Working as a Doctor i the Australian Army Corps has brought Captain Andrew Challen a wealth of experience...Read more on pages 8,9 and 10.

1. Andrew
Southcott
on primary healthcare
ISSUE 5: JULY 2012
04 Dr Andrew Southcott
08 GP Profile
12 Dr Kathryn Fox
16 Exploring the medical museum

3. THIS MONTH IN CANBERRA
Parliament rests, but it’s a busy
month for healthcare changes
July is an eventful With the launch of the Personally previously raised by the RACGP – ‘that
Controlled Electronic Health Record unanimous concern still remained ... that
month for the (PCEHR) system and amendments to the agreement still did not provide clarity
health sector. the private health insurance rebate and relating to intellectual property clauses,
Medicare levy surcharge, Australians are and the separation of responsibilities
Sharon Lapkin looks facing large changes in their healthcare. between HPOs and individual healthcare
at the past month July – which also includes Pneumonia providers’.
Awareness Week, Eye Health Awareness The College is continuing to work with
in Canberra. Month and World Hepatitis Day – is the government and medical defence
actually a quiet month in Canberra with organisations to ensure adequate
no parliamentary sittings. medicolegal protection for all users of the
However, there are major concerns PCEHR system.
being expressed by healthcare Meanwhile, patients will be able to
professionals and medical indemnity sign up for a PCEHR from 1 July. The
insurers about the implementation of the government’s e-health learning centre
PCEHR. went live on 12 May, and from there
President of the Medical Defence Australians will be able to register for
Association (MDA), Associate Professor an e-health record online. A ‘Consumer
Julian Rait told The Australian that the Portal’ can be accessed from the
MDA ‘had serious concerns about the website as well, which will allow patients
legal responsibilities doctors would face’ to access their e-health record after they
if they used the PCEHR, and warned have registered.
members ‘not to participate until these Similarly, a ‘Provider Portal’ is available
problems are properly addressed’. for healthcare professionals to view
It has also been reported recently e-health records once patients have
in Australian Doctor that no insurers given them permission to do so.
have, as yet, stated whether they The legislative changes to the private
would consider raising premiums, and health insurance rebate and Medicare
it remains unclear whether doctors’ Levy surcharge require that they be
indemnity insurance would ‘cover them income-tested against three-income
for claims arising from their use of the tier thresholds. According to the
PCEHR’. Australian Medical Association Australian Taxation Office, ‘higher
(AMA) President Dr Steve Hambleton income earners will receive less private
has advised members not to sign up until health insurance rebate or, if they do
the AMA ‘is happy with the regulations not have the appropriate level of private
and that may not be before 1 July’. patient hospital cover, the Medicare levy
The problem at the heart of the surcharge may increase.’
issue is a government draft requiring The government expects to raise
GPs taking part in the PCEHR to sign $2.4 billion in revenue over 3 years
a contract that states the government from means testing the rebate and has
is not liable if patients’ records are promised to put it back into training
breached. GPs and funding healthcare and
The RACGP stated after viewing a hospitals. But the Opposition claims
revision of the Participation Agreement the government will pump the money
for use with Healthcare Provider back into consolidated revenue to help
Organisations (HPOs) – which balance its budget. Like the rollout of the
addressed a number of concerns PCEHR, only history will tell.
Reprinted from Good Practice Issue 5 – July 2012 3

4. LEAD STORY
Andrew Southcott on
a doctor in parliame
SHARON LAPKIN It was Harvard law graduate, sociologist and the way it has attempted to create an e-health
educator David Reisman who said that ‘if system on a global scale over a 2-year time
you want to get out of medicine the fullest frame. The Coalition, Southcott said, initially
enjoyment, be students all your lives’. Ask explored the idea of a shared electronic health
Good Practice talks to Dr Andrew Southcott and he would probably record in 2004, and it supported the idea
Dr Andrew Southcott agree because his medical training kicked off as a progressive step forward. Despite its
16 adventurous years of parliamentary service concerns, the Opposition is committed to the
about his role as as the federal member for Boothby in South concept of a PCEHR, Southcott said, because
Shadow Parliamentary Australia. Along the way he picked up an of the ‘potential benefits to patients and
economics degree at Flinders University and practitioners alike’. He cited forecasts from
Secretary for Primary then returned to the University of Adelaide, the Booze and Co, showing that a comprehensive
Healthcare. site of his medical studies, to earn an MBA.
As the Shadow Parliamentary Secretary
and properly implemented e-health platform
could save up to 5000 deaths annually.
for Primary Healthcare, politics is Southcott’s The Rudd government, Southcott said,
true love, but it’s his medical education ‘had a national e-health strategy prepared
and experience that provides him with the for them in 2008, which laid out over 10
necessary insight and understanding of his years, an incremental way of implementing
portfolio. ‘I know the space’, which makes it workable e-health solutions’. Instead of
easier, he said. introducing it gradually as recommended, he
After graduating in 1990, Southcott said, ‘In April 2010, Kevin Rudd decided to
completed his internship at the Royal Adelaide go for the big bang approach’ and create a
Hospital from 1992–93. Then in 1994, he ‘PCEHR for all Australians’.
was a surgical registrar in vascular surgery at The latest estimate for the arrival of the GP
the Repatriation General Hospital in Daw Park, software, Southcott said, is now September,
and a surgical registrar at the Breast Cancer and while GPs will be reimbursed for
Unit at Flinders Medical Centre. While he was populating e-health records, it has to be done
a political candidate, Southcott worked as a in the context of a patient consultation with
locum medical practitioner and medical officer. some remuneration available under Medicare.
As an associate member of the RACGP, with a Although it’s an opt-in system, Southcott
non-practising medical registration, Southcott expects very few will sign up and there won’t
said he has the prerequisite knowledge to ably be ‘a lot to see for it. Outside the wave
assist Shadow Minister for Health and Ageing centres there will be nothing’, he added.
Peter Dutton in his portfolio. Southcott said he believes there will be a
Southcott has serious concerns about big difference between people registering
the readiness of the Personally Controlled for the PCEHR and those who actually use
Electronic Health Record system (PCEHR) the system. GPs and other practitioners
and describes its implementation as ‘nowhere will only use it, he said, ‘if they find it
near ready’. ‘In principal’, he said, ‘an useful’, and ‘nothing will replace taking a
electronic health record is a good idea’, detailed history and a focused examination’.
but he criticised the speed with which the However, the PCEHR will have its uses, he
government has implemented the scheme and said, ‘principally for those people who have
4 Reprinted from Good Practice Issue 5 – July 2012

