Order of Australia Medalist
I was born in Melbourne on Valentine's Day, 1927. My father was a medical officer at the Repatriation Psychiatric Hospital at Bundoora, and was later transferred to the newly formed Commonwealth Serum Laboratory where he later became Director of Research.
The family had a nomadic lifestyle over the next decade, moving to Port Pirie in South Australia, Rockhampton in Queensland, Canberra, and Middle Park , Bendigo and Heidelberg in Victoria . Illness delayed my starting school until I was 7 years of age; I then attended eight schools while our family travelled around the country, then spent my senior school years at Ivanhoe Grammar in Melbourne.
I turned 15 during the war years and immediately joined the Royal Australian Air Force Air Training Corps, and signed up for aircrew service upon turning 18.
I was a jackaroo for a short stint after the war, then in 1947 I surprised my family by enrolling in first year medicine in Mildura in northwest Victoria.
My undergraduate clinical years and two residency years were at the Alfred Hospital in Melbourne. In 1953 the hospital seconded me to the Royal Australian Army Medical Corps for a month during the Korean conflict, and I remained in the RAAMC Reserve until 1970.
My residency at the Alfred was followed by a resident year at Melbourne 's Royal Women's Hospital. I spent a further 10 years as an outpatient assistant while I was in general practice in Thomastown in Melbourne's outer suburbs.
The practice lifestyle of the Thomastown days – 200 plus midwifery deliveries a year and up to 60–70 daily consultations – left no time for college activities, or much else. I remember being chided for my lack of research resolve by the weekend locum we were fortunate to have assisting us in 1958–1959. The locum was excited about a patient he had just seen with Bomholm disease, and I commented that I had seen a number of such cases. "Why have you not written about them?" he asked. "Not enough time", I replied – an answer which I feel may have disgusted our locum, who was later better known as Sir Gustav Nossal!
My Early College Days
I joined the college in 1963, following an urging from our local general practitioner and my sponsor, Dr Andrew Fraser. My first college activity was attending a practice management seminar run by Dr Neil Carson. I recall Neil telling us about a new gadget: a clock which could automatically activate the sterilisers in the practice so that the water would already be on the boil when the staff arrived – a novel idea in those days!
In 1965 my family and I moved to Scottsdale in northeast Tasmania. The two person practice I purchased there gradually expanded to four doctors, including a surgeon. A modern hospital with full facilities was built in 1969, replacing the old hospital. We engaged the RACGP’s management advisor, Malcolm McHarg to advise us on how to manage the practice, and during his yearly visits to Scottsdale, Malcolm introduced us to cash flow budgeting and helped us to modernise our practice and patient services. This proved highly successful, and we halved our overheads in three years. As well as commencing my interest in practice management during my time at Scottsdale, I was also involved in two research surveys: 'Infectious hepatitis epidemic in an isolated area' and the 'Social needs survey in northeast Tasmania'.
I was brought back into the college fold one afternoon in 1968 when Dr Norman Rutledge, the newly designated college Fellow in Tasmania, talked me into preparing for the RACGP Fellowship examination. The following year, Norman organised tutorials for six GPs from northern Tasmania under the able guidance of future RACGP President Dr Bill Jackson.
Preparing for the exam involved travelling weekly to Launceston over the mountains on a winter's night, often with ice and snow. Attending the exam, which I sat in 1970, was not without its drama either. I finished at the surgery, had a bite to eat and left for Hobart about 6.00 pm. It was wet, and as I arrived at Ross in the Tasmanian midland the area was flooded. By 9.00 pm we were on an unmade road bypass. One greedy motorist stepped out of line and became hopelessly bogged. Cars in both directions came to a standstill for the next four or five hours. I finally made it to the Travelodge Motel about 4.00 am and the trains started shunting shortly afterwards. But the 9.00 am exam start was no problem for an experienced country GP in those days! I sat the exam and gained the MRACGP (Membership of the RACGP), which later became known as FRACGP (Fellowship of the RACGP).
In the early 1970s I was the ‘chosen one’ from the college's Tasmania Faculty to attend the 'Leura' week. This was a long course, organised by the New South Wales Faculty, which was a great learning experience and introduced me to some notable educationalists.
