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ISSUE 13 FREE

GP Journey January – April 2014

Dr Jenny Wray Heart and soul medicine Also in this issue: Your career GP profiles Clinical cases


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GP Journey

Welcome to the newly named GP Journey magazine!

GP Journey replaces ‘Going Places’ as the title of this fantastic publication brought to you by General Practice Registrars Australia (GPRA).

This new name represents the journey that you might embark on, from medical student through the hospital system, acceptance into the Australian General Practice Training (AGPT) program, and then all the way to attaining your college fellowship. It is an exciting journey, and most likely you will need to navigate through twists and turns along the way. Ultimately, the destination is worth it, justifying all the hard work and sacrifices you would have made to get there! General practice is an attractive profession, as demonstrated by the record number of applications received for 2014 AGPT entry, with almost 2000 applicants competing for about 1200 training positions. Specialist training providers are increasingly more selective about their trainees, and the specialty of general practice is no different. The best and brightest applicants are chosen for training and eventually become well-rounded, highly skilled general practitioners who deliver high-quality healthcare in Australia and beyond. This issue of GP Journey reflects the diversity of a career in general practice, with inspiring profiles of GPs and GP registrars

Published by General Practice Registrars Australia Ltd Level 4, 517 Flinders Lane Melbourne VIC 3001

Staff General Manager Marketing & Communications Sally Kincaid sally.kincaid@gpra.org.au

P 03 9629 8878 F 03 9629 8896 E enquiries@gpra.org.au W gpra.org.au

Medical Editor Dr Chia Pang

ABN 60 108 076 704 ISSN 2203-2657

Editor Denese Warmington denese.warmington@gpra.org.au

including our cover story of the talented and magnanimous Dr Jenny Wray, who was recently awarded with a Member of the Order of Australia and a Telstra Business Women’s Award. Geelong GP Dr Tim Denton, explains how he is spearheading the change towards multidisciplinary primary healthcare, and Tasmanian GP Dr Christine Boyce, tells us how she has struck the right note in her medical career. GP registrar Dr Marlene Pearce, tells how general practice gives her the opportunity to meet the person behind the illness, and Dr Matthew Allan shares his tips on applying for the AGPT program. We also have our regulars including the amusing series Aqueous Humour, clinical cases and reviews. For junior doctors we have listed the contacts for our Going Places Network Ambassadors, and for medical students, our General Practice Students Network. If you have any questions about general practice, I strongly urge you to get in touch with them. I hope you enjoy the magazine!

Dr Chia Pang Medical Editor GP registrar – Bogong Regional Training Network

Going Places Network Manager Emily Fox emily.fox@gpra.org.au General Practice Students Network Manager Alex de Vos alex.devos@gpra.org.au Writers Laura McGeoch Jan Walker Denese Warmington

Graphic Designer Peter Fitzgerald Sponsorship & Events Coordinator Natalia Cikorska natalia.cikorska@gpra.org.au Produced with funding support from

©2014 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.

With you on your journey

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GP Journey in this issue... Upfront

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Cover story 11

First Wave profile Kate McQueen talks about her First Wave Scholarship placement in a small country town in South Australia.

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GP registrar profile Dr Marlene Pearce tells us general practice provides a unique opportunity to get to know the person behind the illness.

Regulars

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20 How to apply for 25 Going Places the AGPT program Network update 22 Dr Matthew Allan – Tips for AGPT program applicants

GP profiles

Clinical cases

Dr Jenny Wray AM has recently been honoured with a Member of the Order of Australia and a Telstra Business Women’s Award but she says her greatest honor is being able to serve her community. Jenny talks to us about her approach to heart and soul medicine.

26 5 minutes with ... Dr Felicia Koh

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36 A woman with a cough not responding to routine antibiotics

Back pages

PGPPP profile Dr Louise Knapp is hooked on general practice after a PGPPP in rural Queensland. She shares her story with us.

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27 Going Places Network Ambassadors

30 5 minutes with ... Alexandra Drucker

28 What you can earn

31 General Practice Students Network contacts

Dr Tim Denton has a passion for multidisciplinary primary healthcare. He shares his passion with us.

40 Reviews 42 Aqueous humour

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Student profile Joe Monteith is a medical student wearing many hats. Joe discusses his plans for the future and his involvement with GPRA. Junior doctor profile Dr Amran Dhillon talks about his former life as a nurse, and his new life as a junior doctor and GP ambassador.

Dr Christine Boyce sings the praises of a career in general practice with a special interest in refugee health.

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43 The PGPPP

38 Clinical Corner 39 Murtagh’s tales

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c o v er st o ry

The gift of giving back

Dr Jenny Wray AM has recently been honoured with a Member of the Order of Australia and a Telstra Business Women’s Award but she says her greatest honour is being able to serve her community.

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“I’m happy to share what I have with those who have less to make a difference.” Don’t make me out to be some kind of halo-wearing saint. This was the message Dr Jenny Wray was keen to get across when GP Journey spoke to her about her long career and recent awards. Yet there is no doubt that giving back to her community on the New South Wales south coast has been a constant theme for Jenny, whether by financing a scholarship fund or training countless new doctors. “If you live in a community you can’t just take from it, you’ve really got to give back. And funnily enough, you find after a while that you feel like the recipient not the donor,” Jenny explains. “I’m happy to share what I have with those who have less to make a difference,” she adds. Jenny’s contributions to rural medicine and her community have been honoured by three major awards. In 2011 she was named the RACGP General Practitioner of the Year, and in 2013 she was awarded a Member of the Order of Australia and was a national finalist in the Telstra Business Women’s Awards. Certainly, she appears to fizz with the energy of a woman half her age – and she wears many hats. She’s been a GP in her community for more than 30 years. She’s a supervisor and encourager of the next generation of GPs. She has a special interest in Indigenous health. She’s a leader and philanthropist in her local community. And she owns two medical clinics – the Lighthouse Surgery in Narooma and the Bermagui Medical Centre. Her reaction to her latest honour, the Telstra Business Women’s Award? “I’m quite shocked, actually. I never expect to win any awards so I must say it’s not how I measure myself by any means,” Jenny says. “I think the judges were looking beyond the financial side of my business because I’m not on the BRW rich list. But I’ve managed to put something back into my community.” The judges highlighted Dr Wray’s determination to tackle large issues such as attracting young doctors to regional areas. To this end, Jenny has set up her clinics explicitly as teaching practices. Each year she hosts a constant stream of GP registrars, junior doctors in the Prevocational General Practice Placements Program and medical students. At her Narooma practice, she has even built on-site accommodation units for them. She admits she has an ulterior motive. She hopes that some of them will return after they finish their training. “Then there’ll still be a practice when Jenny Wray finally turns up her toes,” she says with a laugh. Jenny’s community engagement isn’t limited to medicine. She and her husband Jock founded the Lighthouse Scholarship Fund in 2003. The Lighthouse Scholarship Fund provides money to help support rural students living away from home to study at university. A total

of 19 students have been helped so far. It’s not just for medical students. The fund has produced five doctors, but there have been lawyers, accountants and engineers too. She talks down her philanthropic efforts as small in scale. “I’m actually overwhelmed by some of the amazing philanthropists in this country,” she says. But she is keen to talk up the rewards of a career in general practice to up-and-coming doctors. “If it’s what you really want to do, then it’s the best job in the world. And you can make it the best job in the world by really putting your heart and soul into it. It’s not something you can do working at about 80 percent capacity.” Jenny first decided to put her heart and soul into a medical career as a girl growing up on a farm in country South Australia. When she was seven, she was ill with pneumonia and spent time in the local hospital. “There were no secrets in those days because there was just a male ward and a female ward, adults and children together, and I was listening with absolute keenness to all the conversations going on,” Jenny recalls. “I can remember the doctors and nurses putting in drips and attending to the patients, and I remember thinking I so love this. I so love hospitals.” Jenny also credits a book she read when she was 12 with piquing her interest in a medical career. “I thought I’d be a nurse, and then I read Morton Thompson’s book, The Cry and the Covenant. It’s a novel about Semmelweis, the doctor who discovered the link between handwashing and controlling the spread of infection.” She was accepted into medicine, and spent her early career in South Australia. Later, when Jenny visited her husband’s family farm in Bega with their two young children, she fell in love with the place. In 1977 they decided to settle in the nearby seaside holiday town of Narooma. Jenny has been a GP there ever since. Applying for the Telstra Business Women’s Award was a timeconsuming process, but “only good came out of it in every respect”, she says. Through the detailed analysis of her business structure and values, she realised she was doing too much. Consequently, she has now delegated much of the day-to-day administration to a practice manager. The process of self-analysis also reminded her of the things that make her happy. “I love to keep fit – I swim regularly in the pool and the ocean. I like being busy, but not just busy at work, I like doing things to do with my home and garden. I love embroidery and I love music. I love to have time to myself. Meditation is a regular practice for me. And I need to be connected to my family, my friends and my community. “Last but not least, I know that I’m happy when I’m actually serving other people.” Written by Jan Walker

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M E D I C A L S T U D E N T P RO F I L E

Flying high After spending time on an RAAF base in the Northern Territory, Joe Monteith’s perception of general practice in the Australian Defence Force has changed.

“Being exposed, then inspired to make a difference as a medical student is the best thing you can do.” 8


From Left Joe at the RAAF base at Katherine (Photo by LAC Terrance Hartin) At the GPSN trivia night in Melbourne At the GPRA Breathing New Life Conference in Canberra Opposite page: Joe at the RAAF base in Katherine (Photo by LAC Terrance Hartin) When third year medical student and General Practice Students Network (GPSN) National Chair, Joe Monteith, first ventured up to Katherine for his self-recruited general practice rotation, he thought he would be treating fit and healthy patients, but in reality, he is managing a wide range of presentations. “I’ve been doing a lot of preventive healthcare and I’m dealing with some fairly complex cases – from pregnant women, to procedures to Super Hornet fighter pilots,” he says. “There’s a huge variety of work and lots to do – it’s a fantastic health centre.” Joe’s GP supervisor, Dr Debbie Horsten, is an experienced rural practitioner and a contracted specialist to the ADF. Joe also works alongside a pharmacist, physiotherapist, dentist, medics, environmental health officers and nurses including a mental health nurse and health promotions nurse. His patients wear uniforms and tend to be very proactive in following the ‘doctor’s orders’. “I think it’s because their livelihood is dependent on their health and it’s really important to them,” Joe says. “Aside from that, it’s just like a regular, busy practice.” Joe was attracted to the ADF because of its organisational and administrative structure, as well as the general practice element. He enjoys wearing “two hats” as a medical officer in the defence, where he is learning to deploy entire teams overseas and other skills such as aeromedical evacuation and trauma management. “You’ve got your doctor hat but you’ve also got your organisational and military hat,” he tells GP Journey. “It’s a great learning experience.” During his previous experiences with the ADF, Joe has been lucky enough to fly in a search-and-rescue helicopter as well as a Hercules, which he describes as a “flying hospital”. However, despite the perks and adrenalin-fuelled activities, Joe admits that living and working in remote Australia has its challenges. “For example, I might want to order a particular test, but because we’re quite isolated there are limitations to ordering them,” Joe says. “So you tend to rely on your clinical judgement a lot more.” These challenging conditions have forced the University of Melbourne student to become a fast learner and to start developing the skills necessary to become an independent practitioner. “I really love it here – the GP side of things is great and I can really recommend this placement,” he says. Katherine, also referred to as the ‘Top End’, is 320 km southeast of Darwin and is the fourth largest settlement in the Territory. The town has an urban population of 5849. Although the location is remote, Joe has never once felt lonely, which is something a lot of people fear when they relocate to a distant community in outback Australia. He was also “surprised” at how much there was to do in Katherine. “Once you start getting involved in the community, you find there’s quite a lot going on. It’s also great for sport and recreational activities,” says Joe, who spends his days off exploring the many scenic freshwater gorges around the Northern Territory by kayak.