5. being
nt
chronic disease, who have multiple episodes
of care and multiple practitioners involved in
their care’. Southcott said the government
should have commenced its venture into
national electronic health records with
simple and inexpensive procedures within an
e-health context.
Regarding the reduction of the PIP
immunisation payments, Southcott said it
‘was very poor from a public health point of
view ... as we have seen large increases in
our immunisation levels of children’, due to
the institutional focus. The government is
becoming ‘complacent about immunisation,
and if we don’t maintain these high rates
it’s only a matter of time before we start
seeing preventable diseases of childhood
re-emerging’, he said. ‘The PIP was all
about people incentives to be immunised
and now all of the focus is on the stick
instead of the carrot.’
According to Southcott, ‘two of the
really big success stories of the Howard
government in the general practice space
were firstly, the computerisation of general
practice and secondly, immunisation
incentives’, which ‘we did through GPs and
we did it very successfully. It was a really
good model,’ he said.
An Abbott government, Southcott said,
‘would rebuild general practice’ because ‘we
want to see that general practice is at the
centre of the health system’. In terms of the
PCEHR, Southcott said a future Coalition
government would do a ‘stocktake of where
we’re at’, and ‘our approach would be to
look at practical things that we could achieve
such as electronic prescriptions and discharge
summaries’. He added that what they would
do depended on ‘what they find’, if they took
office after the next federal election. >>
Reprinted from Good Practice Issue 5 – July 2012 5

6. LEAD STORY
>> Southcott said he was ‘very concerned Southcott said he welcomed the news from
about a similar program’ to the PCEHR the Australian National Audit Office that
in the UK, where ‘they spent £12 billion it was now assessing ‘the effectiveness
and really don’t have a lot to show for all of DoHA’s [Department of Health and
that money’. He said e-health is an area Ageing] administration of the GP Super
that can have enormous benefits, but also Clinics program, which is due to table in
where a lot of money could be wasted and autumn 2013.
‘poor planning and implementation’ over 10 Southcott appears pleased with his
years on the summary care record in the career choice to move from medicine to
UK proved to be ‘financially disastrous’. politics. ‘I enjoyed working in medicine
An Abbott government would restore the very much’, he said, ‘but I also had an
private health insurance rebate ‘as soon interest in politics and now I have a great
as we can, when we can’, Southcott said. job where I get to think about and discuss
‘We think private health insurance plays a and make an impact in health policy across
very important role in taking pressure off the board’. In the future, Southcott said
the public system and in providing choice of he’d like to work with Peter Dutton, the
doctor, and also in terms of all of the allied current Shadow Health Minister, in a
health offering as well.’ The PIP was all about Coalition government to help implement
In the area of Indigenous health, people incentives to be the Opposition’s health policy.
Southcott praised aspects of the ‘Close For now he is working hard in a portfolio
the Gap’ initiative, and said he was
immunised and now all that includes primary healthcare, e-health
impressed with the way the RACGP was of the focus is on the stick and preventive health. Southcott, married
working to increase cultural awareness and instead of the carrot. with two school-aged children, also finds
improve primary healthcare for Indigenous time to complete the RACGP’s online
Australians. He also supports the way the QI&CPD and is a big fan of the College’s
initiative works through general practice, long way to go and a large gap in life professional development check Program,
and said ‘we rely a lot on our 7000 general expectancy, mortality rates, complications which he receives in hard copy.
practices and more than 20 000 GPs to do from diabetes and kidney disease in Southcott is passionate about medical
these things. It’s just a matter of thinking Aborigines and Torres Strait Islanders. education and an advocate of general
through “what is the gold standard I can do The status of Labor’s GP Super Clinics practice as a ‘very strong career option’ for
for this patient”. Even if it’s through fairly program is also something that concerns medical students. ‘There’s a lot going on in
non-subjective surveys,’ he said, ‘finding Southcott. He said the Opposition would that space’, he said, and ‘what’s happening
out who are the Aboriginal and Torres Strait rather have built on existing practices than in the medical schools, the GP student
Islander patients in their practices’ so they build super clinics, and added that ‘of the societies, GP registrars’ associations and
can provide the best healthcare available. 64 promised clinics, only 24 are open, at what the College does is making sure they
Despite advances and the College’s hard least three have required additional funding have a lot more exposure to general practice’
work Southcott said there was still a and two have been scrapped completely’. and the rich rewards of a career as a GP.
6 Reprinted from Good Practice Issue 5 – July 2012

