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Mountains and medicine Embracing a locum lifestyle
Also inside gpra networks | gp training | clinical | profiles
January – April 2017
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In this issue...
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3 Welcome
Feature 4 GPRA’s new President Published by General Practice Registrars Australia Ltd Level 1, 517 Flinders Lane Melbourne VIC 3001 P 03 9629 8878 E enquiries@gpra.org.au W gpra.org.au ABN 60 108 076 704 ISSN 2203-2657 Editorial team Registrar Advisor Dr Sama Balasubramanian Editor Denese Warmington denese.warmington@gpra.org.au Writers Laura McGeoch Jan Walker Denese Warmington
Dr Melanie Smith is GPRA’s new president. We talk to Melanie about her career and making a difference in her new role.
Profiles 8 Dr Nick Stacey Dr Nick Stacey’s career is just right for him: a locum lifestyle mixed with the great outdoors. We talk to Nick about practising medicine in high places.
12 Jayden Murphy
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Jayden Murphy is a medical student and the 2017 National Chair of GPSN. He shares with us his journey towards general practice.
18 Dr Nicola Campbell Junior doctor Nicola Campbell has just completed her internship. She talks to us about ‘feeling like a doctor’ and the joy of music.
General Practice Students Network 14 About GPSN
GPRA staff General Manager – Marketing and Communications Wayne Bruton wayne.bruton@gpra.org.au
15 GPSN National Executive and club contacts
Membership Services Manager Faye Simpson faye.simpson@gpra.org.au
21 GP Ambassador contacts
Going Places Network
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20 About GPN
Clinical 24 Dermatology 26 GPRA clinical cases
Also inside 10 General practice training 27 Reviews
© 2017 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. No part of this publication may be produced without prior permission and full acknowledgement of the source: GP Journey, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and is published in good faith. This publication is intended for medical students, doctors and health professionals and, as such, may contain material of a medical or graphic nature. GPRA does not accept liability for the use of information within this publication.
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The Future of General Practice Medical doctors –– GP GPregistrars registrars Medicalstudents students –– Junior Junior doctors
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Save the date Save the date 11––22April 2017 April 2017
What does the future hold for general practice? What does practice? There’s only the onefuture way tohold find for outgeneral – come to #fgp17 There’s only one way to find out – come to #fgp17
Rydges World Square World Square 389Rydges Pitt Street Sydney NSW 389 Pitt Street Sydney NSW
Welcome Welcome to Issue 22 of GP Journey, proudly brought to you by General Practice Registrars Australia (GPRA). GP Journey forms a thought-capturing smorgasbord of different general practice experiences, giving you the human insight into the profession and its members. There is more to medicine than studying, and there is more behind being ‘just a GP’. I hope you take this into consideration on the journey to come, whether you are starting out as a medical student, or a junior doctor gazing starry-eyed upon your fellowship prospects. Career progression makes the professional. The flipside makes you human. Our feature story in this issue of GP Journey is about GPRA’s new president, Dr Melanie Smith. Once tending her skills to computer technology, she now applies her abilities to the healing art that is general practice. And our profile of Jayden Murphy, 2017 National Chair of the General Practice Students Network (GPSN), demonstrates that empathy comes from within. In our humanity lies compassion for our patients. General practice allows you to be who you are first, and a doctor second. Dr Nicola Campbell reminds us that our creativity drives our artform. We are all artists in our own way, and if you have a passion then you must embrace it. Play that instrument, read that book, achieve that high score. There is no archetypal formula in which your mind must conform. The world is your oyster. Let your mind not only wander the pages of Robbins or Murtagh, but across time zones as well. Dr Nick Stacey demonstrates the importance of throwing yourself in the deep end. You can mould your career into what you want it to be; all you have to be willing to do is take that first step. Gently, gingerly, with conviction. Coming to the pointy end of the stick, the importance of GPRA cannot be understated. This organisation forms the backbone of advocacy, and a hub of learning and educational materials for medical students and prospective general practitioners alike. It is not-forprofit, free to join, and worth your time. The evolution of the profession requires your voice, and as part of your membership you will also receive access to exampreparation material and clinical articles from Medicine Today. Join now, and be a part of your local GPSN club or Going Places Network as well.
General practice, like any medical specialty is a long road, where the voyage is life-long, the destination seemingly beyond the horizon. Akin to those milestones you surpass each year, be it completing final exams or finishing another hospital term, there is always more to do. As you do, you grow, looking back in retrospect on what you have achieved. Unfortunately, for many junior doctors, their early career is spent ‘taking a beating’, and expressing resilience towards this as well. While efforts are being made to improve the system, sadly, this bullying culture forms the core of some of our experiences. The responsibility therefore remains with us to be the change that’s needed in this system. Work hard, and be that intern, or registrar, or GP that you wanted to be. The reward will be in your effort, and the fruits of this labour will become apparent. You’re worth more than you think you are. You are your biggest advocate. Dr Sama (Swaminathan) Balasubramanian General practice registrar, Crows Nest, NSW Registrar Advisor, GP Journey Member, GPRA National Advisory Council
GP Journey January – April 2017 3
F E AT U R E
Meet GPRA’s
new President A Q&A portrait
Soon-to-be-fellowed GP and former IT software engineer, Dr Melanie Smith, is the new President of GPRA. GP Journey spoke to Melanie on the brink of immersing herself in her new role. From pixels to patients. That’s the shorthand version of Dr Melanie Smith’s career path to medicine. More than a decade ago, Melanie was an IT software engineer riding the dotcom boom. But she confesses that she found it hard to get out of bed in the morning when the primary goal at work was return for shareholders. Her job dissatisfaction reawakened a long-held interest in medicine, and she decided on a career switch. She says the change transformed her from a focused knowledge worker to a people person who finds meaning at work caring for patients from cradle to grave. Now she’s keen to add medico-politics and leadership to the mix. As she begins her new role as President of GPRA, we questioned Melanie on her appointment and her personal GP journey.
You’ve recently been appointed GPRA President. What was your pathway to the role? I’ve been involved with GPRA through the Advisory Council over the last couple of years as an RLO and enjoyed the advocacy work. I’ve always been a bit opinionated politically and I have an interest in health policy, so I saw it as an opportunity to shape things in the future. I thought why not get involved and have another interest to play alongside my ongoing clinical work and make sure things go in the right direction for general practice – and registrars in particular.
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As GPRA President, how do you believe you can make a difference for emerging GPs at this time? I think general practice has reached a point of significant change. We’ve seen a lot of change in the way training is run in the last couple of years with new RTOs and changes to AGPT policies. And there are hints from the government that major change will continue. I think it’s really important that we have a strong voice to ensure that change is positive and in alignment with our members’ interests as current trainees and future GPs.
