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RACGP conference Preview of the GP15 Conference for
General Practice
Suicide in general practiceSensitively raising and dealing with a complex issue
Palliative careHighlighting rural and remote GPs’
efforts in a vital area of healthcare
ISSUE 8, AUGUST 2015
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www.racgp.org.au/goodpractice
GPs lead the wayWalking the El Camino de Santiago for the RACGP Foundation
Published by
The Royal Australian College
of General Practitioners
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East Melbourne
Victoria 3002
T 03 8699 0414
W www.racgp.org.au/goodpractice
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ISSN 1837-7769
Editor: Paul Hayes
Writer: Bevan Wang
Graphic Designer: Beverly Jongue
Production Coordinator:
Beverley Gutierrez
Publications Manager: Jenni Stiffe
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Kate Marie:
T 0414 517 122
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Editorial notes
© The Royal Australian College of General
Practitioners 2015. Unless otherwise indicated,
copyright of all images is vested in the RACGP.
Requests for permission to reprint articles must be
made to the editor. The views contained herein are not
necessarily the views of the RACGP, its council, its
members or its staff. The content of any advertising or
promotional material contained within Good Practice is
not necessarily endorsed by the publisher.
We recognise the traditional custodians of the land
and sea on which we work and live.
3Reprinted from Good Practice Issue 8, August 2015
18 24
ContentsIssue 8 – August 2015
10
20
06
04Your College
RACGP news and events for August.
06RACGP Foundation
Foundation pathwayRACGP adventurers tackle the historic
El Camino de Santiago.
10Conference for General Practice
Our future in practiceAn early look at the RACGP’s
Conference for General Practice, GP15,
to be held in Melbourne in September.
13Nutrition
Dietary guidelinesThe fi rst in a new series of columns from
the Dietitians Association of Australia
looks at the evidence behind the
Australian Dietary Guidelines.
14Rural Healthcare
Palliative careHighlighting the work Australia’s
rural and remote GPs do in an
essential area of healthcare.
17Ethics in General Practice
Appropriate testsEthical and professional obligations
when a patient requests tests
recommended by an alternative
health provider.
18In My Practice
Community partnershipGPs at WA’s Collie River Valley Medical
Centre believe medical education lies at
the heart of general practice.
20GP Communication
Suicide in general practiceGPs have a vital role to play in working
with patients who have experienced
suicidal thoughts.
23National Faculty of Specifi c Interests
Abuse and violenceSupporting patients who are dealing with
issues such as family violence.
24 GP Profi le
It’s magicDr Vyom Sharma’s love of magic and
performing helped lead him to his career in
general practice.
26Conference for General Practice
GP15 scheduleEducational and social opportunities
atz the RACGP’s upcoming Conference
for General Practice, GP15.
Erratum
Last month’s ‘Cultural awareness’ article (p14) included an error in the
form of misrepresentation of a quote from Dr Tim Senior regarding the
World Health Organization’s (WHO) defi nition of health.
The printed quote mistakenly implied Dr Senior had described the
WHO defi nition of health as only containing the absence of disease;
when, in fact, his actual statement was that the absence of disease is
part of the WHO defi nition.
4 Good Practice Issue 8, August 2015
Images
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Off to RioCongratulations to Queensland’s
Dr Jeffrey Wang, who won the
recent RACGP PayPal Membership
competition. Wang has won a trip
to the 2016 World Organization
of Family Doctors (WONCA)
conference in Rio de Janeiro. The prize
includes fl ights, accommodation and
conference registration.
WONCA is a globally-focused
not-for-profi t organisation that
represents approximately 500,000 GPs,
or family doctors, in 131 countries.
Its values are similar to those of the
RACGP in that it strives to ensure
people all over the world are supported
by GPs and have access to quality care.
Wang was eligible for the prize draw
after paying his 2015–16 RACGP
membership fees on time using the
PayPal online payment system.
RACGP members can renew their
2015–16 membership by visiting
www.racgp.org.au/membership or via
app.racgp.org.au on their smart device.
As part of its community awareness
campaign, the RACGP recently
launched a new website targeted
at patients who want to know more
about the general practice profession.
The website includes a series of
online profi les designed to highlight
on some of the RACGP’s dedicated
Fellows and members working
throughout Australia and overseas.
‘GP Lives’ features personal
stories from RACGP members,
discussing how they came to choose
their profession, their beliefs about
general practice and highlights of
their career. The new series offers
an insight into the different paths
that can lead to a career as a GP,
fostering greater understanding of
some of the benefi ts and challenges
this profession presents.
Visit http://yourgp.racgp.org.
au/Your-GP/GP-Lives for more
information and to meet some of
the members who have already
been featured.
YOUR COLLEGE
The GPMHSC is sponsoring the Emotional health of children ALM at GP15.
This FPS CPD activity will enhance your skills in interviewing children and
teaching them cognitive strategies for managing anxiety and depression.
Register at racgpconference.com.au/alms/emotional-health-alm/
GP Livess
rship
rip
5Good Practice Issue 8, August 2015
RACGP events calendar
August 2015
VIC
Skin cancer theory and
practice workshop
Saturday 8 August,
8.00 am – 12.30 pm,
Royal Australasian College of
Surgeons, East Melbourne
Contact 03 8699 0488 or
VIC
Perform CPR – a
workshop for GPs
Wednesday 19 August,
6.00 pm – 8.00 pm (5.45 pm
registration), RACGP House,
East Melbourne
Contact 03 8699 0488 or
ACT
CEMP intermediate
Friday 14 August,
8.30 am – 5.00 pm,
Rydges Capital Hill, Canberra
Contact 02 9886 4710 or
VIC
Supporting recovery
and return to work
Wednesday 19 August,
6.30pm – 8.30pm, online webinar
Contact 03 8699 0488 or
QLD
Faculty member meeting
Friday 14 August,
6:00 pm – 9:00 pm,
Clovely Estate Winery, Red Hill
Contact 07 3456 8944 or
TAS
Celebrating general
practice: Fellowship and
awards ceremony
Saturday 22 August,
2.30 pm – 7.30 pm,
Museum of Old and New Art
(MONA), Berridale
Contact 03 6234 2200 or
WA
Common
medical problems
Saturday 15 August,
9.00 am – 5.00 pm,
College House, Perth
Contact 08 9489 9555 or
TAS
Annual faculty
general meeting
Sunday 23 August,
10.00 am – 11.00 am ,
ABC Centre, Hobart
Contact 03 6234 2200 or
ACT
CEMP advanced
Saturday–Sunday 15–16
August, 8.30 am – 5.00 pm,
Rydges Capital Hill, Canberra
Contact 02 9886 4710 or
WA
Procedures in
the practice
Saturday 29 August,
9.00 am – 5.00 pm,
College House, Perth
Contact 08 9489 9555 or
For further RACGP events please visit www.racgp.org.au/education/
courses/racgpevents/
GPs honouredThe RACGP was happy to see several GPs and healthcare
professionals among those named on this year’s Queen’s
Birthday Honours List.
Member (AM) in the General Division
• Dr Barry Eastwood Christophers – AM, Malvern East, VIC.
For signifi cant service to the Aboriginal and Torres Strait Islander
community through advocacy roles, and to medicine as a GP.
• Dr William John Peasley – AM, Broome, WA.
For signifi cant service to the community as an inland explorer,
historian and author, and as a GP.
• Dr Anh-Tuan Ngo – AM, Mansfi eld Park, SA.
For signifi cant service to veterans and their families as a supporter
of ex-service groups, and to the Vietnamese community of SA.
Medal (OAM) in the General Division
• Dr Adel Asaid – OAM, Bendigo, VIC.
For service to medicine as a GP, and to the community of Bendigo.
• Dr David George Hollands – OAM, Bete Bolong, VIC.
For service to medicine as a GP, and to ornithology.
• Dr David Howe – OAM, Orange, NSW.
For service to children’s health, and to the community of Orange.
• Dr Philip Kingsley Godden – OAM, Wamberal, NSW.
For service to medicine and to community health.
• Dr Nicholas Gerard O’Ryan – OAM, Canowindra, NSW.
For service to the community through the Prostate Cancer
Foundation of Australia, and to golf.
• Dr Shiva Prakash – OAM, Kingswood, NSW.
For service to medicine as a GP.
• Dr Brian John Norcock – OAM, Naracoorte, SA.
For service to rural medicine, and to the community of Naracoorte.
• Dr Tuck Meng Soo – OAM, Ainslie, ACT .
For service to the community of the ACT as a medical practitioner.
Visit www.gg.gov.au/queens-birthday-2015-honours-list for the full
Queen’s Birthday 2015 Honours List.
Winners of The
further tales
of a country doctor
R Perks, T Huda,
A Sun.
RACGP FOUNDATION
Foundation pathway
PAUL HAYES
The RACGP Foundation’s latest fundraising endeavour saw a group of adventurers journey along the historic El Camino de Santiago.
It would seem people who work in Australian
healthcare tend to welcome a challenge. When
discussing their reasons behind participating
in the RACGP Foundation’s latest fundraising
journey along Spain’s El Camino de Santiago,
which took place 2–13 May, a common theme
quickly emerged.
‘I wanted to give myself a challenge in
life,’ Louise McKenzie, an RACGP support
and training administrator who undertook the
walk, told Good Practice. ‘The El Camino was
something that was way out of my comfort
zone to do on my own and I thought, why not
challenge myself?’
Queensland GP Dr Lisa Oliver was initially
inspired by the challenge undertaken during
the most recent RACGP Foundation event in
Papua New Guinea in 2013.
‘I had been thinking about participating
in this event after I read about the Kokoda
Trail challenge. The El Camino seemed to be
the perfect opportunity to challenge myself
physically and to travel abroad and meet
like-minded people, all while helping raise
funds for the medical community,’ she
told Good Practice.
New South Wales GP Dr Marney Wilson
was inspired by friends as well as the diffi cult
nature of the El Camino.