7. HEALTH
Looking after your own health
NICK JOHNS-WICKBERG Four wheels? Try two, or zero
Busy doctors spend their days taking Going to and from work provides an excellent opportunity
to get some exercise, so consider ditching the car – and
care of their patients’ health, but we the traffic – for a bicycle. In 2010, Dutch researchers
found some simple ways for GPs to found that people who cycled short distances instead of
driving had an estimated increased lifespan of between
stay healthy too. 3–14 months. The risks of cycling, such as exposure
to air pollution and traffic accidents, were shown to be
minor in comparison. If you live far from work, think about
cycling or walking to the train station instead of driving. At
the other end, walk from the station to the office. If you
live in the country, sans the smog, cycling can be even
Enjoy a better for you.
tropical
smoothie
Go for a walk between patients
to cure the
winter blues Taking a quick walk outside between patients can be
beneficial for body and mind. Even a few minutes of
fresh air every hour provides exercise, breaks up your
day and helps you to maintain the necessary levels of
vitamin D. This is especially important in winter, when
many Australians require up to half-an-hour of sun
Ingredients
exposure each day. Walking is also great for lowering
2 ripe bananas
stress levels, so taking a brisk walk around the block can
I cup coconut milk
be exactly what a busy doctor needs.
1 cup low-fat milk
2 tablespoons natural
nat
or vanilla yoghurt
2 teaspoons Manuka honey
Ma
1 teaspoon lin
linseed meal Make work relaxed and more fun
4 ice cubes
M
Method Creating a relaxed and fun work environment is considered
P
Place all in
ingredients into a a good way to keep workers happy and healthy.
blender or food processor
b o Researchers tend to divide this into two categories:
and blend until smooth.
a blen ‘organised fun’ and ‘organic fun’. The former refers to
Serve immediately.
S i events such as birthday celebrations and office outings,
the latter to everyday activities such as telling jokes,
recounting stories and using nicknames. Encouraging
organic fun in particular can make workers feel supported,
which has been shown to improve psychological wellbeing
and reduce the risk of longterm absence from sickness.
In the context of a general practice, the benefits felt
by happy staff – such as less stress and increased
productivity – are likely to flow on to GPs.
Reprinted from Good Practice Issue 5 – July 2012 7

8. GP PROFILE
As an Australian Army Medical Officer,
Captain Andrew Challen has been deployed
to Iraq, East Timor and Afghanistan, but
his service in Australia has also provided
valuable medical experience.
Captain When Challen joined the Army as
a medical student in 2001, he looked
Andrew Challen forward to the opportunity to work overseas
in a range of challenging environments. His
experiences to date include working in an
NICK JOHNS-WICKBERG Afghan summer in temperatures of more
than 50 degrees Celsius, providing forward
resuscitation support from an armoured
Working as a doctor ambulance in Iraq and performing med medical
retrievals in a helicopter in low visibility
in the Australian Army during East Timor’s wet season.
One of the incentives for Challen to
Medical Corps has join the Army was a Defence University
brought Captain Andrew Sponsorship, which paid him a salary w while
he studied and took care of his remaining
remain
Challen a wealth of HECS fees. The freedom to study stud
experiences. without worrying about
part-time work, as w well
as the opportunity
to do medical wo work
overseas meant the
Photos
L to R:
Captain Andrew
Challen; outside the
medical centre in Afghanistan;
performing minor surgery in
Afghanistan.
8 Reprinted from Good Practice Issue 5 – July 2012

9. Army was an attractive option for Challen. And in 2009, in Afghanistan, Challen military training had provided the best
He has also enjoyed and was inspired by provided primary healthcare to deployed possible preparation for medical officers.
the mentorship offered by doctors within Australian soldiers, assisted in clinics for ‘The training the military provides to
the Army, who assisted him to prepare for Afghanistan locals and was team leader in medical personnel is increasingly more
his medical career both in the Defence a Dutch-led hospital. realistic and is helping to better prepare our
Force and civilian life. ‘Every deployment has been rewarding doctors, nurses and medics for the rigours of
As part of the medical corps, Challen has and challenging,’ Challen said. ‘It has also deployment,’ he said.
worked at Holsworthy Barracks in Sydney, provided me with an opportunity to grow Now 32 years of age, Challen has
and Lavarack Barracks in Townsville. He clinically and personally.’ completed his fulltime military service and
completed a Navy diving and submarine The knowledge Challen has gained commenced work in Fremantle Hospital’s
medicine course in Sydney and has worked during his deployments has also proven anaesthetics department. He remains an
extensively with soldiers’ training-related useful in his civilian work in Australia, Army Reservist, and is part of the 2nd
injuries. However, it’s Challen’s overseas especially when it comes to trauma cases. Health Support Battalion where one of
work that has been the focal point of ‘Fortunately, in Australia the incidence of his roles is to educate new Army doctors
his military career and given him with major trauma is small,’ he said. ‘However, about advanced trauma life support in
far-reaching experiences. for medical teams it often means that they battlefield situations.
As well as providing medical support lack the depth of experience when dealing Challen’s military experience has fostered
to ASLAV ambulances in Iraq, Challen with these patients. other professional interests in sports and
helped instruct Iraqi civilians in paramedics ‘My military experience has given me an underwater medicine, which he has turned
and worked in a trauma bay attached to advanced understanding of the challenges into an impressive set of qualifications.
the United States Forward Surgical Team. that these patients can pose to unwary or He has completed a Masters of Sports
As an aero-medical evacuation doctor inexperienced clinicians and has allowed Medicine, a Medical Officer’s course in
attached to the Timor Leste Aviation Group, me to pass on my experience to junior Underwater and Submarine Medicine, a
he completed more than 80 aero-medical doctors.’ Certificate of Ultrasonography in Emergency
retrieval missions with the Australian Army It is difficult to be prepared in a job that Medicine and is now undertaking a Diploma
and the New Zealand Air Force. can be unpredictable, but Challen said in Hyperbaric Medicine.
Reprinted from Good Practice Issue 5 – July 2012 9