Any other big picture aims? For me, it’s all about protecting the integrity of the registrar training program. I want to make sure that registrar needs, rather than institutional, organisational and corporate needs, are at the forefront. General practice is at the heart of primary health care and I would like to see all doctors in training understand how we work for our patients.
What have you been working on so far in your new role? I’m still getting to know what the role involves and what issues are on the table. We did have a win recently with the RACGP in standing up for registrars’ voting rights within the college. We’re also involved with the Department of Health General Practice Training Advisory Committee and keeping a close eye on how the proposed Health Care Homes model of care and funding for the management of chronic disease might affect registrars. On top of that, we have some hardworking committees on the Advisory Council looking to develop resources to support registrar medical educators and wellbeing programs. Overall, it’s a very full agenda.
I’ve always “ been a bit opinionated politically and I have an interest in health policy, so I saw it as an opportunity to shape things in the future.
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Did you go to medical school straight from high school? No. I grew up in Adelaide and my undergraduate degree at Flinders University was a science degree majoring in cognitive science. I ended up starting an honours year in computer science but abandoning that to join the dotcom boom. I worked as a software engineer in research and development for an American telecommunications company in Sydney. I was there for about four years but found it fairly unsatisfying.
Why did you dislike your previous IT job? I found it hard to get motivated to go to work every day when it was really all about maximising returns for shareholders. The technical side of problem solving was fun but it kind of wasn’t enough. However, it was an interesting experience being a female in what was a male-dominated, pretty geeky software engineering environment.
How did you end up in medicine as a second career? I’d always had an interest in medicine but thought I probably wasn’t good enough or brave enough to be a doctor. Eventually, I thought if I don’t try this I’ll always regret it. So I enrolled in a graduate medical degree at the University of Sydney. Then I did my internship in Sydney at Concord Hospital. Along the way, my husband and I had a couple of kids. After the birth of our second child, we moved back to Adelaide and I worked in emergency for a couple years before starting my general practice training.
Where are you in your registrar training? I’m in an extended skills post as a GP registrar in palliative care at The Queen Elizabeth Hospital, Adelaide. I’ve done my exams and I’ll be finishing my training and
GP Journey January – April 2017 5
F E AT U R E
becoming a fellow very soon. Next year I’ll go back and work at Chandlers Hill Surgery in Happy Valley, a great collegiate practice where I’ve really enjoyed working before as a registrar.
What do you find rewarding about being a doctor? One of the things I’ve found to be most rewarding – and surprising – about medicine is that I never thought of myself as a people person. I thought I was introverted and geeky, and now in medicine I’ve really found a joy in learning people’s stories.
With your IT background, are things like FOAMed and social media networking part of your professional life? I use a lot of medical social media. It can be a really good way to learn – often better than textbooks for me.
What are your favourite websites and platforms? I’ve certainly got a lot out of the free open access medical education (FOAMed) blogs and tweets, and things like the GPs Down Under on Facebook. There are interesting clinical titbits, a lot of political discussion and collegiate support from other clinicians. You can pick up on changes in research and what’s happening at conferences via Twitter, as well as topical discussions that prompt you to follow different trails of information.
Why do you think junior doctors should consider a career in general practice? Because when you’re a GP, the world’s your oyster really. You can shape your career in many, many different ways and you really get to know people and their stories.
Who or what inspires you? My late mum inspires me a lot. She was a really strong feminist. She was a political activist at a mature age so she was very involved in politics. My kids inspire me to be a better person. My brother, who’s also a doctor, inspires me. And I’ve met some really inspiring colleagues and supervisors as a JMO and trainee GP. One of the most striking things I found going to medical school was that I met all these really amazing people who had so much talent and capability and caring.
How do you feel as you look forward to the next year as GPRA President? I’m excited and more than a bit nervous. It’s a new area for me. I’ve never had to put my face out there to this extent but I felt it was time to actually stand up and walk the talk.
John Murtagh First Wave Scholarship program Applications open IN May and close EARLY JULY 2017
For more information, visit gpsn.org.au or email firstwave@gpra.org.au 6
Honouring former GPRA Patron, Professor John Murtagh, the John Murtagh First Wave Scholarship program provides positive, early and structured exposure to general practice. Candidates apply via a formal online process with the successful candidates matched with a GP supervisor who mentors them during their scholarship period. The John Murtagh First Wave Scholarship program is open to first and second year medical students studying at an Australian medical university.
GPRA
with you on your journey GPRA is run by members for members. From GPSN university clubs, to hospital-based GP Ambassadors and a national general practice registrar support team, GPRA is with you on your journey from medical student to general practitioner.
Member benefits As a junior doctor or medical student you automatically become an Associate Member of GPRA when you sign up for membership. As a member you receive regular communications about local events and updates about general practice training. You also receive the following member benefits: e ral practic The gene
• Member-priced webinars • Member-priced products and publications • Medical Observer e-subscription • Weekly e-clinical cases • Bank of Queensland products • Access to peer-to-peer networking events • Global Medical Education – 10 percent discount.
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GP Journey January – April 2017 7
G P profi l e
Mountains and
Dr Nick Stacey is enjoying the medical and personal freedom that comes with embracing a locum lifestyle and the great outdoors.
There was another notable difference, though. Perisher doesn’t have the extensive back-up medical support available in most EDs. Air evacuation would take at least half an hour and it was a three-hour drive to Canberra Hospital.
There are two must-haves that Dr Nick Stacey is looking for in his next couple of GP jobs: snow and mountains.
Nick recalls one particularly nerve-wracking moment. “There was this guy who had come off his snowboard and hit a tree,” he explains. “I was stitching up this massive forehead laceration and his ear was half ripped off. He ended up having three skull fractures.”
Nick first combined his personal and professional passions last winter working as a locum GP at Perisher ski resort in the Snowy Mountains. “It was one of the most exciting things I’ve done,” he says. “You learn some really handy skills.” Treating fractures, knee examinations and suturing lacerations were a regular part of the job and gave him a good grounding in first-response medicine. “It was a bit like an emergency department, but without the psychotics and drug abuse presentations,” he says.
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Nick had to consider what to do if the patient’s status deteriorated and he required intubation. “There was one point when I was wondering: ‘Am I a bit out of my depth here?’” he admits. GPs who swap suburban settings for snowfields need to prepare for the extreme. Nick, aged 31 years, has honed his
medicine Medicine allows you “ to work where you want... It’s just a real privilege.
