As the RACGP’s new Victorian Corlis Fellow, Dr Jan Sheringham hopes to see a continually evolving general practice.
General practice extends beyond the four walls of the clinic for many Australian GPs. Whether it is visiting patients in residential aged care facilities or advocating for a political cause, primary healthcare encompasses a wide range of activities.
Victorian GP Dr Jan Sheringham has spent more than 40 years in rural general practice and continues to work outside of the consulting room to help build and reshape the profession she loves.
Sheringham grew up in the central Victorian town of Bendigo before moving to Melbourne to fi nish high school. She then started medical school at Monash University.
‘I decided to go for medicine in Year 11 because you had to choose subjects and I had a good scientifi c and maths background,’ Sheringham told Good Practice. ‘I looked at the things I liked and the things I was good at, put them together and thought about what role I could get into that would marry the two together.
‘Medicine was the obvious choice.’ Sheringham excelled in surgical training during her time in university, but ultimately decided to pursue a career in general practice.
‘I fairly seriously considered going on and doing surgical training because I do enjoy that sort of thing and I did a lot of surgical assisting,’ she explained. ‘As a fourth-year student, when I wasn’t in lectures, I was in casualty all the time.
'[But] I knew early on that I wanted to have a private life and have kids. General practice allowed me to do the best of all the aspects of medicine, including surgery, and it allowed me that ability to have kids.’
Enticed by the prospect of having matching clinical rosters with her new husband, fellow GP Dr Tony van der Spek, Sheringham accepted a medical training position in Bendigo.
We had to do general practice placements in university, so I decided to make contact with people in Bendigo,’ she said. ‘[Tony and I] fi nished up in a small group practice and really enjoyed it because we both worked with different doctors in the same practice. That was how our exposure to rural general practice started.
‘There is no question that if you have a rural bent and you don’t particularly like living in the city, then it is great to be able to return to work and live in the country and be part of the community.’
Sheringham was a GP in Bendigo for more than four decades and has been involved with rural locum work since her retirement from a fi xed attachment.
‘I know it can be really hard to fi nd someone to take over for a short period when [rural GPs] need a break or need to go and upskill in a certain area,’ she said.
‘I normally spend a couple of weeks in each place and I have been to several practices around Bendigo, and around rural and remote Victoria as well.’
This continued commitment to the general practice profession was one of the reasons Sheringham was named the Victorian Corlis Fellow in late 2014 following the retirement of Dr Graeme Jones.
The RACGP’s Corlis Fellows are experienced GPs from each state faculty who provide advice, regional leadership and support, act as a local mentor, and liaise with universities, regional training providers and other general practice organisations.
There are a number of areas in which Sheringham hopes to offer her expertise.
Sheringham hopes to offer her expertise. ‘I certainly want to help the RACGP ride out this current issue with training and education that the Government has thrown up by not defi ning the RTP [regional training provider] situation,’ Sheringham said.
‘There are a number of students and registrars and residents thinking about not getting into general practice given the level of uncertainty.
‘The profession is facing great threats at the moment – not all to do with the Government – but there are areas that are challenges for everyone in the sector.’
As the Federal Government contemplates training programs for GPs, Sheringham believes junior doctors and registrars are not necessarily as well equipped as they could be in areas such as surgery.
‘For today’s younger doctors there is a huge problem because, in their fi rst year out, they are often left on the ward while the registrars and the junior residents go with the surgeon,’ she said. ‘They very rarely get to see the inside of a theatre.
‘It is just not enough and you really have to capture their interest very early on.’
Challenges to general practice
As in most professions, technology has signifi cantly evolved within general practice and the computer is an indispensable piece of equipment in the consulting room. Making the most of computers and their software, however, remains an area in which some GPs can benefi t from developing their skills.
‘I am going around other practices and seeing the levels of things not being done correctly,’ Sheringham said.
‘GPs often don’t realise what the system can do for them if they use it properly and that, ultimately, it can make their clinical lives much easier.’
A signifi cant shift in patient demographic is another challenge for GPs, with growing numbers of older patients now requiring more consulting time.
‘I was at the same practice for over 40 years and I aged with my patients. This can be said for many GPs out there and will continue to happen,’ Sheringham said.
As GPs age along with their patients, Sheringham believes healthcare professionals have an obligation to continue treating them, even after they have moved into an aged care facility.
‘If you have looked after that patient up to that point, it is your responsibility to take them through their fi nal stages,’ she said. ‘That is a real tragedy for so many patients and ultimately leads to the deskilling of general practice. A lot of the doctors now don’t know how to deal with dying patients and their family members.’
The confusion around using suitable and correct Medicare item numbers is something Sheringham also hopes to look at as a Corlis Fellow.
‘There is an issue going on around using the many item numbers that we have already got more appropriately,’ she explained. ‘I don’t think enough GPs use the CDM [chronic disease management] item numbers as we should.
‘If you are not using those correct item numbers then you are actually missing out because you end up using time to see the patients face-to-face for absolutely no remuneration.’
Sheringham has been heavily involved with various medical organisations such as the RACGP and a number of Medicare Locals during her 40 years in general practice. She cites the current political landscape surrounding the Federal Government’s funding for general practice as a key reason more GPs should get involved with medical organisations.
‘If you want to control the direction of general practice and the way your patients are going to be cared for, and not have that subjugated to regulations and restrictions, then you have to be part of coming up with a solution,’ Sheringham said.
Sheringham believes the current discussion around general practice rebates should focus on appreciating GPs’ work in the community.
‘GPs have to value their services appropriately and put it on a comparative level where their skills and provision are with other service providers in the community,’ she said.
‘People in the community appreciate their GPs and know how hard they work for them, and it is about time they stop undervaluing their own services.’
First published in Good Practice May 2015 20 -21