A champion of rural doctors
A commitment to country general practice and a determination to retain a broad based approach to it has resulted in Peter Graham's involvement in establishing recognition for the skills and training needed by country doctors. By continuing to embrace new skills and techniques he has remained in a medical sense 'a man for all seasons'
Origins
Strong country roots meant that where Peter Graham would eventually practice medicine was never an issue for him.
"I was born in Warragul, Victoria, on 22 July 1927, my mother travelling by car in labour from Neerim South, where my father was the manager of the Commercial Bank of Australia."
Peter then arrived as an undiagnosed twin - early signs perhaps that this man would do things his way!
The social hierarchy in country towns in those days always included the bank managers, the doctors, the lawyers and a selected group of well-to-do farmers.
Peters father's profession led him to being transferred from town to town in country Victoria. He spent six very happy years in Charlton before his father joined the army.
The two Charlton doctors, Dr Robinson and Dr Aubrey Baker, were highly respected and were both competent surgeons. As a 12 year old, Peter was determined to become a country doctor like them and was encouraged in that ambition by his parents.
Becoming a doctor
After his early schooling at Charlton Higher Elementary School, Peter won a Scholarship to Geelong Grammar, which he attended from 1941 to 1945. He then moved on to Melbourne University where he completed his medical degree in 1951, and following that, hospital residency at Bendigo Base Hospital.
"The training I had obtained at Bendigo Base Hospital as a junior RMO, although light on in academic theory, was strong in 'hands on' procedural work. The honorary surgeons were only too happy to let the residents carry on with the emergencies and only be called in when they were out of their depth.
"Eugene Sandner, the senior honorary surgeon, was friendly and approachable, and had excellent clinical judgement and all round technical surgical skills.
"In the 50s, five junior residents ran the busy Bendigo Base Hospital with as many inpatient beds, where now there are 24.
"In the second half of our residency year, one of our number, Allan Lapin, an ex-POW and Major in the Army, became acting Medical Superintendent on the resignation of the incumbent."
Peter's political bent became obvious very early on:
"My career path from Bendigo was a choice between pursuing further hospital training or getting out into the real world of country practice.
"That choice was made easier by the low salaries still paid to hospital residents and my ambition to be a country doctor.
"In my final year at Melbourne University, as a Member of the Committee of the Medical Students Society (with the MSS approval), I had conducted a campaign for a living wage for RMOs. I presented a well researched case to the then Hospitals and Charities Commission against the bitter opposition of the established Boards of Management of the major teaching hospitals, and won a reasonable wage award.
"The plight of the ex-servicemen in our year, many with wives and children, and some even building their own homes, helped win the day. The wage certainly would not have allowed the residents to spend their holidays skiing in Vail but it formed the basis of subsequent awards which did!
"I learned a political lesson from that industrial campaign: that right will win but only if it is pursued to the top."
Move to Cohuna
After residency, Peter did an 18 months stint as assistant to Dr Cyril Checci (who was then in his 60s and has only recently retired from practice!) in Glenthompson. That time taught him self reliance but also the frustrations and difficulties of practising without a hospital in a small town.
He arrived in Cohuna in 1954 having bought the practice from the late Dr Charles Stewart, a self taught surgeon, whose repertoire included thyroidectomies, gastroectomies and major bowel surgery. He was used as a consultant surgeon in a district where the nearest surgical consultant was either in Bendigo, 80 miles away or Mildura, 200 miles away. Dr Stewart had the reputation of being able to handle any surgical emergency -usually in a dramatic way. It was said that Fay Maclure, the famous Alfred Hospital General Surgeon, used to assist him when he holidayed in the district.
Dr Stewart was called "old doctor Stewart". He was only 52 years old when he died. He had very big shoes to fill and the expectations of the local population was that Peter ought to continue the same surgical service that Dr Stewart had established.