”
knowledge by doing two 10-day expedition medicine courses and hopes to one day do a “season or two” working as an expedition doctor with the Australian Antarctic Division. He’d likely adjust well to the freezing conditions, having recently trekked to Mt Everest’s Base Camp. When GP Journey caught up with Nick, he was working at Newstead Medical Practice in Launceston, Tasmania, where he grew up. He spent his final registrar year at Newstead and then returned as an associate after receiving his RACGP Fellowship. (In between that, he took six months off and travelled to Norway and Iceland, hiked in the Alps and climbed The Matterhorn.) Nick works four days in the practice and spends the other day as a surgical assistant. He enjoyed similar flexibility and variety as a registrar by working one day a week at headspace, the national youth mental health foundation. He says medical variety and being able to have a break from consulting, especially when seeing a lot of “heart sink” and mental health presentations, helps to avoid burnout. The “traumatic and tragic” cases, including child protection notifications and drug abusers, can also make an impact. But amid the more challenging consults, general practice provides many “moving moments”, Nick says. “I find it really satisfying when patients come back and tell me how much they appreciate my support, or that moment when a person opens up to you about something that’s been really getting to them.
“It might be the middle-aged bloke who comes with a superficial problem as a bit of a front, but after a while they open up and tell you what the real problem is. “The breadth of human emotion you get to observe is so unique and is part of what attracts me to general practice.” Indeed, it was this ‘human’ element that first prompted him to switch to medicine two years into a science degree. “I studied human biology as part of the science degree and it just really peaked my interest.” Meanwhile, the customer interaction he got from part-time jobs working in supermarkets and service stations made him realise he wanted to work with people “rather than just sitting in a lab”. The move to medicine somewhat broke the mould from the rest of his family’s careers; his father and one of his brothers are sheep shearers, while his twin brother is a fire fighter. “I did one week in total of work with dad as a rouseabout and decided it wasn’t for me!” he laughs. “My grandma tells me I’m the first medical person in our extended family.” He enjoyed other specialties during his internship, including three months of anaesthetics as a resident. “But I realised general practice was the option that allowed me to be the most flexible with my interests outside medicine.” Having his own personal interests developed before embarking on his medical journey has been a “saviour” in terms of giving him something outside of work, Nick says. “Be it within medicine or outside medicine, it’s healthy to have a range of interests,” he says. “For me, it’s the outdoors and mountains.” Nick’s next move closer to the mountains will be a locum position at a little country town near Christchurch, New Zealand, for three months. Then it’s back for a ski season at Perisher. He says he’ll be sad to leave his regular patients at Newstead, but can’t pass up the unique opportunity to embrace the “full-time locum lifestyle” and work and travel while he is “single and free”. “Medicine allows you to work where you want,” he says. “It’s just a real privilege.”
GP Journey January – April 2017 9
GP TRAINING
General practice The specialty of choice
General practice was recognised as a medical specialty in 2010 by the Medical Board of Australia. That means general practitioners are considered ‘general specialists’. What is general practice? General practice has been described as a medical specialty that provides ‘person-centred, comprehensive and coordinated whole-person health care to individuals and families in their communities’. A general practitioner is a doctor who treats acute and chronic diseases, which are often in their early stages of development and undifferentiated.
How do I get into general practice training? You can apply to the Australian General Practice Training (AGPT) program as early as your intern year (PGY1) and undertake your second year (PGY2) as part of general practice training. Applicants in later stages of training may be eligible to apply for recognition of prior learning for their hospital-based general practice training component.
Who manages the training program? The AGPT program is managed by the Australian Government Department of Health, and delivers the postgraduate vocational training programs of The Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). The AGPT program is delivered by a national network of training organisations dedicated to supporting general practice registrars as they embark on a career in general practice.
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How long is the training program? The training program involves either a three or four-year full time commitment. Most registrars pursuing the RACGP Fellowship (FRACGP) are able to do so in three years. For those registrars interested in either ACRRM Fellowship (FACRRM) or the Fellowship in Advanced Rural General Practice (FARGP), this is generally acquired over four years. General practice training is quite varied, and registrars acquire experience in different training locations. These locations may include teaching hospitals, rural and urban practices and specialist medical centres. Registrars also undertake an extended skills term and can pursue areas of special interest, such as procedural and academic general practice. There are 1500 funded training places in the program and at least 50 percent of applicants must select the rural pathway for their training.
What are the endpoints? Fellowship of ACRRM and/or the RACGP or FARGP are approved pathways to specialist registration as a general practitioner. Fellowship demonstrates that a doctor has met the required level of competence to deliver unsupervised general practice services in any general practice setting in Australia, whether it be urban, regional, rural or remote. It also confers the ability to access specialist medical registration and consequently A1 rebate rates under Medicare legislation.
For more information visit gpaustralia.org.au For more information about ACRRM or the RACGP, visit the college websites.
What’s your practice? General practice gives you the freedom to follow your passion, subspecialise and design the career that’s right for you. You can even train part-time. Check it out! Aboriginal health Training posts in Aboriginal primary health care offer unique and challenging opportunities and allow junior doctors to play a hands-on role in improving access and preventing and managing chronic disease in Aboriginal communities.
Academic/research Teaching and research can expand your career path in general practice. Research enables you to develop valuable skills to take into your clinical work and could act as a stepping-stone towards an academic career.
Military medicine Training as a registrar in the Australian Defence Force offers opportunities and challenges. There is a focus on emergency medicine and similar skills to rural general practice, including self-sufficiency in remote locations.
Rural general practice
Other extended skills posts Other exciting extended skills posts you can experience as part of your general practice training include:
Doctors undertaking general practice training usually spend some time working in a rural area. As a registrar working in a rural practice you will see a diverse range of presentations that will not only challenge you but provide opportunities to broaden your clinical skills.
• Custodial medicine
Sports medicine
• Mental health
If you have a particular interest in musculoskeletal injuries and exercise medicine, sports medicine could be for you. You could be providing care to elite athletes through to weekend warriors or the non-exercising person just wanting to improve their exercise level or deal with an injury.
• Drug and alcohol medicine • Emergency medicine • Forensic medicine • Obstetrics and gynaecology • Paediatrics • Palliative care • Sexual health and HIV medicine.
What are you waiting for? To find out more about an exciting and rewarding career in general practice visit
agpt.com.au GP Journey January – April 2017 11
S T U D E N T profi l e
GP-plus For Jayden Murphy, 2017 National Chair of the General Practice Students Network, a career in health always appealed. Being diagnosed with his own medical condition helped cement the move to medicine. Jayden Murphy knows what it’s like to be on the other side of a GP’s desk. When he was 19 and part way through a biomedical science degree, he was diagnosed with type 1 diabetes. He had the typical symptoms of losing weight, being thirsty, needing to go to the toilet a lot and being very tired. But in isolation, those symptoms didn’t mean much. And because there was no family history of it, diabetes wasn’t top of his mind. How did he take the diagnosis? “I was okay, to be honest,” he tells GP Journey. “I have a realistic and optimistic view of life, and I know a lot of people with diabetes who have done amazing things.” Growing up in Beaudesert, about an hour’s drive southwest of Brisbane, Jayden says he always had “very good relationships” with the local GPs. Yet as he began to see more of them due to his diabetes, they started to make a bigger impact than just helping him to manage his condition. “My support team pushed me that bit more to get into medicine,” he says. “Being a patient myself has made me see both sides of the coin and respect both sides. The experience just cemented the fact that health care is where I want to be.” Now, finishing his third year of medicine, Jayden is getting plenty of time seeing his own patients. He’s currently doing a rural placement in Griffith in New South Wales, where he generally spends two days a week at a general practice and two days at the Griffith Base Hospital. Work at the practice has given him the chance to see his own patients as part of parallel consults with the clinic’s GPs,
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who come in to “check things off” after Jayden has made his notes. The placement is showing him the impact that GPs can have when they connect with patients at a personal level. He recalls one case when a patient actually came through the emergency department, but the presentation ended up becoming more like a general practice consult. “A man came in because he was worried that he had a lump in his stomach. The doctor and I did tests, but couldn’t find anything,” Jayden explains. “We sat down with him and did a bit of a mental health assessment. He started to mention how stressed he was at home. He and his partner had a new baby and he was trying to care for them, and he had recently moved to the area to get a better job. He was the main provider and felt like he couldn’t fail.” Jayden says being privy to the very personal aspects of patients’ lives and their worries can be “confronting” at
I call it being a ‘GP-plus’. “ That means a GP plus whatever I want to do.”