Having inherited the Lloyd George Record System and its problems from the previous owners of the practice at Scottsdale, I was fortunate to attend the 5th Wonca Conference in Melbourne in 1972 and to hear Lawrence Weed talk about health records and the concept of the problem oriented medical record (POMR). This began my excursion into health records management. I immediately purchased the Medrecord Health Record on behalf of our practice, and the system received instant approval.
In 1972 I joined the RACGP’s Tasmania Faculty Practice Management Committee -- made up entirely by GPs from the northern half of Tasmania – and in the following year I was elected to the RACGP Tasmania Faculty Board. In 1973 I became chair of the Practice Management Committee in Tasmania.
It was at another Wonca conference – this time the 1973 meeting in Singapore – that I first heard mention of something that was to become another enduring interest: the Family Medicine Programme. A year or so later, our practice at Scottsdale sought and was granted FMP accreditation, but we did not attract a trainee. However, we were fortunate to be joined for a fortnight by final year students from the new medical school in Hobart. We must have been favoured, as several of those students are now leaders in Australian medicine.
My first meeting with the RACGP’s Practice Management Committee was in Adelaide, where I met for the first time Dr Clive Auricht, Dr Ted Gawthorn, Dr King Kinder and Dr Frank Fry. It was at this meeting that I witnessed the ballroom of the Hotel Australia littered with the full extent of health records at that time.
It was a frightening picture. (The Tasmania Health Department had sent a quarter of a ton of samples of records in use, and the other states had each tried to go one better!) It was decided to do something about the multiplicity of health records in Australia, and in April 1974 Dr Auricht organised a health records conference with the then Health Commission in Canberra, and with wide participation from interested groups.
Dr Gawthorn worked feverishly to provide a prototype health record for the conference, which was held in Canberra in April 1974. The result of his efforts was 'slaughtered' by the audience and ceremoniously buried on the final day of the conference. Undaunted, Dr Gawthorn and the Practice Management Committee of Council created the forerunner to the present RACGP Health Record in the weeks that followed. This record was refined and other parts evolved during practice trials. Dr Kinder's simple display at that year's college conference brilliantly highlighted the terminal digit and colour coding attributes of the system.
This system (or a clone of it) is the type of health record most practices in Australia now use either in a manual or electronic version. It has placed Australia among the leaders in primary health recording.
The health record meeting in Canberra was a great winner for 'better health' in this country. Dr Kinder, who was also chair of the RACGP National Chairs Committee group, was also responsible for introducing the project development fund, which enabled committees to apply for funds to develop and finance an initiative.
One of the recommendations of the 1974 Canberra conference was to develop a personal health record (PHR). We did this in 1975, however, for political reasons, the 45 000 personal health wallets remained safely locked away and out of sight in a garage for years. Various attempts to reactivate the PHR failed, until Dr Auricht encouraged the South Australian Health Department to provide a PHR for all newborns in that state.
Despite excellent evaluation of this initiative, 10 years elapsed before Dr Graeme Miller won approval for a similar distribution to newborns in NSW and the ACT as a bicentennial project. My efforts failed in Victoria until 1 October 1992, when the PHR was introduced as an election sweetener.
A PHR is now available for all newborns in Australia. An occupational health record is available at some workplaces, and dependents of armed forces personnel have a PHR, as they are often moving to different areas.
Rotary club experiences
I joined the Rotary Club of Scottsdale in 1966, and was president in 1972/73. I organised the cardia-phone link between the intensive care unit at the Royal Hobart Hospital and six rural hospitals. This enabled coronary patients to be monitored in Hobart and safely cared for at distant locations.
There were two other significant activities while I was in Scottsdale. The first was meeting Dr Cunningham Dax who had moved from Victoria to the Health Department in Hobart. The community health services in the northeast area of Tasmania were not well developed. He suggested that a needs analysis should be surveyed. A committee from service groups and community persons was formed, which I chaired. Dr Dax recruited three students from universities in Sydney and three from Queensland. Rotary bought a used car and a questionnaire was developed. Six weeks later, most organisations and many people in the northeast Tasmania had provided input. The resulting report lay dormant for a year. Governments changed and the northeast with its needs analysis complete was ready for change.
Another rotary initiated project in Scottsdale was the building of the first three aged persons units, which have since grown to approximately 100 units plus a hostel and nursing care aged facilities.
