that v ask many Itâ&#x20AC;&#x2122;s often s u o y if t a eir elieve th ng about th ti s life and I b e r te in t over find mos t pops up a what they th d r o w ice, the career cho iety! gain is var and over a

McEwan arah S Dr

But exactly what is variety? Variety comes in many forms – variety in the practice of medicine, variety in the location of where to practice and variety in the preferred hours of practice. All of these aspects of variety are incentives for doctors who want to be able to easily control the kind of career that they want to have. For fulfilment, satisfaction and the all important work:life balance. In my own situation, variety is a very important component for my own career in medicine. I believe that this keeps me forever open-minded and really flexible – important attributes required for a life as a GP. The variety that I choose for my Practice means I am not currently working as a regular mainstream GP in comfortable private rooms, treating lovely patients who have all selected “me” as their GP. My General Practice career has led me down a slightly different path – well, at least for the time being. And that’s how I find myself as a Medical Officer at Hedland Health Campus in South Hedland, Western Australia. Let me tell you a little about Hedland Health Campus. Firstly, it’s the referral centre for the whole of the Pilbara – a huge region with the next port of call being Perth, which is about a two hour flight from here! The climate can be challenging, to say the very least – and the work load is solid. And – dare I use that word? – there is an amazing variety of presentations. These keep our practitioners (who see themselves like Dr House!) fully occupied and interested. I’ve been working in Hedland Health Campus for the past 8 months and I have completely enjoyed – sorry to use that word again – the variety that this job has enabled me to experience. I work in the emergency department and also in the obstetric and gynaecology department. I feel the combination of the two gives me excellent diversity. My emergency department work can be likened more to a GP super clinic, with the majority of our presentations – we’ve actually assessed at 75% – being category 4 and 5. This is where my General Practice skills are at their best.

I wanted to test myself, to see if my skills were good enough to sustain myself in rural practice and also to test whether I had the stamina to undertake the on-call commitments of being a fully fledged GP Obstetrician. And, finally, to test whether I could manage the transition from mainstream General Practice back to the hospital emergency department setting to deliver health care to my patients. I look back to my first ever on-call shift in Port Hedland, where I received lots of encouragement from the midwifery staff, saying “Don’t worry – you will love Hedland … it will be a whole lot slower paced than where you have come from. We normally only have an average of one delivery per day”. Feeling slightly relieved, or in a state of blissful ignorance, I began my first formal 24 hour on-call shift, thinking that one delivery per day was more than manageable. Fast forward to 36 hours after that wide-eyed 08:00 start – I finally finished my shift. I was still wide eyed, but with a smile on my face, even though I was severely sleep deprived after managing to help five women deliver healthy babies into the world … four by vacuum instrumental delivery and one by lower segment caesarean section. To think that I had reservations and worries that I would lose my skills working in such a rural centre … I should think not!! The real initiation and test was over – I had well and truly proven to myself that I do indeed have the skills, I do have the stamina and – after all is said and done – I still had enough energy to instill motivation to five labouring women who also felt the same reservations as I did as to whether they, too, could perform the seemingly impossible task that was set out in front of them. With a well-deserved glass of red in hand, I celebrated! I felt I had finally earned the title of GP Obstetrician and was looking forward to another day … hopefully a little quieter but with just as much excitement and variety! Ahhh – this is the life of a rural generalist that I find so rewarding and I would not have it any other way!

The remainder of the presentations are spread between category 1-3, which help to extend my skills and keep me forever on my toes. I can confidently say I’m more-or-less certain to learn something new every day. My obstetric role is also challenging and, for anybody who has not had the pleasure of being mentored by a rural GP with procedural skills, it’s one which is sometimes difficult to understand. I remember some medical students that I had the pleasure of mentoring being quite puzzled, even astounded – they couldn’t quite grasp how a doctor with the title of a General Practitioner can work in a hospital setting, delivering babies either normally, instrumentally or by caesarean section. It has always been a really difficult task to try and explain that the possibilities in General Practice are endless – only limited by the imagination of the doctor who is in control of their own career path. I look back to where I was 8 months ago: I was just completing my Advanced Diploma of Obstetrics at Tweed Heads hospital and planning to make the move to the red, rural west. A big part of my enthusiasm at that point was to test myself.

