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C a n b e r r a D o c t o r i s p r o u d l y b r o u g h t t o y o u b y t h e A C T A M A

Volume 19, No. 6

July2007

To celebrate Family

Doctor Week, PLONK

is offering a Wine

Tasting Night for GPs.

Thursday 26 July from6:30pmPlonk, Shop 10,

'M' Centre,

Palmerston Lane, Manuka

RSVP: AMA ACT6270 5410

Tuesday 24 July

Woden 6282 2888 Deakin 6124 1900 Tuggeranong 6293 2922 Civic 6247 5478 A member of the I-Med Network

Dr Jeremy Price | Dr Iain Stewart | Dr Suet Wan Chen | Dr Malcolm Thomson | Dr Fred Lomas | Dr Paul Sullivan | Dr Ann Harvey | Dr Robert Greenough

Due to popular demand, NCDI is hosting a second education evening on

“Shoulders & Bone Mineral Density Test Up-date”Presenters: Dr Iain Stewart • Dr David Hughes • Dr Rajeev Jyoti

Tuesday 14th August 6pm at Canberra Business Centre, Regatta Point.All welcome. For more information please phone Tony Dempsey on 0437 141 748

Special offer for the month of August – $70 BMD tests!

The Great BrumbiesRobbery

A great social night washad on Saturday 30th June atOld Parliament House, with thecombined Medical Ball. Finefood, music and a lively auc-tion- in which over $20,000was raised for charity. ABrumbies jersey was on auction- but on the following Mondayit had disappeared! Was this asilent sleeper cell creatinghavoc in Canberra? No, we justforgot that it had been put

behind a door, and securityduly found it on Tuesday.

Another highlight were twosongs from the Medical StudentReview featuring profoundlyrics such as (to the tune of“Goodbye my Lover” by JamesBlunt) “Goodbye my Liver, Youwere my Friend, YouDetoxified me to the End”.Many thanks to all the organis-ers, including Christine andElizabeth from AMA.

Look for the photos in thenext edition of “Canberra

Doctor” and maybe we’ll seeyou there next year!

Family Doctor WeekThis years’ theme will be

GPs: Part of the Family. We willbe doing a primary school visitand emphasising the impor-tance of the Family GP, healthyeating and regular exercise andsport. General Practice contin-ues to be the central plank ofour health system, and in myopinion continues to be under-valued. Ongoing concerns are

the lack of CPI price rises ofthe MBS, failure of item num-bers to adequately compensatefor the management of com-plex chronic diseases thatrequire longer consultations,the failure to classify all ofCanberra as an area of need,and ongoing red tape to accessPractice Incentive Payments.However AMA has had somewins including extra afterhours item numbers, and sig-nificant increases in VeteransAffairs remuneration.

AMA ACT President’s letter

Katy GallagherIt is fitting that theAMA’s annual celebra-tion of general practiceis named FamilyDoctor Week. Whileknown as GeneralPractitioners, our localGPs truly are familydoctors. They see ourbabies grow intoadults, they treat us forcolds and flu’s, managepatients with chronicdiseases, help us quitsmoking, keep an eyeon our mental wellbeing and are availablefor that last minuteappointment when afamily member is ill.

I’m lucky to have a fantasticGP (and GP Practice) for myown family who I rely on forhelp when the children are sickbut also for advice, assistanceand a good chat when timeallows. I know through my ownexperience as a fairly frequentuser of GP services, along withmy responsibilities as HealthMinister, that GP’s in the ACT,despite dealing with everincreasing workloads and otherworkforce pressures always gothat extra distance for theirpatients.

Whilst the ACT Govern-ment has a limited role inGeneral Practice we do recog-nise that GP’s are our key part-ners in our efforts to deliver thebest possible health care systemto the people of the ACT.

As often the first point ofcontact, the family doctor isuniquely placed to treat prob-lems before they become acute,and connect patients with thebroader health system. The slo-gan for FDW this year reflectsthis - "GPs Keeping AustraliaHealthy".

The role of Primary HealthCare is a key element of thework being undertaken in plan-ning for the future strategicdirection of ACT health. TheGovernment has been workingin partnership with communityand key stakeholders, particular-ly General Practitioners, theAMA and Division of GeneralPractice to progress this work.We already have a PrimaryHealth Care strategy that we arein the process of implementingbut we need to ensure that thiswork compliments other plan-ning work that is being done at

the moment particularly aroundkey priority areas to focus onand our city’s future infrastruc-ture needs.

Whilst the acute end of thehealth system will alwaysdemand more resources andincreased capacity, as a govern-ment we are also trying to meetthe health needs of our commu-nity within the community. Thisyears health budget exceeds$800million per annum for thefirst time and whilst the newmoney available has been target-ed towards more acute capacity,particularly in relation to elec-tive surgery and bed capacity, wehave also been able to target newmoney to youth health services,community based mental healthservices, initiatives to supportchronic disease managementand a new program to improvesupport to vulnerable families –particularly those with newbabies.

In relation to chronic dis-ease management this year’sbudget builds on previous budg-ets, with two million dollarsover four years to enable theearly detection of chronic dis-

eases. This funding will supportinitiatives to provide early inter-vention for patients with newlydiagnosed chronic disease, sup-port better disease managementprograms for people at risk, andprovide referral pathways. Thiswill include a direct mail pro-gram, risk factor awareness andpromotion of GP health checks.

As Minister for Health, I amvery aware of the work that isbeing done right across ourhealth system to improve andrespond to the changing healthneeds of our community. Thereis more work to be done as westrive to deliver, in an environ-ment where growth in demandand complexity of patient needcontinues to increase. I havebeen very impressed with thelevel of care, committment andpassion that I have seen as I havemet and talked with doctors ingeneral practice and in the hos-pital setting over the past year. Ilook forward to continuingthose discussions and workingwith you all over the next year.

Happy Family Doctor week!

Dr Andrew Foote.

Katy Gallagher

2 J u l y 2 0 0 7

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Family Doctor Week – a cause for celebration

AssistingCanberraDoctors andtheir families too!The Medical BenevolentAssociation is an aid organisationwhich assists medical practitioners, their spouses and children during times of need.The Association provides a counselling service and financialassistance and is available toevery registered medical practitioner in NSW and the ACT.The Association relies on donations to assist in caring for the loved ones of your colleagues.

For further information please phone Mary Doughty on 02 9419 7062

3J u l y 2 0 0 7

Guest editorial:Dr Alex Stevenson, adoctor in trainingwho has decided ongeneral practice forhis medical career.Alex is a member ofthe ‘Canberra Doctor’committee and amember of the AMAsCouncil of Doctors inTraining writes:Bread(th) and theodd glass of wine.

“I’m going to enrol in theGP training program”. Thisstatement evokes many respons-es among my junior colleagues,including that of sympathy. Thisbegs the question why such aresponse?

I would like to think of it asa positive decision rather than adefault option. There have beenmany factors influencing mycareer decision and I would liketo explore them now.

Most students enteringmedical school don’t have a firmidea about what career path theywill follow. In fact most internsdon’t know what area theywould most like to end up in.Students in their clinical yearsrotate through all of the majorspecialities and some of the sub-specialities. When I was at med-

ical school most students onlyspent a matter of weeks in GPplacements. In fourth year Ihappened upon a free lunch thatwas not, for once, sponsored bya drug company but by the ruralclinical school. I left with a fullstomach and on the list to spenda year in the country in a ruralgeneral practice.

This experience changedmy whole outlook on medicine.

I had the opportunity to seefirst hand the true role of the GPin the community, the holisticcare, right from deliveringbabies to looking after theirgrandparents in the aged carefacility. I saw how caring for acommunity was being morethan a diagnostician. Of course,we mustn’t forget the free casesof wine regularly received (myplacement being in the ClareValley meant this was a promi-nent feature).

While other students in thecity were at the back of a ward-round of countless people, I hadno one to fight with to get expe-riences. Some of my friends didnot deliver a single baby in theirobstetric rotation; the only thinglimiting me was how manytimes I wanted to get up in themiddle of the night.

Rather than the hierarchicalstructure of the hospital, theGPs in the practice became col-leagues and friends. We talked,over many glasses of famousClare Valley Riesling, about thegreat challenge and satisfactionof having a working knowledgeof all facets of medicine.

Once I finished this year inthe country I continued rotating

through the hospital for the restof my degree and into my internyear. By and large I enjoyedthese terms and learnt lots ofgood medicine, but when Ithought about pursuing each asa career I wondered whether itwould be enough for me.

This year, working part timein the emergency department, Iagain realised my interest in thebreadth of medicine. Not know-ing what type of problem willwalk in the door next. Throughthe ED I have met GPs whowork part time in general prac-tice and who participate inresearch, education, publichealth, government policy andspecial interest clinics. Best ofall they can work as much or aslittle as they like and, if theychoose, they don’t have to inter-rupt their sleep with work!!

Perhaps, it is my colleagueswho should be receiving sympa-thy for wasting the best years oftheir lives in the rat race of spe-cialist training without havinghad the opportunity to realisejust what are the benefits of gen-eral practice.

Dr Alex Stevenson

4 J u l y 2 0 0 7

Enduring Powers of AttorneyProfessor BernardPearn-Rowe, con-venor of the AMAsCouncil of GeneralPractice, andProfessor, ClinicalYears, College ofMedicine, Universityof Notre Dame,Western Australiawrites on: the AMAsCouncil of GeneralPractice

A cynic once asked whymany of my GP colleagues spentso much time in Canberra andon teleconference with otherdoctors around the country.