‘I really liked the challenge of such a
long-distance walk,’ she told Good Practice.
‘I also I had friends who had done the
El Camino trek in the past. They came back
full of joy and got a lot of personal satisfaction
from doing it. I was hoping to achieve some
of that for myself.’
For Drs Libby and Ross Hindmarsh, the
oldest participants at age 71, the trek was fi rst
and foremost a physical test they wanted to
tackle – ‘We thought it would be a challenge
to get ourselves fi tter’ – but it also represented
another, more personal opportunity to travel
along the El Camino pilgrimage route to the
shrine of St James the Great.Spain provided a stunning
backdrop for the RACGP
Foundation’s latest overseas
fundraising journey.
6 Reprinted from Good Practice Issue 8, August 2015
‘You hear people talk about pilgrims
walking to Santiago de Compostela, where
the St James shrine is, and we attend St James
King Street Anglican church in Sydney,’ Ross
Hindmarsh told Good Practice. ‘It’s a pilgrim’s
walk and we have never done that.’
The trekkers travelled more than 100 km
along the centuries-old El Camino, starting
in Sarria in northern Spain and walking
through beautiful countryside before arriving
in the UNESCO World Heritage-listed
Santiago de Compostela.
‘When you get to the Cathedral in Santiago
de Compostela it’s very impressive just being
there will all of these people, the hundreds of
people who have just completed the walk,’ Ross
Hindmarsh said. ‘It was exhilarating.’
A worthy cause
As with 2013’s Conquer Kokoda for a Cause, the
trek along the El Camino de Santiago was aimed
at raising much needed funds and awareness
for general practice research. This year’s event
raised $24,000.
‘The RACGP Foundation is one of a few
charities in Australia that fundraises and supports
general practice research and we were honoured
to have RACGP members participate in this
worthy event,’ Melissa Milne, RACGP Foundation
Program Coordinator, told Good Practice.
‘The El Camino trek in Spain provided us
with the perfect backdrop to engage with our
members to fundraise in the name of charity.
I couldn’t think of a better way to spend time
than trekking along the El Camino in support of
a great cause.’
The El Camino participants – Dr Marney
Wilson (NSW), Dr Lisa Oliver (Qld), John
Oliver (Qld), Dr Larry Yee (NSW), Louise
McKenzie (Vic) and Drs Libby and Ross
Hindmarsh (NSW) – were aware of the
importance of the RACGP Foundation
and general practice research when they
signed up for the challenge. >>
A worthy cause
As with 2013’s Conquer Kokoda for a Cause, the
trek along the El Camino de Santiago was aimed
at raising much needed funds and awareness
Hindmarsh (NSW) – were aware of the
importance of the RACGP Foundation
and general practice research when they
signed up for the challenge. >>
7Reprinted from Good Practice Issue 8, August 2015
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8 Reprinted from Good Practice Issue 8, August 2015
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RACGP FOUNDATION
>> ‘General practice is at the frontline
of healthcare in Australia and GP-led
research ensures our community benefi ts
from evidence-based practices, improving
the quality of the primary healthcare we
deliver,’ Oliver said.
While it still represented a signifi cant
challenge, the RACGP Foundation’s
El Camino adventure was defi nitely
somewhat less rugged than 2013’s
Conquer Kokoda for a Cause.
‘This time we wanted to offer our
members an adventure that appealed to all
age groups and fi tness levels,’ Milne said.
According to Libby Hindmarsh, the
less-rugged features of the El Camino
did prove welcome.
‘We stayed in small hotels each night.
They were clean and very nice, and we had
an organised meal at night and breakfast in
the morning. It was very civilised,’ she said.
‘That was one of the reasons Ross and I
thought we would go this time – we thought
we could manage this trek.’
Spanish healthcare
Before setting off on the El Camino, the
RACGP group spent two days in the
Spanish capital of Madrid. While they were
able to take in some of the sights, the group
also visited the Spanish Society of Family
and Community Medicine (SemFYC) for a
presentation on the local healthcare system,
which proved an eye-opening experience.
‘That was a highlight,’ Ross Hindmarsh
said. ‘Their organisation has very similar
ethics to the RACGP, trying to provide
holistic general practice and give people
equity and access to care.’
Wilson appreciated not only the
opportunity to learn about the Spanish
healthcare system, but also the lengths the
SemFYC staff members went to in order to
make the event as informative as possible.
‘I was very impressed with the
presentation they put together. They had
a lot of statistics about health in Spain
and had comparative fi gures for various
countries. They put the effort in to ensure
that Australia was one of the countries
so we could see how the two nations
compared,’ she said.
actice Issue 8, August 2015
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g g g
we could manage this trek.’
p g
countries. They put the effort in to ensure
that Australia was one of the countries
so we could see how the two nations
compared,’ she said. Below: Everyone in the RACGP group – (L–R)
Ross Hindmarsh, Louise McKenzie, Marney
Wilson, local guide David (front), John Oliver, Libby
Hindmarsh, Lisa Oliver, Larry Yee – came together to
help one another along the El Camino de Santiago.
9Reprinted from Good Practice Issue 8, August 2015
‘Then we got to go to a local health
facility, which was very similar, and also quite
different, from general practice in Australia.’
The extra effort of the SemFYC’s staff
members even extended beyond the
presentations and into the evening in Madrid.
‘They did the whole presentation tailored
to Australia and it was just great. It was only
supposed to go for a couple of hours, but
they organised a dinner for that night. They
also brought more GPs to the dinner that
night,’ McKenzie said. ‘They didn’t have to
do that, but they were so lovely.
‘Working in the area of healthcare in
Australia, it was a real highlight to see how
they work in Spain.’
GPs lead the way
Once on the El Camino, the trekkers’ typical
day would start at around 6.30–7.00 am,
beginning with a light breakfast and a debrief
from their local guide, David, about what
they had in store for that day. There would
be a morning tea after about two hours of
walking, followed by lunch and afternoon tea
before arriving at their destination at around
5.00 pm. The group walked an average of
22–24 km each day.
‘That was a real highlight at the end
of every day, reaching our destination
and feeling that we had walked another
day,’ Wilson said.
The disparate nature of the RACGP group
– differing ages and home cities – made for
some very stimulating healthcare-related
conversations along the way. It also meant
different walking speeds, but everyone
made sure to not stray too far apart.
‘Everyone was very considerate of everyone
else. Some of us were fast walkers and some
were slower,’ Wilson said.
‘Over the course of the day the group
could get quite separated – there could be
over 30 minutes between the fi rst and the
last. But several times over the day the faster
ones would stop and give the slower ones
a chance to catch up so they didn’t feel
isolated at the back.’
While everyone loved the beautiful
countryside, wildlife and architecture along the
walk, it was not without its hurdles. Oliver, in
particular, learnt the value of travelling with a
group of fellow healthcare professionals.
‘An unfortunate time for me came when I
took my fi tness for granted and pushed my
knees too hard,’ she said. ‘The dancing I did
[in Madrid] caught up to me and I was left
with a swollen and painful knee at the end
of day three of the trek. I was faced with the
decision as to whether I should continue.
‘However, as my fellow group members
kindly offered medical advice, analgesia and
regular reviews, and a set of trekking poles, I
was able to push through.
‘Thank you, Marney, Ross, Libby and
Larry [Yee].’
When the trekkers fi nally walked into
Santiago de Compostela, they were struck
with a real feeling of achievement that
they had all overcome the challenges of
the El Camino and achieved something
special together.
‘There was a great sense of camaraderie
with completing this challenge as a group,
and I certainly appreciated that when everyone
helped me to complete it,’ Oliver said.
RACGP FoundationThe RACGP Foundation recognises
the important contribution research
makes to everyday general practice.
The Foundation supports
GPs to conduct research into
primary healthcare and develop
research career pathways. This is
accomplished by raising funds to
support a diverse range of research
grants, scholarships and awards
that provide RACGP members with
opportunities to undertake this
valuable research.
Visit www.racgp.org.au/support/
foundation for more information.foundation for more information.
Go to gplearning.racgp.org.au to learn about the available imaging modalities, including newer technologies, and their benefits and limitations based on patient context.
Breast cancer screening and diagnostic breast imagingA new Category 2 activity on gplearning
Do you have a good understanding of the different modalities to help you (and your patients) make appropriate decisions about screening and imaging?
10 Reprinted from Good Practice Issue 8, August 2015
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The RACGP Conference for General
Practice 2015 – GP15 – will be held at
the Melbourne Convention and Exhibition
Centre from Monday–Wednesday 21–23
September. The conference provides an
opportunity for RACGP members and
other healthcare professionals to come
together to build collegiality, take up
learning opportunities and celebrate the
achievements of general practice.
The theme of this year’s conference is
‘Our future in practice’.
‘GP15 is a highlight of the RACGP’s
calendar and this year’s program will
not disappoint,’ RACGP President
Dr Frank R Jones told Good Practice.
‘The conference is a wonderful
opportunity for GPs across the country
to come together and, not only build on
their clinical knowledge and expertise, but
network with colleagues and share their
experiences and ideas.’
Associate Professor Morton Rawlin,
RACGP Vice-President and GP15
Convenor, agrees that attendees enjoy
their chance to catch up with their fellow
practitioners from around the country.
‘The main thing that I am looking
forward to is getting together and talking
with my colleagues who I don’t always get
a chance to sit down with,’ he told Good
Practice. ‘But, also, hearing from some
of the conference’s guest speakers who
are across healthcare in other countries
and learning what is happening around the
world, as well as here in Australia.
‘It gives Australian GPs a chance to
look at what does and does not work and
try to implement these ideas in our own
profession, which is in line with the theme
of the conference.’
