Doctors from overseas

“G’day doc, I’m right off me tucker and crook azadog. Yesterday arvo me neighbour said it’s just the collywobbles but crikey, he’s mad as a cut snake so I thought I’d better find out what the doc has to say. I know youse are flat out but waddaya reckon, she’ll be right? I feel weak as a wet whistle. Not droppin off the perch yet am I? Probably just old age. Howyagoin anyway, settlinin all right? Gotta love the top end mate, heaps better than the big smoke.”

When I arrived in Australia – in Cooktown of all places – one of my biggest challenges was understanding the accent and the slang. I also struggled with basic expressions. I remember being invited ‘for tea’ one night – so after dinner I went over expecting a cup of tea or coffee only; to my surprise our host had prepared a delicious roast. On another occasion I was asked ‘to bring a plate’; I took a few plates and, just to be sure, some cups and cutlery too.

I thought the communication was problematic because I come from a non-English speaking country. It turned out that most immigrants struggle with language, communication and the often slightly different meaning of common expressions, not to mention the bureaucratic jargon. For example, as doctor Jennifer May wrote in the Medical Journal of Australia, a term such as ‘reciprocal recognition of qualifications’ has a different meaning in different jurisdictions.

The first six months were a crash course in ‘Strine’. The patients were wonderful and seemed to strangely feel sorry for the new overseas doctor in town. They taught me all the basics; some gave me Australian slang dictionaries and Indigenous Australians told me stories about their culture. Still, it took a few years before I could fully understand most conversations.

The preparation

For most immigrants the challenges begin long before entry to Australia. The paperwork and background checks required by the Australian government and healthcare organisations – which can take one to two years to complete – are only a small part.

Croc drama: A crocodile dragged a fisherman from his tent on the riverbank and a woman jumped on its back in an attempt to stop the giant reptile. Source: Cooktown Local News

Even though the decision to emigrate is mostly a voluntary one, and it is a privilege to be welcomed to Australia, it doesn’t mean that there are no downsides. Emigrating doctors and their families have to give up their lives in the home country and say goodbye to loved-ones, familiar neighbourhoods, cultures, customs and careers.

It is not uncommon for overseas doctors and their family members to experience some adjustment problems. Many tears have been shed when settling in a remote Australian outback town or new suburb. It can be stressful when a spouse struggles or the children have problems at the local school.

Often well-established and respected at home, immigrant doctors start all over again. They are initially temporary residents with limited rights and no access to Medicare. Their medical registration is conditional, they have to work in places where many Australian trained health professionals don’t want to work, and their future is uncertain and dependent on passing health checks, police checks, language tests, assessments and exams.

My arrival in Cooktown reported in the local newspaper (2004). Full story below.

It can be difficult to negotiate employment conditions or discuss real or perceived injustices – as a conflict may lead to cancellation of sponsorship or visa. Financial challenges are common as starting over in a new country does not come cheap. There are all sorts of legal and tax problems, such as dual taxation. I had to give up my Dutch citizenship when I became an Australian citizen.

For the immigrant there is always ‘the other world’ of their home country. They often use the holidays to fly ‘home’ and visit family and friends for a few weeks, which is joyful but can be intense and emotional. Migrants may never feel one hundred percent part of the Australian society and at the same time they often don’t fit in anymore in the home country, which can affect their sense of belonging and create feelings of loneliness.

Rural medicine

For me another culture shock was rural medicine. The contrast with Amsterdam, where I trained as a doctor, could not have been greater. I quickly had to learn about tropical diseases, snake bites and Irukandji – just to name a few. Shortly after I arrived a 4.2 meter saltwater crocodile dragged a fisherman from his tent on the riverbank when a woman jumped on its back to stop the giant reptile; the story appeared in all the newspapers.

Although many of the medical textbooks back home were written in English, learning to speak the medical jargon in another language was yet another challenge. Names and doses of commonly used drugs differ between countries, not to mention the different guidelines.

I was able to do a few up skilling courses including trauma and emergency medicine and with assistance from helpful and skilled colleagues – sometimes over the phone – and a great nursing team, we were able to manage many problems locally. I am grateful for all those who have welcomed and taught me over the years – patients, staff, nurses, fellow doctors and others.

Not unique

For a long time I thought my ‘adventures’ were unique but over the years I learned about similar stories, not only from overseas doctors but also from Australian graduates, all struggling during their first placements in rural and regional hospitals and GP practices.

These stories are often tales of incredible resilience and courage and what always amazes me is to hear how valued health professionals are in their communities – even though we may often feel ill-prepared or have doubts about our skills and knowledge.

The demands on doctors in small towns can be high, not seldom 24 hours per day. Working towards another degree or fellowship is taxing for anyone, but for international medical graduates coming from a different background there are many extra challenges. The working hours and fatigue don’t go well with training and exam preparation.

