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Points North, Tasmania

'General practice' it was indeed

The practice I joined as a newly appointed fugitive from the English climate and health service dates back to the 1920s, when two local doctors put up their plate in the little seaside town that was to be and remains our home.

Even then, some 40 years later, they were still kindly remembered, one for his devotion to the local football team and robust management of its related injuries, the other whose name was always prefixed by the words 'poor old' for the imposing house he built, still in part occupied by his widow, together with a tennis court behind it.

The town was base and market for the surrounding countryside. On sale days the yards were thronged with local cattle and local butchers, the streets and pubs with farmers, and the surgery with their wives, while the local brass band warbled away on the site of the old post office.

The town boasted a brand new hospital (opened shortly after but not in consequence of my arrival), built to replace the ancient wooden edifice where our predecessors performed, as a matter of course, surgical manoeuvres now reserved for a host of separate and stringently certificated specialists. Here too babies were born into the world while ageing and ailing citizens were ushered out of it among the company of friends and the kindly care of local nurses.

'General practice' it was indeed, and a daunting prospect for the newcomer unaccustomed to the scope and responsibilities expected of him. 'Can't you fix it Doc? You're the Doctor aren't you?'

Even so, we all enjoyed the use and stewardship of ‘our' hospital – 'ours' being us and the town at large, of course. The hospital was staffed by local farmers' wives, refreshing nursing skills and certificates in domesticity and child rearing acquired before marriage. They were mature, worldly, wise and level headed women, and their daughters made excellent auxiliaries.

Here every weekday morning doctors, staff and ancillaries met and mingled, meals on wheels were cooked and distributed via volunteer drivers, domiciliary nurses dispatched, specialist clinics held, casualties patched up or forwarded to more sophisticated places. Here at weekends the hapless duty doctor saw to injured footballers, dealt with drunks and passing strangers, road accidents, overdoses accidental or intentional, all the traffic of our diverse trade.

Upstairs the beds were taken by the sick, the sad, the distraught, the diagnostically uncertain, those convalescing from major ailments treated in more sophisticated places and those seeking respite from the burdens of age and incapacity.

Here the local businessman could bridge the gap between intensive care and home and keep in touch with his affairs; the would be suicide (always at a weekend it seemed), born of adolescent impulse and parental incomprehension, could talk it out without stigma or embarrassment; the head injury could be observed; recovery could be made from major surgery performed elsewhere; and all the small change of doctoring too difficult for home and too trivial for the regional hospitals some miles distant on either side of the town.

Downstairs, the maternity unit, GP run and midwife managed, catered for the increase of the town, while an adjacent geriatric section gave relief to overburdened families.

Our experts were not so much specialist as consultant, known and respected colleagues ready to advise without trespassing on our domain who pulled our clinical chestnuts out of the fire and were not above consulting on our premises.

For our turn we took on extra commitments, management of the simpler fractures from X-ray to rehab, and a naesthetics extending even to the ancient dental chair where our adjacent toothies tidied up the ravages of too much sugar, too little toothpaste and no fluoride at all. We took on 'office procedures' microscopy, culture and sensitivity testing, a degree of serology, and minor surgery, including a brisk line in vasectomies.

We were not alone. Throughout the island similar groups embedded in and caring for their communities widened their scope and honed their skills to meet the challenges of family care.

To keep us up-to-date, the neighbouring specialists and visiting experts – sometimes drug company sponsored, sometimes at our own expense – steered us gently into modernity.

A medical society formed and, funded by our medical community, imported prestigious visitors from the outside world to wine, dine, lecture and lodge with one of us for the weekend. My wife has never quite forgotten encountering a sports medicine guru emerging stark naked from the shower.

“That's all right,” he said “I'll close my eyes.”

Official support services were fairly thin on the ground in those days. The child care officer, a minute and dynamic Scottish lady, quartered the countryside in a Volkswagen not infrequently with a baby on the back seat. The police lent their presence when “the doctor” cajoled an armed and muttering psychotic into safer surroundings, while the ambulance service (first voluntary then professional) were always willing, prompt, cheerful and efficient. The fire service (also voluntary) responded with alacrity to calls – even to the doctor's residence on three occasions to extinguish a chimney fire – without reprimand or complaint.

Times changed

Our little hospital was dismembered, ransacked and given over to desk bound administrators. We watched with jealous eyes the intrusion of dedicated clinics and services on our domain; we learnt that lawyers, or the fear of them, now dictated our scope and practice, that paramedics and casualty departments were the front runners in emergency care.

One by one we welcomed our successors. We learnt, as old dogs sometimes can, a few new tricks and strove to adjust to a newer world of double income families and unassured employment, day nurseries and fast food, supermarkets and super specialists, litigation and protocol. And with it unthought of advances in our field: implant and bypass, oncology and transplant, the very restoration of life itself.

What did we gain, what did we lose, in that all consuming way of life? On the plus side: a sense of belonging and commitment to our little world, a staff whose loyalty survived the transfer from a gloomy concrete warren to custom tailored premises complete with ergonomic chairs they never sat on and a computer they never let us play with, who could tell you more about our patients than a brace of social workers, who could and did spot a battered child from the way it shrank from its mother on being returned from the X-ray cubicle. Above all a wife adept at holding the fort in your absence, resigned to an intrusive telephone beside the bed and inured to a cold back in the small hours of the morning.

What did we lose? Time, leisure, sleep and sometimes temper. It was the family that bore the greatest loss – an absentee father, a disgruntled dad who couldn't make it to the prize giving.

No doubt those who follow will come upon our discarded instruments and obsolete textbooks lurking in the bottom drawer of the desk they took over. They will wonder at our wasting time in home visits, risking catastrophe or retribution in uncertificated procedures and unauthenticated advice.

'It's not the same,' we greybeards mumble.

How can it be? The world's moved on.

But it was fun.

Dr John Stephens

The views expressed by the authors of these articles are their own and not necessarily those of the publisher or the editorial staff and must not be quoted as such. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication.