A life at the forefront of Australian general practice and medical education change
Emeritus Professor Alexander Lyon Arnaud Reid AM, known as Professor Sandy Reid, died in 2019 having spent a life at the forefront of Australian general practice and medical education change. In the 2005 Queen’s Birthday Honours list he was awarded Membership in the Order of Australia ‘For service to medicine as an academic, administrator and practitioner, particularly in the development of medical education and rural health in Australia’.1
Sandy was passionate about practising and teaching medicine, particularly communication in medicine. In his booklet on clinical skills, Not just a GP,2 he notes that he considered emergency medicine and general practice the most diffi cult of the specialties because of their enormous breadth, and he quotes Sir James Spence, ‘father of British paediatrics’:
The essential unit of medical practice is the occasion when, in the intimacy of the consulting room or sick room, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trusts. This is a consultation and all else in the practice of medicine derives from it.
After his death at the age of 89, Sandy’s ashes were scattered on Willans Hill, overlooking Wagga Wagga where he had lived for the last 20 years of his life.
His son Nicholas Reid said:
Sandy lived what might be called, in the words of one of his favourite books, a fortunate life. He cruised the West Indies as a surgeon lieutenant in the Royal Navy in the 1950s and pursued his interests in rural medicine and sailing in country Victoria in the 1960s. But he found his vocation as a medical educator in the then new medical school in Newcastle in the 1970s, and later at the University of NSW’s rural medical school in Wagga Wagga.3
Born in Birkenhead in 1930, Sandy spent his primary school years in Newcastle, England, where his father had moved to take up a chair in philosophy.
He spent his teens at Bryanston, a progressive private school in Dorset where he was sent during the war years to avoid incoming German bombers. Sandy had medical forebears on both sides of the family, stretching back to the 18th century, including a maternal aunt who was an early female medical graduate from the University of Edinburgh, so medicine was an obvious step. Sandy moved to St Bartholomew’s Hospital Medical College (Barts), the great teaching hospital in
London, to begin medical studies in 1948. He described Barts as having a ‘very strong humanitarian tradition’, an approach that he felt infl uenced his career and his advocacy for patient-centred consultation.4
After graduating with an MBBS in 1954, Sandy spent 12 months as a ‘house physician and house surgeon’ at St Bartholomew’s Hospital. He then signed up for four years as Surgeon Lieutenant in the British Royal Navy, spending time in Bermuda and the West Indies, where he acquired expertise in treating sunburn and venereal disease. During the Suez Crisis of 1956, he was on security detail for the Bermuda summit. He told the story of an episode during this detail in which, late one evening, Selwyn Lloyd, the British Foreign Minister, arrived back somewhat under the weather. ‘Are you armed?’ he enquired. ‘Yes sir,’ Sandy replied. ‘Well, there’s a chap comes and empties the dust bins outside my window every morning at about six. Shoot him!’ That was one order not followed.
In the West Indies, Sandy acquired a love of sunshine, and so, like many doctors of his generation, he came to Australia, sailing from London in December 1958 on the Orion – in Sandy’s words, as a ‘Ten Pound Pom’. This was an assisted passage scheme that came to be wholly funded by the Australian Government, where adults paid only £10 towards their fare. Australia provided a natural home to British doctors: there were greater job opportunities and in the late 1950s it was fi rmly in the British orbit. It rode on the sheep’s back, and rural centres were still economically and culturally vibrant. Sandy’s brother Alastair, a psychiatrist, had recently made the same move, becoming superintendent of the Sunbury mental institution in Victoria. Sandy’s brother-in-law, Hugh Carpenter, later a diplomat and medical attaché, followed soon after.
Rural general practice
Arriving in Australia in 1959, Sandy intended to become a rural general practitioner (GP). He worked first as a senior resident at Mooroopna Base Hospital, where he was accommodated in a small weatherboard cottage at the rear of the hospital:
When we arrived the fridge had been stocked with bread, milk, butter and cereal … the laundry was on the veranda with a water closet next to it. This was something of a luxury as most of the houses still had a bucket system emptied by the night soil man.4
Closed in 1974, and partially destroyed by fire in 2011, Mooroopna Base had been the main hospital in the Goulburn Valley area until the growth of nearby Shepparton. Shepparton Base Hospital, developed in the 1950s, eventually led to the closure of Mooroopna Base Hospital in 1974. At the time Sandy worked there, it was mostly run by GPs and residents, and there were only a couple of specialists across the Goulburn River in Shepparton. After leaving Mooroopna, Sandy worked briefly in general practice in Shepparton before moving to Colac in south-west Victoria in 1961.
In Colac he worked in a role that would now be described as rural generalism: the GPs ran the hospital with no residents, and responsibilities included major trauma, obstetrics and anaesthesia. A large part of rural general practice has always been becoming an accepted part of the community, and Sandy was no exception: he joined the local yacht club, played squash, chaired the committee to build a much needed kindergarten, ‘Wydinia’, and became heavily involved in the local theatrical society. Having a talent for accents, he won an award for playing a Welsh idiot.