The workload and the tyranny of distance can make supervision suboptimal; there is often limited support and the amount of bureaucracy can be perceived as overwhelming.

On the bright side, there are many people who warmly welcome and support the newcomers. Professional bodies and colleges offer introductory, support and exam preparation programs, but often the local and individual initiatives make the difference. An example is Dr Farooq Ahmad who, after passing his Australian fellowship exam, decided to support others and has helped hundreds of doctors pass their exams.

In the video below Kenyan born Dr Ken Wanguhu describes the importance of being welcomed by a community as well as the rewards of contributing and ‘giving back’.

Concerns

Although many areas of Australia are relying heavily on international medical graduates, not everyone is happy with the influx of doctors from overseas. Critics of the Australian skilled immigration policy have often mentioned the ‘brain drain effect’ on developing countries: the recruitment of healthcare professionals compromises the, often already struggling, healthcare systems in the developing world.

Concerns have publicly been expressed about doctors from non-Western training backgrounds and the uncertainty around standards and relevance of knowledge and skills to the Australian situation.

The regulation changed in the aftermath of the Dr Jayant Patel case. Dr Patel, nicknamed ‘Dr Death’, was permanently barred from practising medicine in Australia in 2015. Legislation introduced in 2009 now protects patients by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner can be registered.

This example is not unique to Australia nor to international medical graduates. Many countries have similar stories, think for example about Dr Harold Shipman in the UK and Dr Christopher Duntsch in the US.

Although there is anecdotal evidence that patients sometimes avoid seeking treatment by international medical graduates, research indicates that there is no difference in patient satisfaction with, and acceptance of, care by Australian and international medical graduates.

Diversity

The ‘doctors from overseas’ bring diversity, expertise, experiences, cultures, innovation and stories to Australia. Cross-cultural experience appears to be valuable in many ways; some have argued that immigrants are more entrepreneurial, resilient and creative. Whether this is true or not, one thing is for sure, starting a new life in a different country takes courage and perseverance.

My wife Nancy and I have never looked back. Although we miss our family and friends in The Netherlands, we’re grateful for the opportunities Australia has given us. I can only hope I am able to give back what I have received.

Source: Cooktown Local News (2004).

Top Australian GP Bloggers

If you enjoy reading health blogs, look no further! This list of Top Australian GP Bloggers in 2015 contains some pretty amazing Family Medicine blogs with many new and upcoming writers.

In previous years I have listed the sites alphabetically, but this year I thought I’d categorise them as follows:

  1. Lifestyle tips
  2. Doctor’s diary & storytelling
  3. Medical education
  4. Patient information
  5. Healthcare, innovation and health politics

Each blog mention contains a brief description and/or quote taken from the ‘about’ section of that blog. Enjoy!


1. Lifestyle tips

‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn
Top blog: ‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn

‘Lean Green and Healthy.’ By Dr Lyndal Parker-Newlyn

Healthy eating, exercise and weight loss ideas, motivation and support. No scams or fads – just a sensible lifestyle approach. A great blog offering healthy tips, news, information and inspiration.

http://lean-green-and-healthy.blogspot.com.au

‘Eat move chill.’ By Dr Kevin Yong

On his blog Dr Yong shares ideas about healthy living: “It’s about getting back to basics and building a strong foundation of health. It’s about turning your good intentions into lasting change. It’s about you taking control and living a better life.” Very inspiring.

http://eatmovechill.com

‘The healthy GP – Live intentionally, love relentlessly and enjoy your health.’ By Dr Jonathan Ramachenderan

Dr Ramachenderan and his family live in the country in Western Australia where he practices as a General Practitioner and anaesthetist. He has some excellent advice for men and dads.

“We are in the busy, child rearing season of life coupled with the beginning of my career and hence achieving a balance is important. I am passionate about men’s health, helping and communicating with other dads, building stronger relationships with our wives and becoming wiser, stronger and more insightful men.”

https://thehealthygp.wordpress.com


2. Doctor’s diary & storytelling

‘Medical history.’ By Dr Gillian
Top blog: ‘Medical history.’ By Dr Gillian

‘Armchair rants from Dr Deloony, musings on Medicine and Life.’ By Dr Claire Noonan

Dr Noonan is a country GP and freelance writer. “My interests, medical and otherwise include but are not limited to: humans, science, general practice, bariatric medicine and surgery, fiction, music, travel, food/nutrition, mental health, philosophy and kittens. I am VERY interested in kittens.” Personal and well-written posts.

https://drdeloony.wordpress.com

‘Medical history.’ By Dr Gillian

Dr. Gillian is a GP Obstetrician, writer, wannabe photographer. For those with an interest in medical history, her blog has a lot to offer:

“In this blog I combine my love of salacious celebrity gossip, medicine and history to give you all the dirt on Henry VIII’s sex life and how it might make his penis fall off.*”

*Not actually true

http://medicalhistory.blogspot.com.au

‘Ailene Chan.’ By Dr Ailene Chan

Dr Chan has worked in many Aboriginal Community Controlled Health Services and Asylum Seeker and Refugee health in Christmas Island and Nauru.