10. MEDICAL EDUCATION
Studying with a little
help from the ADF
NICK JOHNS-WICKBERG
The Australian
Defence Force
sponsors both
undergraduate and
graduate medical
students.
The Defence University Sponsorship is of up to $43 266. Graduates must have
a program developed by the Australian completed a relevant undergraduate degree
Defence Force (ADF) for undergraduate and and can receive a salary of up to $64 437
graduate students studying an accredited per year. All students in the program receive
degree at any recognised university in 18% superannuation. As soon as the student
Australia. It offers the following benefits: is accepted into the ADF sponsorship
• a salary while studying program, their remaining HELP fees are paid
• Higher Education Loan Program (HELP) by the ADF.
and student fees paid Once students have graduated they are
• superannuation contribution of 18% required to commit the same number of years
Photo • subsidised accommodation they were in a sponsorship, plus one year. So
Isabella Todd, a medical student studying at • free healthcare (dental and medical) if a student was sponsored for three years
the University of Queensland on a Defence • a rewarding career as an officer in the they would need to serve four years in the
University Sponsorship. Navy, Army or Air Force. Navy, Army or Air Force. There is a minimum
‘Many students are yet to realise that they Undergraduate students must have requirement of three years.
can be sponsored later in their degree. If you
get to third year and decide Defence is really
completed one year of a three or four year
where you want to be, you can apply for a degree, or two years of a five or six year Further information
Defence University Sponsorship,’ she said. degree. They receive a salary while studying, www.defencejobs.gov.au/unisponsorship
10 Reprinted from Good Practice Issue 5 – July 2012

11. MED BITES
Stem cells can survive more
than 2 weeks after death
Exciting new research from France in culture, they retained their ability to
has found skeletal muscle stem cells in develop into muscle cells despite having
humans can maintain their regenerative been dormant for so long. It had previously
capacities for up to 17 days after death. been thought stem cells could not
The study, published in the journal, Nature survive more than 1–2 days after death.
Communication, found stem cells are Researchers acknowledged that further
capable of slowing their metabolism by research was needed before clinical trials
adopting a ‘reversible dormant state’, began, but said their work cleared the way
which allows them to survive without for similar studies on stem cells from other
oxygen for an extended time. When placed organs and tissues in the body.
Antipsychotic drugs reduce
relapse in schizophrenics
A systematic review and meta- given placebos. Depot haloperidol
analysis published in The Lancet was found to be the most effective
found keeping schizophrenia patients treatment at preventing a relapse.
on ‘maintenance treatment’ with There were adverse side effects,
antipsychotic drugs after stabilisation however, with patients on the drugs
reduced the likelihood of relapse. 4% more likely (10% vs 6%) to gain
Researchers examined data from weight, 7% more likely (16% vs 9%)
116 appropriate reports with to suffer movement disorders and 4%
information on 6493 patients. They more likely (13% vs 9%) to experience
found that the rate of relapse within sedation. The authors advised that ‘the
a year of initial stabilisation was 27% advantages of these drugs must be
for patients given antipsychotic drugs, weighed against their side-effects’.
compared with 64% for those
WHO issues diesel fume warning
The World Health Organization (WHO) WHO also found ‘limited evidence’
has declared diesel fumes to be to suggest a positive association
carcinogenic. A committee from WHO’s between diesel exposure and bladder
International Agency for Research on cancer. However, it acknowledged the
Cancer (IARC) upgraded diesel exhaust’s classification was based primarily on
rating from ‘probable carcinogen’ to studies involving workers with longterm
‘carcinogen’ on the back of evidence exposure, and health warnings for
showing an increased risk of lung cancer the general population were just an
in heavily exposed workers. extension of those findings.
Reprinted from Good Practice Issue 5 – July 2012 11

12. GP AUTHOR FEATURE
Kathryn Fox on being a
internationally acclaim
SHARON LAPKIN She describes herself as a medical age Fox couldn’t imagine not being able
escapee, but Dr Kathryn Fox’s 12 years in to communicate with her mother and
general practice play such an integral role in father, and them, equally, not being able
her career as an internationally best-selling to hug her. She was drawn as a child to
Kathryn Fox has been crime writer that her medical training is non-verbal cues of communication such
compared to best- as relevant as it ever was. And indeed it as eye contact, and couldn’t perceive not
shows, for her latest novel Cold grave is a feeling that ‘warm, fuzzy love you get when
selling crime authors gripping tale about forensic physician Dr you connect and smile with someone’. As a
Patricia Cornwell and Anya Crichton’s attempt to uncover a series
of sexual assaults on board a luxury cruise
child, she said, ‘for me the worst possible
thing that could have happened in life was
Kathy Reichs, and her liner sailing a mysterious and lawless sea. to not be able to communicate’.
Despite her busy life as a successful About the same time, Fox said, she
study of medicine is novelist, Fox said she missed some aspects started hearing and reading about Helen
an integral part of of general practice. ‘I do miss the contact Keller. ‘I’m still fascinated with how
with people,’ and ‘the privilege of hearing Helen Keller learnt,’ she said, referring
that success. intricate details of people’s lives and trying
to help them through crises’, she said.
However, it’s clear Fox loves what she As a doctor you discover
does. Writing, she said, ‘took over’ her there’s no black and white,
life some years ago and due to the nature everything is very grey.
of crime and thriller publishing, she has
needed to establish a readership and work
fulltime to maintain it. This means Fox to the woman who earned a bachelor of
researches and writes 100 000 words arts degree in 1904, despite being deaf
a year. ‘It’s like doing a masters every and blind. While Fox wanted to study
year,’ she said. ‘A year sounds like a lot medicine to enable her to cure other
for a book, but it’s not’, she added, when people’s communication difficulties, she
you count touring and interviewing and also wanted to write so that she could
everything that goes with promoting a book. tell stories that connected people. This
Fox topped the Australian Capital is a theme that runs through her work as
Territory in English in high school, and a writer. She aims to entertain, but also
she realised in years 11 and 12 that she to present her readers with challenging
wanted to write, but in her early years moral dilemmas. The joy of fiction’, she
she didn’t know what she wanted to write explained, is that it can raise topical
about. From the age of 5 years, she said, and controversial issues and present
she ‘was obsessed’ with finding a cure different sides to the story and readers
for autism, hence her determination to go can be educated and informed while being
into medicine. ‘I had a lot of empathy as entertained – if they’d like to be.’
a child,’ she remembers, and can recall While writing books that challenge
watching a movie where the parents readers’ preconceptions and values, Fox
of an autistic child removed all stimuli emphasised the importance of balance.
Photo and focused one-on-one with him and ‘Medicine especially is full of moral
Opposite page: Dr Kathryn Fox ‘brought him out of his autism’. At that dilemmas,’ she said. ‘As a doctor you
12 Reprinted from Good Practice Issue 5 – July 2012

