Professor Wesley Earl Fabb AM


MBBS, FRACGP

Medical educator Dr Wes Fabb has been writing and lecturing about general practice for many years, in Australia and overseas. Through his work as Honorary Secretary-Treasurer of WONCA (the World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) he has been a leading figure at international conferences and seminars in places such as Melbourne, Mexico City, Toronto, New Orleans, Singapore, London and Jerusalem. Now another initiative will make him a respected figure in China.

The Nature of General Family Practice, which he co-edited with Dr Jack Marshall of Adelaide, is the first book on general practice to be translated into Chinese. The project was initiated by Dr Hugh Carpenter, the former medical officer to the Australian embassy in Beijing (he is now in Moscow).

Dr Fabb

Dr Fabb provided the story behind the photograph (left): "In March this year, in company with the President of WONCA, Dr Don Rae, and our spouses, we travelled to Kaohsiung, a city of one and half million people on the south-west coast of Taiwan, to visit the medical school there where family medicine in Taiwan was founded. The dean hosted a dinner for us that evening and, as is his custom, encouraged as many who would dare, to get up and sing. The photograph shows me making my small contribution to the evening, singing a song I made up on the spur of the moment called "I love WONCA", sung to the tune "Good Night Ladies".

Wesley Fabb was born in Ultima, Victoria, in 1930. He attended a number of primary schools in Victoria and Queensland, The Geelong College for secondary education and The University of Melbourne, graduating MBBS in 1955.

His hospital training included residencies at the Royal Melbourne Hospital and the Mooroopna and District Base Hospital. He was an assistant in group practice in Shepparton from 1958 to 1960; in solo rural practice at Yarra Junction from 1960 to 1971 and has been Visiting Assistant Physician, General Clinic, Alfred Hospital Emergency Department since 1972.

His postgraduate degrees include the FRACGP (1971), and he is either an Honorary Fellow or Member of the following Colleges of General Practitioners: Singapore, South Africa, Canada, Royal College (UK) and Hong Kong.

 

Distinctions and awards

Dr Fabb was made a Member of the Order of Australia in 1987 for his services to medicine and health education. In 1983 he received the Australasian and New Zealand Association for Medical Education's Award for Achievement in Medical Education.

Appointments

Dr Fabb is the National Director of Education of the Family Medicine Programme and Director of Examination Research and Development and Examination Co-ordinator of The Royal Australian College of General Practitioners. He is an Honorary Senior Lecturer, Department of Community Medicine, Monash University and Honorary Secretary/ Treasurer of WONCA.

College activities

Dr Fabb has been prominent in College activities since the mid 1960s when he became the first chairman of the Practice Management Committee of the College. In 1967, with Monty Kent Hughes and Robert Harbison, he mounted the first College examination, and has been intimately associated with the examination ever since. In 1971, he became the first editor of Australian Family Physician and the originator of the CHECK Programme of Self Assessment, both first published in February 1972. These responsibilities were combined with that of Examination Director into a full time post, the first educational post in the College.

In 1973, Dr Fabb was one of the architects of the Family Medicine Programme (FMP) and became Director of Education at its inception, a post he has held ever since. He has been involved in the development of FMP's training and educational programmes and assessment procedures for the last 17 years.

He has attended meetings of the Council of the College for a continuous period of 26 years.

Overseas consultations

Dr Fabb has undertaken many overseas consultancies, some for the World Health Organisation, and visiting professorships, and has been a visiting examiner in countries as diverse as Bahrain, Sri Lanka, Singapore, South Africa, Malaysia and Hong Kong, and was Canadian Commonwealth Fellow in Family Medicine for a period of 6 months in 1979. He was the College's representative on WONCA Council until he became Honorary Secretary-Treasurer of WONCA in 1980.

Special interests

Dr Fabb's special professional interests include medical education and assessment, computer assisted learning and assessment, and writing about and teaching concepts of family medicine and education.

He also takes a lively interest in current affairs, local and overseas, and enjoys reading The Bulletin and Time. He enjoys travel in Australia and overseas, photography and sailing.

Medical reading

His favourite family medicine books include Ian McWhinney's Introduction to Family Medicine, David Shires and Brian Hennen's Family Medicine, Robert Rakel's Textbook of Family Practice and John Fry's Common Diseases. He describes The Inner Consultation by Roger Neighbour as "the best book on the consultation I have read". For general medical reading he has a high opinion of Davidson's Principles and Practice of Medicine. To keep abreast of developments in family medicine he finds Australian Family Physician, Medical Education, Medical Teacher, Journal of Family Practice, Journal of the Royal College of General Practitioners, and the British Medical Journal valuable journals.

Single most significant medical experience

"This experience is offered because it shows how much can be done with limited facilities and support.

"While I was in country practice in the early sixties, one Saturday afternoon a 19 year old footballer was brought in complaining of pain in his chest after having been 'shirt fronted' in a local match. While examining him, I was alarmed to see him take several deep breaths and then stop, his body becoming completely flaccid. He had had a cardiac arrest.

"As I was alone in the surgery at the time, I called upstairs to ring the ambulance and colleagues in the next town, and then, using the only scalpel ready at hand, one with a tiny blade used for paring warts, I opened his chest and began internal cardiac massage, which was in vogue at the time. This was in the days before external cardiac massage had received any credence. Within a minute or so, the patient began to show signs of life. Breathing recommenced and voluntary movement began and became so vigorous that he attempted, not unreasonably, to pull my hand out of his chest. An ECG showed ventricular fibrillation.

"The nearest defibrillator was summoned from a hospital 40 km away, and after about 3 hours of cardiac massage, successful defibrillation was accomplished. Then there was the problem of how to transport this young man to an intensive care unit in Melbourne. We realised that we would have to be ready for any contingency on the way. The ambulance was decked out like an operating theatre with an anaesthetic machine to keep the patient anaesthetised, an ECG, a defibrillator and three doctors all cramped into the back.

In addition, because the early defibrillators could operate only from mains supply, we carried a 50 metre length of electrical cable so that we could plug into the electricity along the way if the need arose. And indeed it did.

About half way to Melbourne, the young man arrested again and internal massage was recommenced. Fortunately we were close to a small town. What happened next was one of the many amusing incidents I experienced in medical practice. The ambulance pulled up noisily to one of the houses, the ambulance driver ran out a length of cable and knocked on the door with the plug in his hand asking the woman who answered, "May I please plug this into one of your sockets?" The woman agreed readily but her husband, whose eyes were glued to the television watching football, did not, throughout this entirely extraordinary episode, take his eyes from 'the box'. This demonstrates either the power of television, or the commonplace nature of an ambulance man knocking on your door asking if he can plug into your electricity.

"The stop was a success, the heart was restarted, and the journey proceeded.

"Finally, we reached our destination at the intensive care unit. In the latter part of the journey we turned off the nitrous oxide and used only oxygen so that the patient by then was quite conscious and gesticulating that he was thirsty, much to everyone's surprise and delight. He had been intubated all this time and therefore could not speak, but made his intentions very obvious. Some 5 hours after the arrest, it appeared that no brain damage had occurred; the patient was aware of everything that was going on around him, and made appropriate responses.

"We left him in the care of the intensive care doctors and made our way back home, rather weary, but gratified at the outcome.

"Unfortunately, in medicine there is not always a happy ending. Over the next week our patient had a stormy time. Naturally he developed an infection where his chest had been opened, which was drained, and later in the week he had a further cardiac arrest which was reversed, and then another and another. Despite all the best efforts of his attendants, he finally arrested and could not be restarted. He died a week after his initial arrest.

"Why did such a young man have a cardiac arrest? The post mortem showed that he had had a myocardial infarction 3 weeks previously and a further one while he was playing football immediately before his initial arrest.

"This episode will always linger in my memory as a reminder that even very young men can have heart attacks. But it also reassures me how much can be done with few facilities so long as some competent helpers are available."

General Reflections

"My 'father in medicine' was Monty Kent Hughes, who engaged me to assist him in the early 1960s and who passed on to me his knowledge of general practice and medical education. He remained my mentor until he died. He was always an inspiration to me. Another very significant mentor was Clifford Jungfer. His knowledge, experience and political wisdom were, and still are, of great value to me.

"General family practice, and the discipline of family medicine, are at long last emerging from the slough of despond. All around the world it is recognised by governments and those who fund health care that general family practice is a cost effective form of health care and that family doctors must be specifically trained for their vital role. Opportunities for health promotion and the prevention of illness and disability abound in general practice and will provide general practitioners of the future with their most rewarding outcomes. There is no more exciting time to be part of the growth of family medicine than at present. It has been a very gratifying experience for me over a period of almost 30 years to see family medicine progress so steadily and now take its central place in the delivery of health care to the community."


Originally published in Australian Family Physician (AFP) Vol. 20 No. 2 - February 1991 pp192, 194-195

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