“Is it the sense of power?”he asked, “or is it just that youneed something to do?”

“And what do you do allthe time – sit around talkingabout fees and protecting yourturf?”

Though this is an extremecase of ignorance, the sad thingis that my skeptical friendexpressed a view that has someresonance around the countryand he wouldn’t be alone inmisunderstanding our purpose.

What is the AMA Councilof General Practice? It’s aCouncil composed of GPs of allinterests and backgroundsthroughout Australia, men andwomen, rural and urban, olderand younger. It’s the peak bodythat independently representsGPs practicing across the coun-try. It’s supported by a dedicatedfull-time secretariat, based inCanberra within walking dis-tance of Parliament House.

The old adage, ‘if you wantsomething done, ask a busyman’ is never more true andmembers of the Council. Allhave multiple areas of responsi-bility where they bring time andexperience to the issues beforethem. There isn’t a member ofthe Council who isn’t stretchedby the matters competing forhis or her time. Need some-thing to do? Give me a break!

But what motivates thesealready busy people to give upweekends and evenings in serv-ice to the Council? In threewords – caring for patients. It’spatient care that motivates theCouncil. A desire to improvehealthcare throughout ourcountry, to highlight inequitiesand to oppose often misguidedactions by government tostretch the health dollar toothinly.

Yes, the AMA is an industri-al body and it would be dishon-

est to pretend that fees and con-ditions of service are not part ofour brief. But they are a smallpart occupying less than 10% ofthe Council’s deliberations.

When previous govern-ments decided that Australiahad sufficient doctors andreduced medical school places,it was the AMA who protestedthe loudest. It’s taken time, butthe stupidity of that policy isnow recognised.

Who took to governmentthe safety net principle to pro-tect the chronically sick andunderprivileged? GPs on theAMACGP !

When the parlous state ofhealthcare of legal refugees wasrecognised, who lobbied gov-ernment, winning new regula-tions to vastly improve theiraccess to services? AMACGP.

Who focussed governmentattention on the denial of basicmedical care to detainees? Whomaintains pressure on govern-ment to increase healthcarespending as the Nation experi-ences ‘the greying of Australia’and medical needs increase?

Governments look to thenext election, but the AMACGPlooks beyond to the future ofhealthcare in this country. Beingtruly independent, it cannot besilenced by threat of sanction orwithdrawal of governmentfunding. It looks at the biggerpicture, not just political expe-diency, and short-term budgetstretching.

My friend was right in onesense – it is the power, but notin the way he meant. Throughthe AMA, the AMACGP is themost potent patient advocate inthe country. The Council ofGeneral Practice has the powerto raise awareness through themedia and to lobby directly togovernment. As in the past, thispower is used responsibly andjudiciously for the good of ourpatients.

Caring for patients – it’swhat doctors do, whether at avery personal level in consult-ing rooms, or on a Nationalbody like AMACGP.

Guest editorial:

A News Magazinefor all Doctors

in theCanberra Region

ISSN 13118X25Published by the ACT Branchof the AMA Ltd42 Macquarie St Barton(PO Box 560, Curtin ACT 2605)

Editorial:Christine BrillPh 6270 5410 – Fax 6273 0455E execofficer@ama-act.com.au

Typesetting:DFS Design GraphixPO Box 580, Mitchell ACT 2911Ph/Fax 6238 0864

Editorial Committee:Dr Ian Pryor – Chair/EditorDr Jo-Anne BensonDr Keith BarnesMrs Christine Brill –Production ManagerDr Ray CookDr John DonovanDr Jeffrey LooiDr Peter WilkinsDr Alex StevensonMs Gemma DashwoodMr Stefan Baku

Advertising:Lucy BoomPh 6270 5410 – Fax 6273 0455Email accounts@ama-act.com.au

Copy is preferred by Email to execofficer@ama-act.com.au oron disk in IBM “Microsoft Word” orRTF format, with graphics in TIFF,EPS or JPEG format.

Next edition of Canberra Doctor –August 2007

Professor Bernard Pearn-Rowe

The Powers of Attorney Act2006 (Act) came into force inthe Australian Capital Territoryon 30 May 2007 replacing thePowers of Attorney Act 1956.From 30 May 2007 any powersof attorney created will need tocomply with the requirementsof the Act. The focus of this arti-cle is on changes related toenduring powers of attorney.

The Act provides that anadult (the principal) may, bypower of attorney, authorise oneor more people (the attorney/s)to do anything for the principalthat the principal may lawfullydo. Unlike a general power ofattorney, an enduring power ofattorney continues to operateand is not revoked by the prin-cipal becoming a person with'impaired decision makingcapacity' which will be the caseif the person cannot make deci-sions in relation to the personsaffairs or does not understandthe nature or effect of the deci-sion the person makes in rela-tion to the person's affairs.

A principal has the capacityto give (or revoke) a power ofattorney under the Act if the

principal is capable of under-standing the nature and effect ofmaking the power of attorney.In essence this means that theprincipal must be able to under-stand the extent of the powerthey are giving to an attorneyand the capacity of the attorneyto use such power. The Actassumes that a principal doesunderstand the nature andeffect of the power of attorneyunless there is evidence to thecontrary. The major develop-ment is that an enduring powerof attorney needs to be wit-nessed by two witnesses at leastone of which must be a personauthorised to witness a statuto-ry declaration such as a solicitoror police officer. In additionboth witnesses must give a cer-tificate stating that at the time ofsigning the power of attorneythe principal appeared to under-stand the nature and effect ofthe power of attorney. This maycause some witnesses to bereluctant to sign a power ofattorney where there is anydoubt in relation to the princi-pal's capacity.

Under an enduring powerof attorney a principal mayallow an attorney to do any-thing in relation to propertymatters, personal care mattersand health care matters. Inessence an attorney can makedecisions in relation to the prin-cipal's financial affairs, livingarrangements and medical treat-ment. This power is subject tolimitations specified by theprincipal.

The appointment of anattorney is only valid where theattorney accepts the appoint-ment by signing the enduringpower of attorney. Attorney'sshould recognise they are takingon significant obligations andthat they can be held personallyliable to the principal if they failto comply with the Act. Forexample an attorney mustrecognise a principal's wisheseven where those wishes canonly be determined by havingregard to past actions.Alex NichollsLawyer ph62253031Minter Ellison Lawyers

From the AMA ACT Industrial Officer:The Australian Government has published the workplace relationsFact Sheet, which employers must provide to all new employees withinseven days of their commencing employment, and to all existingemployees before 4 October 2007. The Fact Sheet is available on theinternet at: http://www.workplaceauthority.gov.au/docs/EMPLOYERS/FactSheet/FS-WR-020707.pdf or by telephoning the WorkplaceInfoline on 1300 363 264.

5J u l y 2 0 0 7

Prof NicholasGlasgow, 2nd Deanof ANU MedicalSchool, writes for‘Canberra Doctor’.

Professor Paul Gatenby,Foundation Dean of the Collegeof Medicine and Health Sciencesat the ANU and FoundationDean of the ANU MedicalSchool will step down as Deanon the 28th January 2008. I amhonored to have been appointedto follow him in these roles.

I graduated from theUniversity of Auckland Schoolof Medicine and entered full-time general practice inAuckland in 1983. In additionto my general practice role, Ideveloped a number of differ-ent areas of special interestincluding addiction medicine(I was a flying doctor to adetoxification unit situated inthe Hauraki Gulf for 5 years),on call services for the policeforce, geriatric medicine, andthe delivery of home based pal-liative care.

My interest in academicpursuits developed from myrole with the Royal NewZealand College of GeneralPractitioners as “Part 1 Censor”for its national examination.The issues of assessment and

certification of competencestimulated a research interestin the cognitive and behaviour-al aspects of clinical decisionmaking.

In 1993 I took up a posi-tion at the newly establishedFaculty of Medicine and HealthSciences within the Universityof the United Arab Emirates.This proved to be a life-chang-ing experience in many ways –not only the exposure to a richdiversity of cultures but alsothe wonderful opportunitiesthat arose from being part of arichly resourced new medicalschool. International leaders inmedical education werebrought to the Emirates to con-duct workshops and confer-ences. I also had time to under-take research (I wrote my doc-toral thesis during this time),publish papers and develop ateaching portfolio.

I came to Canberra in 1997as Associate Professor of GeneralPractice at the Canberra ClinicalSchool leading the developmentof the community and rural pro-grams for the Canberra ClinicalSchool and then the ANUMedical School. My researchactivities focused on asthma andrespiratory health. In 2003 I wasappointed Professor andDirector of the AustralianPrimary Health Care ResearchInstitute at ANU. The researchagenda of the Institute focuses

on health services research andthe nexus between research evi-dence and policy formulation.

So what will my appoint-ment as Dean mean for theANU Medical School? Beingappointed to this role from ageneral practice backgroundhas been unusual in an histori-cal sense. However, this is nolonger the case. Of the 18 cur-rent Deans in Australia, sixhave a general practice back-ground. This is a good thing forthe discipline of general prac-tice as it makes it clear that acareer choice in general prac-tice does not exclude peoplepursuing senior medical schoolroles. A Dean’s role, however, isnot directed at the clinicalbackground of the Dean. It isfocused on leading the MedicalSchool in such a manner thatquality education, research andservice outcomes are realisedacross the whole faculty - clini-cal and non-clinical.