In between his rotations at the RAAF base, Joe has spent time visiting Indigenous communities, which he describes as an “eye-opening experience”. He explains that successfully delivering healthcare to Indigenous patients as a medical student has been his greatest challenge as it takes time to be integrated into the communities – difficult when students are placed in the area for only a few weeks. “It’s hard because you have the passion but you can’t really make a difference in the community until you become a doctor and you have the skills and time.” Joe has listed exposure and making a commitment to return when he’s a medical graduate as two items on his agenda to closing the gap and reducing the impact of chronic disease in Indigenous communities. “It’s almost third world conditions in some parts of Australia and it really makes you want to help in your own country,” Joe explains. “Being exposed, then inspired to make a difference as a medical student is the best thing you can do.” When Joe returns to Melbourne following his stint in the Northern Territory, he’s looking forward to tackling his new role as National Chair of GPSN, Australia’s fastest growing medical student organisation with more than 11 000 members. The former GPSN Melbourne University Student Ambassador said he was inspired to throw his hat in the ring for chair of the network after attending GPRA’s 2013 Breathing New Life into General Practice conference in Canberra. “Seeing the vision that outgoing chair Dave Townsend and other students had on a national level was really encouraging,” he says. As National Chair, Joe plans on consolidating the network’s member benefits, ensuring local clubs run consistent events and implementing a two-way exchange process between the national executive team and local clubs. “There’s a lot of variability in the events and the things GPSN offers its members,” he explains. “In terms of internal policies and procedures, including our national council in the decision making process is a priority.” Joe is part of the first Doctor Medicine cohort at the University of Melbourne and is based at St Vincent’s Hospital. Prior to studying medicine, Joe worked as a pharmacist and was involved in a variety of student organisations. His impressive resume features an extensive list of awards and executive positions in student organisations. He has had a long interest in general practice, which stems from his work in community pharmacy, which he says plays a big role in primary healthcare. “After I graduate I’d like to do a PGPPP rotation and work in rural Australia for a couple of years. Once I specialise as a GP, I’d also like to sub-specialise in paediatrics, obstetrics and gynaecology. “This is all dependent on my upcoming exams of course … fingers crossed!” Written by Alex de Vos

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F irst W a v e pr o file

A brilliant insight When First Wave Scholarship program recipient Kate McQueen met her GP supervisor, Dr Georgina Moore, she was in awe of how much this extraordinary woman managed to pack into her day.

“It gave me a brilliant insight into preventive health, I learnt a lot and had fun.�

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Dr Georgina Moore, a rural generalist, runs the Maitland Community Health Centre in South Australia alongside two other GPs. She spreads her time between the practice, the local hospital, the Aboriginal Community Health Centre in Point Pearce and local schools. “She [Georgina] is extremely competent and has exceptional time management skills,” says the now second year Flinders University medical student, Kate McQueen, of her one-week placement at the Maitland clinic in December 2012. “I learnt so much from her.” Positioned on top of a ridge overlooking the Spencer Gulf and Yorke Valley, Maitland is a small town about 168 km from Adelaide. It has a population of 1056 and is surrounded by barley and wheat crops, which have been described as some of the best in the country due to a higher rainfall than other parts of the Yorke Peninsula. Georgina has lived in Maitland with her two children and husband, a local wheat farmer, for most of her professional life. Over the years she has developed strong relationships with her patients, who have presented at the Maitland clinic since its establishment in 1997. Kate describes the clinic as having a “relaxed and friendly” vibe. “Dr Moore knows everyone as well as the background on all her patients, so when they come in to see her she has a chat to them about the different things going on in their lives and in the community. She’s seen her patients’ children grow up and their families – it’s that wonderful cradle-to-grave medicine.” During her placement, Kate was exposed to a variety of health concerns and was lucky enough to assist Georgina during some of her routine procedures. Kate lists breast and ear examinations, skin lesions, vaccinations, nasal swabs and rectal and abdomen examinations as some of the most interesting. “Dr Moore used me as a second pair of hands and was very patient teaching me skills and helping me with my techniques,” she says. Kate also learnt how to use an otoscope and after the “tenth time” she says she felt “more confident”. During one such examination Kate and Georgina discovered a perforated eardrum in an eightyear-old Aboriginal boy. Georgina immediately called a surgeon in Adelaide and made an appointment for him “right then and there”. Kate describes Georgina’s style of practice as very “hands-on”, and explains that Georgina treated her patients in the consulting room whenever she could instead of referring them to costly specialists in

the city. “We saw a high proportion of skin cancers and Dr Moore would send off the biopsies, get the results and then treat the patient straight away. “It was really great to see this,” she adds. Kate also witnessed the use of interactive digital technology, which has played a huge role in connecting city specialists with rural and remote Australians. “The video conference to the specialist in Adelaide was fantastic,” she says. “It saved the patient having to drive anywhere.” Georgina was instrumental in setting up the Aboriginal Community Health Centre in Point Pearce, now in its eleventh year of operation. Kate describes her visit to the centre as a “highlight of her placement”. “It was really wonderful to see the practice functioning so well,” she says. “The staff are all invested in it and over the years Dr Moore has built up a rapport with the patients so they trust her.” Although Kate found it confronting to see first-hand the appalling health conditions of the local Indigenous community, “I couldn’t believe that people are still suffering from scabies in our developed nation – only two hours west of Adelaide,” she says the clinic, which opens its doors twice a week, has already made an enormous impact on the community’s health. “Since its inception, death rates have reduced along with alcohol-related violence.” So at at the end of her First Wave placement was Kate inspired to work as a GP in rural Australia? “I’ve had a lot of experience with GPs in the city, not only as a patient but also because my mum is a GP in the city. This placement really changed my perception of general practice and showed me how amazing and diverse your skill set needs to be to work as a GP in a country town.” Kate reflects that Georgina highlighted what an “incredible privilege” it is to be a rural GP and how rewarding the role can be. “The patients gave so much back to her and really appreciated everything she did – I think the benefits far outweigh all the responsibilities,” she says. Kate says that the First Wave Scholarship is a “fantastic opportunity” and recommends the program to anyone with an interest in general practice. “It gave me a brilliant insight into preventive health, I learnt a lot and had fun.” Written by Alex de Vos

The GPSN First Wave Scholarship program offers first and second year medical students the opportunity for a positive and inspiring experience in general practice under the guidance of a dedicated general practice supervisor. Third and fourth year medical students from universities in South Australia and Western Australia can also apply for a clinical placement with an Indigenous health provider. Applications for the First Wave Scholarship program open 30 May 2014 and close 30 June 2014. Visit gpsn.org.au for more information. 12


Award winning GP Training on the NSW north coast An outstanding training program delivered by an award winning medical education team on the beautiful north coast of NSW. Training nodes in Tweed Heads, Ballina, Coffs Harbour and Port Macquarie. Visit our website to hear our registrars talk about their experiences with NCGPT: www.ncgpt.org.au “North Coast GP Training is a fantastic place to be a GP Registrar. The region has amazing beaches end to end, stunning hinterland, and perfect climate.When at work, the education and training program at NCGPT is superb - come and join us!� Dr David Chessor 2013 RACGP Rural Registrar of the Year 2013 GPET Registrar of the Year

Want to see if General Practice is for you? Try a 10 week PGPPP term in one of our North Coast Practices as one of your hospital rotations. Go to www.ncgpt.org.au/postupthecoast


P G P P P and me

Hooked on general practice

After doing a PGPPP in rural Queensland, Dr Louise Knapp is certain a career in general practice is the right choice for her. 614


What stage of your training are you at? I’m a junior house officer at the Gold Coast Hospital in Queensland. Where did you do your PGPPP? St George Medical Practice in St George, Queensland. Describe St George to us. St George is a cute town of approximately 3800 people. It is located in the Balonne Shire and is a seven-hour drive from the Gold Coast. Cotton farms surround the area, and the Balonne River runs through the town, which makes it a great spot for catching yellow-belly fish or water skiing! Tell us about some of the work you did during your placement. I got a lot of hands-on experience. This included helping excise/burn off skin lesions, putting on casts, performing Pap smears, giving immunisations, performing spirometry and audiometry, and completing medicals for the cotton farmers. What did you learn from your supervisor? My supervisor was Dr Pam Turnock, who was amazing. Pam had a wealth of experience as a rural GP and she really epitomised the passion and dedication it takes to be a good rural GP. I learnt a lot about medicine from her (and about life in the country), and was able to develop my history-taking and examination skills and formulate management plans to suit the individual patient. I was also lucky to have Dr Mike McDonnell for a few weeks when Pam went on a much-deserved holiday. Dr Mike has a lifelong relationship with St George; his father was the medical superintendent for many years, a role that Mike also took on. Needless to say, he had some cracking medical stories. He also passed on many pearls of wisdom to me. Describe an average day during your PGPPP. For accommodation, I shared the ‘white house’ with another junior doctor on the hospital grounds. In the morning I would simply walk over to the hospital and start the morning round of the private hospital patients by myself. When Dr Pam arrived, I would update her on the overnight progress of our patients and we would formulate treatment plans. I would then go down to the medical practice and start seeing patients. After the first week, I was seeing my own patients and consulting with Pam at the end to formalise management plans. This was a fantastic opportunity because it forced me to make treatment plans based on my assessment, whereas at home, my registrar or consultant typically did this thinking and I completed the jobs. Often during the day we might see a patient in the practice that needed admission to hospital. I would usually accompany the patient to the hospital and do the admission. This involved doing the history, examination, organising blood tests and imaging, and starting medications and fluids after consultation with my supervisor. When the patient was discharged, I would complete the discharge summary and follow them up in the surgery. This was great for seeing the full cycle of care. We had formal teaching twice a week, once with the other hospital doctors and then in the practice. I was also responsible for doing the antenatal audit each week, which ensured all our antenates were up-to-date with their management.