Family Medicine Program
In 1977 I returned to Melbourne with my family. I continued my involvement with Rotary, but intended to have a break from work. I did have a break, but shorter than originally intended. I started working 0.67 time at Deer Park in March 1977. However, one day I called in at the college's Jolimont office regarding a health record issue and met Dr Fabb in the lift. Within a matter of minutes he talked me into assisting the Family Medicine Programme at the program's office at Trawalla, Toorak. A few days later I was duly installed as the FMP's liaison officer. I knew little about FMP, apart from the fact that our practice in Scottsdale had been accredited but had no trainee. This started my journey with FMP that continued for the next 9 years.
The situation at the FMP office at Trawalla was anything but stable on my arrival, but over time, a good working arrangement evolved with the academy and the faculty.
The argument for an FMP state director to be full time or working 50% in practice was often debated. Dr Bill Jackson was strongly in favour of the latter and asked me to apply for the vacancy in Victoria. I was successful, and a co-director was also appointed. Dr Greg Papworth accepted the role of education, and when he later moved to Jolimont, Dr Diana Sutherland took over the education role, and later Dr Roger Strasser was a great help in further developing the learning process.
Dr Elizabeth Banks succeeded me when I eventually resigned as state director in 1985. These days it is a pleasure to meet with many of the young doctors who also journeyed through FMP.
My FMP experience complemented the training that was ever present at Deer Park Community Health Service, where I practised until 1992. Undergraduate and postgraduate teaching was high on the agenda at Deer Park, with up to 50 medical and paramedical students and eight FMP registrars being attached to the clinic each year.
The FMP gained much strength from the Rotating Residency Program (RRP) through the computer matching service that was conducted by the Victorian Medical Postgraduate Foundation – a co-tenant at Trawalla.
The RRP included much sought after hospital posts and attracted many excellent trainees and registrars. As a result of the RRP and other good posts sought after in hospitals, the computer match was a powerful tool for developing the program in Victoria.
Because of the strong educational focus from all parties at Trawalla, the training program was strong in this state, and pruning growth to keep within budget was a constant issue. The program was involved in a number of reviews.
It was in 1980, while at the FMP, that I was asked by Dr John Forbes (who had taken up a role as an advisor to Overseas Aid Abroad after retiring from the Fairfield Infectious Diseases Hospital) if I would help organise postgraduate training for medical staff from the Caltex Oil fields in Sumatra. Over the next decade I organised placements at many institutions in Victoria for 30 doctors and paramedicals.
Practice Management Committee
Dr Kinder was chair of the Practice Management Committee of Council from 1980–1984, and the committee was very active in holding seminars and producing publications on receptionist training. Dr Gawthorn wrote the first edition of the Handbook for medical receptionists in 1976, and more editions ensured over the years.
Some faculties conducted receptionist seminars, and in 1978 a week long practice management course was held in Victoria and continued in various formats until 1985. The course always attracted a good mix of experienced GPs and young FMP doctors.
In the early 80s, Dr Gawthorn and I organised a receptionist training course with practical segments run weekly over a 12 week period. It rated highly but was quite exhausting for the participants as well as the organisers. From this course rose the idea to put the content into the correspondence course that was edited by Dr Gawthorn and unveiled in 1982. The course was circulated nationally and proved successful.
The Start of College Computer Activities
At a meeting of the Practice Management Committee of Council in 1976, Western Australian representative on the committee Dr George Simpson had spoken of his move to computerise the college record. Some computer companies were also moving in that direction, but often used records as a token addition to promote their computer systems.
The PMCC decided to become involved and help the computer industry develop a computerised version of the RACGP Health Record. Following a suggestion from Dr Paul Day, the RACGP 1st Computer Conference was quickly organised and was held at the Victorian RACGP offices at Jolimont in April 1977.
Another conference, chaired by Dr Abe Assef, was held in Sydney at the Boulevard Hotel in 1978. This was highly successful educationally and financially, and enabled the PMCC to develop the Computerised medical records system – proposed minimum standards document, designed by Arthur Andersen. The project also included an accreditation process. There were criticisms of the system, but it was a start toward the computer industry understanding and respecting the primary health record standards that the college had developed.
I was chair or member of the organising group for 10 RACGP computer conferences that were held in 1977–1999.