The ANU has clearly articu-lated a vision for the universityin the document ANU by 2010.Professor Gatenby’s leadershipof the ANU Medical School hasput it in a very sound position.Our faculty includes interna-tionally renowned researchersand educators and benefitsfrom the enormous goodwilland tangible support of keypartners including ACT Health,the Australian Government

Department of Health andAgeing, NSW Health and themany clinicians in Canberraand the Capital Region whowillingly teach into the pro-gram and provide placementsand educational opportunitiesfor our students. The curricu-lum is established.

From this sound base, I seemy role as leading the Schoolinto its next phase and deliverexcellent research, teachingand service outcomes thatmaterially benefit health out-comes and health services inthe ACT and Capital Region,the nation and beyond. How

will this be done? Careful andinclusive strategic planningprocesses will establish clearlyarticulated objectives for theSchool. These high level objec-tives will be translated intomeaningful and achievableactivities for the different unitsof the faculty and individualfaculty members. Processes willbe developed that encouragededication, focus and commit-ment across the faculty toachieve the goals, and redirectactivity in the light ofinevitable unforeseen develop-ments. I look forward to meet-ing these challenges with you.

Professor Nicholas Glasgow

Guest editorial:

6 J u l y 2 0 0 7

ACE study launches in canberra

The study is a sequentialcohort study with 90 subjects ineach of the control and inter-vention arms. The subjects mustbe aged between 18 and 70 yearsof age, be residents of the ACTand involved as a driver or pas-senger, in a motor vehicle acci-dent that happened in the ACTless than 7 days ago, with onlyminor to moderate injury. Thesubjects are recruited with theassistance of the Accident andEmergency Departments ofCalvary Hospital and TheCanberra Hospital.

Recruitment for the controlarm began in September 2006and was completed by mid-May2007. The intervention arm willcommence in July 2007 andshould be completed by the endof the year.

All patients recruited intothe study will be assessed and

monitored using general healthand well-being rating scalesincluding the Short Form 36Health Survey (SF36), theFunctional Rating Index (FRI)and the Hospital Anxiety andDepression Score (HADS).These functional scores will betaken at baseline, at 6 monthsand 12 months.

During the control arm,patients will simply be moni-tored without any specific inter-vention to see how they are cop-ing following their accident,how soon they get back to workand how soon they return tonormal levels of function.During the intervention arm,patients will be offered theopportunity to be assessedpromptly (hopefully within 72hours but certainly within 7days) in the ACE Clinic. It isenvisaged this early intervention

via treating specialists who canindividually assess, providetimely advice and informationto patients will deliver improvedhealth outcome and helppatients play a greater role intheir recovery.

The ACE Clinic, with DrDavid Hughes as MedicalDirector, has been established inthe John James Medical Centrespecifically for the purposes ofthis study. Treatment will not beprovided at the clinic; the clinicwill simply be used for assess-ment, advice and educationalpurposes. The patients will bereferred back to their ownGeneral Practitioner for ongoingmanagement, treatment and/orreferrals. The patients will bemonitored frequently at theACE Clinic and treatment willbe adjusted, in consultationwith their General Practitioner,according to their clinicalprogress. Clinical progress willbe monitored using tools suchas the Neck Disability Index(NDI) and other similar func-tional rating tools.

As well as providing assess-ment and treatment coordina-tion, the Clinic will focus onoptimising communicationbetween all treating parties.

The study will also have aneducational arm with regulartraining sessions on applicationof evidence-based managementin compensable medicine forgeneral practitioners. Inform-ation on future training sessionswill be provided in the proceed-ing months.

A website, www.accident-care.com.au, was launched inJune 2007, and is divided intoseveral components including aresource section specificallystructured for health profession-als with links to information,research papers, guidelines andprotocols for soft tissue injuryassessment incorporating bestpractice in compensable medi-cine. The ACE website alsoincludes online training materi-als for group education andtraining, such as the slide kitstitled “Managing patients withcompensable injuries”, and“Best practice management ofsoft tissue injuries.” and CMEactivities for personal learning.

The main aim of the study isto see whether prompt assess-ment, education, early institu-tion of evidence-based manage-ment strategies and close moni-toring of functional progress canimprove health outcomes inthese patients.

For more information onthe ACE study contact theResearch Coordinator on 1300557479, or www.accidentcare.com.au

Dr Ian Pryor, formerAMA ACT presidentand chair of the‘Canberra Doctor’committee writes:GPs simply gettingfat on payola

Even the patient from outin the bush who comes in tosee you every few years knowsthat GPs can no longer betrusted to give impartial adviceabout medical treatments –especially drug treatments.Everyone knows that becauseof the incredibly attractiveenticements such as ballpointpens, crocodile shaped sta-plers, natty highlighter pens,amazing plastic models ofhuman innards, BMI calcula-tors, step meters, letter open-ers and the like given to doc-tors by drug companies, theyare no longer able to employrational decision making whenprescribing for their patients.

Unfortunately our criticalsenses are not developed suffi-ciently and we are not trainedto withstand the onslaught ofsuch largesse and because wehave such inexperienced,guileless approaches to life, weare just unable to make properjudgements and end up pre-scribing more expensive, lesseffective and less reliabledrugs for our charges.

In addition, there is obvi-ously the issue of near crimi-nal intent to collude withthose drug companies thatgive us the best presents. Ihave to admit that my home ischock-a-block full of amazinggifts. Unfortunately, anythingwith moving parts has conkedout within forty-eight hours oftaking possession - but that isnot the point here is it?

Because of my inherentmoral turpitude and myalmost kleptomaniac tenden-cies in relation to drug compa-ny give-aways, I am mostgrateful for those wise and eth-ically superior colleagues,consumers and others outsidethe profession who have takenup the cause to save me frommoral oblivion by pointing outhow wrong it is for me toaccept these gifts. Making itwrong helps me sleep better atnight knowing that I will nowbe a better doctor.

Even more beguiling is the“trick” pharmaceutical compa-nies play by offering free mealsto make us come to their talks

at nights after work. This isbound to impair our judge-ment, especially as they are alldoing it!! I see a real conflictarising though. What if I doaccept a free meal from onedrug company and feel obligedto prescribe their product, andanother company also takesme out, and then another andanother. This is a real ethicaldilemma. As well there is theproblem of having to feedmyself if I go out after work inunpaid hours to an education-al evening if I don’t eat theirfood. I do think it is wrong toentice me with edible foodthough – and those expensiverestaurants!

The other thing is, and Ihad never thought about thisbefore, they might be offeringinformation which helps pres-ent their product in a goodlight. How tricky is that?

You know what I think? Ireckon that to save me and mysimple GP colleagues the gov-ernment should get the phar-maceutical companies to drawup a business ethics charter.That way, if they find offeringgifts and free meals and enter-tainment to GPs is not costeffective, they can say theyhave had to change becausetheir new charter makes them.

Finally, the only way is forneutral bodies to educate GPson drugs and prescribingwhich of course will require alot of money and a large, high-ly informed impartial work-force. The best people are theGovernment because they willknow the cheapest option forthem and that is such a savingfor all of us -- although if Iwere the patient, I would wantthe best drug with the best tol-erability.

I am pleased that peopleare focussing on the big picturehere because, as a GP, that is anarea that is too hard for me.

Dr Ian Pryor

Guest editorial:The Accident Care Evaluation (ACE) Study is aworld-first medical research project, investigatingthe means of improving clinical outcomes for thosepatients with mild to moderate soft tissue injuriessustained in motor vehicle accidents. The study ledby Associate Professor Paul Smith with co-investiga-tors Dr Brett Robinson and Professor Ian Cameron,officially began in Canberra towards the end of2006. It is a collaboration between the AustralianNational University (ANU), the University ofSydney and the NRMA-ACT Road Safety Trust.

7J u l y 2 0 0 7

Dr RosannaCapolingua, FederalAMA President, andPerth GP writes onFamily Doctor Week

Each year the AMA holdsFamily Doctor Week (FDW) topromote the importance of gen-eral practice to the health andwell being of Australians.

During FDW, the AMAundertakes to raise the profileof general practice with thepublic and lobby Governmentto improve primary health carepolicy.

FDW 2007 will run from22-28 July.

This year’s FDW message is“Your GP: Part of the Family”.The theme is designed to re-mind the community that theirGP sees them through all majorlife events from birth to death.

The AMA will highlightthat GPs are the central, contin-uous provider of care inAustralia. We will remind thepopulation that GPs look afterall aspects of their health, atevery stage of their life.

GPs care for people beforethey are even born and providepalliative services at the end oflife.

The AMA wants to encour-age people to forge strong rela-tionships with GPs and trustthem to provide quality healthcare throughout their lives.

In particular, we want toremind young people that GPsare there to help them and thatdoctors will respect their confi-dences. Adolescents need toknow they can turn to their GPfor help with issues rangingfrom mental illness, sexualhealth, drugs and alcoholthrough to peer and schoolpressures.

FDW will also provide anopportunity to remind familiesof the importance of generalpractice care in the earlymonths of children’s lives. TheGP has a role in immunisation,allergy identification, weightand growth, and hearing tests –to name a few.

At the other end of thescale, GPs are vital to ensuringolder Australians are cared for.People living in residential agedcare are facing increasing diffi-culty in accessing medical carewhen they need it.

The AMA is working toensure these services are prop-erly supported and GPs canprovide care into the future. Itwants aged care to be on thepolitical and public agenda inthe lead up to this year’s Federalelection.

A proposal has been pre-sented to all major parties call-ing for Medicare to be restruc-tured to adequately value GPservices in aged care and allowother members of the generalpractice team help care forthese patients.