Although I worked solidly each day, I was usually home by 4.30 or 5 pm, which meant I could fit in some exercise most days. The other doctors I shared the time with were pretty good at making the most of it, so after work we would often go fishing or to the pub for dinner. What are some of the important lessons you learned about patient care? Patient care should always come first and sometimes that is difficult when you have huge volumes of patients to see in a limited amount of time with limited services and financial constraints. Mastering this must take years; I found seeing 15 patients a day as a junior doctor exhausting. I have an enormous amount of respect for GPs who manage 30+ patients a day, 5 days a week plus on-call duties. With this in mind, I guess it’s pretty important to look after yourself so you can look after your patients! What have you learned about general practice? General practice is by no means the ‘easy option’ in medicine. It is hard work to be a good GP. It is long hours at times, emotionally draining at times, and involves managing complex medical issues as well as the more simple cases. This aside, it is a wonderfully diverse specialty that challenges and allows you to form good patientdoctor relationships, and this ultimately makes it a very rewarding and enjoyable job. I especially like the fact that you are seeing babies, children, adolescents, adults and geriatrics all with their own subset of medical issues. Did anything surprise you about the PGPPP experience? I was brought up in the city and I was surprised by how much I enjoyed the country lifestyle. I missed my family and the shops, but there was always online shopping and Skype! Did the experience make you want to pursue a general practice career? Certainly. What was the best part of the experience? Meeting some great doctors who inspired me to pursue a career in general practice, and meeting some salt of the earth patients who reminded me to not sweat the small stuff. What was the most challenging or difficult? On some days seeing back-to-back patients with complex issues was tiring, but still appreciating that you will have those days. Would you recommend the PGPPP to others? I would definitely recommend the PGPPP, even if you’re not sure general practice is for you. You will learn more about medicine in general, develop practical skills, learn about the barriers to health in the rural setting, and have a great time if you immerse yourself in the community lifestyle.

Louise’s top three tips for someone doing their PGPPP: 1. Go with an open mind. 2. Take every opportunity to learn new skills. 3. Explore the area and make good use of your weekends.

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J U N I O R D O C TO R P RO F I L E

Nurse, doctor ... GP?

A former life as a nurse has had an overwhelming influence on the way junior doctor Amran Dhillon treats his patients and on the type of GP he wants to be.

“In general practice you get face-to-face time with your patients, you can follow them up, provide continuity of care and have the capacity to treat all dimensions of the person.� 16


From left headspace project launch at Channel 10, Sydney With his Hip Hop dance crew ‘Bounczn Dance Company’ Opposite page: Amran at Northern Health Hospital (Photo courtesy of Northern Health) When junior doctor Amran Dhillon started his residency at Northern Hospital he may have had a sense of déjà vu. While he is now called ‘doctor’ when he completes his ward rounds, his first steps down the corridors of the suburban Melbourne hospital six years ago were as a nurse. It’s a second coming that has been embraced by staff and patients. “I’m known as the doctor who used to be a nurse – or the nurse who became a doctor!” Amran tells GP Journey. Amran initially chose nursing because the profession allowed him to embrace his passion for working with people. “It wasn’t until my third year of nursing that I had this little thought, a voice in the back of my head, about doing medicine,” Amran explains. His intrigue with medicine grew during his nursing degree. By the time he’d graduated from Australian Catholic University in 2006, Amran had gained the extra chemistry studies he needed for medical school and passed the Graduate Medical School Admissions Test (GAMSAT). “The voice never went away!” he says. Although eligible to start medicine immediately after graduating from nursing, Amran decided to put his undergraduate degree to use and worked at Northern Hospital for the next two years. He started his medical degree in 2009 at Deakin University in the regional city of Geelong, and continued to drive back to Melbourne on weekends to pick up casual nursing shifts.

anaesthetist. “It’s probably the best time I’ve had throughout my intern year,” he says. “It’s the first time I’ve been quite relaxed and enjoyed the role I’ve played as a doctor. “I’d say these last three weeks have really confirmed my passion not just for general practice, but for rural medicine,” adds Amran, who is exploring general practice further in his role as a GP ambassador for the Going Places Network. Amran is hoping to one day use the flexible work options available to GPs to explore his other health and medical interests. Amran has worked with headspace, Australia’s national youth mental health foundation. He was one of 20 people to be selected as a National Youth Reference member and provided strategic advice on the development of the foundation. As part of this role, he gave the welcome address to the first International Youth Mental Health conference, held in Melbourne in 2010. Sharing the stage with Australia’s health ministers and leading health professionals was a career “highlight”, he says. In his spare time, he also helps a friend run a hip hop dance training company that aims to use movement to empower underprivileged youth. While he doesn’t teach dance, he has performed hip hop in competitions and events with different groups over the years.

Side interests and extracurricular activities, Amran believes, are important for doctors to work at their physical and mental best. “Those practical things you do in life can have such an impact on “I gained a lot of clinical experience working in the emergency room medicine,” he explains. “It [medicine] is not just an academic field ... and intensive care department,” he says. “It [nursing] has had a huge it’s about people. We are dealing with real people, so you need real influence on me and my experience of medicine. life experiences.” “It has given me a sense to know when things are going wrong ... a In the future, Amran hopes to have a “bigger impact on healthcare clinical intuition that I’ve gained over the years. Nursing has helped and to improve patient outcomes” by combining his “on the ground” me to recognise the signs in patients that they are becoming unwell.” hospital experience with an interest in quality and safety. Amran also sights clinical work, such as taking bloods and putting For now, Amran is getting the most out of his hands-on rural genlines in, as practical ways nursing has helped him. eral practice placement. “Rural general practice is the best of both Perhaps more than anything, his undergraduate degree has influworlds,” Amran says. “You have the one-on-one time in the clinic enced the type of relationship he wants to have with his patients. and ability to make that long-term difference ... but you also have “As a doctor, you don’t always have time to practise how you want the benefit of being able to review your own patients at the local to practise,” says Amran, who began his residency last year. “The hospital where you’ve admitted them.” hospital is almost like a production factory. The patient ratio is so Specialising in anaesthetics and emergency, both key to a rural GP’s much higher. When nursing, you’re with a patient for longer, spending work, is also on Amran’s agenda. “I can’t handle not knowing a little minute by minute with them ... I kind of missed that.” bit of everything,” Amran admits. “General practice encompasses all A nurse’s ability to advocate on their patient’s behalf is one of the your knowledge and skills.” reasons he plans to become a GP. “In general practice you get faceAs his medical career advances to yet another level, Amran is to-face time with your patients, you can follow them up, provide staying true to the values he learned in his first experience as a continuity of care and have the capacity to treat all dimensions of health professional. “It’s not just about the organisation you are the person,” he says. working for or about yourself. The number one priority is your At the time of writing, Amran was three weeks into his PGPPP in patient. You are working to help them and there is nothing more the small town of Korumburra in South Gippsland, Victoria. He was rewarding than that.” thriving in the “multi-dimensional” role the practice had given him. Written by Laura McGeoch A regular week has seen Amran work in the clinic, do ward rounds at the hospital, assist visiting surgeons and work alongside the GP

Taking a fresh With look you at on general your practice journey 17


G P R E G I S T R A R P RO F I L E

Finding the human face

Not only does it encompass every specialty, GP registrar Dr Marlene Pearce says general practice provides a unique opportunity to get to know the person behind the illness.

The idea of being a family doctor – in the most traditional sense – had always appealed to GP registrar Dr Marlene Pearce. “When you’re growing up, you don’t imagine doing high-end cardiac surgery,” Marlene tells GP Journey. “I always had that idea of being the doctor who is the friendly person in the clinic who you go to when you’re sick.” During university, Marlene did a six-week rural rotation that included placements at Mitchell, 600 km west of Brisbane, and Charleville, 100 km or so even further west. The experience exposed Marlene to the “impressive” skill set of the rural GP. “They were the family doctors who could do everything!” Marlene says. “They are multi-talented individuals. I thought if I was going to be a GP, I wanted to work in a rural area.” Marlene went on to do her residency at Nambour Hospital on the Sunshine Coast and found that she enjoyed every specialty. But rather than confusing her idea about becoming a GP, Marlene explains that this actually made her choice easier. “The only way to do every specialty was to become a GP.”

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Photos from the top: Wathaurong Health Service, Geelong A gift from a Wathaurong Health Service patient (painted for Marlene knowing “she liked O&G”) Receiving the RACGP Bursary Competition 2013 award from Dr Morton Rawlin Trying kangaroo tail on Cultural Immersion Camp with NTGPE, near Belyuen Community on Larrakia country

of medicine While working in the fast-paced hospital environment, Marlene also realised how much she valued any one-on-one contact she had with her patients. “I enjoyed talking to patients more than I got a thrill out of the clinical environment,” she says. Quality time with patients was something that general practice could offer her. Marlene and her husband Rob, also a GP registrar who she met at university, decided to leave the Sunshine Coast and find a place to complete their training. Looking for a change of scenery, they headed south to test the cooler waters in country Victoria. “Rural Victoria is still not as rural as rural Queensland!” Marlene points out. First stop was Camperdown, a town of about 3500 people in southwest Victoria. During her first term there, Marlene worked in a clinic on weekdays and was on-call at the local hospital over the weekends. Despite having already earned the title of “doctor”, Marlene says it was during her first year of registrar training that she finally felt that she owned it. It’s a title that she’s settling into more and more as her childhood idea of being a trusted family doctor becomes a reality. “Someone I’d seen thought I was a good doctor and brought a family member back to see me,” Marlene recalls. “That someone thinks highly enough of you to recommend you to their relatives ... it’s very rewarding.” Seeing patients from the same family can be really beneficial, Marlene says. “Especially working in Aboriginal health,” she says. “It helps that you understand the patient’s life context.” Marlene spent the first six months of her second term at Wathaurong Aboriginal Co-operative in the regional city of Geelong. It was Marlene’s first experience working in an Aboriginal Health Service (AHS). “I really loved it,” she says. “The benefit of working in an AHS is that it’s a community controlled clinic ... you’re being invited to work there by the community. It helps to remove a lot of the barriers that Aboriginal people face when accessing healthcare.” During her time there, Marlene says she met women who remain some of her most memorable and inspiring patients. “They continually amazed me with their stoicism and ability to hold their families together under a variety of life pressures.” Marlene wrote about her AHS experience in an opinion piece for Medical Observer. Creative and medical writing is something that Marlene enjoys “dabbling” in. She writes a blog (thedoctorsdilemma.wordpress.com) that gives her a chance to “reflect on being a doctor ... and it’s a welcome procrastination tool!” Her other writing credits include being shortlisted for an Australian Doctor short story competition and penning a poem that earned her a study bursary from the RACGP.