In the early 80s, the PMCC activities in computing saw the establishment of faculty subcommittees and the first of many editions of the _Medical computer business directory_ detailing computer company information for GPs in template format. User groups were set up, basic computer courses were conducted and a number of publications were written.
The college council’s attitude to computing was initially very confused. In the early 1980s council was against the introduction of computers in college operations. In 1981, with much assistance and encouragement from RACGP accountant manager Mrs Dorothy Ratnarajah, the Victoria Faculty purchased a computer and produced financial reports that were relayed to the Jolimont office. This soon changed council attitude and a Wang computer machine was installed. Unfortunately, Mrs Ratnarajah resigned in May 1984 due to her husband's ill health, and the mysterious Wang machine pounded on without any human guidance. Three months went by, and council was about to conclude a meeting in Sydney, with some councillors already out the door and heading for their taxi, when I demanded no-one else leave until a decision was made to appoint someone to take control of the Wang machine. The startled council made a rapid move to appointed Ms Jude Blackwood, who successfully guided computer thinking in the college (and among GPs) for more than a decade. The college had made a very fortunate decision in appointing her.
In association with Monash University, the college established Monash University Computer Assisted Programs in 1982, under the chairpersonship of Professor Neil Carson. MUCAPS developed and tested computer applications thought to be useful in the day-to-day operations of a general practice.
Changing the College image
By the time of the 1983 college convention held in Devonport, things were particularly difficult for general practice and GP esteem was low. However, thanks to the organisational brilliance of Dr Hugh Carpenter and the powers of Professor John Ellard, the college took a long hard look at the college's 'labrador' image as portrayed in Professor Ellard's summary, and set about addressing many issues.
The standards and the future of general practice (General practice: the standards and current practice) was developed by a group was led by Professor Wes Fabb, Dr Michael Heffernan and Dr Peter Stone. The published findings set the agenda for many college achievements, including the introduction of vocational registration.
The financial hardship of GPs was addressed by the Relative Values (RV) study led by Dr Heffernan, Dr Stone, myself and others, as well as external advisers. The college introduced the Interpractice Comparison Survey (IPC) to help with the RV study, which arose as an idea from a presentation at the 1981 RACGP Computer Conference. Over a 14 year period, the IPC survey continued to give valuable insight into the economics and behaviour of practices of all sizes and locations.
The Services Division
Another issue arising from the 1983 'think tank' was the need for the college to provide and promote better services to members and potential members. The previous advisory service was revamped and the Services Division established. I was chair of the division until my retirement in 1997.
The Services Division had as its main base the marketing of the health record, as well as arranging printing of a range of college publications. This energised the college committees and prompted authors to write texts and promoting these and other products via the highly successful 'Just a Tick' promotion. This listed college products, which required members to tick items they wished to purchase through the mail. Moreover, there was involvement in seminars, computer conferences, conventions and conferences both national and international (Wonca in particular). The disability insurance package introduced in 1978 continued to be an attractive option for GPs and those completing FMP training.
In late 1984, Mr Gamet Banks was appointed as manager of the Services Division. He developed a marketing plan and a structure for the future. After an exhaustive study, ANZ Travel was appointed to handle travel for the college and its members.
An application for an Australian Government Research and Development Advisory Grants Committee (RADGAC) grant in 1984 to define the requirements of a computer system in pilot practices was not successful. The college activity in telecommunications resulted in council establishing a Telecommunications Advisory Service, of which I became chair.
In 1986 we commenced an email trial at the college. A 1-800 (previously known as 008) service was established to give members better access to the college. Dr Peter Adkins was instrumental in establishing satellite educational programs in the college training program and Dr Peter Fleming was active in developing the Viatel program, a computerised multichoice educational activity used in the FMP and a forerunner to the health scrips on Link and Tricom. A community health information service (CHIS) was also set up on Viatel.
As member interest in computing was strong, a proposal was put to council in 1986 for the appointment of a computer fellow to develop policy and respond on computer issues. Dr Michael Crampton was appointed and did an excellent job. One of his more difficult tasks was to disentangle the medicopolitical impasse that was holding up the introduction of computer prescriptions in Australia. Computer prescribing was well established overseas and proved a success when it was finally introduced here. Dr Crampton's tenacity and dedication to resolve this issue earned him applause from those involved in the lengthy debate. The position of Computer Fellow was then held by Dr Patrick Bolton and later Dr Ian Cheong.