The conference is focused on how the RACGP can help its members achieve their goals and pursue their interests
Federal Minister for Health Sussan
Ley will be among the GP15 speakers,
with the opening plenary to feature an
address from Dr Alessandro Demaio, a
Postdoctoral Fellow in Global Health and
non-communicable diseases at Harvard
Medical School. Demaio’s speech,
‘Rethinking the future of general practice’,
will look at the developing future of the GP
and of general practice.
As many as 1500 people, including
more than 900 healthcare professionals,
are expected to attend GP15. This year’s
conference will include a range of active
learning modules (ALMs), short paper
From top: RACGP President Dr Frank R Jones will
be on hand to open GP15; the Academic Session,
Fellowship and Awards Ceremony will welcome the
RACGP’s newest Fellows and recognise its most
outstanding GP, registrar, general practice and more.
CONFERENCE FOR GENERAL PRACTICE
BEVAN WANG
Healthcare professionals from all over Australia are set to come together in Melbourne for GP15, the RACGP’s Conference for General Practice. Our future
11Reprinted from Good Practice Issue 8, August 2015
GP15 themesThe GP15 theme, ‘Our future in
practice’, will see the conference
explore ideas and topics that will
inspire and encourage GPs to
consider their future in general
practice, as well as their impact on
patients and communities.
Discussions at the conference
will focus on ensuring general
practice remains at the centre of
the Australian healthcare system
through GP-led coordinated
care. They will also include
how technologies and business
structures can be used to improve
the effi ciencies and effectiveness
of a practice, and developing skills
and knowledge to improve the
outcomes for a practice, patients
and the community.
GP15 will also provide Australia’s
healthcare professionals with a
range of networking opportunities,
plenaries, clinical workshops and
research presentations to support
their continuing professional
development and patient care.
Program streams include:
Aboriginal and Torres Strait Islander
health; rural health; family health;
mental health; GP research,
education and training; chronic
conditions and pain management;
and business, technology and
innovation.
Visit http://racgpconference.com.au
for more information on GP15 and
to register for the conference.
presentations and workshops to assist
GPs in fulfi lling their Quality Improvement
and Continuing Professional Development
(QI&CPD) requirements.
‘We are also going to have quite a few
activities whereby people will be able to
meet with members of the National Faculty
of Specifi c Interests, National Rural Faculty
and the National Faculty of Aboriginal and
Torres Strait Islander Health to learn more
about those different aspects of general
practice,’ Rawlin said.
‘We want members to know how they
can become part of such groups, and learn
about some of the advantages of being
part of something in addition to the general
practice profession.
‘The conference is really going to be
focused on how the RACGP can help its
members achieve their goals and pursue
their interests.’
One of the new innovations at GP15 will
be the introduction of an e-health café,
which delegates can visit to help keep their
fi nger on the pulse of the latest technological
advances in primary care. This new feature
is a peer-led demonstration in which GPs
who are experienced in social media and
technology explain how these tools can help
GPs in their everyday practice.
‘Delegates can stay up to date and
access some assistance in terms of e-health
activities in primary care,’ Rawlin said.
‘This can help participants to assist their
patients and better engage with e-health for
their practice.’
Traditional activities
The conference will begin with the RACGP’s
Academic Session, Fellowship and Awards
Ceremony on Sunday 20 September. This
event gives the RACGP the opportunity
to recognise and acknowledge the
achievements of its members, and to meet
with delegates from other Australian and
international medical colleges.
New Fellows will also be presented with
their diplomas in a ceremony for friends
and family. A number of major awards,
including 2015’s General Practitioner of
the Year, General Practice of the Year,
General Practice Supervisor of the Year and
General Practice Registrar of the Year, will
also be presented.
The RACGP’s highest accolade, the
Rose-Hunt Award, will be presented at
the Academic Session, Fellowship and
Awards Ceremony. The award is a gift to
the RACGP from the UK’s Royal College of
General Practitioners and is awarded to an
RACGP Fellow or member who has provided
outstanding service in the promotion of the
values of the RACGP.
The RACGP’s 58th Annual General
Meeting and Convocation of the RACGP will
take place on Tuesday 22 September. >>
in practice
12 Reprinted from Good Practice Issue 8, August 2015
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>> ‘Convocation provides RACGP members
with the opportunity to raise matters of
signifi cance with other members and inform
the RACGP Council about issues that GPs
consider important,’ Jones said.
Educational activities
This year’s conference includes the
introduction of a scientifi c committee,
which received a record number of abstract
submissions for workshops, oral sessions,
short papers and posters focusing on the
conference themes. The scientifi c committee
has been working hard to select the best
abstracts to ensure delegates get the most
out of GP15.
‘There were plenty of abstracts submitted,
which all came through to the scientifi c
committee,’ Associate Professor Chris
Hogan, a Melbourne GP and Chair of GP15’s
Scientifi c Committee, told Good Practice.
‘The committee has chosen those which will
really inform and educate.
‘We are hoping that delegates can come
together, learn from each other and be there
in the spirit of collegiality.’
The large number of educational activities
available for delegates will be a core
component of GP15. (Refer to page 26 for
activities and events.)
‘We have a signifi cant number of QI&CPD
activities throughout the conference, including
a large number of ALMs,’ Hogan said. ‘We
tried to look at what previous delegates have
said they wanted to attend, but also at what
is new in general practice that would benefi t
the profession.
‘A great deal of consideration goes into
these activities and I hope delegates will
enjoy and learn from them.’
Delegates are encouraged to register
early for the 11 available ALM topics, which
are traditionally very popular and tend to
fi ll upquickly.
‘A lot of the ALMs have been
commissioned and put up by the RACGP’s
state faculties or the National Faculty of
Specifi c Interests,’ Hogan said. ‘The idea of
that is to provide the ALMs with an increased
depth of knowledge and discussion.’
GP15’s ‘Our future in practice’ theme
encourages GPs to engage in an open
discussion about their future role in general
practice and its consequences for patients.
‘We are in a time of considerable change
in general practice and the profession
is certainly being seen as the important
motivator of change within the health
system,’ Rawlin said. ‘General practice
and GPs need to have the ability to talk
through some of those issues and that is
what we are hoping to provide throughout
this conference.’
Given this changing face of general
practice, Jones wants to see GP15’s
attendees be inspired to look ahead and
examine the direction of the profession and
their role within it.
‘I hope the conference gets delegates
thinking about the future of general practice
and how we as GPs can work towards
creating a sustainable model of general
practice, one in which our patients’ wellbeing
is at the core,’ he said.
CONFERENCE FOR GENERAL PRACTICE
Meet the editorsThe RACGP’s journal, Australian
Family Physician (AFP), will
be hosting a ‘meet the editors’
session on Monday 21 September
from 12.30 pm – 1.30 pm at the
RACGP exhibition stand, followed
by a peer reviewer support program
workshop from 3.00 pm.
GP15 will include a number of educational
opportunities to help GPs fulfi l QI&CPD requirements.
13Reprinted from Good Practice Issue 8, August 2015
NUTRITION
Dietary guidelinesAMANDA LEE
The fi rst in a new series of columns from the Dietitians Association of Australia looks at the evidence behind the Australian Dietary Guidelines.
Unhealthy diets are now the major
preventable risk factor contributing to the
growing burden of disease in Australia.1
At least 35% of the energy intake of
adults and 39% of children is now derived
from ‘discretionary’ choices (junk foods).2
The incidence of diet-related chronic
diseases, such as type 2 diabetes and some
forms of cancer, is rising.3 Poor diets are
also the major contributor to rising rates
of overweight and obesity in Australia.
According to the Australian Health Survey:
First Results, 2011–12, 63% of Australian
adults and 25% of children are now
overweight or obese.
There is now a greater variety of dietary
options than ever before, with media
headlines often proclaiming what patients
should and should not eat. So-called ‘fad’
diets have also grown in popularity.
Much of the available information is
not based on empirical nutrition science.
Australians are often confused about what
they should eat to improve their health and
it can be diffi cult for GPs to give patients
the best advice.
The National Health and Medical Research
Council’s (NHMRC’s) 2013 Australian
Dietary Guidelines can help GPs cut through
the dietary misinformation and offer patients
advice based on the best available evidence.
The latest Australian Dietary Guidelines
draw on: the NHMRC’s Evidence report
of systematic literature reviews; the
NHMRC’s A modelling system to inform the
revision of the Australian Guide to Healthy
Eating; previous dietary guidelines; current
Australian nutrient reference values; and key
authoritative international reports.
What has changed?
The evidence base underlying the Australian
Dietary Guidelines has strengthened
for health benefi ts associated with
consumption of:
• milk – cardiovascular disease (CVD),
stroke, hypertension, type 2 diabetes,
colorectal cancer
• fruit – CVD, stroke, excess weight gain,
oral and nasopharyngeal cancer
• non-starchy vegetables – mouth, pharynx,
larynx, esophageal and stomach cancers
• wholegrain cereals – CVD, type 2 diabetes,
excess weight gain, colorectal cancer
• fi sh – CVD, stroke, dementia, macular
degeneration of the eye
• breastfeeding – weight gain later in life.
The evidence base has also strengthened for
health risks associated with intake of:
• sugar-sweetened beverages – weight gain
in adults and children
• weekly intake of > 450 g red meat –
colorectal cancer.
Other key updates to the Australian Dietary
Guidelines:
• Covers ages six months to 70-plus
(previously two years and older).
• Refl ects Australian food supply and
consumption patterns.
• Shifted focus from limiting total fat to
limiting most foods high in saturated fat.
• A healthy fat allowance is promoted by
separation from discretionary foods.
• Greater articulation throughout
the life span.
Conclusion
Recent reviews of the evidence on food,
diet and health relationships confi rm that
dietary patterns consistent with the Australian
Dietary Guidelines are associated with
positive health outcomes.
The challenge is to ensure evidence-
based guidelines, particularly a renewed
emphasis on achieving and maintaining a
healthy weight, are strongly and consistently
promoted within a context that encourages
and supports nutritious food choices, dietary
patterns and healthy lifestyles.