In addition, the AMA willdeal with the issue of task sub-stitution. Patients want to knowtheir care is being provided by adoctor. Other primary careproviders can enhance the pri-mary care team but a GP mustlead the team.

Dr Rosanna Capolingua

Guest editorial:Jacqui Burke, MLA, ShadowMinister for Healthwrites for ‘CanberraDoctor’

“The only thing constant inlife is change” – Francois de laRochefoucauld

With such a range of forcesreshaping health care deliveryin Australia, is it any wonderthat the role of GPs in our com-munity continues to evolve?

Advances in medicinemean people are living longerand, while many diseases andconditions are now treatable,our modern lifestyles haveresulted in a new range of“lifestyle” diseases and condi-tions, such as obesity, depres-sion, type-2 diabetes and someforms of cancer.

These lifestyle diseases andconditions represent some ofthe greatest threats to ourhealth system.

These diseases will createan enormous burden on ourhealth system and our familydoctors will have a key role toplay in meeting this challenge.

Many of these lifestyle con-sequences are preventable and,therefore, the role of familydoctors will be more importantthan ever to help reduce thisburden on our health system.

An important aspect ofthis process will be throughthe early identification andmanagement of these condi-tions and also through the pre-vention of these diseases byhelping people make healthychoices.

Family doctors know theirpatients well and have theirtrust. Surveys of Australiansconsistently rank the family

doctor among our most trustedprofessions.

What this tells us is that,when it comes to encouraginghealthy lifestyles we, as politi-cians are unlikely to be ofmuch use on the ground.

On the other hand, a quietword from the family doctorand a plan for improving phys-ical activity and diet can notonly reduce the potential bur-den on our health system, butit can save lives.

The Canberra Liberals arecommitted to helping GPswork with the community toimprove our overall health.The relationship between GPsand families is highly valuedand adds to the quality of life.

The Liberals have commit-ted to maintaining and build-ing these important links bothin the ACT and nationally.

At the last ACT election in2004, the Canberra Liberalscommitted to a PreventativeHealth Fund, to be adminis-tered by experts in the fieldand tasked with implementingchronic illness managementprograms and preventativehealth measures.

Specific chronic illnessesto be targeted by the Fundinclude heart disease, stroke,chronic obstructive pulmonarydisease, depression, lung can-cer, diabetes, colorectal cancer,dementia, asthma andosteoarthritis.

Family doctors are excel-lent partners in targeting theseillnesses and in assisting inimproving the overall health ofour community.

In promoting healthy eat-ing and physical activity,reducing or eliminating tobac-co use, promoting safe alcoholuse, promoting better mentalhealth and sexual health andencouraging immunisation,

the family doctor can helpensure we have a health systemfocussed on providing the bestpossible outcomes for allCanberrans.

The Canberra Liberals arecommitted to a wide rangingand effective health system. Webelieve that, for every dollarwe invest on prevention andearly intervention and on theeffective management ofchronic conditions, we will seeconsiderable benefits in thelong term with, for example,fewer hospital admissions. Wesee family doctors as a criticallink in that system.

Family doctors are at thefront-line of our health system.As such, I would be very inter-ested to hear family doctors’ideas for improving the deliv-ery of health care in the ACT.

Jacqui Burke MLA is theDeputy Leader of the Oppo-sition and Shadow Minister forHealth, Housing & DisabilityServices.

Jacqui is available on 026205 0133.

Jacqui Burke, MLA

Guest editorial:

8 J u l y 2 0 0 7

This is what Dr KellyLowther sent in!

1. Who has influenced youmost, professionally?Doctors in training I haveworked with and my generalpractice medical educators.

2. Who has influenced youmost, personally?My mother.

3. What is your motto?To live a happy life.

4. Whom do you admire?My husband, he has somany talents and qualitieswhich I aspire to.

5. What has been your bestmedical experience? Finalyear medical school electiveto Samoa. Holiday andlearning combined on twotropical islands. Paradise!

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why? Many greatrole models- not just one.Favourites were those withenthusiasm, time, an interestin teaching and who wereencouraging.

7. What has been your mostformative experience?Internship and residency.Those years were demand-ing, yet rewarding, puttingtheory into practice.

8. What has been your great-est achievement? Being amother to a 7 month olddaughter.

9. What is your favouriteauthor? And yourfavourite book? I am not abook worm, so no favouritesof all time.

10.Do you have a favouritemovie of all time? If so,what is it? And why is it afavourite? Lord of the ringstrilogy- great story, beautifulsetting and amazing specialeffects.

11.What is, or would be, yourfavourite holiday destina-tion? A tropical island withbeautiful beaches,snorkelling and friendlypeople. Samoa was just that,however I would like toexplore more south pacificislands.

12.How would you describeyourself? A happy personwith many roles who lovesto explore and learn newthings.

13.What are you looking for-ward to? My next holidayand completing all thehome renovations I haveplanned.

14.What do you like todrink and eat and do youhave a favourite restau-rant in Canberra? If yes,what is it? I like Thai food,enjoy Teppanyaki restau-rants and I have an interestin photography.

15.What is success to you?Reaching goals which bringhappiness.

16.What has been your mostsatisfying professionalexperience? I enjoy beingable to give time in patienteducation. No grand expe-riences in my short andhumble career.

17.What is your request tothe Federal political par-ties as we approach anelection? Invest in educa-tion. We can grow strongercommunities through edu-cation.

18.What makes generalpractice special for you?Diversity and work lifeflexibility.

19.How do you see thefuture of general practice?Not sure, however theirwill always be growth,progress and no doubtchange.

20.Your turn to ask a ques-tion? How would youanswer so many questions?

GP profiles

Dr Kelly Lowther and her daughter Makayla.

This is what Bob Allanreplied!

1. Who has influenced youmost, professionally?Kerry Delaney was my bossin 1980 soon after I joinedthe Navy. We assume doc-tors are officially taughtprofessionalism but wearen't. Kerry was able todefine and crystallise con-cepts around the role of theprofessional, when all Iknew (a little at least)about being a doctor wastreating sick people. DavidMcNicol influenced megreatly when I first came toCanberra, and is responsi-ble for my involvementwith the AMA.

2. Who has influenced youmost, personally? Sadly, I can't blame anyonebut myself.

3. What is your motto? Trust your own gut feelingsand instincts.

4. Whom do you admire?I admire some of my col-leagues who are alsofriends. I won't identifythem lest it alter our rela-tionship.

5. What has been your bestmedical experience?Being successfully treatedfor Dukes C colorectal can-cer nine years ago. I will beeternally grateful to thosethat cared for me when Ithought I had run my race.

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why?None really. I was a disin-terested student, and I sus-pect my teachers were aver-age. I try to forget thatstage of my life - I've cer-tainly forgotten everythingfrom my medical course.

7. What has been your mostformative experience?Working as a young med-ical officer in PNG. Aftercrash courses in anaesthet-ics and obstetrics I wasdropped in to the positionas Principal Medical Officerat the Patrol Boat Base onremote Manus Island. Aftera ten-day hand over frommy predecessor, MikeFlynn, I remember seeinghim off at the airport. Asthe plane roared into thePacific sky I vividly recallan overwhelming sense offoreboding as I felt grosslyunder-prepared for thetask. My instincts wereright.

8. What has been your greatest achievement?Surviving the above for twoyears. I was also pleased tohave trained in endoscopy

and colonoscopy proce-dures and to have thattraining officially recog-nised last year.

9. What is your favouriteauthor? And yourfavourite book?I am no literary buff. Idon't have time for readingnovels, except maybe onholidays with the family.I've enjoyed Tim Wintonand Bill Bryson.

10.Do you have a favouritemovie of all time? If so,what is it? And why is ita favourite? I don't have time formovies. I seem to beimmersed in real life dra-mas all day (usually not myown) so I tend to spendfree time on technical pur-suits.

11.What is, or would be,your favourite holidaydestination?I love Australia's desertsand remote coastline. I tryto get out on a trip to thebush at least once a year.Having said that, last yearmy son and I went back toManus in PNG. That was agreat holiday, and very nos-talgic. I am looking forwardto a week in Noosa in July.Living in the bush has letme feel like I am holiday allthe time.

12.How would you describeyourself?I am a caring, introspective,thoughtful, somewhat ego-tistical, and curious atheist.I despair of what thehuman plague is doing tothe Earth.

13.What are you looking for-ward to? Nothing special. I amenjoying each day at themoment. The weeks rollpast so quickly you can'tafford to put enjoyment onhold for some future date -you may not make it.

14.What do you like to drinkand eat and do you havea favourite restaurant inCanberra? If yes, what is it?I enjoy wining and diningwith friends. I belong totwo wine clubs. We havemany good restaurants inCanberra – it’s the compa-ny that makes the night.

15.What is success to you?I think Maslow had somethoughts on this. Asidefrom enough wealth tokeep the wolf from thedoor, I think success is tohave earned the respect offamily, friends, colleaguesand clients.

16.What has been your mostsatisfying professionalexperience?Working in PNG. Runningmy own practice, and thenwalking away from it whenthe time was right. Beinginvolved with the AMA.Some medical procedureshave given great satisfac-tion: caesarian sections andtrauma surgery in PNG, myfirst unassistedcolonoscopy as a trainee(thanks Terry Gavaghan).

17.What is your request tothe Federal political parties as we approach an election?Making requests to politicalparties is pointless. Theydo whatever they need todo to win the election andnothing else. I know fromyears of bitter experience inmedical politics that whatwe ask for doesn't matter ajot. Even when presentedwith incontrovertible evi-dence for introducing ameasure or changing some-thing, it won't happenunless there are votes in it.Far better to influence thehearts and minds of theelectorate than to grovel tothe pollies.