The work in computing was occupying most of PMCC's attention, so in 1987 council created the National Computer Committee (NCC) as a subcommittee of PMCC, and in 1991 NCC became a standing committee of council.
In 1988, the college commissioned Bellamy and Associates to prepare an update of Arthur Andresen's Computerised medical records system – proposed minimum standards document. The same year, the college and MUCAPS undertook a computer assisted practice project (CAPP) setting up a trial similar in design to that used to introduce the RACGP Health Record in 1975. The project was sponsored by Medrecord Computer Systems.
College publications always played a big role in Practice Management Committee and Services Division activities. Dr Gawthorn was a prolific writer and wrote a series of receptionist booklets and was co-author of A manual for general practice. There was a handbook series on problem oriented medical records: The practice, Solo, Partnership or associate, Finance and Where should you borrow?. Later, Dr Brian Storer, in conjunction with the School of Architecture in Adelaide, provided text for an excellent handbook, The design of doctors' surgeries.
I had an interest in making an appointment system work and wrote a paper that was later the basis for the Doctors Appointment System book devised by Dr Andrew Magennis. Dr Rod Lambert coauthored A handbook on computers in general practice.
The American Academy of Family Physicians sent the college copies of its useful book on organisational principles in general practice. We sought permission to use the book and used it for several years, however, it was time for the college to do its own thing. Dr John Stevens agreed to edit the text provided by multiple authors, and the PMCC produced Organisation of general practice, which adorns the bookshelves of many GPs.
I recall well the printing of the first edition of the Guidelines for preventive activities in general practice booklet in 1991. It had just been sent to the mailing house for distribution. The secretary-general rang me just after 5.00 pm to say that the Department of Health had informed him that the booklet was not to be distributed, due to the Treasury Department being concerned that the information contained in it would encourage GPs to overservice patients. I rang the mailing house and was informed the job would be finished and dispatched within the hour.
The next morning I rang the secretary-general and told him the booklets had been dispatched overnight. The college received a 'rap over the knuckles' for circulating the booklet, but the preventive guidelines did not cause overservicing, nor blow out the federal budget!
In the 1980s, the state health drug agencies sought the college's assistance to develop a doctor's bag record of drugs of dependency. The Victorian Department of Health led the project, with quick consensus from the other states, and the small booklet was completed. It is now known as Schedule 8 drugs – a record book of administration, now familiar to most doctors. Fewer than 5% of doctors were keeping records before the release of the booklet.
The RACGP Health Record continued to be sought after by practices, and after 10 years of use, PMCC decided to do an indepth review of the record in 1985. Dr Gawthorn led the way and developed a number of modifications of the system, paying particular attention to the installation booklet, rewriting it as 'How it works for you!' and modifying some forms.
There was controversy in 1986 when Merck Sharp and Dohme (MSD) sponsored the RACGP Health Record. The significant funds they provided were placed in the college's Family Medical Care, Education and Research Foundation. After some years MSD ceased to sponsor the system. Subsequently Bristol-Myers Squibb took over sponsorship of RACGP Health Record.
The Services Division introduced the ANZ Visa card and EFTPOS in 1986 and the multiple accounts operating throughout the college with various banks were consolidated with the ANZ Bank. The funds generated by the ANZ Visa Affinity card, enabled the college to create the position of Practice Advisor which was filled by Dr Frank Fry.
The Services Division became the focus for enquires from doctors, organisations and the public. A well received initiative of the division was the presentation of a college name badge and a college scarf tie to new fellows. In 1987 Franklin Mint created a 'Bligh House' silver plate that was keenly sought by members.
In 1987 Dr Steve Hodby and the Practice Management Committee in Western Australia (WA) produced a state directory of WA members. Out of this initiative grew the directory of RACGP members and their special interests, first published by the Services Division in 1988, and then subsequently in 1990, 1992, 1995 and 1998.
The directory listed fellows and members, their practice locations, special interests and languages they spoke. It was distributed to all college members and an abridged version was available at maternal and child clinics, hospitals and libraries. The directories were sponsored by a range of pharmaceutical firms.