References1. Institute for Health Metrics and Evaluation. Global Burden
of Disease Country Profi le Australia. 2013. Available at
www.healthdata.org/sites/default/fi les/fi les/country_
profi les/GBD/ihme_gbd_country_report_australia.pdf
2. Australian Bureau of Statistics. Australian Health Survey:
Nutrition First Results - Foods and Nutrients, 2011-12.
Canberra: ABS; 2014. Available at www.abs.gov.au/
ausstats/[email protected]/Lookup/4364.0.55.007main+featur
es22011-12
3. Australian Institute of Health and Welfare. Australia’s
health 2014. Canberra: AIHW; 2014. Available at www.
aihw.gov.au/publication-detail/?id=60129547205
Amanda Lee is an accredited practising dietitian with
more than 35 years’ experience as a practitioner and
academic in nutrition, obesity and chronic disease
prevention, Indigenous health, and public health
policy. She is a professor at Queensland University of
Technology’s School of Public Health and Social Work
and School of Exercise and Nutrition Science and was
Chair of the National Health and Medical Research
Council’s Dietary Guidelines Working Committee.
Nutritional resources
Australian Dietary Guidelines
Visit www.eatforhealth.gov.au/
guidelines for more information on
the Australian Dietary Guidelines
(2013), including the Australian
Dietary Guidelines – Summary and
Australian Guide to Healthy Eating
poster, as well as detailed methods,
references, materials and resources.
SNAP guide
The RACGP’s Smoking, nutrition,
alcohol, physical activity (SNAP): A
population health guide to behavioural
risk factors in general practice offers
GPs and practice staff effective
clinical strategies on working with
patients on these lifestyle risk factors.
Visit www.racgp.org.au/your-practice/
guidelines/snap for more information.
14 Reprinted from Good Practice Issue 8, August 2015
Images
RA
CG
P; C
laire H
epper;
Ken W
anguhu; S
hutters
tock
RURAL HEALTHCARE
Palliative careBEVAN WANG
A new report from the RACGP’s National Rural Faculty highlights the work Australia’s rural and remote GPs do in a vital area of healthcare.
Palliative care involves patients, their
families and their healthcare providers,
particularly GPs. Its primary aim is to
respect the wishes of the patient’s
attitude towards treatment, as well as
ensure their comfort.
‘One of the privileges of being a GP
is that you get to share a journey with
your patients. Sometimes that journey
starts from birth and continues through all
stages of their life,’ Dr Ayman Shenouda,
a NSW GP and Chair of the RACGP’s
National Rural Faculty (NRF), told
Good Practice.
‘Palliative care patients tend to prefer
that their GP care for them. GPs are
aware of the patient’s history, as well as
their psychological and physical capacity
to deal with their illness.’
The NRF conducted a survey in early
2015 that was designed to examine the
palliative care experiences of Australian
rural and remote GPs. Among of the
survey’s key fi ndings was the fact that
a majority of these rural GPs already
provided palliative care services in
patients’ homes, hospitals and aged
care facilities.1
From top: Dr Ayman Shenouda believes rural GPs’ patient
relationships make them well placed to offer palliative
care services; Dr Claire Hepper describes palliative care
as extending beyond end-of-life to ‘incurable, life-limiting
illnesses’; Dr Ken Wanguhu feels rural communities are
most likely to look to their GPs for palliative care.
15Reprinted from Good Practice Issue 8, August 2015
‘When there’s no specialist, especially in
the more remote communities, it is important
that the GP takes on the responsibility to look
after the patient and their family,’ Dr Ken
Wanguhu, a South Australian GP and the
RACGP’s Rural Censor, told Good Practice.
‘GPs have to take on this role because their
patients and community look to them to
provide this service.
‘It is often a long process because you have
those diffi cult conversations around dying
for some. And you have to have the skills
to manage their physical and psychological
symptoms, and support the family as well.’
Studies have consistently found 60–70%
of Australians would prefer to live out their
fi nal days at home rather than in a hospital or
residential care.2 However, it is estimated that
only 14% of people die at home, with 54% in
hospitals and 32% in residential care.3
‘You need someone with the skills to
manage all of the symptoms and also to
know and understand exactly what the
patient wants,’ Wanguhu said. ‘You really
have to ask tough questions such as,
“Where do you want to die?”, because if
you don’t do it right, it means people do not
get their wishes.
‘It is important to have the conversation, no
matter how hard it is, to fi nd out your patient’s
wishes when it comes to pain relief and the
place where they want to be for the rest of
their life.’
While palliative care can traditionally
be more associated with terminally ill and
end-of-life patients, views on the fi eld have
been changing in recent years.
‘I think we are still fi ghting the misconception
in the public that palliative care is just terminal
care,’ Dr Claire Hepper, a Victorian GP with
a special interest in palliative care, told Good
Practice. ‘GPs from all walks of life have
been doing palliative care, the care of people
with incurable, life-limiting illnesses such as
diabetes or chronic obstructive pulmonary
disease, since general practice began.’
Community benefi ts
Bettering the Evaluation and Care of Health
(BEACH) data found an estimated one out
of every 1000 Australian GP encounters
in 2012–13 was for issues related to
palliative care.4 GPs play a central role
in coordinating multidisciplinary systems
for patients in palliative care in rural and
remote communities.
‘Ideally, you need a team approach in
dealing with palliative care patients, which
involves palliative care nurses, social workers,
psychologists, occupational therapists,
physiotherapists, pharmacists, pain
management protocols, pastoral care
and sometimes hospital admission,’
Shenouda said.
‘Support from allied health professionals
plays an important role in improving both the
patient’s and the GP’s experiences. When you
are out in the communities you have to do the
best you can with what you’ve got access to.
‘You really need to have a well-
coordinated team approach to ensure the
best patient care.’
Around a quarter of participants in a
2014 RACGP survey on rural training needs
believed their local community would benefi t if
they had more training in palliative care.5 More
GPs are going to be required to deal with
palliative care as this area of general practice
continues to evolve.
‘Getting the skills and the suffi cient
training is really important for those who
are in rural and remote communities due
to diffi culties in accessing specialist care,’
Wanguhu said. >>
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16 Reprinted from Good Practice Issue 8, August 2015
RURAL HEALTHCARE
>> ‘Many GPs already have the skills
when it comes to listening to the patient
and understanding what they want, but
it is often the technical things that we
need refreshers on.
‘It would be really helpful, for example, to
know that I could get a palliative specialist or
a pain specialist who I can call when I’m not
sure how to deal with things.’
The NRF’s 2015 rural palliative care
survey also found a majority (62%) of
hospital, residential aged care and hospice
facility visits were for patients who were
familiar to the GP.1 Shenouda believes
this doctor–patient relationship is a major
advantage because it allows GPs to
provide additional care to others who have
been affected.
‘Palliative care is not just about supporting
a patient suffering with a terminal illness. It
involves the family around the patients,’ he
said. ‘Rural GPs are often familiar with the
patient’s family and some of the issues they
might be struggling with.
‘There is a lot of emphasis to provide care
for the carers and, a lot of the time, they
really need the emotional support and to just
have someone to talk to.’
Challenges in care
A majority of the palliative care survey
participants (63%) indicated a need for
greater involvement in GP-led services in the
local community.1
‘The GP probably knows the patient
and the family better than anyone in the
healthcare team and that is what is going to
matter in end-of-life,’ Hepper said.
‘Whatever we do, we need to make sure
that the best person, in this case the GP, is
leading the discussion and expressing the
wishes of the patient.’
Another area of need highlighted in the
survey included training and education
across the palliative care team, particularly in
relation to pain and symptom management.
The survey found that 73% of participants
would like more GP-specifi c training
opportunities.1 Hepper believes GPs can
benefi t from more training in areas such as
pain relief for end-of-life care in order to
complement their existing skills in chronic
disease management.
‘GPs already have all the listening skills,
all the clinical skills, to support people, but it
would be good to have some extra training
to boost the confi dence and support for
practical symptom control’ she said.
‘Having the confi dence to know how to
titrate analgesia is important. I get a lot of
calls about that. People call to double-check
because there is this fear of morphine.’
Issues of time and workload were rated as
the most signifi cant barriers to GPs providing
palliative care in aged care facilities, hospitals
and homes.
‘Time constraint is always an issue with
general practice and it is one of the things
that we train our registrars to be able to
manage,’ Shenouda said. ‘It is important
that GPs are able to prioritise and manage
time and still be able to provide quality care
to the patients.’
Given there is no specifi c Medicare item for
palliative care-related treatment, Hepper said
changes may be required to ensure GPs are
adequately remunerated for the time spent
with palliative care patients.
‘It is important to be aware of how
Medicare can work better with the doctors so
they get the remuneration through different
Medicare item numbers, including chronic
disease management,’ she said.
GPs are aware of palliative care patients’ history, as well as their psychological and physical capacity to deal with their illness
‘Money isn’t the most important thing,
but if you can’t keep the doors open
because you’re losing money, no one is
going to be doing palliative care.’
GPs also need to be mindful of their
own wellbeing in this sensitive area and
ensure they have proper systems in place
to cope with the stress associated with
palliative care.
‘This is an area that can really affect the
GP and you have to attend to your own
self-care. Listen to yourself, make sure
you’re looking after yourself in body and in
mind,’ Hepper said.
‘It is about building your resilience to be
with someone in discomfort and making a
difference in their life.
‘For GPs who are feeling unwell and
down, they need to talk to someone
about it and have the emotional and
clinical support.’
Wanguhu agrees it is important for GPs
who are involved in palliative care, especially
in rural and remote Australia, to be able to
draw support by talking to others.
‘In my case, we have a system of debriefi ng
and sharing the work in our practice, but it’s
a really diffi cult thing in general practice,’ he
said. ‘[Rural] GPs are part of the community –
these are not people who I see then go home
and forget, because I see them when I walk
down the street and play football with them.