times. “But it’s also what is special about our field of work… when people put that trust in you,” he says. “Sometimes that’s what the patient needs. Someone who can listen and be an impartial third party.” On the day he’s not in the practice or at the hospital, he focuses on academic work, which includes a 12-month research project. He’s chosen a topic he can relate to. “Diabetic control in adolescents,” he says. “It’s an area that is spoken about a lot, but no-one really knows how to approach it. “We know teenagers already go through tough times and adding a chronic disease into the mix isn’t going to make it easier for them,” he says. Having completed a Master degree in research, it seems he’s struck the perfect mix with his current placement. “It’s good because I’m seeing patients every day and then going home and figuring out ways of how to better the system and health care.” Research and being able to contribute to the bigger health care picture may be part of the reason Jayden joined the General Practice Students Network (GPSN) in his first year of medicine. In 2016 he was elected as the National Vice Chair, and he is the now the National Chair for 2017. Jayden is still excited about the potential of the network, and is also proud of its achievements and resilience through recent funding challenges. As he nears the end of his degree, Jayden will continue to explore medicine in more rural areas. He’ll stay in Griffith for the first half of 2017 and is planning an elective medicine term in the Northern Territory. Then it’s back to country New South Wales, perhaps Wagga Wagga or Orange, to do a rural surgery term. Looking further ahead, he wants to take advantage of the variety that general practice offers. “I call it being a ‘GPplus’,” he explains. “That means a GP plus whatever I want to do. And I want to be in a town that’s small enough that the GPs can do a lot more, but big enough so that there’s room to grow.” Jayden says he’s grown a lot personally in the past few years since starting medicine. “I’ve learned about self resilience while being in high stress or difficult situations,” he says. Yet even in the challenging situations, he still hangs on to the many positives that he’s experiencing on his medical journey. “Someone once told me when I started medicine that the lows make the highs better,” Jayden says. “And it’s true.”
GP Journey January – April 2017 13
G enera l practice students networ k
Your student community The General Practice Students Network is a national network of university clubs based at every medical school in Australia, supported by a national executive committee. Club chairs promote GPSN at their university and are a point-of-contact for medical students with general practice career questions. GPSN clubs host a range of educational and career-focused events across Australia and provide professional resources to medical students. GPSN is supported and funded by GPRA. Being part of GPSN is being part of a community of more than 25,000 medical students, junior doctors, general practice registrars and new fellows.
Connect with us There are many ways to get involved in GPSN. At the university level, members have access to events run just for them by their university GPSN club, or become part of the club executive, where they can continue their passion for general practice through advocacy and events. At a national level, members can become involved with GPSN working groups, attend the GPSN national conference or become part of the GPSN National Executive team.
Why join? As a GPSN member, there are many benefits available to you, including access to free events, discounts and free resources as well as national representation on external committees. We are constantly working on new benefits, based on member feedback. Visit gpsn.org.au to learn more. As a GPSN member, you also become an Associate Member of GPRA. Both GPSN and the Going Places Network, which is for junior doctors, are represented on the GPRA Board and on various external organisations. The GPSN National Executive and Council work to ensure you have the right support to assist you on your journey through medical school, your transition in to the hospital system and on to general practice.
National council The GPSN National Council comprises the local university club chairs and the national executive. The national executive meets frequently throughout the year to discuss, debate and share ideas, and to further develop the network.
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GPSN provides unique “ and diverse opportunities for medical students to engage with community and other medical students on a national level. During my two years at the University of Notre Dame Fremantle, I have become increasingly passionate about the possibilities that general practice offers. I am excited to continue my journey within this fantastic network that continues to facilitate engagement of medical students with general practice.
�
Megan Bleeze GPSN National Secretary, 2017
2017 GPSN National Executive National Chair Jayden Murphy University of Wollongong chair@gpsn.org.au
National Vice Chair Cassie Williams University of Melbourne vc@gpsn.org.au
National Secretary Megan Bleeze University of Notre Dame Fremantle ns@gpsn.org.au
National Working Group Officer Arianne Kollosche Griffith University wgo@gpsn.org.au
GPSN University Club contacts University
Contact
NSW and ACT University of New South Wales
unsw@gpsn.org.au
University of Sydney
usyd@gpsn.org.au
University of Western Sydney
westsyd@gpsn.org.au
University of Notre Dame Sydney
undsyd@gpsn.org.au
University of Wollongong
wollongong@gpsn.org.au
University of Newcastle
newcastle@gpsn.org.au
University of New England
newengland@gpsn.org.au
Australian National University
anu@gpsn.org.au
QLD University of Queensland
uq@gpsn.org.au
Bond University
bond@gpsn.org.au
Griffith University
griffith@gpsn.org.au
James Cook University
jcu@gpsn.org.au
SA and NT University of Adelaide
adelaide@gpsn.org.au
Flinders University
flinders@gpsn.org.au
Northern Territory Medical Program
ntmp@gpsn.org.au
VIC University of Melbourne
umelb@gpsn.org.au
National Events and Projects Officer
Monash University
monash@gpsn.org.au
Deakin University
deakin@gpsn.org.au
Vinay Murthy University of Western Sydney neo@gpsn.org.au
TAS University of Tasmania
utas@gpsn.org.au
WA University of Western Australia
uwa@gpsn.org.au
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notredame@gpsn.org.au
Terence Luo University of New South Wales leo@gpsn.org.au
Get in touch
Promotions and Publications Officer Jaffly Chen University of New England publications@gpsn.org.au
If you have any questions about a career in general practice or would like to attend a local GPSN educational event, please contact your local university club chair. To find out about projects the national executive team is working on, please contact one of the team members.