Australian and New Zealand College of Obstetricians and Gynaecologists. As she was gearing up for a week of 12.5 hour nightshifts, Marlene noted that she was looking forward to returning to the more balanced life of a GP. “Coming back into the hospital for the last six months has confirmed to me I made the right choice to come out of the hospital!” She advises students and junior doctors to consider all the different fields that GPs can branch out into. “There are many different ways to practise general practice in Australia.” But like every job, general practice also has its challenging days. Marlene sights working with the “worried well” – fuelled by ‘Dr Google’ – as one of the harder points. “Part of the skill of being a GP is to know when to order tests and when not to order tests,” she says. “You’ve got to learn when things are within the realm of normal for that person.” How does she know when she is faced with the worried well or something, well, more worrying? “It’s still a work in progress!” she responds. “It’s an ongoing professional confidence that you develop ... over years and years.” When it comes to the good days, Marlene again points to the rapport that GPs can build with their patients. “Explaining something to a patient that they’d never had explained to them before and seeing the ‘light bulb moment’ ... general practice is one of the specialties that you have the time to do that well.” “For ‘people people’ it’s a great job,” she adds. “You get face time and time to explain and make shared decisions with patients.” Written by Laura McGeoch

When GP Journey spoke to her, Marlene was working in Geelong hospital’s maternity ward completing a diploma through the Royal

With you on your journey 19


M y C areer

How to apply for the AG Application and selection process Selection into the AGPT program is a national merit-based, competitive and multi-phased process used to determine which applicants are best suited to general practice. The application and selection process is managed by General Practice Education and Training Limited (GPET), the Australian Government funded organisation responsible for the funding and management of the AGPT program.

Applying for AGPT Applicants apply online via the GPET website. Applicants will need to upload required supporting documentation and identification together with their online application. Upon submission, each applicant will receive an emailed PDF of their application. The supporting documentation required varies for Australian medical graduates (AMGs), overseas-trained doctors (OTDs) and foreign graduates of accredited medical schools (FGAMS). Visit the GPET website for details at gpet.com.au The AGPT application and selection process is made up of three stages: 1. Application and eligibility check Once applicants have submitted their online application it is 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. Applicants will receive an email from GPET advising if they are ineligible. Refer to the GPET website for eligibility criteria at gpet.com.au 2. National assessment Eligible applicants will be invited to participate in the national assessment and short listing process for the 2015 AGPT program cohort. This process will include undertaking Multiple Mini Interviews (MMIs) and undertaking an online Situational Judgement Test (SJT). These tests are not focused on your clinical knowledge, but rather your aptitude for general practice as a medical specialty. The standardised results of these two assessments will determine each applicant’s total AGPT selection score. Based on rank and the availability of places at their preferred regional training provider (RTP), applicants will be shortlisted to their highest available preference. For details regarding the national assessment and short listing phase, please visit the GPET website at gpet.com.au 3. RTP selection and placement offers RTPs will use the results from the MMIs and SJT (and any further requested information, which may be obtained through a placement assessment or by contacting nominated referees) to determine appropriate allocation of places. Applicants will be advised of the outcomes of the allocation, and suitable applicants will be offered training places.

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What do I need to do to prepare my application? There are a number of things you can do now to prepare for your application. Supporting documentation Clear, colour scans of original official documents (eg. citizenship) must be included with your online application. Applicants who do not provide all the required documentation will not be included in the selection process. The full list of documents required are available in the 2015 AGPT Applicant Guide, which will be available on the GPET website from February 2014 onwards.You can prepare this documentation prior to opening of applications. Referees All applicants must provide the details of two referees in their online application. Referees ideally should be a medical practitioner who has directly supervised the applicant for a period of at least four weeks within the past three years. Applicants need to select referees who are able to confidently make judgements about the applicant’s professional capabilities and suitability for general practice, and who can be contacted during the selection period. Selecting a preferred RTP Applicants are able to nominate up to four RTPs to train with.You are encouraged to contact the RTPs you are interested in training with, prior to applying, to assist you in determining where you would like to train. A map of RTPs and contact information is available on the GPET website under ‘Training providers’ at gpet.com.au What is an MMI? MMIs involve applicants being rotated between interview stations with each interviewer asking the same question to each applicant individually. The questions are based on the competencies required to practise, for example, communication skills. 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 applied for the next question. There are a total of six MMI questions. Applicants sit the MMIs at National Assessment Centres. What is an SJT? The SJT is an online multiple choice test undertaken at a National Testing Centre. It consists 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. Examples are available on the GPET website.


PT program Applications for the 2015 Australian General Practice Training program key dates

Keep an eye on the GPET website for detailed and up-to-date information about the selection process and application requirements.

Applications open 10 am AEST Monday 14 April 2014

To find out more about the application and selection process, visit the ‘Junior doctors’ section of the GPET website and click on the ‘New applicants’ page at gpet.com.au

Applications close 10 am AEST Friday 9 May 2014 National Assessment Centres – SJT online: 26 May to 15 June 2014 National Assessment Centres – MMIs: 6–29 June 2014 Please visit gpet.com.au for the most up-to-date information on dates.

Please contact AGPT Selection for further information via email at selection@gpet.com.au or call 1800 DR AGPT (1800 37 2478) or if calling from overseas +61 2 6263 6776.

Explore the possibilities of General Practice Training

Applications for the 2015 Australian General Practice Training Program open 14th April 2014, and close 9th May 2014.

To find out more, contact one of the NSW Regional Training Providers or visit www.agpt.com.au

www.agpt.com.au


The AGPT program Tips for a successful application

Dr Matthew Allan was recently accepted into the AGPT program. He shares his thoughts about the application process and offers some tips for those considering applying into the program in the future.

When did you apply? I applied in 2013 (PGY1) and will start general practice rotations in 2015. How did you find the application process? The online application was straightforward. How was your experience with the Situation Judgement Test and the Multiple Mini Interviews? None of the interviewers were intimidating. They were all fair and helpful, so that put my mind at ease. The actual interview questions were varied but gave me an opportunity to show off my personal experiences and speak about why I wanted to be a GP. The SJT was harder than I expected, but there is no real way to prepare for it. Some of the scenarios and options really make you think! What did you find most challenging about the process? The SJT, as I had no idea what the right answer was for some of the questions. What are your top three tips for those considering applying into the program? 1. Start the online application process early. It may take some time to get approval from referees or to gather all the information required. Starting the application early will mean you have a whole month to organise this. 2. Get on the RACGP website and look at the section on ‘what is general practice’ and its core values. This was particularly useful in helping me frame some of my interview answers. 3. Look at the different regional training providers and see what they offer and how they differ. Some may be more flexible than others and some may have opportunities you didn’t realise existed. Well done on being accepted into the program. What are you most looking forward to when you enter GP-land?

• Having more autonomy in my work • Reasonable work hours • A new type of challenge • Not having to share a ward computer • Not having a pager • Getting a lunch break (hopefully) … I could go on …

6 22


Is general practice the specialty you have been looking for?

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Join the Going Places Network today and find out more about general practice. • More than 3500 junior doctors have already joined us • Network with experienced GPs and meet other peers interested in becoming a GP

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• Attend free networking and educational lunches and dinners • Access free tools and resources • Get key information from your local GP ambassador in your hospital

gpaustralia.org.au Online support for junior doctors interested in general practice

Taking a fresh look at general practice 23


Feb 28 7 March to

24


Going Places Network

Update

2013 was a busy year for the Going Places Network. Fantastic events were held around the country and we now boast over 3400 members. Below is a taste of what we got up to. Not a member? Join us in 2014 and get a head start to your GP career. NSW/ACT Held at the Living Room in North Sydney, the ‘Branches of the GP Tree’ event showcased the varied options a career in general practice can give. Hosted by GP ambassadors, Marianne Moore and Phoebe Norville, and supported by the NSW RTP Collaborative (who provided door prizes) and NCGPT as a GPRA sponsor, the event was well attended by junior doctors, students and registrars. Dr Guy Davies gave a wonderful insight into his career as a GP and lecturer, while still being involved with family and volunteering in the community, and Kylie Ellingsworth (NSW RTPs), Didi Stigter (RACGP) and Susan Jones (RACGP) were on hand to answer specific questions about the AGPT program.

QLD GP registrars, junior doctors and medical students hopped on board the GP Food and Wine Tour to Mount Tamborine in the Gold Coast hinterland for the ‘Take a break. Get a GP Life’ event. Local GPs, Dr Leeann Carr-Brown and Dr Ann Bennett shared their experiences, Dr Rebecca Farley talked about refugee health, and Dr Wesley Ko talked about PGPPP placements at his Bundaberg general practice.

Of course, it wasn’t all just talk – participants got to know the speakers and each other better over the wine tastings and local artisan food stops. It could be easy to get used to this sort of life!

VIC Junior doctors and students flocked in droves to the annual Geelong dinner held at Le Parisien. Three inspiring and informative speakers, Dr Marlene Pearce, Dr Tim Denton and Dr Tanya Scott touched on the variety a career in general practice can offer and spent the night networking with attendees. Pauline Ingham from VicNet headed a Q&A session on the GP training program while Trish Johnston from ACRRM answered questions on the ACCRM training pathway. The night concluded with the lucky door prize, kindly donated by VicNet. Deakin university student, Amelia Nurse was thrilled to win the copy of Murtagh’s General Practice.

SA The 2013 Prevocational Forum was held in Adelaide and offered delegates a wonderful opportunity to be a part of the ideas and changes we both want and need in medical

education. There were many inspiring speakers including Dr Ian Curran (Clinical Advisor at the NHS, England), Dr Maura Kenny (psychiatrist and coordinator of mindfulness-based cognitive therapy programs), Dame Lesley Southgate (Professor of Medical Education at St George’s Hospital, London) and Dr Robin Youngson (anaesthetist and founder, ‘Hearts In Healthcare’). A recurring theme of the forum was compassion and self-care in medicine, which was highlighted by Robin Youngson’s talk on the difference compassion to ourselves and compassion to others makes. His talk left delegates deeply moved and clamouring to get a copy of his book, Time to Care. Adding to the weight of his argument was Maura Kenny’s talk on mindfulness – leading many to conclude that perhaps this has become the missing link between a ‘just’ functional healthcare system and a healthcare system that excels in outcomes and quality of life for both patients and healthcare workers. See page 26 for more about Dr Youngson’s foundation and to see how you can win a copy of his book.