‘While we are close with our community,
and it might be very diffi cult to have to
deal with losing a neighbour or friend, we
must keep up with this work that is so
important to them.’
References1. The Royal Australian College of General Practitioners.
Preliminary results: RACGP National Rural Faculty –
Palliative care survey. Melbourne: RACGP; 2015.
2. Higginson I, Sarmento V, Calanzani I, Benalia H,
Gomes B. Dying at home - Is it better? A narrative
appraisal of the state of the science. Palliative Medicine
2013;27(10):918–24.
3. Broad J, Gott M, Hongsoo K, Chen H, Connolly M.
Where do people die? An international comparison
of the percentage of deaths occurring in hospital
and residential care settings in 45 populations, using
published and available statistics. International Journal of
Public Health 2013;58:257–67.
4. Britt H, Miller GC, Henderson J, et al. General practice
activity in Australia 2012–13. General practice series no.
33. Sydney: Sydney University Press; 2013.
5. The Royal Australian College of General Practitioners.
New approaches to integrated rural training for medical
practitioners. Melbourne: RACGP; 2014.
Palliative care surveyThe National Rural Faculty’s
palliative care survey, conducted
among its members in April 2015,
aimed to examine the extent of
and demand for GP-led services
in rural and remote communities
throughout Australia.
The survey found that, while time
constraints and relatively limited
training can be barriers to rural GPs
providing palliative care services,
a majority of those surveyed were
actually already providing patients
with high-quality services in homes,
aged care facilities and hospitals.
Visit www.racgp.org.au/
yourracgp/faculties/rural/projects/
palliative-care-survey for more
detailed information on the survey.
17Reprinted from Good Practice Issue 8, August 2015
ETHICS IN GENERAL PRACTICE
Appropriate tests
SARA BIRD
GPs’ ethical and professional obligations when a patient requests tests recommended by an alternative health provider.
What should you do if a new patient presents
you with a long list of tests and tells you, ‘My
naturopath needs you to order these tests
before I next see them’?
When faced with this type of request,
GPs may feel caught between their
professional responsibility to only order
clinically-indicated tests and their desire to
comply with the new patient’s wishes, or
even a fear of missing something.
Such situations raise a number of questions
for GPs: What is my duty of care? What are
the professional and medico-legal issues?
Am I obliged to comply with or refuse the
patient’s request?
Duty of care
GPs owe their patients a duty to exercise
reasonable care and skill in the delivery of
medical services, including taking history,
examination, investigation, diagnosis and
management, as well as the provision of
information and advice.
If a request for tests comes from a naturopath
(via a patient) and the GP is not involved in an
initial assessment of the patient, with whom
does the legal liability rest?
From a legal perspective, the practitioner
who orders a test has a responsibility to review
the results and determine if further action
is required. The GP cannot delegate this
responsibility to the naturopath, especially since
the GP has greater clinical knowledge and the
naturopath may not have the required knowledge
to interpret the results and determine appropriate
clinical management.
There may be a heightened medico-legal risk
for a GP in acceding to a patient’s request for
tests ordered by their naturopath, particularly
if the GP is not familiar with the tests and their
interpretation. The GP is not following their usual
practice in managing a patient and ordering tests
in this manner, which, again, leaves the GP at
potentially greater medico-legal risk.
There may also be additional challenges in
follow-up, such as the patient refusing to see
the GP to discuss any clinically signifi cant
test results.
Professional obligations
The standards of ethical and professional
conduct expected of doctors by their peers and
the community are set out in the Medical Board
of Australia’s Good medical practice: A code of
conduct for doctors in Australia (the Code).
If the GP orders the tests with the intention of
handing over the results for management by the
naturopath, the Code states:
‘Good medical practice involves taking
reasonable steps to ensure that the person
to whom you delegate, refer or handover has
the qualifi cations, experience, knowledge
and skills to provide the care required.’1
The need for the GP to respect a patient’s
right to make their own healthcare decisions
must be balanced against the GP’s obligation
to ensure the services they provide are
necessary and likely to benefi t the patient.
Medicare
Medicare benefi ts are only claimable for
‘clinically relevant’ services.2 A medical service
is clinically relevant if it is generally accepted
in the medical profession as necessary for the
appropriate treatment of the patient. When a
service is not clinically relevant, the fee and
payment arrangements are a private matter
between the practitioner and the patient.
Specifi cally in relation to Medicare benefi ts
for pathology services, the treating practitioner
must determine that the pathology service
is necessary in order to bill the service to
Medicare.2 In this situation, the naturopath
may be able to order the tests, but the patient
would be responsible for the full cost and it
would appear the naturopath is asking the
patient to see the GP so the tests can be
ordered under Medicare.
Conclusion
If the GP does not believe the tests requested
by the naturopath are clinically relevant, they
are not obliged to order them and the tests
must not be billed to Medicare. Ultimately,
however, it is important to note that the
patient can still consult the naturopath, even
if the GP refuses to order the tests.
Depending on the circumstances, the
GP may therefore choose to: say ‘no’ at
the outset of the consultation, especially
if the new patient has only attended the
GP for the purpose of obtaining the tests
under Medicare; or proceed to assess the
patient as per their usual practice in order
to determine if the tests are necessary and
clinically-indicated.
References
1. Medical Board of Australia. Good medical practice: A
code of conduct for doctors in Australia. Available at
www.medicalboard.gov.au/Codes-Guidelines-Policies/
Code-of-conduct.aspx [Accessed 10 July 2015].
2. Department of Health. Medicare Benefi ts Schedule
Book. Canberra; DoH; 2014. Available at www.health.
gov.au/internet/mbsonline/publishing.nsf/Content/
432EE55FAB58E5C4CA257D6B001AFB8A/$Fi
le/201411-MBS.pdf [Accessed 30 June 2015].
This article is provided by MDA National.
They recommend that you contact your
indemnity provider if you need specifi c advice
in relation to your insurance policy.
18
IN MY PRACTICE
Images
West
ern
Aust
ralia
n G
enera
l Pra
ctic
e E
duca
tion a
nd T
rain
ing
Community partnershipBEVAN WANG
GPs at Western Australia’s Collie River Valley Medical Centre believe education lies at the heart of general practice.
The town of Collie is situated in Western
Australia’s south-west, 40 minutes from
Bunbury and two hours from Perth. While it is
traditionally a coal-producing town, the area
has diversifi ed into areas of agriculture and
other major industries over the years.
Collie River Valley Medical Centre, which
fi rst opened its doors in 1998, is located in the
middle of town and is able to provide care for
people in the region’s surrounding industries,
as well as those in the general community.
‘There was originally a group of doctors
who separated from an existing practice and
relocated to an older building in the CBD of
Collie,’ Dr Peter Wutchak, practice principal
and long-time RACGP Fellow, told Good
Practice. ‘They purchased it, renovated it and
opened the practice to the community.’
Collie River Valley Medical Centre has
been a procedural general practice since its
inception and offers obstetrics, anaesthetics,
minor general surgery and gynaecological
procedures. The practice currently has four
GPs and three general practice registrars to
service the town’s 7000 residents.
The practice’s commitment to the health
and wellbeing of the community extends to its
partnership with the Collie District Hospital.
‘The practice has been involved with the
local hospital since 1998 and we make sure
that we have one doctor who is on call and can
provide 24/7 service to the hospital if need
be,’ Wutchak said. ‘The hospital has 23–25
beds, but the emergency department isn’t run
by doctors but by the nursing staff. We come
to the hospital on an on-call basis.’
Refl ective training
Collie River Valley Medical Centre fi rst started
training general practice registrars in 2004
with the aim of increasing GP numbers in the
local community.
‘We looked at general practice training
as an avenue to help us with our workforce
because we often struggled to get doctors to
come to Collie,’ Wutchak said.
‘The community is really a procedural town
and, therefore, we needed to train future GPs
who would want to play a role.
‘I thought it would be a good opportunity to
see if we could fi nd someone who might grow
with their education in Collie and be a good
fi t for the town.’
The practice was awarded the Training
Practice of the Year Award for 2014 by
Western Australia General Practice Education
Training (WAGPET) in recognition of its
commitment to medical education.
‘The general practice is often very busy and
that means the registrars are getting a lot of
experience,’ Wutchak said.
‘I am best served to try and help the
registrars negotiate through that experience so
that they can get the most out of their learning.
Staff at Collie River Valley Medical Centre
work to provide occupational health services
to the town’s various industries, as well as
more general care to the wider community.
Reprinted from Good Practice Issue 8, August 2015
19Reprinted from Good Practice Issue 8, August 2015
‘We do have a formal teaching approach,
but it is mostly refl ecting on interesting cases
they have been involved. Really showing
by example and refl ection on their own
experiences, rather than a more formalised
teaching approach.’
Collie River Valley Medical Centre has
placed more than 25 registrars, as well
as a further seven prevocational junior
doctors, since 2004.
‘As time has gone on I have really enjoyed
the education part,’ Wutchak said. ‘You
realise how important training the next
generation of GPs is because they are
going to take over the reins when my
generation retires.
‘I am fairly empathetic and understanding
of where these guys are coming from
because I have done exactly the same thing.
I know what it feels like to be supported or
unsupported and what works in terms of
medical education.’
Wutchak believes that exposing younger
general practice registrars to procedural work
early in their career will ideally entice more to
take up the special interest.
‘Showing them the procedural aspects
of general practice will defi nitely broaden
their understanding and views on being a
procedural GP,’ he said. ‘If they are interested
in things like obstetrics or surgical procedures,
we will try and invite them and involve them in
that part of the practice.
‘Ultimately, we need to have a look at
what their training and learning plans are
and refl ect our education on their needs or
else they’re not going to get anything out of
the experience.’
Occupational health
The practice expanded in 2012 in order to
increase its capacity to facilitate occupational
health, preventive health checks and allied
health services for the people in and
around Collie.