13. XXXXXXX XXXXXX > article by xxxxxxxxxxxxx
GP and an
ed crime writer
discover there’s no black and white,
everything is very grey. That’s why you
can’t judge patients because you’re never
quite in their shoes, and you’re not there
to pass judgement.’ This understanding
is reflected in Fox’s writing, which can be
read purely as the crime thriller genre,
or as a tale that challenges dominant
narratives and asks uncomfortable
questions. To get the most out of reading
Fox, however, the reader should enjoy
the adventure, but also contemplate the
moral dilemmas contained within it. On
her writing, she said: ‘I’m hoping I’m
not passing judgement. I’m presenting
information and I’m telling a story.
Primarily, I love to tell stories.’
Fox also likes to raise awareness and
bring subjects into mainstream media
that people may have not thought about
before. Her last novel, Death mask,
explored footballers and head injuries,
and footballers and bad behaviour. It
examined the culture of football and
the physical problems associated
with repetitive concussions. Fox also
noted a recent study had identified a
correlation between chronic traumatic
encephalopathy (CTE), found on post
mortem, in Iraq and Afghanistan war
veterans who had committed suicide after
being close to repeated explosions during
their military service. The explosions
were thought to cause the same type
of damage as suffering repeated blows
to the head. CTE causes ‘impaired
judgement, poor impulse control, poor
memory, depression, addictive behaviours
and sexual inappropriateness’, Fox said.
‘I just try to open it up ... I ask why?’
she added, and agreed that her writing
was a mechanism to explore sometimes
disturbing topics and social issues. > >
Reprinted from Good Practice Issue 5 – July 2012 13

14. BOOK GIVE-AWAY
>> When she was a child Fox said she believed that ‘evil
did not exist as an entity, that it was merely a lesser degree
Good Practice free book of good and conscience’, however, she has since changed
her mind. ‘Now I believe that evil really does exist – as an
absolute.’ The turning point for Fox was reading In cold
give-away: Cold grave blood by Truman Capote, a fictionalised account of the
factual brutal murder of a family of four in Kansas in 1959,
for no apparent reason. She began to question whether the
by Kathryn Fox common assumption that there was always a reason for an
evil act – that it could always be explained by something that
had happened to the perpetrator, or by a medical condition,
If you’d like a copy was correct. Sometimes, she said, ‘people are cruel and
destructive just because they can be’.
of Kathryn Fox’s new The treatment of women is an issue Fox takes
crime thriller, email seriously, and she has studied world religions and the
cultural executions of those religions in relation to
your name and address women’s roles. Along with two friends – Linda Fairstein,
the United States’ foremost legal expert on domestic
to goodpractice@ and sexual violence and author; and Dr Kathy Reichs,
racgp.org.au. The first professor of forensic anthropology and an author – Fox
shares similar views on the way sexual assaults are
20 people will receive handled around the world. The trio support each other’s
a free copy in the post. writing and mutual concern about the disempowering
of women. They aim to raise awareness through public
Title: Cold grave
Author: Kathryn Fox
speaking and through their writing and work to ‘give
Publisher: Pan Macmillan Australia: voiceless people a voice in fiction’.
www.panmacmillan.com.au The prevalence of domestic violence particularly
RRP: $27.99 concerns Fox, and she works with female victims of
male violence to help them understand that ‘just because
Forensic physician Dr Anya Crichton needs a break. Cocooned someone assaults you and says I’m sorry I love you
from the world aboard a luxury cruise ship, nothing can interrupt doesn’t make it all right.’ ‘One of the things I’m really
time with her precious 6-year-old son. passionate about’, she said, ‘is giving girls enough self-
Peace is shattered when the body of a teenage girl is discovered
esteem to know that love is an action not a word – love is
shoved in a cupboard, dripping wet. With no obvious cause of
a series of actions’.
death and the nearest port days away, Crichton volunteers her
For Fox, ‘writing is like breathing’, and ‘once you
forensic expertise.
start exercising the right side of your brain it’s like a
She quickly uncovers a sordid pattern of sexual assaults,
floodgate’, she said. As a writer and a doctor, she finds
unchecked drug use and mysterious disappearances. With the
many similarities between the two. ‘When a patient comes
crew too afraid to talk, she is drawn into the underbelly of the
to you they are telling you a clue’, she said, ‘they don’t
cruise line, its dangerous secrets and the murky waters of legal
necessarily know what is going on; you have to interview
accountabilities.
and elicit, and then you do your investigation and then
Book give-away closes 20 July 2012. All winners’ names will be published in the come up with an hypothesis’ – the same as in a crime.
August issue of Good Practice.
Fox is a linguistic thinker who thinks in words rather
than pictures. She writes the dialogue first, almost like a
play. ‘Then I have to go in and put in the direction and the
description,’ she said. Prior to writing her first novel, Fox
wrote freelance articles where she learnt the discipline of
Letters writing everyday and the importance of word counts. She
also learnt, she said, that part of learning to be a writer
Interested in providing feedback on Good was being able to accept criticism and critique. ‘Writing is
Practice? Please email your letters, including about rewriting,’ she added, and ‘you have to read’.
your name, title, address and office-hours phone When Fox was 16 years old, the Dalai Lama visited
number, to goodpractice@racgp.org.au or post Australia and she was lucky enough to meet him. As he
to Editor, Good Practice, The RACGP,1 Palmerston shook her hand he said: ‘I’m so glad to have finally met
Crescent, South Melbourne, VIC 3025. you.’ It was a ‘static electricity handshake’ she said, and
Note: letters must be under 200 words for many years remained puzzled by his choice of words.
and may be edited for clarity and space. Eventually, that experience became the unlikely genesis for
her debut novel and the rest, as they say, is history.
14 Reprinted from Good Practice Issue 5 – July 2012

