Man about town
Becoming part of the community and understanding the needs of its people have gone a long way in making Mark Miler a successful rural GP.
Dr Mark Miller believes working in general practice is about much more than just seeing and treating the next patient.
'If you break medicine down into cardiovascular, respiratory, GIT [gastrointestinal], that's one way to do it. But ... in general practice you deal with the whole person,' he told Good Practice.
As the recipient of the RACGP's GP of the Year Award, Miller understands that knowing and treating patients as people, rather than as, say, a broken ankle, is what makes life as a rural GP so special.
'You can look after the broken ankle as well, but the whole point is one broken ankle is different from another because [the patient] might live on their own and you have to organise Meals on Wheels, or find them a community nursing package,' he said.
'How they live, where they live and who looks after them. All of that stuff is the stuff you know intimately and often allows you to do quite a good job of looking after them.
'You're more likely in general practice to be aware of those things.'
On the coast
As a GP at Goolwa Medical Centre in the South Australian town of Goolwa, around 100 km south of Adelaide, Miller and his family are embedded in the local community. He and his wife, also a doctor, moved from Adelaide in 1992 following Miller's stints in the SA capital's Royal Adelaide, Queen Victoria and Women's and Children's hospitals.
'My wife and I planned to go overseas and do some more anaesthetics and obstetrics over there as part of training for rural practice,' he said. 'But Goolwa lost one of its doctors and our parents had retired down there, my wife's parents. They kept ringing us up and saying they're desperate for doctors down here, why don't you come down here?
'So in the end we just ended up having a three-month holiday and ended up at Goolwa.'
A popular retirement and holiday spot with a population of around 7000 (which doubles or even triples during summer), Goolwa would seemingly offer a relatively sedate range of patients. But life as a GP on SA's southern coast is far from dull.
'They call this area [Goolwa and nearby towns of Middleton, Port Elliot and Victor Harbor] God's Waiting Room. There's quite an elderly population,' he said. 'But having said that, there's childcare, there's two primary schools, one public and one private, and the private one goes through from reception to year 12.
'So if you look at the demographics of the practice it's actually quite even, but it has a long tail because of the many retirees.'
This means Miller's scope of practice is quite wide, including chronic medicine, mental health, nursing home and hospital visits, and palliative care.
In case of emergency
What may come as a surprise, however, is the number of emergency cases Miller and the GPs at the Goolwa Medical Centre regularly face.
'We've got a large treatment area and we take untriaged ambulances at the clinic,' he said. 'We get between 400-600 ambulances in a year, untriaged, that just turn up at the surgery.'
Miller believes it's this type of treatment that makes rural GPs so important to their local communities, which is why he opposed a funding situation that arose earlier this year that would have seen Goolwa Medical Centre's GPs travel to the hospital in Victor Harbor, more than 20 km away, to see local emergency patients, potentially making them wait up to 40 extra minutes for treatment.
Miller and his fellow GPs argued treating emergencies in Goolwa would be better for patients, as well as other medical professionals.
'It alleviates the pressure on the local accident emergency: we use our nursing staff, our equipment and our gear,' he said.
'When we went through our last negotiations with Country Health [SA] they weren't sure whether they wanted to support that or not. But we had a lot of support from the community to maintain the service.
'I think people really understand that that's a really useful thing because another 20 minutes of travelling time when you're really crook, and then another 20 minutes before we get over there, that's really quite a long delay.'
With the funding situation resolved, Miller and the other GPs are able to continue their busy emergency work for the locals.
'You need to be conscious of what works in the community,' he said.
Teaching and learning
In addition to everything he does for the local community, Miller is also an advocate for going the extra mile to help his professional community.
'You can go through medical practice one patient and one consult at a time. You can go through your whole career doing that,' he said. 'But we all have a broader role, so it's actually nice to be involved in the education side of things.'
Miller has done lots of work with international medical graduates (IMGs), providing tuition and mentoring, and was instrumental in facilitating their assessment process through the development of the Pre-Employment Structured Clinical Interview (PESCI) and Fit for Intended Clinical Practice Interview (FICPI) tools.
He has also worked extensively as a GP supervisor, and more than 30 registrars have passed through the Goolwa Medical Centre's doors during his time there. Recent years have seen the practice take on an even greater teaching role.
'We now have medical students who spend the whole year with us, all of their third year, as part of the rural curriculum,' he said. 'So they actually come into the practice and rotate over to the hospital, but they don't actually go up to Flinders [Hospital]. They spend most of their time with us, doing the teaching and the learning.'
The students gain a holistic view of medicine from the range of presentations common to a rural practice, Miller said, and the Goolwa Medical Centre's numerous emergencies mean they get to spread their medical wings even further.
'It's a bit stressful at times and it makes a good training environment for our registrars and students because they get exposed to both acute and chronic medicine,' he said. 'It certainly keeps us all up to date.'
Miller's love of education extends to his work with the RACGP, where he has held several positions, including South Australian FRACGP Examination Panel Chair and South Australia and Northern Territory Censor.
'That's a really fulfilling job which brings us in contact with candidates and registrars,' he said. 'I firmly believe the way the College has its curriculum set up really does provide a good road map for how we should think as general practitioners over and above the topics that we learn about.'
For Miller, being named GP of the Year is a great endorsement of all the time and effort he has put into his career (though he admits running late for work when President Liz Marles called to tell him of his win was an amusing contradiction), but he warns it can't all be about the job.
'I think being involved in other things and having a work-life balance is important,' he said. 'It's busy at the practice, but it's also good to come home and sit about and read a book.'
Written by Paul Hayes - First printed in Good Practice Issue 11 - November 2013