‘We were thinking about our approach
to occupational health and really wanted to
tailor our services to cater to the needs of
the community,’ Wutchak said.
‘Collie is an industrial town and there were
a number of new projects and expansions
happening at that time in the mining sector,
and a lot of occupational-type health activity
that was needed.’
Wutchak has worked hard to make health
examinations and pre-employment checks
easier for local businesses to access.
Training the next generation of GPs is important because they are going to take over when our generation retires
‘We noticed that there were a number of
patients who were having to go elsewhere
for pre-employment medicals and other
aspects of their occupational health,’ he said.
‘We took steps to build a part of the
practice which would allow us to provide
this service for the community. As this need
decreased in recent years, we have been
able to use that expanded part of the surgery
and adapt it towards preventive health clinics.
‘Having this other side of the practice
allows us to run a much more relaxed
environment that can cater to this growing
group of non-acute patients. It allows us
time to allocate it to patients for proper
health assessments and we have a system
where we rotate the doctor who is working
in that area. There is also a nurse who is
allocated to them.
‘This then allows the nurse to do some
of the aspects of the assessment that
you would otherwise not be able to do in
a short consultation, before the patient
sees the doctor.’
The practice runs a number of clinics each
week in areas such as women’s health, skin
and hearing checks, postnatal and antenatal
care, diabetes, immunisation and asthma.
‘Over the time that I have been here, there
has been quite a push towards preventive
health playing more of a role in consultations.
Introduction to things like GP management
plans and health assessments for patients
over the age of 75, and diabetic cycles of
care have made a difference to our patients,’
Wutchak said.
‘General practice has been, and is going
to be, more progressive and proactive when
it comes to preventive health, which will
serve and benefi t our patients.’
Injury management is another aspect
that the practice provides to a working
community. Wutchak believes using
evidence-based methods will help ensure
the most appropriate treatment for patients
and allow them to return to work in a
timely manner.
‘We work closely with exercise
physiologists and nurses in the purpose-built
facility to make sure the injured worker is
getting the best care,’ he said. ‘By doing
this we can treat the patient from start to
fi nish, when they come in for the acute
management, through to their rehabilitation
and back to work.
‘General practice works so well in this area
because we can treat and monitor the patient
all the way through and provide that holistic
care and continuity they need.’
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20 Reprinted from Good Practice Issue 8, August 2015
Image S
hutters
tock
Suicide remains a signifi cant problem
throughout Australia. According to the latest
data from the Australian Bureau of Statistics
(ABS), suicide accounted for more than
2500 deaths in 2013, an overall rate of
10.9 deaths per 100,000 population.1
As the fi rst point of medical contact for
the majority of Australians, GPs are at the
frontline in working with people who have
considered or attempted suicide.
Dr Vered Gordon, a GP facilitator with
the Black Dog Institute, believes GPs’
ability to provide a safe place for people to
discuss their feelings can make a signifi cant
difference in working with those who may be
considering suicide.
‘Suicidal thoughts are very common in a
variety of mental health conditions and we
do know that it’s helpful for patients to be
able to talk about their suicidal thoughts
and share that with someone they trust and
who can understand and won’t judge,’
she told Good Practice.
‘I think the big thing we want GPs to do
is really feel confi dent and willing to have
conversations about suicidal thoughts.’
Direct approach
The fi rst step in treating people considering
suicide in general practice is to have the
conversation about it. While this may sound
relatively straightforward, the sensitive nature
of the topic can make raising the issue of
suicide diffi cult for GPs and patients.
According to Dr Jill Gordon, a Sydney GP
and Chair of the RACGP’s Psychological
Medicine working group, a more direct
approach is usually the best one.
‘It’s very important to ask the question,
and that is probably the single biggest barrier,’
she told Good Practice. ‘Sometimes I think
people worry that by bringing up the topic of
suicide they may actually make it more real
for the patient.
‘[But] the evidence tends to suggest
that a matter-of-fact empathic approach is
really important from the patient’s point of
view because they may be feeling anxious
about the prospect of disclosing and what
that might mean.’
While a direct approach is defi nitely
preferred, Dr Siva Bala, a community-based
psychiatrist who works with GPs in the area of
suicide prevention, recommends not making a
suicide-related question too ‘clinical’.
‘What I advise against is checklist-type of
questioning – “How have you been sleeping?
How is your diet? How is your weight? Are
you suicidal?” That comes out of the blue and
is not therapeutic,’ he told Good Practice.
‘There are different ways of handling it.
One is to talk about less strenuous subjects,
such as eating, weight, those sorts of things,
GP COMMUNICATION
PAUL HAYES
GPs have a vital role to play in working with patients who have experienced suicidal thoughts.
Suicide in general practice
Are you okay?Thursday 10 September is
World Suicide Prevention
Day, as well as R U OK?
Day in Australia.
The international theme
of World Suicide Prevention
Day, ‘Preventing suicide:
reaching out and saving
lives’, is designed to
reduce the stigma around
talking about suicide
prevention. R U OK? Day
is dedicated to reminding
people to ask family,
friends and colleagues the
question, ‘R U OK?’.
Visit http://wspd.org.au
or www.ruok.org.au for
more information.
21Reprinted from Good Practice Issue 8, August 2015
Images
Siv
a B
ala
, Vere
d G
ord
on, C
laudio
Vill
ella
and establish if the person is distressed –
“It sounds like you’ve got a lot of stress and
haven’t been sleeping. With all of this going
on have you ever felt like you can’t go on or
life is not worth living?”
‘[It’s] linking suicide and depression to
what they have already told you, so it’s a
more natural gateway to a conversation about
suicidal ideation.’
Establish risk
Once the issue of suicide has been
recognised in a consultation, a further step
is to determine the likelihood of those ideas
being acted upon.
‘Once a suicidal thought is declared then
the GP has to go through a process of
identifying things such as the frequency of
the thoughts, the intensity, the duration and
the likelihood of the thoughts being carried
out,’ Bala said. ‘What are the promoting
factors of the thought and what are the things
that might protect the person from carrying
out this thought?
‘Having worked that out, then the GP might
come to an overall assessment of what needs
to happen next. Can the person be managed
in a local setting, with the GP providing more
support? Can they be referred to a local
service for a non-urgent assessment? Can
they be admitted to hospital?
‘The GP is really a triaging person in this
instance and they provide a deeper evaluation
of the suicidal thoughts and the risks of acting
them out.’
We know it’s helpful for patients to be able to talk about their suicidal thoughts with someone they trust
The often close doctor–patient relationships
that exist within general practice can make
GPs particularly well suited to help patients
establish hope and maintain a positive sense
of their own lives.
‘Our relationship with our patients is part
of what we can do to help keep them safe,’
Vered Gordon said. ‘You may know their
family, their children, their partner. You may
have a fair understanding of the people who
really care for them who very much want them
to be here and stay in their lives.
‘Support is really integral and family
members have a really important role to play
in helping to keep people safe and helping
people be well. It’s important to work out
who those people are in a person’s life,
and work with the person you are looking
after to engage those people in providing
some of the support and care that is going
to be required.’
However, according to Jill Gordon, GPs
should be clear that including any family and
friends in treatment will not come at the cost
of the patient’s privacy.
‘It’s really important for someone to
feel that they have confi dentiality in the
consultation, but not confi dentiality to a
degree that puts them at a risk of harm,’
she said.
‘That is something that I would share
with the patients, share my dilemma with
them – “I am really worried about you and
your wellbeing, I want to make sure that you
are safe and I would like to know that there
are other people around you who are also
helping to care for you. Does anyone else
know how bad you have been feeling?”
‘You are trying to move them in the
direction of actually being able to talk to
others about how they are feeling.’
Beyond general practice
While GPs are well equipped to treat patients
who have expressed suicidal thoughts, the
serious nature of the presentation means
they, and their patients, can benefi t from a
referral if they believe the situation cannot be
best handled in general practice.
‘I don’t think GPs should feel that they can
do everything and I think they should share
that concern with the patient and say, “I have
someone who I know is very skilled in helping
people and I would really like you to go and
see them”,’ Jill Gordon said. ‘I don’t think
you should take any risk if you really think
someone might be likely to harm themselves.’
In addition to referral to specialists like a
psychologist or psychiatrist, Vered Gordon
suggests looking further afi eld.
‘There is a variety of different support
around and sometimes people may already
belong to some support,’ she said. ‘For
example, some of the people I look after
might belong to a church or another religious
institution where there is already a culture of a
caring community that they can tap into.
‘Community mental health centres will often
have various support groups and programs
where there is also peer-to-peer support and
that can be very useful.
‘In acute times, you may involve an
extended-hours mental health team that
may provide calls or visits to the person at
home with, for example, a newly-diagnosed
depression. You are going to need an
extra level of supervision and support for
that person.’
Those acute cases may also require GPs to
invoke their state or territory’s mental health
act and compel a patient to enter care if they
believe that patient is in danger.
‘That is certainly something doctors need
to understand: if they think that anyone is a
danger to themselves or to others then they
defi nitely need to act and not take the risk,’
Jill Gordon said.
Specifi cs can vary depending on location,
but, broadly speaking, invoking a mental
health act involves contacting appropriate
authorities, such as a crisis support team or
even the police, in order to ensure a patient is
taken for further evaluation. >>
Left to right: Psychiatrist Dr Siva Bala suggests GPs make questions of suicidal thoughts part of standard practice in
order to normalise the conversation; Dr Vered Gordon believes GPs’ knowledge of patients and their families helps them
to establish a safe environment; Dr Claudio Villella recommends GPs who treat patients for issues around suicide have
support networks in place to help ensure their own wellbeing.
22 Reprinted from Good Practice Issue 8, August 2015
RACGP National events guide
Showcasing workshops, conferences and
information sessions all around Australia to
support your continuing professional development.
You’ll find lots of information about whats on in
your state each month to assist you in fulfilling
your QI&CPD requirements including Category 1
and Category 2 activities and CPR workshops.