GP Journey January – April 2017 15
AFTER HOURS MEDICINE: MEETING A REAL NEED IN THE COMMUNITY After hours primary care (known as ‘medical deputising’) provides urgent, episodic care to patients on weeknights and weekends, when GP Practices are closed. Medical deputising is an important sector in Australia’s medical landscape, filling the gap between the GP and the hospital emergency department. Along with caring for patients in need, after hours doctors support the family GP and help reduce pressure on the hospital system. It is often Australia’s most vulnerable patients who need urgent care after hours: the elderly, and very young children. National Home Doctor Service is Australia’s largest and only national network of home visiting doctors. Our declared mission is to provide the highest quality care to patients in the after hours for acute, episodic illnesses and injury. That’s why we want more GPs and GP registrars to join us working in the after hours.
FLEXIBLE AND REWARDING
Working with National Home Doctor Service gives you the opportunity to work as many hours as you choose, from a few hours a week to a full time roster. You will be fully supported by our highly qualified team of Medical Directors, with our inhouse RACGP continuing professional development sessions that support you to learn and understand the varied clinical issues confronting patients in the after hours.
“ROUND THE CLOCK” MEDICARE – A POLICY SUCCESS In 2005 the Federal Government increased the Medicare Benefits Schedule rebate for after hours medical deputising services, with the aim of reducing pressure on Emergency Departments and ambulance services. A recent
WEB HOMEDOCTOR.COM.AU EMAIL RECRUITMENT@HOMEDOCTOR.COM.AU
report from Deloitte Access Economics shows that due to these initiatives, low acuity presentations to EDs have declined by 7%, representing significant savings to the health care system. In addition to the economic benefits of home
visits within the Australian health care landscape, the service supports better patient outcomes through timely treatment, particularly for the elderly, families with young children and those living with disabilities.
“There are certain skills you can only learn doing home visits.” —Dr Jonathan Levy MBBS,BSc (Medical Psychology), FRACGP, FARGP Medical Director, National Home Doctor Service
J U N I O R D O C T O R profi l e
Musical
medico
Dr Nicola Campbell talks medicine, music, macarons – and feeling like a doctor.
Playing music in an orchestra and working as a doctor have much in common – shiny instruments, years of study, harmonious teamwork and the pressure to perform. Cello-playing junior doctor and aspiring GP, Dr Nicola Campbell, has just finished her internship at Toowoomba Hospital and reports it’s been a year of finding her rhythm and slowly beginning to “feel like a doctor”. “Graduating was a great feeling although I must admit I sort of expected that on my first day I’d feel like a doctor but I don’t quite think I did.” Now after a year as an intern, with rotations in general medicine, general surgery, psychiatry and emergency behind her, Nicola says she’s “getting there”. “The cases where I’ve had a chance to be a bit independent but still supported are the times where I start to feel more and more like a doctor,” she reflects. Nicola says the transition from medical school to hospital doctor is a big one for graduates because the emphasis shifts from simply knowing the right textbook answers to knowing how the hospital system works. “As a junior doctor, it’s a bit about your knowledge and a bit about knowing where to look for answers. But a lot of it is about relationships and how you interact with the nursing staff and allied health and the other doctors in your team and the patients themselves.” GP Journey first met Nicola a couple of years back when she was National Chair of GPRA’s General Practice Students Network. At the time she was an over-achiever with a crazybusy schedule of activities and a trove of awards on her CV. A quick scroll of her LinkedIn profile sums it up: Griffith University Class of 2015 Local Community Service Award;
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Griffith University Class of 2015 Women’s Health Prize; John Flynn Placement Program Scholar, Lithgow, 2013; First Wave Scholarship, Kingaroy, 2012; Vice-Chancellor’s Scholar, 2008. And that’s just a small sample. It’s not all work and no play either. Nicola nurtures her creative side by playing cello in the Queensland Medical Orchestra. So is Nicola still the crazy-busy over-achiever of two years ago? She laughs uproariously. “I just can’t say no really. I’ve definitely tried to take all the opportunities that I’ve had. I think medical school and your training years are a really great time to be able to explore a lot of different avenues and places where medicine can take you.” Nicola goes on to explain that while she’s still busy, she’s pulled back on the crazy pace, reducing extracurricular activities to concentrate on her hospital training. She has applied for the general practice training program and looks forward to continuing at Toowoomba Hospital. Nicola’s passion for medicine is something she could never have imagined when at school on the Sunshine Coast of Queensland. “There were people asking me at high school if I’d like to do medicine because I really liked science and my answer was an absolute no,” she recalls. “I went to uni and did a Bachelor of Biomedical Science with the intention of going towards research. And then, the second year in, I realised that I really loved the science but I really wanted to work with people.” After completing her science degree at Queensland University of Technology, Nicola switched to medical school at Griffith University. General practice is a good match for Nicola’s wide-ranging interests. Primary care, public health, mental health and infectious diseases are all on her list of enthusiasms. Rural general practice is another special interest for Nicola. She credits her First Wave placement in Kingaroy and her John Flynn Placement Program stint in Lithgow for introducing her to the multi-skilled rural generalists who run many country hospitals. “The GPs there are just so incredible and talented in so many different fields,” she says. “And the continuity it provides for the patients is unparalleled.” Perhaps not surprisingly for a musician, Nicola is drawn to the idea of creativity in medicine and the notion that medicine is both an art and a science.
Science is how you think “ about diagnosing and treating illnesses but the art is how you guide the patient through it.
”
“Medicine is often very guidelines-driven and evidencebased, which is great, but there’s room for a little bit of creativity and flexibility. Science is how you think about diagnosing and treating illnesses but the art is how you guide the patient through it,” she observes. On a personal level, Nicola applies a creative approach to debriefing by journaling and networking with peers through social media. “I’m addicted to Twitter in the best possible way,” she laughs. Baking treats for friends and colleagues is another addiction. French-style pastel macarons were favourites at medical school; now it’s cupcakes and brownies with morning tea on the wards. To balance the sugar load, she enjoys hiking the hills around Toowoomba with friends. Music remains a constant creative outlet for Nicola. She’s been playing the cello since year 4 – “when it was taller than me” – and once played in the Queensland Youth Orchestra. “On my very first day of med school, I met another medical student who played trombone and he told me I should come and play with the Queensland Medical Orchestra,” Nicola recalls. The orchestra comprises doctors, medical students, allied health professionals and patients who play everything from concertos to show tunes and folk songs. When concerts are held in the historic Old Museum building in Brisbane, proceeds go to charity. “Meeting and playing with other doctors and medical students in the orchestra outside the hospital setting is incredibly rewarding,” she says. Sounds like a life in harmony.
For details of the QMO’s next concert, visit qmo.org.au
GP Journey January – April 2017 19
GOING PLACES NETWORK
Your prevocational What is the Going Places Network? The Going Places Network (GPN) is for junior doctors interested in the most challenging and versatile medical career of all – general practice. Joining GPN gives you access to national general practice focused events, publications, online resources and more.