WA WA network members praised the quality of teaching provided by WAGPET registrars at their clinical skills workshop held in October. The workshop provided the perfect opportunity to refresh clinical skills across a range of general practice topics. Divided into small groups, members rotated through six 30-minute stations that covered antenatal care, diabetes, paediatrics, Pap smears, respiratory (spirometry and spacers) and ear, nose and throat. It was a fabulous afternoon and everyone valued the opportunity to interact and brush up on some of the practical skills needed for general practice. The WA GP ambassadors extend their appreciation to the GP registrars who gave up their Saturday to provide the skills stations, their eagerness for teaching and knowledge of common clinical cases was appreciated by all.

With you on your journey

25


5Dr Felicia minutes with ... Koh – GP ambassador, Monash Health,Victoria What are you looking forward to most as a GP? Being in the forefront of health and wellbeing and being ‘hands on’ in the community. Why did you choose general practice? It was the opportunity to sub-specialise, the flexibility and the ability to get involved in other areas and medical and extracurricular activities. Who or what inspires you? People who live out their call in life and bless others by doing so. Which three words best describe you? Social media, travel, opportunist. What three things would you take to a deserted island? My bed, my mobile phone and a change of clothes.

Write and win “If you only read one book about healthcare in your lifetime, whether you are a patient or a professional, let this be the book.” Michael Brophy, Irish Society for Quality & Safety in Healthcare Time to Care: How to Love Your Patients and Your Job was written by Dr Robin Youngson, a practising anaesthesiologist and founder of Hearts In Healthcare, an international movement dedicated to re-humanising healthcare for both patients and practitioners by restoring compassion as the centre of patient care.

“For our patients, illness and injury often hit like a landslide. Our caring touch might be the only thing that gives hope and comfort.” Dr Robin Youngson, founder, Hearts In Healthcare To win a copy of Time to Care: How to Love Your Patients and Your Job, simply email goingplaces@gpra.org.au with a brief example of compassion you experienced or observed in a medical setting, and how this made you feel. Entries close 1 March 2014. The winner’s response will be published in the next issue of GP Journey. To learn more about Hearts In Healthcare, visit heartsinhealthcare.com

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Going Places Network

GP AMBASSADORS

NSW John Hunter Hospital Gosford Hospital Bankstown Hospital Royal North Shore Hospital Westmead Hospital Royal Prince Alfred Hospital St George Hospital The Canberra Hospital Hornsby Hospital Network Tamworth Hospital Wollongong Hospital

Contact johnhuntergp@gpra.org.au gosfordgp@gpra.org.au bankstowngp@gpra.org.au royalnorthshoregp@gpra.org.au westmeadgp@gpra.org.au royalprincealfredgp@gpra.org.au stgeorgegp@gpra.org.au canberragp@gpra.org.au hornsbygp@gpra.org.au tamworthgp@gpra.org.au wollongonggp@gpra.org.au

QLD Cairns Base Hospital Gold Coast Hospital Logan Hospital Mackay Base Hospital Nambour Hospital Princess Alexandra Hospital Redcliffe Hospital Rockhampton Hospital Toowoomba Hospital Townsville Hospital

cairnsgp@gpra.org.au goldcoastgp@gpra.org.au logangp@gpra.org.au mackaygp@gpra.org.au nambourgp@gpra.org.au princessalexandragp@gpra.org.au redcliffegp@gpra.org.au rockhamptongp@gpra.org.au toowoombagp@gpra.org.au townsvillegp@gpra.org.au

SA and NT Flinders Medical Centre Lyell McEwin Hospital Modbury Hospital Royal Adelaide Hospital The Queen Elizabeth Hospital Royal Darwin Hospital

flindersgp@gpra.org.au lyellmcewingp@gpra.org.au modburygp@gpra.org.au royaladelaidegp@gpra.org.au queenelizabethgp@gpra.org.au darwingp@gpra.org.au

VIC Eastern Health Shepparton Hospital St Vincent’s Hospital Austin Hospital Ballarat Hospital Geelong Hospital Northern Health Southern Health Western Health

boxhillgp@gpra.org.au sheppartongp@gpra.org.au stvincentsgp@gpra.org.au austingp@gpra.org.au ballaratgp@gpra.org.au geelonggp@gpra.org.au northernhealth@gpra.org.au southernhealthgp@gpra.org.au westerngp@gpra.org.au

Want to get involved? Going Places Network GP Ambassadors are junior doctors who have a real passion for general practice. To find out more about becoming a GP ambassador, email goingplaces@gpra.org.au

TAS Royal Hobart Hospital Launceston Hospital

royalhobartgp@gpra.org.au launcestongp@gpra.org.au

WA Royal Perth Hospital Sir Charles Gairdner Hospital Fremantle Hospital Joondalup Health Campus

royalperthgp@gpra.org.au charlesgairdnerGP@gpra.org.au fremantlegp@gpra.org.au joondalupgp@gpra.org.au

With you on your journey 27


What you can earn

The earning power of GP registrars and GPs is excellent when you consider the flexibility and work-life balance of the profession. GP registrar salaries Full-time GP registrars work a minimum of 38 hours a week. This includes education time and administration time. The actual hours of consulting (seeing patients) are usually between 27 and 33 hours per week. This can vary, especially in rural areas. Registrars can choose a set salary model or negotiate a percentage of income generated by the patients they see in the practice. In this case, remuneration is determined by how many patients are seen and whether there is bulk-billing or private billing. Minimum terms and conditions During the first two GP terms (or ACRRM equivalent), GP registrars are guaranteed minimum terms and conditions of employment according to the National Minimum Terms and Conditions (NMTC) document agreed by GPRA and the National General Practice Supervisors’ Association. Minimum salary rates are set out in the table below, or alternatively the registrar is paid a minimum of 45 percent of gross billings, whichever is greater. 2013 training year minimum salaries, plus 9.25% superannuation Annual salary

Weekly

GP term 1 registrar

$72,760

$1,399

GP term 2 registrar

$87,476

$1,682

Different remuneration systems On-call and hospital VMO work earn GP registrars a minimum of 55 percent of the hospital billings. In certain settings, registrars may work in salaried practice, especially ADF registrars, those in Aboriginal Medical Services and some rural and remote hospitals that also provide GP services to the community. It is important to note that working in rural areas, doing procedural work and working as a hospital VMO tend to attract significantly higher incomes. However, even in urban areas GP registrars often earn more than what is stipulated in the NMTC document. For GP registrars and GPs practising in rural areas and identified areas of need, incentive payments are available on top of a regular salary. What established GPs earn Established GPs can earn good money, with the actual amount dependent on the nature of the practice and hours worked. In addition, there is the opportunity to run your own medical practice if you choose – all this with flexible hours and choice of practice style!

Training stage Location

Practice style On-call % of billings paid

Average patient consultations (hours/week)

Weekly*($)

Annual*($)

GP term 1

44.9%

4 patients per hour –

$2,307

$120,000

Any

N/A

(or equivalent)

28 hours per week

GP term 2 Remote (or equivalent)

Salaried hospital-based medical officer procedural work (anaesthetics)

1 in 60 hours 2–3 days

$3,007

$160,000

GP term 3 Rural (or equivalent)

50% mix billing, hospital admitting rights, procedural work (anaesthetics)

1 in 6 days

28–30 hours

$2,788

$145,000

Locum (newly Rural fellowed GP)

60% mix billing, hospital N/A 38–40 hours admitting rights

$3,600

$187,200

Established Urban (busy practice)

65% private billing, hospital admitting rights

$5,175

$269,100

N/A

45 hours

* Salary includes billings paid and has been calculated using the earnings calculator. It is intended as an estimate only and based on 2013 figures. Visit gpaustralia.org.au/earnings-calculator. Refer to the NMTC at gpra.org.au/national-minmum-terms-conditions

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If you are interested in general practice, or just considering your options, GPSN is a great way to kick start your career.

Free networking events — meet others who share an interest in general practice.

• • •

Free professional development events – attend student-focused general practice seminars, workshops and skills sessions

Opportunity to apply for a GPSN First Wave Scholarship and a chance to win some great prizes and places at conferences

Regular e-news and other resources providing all the latest on all things GP Free publications – GP First guide to general practice, GP Journey magazine and GP Companion – a handy pocket reference for GP rotations

Join online today – it’s free Contact your university GPSN chair (see page 132)

gpsn.org.au Online support for medical students interested in general practice


5 minutes with ...

Alexandra Drucker – GPSN university club chair, Deakin University,Victoria What year are you in? Year 1, Bachelor of Medicine/Surgery. What are some of your plans as a new GPSN club chair? To engage old and new students by raising awareness of the benefits of general practice through fun and informative events. What made you interested in general practice? Being a GP, you get to initiate a very important relationship with patients, one that may be maintained throughout their life, and in doing so, you play a vital role in promoting their health and wellbeing. Who or what inspires you? Every med student who has survived the hectic and stressful – but consistently rewarding – experience of studying medicine. Which three words best describe you? Outgoing, passionate, kind.

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General Practice Students Network NATIONAL COMMITTEE University University of Melbourne Griffith University University of Melbourne Notre Dame Fremantle Monash University University of Notre Dame Sydney Notre Dame Fremantle University of Western Sydney University of Western Sydney Monash University

Position National Chair National Vice Chair National Secretary Working Group Officer National Events Officer Internal Communications Officer Sponsorship Officer Local Events Officer Promotions and Publications Officer Online Officer

Name Joesph Monteith Nicola Campbell Danielle Todd Amer Mitchelle Jessica Deitch Emma Thompson Anmol Khanna Likhitha Sudini Rajdeep Ubeja Emily Jenkins

UNIVERSITY CLUB CHAIRS NSW and ACT University of Sydney University of Western Sydney University of New England University of New South Wales University of Wollongong University of Newcastle University of Notre Dame Sydney Australian National University

Name Yvonne Nguyen Jarrod Bradley Emma Gordon Aaron Chu Natalie Campbell Hayley Morgan Sofia Dominguez Jenny Chen

Contact undsyd@student.gpra.org.au westsyd@student.gpra.org.au newengland@student.gpra.org.au unsw@student.gpra.org.au wollongong@student.gpra.org.au newcastle@student.gpra.org.au undsyd@student.gpra.org,au anu@student.gpra.org.au

Contact chair@gpsn.org.au vc@gpsn.org.au ns@gpsn.org.au wgo@gpsn.org.au neo@gpsn.org.au ico@gpsn.org.au sponsorship@gpsn.org.au leo@gpsn.org.au publications@gpsn.org.au media@gpsn.org.au

SA and NT Flinders University Shauna Madigan flinders@student.gpra.org.au University of Adelaide Christopher Le adelaide@student.gpra.org.au Jennifer Dang adelaide@student.gpra.org.au Northern Territory Medical Program Vacant ntmp@student.gpra.org.au (Flinders University) VIC Deakin University Alex Drucker deakin@student.gpra.org.au Monash University Amanda Tan monash@student.gpra.org.au University of Melbourne Sophie Dunn umelb@student.gpra.org.au TAS University of Tasmania

Saranga Jinadasa Caitlin Cannan

utas@student.gpra.org.au utas@student.gpra.org.au

WA University of Western Australia Vacant uwa@student.gpra.org.au University of Notre Dame Fremantle Emma Price notredame@student.gpra.org.au QLD Bond University Frank Dorrian bond@student.gpra.org.au Chloe Tyson bond@student.gpra.org.au James Cook University Lawrence Ling jcu@student.gpra.org.au University of Queensland Johnson Huang uq@student.gpra.org.au Griffith University Jenna Weetman griffith@student.gpra.org.au

With you on your journey 31


G P pr o file

Primary interests Dr Tim Denton is a champion of the multidisciplinary primary healthcare model. His current directorships and strategic planning roles round out a career that has spanned interests in Aboriginal health, youth mental health and the elderly.