Visit www.racgp.org.au/education/courses
for more information.
tt.
GP COMMUNICATION
>> ‘What you are really doing is making
sure they are transported to hospital for an
assessment. You are not hospitalising them,
you are enforcing an assessment of their
safety at the hospital,’ Vered Gordon said.
‘It’s not common but I think there are times
when it is necessary.
‘At times it is apparent that, despite all
the measures we are able to put in place, a
person’s level of risk remains very concerning
and a mandated assessment is essential.
In that situation, I think you are obligated to
ensure the patient’s safety and if they are not
willing to go voluntarily you would be bound to
make sure they were at least transported to
hospital for a more thorough assessment.’
GP wellbeing
The nature of suicide means that regardless
of whether a GP does everything right in their
treatment, there will be some patients who do
take their own life. It is essential for healthcare
professionals to consider their own wellbeing in
such a situation.
‘I think it’s really important, if GPs are often
seeing a lot of people who are having suicidal
thoughts, to have some support networks in
place before a crisis situation like a completed
suicide,’ Dr Claudio Villella, GP advisor for
youth mental health organisation, headspace,
told Good Practice. ‘That might be meeting
regularly with some colleagues, like a Balint
group or a support group with other GPs, or
even having regular supervision.
‘GPs usually aren’t used to having
supervision, but I think it’s worthwhile if you are
seeing a lot of people with suicidal risk. Just to
have a sounding board about the people you
are worried about and as a cross-check around
your management approach.
‘Then if you do end up in a situation where
a tragedy occurs, you have got natural support
with people you are already connected to.’
Jill Gordon agrees with the potential benefi ts
of GPs being able to discuss the stressful
nature of working with patients who are
considering or have committed suicide.
‘Each state has a doctors’ health advisory
service that is manned by doctors for doctors.
Someone might call the helpline and say, “I am
going through a really hard time that I feel I can’t
talk to anybody about”, and talk it over,’ she said.
‘If people are fortunate enough to have other
doctors in their practice who they trust and share
cases with, people will often talk about it in the
context of their own colleagues within a practice.
‘It [suicide] is a very confi dence-shaking
experience and I think it’s really important
to be able to express that and seek support
from others who understand.’
Reference
1. Australian Bureau of Statistics. Causes of Death,
Australia, 2013: Suicide, Key Characteristics.
Available at www.abs.gov.au/ausstats/[email protected]/
Lookup/by%20Subject/3303.0~2013~Main%20
Features~Key%20Characteristics~10009
[Accessed 25 June 2015].
RACGP and mental health
The RACGP has many different
resources to help GPs better
understand and handle issues of
mental health and suicide. These
include clinical resources, guidelines,
online learning activities and contacts
for other mental health professionals
throughout Australia.
Visit www.racgp.org.au/your-
practice/mh/resources for more
information on the RACGP’s
mental health resources.
23Reprinted from Good Practice Issue 8, August 2015
NATIONAL FACULTY OF SPECIFIC INTERESTS
BEVAN WANG
The RACGP’s Abuse and Violence network believes GPs have an important role in supporting patients who are dealing with issues like family violence.
About the networkThe NFSI’s Abuse and
Violence network was
established in 2011 and
hopes to support GPs in
providing care for patients
who have experienced
abuse and violence.
Network members helped
develop and write the
RACGP’s Abuse and violence:
Working with our patients in
general practice (4th edition)
(the White book). They also
conduct webinars for GPs
and worked on the gplearning
domestic violence module.
Visit www.racgp.org.au/
yourracgp/faculties/specifi c-
interests or contact pam.
more information or to join.
Intimate partner abuse, commonly referred
to as domestic violence, is the most common
form of assault towards women in Australia.1
One in three women will experience some form
of physical or sexual violence perpetrated by
their partner.2
‘The facts show that at least one woman per
week in Australia is dying from family violence
and we as a community need to address this,’
Dr Libby Hindmarsh, a Sydney GP with a
special interest in abuse and violence, told Good
Practice. ‘The community is at last beginning to
talk about it and acknowledge it as a national
emergency, instead of it being something that is
swept under the rug.
‘This issue might still be hidden to a large
extent, but GPs and other health professionals
are working on that and recognising that it is a
serious issue in the Australian community. That
is a good fi rst step.’
Hindmarsh has been involved with the
RACGP in the area of abuse and violence since
1992. She became co-Chair, with Professor
Kelsey Hegarty, of the National Faculty of
Specifi c Interests’ Abuse and Violence network
when it was established in 2011.
‘Abuse and violence really covers a whole
spectrum of issues, particularly domestic
violence and sexual assault, but also areas such
as child abuse, elder abuse, adult survivors of
child abuse and bullying, as well as perpetrators.
It also covers Aboriginal and Torres Strait
Islander family violence, and violence in migrant
and refugee communities,’ she said. ‘We have
to confront the fact that some people are being
abused by family members and friends and
they need someone they can trust to talk to
and confi de in.
‘GPs have a role in identifying, treating and
preventing abuse and violence. As GPs, we need
to be equipped for that role to help and give
support to our most vulnerable patients.’
Supporting network
Hindmarsh believes the close relationships GPs
often have with their patients means they are well
positioned to be alert to the possibility of issues of
domestic violence and other forms of abuse.
‘Women who have been abused identify family
members as being the people they might talk to
fi rst, and GPs are generally second,’ she said.
‘However, it doesn’t usually present with the
woman walking through the practice door saying,
“I’ve been abused”.
‘It arrives in much more subtle ways related
to all sorts of symptoms, the most prevalent of
which is depression and anxiety, and GPs need to
be aware of these signs.’
It has been estimated that a full-time GP will
see an average of fi ve women each week who
experienced some form of domestic violence.3
‘GPs may need help to feel competent
because you never know when you might
encounter one of these patients,’ Hindmarsh
explained. ‘GPs need to be encouraged to identify
patients who are or have been abused, to explore
the safety of the patient and help the patient to
work out what is going to work for them.
‘We would be encouraging GPs to do the
“9 Rs” because that’s what we hope will be
the steps.’
The 9 Rs is a list of steps – role, readiness,
recognise, respond, risk, review, refer, refl ect,
respect – designed to help GPs be better
prepared for the intervention with patients
who have experienced abuse and violence.
A detailed explanation of the 9 Rs is available
in the RACGP’s Abuse and violence: Working
with our patients in general practice (4th edition)
(the White book).
For Hindmarsh, abuse and violence is an area
that affects all aspects of life.
‘Certainly, I would be working with patients
around housing and fi nancial assistance, if that’s
what they need, because that is usually the fi rst
step,’ she said. ‘Some of the work in Victoria
at the moment is looking at trying to keep the
women and children at home and remove the
perpetrator from the house but, at the end of
the day, there needs to be different solutions for
different people.
‘GPs usually know these patients well and
have a good patient–doctor relationship with
them. They are often the best people to look out
for these patients.’
References1. Australian Bureau of Statistics. Personal Safety. Canberra:
ABS; 2012.
2. World Health Organization. Responding to intimate partner
violence and sexual violence against women: WHO clinical
and policy guidelines. Geneva: WHO; 2013.
3. Hegarty K. What is intimate partner abuse and how common
is it? In: Roberts G, Hegarty K, Feder G, editors. Intimate
partner abuse and health professionals: new approaches to
domestic violence. London: Elsevier; 2006:19–40.
Abuse and violence
It’s magic
By the very nature of their profession,
GPs have to be skilled in a number of
different areas and they are always
learning and upskilling throughout
their careers.
Dr Vyom Sharma, a young Melbourne
GP who was awarded his RACGP
Fellowship earlier this year, has spent
much of his career in medicine developing
extra skills. It is outside of the consulting
room, however, that he has cultivated
some of his most interesting abilities.
‘I was initially introduced to magic and
performing in my fi rst year of university,’ he
told Good Practice. ‘As a medical student
who was sitting in lectures and tutorials
with god-knows-how-many contact hours
a week, it was very interesting to have this
thing on the side.’
Sharma’s love of magic saw him take
time off from medicine to perform in
Australia and overseas, including at the
Melbourne Comedy and Edinburgh Fringe
festivals, but he never left his medical
ambitions behind. While he initially
started towards a career in surgery, the
time Sharma spent away from full-time
medicine gave him a much different
perspective on his vocation.
‘I did a few months of locum shifts
[during my time off],’ he said. ‘That was
really fun, doing medicine not on a career path,
but more as a job. Not as a means to an end,
but the end being just doing the job and not
having to worry about career progression.
‘That was very liberating and made medicine
really interesting and just fun to do.’
After close to 18 months spent primarily
travelling and performing magic, Sharma
decided it was time to get back to his medical
career. His choice of specialty, however, had
taken a turn.
‘I thought long and hard about what
kind of specialties to do and after some
pretty deliberate weighing up I decided to
go for general practice. It was the perfect
decision,’ he said.
Parallel education
While Sharma’s love of magic may have
initially been an interesting hobby outside of
medical school, it soon occupied a much larger
portion of his life.
‘It was a pretty intensive period, actually,
during medical school. It was almost like this
parallel education I was having in sleight of
hand,’ he said.
‘I probably spent the same amount of time
in the State Library of Victoria, which is where
I read a lot of these [magic] things, as I was
putting in at the medical school library.’
His love of magic and performing eventually
led Sharma to something of a crossroads and
he ultimately had to determine whether he
could give his medical career the attention and
focus he knew it deserved.
‘It got to about my internship and I was
struggling to balance performing on the side
while working as an intern. And I was still
interested in doing surgery at that point,’ he
said. ‘I realised how untenable it was to balance
both of these things out the way that I wanted
to. For that and various other reasons I decided
that I needed to take a short break from
medicine to pursue performing a bit more.’
