Author: Paul Hayes
This year’s RACGP award winners show some of the best of general practice in Australia.
‘So, what are your special interests?’
A common question asked of many GPs. For long-time Tasmanian GP Dr David Knowles, this line of enquiry stirs some emotions about his love for general practice and serving his community.
‘I often get asked and I always find it hard to answer. I thrive on the comprehensive and continuous care that I can provide in my practice,’ Dr Knowles, the 2017 recipient of the RACGP’s Rose-Hunt Award, told Good Practice. ‘I see a lot of people with diabetes and we run a dedicated nurse-led clinic at our practice, I see a lot of patients with haemochromatosis and manage their venesections, I do dedicated travel sessions.
‘My community influences my skillset.’
This attitude also influences Dr Knowles’ approach to education, especially fitting given his is also the RACGP’s 2017 General Practice Supervisor of the Year.
‘I want to inspire our medical students and registrars, just as I have been inspired by my mentors,’ he said.
As a person who describes himself as ‘not someone who likes the limelight’, Dr Knowles took the news of winning the Rose-Hunt, the RACGP’s highest accolade, in his stride, though the significance of the award was certainly not lost on him.
‘I am honoured and humbled that my peers and the RACGP would deem I was worthy of this award. Many of my GP heroes and mentors are previous winners of this prestigious award and to be included on a list with them is hard to fathom,’ he said. ‘I am actually delighted that my college would have chosen someone who works more in the background and whose primary job is at the coalface.
‘I think for every member who is out there working with their communities, this year’s award is a recognition of what they do, because that is what I do and I know this is valued by our college and our Council.’
While the Rose-Hunt is a major honour, acknowledgement as a general practice supervisor ‘sits most comfortably’.
‘To be recognised for this role is a great honour,’ Dr Knowles said. ‘Our practice creates an environment where everyone aims to be the mentor, and we create an environment where medical students, registrars, nursing students and pharmacy students feel comfortable to ask any question, challenge themselves and learn.
‘Is does not take long for everyone to realise they are teachers themselves. I am taught something new every time I turn up to work.’
Dr Amanda Bethell wasn’t expecting to learn she was in the running for the RACGP’s 2017 GP of the Year.
‘I didn’t know I’d been nominated,’ she told Good Practice.
News that she had won, however, was not unwelcome.
‘It’s pretty exciting.’
As an experienced rural GP, Dr Bethell’s initial thoughts about taking up a life in medicine were shaped (rather appropriately, as it turned out) by what she saw in television.
‘My only knowledge of medicine was from watching TV shows A Country Practice and The Flying Doctors. As far as I was concerned, that was medicine,’ she said.
Dr Bethell now practises in the rural South Australian town of Port Augusta, about 320 km north of Adelaide with a population of close to 14,200 people. She is very comfortable in this type of setting and is drawn to the nature of healthcare delivery it affords.
‘I really love the diversity. I like that in general practice you get to meet the whole breadth of humanity – different cultures, different ages, a whole bunch of different health problems,’ she said.
‘I love the intellectual challenge of seeing undifferentiated problems; if you are a sub-specialist you already know what a problem is when it comes to you. I love, in rural general practice, the ability to do both the clinical work and the hospital work.
‘Since moving back to Port Augusta in the last six years … I have to use so many different skills that there wasn’t a call for in [my time in] the city because people were going to different places for different things.’
Dr Bethell also loves to express this love of rural healthcare when she is teaching medical students and general practice registrars.
‘I spend my whole time telling them that rural general practice is the only way to go,’ she said. ‘I like the role of a mentor; I learn from the registrars as well as they learn from me and, I hope, the medical students.
‘A lot of the time my medical students are at a stage where they have got all of their [academic] knowledge, so you are seeing them start to apply that and actually think about how they would manage a situation, and helping them with their practical skills.
‘So being able to, for example, take somebody from not being able to take bloods to being able to put a drip in really well.
‘That kind of thing is very satisfying.’
Much like her fellow South Australian, Dr Bethell, general practice registrar Dr Adelaide Boylan has an immediate response when considering what she loves about general practice.
‘The diversity,’ she told Good Practice. ‘The opportunity to see different people at different stages of their lives, with different problems all day long.’
As the RACGP’s 2017 General Practice Registrar of the Year, Dr Boylan has embraced all that comes with entering primary healthcare.
‘I think the diversity is so enjoyable and makes for such interesting days, but it can also be terrifying and a bit overwhelming at times,’ she said. ‘It’s proven to be challenging, but I love it.’
That diversity extends beyond the consulting room for Dr Boylan, who divides her time between a number of different areas of healthcare. A typical week includes time at a private family general practice, in aged care, and engaging in teaching and content development at Adelaide University.
‘That’s the nice thing about being a GP – having your finger in lots of different, interesting pies. It keeps your mind open in doing different things, while also being there enough to contribute properly,’ she said.
Having trained and worked as a lawyer prior to entering medicine, Dr Boylan has found such a background can come in handy in her new vocation.
‘I think my law training has been a good background in communication aspects of my job, having a little bit of an idea about risk management and probably being less fearful of the legal system,’ she said. ‘Sadly, in medicine now people are terrified of the medico-legal consequences of their decisions.
‘Hopefully that will change over my professional lifetime.’
While she has only been in general practice for a few years, Dr Boylan has already experienced some of the best the profession has to offer.