What is a GP Ambassador? GP Ambassadors play a pivotal role in the Going Places Network. As the champions of general practice in their hospital, they have a strong dedication to developing and promoting GPN while being the primary point of contact for other junior doctors wanting to find out more about general practice. GP Ambassadors also help us run our GPN events, from hospital-based coffee mornings and educational workshops to larger networking events, such as winery tours and barefoot bowls.
As a GP I’m looking forward “ to getting to really know my patients and advocating for their best interests in the health care system. Dr David Lim
”
GP Ambassador, Flinders Medical Centre, SA
How can a GP Ambassador help me? GP Ambassadors are always willing to give honest and useful advice. Whether you have a question about a career in general practice and the training program, or just simply want to chat, your local GP Ambassador will make time for you and offer you the support you need.
How can I contact my GP Ambassador? Visit gpaustralia.org.au/gp-toolkit/ambassadordirectory/ for a state-by-state listing of our GP Ambassadors or find your hospital-based GP Ambassador from the list on page 21.
I chose general practice for “ the diversity of patients; to develop skills to work in rural areas and third world countries; and for the lifestyle. Dr Lucy Morris
”
GP Ambassador, Gosford Hospital, NSW
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community I chose general practice because I’m “ passionate about community medicine. For me it’s the only area of medicine that gives more energy than it takes. I love it.
”
Dr Josh Saunders GP Ambassador, Ballarat Base Hospital, Vic
Find your GP Ambassador Check out the list below for contact details of your local GP Ambassador. NSW and ACT
SA and NT
Hospital
Contact
Hospital
Contact
Bankstown Hospital
bankstowngp@gpra.org.au
Flinders Medical Centre
flindersgp@gpra.org.au
Gosford Hospital
gosfordgp@gpra.org.au
Lyell McEwin Hospital
lyellmcewingp@gpra.org.au
Hornsby Hospital Network
hornsbygp@gpra.org.au
Modbury Hospital
modburygp@gpra.org.au
John Hunter Hospital
johnhuntergp@gpra.org.au
Royal Adelaide Hospital
royaladelaidegp@gpra.org.au
maitlandgp@gpra.org.au
Royal Darwin Hospital
darwingp@gpra.org.au
Royal North Shore Hospital
royalnorthshoregp@gpra.org.au
The Queen Elizabeth Hospital
queenelizabethgp@gpra.org.au
Royal Prince Alfred Hospital
royalprincealfredgp@gpra.org.au
St George Hospital
stgeorgegp@gpra.org.au
Tamworth Hospital
tamworthgp@gpra.org.au
The Canberra Hospital
canberragp@gpra.org.au
Westmead Hospital
westmeadgp@gpra.org.au
Wollongong Hospital
wollongonggp@gpra.org.au
Maitland Hospital
VIC
QLD Cairns Base Hospital
cairnsgp@gpra.org.au
Gold Coast Hospital
goldcoastgp@gpra.org.au
Logan Hospital
logangp@gpra.org.au
Mackay Base Hospital
mackaygp@gpra.org.au
Nambour Hospital
nambourgp@gpra.org.au
Princess Alexandra Hospital
princessalexandragp@gpra.org.au
Redcliffe Hospital
redcliffegp@gpra.org.au
Rockhampton Hospital
rockhamptongp@gpra.org.au
Toowoomba Hospital
toowoombagp@gpra.org.au
Albury Wodonga Health
wodongagp@gpra.org.au
Austin Hospital
austingp@gpra.org.au
Ballarat Hospital
ballaratgp@gpra.org.au
Eastern Health
boxhillgp@gpra.org.au
Launceston Hospital
launcestongp@gpra.org.au
Geelong Hospital
geelonggp@gpra.org.au
Royal Hobart Hospital
royalhobartgp@gpra.org.au
Northern Health
northernhealth@gpra.org.au
Shepparton Hospital
sheppartongp@gpra.org.au
Fremantle Hospital
fremantlegp@gpra.org.au
Southern Health
southernhealthgp@gpra.org.au
Joondalup Health Campus
joondalupgp@gpra.org.au
St Vincent’s Hospital
stvincentsgp@gpra.org.au
Royal Perth Hospital
royalperthgp@gpra.org.au
Western Health
westerngp@gpra.org.au
Sir Charles Gairdner Hospital
charlesgairdnergp@gpra.org.au
TAS
WA
GP Journey January – April 2017 21
A D V E R TO R I A L
Know When to SAY No By Dr Reg Bullen MDA National Cases Committee Member Nyet, nada, non, nein, no! In any language, “no” is generally an unacceptable word, even more so at first acquaintance.
to me, not new to the practice) after establishing why they have attended, I explain how General Practice works for me, and therefore if they still wish to see me, how it will work for them.
But in medicine (especially in General Practice), it has the ability to fracture a working therapeutic relationship. In some fraught encounters, it may even pose a genuine risk to the one proffering it as a response. Sometimes a refusal is seen as unreasonable, unreasoned and not within the recipient’s immediate past experience.
The conversation goes along these lines:
You may be refusing to bulk bill, prescribe a sought medication (not just narcotics, steroids or “benzos”), order an unnecessary test or investigation, backdate a certificate or a referral, or partake in some wonderful financial partnership opportunity or social event. I’ve had them all offered to me! The above events do not occur in isolation. The absolute requirement for making a request of a doctor used to be when the patient was in the same geographic location as the doctor. This is no longer the case with the advent of telemedicine, social media and various internationally based prescribing/dispensing services which, in my opinion, should be avoided. In our practice we have several protocols in place: signs declaring narcotics/S8s will not be prescribed on first visits; that anything requiring a signature requires the requestor’s personal presence; that co-prescribing will only occur after the practice has received an appropriate request and has agreed to participate; that anyone on narcotic medication will sign an individual prescription contract (and breaking that contract ends the relationship at the first instance). These are all good aids to appropriate practice. But the foundation to them all is what I call my “philosophy of patient engagement.” At the first consultation with a new patient (that is, new
The way I like to work is to form a partnership with my patients that enables us to best meet your healthcare needs. Both of us bring some differing expertise to the partnership, so I suggest we both retain the right to say “no” to the other’s requests. Now I’m a little sneaky, and if you say “no” to something I think is really important, I will try to persuade you but I will not force your compliance... Equally there are occasions when you will request something and I will say “no” to that particular request. Does that sound fair to you? This establishes a foundation for an acceptable, medically relevant consultation outcome while also presaging the doctor’s absolute right to say no. It does so without any risk to reputation, verbal or physical abuse, or referral to the various authorities that oversee our profession. It will not stop the “end of session, strung out, desperate addict”, but not much will. However, it does provide for a consistent platform for ethical decision making and the provision of good reputable practice. Also, over time, it will mean you will not be the “other” doctor who is quoted by the patient in an effort to provide implied “peer pressure to comply” on one of your colleagues. This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.
