Australian General Practice - A celebration

Historical background | Foundation | Developmental phase | Expansion phase | Consolidation phase | References and resources

Historical background

Medical practice in Australia began with the First Fleet in 1788. The evolution of the practice of medicine in the world had been slow up to this time. The study of medicine had long been an academic subject with universities offering doctorates in this branch of knowledge. From early records, different branches of the profession were not regularly distinguished in England until the sixteenth century. The Royal College of Physicians was founded in 1518 to bring together those who practised medicine. This distinguished its members from other healers and practitioners and bestowed upon them certain exclusivity. The surgeons on the other hand had come from the Company of Barber Surgeons (1540) to establish the Company of Surgeons in 1745. Stimulated by the energy and research of John Hunter – who had been influenced by the work of his older brother William Hunter, a physician and a graduate of Glasgow University – the Company sought academic status and became the Royal College of Surgeons in 1800 soon after John Hunter’s death.

Another group of practitioners, the apothecaries, had ‘after a long struggle moved out from their original place as spicers in the Company of Grocers’¹ formed the Society of Apothecaries in 1617, to regularise their dispensing of physic. This society was recognised by the Apothecaries Act in 1815 to license apothecaries in the field of medicine and were the forerunners of the discipline of general practice.

When the First Fleet arrived in Australia, it brought convicts, sailors and soldiers but also other functionaries to service the fledgling needs of the new colony. These included naval and military surgeons to meet the medical requirements of the settlers. There appeared to be a policy in place in the British Colonial Office that provided for the transportation of convicted professionals such as doctors, architects, engineers and others to meet the growing demands for the development of the colony.

William Redfern, a surgeon, was convicted and transported in 1801. He was immediately sent to work on Norfolk Island. Later he became the first superintendent of the Rum Hospital and personal physician to Governors Bligh and Macquarie. Like others in the colony he practised as a physician and surgeon, an appellation assumed by early GPs. This is reflected in the memorandum of association of our college which refers to the practice of medicine and surgery in general practice. Initially the colony was essentially a garrison situation and in its earliest days ‘local measures were introduced for formal recognition of acceptable status’.¹

With the settlement of other colonies and the discovery of gold, ‘medical registration was not too long delayed, not too lax, to permit reasonable control over the situation, so that with the stimulus of strong competition, satisfactory standards were in the main soon established and maintained’.²

Practices were established far and wide and as they expanded took on ‘assistants with a view’ to learn the art. Medical education received a further stimulus with the establishment of medical schools in Melbourne and Sydney early in the second half of the nineteenth century. These schools taught the basic sciences and the clinical skills of medicine, surgery and the other modalities of medical practice, thus graduating undifferentiated doctors. Nevertheless, registration was not entirely confined to medical graduates until late in the nineteenth century and early twentieth century in some states. Many had received their training and registration through attachment as assistants

General practice became a primary source of teaching and learning. Before 1900, specialists and specialist teaching positions were recruited mainly from overseas – although increasing numbers came from the ranks of general practice where one partner or a number of partners would train and study in a particular specialty. Higher qualifications were obtained with additional training overseas. This situation continued well into the twentieth century.

The Royal Australasian College of Surgeons was formed in 1927 and the Royal Australasian College of Physicians in 1938, and both introduced formal qualifications in their specialities. Some specialists retained a small nucleus of a general practice until after the Second World War. In fact a number of teaching hospitals prior to that war had very competent specialists on the staff who were also in general practice. This of course resulted in a high standard and competency in teaching good general practice. The patient’s recovery depended as much on the interpersonal and clinical skills as well as the care and comfort provided by the doctor as on any medical treatment that was offered. Lodge or panel practices that paid an annual fee for patient care provided the doctor with a security of income. This was the basis of many ethical standards as well as being a form of goodwill.

The caring nature of general practice as well as its clinical acumen has been well illustrated through many anecdotes. It was widespread throughout the length and breadth of Australia. Even in isolated areas, doctors were found practising with a wide range of skills and the assistance of bush nursing and district hospitals. A flying doctor service covered the areas too sparse to support a doctor.

The situation changed with the Second World War. Many GPs as well as specialists joined the armed services. The services set about training many of these GPs into specialists. At the end of the war, general practice was denuded of these veterans’ skills as they entered their chosen specialty. Specialist training became exclusively confined to teaching hospitals. Specialists were no longer mainly recruited from the ranks of general practice. Suddenly GPs were referring patients to specialists who had no experience and little knowledge of general practice. They were also deprived of the previous input from their colleagues in general practice who were training to be specialists. This was nearly akin to what had been happening in Britain for the previous 150 years.³