"Cohuna, with its well staffed 24-bed hospital provided an environment in which to practise real medicine and to deal with serious illness, not just trivia. The post-war baby boom was in full swing, and I was soon too busy to think of much else than my clinical deficiencies. I was inundated with patients, who, since Dr Stewart's death six weeks previously, were sick of making do with infrequent clinics run by friendly neighbouring practitioners or travelling away for their urgent medical care.
"It was some time before my wife and I had a chance to enjoy the other side of Cohuna: its grass tennis courts and golf course and the vast Gunbower Forest, part of the Murray River flood plain spread between an old anabranch of the Murray, the wide Gunbower Creek, which wound its way alongside the Main Street, and the Murray River 8 km to the North.
"Dr Stewart's faithful surgery nurse Jean Poxon, after looking me over with some reserve agreed to stay on. Her skills and local knowledge were invaluable.
"Dr Stewart had a vast library, mostly surgical text books all well thumbed and annotated. I had plenty of required reading. I welcomed gratefully the help of more senior colleagues in neighbouring towns, for anaesthetics and surgical assistance. Dr Wally Moon of Kerang, Dr Gavan Gibson of Barham and Dr Harold Retallick of Pyramid Hill were prepared 'to drop everything' and help out in emergencies.
"The Pyramid Hill practice was bought by Dr Bill Jackson (who later became President of RACGP), a recent graduate like myself and with a natural surgical talent and judgment. Our friendship continues to this day although he left for Tasmania in 1964.
"Dr Keith Tellesson, a Sydney graduate, joined the practice in 1955, and was a partner for 14 years. He became interested in anaesthetics and introduced relaxant anaesthetics into the district and had skills complementing my surgical interests."
It was during these early days that Peter had an experience which has stayed with him since:
"I have vivid memories early in my career at Cohuna of being called to attend a middle-aged man on an outlying farm who attempted suicide with a shot gun. He aimed for his heart but missed and devastated his humerus and shoulder girdle.
"I was forced to do a forequarter amputation under an open ether anaesthetic after resuscitating him with ultra fresh donor blood."
Family life
"In September 1952 I married Ann Phillips, an Alfred nurse and city girl, who approved and supported my life long ambition to be a country doctor. Throughout my 38 years at Cohuna she has brought up a family of 6 children, often with very little fatherly help, especially during the times I had been without an associate.
"She has survived the obsessions of a doctor-husband who was heavily involved in community affairs (including 14 years as a Shire Councillor) and the frequent night meetings which that commitment involved."
Peter and Ann also have 13 grandchildren, four of whom were delivered by him at Cohuna District Hospital.
However, he feels it may be a reflection on his lifestyle that none of his children have followed him in a medical career!
Life at this time wasn't all hard work, and it also afforded him one of his most humorous experiences:
"Ann and I were spending the weekend in Melbourne at the Windsor Hotel. The family were at home being cared for by a reliable family nanny. Our stay was cut short by a telephone call from my partner Keith Tellesson to tell us that our eldest daughter, Elizabeth, aged 12 years, had acute appendicitis and needed an immediate operation. I told him to go ahead and call over Dr Hugh McDonald from Kerang. He asked me then who I wanted to do the operation. I said "Let Hugh do it". When we returned home we found that Keith, who was usually an anaesthetist, had done the operation and Hugh McDonald, a very occasional anaesthetist had administered the anaesthetic. My partner had interpreted "Hugh'' as "You". The operation was successful - a good example of the versatility of the country GP."
Rural Doctor's Association
Beginnings
"The formation of the Royal Australian College of General Practitioners in 1958 brought a resurgence and excitement to general practice that country doctors welcomed. Bill Jackson and I were foundation members and attended the exciting conference in 1972 in Melbourne at which Larry Weed spoke eloquently about Problem Oriented Medical Records. Attitudes towards medical records changed throughout Australia and the data bases for patients histories must have cost the National Health Service billions of dollars.
"In 1978, after attending the WONCA Conference in Montreaux, Switzerland, Dr Rex Walpole and I, together with our wives, toured France and Spain and the United Kingdom, visiting country general practitioners.