“I have a passion for multidisciplinary primary healthcare. That’s really my driving force.” 26 28 32


From left Tim with the former prime minister Julia Gillard at the opening of the Kardinia Health GP Super Clinic in Geelong At an Aboriginal Community at Maningrida, Arnhem Land, 1998 Opposite page: Tim taking some time out kayaking On the face of it, Geelong’s Surf Coast is a laid-back haven for surfies and seachangers. In fact, the SeaChange TV series was shot in the area. But beneath the tranquility, a quiet revolution in Australia’s healthcare system is taking place. It’s about the way our primary healthcare is delivered, and local GP Dr Tim Denton is leading the charge. “I have a passion for multidisciplinary primary healthcare. That’s really my driving force,” he says. “I spend half my time working as a GP. Then I spend half my time chairing Kardinia Health, which is responsible for the Kardinia Health GP Super Clinic in Geelong, and I also chair the Geelong Medicare Local.” This big-picture, strategic planning role focuses on ways to meet the healthcare needs of the local community. So what exactly is multidisciplinary primary heathcare, and how is it different from the traditional GP clinic, GP Journey wanted to know. “With the 1970s model of a general practice, you had three or four or five GPs working full-time, you had a receptionist, and if you were lucky you had a nurse who did the injections and took blood,” Tim says. “We now have a team of nurses who run our chronic disease management, using cdmNet, which is an internet-based chronic disease management tool. Everyone who’s in the team, wherever they are, can plug into this,” he explains. The multidisciplinary team may also include physiotherapists, exercise physiologists, dieticians, podiatrists, psychologists, even rheumatologists, and many of these practitioners may be housed under one roof in the clinic. Team members collaborate on each patient’s case.

“He was a Jack Thompson-type character – just delightful. He was one of a number of people who stood out, people who wouldn’t take no for an answer. That’s why I guess I was always attracted to things like lndigenous health.” A trip to India as a young man was a further catalyst. It exposed Tim to the poverty and disadvantage of the third world, and when he came back to Australia he resolved to do something for the poorest and most disadvantaged people in his own country. In 1982 he found himself working in shockingly primitive conditions with the Pitjantjatjarra and Ngatatjarra people on the South Australian, Western Australian and Northern Territory tri-border. He spent a year as the only doctor on the ground between Kalgoorlie and Alice Springs. Feeling burnt out, he returned to Geelong to establish a GP practice. It was the place he had called home since completing his medical degree at Melbourne University and moving there to do his residency at Geelong Hospital. Fast forward to 1998, now with his wife Renee, also a GP, and their three young children in tow, he again felt the urge to go bush and work in Indigenous health. The job was located in Maningrida, a community of 2000 Aboriginal people in Arnhem Land in the Northern Territory. Tim and Renee shared one full-time job so they could also share childcare duties.

It can result in better outcomes for patients while saving the government money, Tim says.

Tim learnt to do chest X-rays and worked in conjunction with the NT TB clinic. The high level of cardiovascular disease was also addressed. And he was pleased to see that resources were vastly superior to his first experience in remote Aboriginal health years before. “The health crisis pretty much stopped after we got up there. When you use standard treatments, they work,” Tim says.

The Surfcoast Medical Centre in Anglesea where Tim practises as a GP, and the Kardinia Health GP Super Clinic in Geelong of which he is chair, are both recognised as successful multidisciplinary primary heathcare practices.

He describes his family’s time in Arnhem Land as brilliant. “It’s stunning country and a perfect place for our children to grow up. It was very ‘Huckleberry Finnish’. I love Aboriginal people and Aboriginal culture, so it was very satisfying.”

Tim explains that Australia is learning this model from the United Kingdom, New Zealand, Holland and Scandinavia. He recently attended a conference in Scandinavia on the subject. “Certainly, the Swedes do it beautifully,” he says.

The couple eventually returned to Geelong for the children’s secondary education. Tim resumed his work as a GP while developing his interests in strategic planning, corporate governance and management.

To gain the skills for his board-level work, Tim did a course in corporate governance in 2012 and is a graduate of the Australian Institute of Company Directors. The organisations he chairs collaborate with a number of key players in healthcare, including Barwon Health, which is the local health network, and Deakin University. One thing that currently excites Tim is the prospect of setting up a primary health research program with the university. “The collective action concept works,” he says. “If you collect the right people around you, all of a sudden ideas bounce, the think tanks take off, and the next thing you know you’re actually writing a paper.” Indigenous health has been another of Tim’s enthusiasms during his long career. His interest was sparked in part by an elective he did in 1977 as a medical student on Thursday Island where he met Fred Hollows.

He also spent time working with young people in the headspace program, with elderly people in aged care and he participated in a short working visit to Timor-Leste in 2006. Outside medicine, Tim’s interests are just as wide-ranging. He keeps fit by kayaking and running with his dogs, he regularly travels overseas and he reads voraciously. When GP Journey rang he was making his own prosciutto! Perhaps more surprisingly, he recently spent four years building a stone house on a bush block. One stone at a time. A bit like building a new model of multidisciplinary primary healthcare for Australia. Written by Jan Walker

Taking a fresh look general practice 29 With youaton your journey 33


G P pr o file

A higher plane Irish-born GP and part-time soprano Dr Christine Boyce sings the praises of a career in general practice with a special interest in refugee health. Refugee health defies any neatly drawn borders of medicine. And that’s exactly why Hobart GP Dr Christine Boyce loves it. It’s also about the cultural, economic and social issues that intersect with medicine. In fact, many refugees view their GP as a first stop for multiple resettlement woes. Problems with Centrelink benefits? Housing? Language? The doctor is in. Every Friday Christine holds a refugee health clinic at the Augusta Road Medical Centre in Lenah Valley. The patients come from a United Nations of cultural backgrounds – Africa, Myanmar, Afghanistan, Bhutan – and some carry the baggage of torture and trauma. So how did Christine become involved in refugee health? “Look, I get bored really easily and I continually have to be doing something a bit different,” she muses in a warm Irish lilt. “When refugees popped up in Hobart in 1999 I suddenly realised I was able to work with an interpreter. I was able to work with other professionals like psychologists and social workers. And I was able to see different kinds of problems. I just really liked the work.” One thing Christine especially enjoys is being part of a multidisciplinary team. “There’s a lot of inter-agency work,” she says. “I enjoy that

“In refugee health you have to be capable of going with the flow and being a really good team player. It’s not for lone rangers.” 34


because you’re working with teachers of the Adult Migrant English Program, settlement workers at the settlement service, torture and trauma counsellors, and it goes on and on.”

two children while Christine completed her hospital training and GP fellowship, and she has worked as a GP ever since. In 2009 she was named the RACGP General Practitioner of the Year.

Then there are the medical cases rarely seen in the general Australian population, like tropical diseases and rickets.

To keep the boredom factor at bay, Christine complements her refugee work with a medley of other medical interests. When GP Journey spoke to her she was about to give a sex education talk to a group of local schoolgirls. She gets a buzz out of working with young people and says she is “desperate to get back to adolescent health before the adolescents think I’m too old to bother with”.

It also helps to be able to cope with chaos. “It’s chaotic because of the nature of the clients,” Christine explains. “You can’t depend on them to even come to an appointment when they’re supposed to come. If they do come, they may bring three other family members. And it’s not okay to say I’m sorry they’re not booked in today. Culturally, that’s completely inappropriate. In refugee health you have to be capable of going with the flow and being a really good team player. It’s not for lone rangers.” A recent project she is very proud of is leading a team to set up a new clinic in Hobart for refugees who have just arrived, supported by Tasmania Medicare Local. It’s an idea she has long championed so to see it come finally come to fruition after countless 7 am to midnight days is very gratifying, she says. Christine’s life is worlds away from the lives of her refugee clients, but one thing they have in common is growing up outside Australia. “I grew up in a tiny rural village on the northwest coast of Ireland called Carrigart in County Donegal. My role models there were probably my parents and grandparents who were all massively keen on education, which was unusual in a small Irish village in the 1970s,” she recalls.

Then there’s her mainstream general practice work as well as supervising GP registrars and teaching medical students at the University of Tasmania. She’s a popular presenter at conferences around Australia for medical students and trainee doctors who appreciate her plain-talking style. Her shiniest nugget of advice for GPs in the making? Get yourself some great role models, inside and outside medicine, then channel them. “My role models include a friend who’s a psychologist and another who works in industry doing leadership training. If I’m in a difficult situation, I ask myself what would they do, then I do it,” she says. Christine goes on to explain that while you may feel uncomfortable taking a tough stance on something or doing something you normally wouldn’t do, you may find it easier if you’re in character as your role model. “Having good role models has sustained me over the years,” she adds. In her leisure time, Christine describes music as her favourite balm. “If I need to ascend to some sort of higher plane I will always be doing that through listening to music,” she says.

“My mother was the pharmacist, and we lived in a little medical enclave where you had the doctor’s house, the nurse’s house and the pharmacist’s house all in a row. The local family doctor got me interested in what he did from a pretty early age.”

Not just listening, either. She sings soprano in the Tasmanian Symphony Orchestra Chorus, plays piano and performs chamber music.