n to the ofte eat access s t n o fr u ese gets yo common th bstetrician g far more ing a GP O in e b m some f p o co u e rt b a P en conjure s that are ft e o m s a e n yl y st b ve life Chill for a comical ba of alternati se include e ce n th le – s va e re p ly the most baby nam days. The and possib lternative a – , l ir ve g ti a a r in ee) fo quite imag d Ab-ce-d e. (pronounce e cd b e and Girli A yi o y, o B b f twins … o t e ch s a r e use of su amusing fo question th to t o ey n th ce n n e xperie ing wh t through e are not jok rn ts a n le ot so re n a ve p re a e a h I joy and es, as th bundle of tional nam ir n e ting ve th a n r e tr co fo n u om their en name their chos received fr s ce k the n o r u lo o ve c n li ti n e a ility to d ympathe ted the ab ve of the s c ti e with ia rf c e l” p a re u p w s p o a oooo unu , I have n s lt u ’s s it , re e a m s oor vely na doctors. A y for the p ’t that a lo deeply sorr ne “oh, isn g li n li rd e a by deedd fe e n e a m id a st g their n whilst ins in , g e n il a m h s c t t n ell tha rn 18! a confide wing full w en they tu hild … kno they do wh g in th t rs helpless c e the fi ost likely b poll will m

Photography: JK Photography

Going Places – ISSUE #5

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After a number of years working as a GP in regional Queensland, Dr James Finn is now city based, working in addiction medicine in Brisbane at two Queensland Health Drug Treatment clinics. Until 2009, he was a long way from the bright lights, as he spent five years as the sole doctor for the small town of Dirranbandi on the Darling Downs, about 600km west of Brisbane – close to the wellknown cotton property of Cubbie Station. Jim recently stood down as Vice President of the Rural Doctors Association of Australia after many years of involvement in the medico-political areas of General Practice. However, he remains on the Board of the CSQTC GP training organisation and on the State Council for SDQ (Salaried Doctors Queensland). Jim came to medicine relatively late – before this, for almost a decade, he was working as a high school physics and maths teacher until he decided to change careers. He was accepted into postgraduate medicine at the University of Queensland, on a rural bonded scholarship. “I took the rural scholarship because I really wanted to do General Practice work and get some experience in a rural area where I could be a jack of all trades.”

“Calls from the hospital at night never occurred for minor things, because the experienced nursing staff take care of most issues … so they only call you up for something pretty major.” After two years at Roma, Jim moved to a more remote post at Dirranbandi, where he was the only doctor for the small town and surrounding district. The private practice was attached to a small hospital with twelve acute beds and a nursing home. From Dirranbandi, Jim also ran a clinic in Bollon, a bush nursing service that was about 100 km by dirt road to the west, and a small clinic in Hebel, a little town of 13 people. “People from the station would come in and see me there in a little purpose-built consulting practice, with a consulting room and a waiting room … that was about all there was.” The hours at Dirranbandi could be challenging, Jim says. His ward round at the hospital started at around 8am, then he would consult in his private practice until around 5pm. Another ward round at the hospital took place around 6pm – and then emergencies could come in at any time through the night and day.

Moving back to the city, Jim says he chose a role in addiction medicine over broad General Practice because he had enjoyed his experience working in inpatient detoxification at the Royal Brisbane Hospital. “The majority of people with addiction issues are to prescribed medications or to alcohol and cigarettes, so it was something I had experience with in General Practice and at Dirranbandi. I’d also done some inhospital alcohol detoxifications, occasionally with patients sent out to me from the city.”