But by 1969, he was looking for broader pastures, and answered an advertisement for a position at Belmont, on Lake Macquarie in New South Wales, a lake which he considered had the best sailing in Australia. He continued to work at the Belmont practice until 1989. The practice was notable for other GPs such as Dr Jill Gordon, who worked with him at Belmont and the University of Newcastle, before leaving to pursue an academic career at the University of Sydney. Sandy worked in one last general practice after he ‘retired’ to Wagga Wagga in 1997, working part time at the Kooringal Medical Centre until health, and the opportunity to work again in medical education, changed his direction again.
Through his work with the University of Newcastle School of Medicine, The Royal Australian College of General Practitioners (RACGP) and its Family Medicine Programme, and later through Coast City Country GP Training (CCCGPT) and the UNSW Rural Clinical School, Sandy promoted medical practice to generations of medical students and doctors in training.
It was in the mid-1970s, when there was considerable interest in developing another medical school in New South Wales, that Sandy found his true metier. He was part of the committee from the Central Northern Medical Association that successfully lobbied the Karmel Committee, chaired by economist Professor Peter Karmel, to recommend in its report on expansion of medical education that the site of an innovative new medical school should be Newcastle.5
In 1974 David Maddison was appointed the Foundation Dean of Medicine at the new Newcastle Medical School. Initially, Sandy was concerned about this, since Maddison had been the dean of the very conservative University of Sydney Medical School. But he quickly found that Maddison was keen to try something very new, and Sandy joined the planning committee. A vibrant group of academics, including Charles Engel, Rufus Clarke, Stephen Leeder and Tony Vinson, designed a medical curriculum from the ground up. Sandy described the curriculum as avoiding the compartmentalised teaching still common at that time, and focused on experiential learning, being designed to spiral around clinically relevant conditions. As well as having new structures for admission to medicine, the course favoured community-connected, problem-based learning.
When the first cohort of medical students began in 1978, Sandy was part-time Fellow in Community Medicine in the Division of Developmental and Social Medicine. General practice was not recognised as a separate department at Newcastle until Sandy became the Foundation Professor for General Practice in 1992. Despite this, Sandy quotes David Maddison as strongly supporting general practice training but feeling that ‘all too often the student would sit staring out of the window with no idea of what was really going on’. Maddison encouraged Sandy to develop a teaching program that required students to look at consultations from a number of viewpoints, then write up the
experience. Sandy developed prompts such as: ‘Discuss two cases you have seen where the doctor used time as a diagnostic management tool, and it was safe to do so’.
Sandy also attributed the Newcastle course with pioneering the use of country centres for teaching: sending groups of students to towns such as Maitland, Port Macquarie, Tamworth and Orange, where academic staff would visit to examine student skills with local clinicians. He strongly supported this, developing for students the Country term handbook, written in 1994. His years at Newcastle also involved collaborating in extensive primary care and general practice research, often related to behavioural issues such as smoking and drinking status and response to interventions. He was a researcher on numerous successful funding applications, ranging from National Health and Medical Research Council grants exploring the ‘Detection of psychiatric disturbance by general practitioners’ (1982) and ‘Development and evaluation of a women’s health programme’ (1991), to a study funded by the Commonwealth Serum Laboratories on inactivated influenza vaccine (1990).
His support of general practice was at an international level. In 1976 he was awarded a Kellogg Scholarship to visit various centres of excellence, looking mainly at the North American model of teaching general practice, visiting medical schools at Calgary and later Montreal and McMaster. He also had visiting professorships at the Chinese University of Hong Kong and at Halifax, Nova Scotia, and was visiting examiner at the Fiji School of Medicine. He was an early supporter of the World Organization of Family Doctors (WONCA), established in 1972, and attended a number of its conferences, including in London in 1986. When he ceased his work in part-time general practice at Belmont in 1989, he took a six-month sabbatical at Oxford, travelling also in Britain and on the continent, visiting various universities. In Sweden he spent time at Linköping. He felt Swedish medicine at the time was highly organised, with much more use of nurses than he had encountered elsewhere.
Links with the RACGP
Sandy sat the new RACGP Membership exam in 1972, four years after the first college exam was held, and become a Fellow of the RACGP (FRACGP) in 1974. He was a college examiner for the RACGP Fellowship examination from 1974 until 2012, and also examined with the Australian Medical Council for overseas-trained doctors from 1994. This era marked of the birth of the Family Medicine Programme and the concept that GPs would benefit from more formal training leading to Fellowship. The program took its first trainees in 1974, and Sandy worked with it from its inception, attending early meetings at Marysville, Victoria and becoming the first ‘area co-ordinator’ for the Hunter region between 1974 and 1982, and between 1985 and 1997 he was medical educator of the Wallsend Family Medicine Programme training unit. At various times he was on the editorial boards of the RACGP’s Australian Family Physician and the Australian Journal of Rural Health.
