RANZCR Trailblazers

Patient-centred Care and the Importance of Continuing Medical Education

More from our RANZCR Trailblazers series with excerpts from the oral history interviews made in 2016 by the then College archivist, Ms Eva Stokes-Blake.

In this edition, read on for insights and recollections from Professor Gillian Duchesne and past president Professor John Earwaker.

In these excerpts we see how both recognised the opportunities to follow their interests and curiosity, demonstrating the importance of taking a decision and sticking with it. We see also their dedication to clinically and educationally advancing the professions and importantly, their dedication to care and to patients.

We thank Eva Stokes-Blake for her invaluable work in amassing oral histories for future generations of radiologists and radiation oncologists. We would also like to invite your expressions of interest to actively participate in clinician-to-clinician interviews of RANZCR Trailblazers (of your nomination), more details are available via editor@ranzcr.edu.au.

Access the full recordings from the two interviewees for much more detailed history of the professions and the College here: www.webcast.ranzcr.com/ Mediasite/Showcase

We hear first from Professor Gillian Duchesne on her dedication to putting patients at the centre of their care. Prof Duchesne’s most fundamental advice is “whatever you’re going to do, you can’t be faulted if you look at it from the point of view of how it’s going to affect your patients.”

Professor Gillian Duchesne

Professor Gillian Duchesne

Career planning

You know it’s funny, I don’t know how many people plan from day one how their careers are going to pan out. You have to be prepared to be flexible, to take the opportunities as they appear. I already mentioned that my mentor in Bristol said, “Did I really what to do academia or did I want to be a jobbing physician?” When I got to the Marsden the academic environment there was just fantastic, so I did three and a half years registrar training and got my fellowship. Then I disappeared off into the labs for two years to do a doctorate in cell biology which …was absolutely fascinating, superb; people said ‘you’ll miss the clinic’, but you actually don’t because you get so much more out of that. Understanding the scientific method then allows you, when you to come back into the clinic, to look at things from a different perspective.

So I did two years of doctorate and then returned to the clinical world as a senior registrar again at the Marsden and I was attached to the academic unit which specialised basically in neurological tumours. I had two years doing that.

I started writing papers myself, which is something you really have to learn to do, someone has to guide you through it to start off with but I was hooked on the academic world then. At the beginning of 1989, I was fortunate to be appointed senior lecture at University College London with a consultant appointment at Middlesex Hospital. I was there for seven years and I don’t think I have ever worked quite so hard in my life. But it was an extraordinarily interesting time, I had a full clinical load but I was very well supported by a good clinical team. I continued to run a small lab program although at that stage it was quite difficult to balance everything out. I set up and ran a master’s course in the science of oncology, so cancer science masters, which was fantastic. In fact, it was one of the things that contributed to us receiving the Queens Award for higher and further education. Which was great. We all tripped off to Buckingham Palace and met Her Majesty and Her Majesty’s husband and got a nice award for that. So that was good.

However in late 1995–96, Prof Lester Peters took over as Director of Radiation Oncology at Peter Mac and he was looking for academic radiation oncologists and I was offered the chance to come out here and have a look at Peter Mac and see whether I wanted to join in. The moment I landed, it sounds trite but it’s not, the moment I landed in Australia, I loved the country and the environment of Peter Mac was just buzzing and thriving, Lester had just come in and was re-vamping things and it was such a superb opportunity. So I made the great decision to jump with both feet first. But you do that if given an opportunity like that. I was then in my early 40s. If I wasn’t going to do it then, I never would and so we came out here in September 1996, so I’ve just done the 20 years here and I have to say, I haven’t looked back.

The opportunities have been superb; clinically, academically but also in terms of developing my leadership profile which was almost serendipitous. Not something I necessarily planned to, I was always interested in finding out a little bit more, getting a new perspective on something, giving something back and I was somebody who just couldn’t say no. The opportunities, as I say, were superb.

Patient-centred care

I think it’s really pertinent to say for the archives, that patients are now part of the partnership and it’s one thing I’ve always wanted to strive for, is to make a patient feel that you are actually working together to get an outcome and get rid of the patriarchal view that we make decisions for you but rather we will discuss it together and sort it out.

We should/ I should mention, give tribute to a wonderful person called Ian Ruth, I don’t know if you have ever come across him, he was an academic at Peter Mac in the labs at one stage and went into education and worked at the University of Melbourne. He got prostate cancer about 15 years ago— aggressive. I was fortunate enough to be his physician and treated him and he became the most wonderful patient advocate for men with prostate cancer but more than that for patients with cancer in general, ensuring good access and so on. He’s done a lot of work, did a lot of work with the College and with both state and federal government to ensure that people had equitable access to radiation therapy and so on. He unfortunately died from his disease about 18 months ago, but he was a model of how the patient as the consumer and the professionals as the care providers can work together to improve how care is delivered. He was an inspiration to a lot of people.

Advice for upcoming radiation oncologists

I think the fundamental bit of advice I’ll give is whatever you’re going to do, you can’t be faulted if you look at it from the point of view of how it’s going to affect your patients. The patients come first—are their outcomes going to be better, how might they be effected by anything I do? If you take that tenet and you work through even if you come away with something that isn’t popular or it’s political—not a happy choice—you can’t be shot down. You are doing it for the patient not yourself and I think that’s an incredibly strong tenet.

Professor John Earwaker

Professor John Earwaker

What first interested you in following a career in radiology?

I graduated in medicine in 1962 in Brisbane. My ambition was to be an orthopaedic surgeon Sadly,18 months later I was diagnosed with ankylosing spondylitis. It was then that I realised that going forward there was the prospect of a physical impediment to any career which involved procedural work.

So after showing some initial interest in radiotherapy, I ultimately opted for a career in diagnostic radiology, which I began in 1965 a as a registrar at the Royal Brisbane.

Do you have any memories on those early days as a radiologist?

I was the registrar at the Royal Brisbane, which was then called the Brisbane General Hospital. The staff consisted of a director, a deputy director, one staff radiologist and three registrars. The total throughput in that department at that time was something like 70,000 examinations a year, so it was grossly understaffed. There was virtually no formal teaching of the trainees. You learnt on the job, and it was vastly different from what it is today. So, in 1967 with the help of John Masel we introduced the first Queensland Branch Registrar lecture series.

You've held a lot of different positions of office at the College, from a committee member; a councillor, a member of the education board and finally holding the position of president. Which position would you find most memorable?

It all depends what you mean by memorable. Looking back at my involvement in the College, I think my involvement in the educational activities of the College was by far and away the most significant and rewarding. I chaired the Continuing Education Committee for 15 years and was responsible for the first realistic College continuing medical education (CME) program to be launched in this country.

The CME activities of the College for years centred around the Annual Scientific Meeting and in fact the Annual Scientific Meeting did really not have much of a continuing medical education element within it. It really consisted of the wisdom of visiting luminaries from overseas, most often from Britain and latterly, from the United States. And there wasn't really much in the way of continuing refresher type courses.

In the late 1980s, the College through the efforts of Professor Geoff Benness established a liaison with the American College of Radiology (ACR). The ACR was in fact the benchmark of continuing medical education in America; in that they provided a lot of postgraduate programs for radiologists. At that time, they had devised a series of programs called Viewbox Seminars. Professor Benness and Peter Duffy and several of the radiologists from Sydney then combined to bring one of those courses to Sydney.

It was an outstanding success, and was soon followed by two more similar courses. At that time, I was the chairman of the College Continuing Education Committee and decided that we had sufficient home-grown talent to mount one of these courses ourselves. We then successfully staged a similar course in Sydney in 1981 and that was followed by a Body CT Seminar in 1983. I think that this was probably the turning point for continuing education within the College.

Subsequently the continuing education segments at the annual meeting became more and more prominent. I was involved at various times in the organisation of five annual meetings of the College, including one in Singapore which I organised in 1986 with Angus Robertson.

The first annual meeting in 1977, I did by myself, with the help of my wife and the state committee. We had no conference organisers. I virtually organised it with my wife from the kitchen table at our house. I guess it was quite a controversial meeting because it was held at the Gold Coast and a College meeting had never been held outside a capital city before that time. The outcome proved to be a great success.

In the 1980s, the ACR introduced a system of credits for CME participation The College was among the first in Australia to follow down this pathway, so that in 1998 when I attended the inaugural meeting of College CME chairs at the RACS in Melbourne, we were well ahead of the field with the CME program that we already had in place.

Do have any memories you'd like to share of advancements in the development of radiology?

At the outset we virtually lived in the dark. We were like mushrooms, and that's the way that radiologists were regarded. Historically hospital X-ray departments were in remote locations.

I have personal experience of one located in the basement in London and another located within the ceiling in Oslo! There was not a lot of interaction between clinicians and radiologists. Radiologists were treated as not much more than technicians. In the teaching hospitals clinicians would come to the department for clinical meetings and that was about it. …

Then we saw, particularly in the United States, the development of radiology departments, which were teaching and academic departments, and they blossomed in the 1960s and 1970s.

At that time in Australia that type of department just did not exist. So Australian radiologists like myself tended to go overseas to gain further experience in that environment.

But gradually it happened here, both with the return of specialty trained radiologists, and the emergence of the new technologies. The dynamics changed with increased consultation with us, by the clinicians. We had subspecialised, so we knew just as much as the urologists or the neurosurgeons. The standing of departments was raised with the influence of respected figures such as Bill Hare, John Hunt, Hal Luke, Peter Breidahl, Colin Alexander and Jim Hood. Not only did the new technologies bring with them exciting imaging vistas, but there were also more informed opinions. Furthermore, the 1990s witnessed the advent of the various subspecialty groups within the College, which have since flourished. For those of us raised in the era of barium and the air encephalogram, we had emerged from the shadows and had finally arrived.