Christine completed her medical degree at Dublin’s Trinity College in 1987. Early in her hospital training she met “an Australian who was training in geriatric medicine and he lured me to Australia”. Christine and her husband Frank settled first in Perth, then in Hobart. They had

“The human voice is an endless source of wonder to me,” Christine says. Her career in general practice remains a similar source of wonder. “I’ve been doing general practice for 20 years and I just like it more and more,” she concludes. Written by Jan Walker Christine with the Tasmanian Symphony Orchestra Chorus (seventh from left, third row from bottom)

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A woman with a cough n to routine antibiotics What diagnoses should be considered in this patient, whose respiratory symptoms have failed to respond to routine antibiotic therapy? How should she now be investigated and managed? CASE SCENARIO Jiesi, a 27-year-old woman from China, presented with a cough that had been troubling her for the past fortnight. She is studying accountancy at a private college in the centre of Sydney and she lives with her husband and 18-month-old daughter. One week before presenting, she noticed shortness of breath and then developed right-sided chest pain. She was taking no regular medications and she is a non-smoker. The patient’s temperature was 38.6oC, so she was prescribed antibiotics (amoxycillin and roxithromycin) for suspected communityacquired pneumonia (CAP). After a week of treatment there was no change in her condition so a chest X-ray was performed (see Figure). Why has Jiesi not improved on the prescribed antibiotics? COMMENTARY The antibiotic combination of a ß-lactam (amoxycillin) and a macrolide (roxithromycin or clarithromycin) is recommended treatment for CAP. 1 The fact that this patient has not responded to this treatment suggests that she does not have CAP. The chest X-ray reveals a right-sided pleural effusion, which explains her chest pain. DIFFERENTIAL DIAGNOSIS The following diagnoses should be considered in this case:

Para-pneumonic effusion. Patients with CAP may have an effusion that develops in the pleural cavity adjacent to the area of pneumonic consolidation. However, the fact that Jiesi has not responded to the antibiotics makes this diagnosis less likely.

Malignant effusion. This can occur as a secondary manifestation of a primary cancer in the lung or elsewhere, such as the breast.

A malignant pleural effusion can also be due to mesothelioma, which is a primary malignancy of the pleura. Mesothelioma is particularly related to previous asbestos exposure. Jiesi had no history of asbestos exposure, so this diagnosis is unlikely. Malignant pleural effusions are more likely in older patients.

pleural effusion. This patient has come from a country • Tuberculous that has a high prevalence of tuberculosis (TB), so this diagnosis

should be investigated further. There are numerous clinical presentations of TB, including lymph node enlargement, respiratory symptoms with radiological pulmonary infiltrates or nodules, pleural effusions or asymptomatic radiological pulmonary lesions. Non-pulmonary presentations can occur and are considerably less common – these include renal disease, bone involvement and meningitis in children and in adults who are immunocompromised.

This article originally appeared in Medicine Today 2013;14(6):68–69 and is reprinted here with permission.

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ot responding APPROPRIATE INVESTIGATIONS

Summary

For a patient with suspected TB, sputum culture for Mycobacterium tuberculosis may establish the diagnosis. The diagnostic yield may not be high so other investigations will probably be required. Blood tests to check total white cell counts, which are raised in infection, and general markers of inflammation, such as C-reactive protein, may be helpful.

The possibility of TB should be considered in patients from countries that have a high prevalence of the disease, especially in those who present with respiratory symptoms. Appropriate investigations should be arranged. The sooner a diagnosis is made the better, because appropriate treatment can be initiated earlier and contact tracing can be undertaken promptly. Delayed diagnosis means a greater risk of contacts of the patient being infected.

Pleural fluid analysis is an appropriate investigation. The patient will require referral to a hospital or to an imaging centre so that a sample of pleural fluid can be obtained under ultrasound control. The fluid should be analysed for pathogenic organisms, malignant cells and biochemical indices to determine whether it is an inflammatory exudate or a transudate. For some patients with pleural TB, pleural fluid analysis may be negative and so pleural biopsies may be required to make the diagnosis. CLINICAL COURSE Culture of Jiesi’s sputum specimens did not yield any pathogens. The pleural fluid was initially tested with polymerase chain reaction (PCR) for TB, which gave a positive result. Microscopy of the pleural fluid did not reveal any acid-fast bacilli but cultures grew M. tuberculosis after two weeks. The patient commenced standard treatment for M. tuberculosis infection, which consists of four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) for two months. TB can be a presenting manifestation of HIV infection, so a blood test for HIV was performed (negative result). Once the sensitivity of the infecting organism was established from the laboratory assays, the patient continued treatment on two drugs (isoniazid and rifampicin) because the M. tuberculosis isolate was fully sensitive. She requires treatment for a minimum of six months and will need monitoring for possible adverse effects of the medications.

Author J. Paul Seale MBBS, PhD, FRACP, is Professor of Clinical Pharmacology, University of Sydney and Honorary Visiting Physician, Royal Prince Alfred Hospital, Sydney, New South Wales. Competing interests: None. References 1. Lim WS, Baudouin SV, George RC, et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64 (Suppl 3):iii1–55. 2. Mandalakas AM, Hesseling AC, Gie RP, Schaaf HS, Marais BJ, Sinanovic E. Modelling the cost-effectiveness of strategies to prevent tuberculosis in child contacts in a high-burden setting. Thorax 2013;68:247–255.

Medicine Today provides GP Journey with selected articles from its archive of peer reviewed clinical content. To view the full archive, visit Medicine Today’s website at www.medicinetoday.com.au or download the new Medicine Today for iPad, available from the App Store at https://itunes.apple.com/app/id666623264 Registration is free to all members of GPRA, GPSN and GPN.

It will also be necessary to screen her close contacts – this includes her young daughter, who may require isoniazid preventive therapy.2 This contact tracing will be undertaken by the designated staff under the auspices of the state health department.

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Clinical

CORNER

Clinical Corner case studies and tips for treating patients are provided courtesy of Medical Observer. The following case studies are by Dr Ian McColl.

A mossy leg gathers fluid

Chronic venous insufficiency causes microlymphatic damage, which then leads to chronic lymphoedema. This gives rise to lipodermatosclerosis, a disorder that causes collagen and scar tissue to be formed in the underlying fat at the ankle, which in turn worsens the lymphoedema. The skin then starts to form scaly crusts, which can ooze and build up over time to form the so-called ‘mossy leg’.

fingers, which remain unaffected. The common contact allergens in this area are preservatives or perfumes in creams, nail polish and nickel from handling coins. However, unilateral eyelid dermatitis on the person’s hand dominant side can be due to transferring unusual allergens such as plants and glues. Bilateral eyelid dermatitis can be a manifestation of both atopic and seborrhoeic dermatitis where rubbing causes most of the dermatitis picture. Most patients will need patch testing. Use 1% hydrocortisone ointment to minimise the risk of glaucoma. For more images, see medicalobserver.com.au/clinicalreview/dermatology

Nail matrix dystrophy

This patient’s nail dystrophy would appear to be due To reverse this process, compression and a strong to some infective process destroying the nail matrix. steroid cream is required, plus 5% salicylic acid in sorbolene cream to remove the scale. For more images, see medicalobserver.com.au clinical-review/ dermatology

An irritation on the eyelid

Eyelid dermatitis can be a diagnostic dilemma. Eyelid skin is very thin, it can be easily irritated and contact allergens can penetrate more easily than in other parts of the body. Often allergens are transferred from the

However, these are two basal cell skin cancers that have been neglected and are destroying the nail apparatus. These tumours will have to be excised down to bone with consequent loss of the nail. Squamous cell carcinoma is more common than basal cell carcinoma in this area, but biopsies have confirmed the diagnosis in this case. BCCs will generally not involve the underlying bone but the same cannot be said for SCCs. If they had been diagnosed in this area, then X-rays of the underlying bone would have been required. Most SCCs involve the nail bed and will lead to elevation of the nail with a protruding mass underneath it. This is usually misdiagnosed as a subungual wart. Some cases of SCC in this area may actually be papilloma virus related. For more images, see medicalobserver.com.au/clinicalreview/dermatology

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Murtagh’s tales Drawn from over 30 years experience as a GP, Professor John Murtagh’s clinical cases provide valuable insight to the problems that GPs can encounter. Bizarre behaviour in a 35-year-old woman A 35-year-old woman presented with her husband for a consultation. He described some unusual episodes of abnormal behaviour in his wife over the previous 3 weeks. These episodes began with an unfocused stare and, at that time of the episode, his wife did not respond to anything said to her, and she licked or smacked her lips and her mumblings could not be comprehended. She appeared to make the same noise on each occasion of the episode. The patient continued with activities that she had been doing at the time of the episodes, but in a poorly directed manner. On other occasions, she would tug or pluck at her clothes. Sometimes she would pace around the room. Each episode lasted about two minutes and ended with the woman looking bewildered and uncertain about what had taken place. The episodes had also been occurring at work for about 4 weeks.

Charlie’s mother states that there is no history of an injury, although he has been playing football recently. About two weeks ago he had a mild upper respiratory infection. On examination the child looked well, 50th percentile for height and weight with normal vital signs including his temperature. Examination of the knee was normal with no localised tenderness and a normal range of active and passive movements. However, examination of his right hip revealed limitation of internal rotation, abduction and extension. Charlie complained of knee pain during these movements, especially passive movements. Diagnosis Irritable hip due to transient synovitis related to a preceding viral infection. Plain X-ray was normal but ultrasound showed fluid in the hip joint. Charlie was treated with bed rest and ibuprofen and settled to normality in 7 days. A follow up X-ray was arranged in 6 months to exclude Perthes disease. Practice point Remember that pathology in the hip can present with ipsilateral knee pain.

Diagnosis and discussion This patient has complex partial seizures (temporal lobe epilepsy is a common subset). The major issue in making the correct diagnosis is that complex partial seizures always indicate a pathological process within the cortex (albeit frequently temporal cortex). This epilepsy may be the first symptom of an underlying progressive disorder such as a cerebral tumour. Correct diagnosis is important for recognising serious underlying pathology and for correct treatment. Complex seizures may progress to generalised seizures. A routine electroencephalogram (EEG) may provide evidence of a focus. A computed tomography (CT) scan or magnetic resonance image (MRI) is mandatory if the EEG suggests focal epilepsy. Focal epilepsy is notorious for being difficult to control. Carbamazepine is usually the agent of first choice and or sodium valproate.

A 6-year-old boy with knee pain and a limp

Charlie is a healthy and active six-year-old boy. His mother brings him to the surgery because she is concerned and puzzled by his complaint of right knee pain. Charlie says that he has had a sore knee on and off for 2–3 days. He has developed a noticeable limp. His mother could not find any soreness or other signs on the knee.

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Reviews Oxford handbook of clinical medicine, 8th edition

Oxford handbook of general practice, 3rd edition

The Oxford Handbook of Clinical Medicine is one of the most noticeable medical necessities of the modern day medical student and junior doctor. This amazing yellow, red and green book can be found in the hands of students during lectures, PBL sessions and ward-rounds as we desperately try to seek out the correct answers – and most times the book delivers.

When I was asked to do an app review for GP Journey, my aim was to review at an app that was at the core of general practice. A search of the iTunes Store revealed the third edition of the Oxford Handbook of General Practice by Simon, Everitt and van Dorp. Basically this is the original textbook converted to an app or AppBook.

As soon as I found the Oxford handbook had been turned into an app I had to get it. The price starts at $59.99, which I thought was rather expensive for a medical app. Nonetheless, after a couple of days we became almost inseparable! All the contents from the book are integrated into the app with a user-friendly interface. The search function is well designed, giving users the option to find titles, key words and images. The app also incorporates a medical calculator that allows users to convert units, calculate patients’ BMI and perform metabolic and respiratory calculations (eg. the alveolar-arterial oxygen gradient). In terms of the actual content, the medical disciplines, such as cardiovascular, haematology and surgery chapters, are well organised with high resolution images that can be zoomed in and out. The app separates important areas such as emergency and reference intervals for easy reference, and navigating through different topics was a breeze. I found it very handy to use while studying, and even while waiting for friends or while on long flights. Pros: User friendly interface, high resolution images, medical calculator, ability to makes notes, free updates after you purchase, handy and reliable medical information. Cons: The price! Price: $59.99, available through the iTunes Store Compatibility: Available for both Android and Apple Rating: ★★★★ out of 5 Review by Joon Sung Medical student, Bond University, Qld

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The price is fairly high, given that the hardcopy version costs around $65.00. Australian users should be aware that the Oxford handbook is UK based and a few of their practical tips either only partially or don’t apply to Australian users. There are a few handy functions for an app-based textbook, such as the bookmarking function, which allows you to review the history of the pages you’ve gone through, and a text search function. I was hoping that being an app-based textbook, the conversion to electronic form would take advantage of the new format and add clinical photography, especially in the dermatology section. Sadly, this has not been explored to its full potential and it is mainly a heavily text based AppBook with images few and far between. As an AppBook it stays true to its roots, for better or worse, by mainly being an electronic port of the hard copy version, useful for those who are sick of lugging books around and having a bit of light reading for those relaxing days. Pros: A true reflection of the original text only more portable with extra search functions. Cons: See Pros. Price: $51.99, available through the iTunes Store Compatibility: iOS and Android devices Rating: ★★★ ★ out of 5 Review by Dr Jomini Cheong GP ambassador,Vic


DrugDoses, version 4 I think almost everyone in the medical field who has done a term where you need to make decisions involving paediatrics has heard of Frank Shann and his little ‘Drug Doses’ book, and if you haven’t then you should definitely look in to it! Frank Shann, from the Royal Children’s Hospital in Melbourne, wrote the first edition of Drug Doses in 1983. It was designed to be a quick reference guide for doctors prescribing paediatric (and some adult) drug doses. The book itself is not particularly pretty, but it has been immensely useful over my (still early) medical career and now comes in app form with lots of added goodies (including a multitude of scores and calculators). The DrugDoses app would suit both hospital and GP-based doctors who want quick access to safe prescribing, particularly for children. The DrugDoses app will set you back $15.99 (keeping in mind the hardcover book costs $9.00 excluding postage and handling) giving you a 2-year license to use it. After that you have the option of purchasing a lifetime license for $5.49. I think the convenience of having this reference on your phone rather than carrying around the book itself is invaluable – particularly if you are prone to losing or forgetting things like I am! The little Drug Doses book, and now the iPhone app, have been two of my best medical investments, saving me time and ensuring the safety of my patients. And don’t forget its tax deductible! Pros: Lots of extras such as scores and calculators, convenience, tax deductible. Cons: None! Price: $15.99, available through the iTunes Store Compatibility: Requires iOS 5.1 or later. Compatible with iPhone, iPad and iPod touch Rating: ★★★★ out of 5 Review by Dr Sarah Devereux, GP ambassador, WA

Women’s health in general practice, 2nd edition Danielle Mazza I was first recommended Women’s Health in General Practice last year by a GP registrar when I was completing my PGPPP. She had found it very useful when completing her RANZCOG diploma and throughout her GP training. Last month I attended a weekend lecture by Danielle Mazza on women’s health, at which she passed around this latest edition of her book. The lecture and book were excellent so I jumped at the opportunity to review the book for GP Journey. Women’s Health in General Practice is an excellent resource for junior doctors completing a hospital based women’s block or PGPPP, as well as for GP registrars and GPs. It comprehensively and practically covers women’s health issues across the lifespan, from puberty to post-menopause. Topics include pubertal development and adolescent gynaecological issues, primary amenorrhoea and dysfunctional uterine bleeding. It has specific chapters on menstrual problems, new developments in contraception, management of unplanned pregnancy, infertility and PCOS, initial management of infertility by the GP, and preconception and postnatal care. It provides information on screening programs for women’s health, breast problems, sexual problems, and genital and urinary tract disorders. There is also a chapter on menopause, including information on hormone therapy and osteoporosis. The content of Women’s Health is well formatted into chapters with specific topics and clear subject headings. Information is then presented under clinical questions a GP is likely to ask – a format not liked by all. Many relevant case studies are used throughout. The figures, tables, boxes and key information segments also help present information clearly, making it easy to access. Helpful photos are included, which show the appearance of many cervical and genital tract conditions. This second edition has been fully revised, incorporating a review of the most recent research to provide up-to-date evidence to guide clinicians’ decisions regarding investigation and management of women’s health conditions. As a female GP registrar, I see many women with health issues specific to women. I have found this book a very useful resource to fill my knowledge gaps, accurately answer patients’ questions, and atofresh help look provide effective,practice evidence-41 Taking at general based women’s healthcare. Women’s Health in General Practice, 2nd edition, is published by Elsevier, 2011. RRP $104.95 Review by Dr Liz Bond GP Registrar, Melbourne Vic

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Aqueous humour Inspiring before expiring By Dr Marcus Gunn Surely one of the joys of the GP’s life is to be invited to the local medical school to give a careers talk. I used to get invited to do this a lot as a younger man, rolling up in my ginger suit with a carousel of 35 mm slides under my arm. The students used to thrill to my exciting anecdotes of a career in general practice and I like to think that I encouraged a few to take this path. For reasons that escape me, the invitations dried up at much the same time as my stock of witticisms. I knew my time was up when I delivered my killer closing anecdote to appalled silence, only to realise that in fact I’d opened with the same story half an hour before. At least they’d been paying attention. But it was confronting to come to the understanding that I’d been giving the talk for enough years to have decayed from Inspiring Young Role Model to Boring Old Fart. So it was with a mixture of excitement and apprehension that I received an invitation to go back to the crucible of my medical education and give a talk on general practice to the Final Year students. Clearly someone had just pulled out, because there was a surgeon, a paediatrician and a psychiatrist all there as well and their name tags were printed. Mine was hand written. We sat as a panel at the front of the lecture theatre and the several hundred students settled in their tiered ranks like rowdy pigeons. The lights dimmed as the Medical Students’ Society president introduced us, and a glowing orchard of Apple logos bloomed in the darkness. The students were focused intently on the screens of their portable computers, their faces eerily lit by the unmistakable blue of Facebook. They seemed to pay scant attention to the surgeon, even though he made a lot of chopping motions with his hands and managed to mention his Mercedes. The paediatrician briefly gained their attention when she snapped that if they wanted to do paeds because they loved children, they’d be better off becoming a primary

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teacher. And the psychiatrist hammered home the stereotypes by just standing in front of the group and gesturing expansively for them to speak. It was my turn at last and I figured I’d better diverge from my prepared script. “General practice,” I declared, “is the most boring job in the world. I paused for effect and twinkled in an avuncular fashion at the front row. “Unless, that is, you are interested in people and want to be given the most astonishing access to their lives. Their hopes, their fears, their disappointments and successes. If you want to go to work every day and come home again having been completely fascinated by what you’ve learned, then general practice is the discipline for you. If you want to use every aspect of your clinical skills every day, then be a GP. And if you want to make a long term difference to people’s health, then come and join us.” And so on. There really was no need for hoary old anecdotes or tiresome war stories. The students were genuinely interested in what being a GP entailed, they asked lots of insightful questions and their applause seemed sincere. I floated out to the car park feeling well satisfied and found that I was actually parked next to the surgeon and his much-mentioned Mercedes. “You know,” he said as he blipped the lock, “I heard you give a careers talk here when I was in Final Year. I’ll never forget it.” I murmured something self-deprecating. “Yes,” he said sinking into the fine leather. “You told the same story twice.”


Discover the opportunities within the Prevocational General Practice Placements Program The Prevocational General Practice Placements program (PGPPP) is managed by General Practice Education and Training Limited (GPET) on behalf of the Australian Government. PGPPP is facilitated through regional training providers (RTPs) and delivered by accredited practices and medical services throughout Australia. The aims of the program are to:

Enhance participating doctors’ understanding of general practice and the role GPs play in the delivery of health services at the primary and secondary healthcare levels understanding of the integration between primary and • Increase secondary healthcare by participating doctors. Why do a PGPPP placement? The PGPPP provides junior doctors with unique general practice experiences through:

“There were many rewarding aspects of PGPPP but I think the overall theme was that it challenged me.” Dr Jessica Reagh, PGPPP placement – Groote Eylandt Island, NT

real life experience in general practice over and above that of • Aundergraduate training • Exposure to a variety of health services that may include Aboriginal and Torres Strait Islander health, general practice surgery, migrant health and aged care

and personal mentoring by respected and dedicated • Ongoing GPs in the field patient contact in a range of primary care settings such • Direct as general practice, Aboriginal Medical Services, drug and alcohol services and community-based facilities

• Enhanced understanding of the Australian healthcare system opportunities to network with community-based GPs, • Great other health professionals, and local communities Increased confidence and independence to take into future • training and work environments An opportunity to have some autonomy with support • and supervision.

“Having so much responsibility for patient care was initially daunting but became a major attraction of the PGPPP term as the weeks progressed. Whatever career junior medical officers are interested in pursuing, a PGPPP term is a highly valuable opportunity to develop one’s independence, clinical reasoning and practical skills. I would highly recommend it!” Dr Anna Sambell, PGPPP placement – Central Coast, NSW Want to know more? Talk to the junior doctor manager at your hospital or go to gpet.com.au to contact your local RTP.


With you on your journey students

junior doctors

registrars

General Practice Students Network gpsn.org.au

Going Places Network gpaustralia.org.au

General Practice Registrars Australia gpra.org.au

General Practice Registrars Australia Level 4, 517 Flinders Lane, Melbourne Victoria 3001 P 03 9629 8878 W gpra.org.au

GP Journey Issue 13