15. A place for living
NICK JOHNS-WICKBERG
The Think Pink Foundation’s Living Centre
(TLC) in Melbourne offers free support
services for men and women diagnosed with
A breast cancer centre breast cancer and those who care for them.
One of the centre’s most important
in Melbourne offers functions is providing a two-bedroom
patients a range of apartment for patients who cannot afford to
stay in Melbourne for treatment.
free support services, Manager of operations at TLC Danielle
including emergency Spence, who has more than 10 years’
experience as a breast care nurse, said the
accommodation. apartment has been a lifesaver for people who
would otherwise have to commute several Spence said it relies on money from corporate
hours each day for radiotherapy courses sponsors and private donors, and has no
lasting up to 6 weeks. political or religious affiliations. Fulltime breast
The apartment is for people who live more care nurses and administration staff are paid,
than 100 km from their treatment centre, but all other employees volunteer.
and they must be accompanied by a carer. Spence said TLC has ‘purposely tried to
The apartment has proved to be very popular not affiliate directly with a particular hospital,’
and Spence and her colleagues rely on and ‘kept our independence by not taking
referrals from rural GPs and other healthcare government funding’.
professionals to select eligible patients. Although most services can be accessed
‘It is pretty popular and we really leave it to without a formal referral, Spence would like
our rural breast care nurse colleagues to refer to see more GPs recommending TLC to their
people to us, because we try and base it on patients.
needs,’ Spence said. ‘I think we are a great referral source,’ she
The centre’s other services include said. ‘This living centre is quite unique in that
counselling from breast care nurses, everything we offer is free, and we do have
professional massages, art therapy classes, professional support in our breast care nurse
a wig salon and support groups for both counsellors.’
sufferers of cancer and their partners. It does Since opening in 2010, TLC has had
not offer treatment advice, instead focusing contact with more than 2000 patients and
on overall wellbeing. carers. Think Pink hopes to increase this
Operated by the Think Pink Foundation, number and is looking to open living centres in
TLC receives no government funding. other Australian cities.
Promoting quality
general practice
education and training
www.agpt.com.au
Reprinted from Good Practice Issue 5 – July 2012 15

16. MEDICAL HISTORY
Explore medical his
NICK JOHNS-WICKBERG In the late 19th century Australian GPs ‘I think by analysing past practice
had an important and wide-ranging role it actually informs current practice,’
in their communities. As well as treating Healy said.
common injuries and ailments they would Fascinating exhibits are everywhere
Explore medical perform surgery, deal with accidents, at the museum. The most striking is
history at The practise obstetrics and administer the transplanted Savory and Moore’s
anaesthesia. They were mobile medical pharmacy, which opened in 1849 in
University of saviours who would often make house London’s Belgrave Square and was
Melbourne’s Medical calls, carrying their livelihood in a large moved to the museum in 1971. The
wooden chest full of strange and pharmacy is a replica of its 19th century
History Museum. wonderful substances. Also playing original and similar in style to Australian
the role of pharmacist, they would use pharmacies of the time. Its shelves are
these ingredients to make all manner of lined with scores of different medicines,
medicines, many of which were low in which would have been made onsite
scientific value but high in hope. by pharmacists when the store was
Dr James Napthine worked during functional.
the 19th century as a GP in Port Fairy Hanging in the museum’s far right
and Stawell. His medicine chest and its corner is a photograph of an early
contents are on display, along with more dissection class taken in 1864. Due to
than 6000 other interesting pieces, at complaints about the smell of cadavers,
the University of Melbourne’s Museum of the class was originally forced into
Medical History. stables at the most remote corner of
The museum’s collection chronicles Melbourne University, which Healy said
the development of medical technology reflected the view that medicine was
in Australia and around the world, while considered a ‘dirty’ profession at the
also celebrating the camaraderie and time. The photograph shows the full
quirkiness of life as a medical student. cohort of medical students – all eight of
Curator Dr Jacqueline Healy gives them – dissecting cadavers in their basic
Photo free tours of the museum to doctors, facility.
L to R: Statue of Dr students and members of the public. Some of Australian medicine’s
James Beaney, the She said that ‘looking through the prism more colourful characters also have
Savory and Moore
pharmacy, Dr James
of medical history’ could provide valuable their stories told at the museum. Dr
Naphine’s medicine perspective for people in medical James Beaney – affectionately known
chest. careers. as ‘Champagne Jimmy’ thanks to his
16 Reprinted from Good Practice Issue 5 – July 2012

17. tory at the museum
tendency to celebrate medical successes lessons of medical history,
with a bottle or two of the bubbly which is that the most important
beverage – was a senior surgeon at discoveries are often initially
the Melbourne Hospital. He achieved dismissed.
notoriety in 1866, when he was accused According to Healy,
of murdering barmaid Mary Lewis by examining medical history can
performing an illegal abortion, but he was help identify areas in which
acquitted after two trials. Champagne the field has not advanced
Jimmy’s quirks are remembered in as it should. She nominated
a statuette, with his hair shaped into an 1887 photograph of the
devil’s horns and an empty bottle of his Melbourne Medical School’s
favourite drink at his feet. first female students as an
It’s easy to miss and doesn’t look example. The seven women
anything like its modern equivalent, but in the picture fought hard for
one of the museum’s most interesting their right to study medicine,
artefacts is a hollow wooden tube with and in the decades following
an earpiece, which is actually an early the photo many women had to
stethoscope. Invented by Frenchman work harder than men for the
René Laënnec in 1816, the device, opportunity to study medicine.
which has become the medical Healy said she had noticed an
profession’s most recognisable symbol, extraordinary interest in the history
was initially ridiculed by doctors – who of medicine. She meets doctors
instead preferred to press their ear of all ages pondering what their
against the patient’s chest. As late as profession would have been like in
1885, medical professionals continued previous generations. ‘You have the
to shun the device, with one professor senior doctors who are coming in
saying ‘He that has ears to hear, let him and looking at instruments like the
use his ears and not a stethoscope.’ The amputation kit and musing on the
design was later improved by replacing difference that makes,’ she said.
the wood with rubber tubing and adding
a second earpiece, and the rest is Further information
history. Medical History Museum
The story of the stethoscope, Healy The University of Melbourne
said, sums up one of the most valuable www.medicine.unimelb.edu.au
Reprinted from Good Practice Issue 5 – July 2012 17