His long teaching career meant that he ran into previous students: two notable ones he remarked on were his treating cardiologist in Newcastle, and the first director of Greater Murray Rural Clinical School. Professor Mohammed Khadra, a urologist, had been a student at Newcastle. Not long after Sandy moved to Wagga Wagga, Professor Khadra was appointed the first director of the UNSW Greater Murray Rural Clinical School (now the UNSW Rural Medical School). When Professor Khadra left in 2002, Sandy agreed to take on the role of director of the still-young clinical school for three years.
After a new director was appointed in 2005, Sandy continued to teach within the school, and also became Senior Medical Educator for CCCGPT. Further, he become increasingly involved in preparing candidates for the FRACGP exam, particularly overseas-trained doctors. He was proud to have some of the best pass rates in the country. The work with CCCGPT led to two publications: I feel crook doc! and Not just a GP. The first of these was aimed mainly at overseas-trained doctors to acquaint them with some of the vernacular patients might use in the consultation room. As Sandy said in its introduction:
When I came to this country as a migrant from Britain I found that there were many Australian expressions which were quite new to me. I can imagine how difficult this must be for those of you for whom English is not your first language. This short guide may help. As a general guide however: if you do not understand what your patient is telling you, do not be afraid to ask.6
In 2015 the government moved general practice training away from regional providers; they were invited to tender to provide services and the tender went to GP Synergy, thus ending another part of Sandy’s teaching life.
Yachts and sailing were always part of Sandy’s life. During his time at Barts, many of Sandy’s friends were older students, returning to university after serving in the Second World War. In the holidays, they would often borrow or hire yachts and sail to France or the Channel Islands. Sandy once observed to a former naval officer friend that the lights of Southampton seemed unusually bright. They belonged to the Queen Mary, rapidly approaching and necessitating quick action.
Colac, where Sandy spent the 1960s as a GP, had the advantage of Victoria’s largest natural freshwater lake and an active yacht club. He sailed heavyweight Sharpies and became the second owner of the first fibreglass catamaran in Australia. Moving to work at Belmont meant living near Lake Macquarie, the largest coastal saltwater lake in the country and ‘therefore a very popular sailing centre from tiny sabots to sixteen foot skiffs and ocean racers that would access the ocean via the Swansea channel’. When Sandy first arrived at Belmont he sailed on Wednesday afternoons with Keith Cocking, who worked with him as a GP in Belmont7 and who had an ‘oldish’ yacht. Soon after, Sandy bought the hull of a 23-foot fiberglass yacht, which he rigged and fitted it out. Sailing was a part of his life until increasing back problems forced him to sell his yacht to one of his crew.
During his naval years, Sandy met his first wife, Ardyne (who was also in the navy), during rehearsals for a play. The marriage ended while he was living in Newcastle and he married Rae. They remained at Newcastle until ill health forced him to retire, for the first time, in 1996. When an artificial heart valve saw him returned to good health, he and Rae moved to Wagga Wagga to be nearer Rae’s daughter Justine. Sandy is survived by Rae; his former wife Ardyne; his sons Nick, a historian of ideas, and Hugh, an emergency physician; his stepchildren Justine and David, both highly successful business owners; and a number of grandchildren. Nick has noted that, despite his descent from John Knox and a host of Presbyterian ministers, Sandy was an atheist and not expecting an afterlife.
I first met Sandy when I was a young Family Medicine Programme trainee working in its New South Wales Office as Trainee Liaison Officer in the 1980s. We met again 20 years later, when I taught general practice and population health for the fledgling UNSW Rural Clinical School in Wagga Wagga. In his role as director of the school, Sandy provided a steadying influence and a wealth of general practice and medical education experience.
– Associate Professor Catherine Harding
Wagga Wagga Rural Clinical School,
University of Notre Dame Australia
These notes could not have been completed without the information provided to me by Professor Reid’s sons, Nicholas and Hugh Reid.
- Department of the Prime Minister and Cabinet. Australian honours search facility. Professor Alexander Lyon Reid. Canberra: PM&C, 2020. [Accessed 13 February 2020].
- Reid ALA. Not just a GP. Wagga Wagga, NSW: Coast City Country GP Training, 2013.
- Nicholas Reid. Personal correspondence to author. Email, 21 January 2020.
- Professor Sandy Reid. Personal notes, 2016.
- Committee on Medical Schools to the Australian Universities Commission. Expansion of medical education: Report of the Committee on Medical Schools to the Australian Universities Commission. Parliamentary Paper no. 110. Canberra: Government Printer of Australia, 1973. [Accessed 13 February 2020].
- Reid S. I feel crook doc! Language, cultural issues and etiquette in the Australian consulting room. Wagga Wagga, NSW: Coast City Country GP Training, 2005.
- Knox EG, editor. Medical directory of Australia 1980. 18th edn. Glebe, NSW: Australasian Medical Publishing, 1980.