18.What makes general practice special for you?About once a day you getto intervene in a way thatchanges a persons or a fam-ily's life for the better.

19.How do you see thefuture of general practice?Its a growth industry in anundersupplied market. Theshortage of GPs is the com-munity's reward for havingscrewed GPs with Medicareover the last 20 years. Forthe GPs who have survivedthe lean times the boomtimes are about to start.

20.Your turn to ask a question? I have none.

Dr Bob Allan

“Canberra Doctor”is proud to profile some of Canberra’s GeneralPractitioners.

9J u l y 2 0 0 7

This is what ClareWillington replied!

1. Who has influenced youmost, professionally? Mycolleagues at the InterchangeGeneral Practice, GPs, nurs-es, management and recep-tionists…a very supportiveand inspiring bunch of pro-fessionals and friends.

2. Who has influenced youmost, personally? My part-ner Ross … he has sharedmy life for 30 years andhelped me to develop mysense of humour amongstother things.

3. What is your motto?“Avoid mottos!”

4. Whom do you admire? My daughter and herfriends…24 year olds arevery inspiring people!

5. What has been your bestmedical experience? I spent3 months working in Kenyaas a final year medical stu-dent, this was the founda-tion of all my subsequentmedical experience and stillfuels my passion for humanrights.

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why? Prof EricBeck, at University CollegeHospital London, for hisgreat teaching and gener-ous spirit.

7. What has been your mostformative experience?Becoming a parent

8. What has been your great-est achievement?Overcoming my fear ofwater and learning to swim5 years ago.

9. What is your favouriteauthor? And yourfavourite book? I am plan-ning to re-read “ Love in theTime of Cholera” by GabrielGarcia Marquez…a beautifulbook about many kinds oflove.

10.Do you have a favouritemovie of all time? If so,what is it? And why is it afavourite? It’s toss upbetween “The Lives ofOthers” by Florian Henckelvon Donnersmark a greatwork of art about the impor-tance of creativity in the faceof repression and “ A CloseShave” by Nick Parkbecause animation is a mar-vellous form of creativityand Wallace and Gromit aretwo of the most wonderfulcharacters in British cinema.

11.What is, or would be, yourfavourite holiday destina-tion? Japan…complex, fas-cinating, wonderful and notmuch jet lag getting thereand back.

12.How would you describeyourself? Complex, fasci-nating, wonderful and fre-quently feel jet lagged, butregrettably without the asso-ciated travel.

13.What are you looking for-ward to? Going to Japanagain

14.What do you like to drinkand eat and do you have afavourite restaurant inCanberra? If yes, what isit? “Sammy’s” before amovie at the Dendy Cinema– a jasmine tea , “DrunkenChicken” and a bowl ofmixed green vegies.

15.What is success to you?Keeping my sense ofhumour and not letting thedarker side of the humancondition wear me outbefore the weekend arrives !

16.What has been your mostsatisfying professionalexperience? There have beentoo many satisfying experi-ences to single one out…working with people as a GPis endlessly interesting, chal-lenging and often very pro-fessionally satisfying.

17.What is your request tothe Federal political par-ties as we approach anelection? I would urge fed-eral politicians to develop abi-partisan approach to thehealth of Australians with a20 year primary health carestrategy to put health pro-motion and disease preven-tion at the top of the nation-al agenda….to create ahealth system that wouldemphasise the importance ofthe health of people espe-cially antenatally and in thefirst 3 years of life as thefoundation for life longhealth and well being.

18.What makes general prac-tice special for you?General practice is neverboring, not knowing whatproblems will present onany given day keeps melearning and fascinated bythe human condition.

19.How do you see the futureof general practice?General practice ….if wedidn’t have it, we’d have toinvent it. There will alwaysbe a need for a first port ofcall generalist in our healthcare system. The immediatefuture looks challenging asthe shortage of GPs wors-ens….but the new medicalschools and increased stu-dent numbers should pro-vide sufficient doctors tomeet the need in the comingdecades.

20.Your turn to ask a ques-tion? No more questionsplease!

Dr Clare Willington

This is BrendaMcDonald’s response.

1. Who has influenced youmost, professionally?I was influenced most pro-fessionally by the four part-ners in the South GranvilleSydney practice where Istarted in General Practice.Each had a different styleand interest and was a greatmentor.

2. Who has influenced youmost, personally? Personally, my Mum hasinfluenced me the most.She never gives up despiteall adversity.

3. What is your motto? My motto is "things will getbetter". Doesn't alwaysseem to work though.

4. Whom do you admire?I admire all those GPs outthere who own their prac-tices and are trying to keepthem going with doctorshortages and all the newrules including accredita-tion to handle as well.

5. What has been your bestmedical experience?My best medical experiencewas being a medical stu-dent in the clinical years. Istill remember the excite-ment that each new termbrought. I also enjoy tutor-ing the ANU medical stu-dents in clinical skills. Ithink they remind me ofmy own enthusiasm as astudent.

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why?The teacher I most admiredwas Prof James Lance, pro-fessor of neurology at POWand PHH Sydney. He wasalways the gentleman, kindto patients, staff and med-ical students and also agreat teacher.

7. What has been your mostformative experience?My most formative experi-ence was running my owngeneral practice at Curtin.Makes one appreciate busi-ness management skills aswell as being one’s ownboss. I sold it when my firstchild was born after realis-ing that I wasn't super-woman.

8. What has been yourgreatest achievement?My greatest achievementwas Acting MedicalSuperintendent atWollongong Hospital for 12months after a short periodas Deputy Medical

Superintendent. Thankheavens for a supportiveCEO and Board Members.However I decided thiswasn't for me and returnedto General Practice andmoved to Canberra.

9. What is your favouriteauthor? And yourfavourite book?Favourite authors arePatrick White, Robin Cookand James Herbert.Favourite book was PatrickWhite's 'Tree of Man'.

10.Do you have a favouritemovie of all time? If so,what is it? And why is ita favourite? Favourite movie is the Lordof The Rings triology. Fairlyclose to the books and greatcasting.

11.What is, or would be,your favourite holidaydestination?My favourite holiday desti-nation would be one daysailing down the Nile andvisiting the Pyramids.

12.How would you describeyourself?I would describe myself asquiet and reserved and sen-sitive.

13.What are you looking for-ward to? I am looking forward to

retiring one day and takingup music and art lessonsagain.

14.What do you like to drink and eat and do youhave a favourite restau-rant in Canberra? If yes,what is it?I enjoy Evans and Tate’sChardonnay or the occa-sioal Midori Illusion madeexpertly by my son. Myfavourite restaurant isAntigos in Civic, or, forspecial occasions, Axis inthe Museum.

15.What is success to you?Success to me is being

healthy, happy and finan-cially secure.

16.What has been your mostsatisfying professionalexperience?My most satisfying profes-sional experience wasworking part time at theChronic Wound Clinic atPhillip Health Centre.Watching resistant ulcersfinally close or just keepingthings in status quo sopatients could keep theirlimbs was very rewarding.

17.What is your request tothe Federal political parties as we approach an election?My request to FederalPolitical Parties would beto simplify the paperworkthat currently plagues gen-eral practice and to makesupport services such associal workers and agedcare workers more availableto help with the burden ofthe aging population.Improve nursing homestaffing and funding forattending medical practi-tioners and allied healthpractitioners. Recognise thetime and expertise neededin treating the elderly pen-sioner and increase theMedicare rebate.

18.What makes general practice special for you?General Practice is specialbecause of the relationshipsthat the doctor builds withthe patients and their fami-lies. The wide variety ofwork is both challengingand rewarding. Helpingpeople through their healthor personal crises is verysatisfying.

19.How do you see the future of general practice?The future of general prac-tice lies in more trainees.As the work force is dimin-ishing the burden is fallingonto less doctors and theaging population with theirmany medical problems aretaking up much more time.Preventative care is impor-tant but we need the doc-tors to have the time to dothis as well as treat acuteproblems. Hopefully youngdoctors will be attractedfrom all the new medicalschools to go into generalpractice and if some of themore mundane duties canbe removed, more time canbe spent doing what wetrained to do and that istreat patients.

20.Your turn to ask a question? I cannot think of any ques-tions.

Dr Brenda McDonald

1 0 J u l y 2 0 0 7

This is Karen Flegg’sresponse to our questions.

1. Who has influenced youmost, professionally?In 1983, I had my first gen-eral practice term in theFamily Medicine Program. Iwas sent to “Warri some-thing up near Queensland”to quote Dr Anne Harveywho broke the news of myplacement. That wasWarialda and the beginningof my love of rural practice.I recall Anne warning methat women registrars who“went rural” got married tofarmers! (and yes, despitemy initial denials I did endup marrying a farmer). In my next year of theFamily Medicine Program,in the town ofMuswellbrook, I wasshocked that a guy called DrCampbell Miller actuallycame out to see me and doan ECT visit at the localcafé. It was the only time inmy 3.5 years as a registrarthat anyone came out fromthe city to visit me and afterMuswellbrook, I spent mytime in a one doctor townwith a supervisor in Sydney.I remember feeling veryalone and unsupported dur-ing this period of my career.Currently, I love going outto rural towns to do ECTvisits on registrars, to makecontact and let them knowthey are not alone.