18. 25 – 27 October 2012
Gold Coast
Convention and Exhibition Centre
Leading primary care
Leading primary care is the overarching
theme of The Royal Australian College
of General Practitioners (RACGP) annual
conference, focusing on practical skills
to support your daily practice.
The program will explore the following key streams:
Chronic disease Men, women and
children’s health
Clinical skills
Skin and bones
Education and training
Telehealth/Business
e-health and the PCEHR innovations.
View the conference program via your mobile,
tablet or desktop computer. Visit
www.gpconference.com.au/gp12program to:
Create your own
program schedule
View session details
Take notes on sessions
and workshops
Access speaker profiles.
Register by 10 August 2012
and save up to $100 with early bird rates*
* Conditions apply.
Visit www.gpconference.com.au
for details.

19. Guest speaker program
Stuart Patterson Lecture Leading primary care: General practice leading primary care:
health reforms, the UK perspective showcasing the evidence
Thursday 25 October 11.30 am – 12.30 pm Friday 26 October 3.45 pm – 5.00 pm
Professor Clare Gerada
International keynote
Dr Eleanor Chew Professor
Facilitator John Murtagh
What still has to be done to close the gap?
Thursday 25 October 4.45 pm – 5.45 pm
Associate Professor Dr Jeanette Ward
Marie Pirotta
Mr Mick Gooda Ms Mary Martin Associate Professor
Brad Murphy
Health reform: a citizen’s jury
Saturday 27 October 9.00 am – 10.30 am
Ms Melissa Sweet Associate Professor
Facilitator Mark Wenitong
Leaders in primary care
Friday 26 October 9.00 am – 10.30 am Dr Harry Pert Dr John Buckley
International keynote Facilitator
Dr Justin Coleman Professor Dr Malcolm Professor
Dr Steve
Michael Kidd Parmenter Claire Jackson
Hambleton
More guest speaker details to be confirmed.
Professor
Jane Gunn
For more information and to register go to
www.gpconference.com.au

20. The San Antonio
Riverwalk Sharon Lapkin
recalls the charm
of San Antonio’s
famous Riverwalk.
Most people travel to San Antonio in But it’s not the historic battles or the Arched fairytale-book footbridges allow
Texas to see its most famous attraction, famous buildings that attract some people to visitors to cross the river and explore the
the Alamo. The former Catholic mission San Antonio. It’s something far gentler. The Riverwalk from both sides. The famous
and its impressive fortress grounds were San Antonio Riverwalk, also known as Paseo Arneson River Theatre sits snuggly on one
the site of the Battle of Alamo in 1836. del Rio, is a charming network of pedestrian- side of the river while the audience enjoys the
And it was this setting that inspired John only pathways along the San Antonio River, performance from grass-covered steps on
Wayne to make a movie in 1960 about the one story beneath the city proper. Like a the other. Built in 1939, the unique theatre
historic standoff between the Mexicans mini-Venice the narrow pea-green river winds was featured in the movie Miss Congeniality
and the Texans. The legendary actor and loops around cafes, restaurants, hotels, starring Sandra Bullock and Michael Caine.
starred in it, along with a number of other shops, gardens and historical sights. Built in The colourful restaurants and cafes
Hollywood heavyweights, and despite a 1929, the Riverwalk hugs the banks of the dotted along the Riverwalk offer first-
few historical inaccuracies it went on to river for almost 13 kilometres, and by 2013 class Mexican food and margaritas, and
win an Academy Award and be nominated local authorities hope to have lengthened it to consuming such local delights requires
for several others. 24 kilometres. that you sit by the river and be serenaded
20 Reprinted from Good Practice Issue 5 – July 2012

21. GET LOST
by charming Mexican mariachis. The Iron vintage architecture. The oldest continuously There are other more modern hotels in
Cactus Mexican Grill and Margarita Bar operating hotel west of the Mississippi, San Antonio, and venturing into the city
serves a renowned signature margarita ‘El the Menger has played host to American proper reveals the seventh largest city in
Agave’, which is one of the best in Texas. It luminaries such as President Theodore the United States. There’s a fantastic zoo,
can be enjoyed from the restaurant’s private Roosevelt and baseball great Babe Ruth. beautiful botanical gardens, the ornate
patio beside the river, although with more The main hall of the hotel’s lobby features Majestic Theatre, which features a domed
than 100 tequilas to choose from the Iron photographs of many of its famous guests, theatre painted with clouds and stars, and four
Cactus keeps some of its customers around along with antiques, artifacts and paintings 18th-century missions to visit. But whatever
a bit longer than they intended. from the early days of United States’ history. you do in San Antonio, be sure to linger along
The best accommodation near the Riverwalk The Menger Bar, voted one of the most the Riverwalk for as long as possible.
is the exquisite Victorian-era Menger Hotel. historic bars in the United States, is the
Built in 1859 on the site of the first brewery legendary bar where Teddy Roosevelt recruited More information
in Texas, it sits a stone’s throw from the his rough riders and, evidently, the site of more San Antonio Convention and Visitors Bureau
Riverwalk and offers three levels of elegant cattle deals that any other location in Texas. http://www.visitsanantonio.com/index.aspx
Reprinted from Good Practice Issue 5 – July 2012 21