D ermato l ogy q ui z
A child with swollen lips and angular cheilitis By Victoria Harris and Gayle Fischer
Case presentation A 12-year-old boy presents with a three-month history of painless swelling of his upper and lower lips and angular cheilitis. He is otherwise well and is taking no regular medications.
Differential diagnosis For the patient described above, acute allergic angioedema, which occurs within one to two hours of contact with an allergen, is an important differential diagnosis to consider. Acute allergic angioedema can involve swelling of the lips and almost always occurs with urticaria. It may also result in airway compromise and is potentially a medical emergency. However, it is an intermittent condition, not a chronic one. The correct diagnosis is orofacial granulomatosis, a rare chronic inflammatory disease characterised by relapsing/remitting lip swelling. It can also involve the buccal mucosa, gingivae and floor of the mouth. Orofacial granulomatosis is characterised by the histological finding of noncaseating granulomas that are indistinguishable from those of Crohn’s disease and similar to those of sarcoidosis.
inflammation, even when gut symptoms are not present.2 Mucosal signs such as linear ‘knife-cut’ ulcers and buccal swelling that gives a ‘cobblestone’ appearance may indicate Crohn’s disease as the underlying pathology in orofacial granulomatosis.3
Sarcoidosis Sarcoidosis, which is characterised by noncaseating granulomas that can affect many different parts of the body, usually starts in the lungs or the lymph nodes of the chest. Patients can have associated generalised, nonspecific symptoms that should prompt further investigation (eg. malaise, weight loss, loss of appetite and night sweats), but sarcoidosis can be isolated to the skin. Cutaneous sarcoidosis is known to be a great imitator, but skin biopsy will show noncaseating, epitheloid granulomas for diagnostic purposes.
Melkersson-Rosenthal syndrome
Orofacial granulomatosis is a condition restricted to the orofacial region that may be caused by several granulomatous conditions. It encompasses more that one aetiology.1 The reported conditions are Crohn’s disease, sarcoidosis, Melkersson-Rosenthal syndrome and tuberculosis.
Melkersson-Rosenthal syndrome is an uncommon syndrome that results in chronic lip swelling due to granulomatous inflammation with recurrent facial palsy.4 It may have a genetic predisposition: patients may have an affected sibling or other relative who is unaffected except for a fissured tongue. Miescher’s cheilitis, another example of chronic swelling of the lip with confined granulomatous changes, is generally regarded as a monosymptomatic form of MelkerssonRosenthal syndrome, but the possibility remains that these are two separate diseases.
Crohn’s disease
Tuberculosis
Orofacial granulomatosis and oral Crohn’s disease share a number of clinical and histological features but the exact relationship between the two conditions is unknown. Although oral manifestations of Crohn’s disease can affect all age groups, they happen most frequently in children.2 The younger a child, the more likely it is that he or she will have intestinal
Tuberculosis is a rarer cause of orofacial granulomatosis and should be considered in patients who have a family member with the infection and in immigrants from countries where it is endemic.5 Patients with orofacial granulomatosis due to tuberculosis present with associated cervical lymphadenopathy and systemic features such as fever and malaise.
Discussion
This article was originally posted with Medicine Today 19 August 2016, and is reproduced here with permission. © Medicine Today 2016.
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are variably effective – these can be used as topical or systemic preparations or intralesional injections (triamcinolone acetonide 5 to 40 mg/mL).8 Intralesional corticosteroid is usually first line treatment but needs to be repeated at regular intervals, between six and 12 weeks. In patients with concurrent Crohn’s disease, early referral to a gastroenterologist is warranted. Systemic treatment for Crohn’s disease can improve orofacial granulomatosis. Topical tacrolimus ointment has been reported to be effective for oral and perineal Crohn’s disease but this is only likely to be effective in mild disease. The patient’s swollen lips and angular cheilitis
Investigations A diagnosis of orofacial granulomatosis is confirmed by a lip biopsy. Investigations should be aimed at identifying any underlying local or systemic disease. Recognised causes of granulomas such as sarcoidosis and Crohn’s disease should be excluded with requisite serology and chest X-ray. Intradermal tuberculin skin test and/or Quantiferon Gold blood test can be performed if there is suspicion of tuberculosis. Endoscopy or colonoscopy may be indicated if the history is suggestive of Crohn’s disease.5 A dental assessment to exclude active dental and periodontal disease is advisable. Patch testing for unrecognised food allergies may also be undertaken. Atopy occurs more frequently in patients with orofacial granulomatosis than in the general population and allergies to a variety of agents (such as toothpaste, cinnamon foods, preservatives, dental materials and infections) have been suggested as possible aetiological factors. However, although patients are often atopic and exclusion diets may be helpful, a relevant allergen is rarely found on patch testing.6
Management Spontaneous remission of orofacial granulomatosis can occur but is rare. Management is essentially symptomatic, and the degree of disfigurement needs to be considered when approaching treatment. For patients with mild disease, dietary modification (exclusion of cinnamon and benzoate) can be trialled initially.7 For patients with recurring lip swelling episodes, oral medications such as tetracycline, metronidazole or dapsone are sometimes helpful in reducing inflammation. Corticosteroids
The response of orofacial granulomatosis to treatment is slow. Partial or complete improvement can be observed in most but not all patients, although this can take years. Treatment of disfiguring permanent orofacial swelling of severe orofacial granulomatosis can be exceedingly difficult. Surgery may be required for patients with severe permanent swelling that interferes with speaking or eating.
Outcome For the case patient presented above, initial treatment with oral minocycline (100 mg daily) reduced his swelling initially, but the treatment became less effective with time. Over the next year he was treated with intralesional triamcinolone acetonide (10 mg every three months). He was referred for colonoscopy and found to have asymptomatic Crohn’s disease. Treatment with azathioprine was commenced, and the boy’s lip swelling resolved.
Authors Dr Harris is a Dermatology Research Fellow and Associate Professor Fischer is Associate Professor of Dermatology at Sydney Medical School – Northern, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales. Competing interests: None. References are available online at Medicine Today. Medicine Today provides GP Journey with selected articles from its archive of peer reviewed clinical content. To view the full archive, first register to use the website at http://medicinetoday. com.au/user/register and then browse the content online or download Medicine Today for iPad, available from the App Store at https://itunes.apple.com/app/id666623264. Registration and online access to Medicine Today’s rich knowledge bank of clinical content is free to all members of GPRA, GPSN and GPN.
GP Journey January – April 2017 25
G enera l practice cases
exam bo ok
book
ISBN 978 -0-
The gene ral pract ice exam
The following cases have been taken from the GPRA publication, The general practice exam book.