“Being a doctor means being a global citizen. I will share with you my travels, the people I meet and the things I’m learning in medicine and in life.” Beautiful blog!

http://www.ailenechan.com

‘DrJustinColeman – Medical writer, editor, blogger.’ By Dr Justin Coleman

Dr Justin Coleman is a well-known GP-writer who looks sceptically at health interventions where the evidence suggests they might not actually be worthwhile. This is part of his broader interest in the public health concept of equity – fair access to primary health care for everyone.

As he writes on his blog: Despite earnest intentions, he frequently breaks out into lighter reflections on GP practice, with its quirks and oddities – often discovering the oddest person in the room is him!

http://drjustincoleman.com

‘Genevieve’s anthology – Writings to amuse, teach, inspire and entertain.’ By Dr Genevieve Yates

The multi-talented Dr Yates is not only a freelance columnist and novel/play writer, but she also finds the time to play and teach violin and piano, sing, and play in two orchestras.

“This website features a collection of my writings. Here you will find links to and samples of my newspaper columns, novel, short stories, plays and creative medical educational material, plus the odd blog or two.”

http://genevieveyates.com

‘Dr Charles – The blog musings of Dr Charles Alpren.’ By Dr Charles Alpren

Dr Alpren worked at (and blogged about!) the Ebola Treatment Centre in Sierra Leone. He is currently a locum GP who works all over Australia. He has an interest in children’s health, vaccinations and infectious disease, and is also interested in teaching and Public Health.

https://doctorcharles.wordpress.com

‘Jacquie Garton-Smith.’ By Dr Jacquie Garton-Smith

Working as a General Practitioner with a special interest in counselling and family medicine has given Dr Garton-Smith insight into relationships and communication as well as responses to life events:

“My experience is that we can often access our emotions, learn and better understand ourselves through fiction.”

Dr Garton-Smith was the Western Australian Winner of 2009 Medical Observer Short Story Competition for GPs. She is currently working on two novels.

http://jacquiegartonsmith.com

‘KarenPriceBlog – Hippocrates meets Xanthippe.’ By Dr Karen Price

Miscellaneous topics and reblogged posts – often with thought-provoking commentary by Dr Price. Dr Price is Chair of the Women In General Practice Committee of the Victorian RACGP.

“I am active on Twitter and interested in technology as it relates to health. I am prone to an occasional rant so the picture of me with a thistle is probably appropriate. I welcome respectful debate as it contributes to the Science and Art of Medicine.”

http://karenpriceblog.com

‘Peak Health – Challenging the assumption that our health and our longevity will inevitably improve.’ By Dr George Crisp

Our health depends on a healthy environment, says Dr Crisp – who is passionate about our environment.

http://georgecrisp.blogspot.com.au

‘A fig page – Random thoughts from someone who loves Jesus.’ By Dr Joe Romeo

A spiritual blog by Dr Romeo, who is a full-time country GP, aspiring songwriter/ worship songwriter, father of 6 and follower of Jesus Christ.

http://afigpage.blogspot.com.au


 3. Medical education

‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce
Top blog: ‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce

‘FOAM4GP – Free Open Access Meducation 4 General Practice.’ Various authors

Excellent and comprehensive collection of blog posts and podcasts by various rural and city GPs.

“This blog and podcast is for Australian General practitioners, training to be one or already working as one. We cover the whole range of our medical specialty and give you what you need to pass your exams and keep learning in your clinical practice.”

The blog was founded by Dr Rob Park, Dr Minh Le Cong, Dr Casey Parker, Dr Tim Leeuwenburg, Dr Jonathan Ramachenderan, Dr Melanie Considine and Dr Gerry Considine.

http://foam4gp.com/about

‘Bits & Bumps – Obstetrics and Gynaecology FOAM.’ By Dr Penny Wilson and Dr Marlene Pearce

Excellent podcasts including useful links to resources for anyone with an interest in obstetrics and gynaecology – produced by two passionate GPs from Western Australia and Queensland.

http://bitsandbumps.org

‘Michael Tam – Publications archive.’ By Dr Micheal Tam

Michael Tam is a Staff Specialist in General Practice at the Academic General Practice Unit in Fairfield Hospital, in Sydney. His blog is a collection of interesting research articles and interviews.