22. BOOK REVIEWS
How doctors think
Written for patients and physicians alike, diagnoses – the doctor’s mood on the day,
Dr Jerome Groopman’s How doctors whether or not they like the patient, what
think is a fascinating insight into why conditions the doctor is more accustomed
doctors make certain decisions, and why to seeing – and that an original
they may not always get it right. Three misdiagnosis can gain momentum, which
decades into an illustrious medical career, leads doctors further down the wrong path.
including being a successful author and a A staff writer at The New Yorker,
chair at the Harvard School of Medicine, Groopman expresses complex medical
Groopman comes to the realisation that situations in a way ordinary people can
doctors can miss crucial information understand and enjoy. He encourages
because they aren’t taught to listen to patients to be active in their treatment
what patients say and reflect and think and ask questions if they are unsure of
deeply about it. He also notices flaws in anything.
algorithmic thinking methods being taught This book reveals an illuminating view
to young doctors, which he says can be of current medical practice and provides
Author: Jerome Groopman useful in simple diagnoses but otherwise patients, and doctors alike, with useful
Format: softcover ‘constrain’ the mind. information to make better judgements
Publisher: Scribe Groopman explores these issues and together. Groopman draws on his extensive
RRP: $29.95 other aspects of the doctor’s psyche experience, including his own as a patient,
through a combination of firsthand to encourage his colleagues and patients
accounts and case studies. He writes to develop more informed patient-doctor
that seemingly small factors can influence relationships.
Seize the day: How the dying teach us to live
Marie de Hennezel is a psychologist become what he or she was called to
working in a French hospital for the become: it can be, in the fullest sense of
terminally ill. Her writing is well known the word, an accomplishment.’
internationally and Princess Diana once The author writes that ‘After years of
invited her to tea and told her she was so accompanying people through the living
moved by her book Intimate death, (this of their final moments, I do not know
book’s former title) she had read it ‘twice anymore about death itself, but my trust
running’. in life has only increased.’ She describes,
In the foreword of this second edition throughout the pages of her book, the
written by former French president various patients she has assisted to die
Francois Mitterrand, he laments the with dignity. Some arrive at the hospital
inadequacy of the ‘modern spiritual desert’ with no knowledge of their impending
to embrace the final journey and says death, due to their close relatives’ inability
that previous generations looked squarely to accept their medical conditions rather
at death and ‘mapped the passage for than any indication they cannot accept
both the community and the individual’. their fate themselves. These people,
The author, he says, presents ‘a lesson de Hennezel writes often think they’re
in living’, and ‘perhaps the most beautiful protecting the person who is dying, but
Author: Marie de Hennezel lesson’, he adds, of this book is that they are really trying to protect themselves.
Format: softcover ‘Death can cause a human being to This is a profound and unforgettable book.
Publisher: Scribe 2012
RRP: $24.95
22 Reprinted from Good Practice Issue 5 – July 2012

23. PUBLISHED BY ADVERTISING ENQUIRIES
The Royal Australian College of General Practitioners Kate Marie – T 0414 517122 E kate.marie@racgp.org.au
1 Palmerston Crescent, South Melbourne,
Victoria 3205 PHOTOS
T 03 8699 0414 Cover photo, pp5,6 © Andrew Southcott; pp8–10 © ADF; p13 © Kathryn
E goodpractice@racgp.org.au Fox; p15 © Think Pink Foundation; pp15,16,17 © Nick Johns-Wickberg;
www.racgp.org.au/goodpractice pp16,17 © University of Melbourne; pp20,21 © Sharon Lapkin. All other
ACN 000 223 807 ABN 34 000 223 807 photos by shutterstock.
ISSN 1837-7769
EDITORIAL NOTES
STAFF © The Royal Australian College of General Practitioners 2012. All rights
Publications Manager Helen Barry reserved. Requests for permission to reprint articles must be made to the editor.
Editor Sharon Lapkin The views contained herein are not necessarily the views of the RACGP,
Writers Nick Johns-Wickberg, Sharon Lapkin its council, its members or its staff. The content of any advertising or
Graphic Designer Beverly Jongue promotional material contained within Good Practice is not necessarily
Production Coordinator Morgan Liotta endorsed by the publisher.
Reprinted from Good Practice Issue 5 – July 2012 23

24. RESTORE SIGHT
FOR JUST $25
Photo courtesy of www.michaelamendolia.com
PUBLISHED BY ADVERTISING ENQUIRIES
We need to perform 12,000 operations each month
The Royal Australian College of General Practitioners
1 Palmerston Crescent, South Melbourne, Victoria 3205
Kate Marie
T 0414 517122 E kate.marie@racgp.org.au
Three out of four people PHOTOS blind
T 03 8699 0414 who are only 20 minutes and cost just $25.
E goodpractice@racgp.org.au
can have their sight saved or restored.
www.racgp.org.au/goodpractice Cover photo p.20–21 © Gregory Watson. All other photos by shutterstock.goal is to restore sight
Each month, our
ACN 000 223 807 ABN 34 000 223 807
ISSN 1837-7769 some developing countries the operation
In to 12,000 people. Donate now to help
EDITORIAL NOTES
© The Royal Australian College of General Practitioners 2012
STAFF to overcome cataract blindness can takefor permissionusreprint articles mustFred’s work.
All rights reserved. Requests to continue be
Managing Editor Denese Warmington made to the editor.
Editor Sharon Lapkin The views contained herein are not necessarily the views of the RACGP,
Journalist Nick Johns-Wickberg its council, its members or its staff. The content of any advertising or
DONATE NOW
Graphic Designer Beverly Jongue
Production Coordinator Morgan Liotta
promotional material contained within Good Practice is not necessarily
endorsed by the publisher.
1800 352 352
www.hollows.org.au