"We discovered that a doctor in a small town the size of Cohuna (2300) would not expect to have a hospital. All patients needing hospital treatment or a general anaesthetic would be sent to the nearest large hospital with specialist units.
''This may be fine in most parts of England where the nearest large hospital may be only 10 km away, but in Spain and some parts of France the distance may be more than 100 km. It is a long way to be sent to have your baby or to travel to admit your child suffering from severe croup in the middle of the night. We were convinced the decentralised Australian solution was the best for rural towns.
"The Country Towns-Country Doctors conference of rural health workers, brilliantly organised by Rex Walpole in Melbourne in November 1978, crystalised the dormant notion that rural doctors were a different breed, and outlined strategies for rural support and training.
"Alas, without Government financial support and will, 'the light went out' and was not rekindled until the Toowoomba Rural Health Summit organised by rural doctors' associations 13 years later."
Country practice and politics
"I later realised that country GPs who were specially in need of training in procedures which their metropolitan colleagues were no longer requiring or using, were being neglected by the Family Medicine Programme.
"As a member of the Faculty Board (Victoria) I became the convener of the Special Interest Group in Rural Practice. It had no broad political base and there fore made little impact on training programmes or selection of recent graduates interested in a career in country practice.
"Very soon the supply of rotating residents spending 6 months in my practice and then 6 months obstetrics also dried up, but not before our practice had the privilege of introducing some excellent senior graduates to country practice, one of the most outstanding being Roger Strasser, now Professor of Rural Health at Monash University.
''Having seen in a neighbouring small town, the consternation caused when procedural skills are not practised by a doctor newly taking over an isolated rural practice, I became interested in the need to foster the idea that isolated practice was a vocation for an elite practitioner not a drop out type doctor.
"By regular newsletter and bush telegraph, I tried to foster an association of isolated rural general practices (80 km or more from the nearest procedural centre). Victoria, although one of the smaller States, had 26 such practices. Once again, neither Governments nor specialist col leagues would listen to a group with a narrow base.
"At the second AGM of the Rural Doctors Association of NSW at Coffs Harbour in 1990, I met an enthusiastic group of NSW and Queensland doctors who were expressing the same sentiments and policies for rural practice that I had been espousing in vain for 10 years.
“John Quayle, of Echuca, and I decided to found the Rural Doctors Association of Victoria. On our return we set about recruiting Victorian Rural Doctors, and in September 1991 at Echuca, held our first AGM and Scientific Meeting. The success of that conference and the resultant boost in our membership and enthusiasm enabled the RDAV to become a medico-political voice for all Victorian 'bush' doctors. ''We were able to lead a successful fight against the Victorian Hospital Services Paediatric Plan (August 1991) recruiting the AMA and RACGP along the way. That plan if implemented would have specifically reduced inpatient paediatric services in small rural hospitals.
"It has been my pleasure to help the formation of a Federation of State RDAs, the Rural Doctors Association of Australia and be a Foundation Member of the Faculty of Rural Medicine within the RACGP and the Faculty's Provost."
Summing up
Peter's involvement in medicine and his community is reflected in the breadth of his work and the various committees he has been involved with, both medical and non-medical (including Shire President from 1987-1988).
The practice's dedication to procedural work has resulted in it purchasing equipment rather than relying on the hospital to buy it, these include:
Brown's electrodermatome, cystoscope and resectoscope, and laparoscope, gastroscope and colonscope and more recently arthroscopic equipment, ultra sound and slit lamp.
The challenge of an isolated rural practice is the opportunity to provide an enlarging service to one's patients by informal and formal post graduate education from the best teachers, both in Australia and overseas, usually in short courses or experience.
"The formation of rural training units in all the larger States to pursue this training and experience has given me hope that the traditional older country doctor will be at last succeeded by a new breed who will carry on that tradition of multiskilled rural practice".
First published in Notable Australian Doctors Series - Australian Family Physician Vol. 22, No. 2, February 1993