It’s beautiful to be part of a specialty where there is no set path and you are free to make your own way
The year and a half Sharma took off to follow
his magic ultimately proved a blessing for both
of his interests. The time not only allowed his
performing to reach ‘a whole other level’, it
also gave him a new viewpoint on medicine and
what he wanted to achieve in his career, leading
him to the varied life of general practice.
‘It’s a great specialty because there is
nothing that ever becomes too familiar,’ he said.
‘You never really see anything often enough for
it to become boring. There is so much variety.
‘There is not another specialty where you
are going to fi nd more varied work. It’s actually
quite beautiful to be part of specialty where
there is no dedicated set path and you are really
quite free to make your own way.’
Well practiced
By his own admission, Sharma was not
necessarily ‘refreshed’ when he restarted his
medical training after a year and a half away.
But it wasn’t long before his fi re for general
practice was well and truly lit.
‘It was only when I did my fi rst shift back
that I realised how ready I was for it,’ he said.
‘When I did that fi rst shift I was just so excited
by the end of it. It felt amazing. Images
Vyo
m S
harm
a
PAUL HAYES
Dr Vyom Sharma’s love of magic and performing helped lead him to his career in general practice.
24 Reprinted from Good Practice Issue 8, August 2015
Dr Vyom Sharma has performed magic and
comedy all over the world, including at the
Melbourne Comedy and Edinburgh Fringe festivals.
GP PROFILEORRO
‘It was like my palate has been cleansed
and I thought, this is what I do. It’s a blank
slate. People come in with problems, I am
supposed to become familiar with them and
talk to them and understand it, and come up
with solutions they can use in some way.
‘It was a completely new view on medicine
when compared to what I had been doing.
I had lost all perspective of that when I was
working in the hospital system and just seeing
it as this process that I had to go through.’
Much of Sharma’s expanded view on
general practice had to do with the area many
GPs love most about their profession.
‘I knew I really liked talking to patients
and I knew there was probably no other
specialty where you get to do that in the same
way,’ he said.
‘General practice is very intensive on patient
contact. The job is 90% communication,
really, and dealing with people is easily the
best part of the job.’
Sharma’s general practice training, which
took place among a number of very different
patient demographics, also opened his eyes to
the varied nature of the specialty.
‘Part of the training was six months at
the Dandenong Superclinic [Victoria], where
there is a big emphasis on refugee health.
So a lot of my patients were refugees or
asylum seekers and I was dealing with all of
the issues that come with that,’ he said.
‘I don’t know that I would have had [that kind
of experience] in any other specialty.’
Working with many older patients in the
Melbourne outer-metropolitan suburb of
Glengowrie, where Sharma found patients
were less likely to attend hospitals for
geographic and personal reasons, afforded
him the opportunity to hone many of the
skills that GPs don’t necessarily use on a
day-to-day basis.
‘Treating these patients and taking on a
lot more responsibility … there was a lot of
stuff that you would otherwise refer to the
emergency department that you would deal
with in a general practice setting. That was
very exciting,’ he said.
‘For example, there’s people [in general
practice] who probably wouldn’t have
plastered for months or years because
you usually send the patient down to the
emergency department or somewhere else.
So having to do these things frequently in
Glengowrie was a huge advantage.
‘Working in that outer-metropolitan area
was a real education, having to take on a
lot more responsibility and practise a lot
of things that you read in a book. It was
pretty amazing. I think I upskilled more in
those six months than I did in any other six
months of medicine.’
Sharma’s current role as a GP for an after-
hours home-visit service that involves many
acute cases allows him to maintain the skills
he has developed.
‘That keeps me sharp,’ he said. ‘It’s an
interesting facet of general practice; that very
acute care and triage that you often have to
do. It’s almost exclusively those presentations.
You see something new or exciting with pretty
much every patient.’
25Reprinted from Good Practice Issue 8, August 2015
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26 Reprinted from Good Practice Issue 8, August 2015
CONFERENCE FOR GENERAL PRACTICE
GP15 scheduleOpening plenary
Dr Alessandro Demaio
‘Rethinking the future of general practice’
Monday 21 September, 8.30 am – 10.00 am
Melbourne Convention and Exhibition Centre
Exhibition
The GP15 Exhibition will run across
all three days of the conference
(Monday–Wednesday 21–23 September).
With more than 110 organisations and
130 booths, this will be the largest
RACGP Exhibition ever and provide
something for all attendees.
Active learning modules (ALMs)
Rural hospital forum and simulation
Sunday 20 September, part one (forum)
12.30 pm – 3.30 pm
Monday 21 September, part two (simulation)
9.15 am – 12.15pm or 1.30 pm – 4.30 pm
Dermatology for GPs: clinical
management of common
skin cancer presentations
Monday 21 September
10.30 am – 6.00 pm (fully booked)
Tuesday 22 September
8.30 am – 4.30 pm (fully booked)
An integrative approach to mental health
Monday 21 September, 10.30 am – 6.00 pm
Can we do better than ‘I treat everyone
the same’? A practical workshop
to improve outcomes for Aboriginal
and Torres Strait Islander peoples
Monday 21 September, 10.30 am – 6.00 pm
The latest in Chronic Obstructive
Pulmonary Disease (COPD)
diagnosis and management
Tuesday 22 September, 8.30 am – 4.30 pm
A patient-centered approach to cancer
in general practice – communications
and survivorship strategies
Tuesday 22 September, 8.30 am – 4.30 pm
Emotional health of children
Tuesday 22 September, 8.30 am – 4.30 pm
Future of general practice:
future proofi ng your practice
Wednesday 23 September, 8.30 am – 4.00 pm
Introduction to research – turning your
research idea into a reality
Wednesday 23 September, 8.30 am – 4.00 pm
Caring for patients who
are socially disadvantaged
Wednesday 23 September, 8.30 am – 4.00 pm
Rural general practice business tools
Wednesday 23 September, 8.30 am – 4.00 pm
Visit http://racgpconference.com.au/alms for more
information on GP15 ALMs.
CPR workshops
Monday 21 September
10.30 am – 12.00 pm
CPR workshop A1 – Room 205 (fully booked)
CPR workshop A2 – Room 206 (fully booked)
CPR workshop A3 – Room 214 (fully booked)
1.30 pm – 3.00 pmCPR workshop B1 – Room 205 (fully booked)
CPR workshop B2 – Room 206 (fully booked)
CPR workshop B3 – Room 214 (fully booked)
4.00 pm – 5.30 pm
CPR workshop C1 – Room 205
CPR workshop C2 – Room 206
CPR workshop C3 – Room 214
Tuesday 22 September
8.30 am – 10.00 am
CPR workshop D1 – Room 205 (fully booked)
CPR workshop D2 – Room 206 (fully booked)
11.00 am – 12.30 pm
CPR workshop E1 – Room 205 (fully booked)
CPR workshop E2 – Room 206
2.30 pm – 4.00 pm
CPR workshop F1 – Room 205
CPR workshop F2 – Room 206
Wednesday 23 September
8.30 am – 10.00 am
CPR workshop G1 – Room 205 (fully booked)
CPR workshop G2 – Room 206
CPR workshop G3 – Room 214
11.00 am – 12.30 pm
CPR workshop H1 – Room 205 (fully booked)
CPR workshop H2 – Room 206
CPR workshop H3 – Room 214
2.00 pm – 3.30 pm
CPR workshop I1 – Room 205
CPR workshop I2 – Room 206
CPR workshop I3 – Room 214
Visit http://racgpconference.com.au/cpr for more
information on GP15 CPR workshops.
Social functions
National Faculty of Aboriginal and
Torres Strait Islander Health dinner
Sunday 20 September, 7.00 pm – 10.00 pm
Melbourne Public, 11 Dukes Walk
South Wharf Promenade
Sweet time – New Fellows and
registrars celebrate
Sunday 20 September
7.30 pm – 9.30 pm
Om Nom, 187 Flinders Lane, Melbourne
Future connections in health,
GP15 welcome reception
Monday 21 September
6.00 pm – 7.30 pm
Cargo Hall and Plus 5
39 and 37 South Wharf
National Faculty of
Specifi c Interests dinner
Monday 21 September
7.30 pm – 10.00 pm
Byblos Bar and Restaurant
G12 World Trade Centre
UN–urban National Rural Faculty
cocktail function
Tuesday 22 September
7.00 pm – 11.00 pm
The General Assembly
29 South Wharf Promenade
Visit http://racgpconference.com.au/social for more
information on GP15 social events.
Visit http://racgpconference.com.au/
program for the full GP15 program.
Finding your dream home is difficult. Finding the right mortgage can be a nightmare.
We suspect you may have better and more pressing things to do than comparing all the options available in order to make a decision as to which one is right for you.
But for us, it is what we do.
We’re specialists. We know our clients’ inside out and design financial products that are tailored to meet your needs.
So bank on us. We won’t rest until you do.
Visit us at boqspecialist.com.au or speak to our financial specialists on 1300 131 141.
Equipment and fit-out finance / Credit cards / Home loans / Commercial property finance / Car finance / Practice purchase loans SMSF lending and deposits / Transactional banking and overdrafts / Savings and deposits / Foreign exchange
100% Interest. Non-variable. That’s what we put into getting you the right mortgage
BOQS000005 09/14
Products and services are provided by BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL and Australian credit licence No. 244616. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges and eligibility criteria apply.
O U R F U T U R E I N P R A C T I C E
Melbourne Convention and Exhibition Centre
21 – 23 September 2015www.racgpconference.com.au
The Good GP never stops learningGP15 is the event of the year for you to attend to further your learning.
Over 100 presentations covering seven clinical,
educational and business streams
Greater variety of ALMs than ever before
with twelve to choose from
CPR workshops to assist you in fulfilling your
2014–16 QI&CPD requirements
Extensive trade exhibition with over
100 confirmed organisations
Register now to confirm your place at GP15! www.racgpconference.com.au
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Media partners
GP15 is proudly sponsored by