Dr Jim Finn

The GP who’s made the change from country practice to addiction medicine in the city. After his internship at the Royal Brisbane hospital, Jim was accepted on the GP Training Program and went west, doing both the required GP hospital year plus a year in General Practice clinics at Roma Hospital. Although these clinics were administered within the hospital system, they provided a really good grounding in General Practice, he says. “I really enjoyed the continuity of care; that’s to say if someone came in with a particular condition, it was rare to refer them on, because I was the one doing everything and I could avoid the mistakes in medicine that can occur during handovers. Whenever I needed a second opinion, there were often people I could ask – like an experienced GP in town or a visiting physician.” His time at Roma was very busy, with just two to three doctors handling all the on-call for the district – and two or three calls a night, every second night, were very common.

“On average I used to do 22 days on, with six days off, but the roster in Queensland has changed now to 20 days on and eight days off, which is much better.” Jim enjoyed the experience but admits it was hard to switch off on his days off, when the relieving doctor took over. “Because I lived in the hospital grounds, if an ambulance or anyone turned up at the hospital, I’d always go over and stick my nose in it – I just couldn’t help myself! I could only ever relax if I left town.” After five years at Dirranbandi and two at Roma, Jim and his wife decided to move back to the city where they had more family support – an important consideration as they had two young children. “I loved the experience because they were both great places to work,” he says. “I’m so pleased I’d had all the intense experience in Roma prior to going to Dirranbandi, because you are faced with most things when you work that many hours!”

The work:life balance is terrific – the hours are great for family life, Jim says; he works five days a week, with one in three weekends on call. While the move from rural procedural General Practice in a remote town to addiction medicine in the city has been quite a big one, it’s just a taste of the sweeping and extensive variety covered within the GP Specialty, he says. “When I first went into General Practice, I didn’t realise the complexity! Almost all disease – well, let’s say 99.5% of it – is managed by GPs on an outpatient basis. So for every 200 General Practice consults, only one person will ever be admitted to a hospital. And across that broad range of disease, the scope and variety of practice is just phenomenal.”

Photography: Warren Fleming

Going Places – ISSUE #5

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What should I do with my completed form? You have two options – either… • Hand it to your GP Ambassador or • Fold in half, moisten edges to seal and mail. No stamp is required.

G oing P laces NETWORK

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Join the Going Places Network right now! It’s easy to become a member – and it’s FREE! Just complete the form below and post it back to us … you don’t even need a stamp!

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Which hospital are you based in or going to be based in?

Are you an International Medical Graduate (IMG)?

Yes

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Have you or are you planning to participate in the Prevocational General Practice Placement Program (PGPPP)?

What should I do with my completed form? You have two options – either… • Hand it to your GP Ambassador or • Fold in half, moisten edges to seal and mail. No stamp is required.

G oing P laces NETWORK

Taking a fresh look at General Practice An initiative of GPRA

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irements:

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Delivery Address: Suite 4 Level 4 517 Flinders Lane MELBOURNE VIC 3000

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If all the application forms have been used, you can still join Going Places by applying online. Just go to www.gpaustralia.org.au/going places

Join the Going Places Network right now! It’s easy to become a member – and it’s FREE! Just complete the form below and post it back to us … you don’t even need a stamp!

BECOME A MEMBER – IT’S FREE

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Postcode

Other

Which hospital are you based in or going to be based in?

Are you an International Medical Graduate (IMG)?

Yes

No Yes

Have you or are you planning to participate in the Prevocational General Practice Placement Program (PGPPP)?

What should I do with my completed form? You have two options – either… • Hand it to your GP Ambassador or • Fold in half, moisten edges to seal and mail. No stamp is required.

G oing P laces NETWORK

Taking a fresh look at General Practice An initiative of GPRA

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; of 3 mN; and, .5mN.

irements:

ilename: D47707576001110220Y110308.pdf

No print content can appear in the bottom 15 mm on the front of the article or 20mm on the rear of the article.

date: 08/03/2011 08:22:29

WARNING Changes to this artwork not complying with Reply Paid Service Guidelines may result in cancellation of your Reply Paid service.

Fold in half on dotted line, moisten edges on reverse to seal and mail. No stamp is required.