2. Who has influenced youmost, personally?My dad, Dennis – for notbeing prejudiced about girlsgetting an equal educationand because he saw educa-tion as a great liberator.Evidence shows if you wantto get people in the thirdworld out of poverty andimprove health indicators,you educate the girls.

3. What is your motto?Everything is perfect just asit is.

4 Whom do you admire?I sought out a mentor (whowill remain nameless) someyears ago when I first gotinvolved in medical organi-sations. His task, was toteach me in two years, whathad taken him 20 years tolearn about business, gover-nance and management. Asin Mission Impossible, themission was accepted andlargely achieved!

5. What has been your bestmedical experience? Beingable to contribute to thoseless fortunate by sheer acci-dent of birth, by going onmission with MSF in Iran, in2005. Initially, I wondered if Iwould cope, especially as Ihadn’t practiced rural medi-

cine in 16 years. In actuality, Ithrived and felt my contribu-tion was all the more, forbeing able to teach our wayof working to my Iranian col-leagues who were hungry forsuch input. While my Frenchproved strong enough forinteractions with my Frenchcolleagues, I have to admit,the failure of this venture wasmy attempt to learn Farsi.

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why? This is atough one. I had two greatteachers, one in medicineand one in surgery, which isa sound foundation for anymed student. They were likechalk and cheese in mostrespects. One looked like adishevelled drunk and theother was always immacu-lately groomed; one taughtme how to overcome mytone deafness for diastolicmurmurs and the othertaught everything there wasto know about scrotal lumpsand bumps. Both howevertaught me that “X” nevermarks the spot! A great les-son in life!Unfortunately, my two weeksin general practice was sucha flash in the pan that I bare-ly remember a thing!

7. What has been your mostformative experience?The things that have influ-enced me in how I havepractised medicine have allbeen personal - workingclass background, wander-lust, divorce, cultures ofother countries, and notleast, depression while I wasworking in a solo doctortown. That was a difficulttime and initially, I was mis-diagnosed as an overworkeddoctor and sent back to domore work. I then incurredthe criticism of colleaguesfor writing about my experi-ence in the medical press.Depression used to be a bitlike miscarriages – no onespoke about them. That is ofcourse changing and I defi-nitely think it is importantto share your experiences sowe all realise these thingshappen commonly and topeople we know. My depres-sion helped me grow profes-sionally and personally. Itradically changed the waythat I interact with mypatients and marked thebeginning of my spiritualjourney - an ongoing questto know myself.

8. What has been your great-est achievement? It is hardto single out any one particu-lar experience. For the press,I would have to say success-fully resuscitating my fatherat my brother’s wedding.

9. What is your favouriteauthor? And yourfavourite book? PatrickWhite? Oscar Wilde? Atschool I didn’t like either ofthem, but with life experi-ence, I have grown to enjoytheir works immensely. It’shard to single out one par-ticular work.

10.Do you have a favouritemovie of all time? If so,what is it? And why is it afavourite? I don’t know whybut “Papillon” (1973) sticksout in my mind. It is not myusual type of movie, but therelentless persistence anddogged pursuit of personalfreedom strikes a chord withme . (And who doesn’t likeSteve Mc Queen and DustinHoffman?) My usual sort ofmovie is more French arthouse such as, “Une AffairePornographique” – a won-derful piece demonstratinghow each person remembersthe same event so very dif-ferently and … so delight-fully French, to call a lovestory, a pornographic affair!

11.What is, or would be, your favourite holiday destination? I love theMiddle East, having workedand travelled extensivelythrough the Jordan, Syria,the Gulf countries, and Iran.The people are so embracingand generous. In contrast toother destinations I havenever felt unsafe as a solowoman traveller, nor tired ofthe archaeological and cul-tural wealth of the MiddleEast. I hope to visit Iraq inthe future - hopefully theancient sites will have sur-vived the current war. That said I have spent moretime visiting France thanany other country and Ihave to say I feel at homethere - enjoying the food,wine and practising myFrench.

12.How would you describeyourself? Is this going toend up on an internet datingsite somewhere? Let’s see…An independent, intelligentand perhaps overeducated,complex, well travelledwoman trying to strike abalance between work, aspiritual journey and cre-ative desires. Someone whowants to make a differenceto those in need, to walklightly on the earth in doingit…and to have fun doing it!

13.What are you looking for-ward to? Getting organisedto paint more and work less.I have a fine arts diplomamajoring in painting andprintmaking. I love to paintlarge abstracts and nudes. Ialso look forward to thetime when I can look aftermyself better through medi-

tating and doing yoga everyday.

14.What do you like to drinkand eat and do you have afavourite restaurant inCanberra? If yes, what is it?I looooove chocolate (espe-cially Lindt Lindor) butunfortunately Canberra doesnot have a chocolate restau-rant. I enjoy the GriffithVietnamese. Drink? I like anice Sav Blanc but the preser-vatives create havoc.

15.What is success to you?To live in the moment and

not emotionally engage withwhatever drama is happen-ing. (i.e. not buying intoother’s bs)

16.What has been your mostsatisfying professionalexperience? There are somany to choose from…resuscitating my father ..surviving and thriving inIran, …helping to set up theSt George Division of GP?Actually, when I think ofwhat has stuck in my mind,it is the people I have metand the everyday things ofclinical practice - stitchingan ear back on that a horsebit off and having it take;coincidentally finding anabdo tumour on someonewith a skin lesion on theirarm; making the diagnosisof acute ketoacidosis in a 9year old boy; getting a linein a flat patient; beingthanked for listening andbeing there for a youngwoman distressed about hergenital warts. Being thanked– that’s a good one.

17.What is your request tothe Federal political par-

ties as we approach anelection? Please… no morecomplex item numbers…

18.What makes generalpractice special for you?Besides the obvious answerof caring for patients andtheir families, it is aboutpeople – not just patients,but also the very dedicatedco-workers I have had theprivilege to work with –nurses, receptionists, prac-tice managers, communitynurses, other doctors.People whose company Ihave enjoyed and who havehelped get me through thetough times!And I shouldn’t forget myadvert for registrars: “beinga GP is a flexible career –you can work full time orpart time; in urban, ruraland/or remote settings; inAustralia, or overseas”.

19.How do you see the futureof general practice? Moreteamwork; bigger groups ofdoctors working together;inter-referral between GPswith subspecialisations;more non fee for servicepayments (more of thoseitem number I don’t want);lots of workforce issues forat least ten years; and unfor-tunately, the number of ourmedical organisations andour diverse opinionsremaining a divisive factorthat reduces our ability tolobby Government for themaximum benefit of GeneralPractice.

20.Your turn to ask a ques-tion? You forgot the work-force question .. How oldwill I be when I retire????

Dr Karen Flegg (self portrait)

GP profiles…continued

1 1J u l y 2 0 0 7

This is what Tuck MengSoo replied!

1. Who has influenced youmost, professionally?I think I have been mostinfluenced professionally byDr Peter Rowland. He start-ed the Interchange GeneralPractice and was sadly mur-dered in 1996. I wasimpressed by his activismon behalf of disadvantagedminorities and at ourPractice, we try to maintainhis vision of medicine inthe service of humanity andto look after the disadvan-taged he drew to him andcared for.

2. Who has influenced youmost, personally? I havebeen most influenced per-sonally by my partner, PaulHartigan. He has given methe support personally andprofessionally to be where Iam today. The other power-ful influence on me person-ally is the philosophy ofBuddhism.

3. What is your motto? The goal of human existenceis happiness.

4. Whom do you admire?I most admire the unsungpeople who do the littleheroics of everyday life.Nobody knows them oracknowledges them but bytheir actions, they givemeaning to the lives of thepeople around them.

5. What has been your bestmedical experience? Mybest medical experience is tosee some of my patients withdrug abuse problems recoverand make something of theirlives.

6. When you were a medicalstudent, which of yourteachers did you mostadmire? Why? I can't thinkof anyone I really admired!There were many good doc-tors but I probably didn'tunderstand enough of theart of medicine then torealise what I was seeing.

7. What has been your mostformative experience?Sitting the FRACGP examwas actually a very formativeexperience for me. I finallyunderstood how to structurea patient-centred consulta-tion.

8. What has been your greatest achievement? I think my greatest achieve-ment is to have a successfulrelationship with my partner.

9. What is your favouriteauthor? And your favouritebook? My favourite authoris Jane Austen. I think Prideand Prejudice is a perfectromantic comedy with lots

of wit and intelligence toleaven the romanticism. Myfavourite book is probably"Guns, Germs and Steel" byJared Diamond for its revo-lutionary view of humanhistory and its erudite argu-ment against racism.

10.Do you have a favouritemovie of all time? If so,what is it? And why is it afavourite? I think that if Ihad to pick a favouritemovie, I would probablypick "Blade Runner". Unlikemost people, I actually pre-fer the original version tothe director's cut whichunfortunately, is all that isavailable now. The vision ofa dystopian World in BladeRunner has been hugelyinfluential and most sci-fimovies since then have bor-rowed from the look ofBlade Runner. Blade Runneralso exemplifies the best ofsci-fi in that it marries anexciting adventure with anexploration of deep philo-sophical questions of humanexistence. Other movies thatI have been very impressedby include "2001:A SpaceOdyssey", "The Colour OfParadise", "PrincessMononoke", "Raise The RedLantern" and "RainingStones".

11.What is, or would be, yourfavourite holiday destina-tion? My favourite holidaydestination so far has beenKyoto which I visited inApril 2007.

12.How would you describeyourself? I want to be wiseand I try to be happy and Itry to remember I amhuman and imperfect.