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geneheral p ractice
992453
Visit gpra.org.au 9 7809 92
6-1-9
Kath O’C onnor Robin Pa rk Fabian Sc hwarz Tammra Warby Yashar Al iabadi Za deh
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Case 1
Case 2
Doris, a 68-year-old woman presents with a lesion on her right inner arm (see figure below). She noticed it rapidly growing over the previous two months. It is firm and has a solid keratin core. The most likely diagnosis is:
Alicia, a 16-year-old female, presents to your clinic requesting advice regarding her acne. She has had difficulty with mild comedomic acne for the past 12 months (see figure below). You give Alicia the following advice:
A. Bowen’s disease
A. She should avoid chocolate and fatty foods
B. Keratoacanthoma
B. Using cosmetics will make her acne worse
C. Basal cell carcinoma
C. She should use appropriate sun protection
D. Solar keratosis
D. She should wash her face daily with soap
E. Amelanotic melanoma.
E. Gently lancing white-head lesions with a sterile needle and then wiping them with an alcohol swab can be helpful.
Image reproduced with permission. New Zealand Dermatological Society Inc. Published online at dermnetnz.org
Answer to Case 1 This question raises the importance of history in dermatological disease. The rapidity of onset and typical appearance and history are most consistent with a keratoacanthoma. Bowen’s disease does not enlarge in the same way. A squamous cell cancer (SCC) or a basel cell carcinoma (BCC) is possible, but the duration makes this less likely. A solar keratosis is also possible but this does not fit with the appearance of the lesion. An amelanotic melanoma does not fit the timeline or the presentation.
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Answer to Case 2 This question requires a knowledge of the evidence base behind advice that is commonly given regarding the management of acne. There is no evidence that diet or the use of cosmetics contribute to the worsening of acne. Soap products should be avoided in all patients with acne. White-heads should not be lanced as this can lead to scarring. Transient sun exposure can improve acne but this should not be suggested as a treatment due to the sun’s damaging effects on skin.
Reviews Apps
Clinical Sense Clinical Sense provides a step-by-step story of a patient from their presentation to the emergency department to their regular consultation at the clinic. Along the way, multiple-choice questions on diagnosis, investigation and management are asked about the patient. A great resource for playing on the go, it gives medical students and junior doctors a great way to revise specific clinical conditions from diagnosis to management. References to research text and relevant explanations are also provided to ensure that information provided is supported by recent evidence. There are many clinical scenarios to start, with new vignettes added each update. The information provided is based on the US health system, so be sure to cross-reference with Australian guidelines. Cost: Free Compatibility: Available on iOS and Android (best viewed on tablet device such as iPad) due to small text) Rating: 4/5
OSCE Revision for Medical Students
A good app with lots of promise, though images would have made it perfect.
Matthew Roche
Cost: Free
This not-for-profit app was created by junior doctors to assist students in practising clinical skills. The app not only provides step-by-step instructions on how to perform a full abdominal examination – simple procedures, such as the humble venepuncture, are thoroughly explained to ensure nothing is missed.
Compatibility: Available on iOS and Android Rating: 3/5
The application works great as a simple easy-to-read guide, serving as a companion to clinical examination textbooks. However, its lack of pictures can make understanding certain movements difficult.
App reviews by Zheng Jie LIM (Zee), year 3 MBBS (Hons) student, Monash University, Vic
GP Journey January – April 2017 27
Reviews Apps
MedSchool The Medical Company In my opinion worth every bit of storage space on your phone, MedSchool has everything you need as a medical student doing an emergency department shift or an intern admitting a patient. The front page has a host of useful tables to help with assessing a patient by the bedside, including GCS, acid-base references and a Snellen chart for use at arm’s length. If that isn’t enough, there are tabs at the bottom that give you a rough skeleton on history and examination, as well as investigations and basic initial management – a great guideline for clinical examination.
Journal Club: Landmark medical trials at your fingertips Peripheral Brain, LLC Journal Club is exactly what it stands for: quick review and summaries of journal articles. This app summarises the various landmark clinical trials at the forefront of medical guidelines. Every article starts with a ‘bottom line’ section, which helps the reader to get the most important results from the research without reading the entire article. The studies are published according to disease or by specialty with the added option of bookmarking your selected studies for quick reference. This is a
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handy resource for any medical student or doctor undertaking research, or for the physician exams. Updated every month, this app keeps you up-to-date and at the forefront of medical research. Cost: $10.99 Compatibility: Available on iOS and Android Rating: 3/5
MedSchool comes with a calculator for various systems, allowing you to quickly work out a patient’s CHA2DS2-VASc or Alvarado score. Definitely a useful app to use while following your medical team, or as a quick revision before any OSCE! Cost: Free Compatibility: Available on iOS and Android Rating: 5/5 – this is my favourite app I use every day!
DDx Mnemonics Learn From Apps Differentials for chest pain? Pancreatitis? Enlarged kidneys? It’s difficult to remember the various conditions that can manifest as a simple symptom – and that is where DDx Mnemonics comes in handy.
or add your own supplementary information. However, at a price of $1.49, there may be better applications available online that can do this for free. Cost: $1.49 Compatibility: Available on iOS and Android Rating: 2/5
Categorised by system, the mnemonics aid in rapid recall of the various possible diseases from a presenting complaint. You can favourite a mnemonic for quick reference, plus you can edit the given mnemonic to include more conditions
App reviews by Zheng Jie LIM (Zee), year 3 MBBS (Hons) student, Monash University, Vic
Books Mechanisms of clinical signs, 2nd edition Mark Dennis, William Talbot Bowen, Lucy Cho The art and science of clinical examination is a vital component of patient assessment and management. The Mechanisms of Clinical Signs textbook aims to provide a more complete understanding of many clinical signs. The book is structured in a way that allows it to be used for quick referencing: each clinical sign is assigned its own section and is grouped according to body system. Clinical signs are also indexed according to conditions. For each sign, a detailed explanation is provided, largely focused on the underlying pathophysiology or mechanism. Many of these explanations include helpful images, flowcharts and diagrams, and important clinical signs are emphasised throughout the book using the term ‘clinical pearl’.
The eBook version also includes videos, audio files and multiple-choice questions. The analysis of each clinical sign is strengthened by the inclusion of a discussion of its supporting evidencebase. The textbook is meticulously referenced and a list of sources is provided at the end of each chapter. Overall, this textbook is successful in providing a sound understanding of the underlying mechanisms of clinical signs. The information is presented in such a way that enables the reader to more easily remember the application of each clinical sign. The concise, structured layout of the book makes it a practical reference tool for those wishing to learn or review clinical signs. Both medical students and doctors will be able to benefit from this excellent resource. Publisher: Elsevier, 2015 Cost: $79.20 Rating: 4/5 Reviewed by Daniel Green Final year medical student, Australian National University, ACT
GP Journey January – April 2017 29
With you on your journey GPRA – proudly supporting medical students and junior doctors on their journey to general practice.
Students visit
gpsn.org.au Junior doctors visit
gpaustralia.org.au