Other books prepared by PMCC and other committees produced by the Services Division include:
- Sterilisation and disinfection guidelines for general practice
- Practice procedures manual
- Standards for general practices
- Running a successful general practice
- Planning a successful general practice
- Medical care of older persons in residential aged care facilities
- Correspondence course for medical receptionists
- Women and violence
- Australian arboviruses of medical importance
Victoria Faculty Activities
In 1990 the Australian Medical Association (AMA) President and the chair of the Victoria Faculty set up a liaison group, which has continued as an effective interchange between the two organisations. I co-chaired the liaison group in 1992–1995 and have remained involved ever since its inception, as I consider its existence to be highly relevant to the medical profession.
Shortly before his untimely death, Dr Peter Stone invited me to take on the secretaryship of the Victorian Medical Postgraduate Foundation (VMPF), from which position he had resigned to become the medical director. I continued as VMPF secretary and public officer until 2003. I have continued as chair of the Country Education Program (CEP) at VMPF and as the VMPF representative on the University of Melbourne Faculty of Medicine, Dentistry and Health Sciences.
When the GP divisions were initiated in 1992, I was RACGP Victoria Faculty Chair and co-chair of the management group set up to establish the program in Victoria, and chaired the State Reference Group set up in 1994 to consider the projects put forward by Victorian divisions. In 1995 I was a member of the State Advisory Panel, which continued the assessment of projects. At that time I was a member of the Victorian Health and Community Services (H&CS) Immunisation Advisory Group, a member of the Consultative Committee on Implementation of Mandatory Reporting, the National Childhood Immunisation Education Subcommittee and the Better Mental Health Outcomes Reference Group.
In 1992 the Services Division arranged several functions at the Wonca conference in Vancouver, which attracted 250 attendees from Australia.
The 1993 Interpractice Comparison Survey results were the basis of a research project entitled 'Issues of definition and structure surrounding general practice organisation' and funded by the Department of Human Services and Health. Professor Andrea Mant from the Research Committee, Dr Frank Fry from the Practice Management Committee, Dr Ian Tullock and I assisted the researcher, Ms Linda Kehoe, in developing the project.
A 1993 study by the Wonca Practice Management Committee sought information from some 63 Wonca member countries. Responses were received from 35 countries. An analysis revealed that primary care was changing rapidly and was set to play a greater role in the future, that the diversification of funding sources reduces dependency, and that research is essential if the issues raised in the report are to be addressed.
The fifth edition of the Medical Receptionist Course was printed in 1993. The 6th edition was completely rewritten and the format updated by Dr Andrew Magennis. Many receptionists have returned the exercises developed with the course for assessment.
Another review of health records was conducted in 1995 and changes were made to the forms with a focus on prevention. A video was produced and made available to all users of the RACGP Health Record.
The magnitude of the college health record operations is a wonderful college achievement, and despite some 40% reduction in use with the advent of computer records, the manual record is still used in more than half of general practices.
My life in the college has been a wonderful experience. The computer development and standards, the training program, the Interpractice Comparison Survey, the vision of general practice, the move to vocational registration, and well as the activities of the Services Division, were the areas I also found rewarding.
My greatest satisfaction was to see the health record accepted and make such a difference to patient care. My greatest regret was to see the rural split and subsequent loss of the training arm of the college.
The college has been kind by awarding me with the honour of the Rose-Hunt Award in 1994 and making me a Life Fellow of the college in 1999, and in the same year I received the Order of Australia Medal.
The contribution I have made to the college was no more than that made by many others over the years and was made possible due to the assistance I received. I would like to pay tribute to Dorothy Ratnarajah, Helen Kludt, Greta Haig, Lisa Thompson and Robyn Cronnolly, as well as the many others, who also gave me support.
I believe I was fortunate to be in the right place at the right time.
Dr John North OAM RACGP Life Fellow
- RACGP Tasmania Faculty board member
- RACGP Victoria Faculty board member
- Family Medicine Programme state director (1978-1985)
- Practice Management Committee of Council chair (1984-1988)
- Services Division chair (concluding 1997)
- Committee of National Chairs member (1984-1997)
- RACGP Victoria Faculty Deputy Chair (1990-1991)
- RACGP Victoria Faculty Provost (1999-2001)
- RACGP Victoria Faculty Chair (1992-1995)
- RACGP Victoria Faculty Provost 1999-2001