13.What are you looking for-ward to? I am looking for-ward to my next holiday-Cambodia or Iran.

14.What do you like to drinkand eat and do you have afavourite restaurant inCanberra? If yes, what is it?I consider myself a bit of agourmet and I have been tomany of the best restaurantsin Australia in the last 15years. I think haute cuisinein Australia is becoming toopreoccupied with techniqueand the food on the plate isgetting too highly worked.

As a result, I find I preferethnic food these days-foodthat is closer to its roots. Idon't have a favourite restau-rant currently. My favouriteused to be the ParamountRestaurant in Sydney for itscutting edge fusion cuisineand its wonderful desserts.

15.What is success to you?Success for me is to behappy and to create the con-ditions for happiness inthose around me.

16.What has been your mostsatisfying professionalexperience? My most satisfy-ing professional experiencehas been to run a successfulgeneral practice. The practicehas survived economicallyand I think provides a sup-portive environment for doc-tors and staff to give first-class primary healthcare toall patients. I think the prac-tice enables the people work-ing here to fulfill themselvesprofessionally.

17.What is your request tothe Federal political parties as we approach an election? I hope theFederal political parties willstop treating climate changeas a political football andtake this threat to all lifereally seriously. I am sur-prised that the Coalitionhasn't been presented withthe enormous economic costof NOT implementing effec-tive measures to combat cli-mate change now.

18.What makes general practice special for you?The personal contact I havewith my patients and theprofessional autonomy Ihave are what makes generalpractice special for me.

19.How do you see the futureof general practice?Corporatisation represents ahuge threat to the generalpractice we know and ourpatients love. When a criti-cal percentage of GPs crossover to corporate medicalpractice, traditional generalpractice will no longer to beable to cope with the com-plex patients with chronicmedical problems that it willbe left to manage. Whatthen? Workforce issues willcontinue to be a problem inthe short to medium termfuture. While primary careteams have been mooted asthe solution to everything,I've yet to see how theycould work for the averagegeneral practice as opposedto a few specialised areas.

20.Your turn to ask a question? If the leaders ofthe free world believe in justwars, why don't they sendtheir children to fight inthem?

Dr Tuck Meng Soo

Dr Paul Jones,President elect of theAMA ACT and ACTrepresentative to theAMAs Council of General Practicewrites: General prac-tice, at a crossroads

I don’t believe it’s overstat-ing the situation to suggestthat General Practice in thenext ten years is going to betransformed. It will be trans-formed by shifts in workforce,by changes in work practices,by shifts in the ownershipstructures of practices and byshifts in technology and com-munication, to name a few.Recently, acting as chair of theACT Government taskforce onGP Workforce has focused mymind more than a little onhow some of these changes areand will affect us here on theground in the ACT.

With respect to workforceand work practices, there aremany different proposals beingput up as “the answer”. Someof these in my opinion seri-ously risk one of the greateststrengths of General Practice,the capacity of GPs to have anoverview of our patients’health and the context inwhich it lies, particularly withrespect to family, work andother lifestyle issues. GPs arethe last “generalists” in thehealth system and we shouldfight very hard to preserve ourplace at the centre of care.Every GP and most of ourpatients know this. Risks willcome from the many “solu-tions” proposed for expandingthe roles of nurses (althoughtheir workforce issues are ifanything worse than ours),other allied health profession-als and the possible “physi-cians’ assistants”. We need tobe very sure that good hardevidence for better outcomesis demanded of those propos-ing such changes.

With respect to ownershipstructures, I believe that thereal key here is not ownershipof practice, but the proper cap-italization of practices to pro-vide good infrastructure inwhich GPs work without con-suming the GPs’ earnings toprovide that infrastructure. It’spopular to suggest that certainkinds of practice ownershipwill provide certain outcomes.To some degree this may betrue, and a diversity of prac-tices is both desirable and nec-essary. However, it is only truebecause the flawed system ofrebates under Medicare makes

it so. The piecemeal, patch-work approach to bloating theMBS schedule with items forall sorts of specific conditionsmust go; the simple seven tiersystem, with a fair rebate forevery patient, whatever theircondition, must be imple-mented.

With respect to technolo-gy and communication, pro-gress is frustratingly slow andin my view in some waysheaded in unwanted direc-tions. Communication aroundthe country between healthproviders remains patchy anddevelopers of electronicpatient records persist withmodels and directions whichare clearly self-serving, notpatient-focussed nor indeeduseful to GPs. Models pro-posed by governments andcommercial interests focus onlarge databases, held by “agen-cies” which they will then con-descend to “allow” to beaccessed by health practition-ers. Reassurances of the secu-rity of such systems are worthlittle, in my view, and evenmore futile are assurancesabout the uses to which bothidentified and de-identifieddata may be put.

When I talk to patientsabout this, what they seem towant is a record which theyown, which they keep, andthen share with their doctorsand others providing theircare. This option should beexplored.

Finally, I repeat my exhor-tation to my GP colleagues,particularly those youngerones who will have to live withthe transformations of GeneralPractice which are ahead of us,to inform yourselves, to beinvolved, to join and shape thedebate within the AMA, theCollege and Divisions. Don’tallow others to set the agendafor you, be active in the publicdebate and inform yourpatients of the implications ofchanges you see proposed.

Guest editorial:

Dr Paul Jones

The PatCH ConsumerNetwork (Network) celebrated its secondyear by launching a newinitiative to help parentsof children with chronichealth problems managetheir children’s healthrecords.

In 2005, the PaediatricDepartment at Canberra Hosp-ital (PatCH) called on the com-munity to help identify how itcan work towards improvingpaediatric health care services atthe Canberra Hospital. In July2005, the PatCH ConsumerNetwork was established. Foll-owing on from the group’s aimsand objectives which weredeveloped in 2006, the Networkidentified three key areas whichrequire the most urgent prog-ress: Emergency Department;Transition and Chronic illness.

Many members of theNetwork are parents or carers ofchildren with various chronicillnesses and they saw a com-mon need for an easy to useresource to help parents and car-

ers organise paediatric patient’shealth information. ThePersonal Health Record or PHRFolder was developed by thePatCH Consumer Network incooperation with PatCH.

‘One of the biggest frustra-tions for parents of childrenwith complex and chronic ill-nesses is repeating a story overand over again in one visit’, saidAssociate Professor GrahamReynolds of PatCH.

Professor Reynolds describ-ed the PHR as an extension ofthe “blue book”.

The PHR Folder will beissued to parents of childrenrecently diagnosed with chronicillnesses – the ‘frequent flyers’ ofthe health care system. Itincludes a CD or computer flash

drive template which allowsparents or carers to record apatient’s medical informationincluding:� medical team contact

details, starting withGeneral Practitioner;

� medical history;� test results;� medications; and � hospital stay data.

The template can be easilydownloaded onto a home com-puter and then modified to con-tain as much detail about thepatient’s condition/s as parentswish. Once the template hasbeen filled in, it can be printedout and the pages slipped intothe plastic sleeves of the folder.The folder then becomes a use-ful resource for General Practit-ioners, Paediatricians and aRegistrar in the case of anadmission to hospital.

For more information regard-ing the PHR folder, please contactCatherine Nancarrow, PatCH Vol-unteer Coordinator at Catherine.Nancarrow@act.gov.au.Anyone seeking further infor-mation or involvement in theConsumer Network shouldcontact the PatCH ConsumerNetwork via email atPatCHParents@act.gov.au ortelephone 6244 3740.

1 2 J u l y 2 0 0 7

By Chris Gilbert, a thirdyear medical student atthe ANU Medical School

It was 7:30am on Mondaymorning and here I was stand-ing outside the surgery of a localCanberra GP, Dr CameronWebber. I had not previouslycome across Dr Webber,although I suspected that I hadattended high school with oneof his sons (which was later con-firmed by photos in his office).This was my first placement inGeneral Practice as part of the3rd year of my MBBS at the ANUMedical School. What did Iexpect? I’m not really sure – butI was hoping to be placed withsomeone who had an interest inSports Medicine. Regardless ofthe type of medicine I was goingto see, I could be fairly sure,judging by the hour at which Iwas standing outside his clinic,that this was going to be a dedi-cated couple of weeks.

As the first week unfolded itwas clear that Dr CameronWebber had much more to offerthan just an interest in SportsMedicine. In fact, if anything thiswas one of the smaller strings tohis bow. By the end of the firstmorning I had received a crashcourse in differentiating betweenbenign and potentially malig-nant skin lesions. In addition, DrWebber runs numerous proce-dural clinics throughout theweek for those patients requiringthe removal of skin lesionsdeemed to be suspicious. Thiswas a fantastic hands-on learn-ing experience which soon sawme promoted to the position of

surgical assistant. In order tocomplete the experience, Iaccompanied Dr Webber to clin-ics at Canberra Grammar Schooland Jindalee Nursing Home.Although there was not a lot ofSports Medicine to be seen atJindalee (or for that matterCanberra Grammar School,where every adolescent seemedto have an URTI), the combina-tion of each setting provided awell rounded clinical experience.

Perhaps the greateststrength of Dr Webber’s practiceis his innate ability to impartknowledge to those around him.This can be seen in any of hisinteractions with patients andwas indeed a blessing as a med-ical student. The two weeksspent with Dr Webber were as Ihad suspected; a full time com-mitment. But it was a commit-ment laden with a wealth ofknowledge. It was a tribute to DrWebber that he was able to ded-icate himself to his practice, letalone to teaching, during a verytough period of his life in whichhis sister passed away.