‘I’ve just come back to working at a practice that I haven’t worked at since 2014. It’s been particularly lovely to see a lady who has had lots of problems with fertility, who has had two babies in the interim,’ she said. ‘And also some adolescents and people in their early 20s who were struggling with some mental health problems, who have come through the other side of that and seem to be doing a lot better.
‘That’s really nice, to come back and observe them after having not seen them for a few years and feel like maybe you were slightly involved in helping them overcome that problem.’
Atticus Health Carrum
While some monikers are undoubtedly more creative than others, general practices are often furnished with names that are rather straightforward – banal, even. Melbourne’s Atticus Health Carrum, however, is not one of those practices.
‘The practice was named after Atticus Finch from the novel, To Kill a Mockingbird,’ Dr Floyd Gomes, GP and practice founder, told Good Practice.
As Dr Gomes explained, lawyer Atticus Finch’s efforts in defending Tom Robinson, a black man in America’s south in the 1930s, went a long way in helping to determine the practice’s overarching philosophy.
‘Atticus Finch has very little vested interest in supporting this individual per se. He did it as a statement of ethics,’ Dr Gomes said. ‘He was happy enough to support an individual in the midst of a lot of backlash.
‘The other part of that is to really empathise or understand people from their points of view … to try and take your lens off of the world. I think that is the main thing that we strive for at the practice, to try our very best to view the world through the eyes of our patients.
‘On the back of our business card, there is a quote from the novel: you can’t understand a person until you walk in his shoes.’
All of the staff members at Atticus Health Carrum go to considerable lengths to live up to this ideal, regularly working outside of the practice to provide the local community with high-quality healthcare services. This sees them visit retirement villages, nursing homes and even secondary schools.
‘We try to make it as efficient as possible, but there are challenges in working in those environments, be they IT or scheduling, that add a layer of complexity when trying to get out of the clinic and into the community,’ Dr Gomes said.
‘That takes people’s willingness to be involved.’
All of this effort is what makes being named the RACGP’s 2017 General Practice of the Year all the more validating for Atticus Health Carrum.
‘It’s mainly at a team level because a lot of members at Atticus Health Carrum go outside their usual work, and it recognises that extra effort that they put in outside the clinic boundaries,’ Dr Gomes said. ‘The award recognises that is something special that they are doing.’
In addition to all of the work done externally, the practice itself offers something of a single point of access for locals.
‘We provide a range of different services – GPs, specialists, a gym with an exercise physiologist onsite, podiatry, psychology, dietetics, massage,’ Dr Gomes said.
Atticus Health Carrum is also a teaching practice, with general practice registrars playing a key role in its services. This offers the opportunity to not only educate the next generation of doctors about the facts and figures of healthcare, but also some of the values behind its delivery.
‘I have a saying that I share with registrars: remaining relentlessly solution-focused,’ Dr Gomes said. ‘That has been the mantra of our clinic and the way we do things – to see things in an “as is” form, warts and all, even though that is difficult at times, and find a solution to that reality.’
As GPs are often wont to do, Dr Denise Powell’s first instinct was to defer praise when discussing winning the 2017 RACGP Rural Brian Williams Award, which acknowledges a practitioner whose guidance and support enables rural GPs to dedicate themselves to their patients, families and communities.
‘It is a great acknowledgment of the work that my colleagues have done,’ she told Good Practice. ‘I was very surprised and honoured that they thought enough of rural women to nominate me when they have also done the same amount of work towards progressing rural medicine that I have.’
A long-time resident and GP in Queensland’s Bundaberg region, Dr Powell initially planned a career in psychiatry, but came to love the frontline aspect of rural general practice.
‘As I was progressing through medicine as a student, I believed in my great naiveté that it would be more useful to try to work with people at the beginning rather that at the significantly progressed and end stages of mental health,’ she said. ‘I think working in general practice suits me best.’
Dr Powell is passionate about general practice education, and not just for medical students and general practice registrars.
‘I think developing general practice for people other than doctors is really important, so I have had a number of nurses and a physician’s assistant train in my practice,’ she said. ‘Most of my administrative staff have qualifications as medical assistants.’
Gladstone Street Medical Clinic’s Dr Cassie Rickard, the RACGP’s 2017 Rural Registrar of the Year, has made herself a valuable part of the workforce in Victoria’s Gippsland region. A commitment to rural healthcare has been evident from her time as a medical student, seeking out remote placements in East Gippsland and the Northern Territory.
‘I was impressed by the scope of practice offered by rural GPs, and the satisfaction of working in a small community,’ she told Good Practice. ‘I feel privileged to share patient journeys.’
Dr Rickard balances part-time practice with teaching through Eastern Victoria (EV) GP Training and the Monash School of Rural Health. While acknowledging the difficulties of medicine, Dr Rickard found being named the Rural Registrar of the Year helped validate her efforts and sacrifices, as well her husband’s.
‘I also feel it recognises the efforts of mentors and colleagues, who inspired and supported me and helped make me the doctor I am today,’ she said.
Originally a psychologist, Dr Chris Harrison has contributed much to general practice. Receiving the RACGP’s 2017 Honorary Membership Award has helped him feel even more a part of the profession.
‘As a non-clinician researcher, it really is an honour,’ he told Good Practice. ‘This award makes me feel like I am part of the club.’
Dr Harrison has been heavily involved in general practice research for 15 years, having worked as a senior analyst on the Bettering the Evaluation and Care of Health (BEACH).
Dr Harrison has published almost 100 journal articles, contributed to 23 books and delivered close to 60 conference presentations, including GP17, on the results of his research.