General Practice Registrars Australia Reply Paid 87115 MELBOURNE VIC 3000

Delivery Address: Suite 4 Level 4 517 Flinders Lane MELBOURNE VIC 3000

Application forms removed?

If all the application forms have been used, you can still join Going Places by applying online. Just go to www.gpaustralia.org.au/going places

Join the Going Places Network right now! It’s easy to become a member – and it’s FREE! Just complete the form below and post it back to us … you don’t even need a stamp!

BECOME A MEMBER – IT’S FREE

Or – if you prefer – you can join online at www.gpaustralia.org.au/goingplaces

MOISTEN TO SEAL

M E M B E R S H I P F OR M

Join FREE today! *

Fill in the short form below and be on your way to Going Places

Indicates mandatory field.

Title

Gender

DOB

First Name

Last Name

Mobile

Address

Suburb

State

PGY 1

PGY 2

PGY 3

PGY 4

MOISTEN TO SEAL

Stage of training

Postcode

Other

Which hospital are you based in or going to be based in?

Are you an International Medical Graduate (IMG)?

Yes

No Yes

Have you or are you planning to participate in the Prevocational General Practice Placement Program (PGPPP)?

What should I do with my completed form? You have two options – either… • Hand it to your GP Ambassador or • Fold in half, moisten edges to seal and mail. No stamp is required.

G oing P laces NETWORK

Taking a fresh look at General Practice An initiative of GPRA

MOISTEN TO SEAL

; of 3 mN; and, .5mN.

irements:

ilename: D47707576001110220Y110308.pdf

No print content can appear in the bottom 15 mm on the front of the article or 20mm on the rear of the article.

date: 08/03/2011 08:22:29

WARNING Changes to this artwork not complying with Reply Paid Service Guidelines may result in cancellation of your Reply Paid service.

Fold in half on dotted line, moisten edges on reverse to seal and mail. No stamp is required.

General Practice Registrars Australia Reply Paid 87115 MELBOURNE VIC 3000

Delivery Address: Suite 4 Level 4 517 Flinders Lane MELBOURNE VIC 3000

Application forms removed?

If all the application forms have been used, you can still join Going Places by applying online. Just go to www.gpaustralia.org.au/going places

Where to from here? So, you’ve read through Going Places and now you are curious about General Practice as a career. Or maybe you’ve already decided that being a ‘General Specialist’ is your vocation! What’s next? Here are four ways to start Going Places in your career as a GP:

OPTIONS: 1 Join the Going Places Network Become part of the Going Places Network at your hospital. It’s a fun way to network with others who have an interest in General Practice, whilst developing your professional knowledge and credentials! See below for more information. Looking for the Going Places Network at your hospital? Visit: www.gpaustralia.com.au/goingplaces to find out more and join on line.

Email: goingplaces@gpra.org.au with ‘Going Places Network’ in the subject line. Tell us what hospital you are based at – then we’ll hook you up with your local network!

2 Talk to your GP Ambassador Our GP Ambassadors are junior doctors who have a real passion and enthusiasm for General Practice. They’ll be able to answer all your questions about General Practice. If there are any questions they can’t answer, they’ll find the answers for you!

Visit www.gpaustralia.com.au/goingplaces to find out who’s the GP Ambassador in your hospital or area – also look out for posters on notice boards in your hospital. 2 011

3 Find out about how you can become a GP Ask your GP Ambassador for a copy of the Going Places Prevocational Doctors Guide to GP Training – your comprehensive guide to becoming a GP. They’ll also be able to provide the AGPT (Australian General Practice Training) 2012 Handbook, which has full details of the AGPT program. Alternatively, you can email goingplaces@gpra.org.au with ‘Information Pack’ in the subject line and all your details in the email. Take a look at page 29 of this issue of Going Places for our guide to Applying for GP Training.

General Practice

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4 Visit www.gpaustralia.org.au To find out how General Practice training works, visit the website! It will guide you through who is involved in providing you with the information and contact details to help you plan your path into General Practice.

Going Places – ISSUE #5

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