The dedication which DrWebber brings to his medicalpractice is truly inspirational.Whilst this type of practice maynot be everyone’s cup of tea, itwas a fantastic opportunity tolearn and provided great insightinto how rewarding GeneralPractice can be if you are moti-vated to do it well.

Chris Gilbert

Is this the DermatologyClinic or a GeneralPractice?

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Solutions for the ‘frequent flyers’ of chronic illness

1 3J u l y 2 0 0 7

Dr James Cookman,President of the ACTdivision of generalpractices writes on“this curious creates – the family doctor”

Greetings all. I am pleasedand grateful for the opportunityto contribute, again, to the annu-al Canberra Doctor “FamilyDoctor Week” edition. And morethan a little bemused, although itdid take me a short while todecide why. Frankly, I am notcurrently sure what a “familydoctor” is. More alarmingly, Iconfess, I am not at all sure thatI’ve ever had a clear notion ofwhat distinguishes this curiouscreature - “the family doctor”.

Does this practitioner refuseto treat patients who have no

family? The churlish among youwill say that everyone is a mem-ber of the human family but thatundermines the term further.And what, pray, is a family? Thedefinition of a family is now nec-essarily and properly so broadthat it’s use as a descriptor infront of “doctor” does not, tome, augment it’s meaning. Howquaint that we persist with it. Ibelieve we need a new term torepresent and capture the scopeand activity of ModernAustralian General Practice.

I apologise to readers whohave a strong attachment to theterm. But I submit that it’s prob-ably a purely sentimental one ifyou think about it. You can’tguarantee to have a relationshipwith all family members -indeed, where does a given fam-ily begin and end ? - and in someinstances nor should you.Additionally, “family” is a veryemotive term and, for many, not

all the emotions associated withit are positive. So the term “fam-ily doctor” is - potentially -alienating.

Stick with me - there’s apoint to all this.

Let’s think about the scopeof modern practice. It’s nolonger true that General Practiceis concerned almost exclusivelywith episodic care [get sick - seea doctor]. It has long since beenthe case that a much greater partof our work concerns chronicdisease management, whichinvolves the maximisation ofhealth despite a chronic diseasestate. In my view, we now needto evolve our role in populationhealth. In other words, we needto maintain and use our ownpractice health data to demon-strate improvements in popula-tion health. Of course, modernIT affords us the opportunity todo this.

Let me give you a specificexample. It is known that 20%of the adult population havehypertension. For various rea-

sons, only about half of theseever get treated. And only abouthalf of those ever get control.And this is clearly not goodenough. Should we be extractingour practice data to demonstratethat 20% of our adult patientsare taking hypotensives andachieving satisfactory control?Who should receive this infor-mation? And how much shouldthey pay you for it? The answersto these questions are “I believeso”, “ A credible, functional pri-mary health care organization”and “A reasonable fee”.

So what do we call this crea-ture who does provide episodiccare but is able to managechronic conditions supported byup to date IT, with access topractice population health data?Not, in my view, “family doctor”.I find the term quaint, limitingand not a little condescending. Ilike Primary Health Practitioner.

A Primary Health Practit-ioner is someone who is the firstpoint of contact for the patientwith the health system, has the

capacity and the inclination todevelop an ONGOING relation-ship with the patient, receivesmost of the clinical history denovo from patients themselves[rather than from referral let-ters] and reports only to thepatient [not referrers].

If you don’t like PrimaryHealth Practitioner then fine -let’s workshop it. But let’s get ridof the egregious “family doctor”.

Come on everybody. It’s timeto move on.

Dr James Cookman

Guest editorial:

By Dr Rod Pearce,chair of the AMAsCouncil of GeneralPractice and AdelaideGP writes on FamilyDoctor Week

All GPs should get behindFamily Doctor Week by usingthis week to talk to their patientsabout the central role their GPhas in health care throughouttheir lives. Remind them thatbeyond treating coughs andcolds, you can provide specialistlong-term continuous care ofchronic conditions, lifestyleadvice and counselling.

GPs should also all take amoment during FDW to reflecton the excellent job we do day-in and day-out under manystresses and strains and whatmeasures will help us continueto provide this great service intothe future.

One of the major healthissues the AMA will focus onduring FDW is aged care.

Australia’s population is age-ing. Over 20% of the populationis over 55 years of age and this isexpected to grow to over 30% inthe next fifteen years. Approx-imately 90% of people aged over65 attend a GP at least once ayear. Those visits account for25% of all general practice con-sultations.

The demand for generalpractice care will increase as thepopulation continues to age.Therefore, Australian govern-ments must start to developways of better structuring thehealth system to care for olderAustralians in the future.

The AMA has long called fora restructure of the MBS so itproperly rewards general prac-tice services and allows doctorsto spend more time withpatients. Being able to spendtime with patients, particularlyolder patients, is important for anumber of reasons.

It will provide GPs with theopportunity to better care forpatients with complex andchronic illnesses, the number ofwhich will grow as Australiansage. It will allow GPs to providemore preventive and manage-ment care for their patients.

This will help in earlier identifi-cation of problems and earlierintervention.

The current MBS has failedto keep pace with the true costof providing services and it failsto adequately support team care.

Team care, with the GP atthe centre, is the way of thefuture as it will allow patients toreceive care from the teammember best placed to provideit and will allow GPs to spendmore time with patients thatspecifically require their clinicalservices.

The AMA and RACGP haveworked together to develop andpresent a proposal to Govern-ment based on this conceptwhich is designed to improveservices in aged care facilities.

The AMA believes if thisproposal is embraced by Gov-ernment and proves to be suc-

cessful it should be extendedthroughout the MBS to improvecare in all areas, including homevisits and after hours.

A copy of the paper ‘GPServices to Residential AgedCare Facilities’ can be viewed atwww.ama.com.au

Dr Rod Pearce

Guest editorial:

1 4 J u l y 2 0 0 7

A Canadian inAustralia: Dr SueDouglas writes“different cover,the same oldstory”

I am a Canadian GP orFamily Physician as we callourselves in Canada. I movedwith my family to Australia ayear ago with 14 years of clini-cal and 12 years of medicalteaching experience under mybelt.

So why did my family and Idecide to leave a wonderfulcountry like Canada? The longand short of it was – I wasoffered a job!

I had decided to leave myold job where I was acting headof a large Family Medicinedepartment. I had pretty muchdecided to quit academic medi-cine when my husband showedme an advertisement in theCanadian Family Physician foran academic physician inGeneral Practice in Australia.We were both ready for anadventure and nine monthslater found ourselves, and twoboys along with eight largebags of luggage, and one neu-rotic dog, on a plane bound forCanberra.

Actually Canada andAustralia share a lot in com-mon. Both are large sparselypopulated countries of unpar-alleled physical beauty. Theircitizens enjoy an enviable qual-ity of life that compared to themajority of the world’s citizensis marked by peace and securi-ty. Australians like Canadianstry to strike a balance betweenindividual rights and thegreater social good. In generalCanadians and Australians areboth warm friendly unpreten-tious people who enjoy sharinga cold beer with good friends.

Canada and Australia alsoshare similar challenges par-ticularly when it comes to thedelivery of high quality med-ical care to its widely scat-tered population. Althoughthey don’t like to advertise it,neither country has ever beenable to produce enough doctorsto meet its needs. Consequentlyboth have been dependent oninternational medical graduatesto deliver medical care to its cit-izens especially those that livein rural and remote regions.

Canada like Australia hasa critical shortage of GPs/Family Physicians. This short-

age is getting worse not betterand affects urban as well as ruralareas. The reasons behind theshortages are similar in bothcountries. Both the Canadianand Australian governmentsmade similar myopic decisionsto cut medical school places inthe late 80s, early 90s. Ten yearslater the citizens of Canada andAustralia are paying the belatedcosts (with interest). There is ashortage of doctors in bothcountries but General Practiceand Family Medicine have beenparticularly hard hit. In bothcountries the cost of a medicaleducation has escalated expo-nentially in the last decade. Thehigh debt load upon graduation,combined with the significantpay differential between GPsand specialists, are swayingundecided students towardsspecialist medical careers. Thehigh cost of tuition may also bea factor in who decides tobecome a doctor by dissuadingstudents from working class andminority backgrounds who mayhave limited funds.

Another threat to thedeclining number of FamilyPhysicians is the growing chal-lenge of providing studentswith a meaningful GeneralPractice educational experi-ence. In Halifax, where I used towork, every year it would become more difficult to findenough GP supervisors for ourmedical students. Even sadderwas the fact that we regularlyhad to turn down students whorequested electives in FamilyMedicine because of insufficientnumbers of GP teachers.

What is behind theseshortages? First there is thedeclining number of GPs andthe growing demands on thoseleft behind. Like their Australiancounterparts, most CanadianFamily Physicians start runningonce their feet hit the ground inthe morning and don’t stop untilthey fall into bed in theevenings. Days are jam packedwith patient, practice and familyresponsibilities. In Canada it isnot uncommon for GPs to havea three to four week waiting list.Similarly it is not unusual forrural GPs to see 60 plus patientsa day simply because there is noother doctor in town who cansee them. The thought of incor-porating teaching into analready overloaded schedule isan overwhelming prospect formany GPs. Similarly, GPs do notwant to take precious time awayfrom patient care in order toteach!

It also doesn’t help that GPsfeel that they are not appropri-

ately remunerated or valued fortheir teaching role. Medicalstudent teaching is almost uni-versally a money losing ven-ture. The literature shows thaton average GPs spend an extrahour teaching per clin