Dr Tam’s clinical interest is in comorbid substance use disorder and mental health disorders. His research interests are in the detection of at-risk drinking in the primary care setting, and in e-learning in medical education.

http://vitualis.com

‘GreenGP – Reflections of a Rural GP.’ By Dr Melanie Considine

An interesting blog with lots of medical conference reports, tips for students and GP registrars – including how to use social media. Dr Considine is a board member of the SA/NT RACGP Faculty and the RACGP National Rural Faculty.

https://greengp.wordpress.com

‘Broome Docs – Medical education blog for rural GPs.’ By Dr Casey Parker

Top blog intended to provide a single source of up-to-date educational material for country doctors.

“I hope this site can expand this brain pool of rural doctors – please feel free to leave comments on the cases and posts presented – we can all learn from one another – no matter how far we are from the really smart guys in the big centres.”

http://broomedocs.com

‘THE PHARM – Prehospital and retrieval medicine.’ By Dr Minh Le Cong

Dr Le Cong’s comprehensive blog is for the health professionals working in remote locations, outside a hospital, on aircraft, ambulances, in outposts who have to deal with emergencies and the unexpected.

“My focus is rural Australia but my journey will be international, hearing from folks in other countries and how they deal with out-of-hospital emergencies. Of course I am a flying doctor so there will be a healthy dose of aeromedicine.”

http://prehospitalmed.com

‘KI Doc – Kangaroo Island doctor blogging about Rural Medicine in Australia.’ By Dr Tim Leeuwenburg

Encouraged by emergency medicine and retrieval medicine blogs such as EmCrit, Resus.me, BroomeDocs and Prehospitalmed, Dr Leeuwenburg has embraced the #FOAMed paradigm: “Whilst the lifeinthefastlane emergency physicians have lead this in Australasia, I reckon #FOAMed has a lot to offer rural doctors.” Excellent blog.

http://kidocs.org

‘Rural GP Education – Thoughts and experiences on the journey to enlightenment.’ By Dr Ewen McPhee

Dr McPhee is an experienced rural GP and educator in Central Queensland. On his blog he shares his thoughts and other interesting posts about healthcare and medical eduction.

https://ewenmcphee.wordpress.com


4. Patient information

‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis
Top blog: ‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis

‘Dr Ginni Mansberg.’ By Dr Ginni Mansberg

Ginni Mansberg is a well-known, celebrity doctor in Australia. She is a Sydney GP sidelining for Sunrise & Morning Show, various magazines, and is a self-proclaimed wannabe Masterchef and caffeine addict.

http://www.drginni.com.au/blog.html

‘Do It Yourself Health DIY Health), Healthy Living and Health Information from Dr Joe.’ By Dr Joe Kosterich

Dr Kosterich is a well-known GP, author, and keynote speaker. “Your well-being is the most important thing you have.  My passion is empowering you to take charge of your own health through easy to understand steps enabling you to live well for longer.”

http://www.drjoe.net.au

‘PartridgeGP – professional, comprehensive and empowering healthcare.’ By Dr Nick Tellis

This is a great example of a practice website with health tips and interesting newspaper articles and reblogged posts including comments by Dr Tellis. Dr Tellis is passionate about great quality General Practice and is enjoying beach-side practice after seven years in rural South Australia.

http://partridgegp.com

‘The Healthy Bear.’ By Dr George Forgan-Smith

Dr George Forgan-Smith is a GP and passionate gay doctor in Melbourne Australia: “I have a strong interest in male health, mental health and health promotion. I enjoy writing and teaching and I hope that this website may help to inspire other men to move towards health in all aspects of their life.”

http://thehealthybear.com


5. Healthcare, innovation & health politics

‘Lean Medicine.’ By Dr Moyez Jiwa
Top blog: ‘Lean Medicine.’ By Dr Moyez Jiwa

‘The Influence of the Tricorder.’ By Dr Tim Senior

Dr Senior has an interest in Aboriginal health & medical education. Other themes he often writes about are environments that keep us well and social justice.

His blog is an amazing collection of various articles he has published over the years. “I write stuff. It ends up in various places on the web. This site keeps track by linking to it all from one place.”

http://iofthet.blogspot.com.au

‘Lean Medicine.’ By Dr Moyez Jiwa

A well-written and beautiful blog about solving healthcare problems with creativity, intuition and insight with lean and inexpensive innovations. Dr Jiwa is Professor of Health Innovation at Curtin University and a GP practicing in Western Australia. He is also the Editor in Chief of The Australasian Medical Journal.

http://leanmedicine.co

‘Dr Thinus’ musings – This is Canberra calling.’ By Dr Thinus van Rensburg

“Canberra – we love it and, despite what the rest of Australia might think, it is not just about pollies and Public Servants. It has it’s ups and downs but this is our hometown and I hope readers enjoy my occasional posts.” Honest commentary on a variety of articles and reblogged posts by Dr Van Rensburg.

https://tvren.wordpress.com

‘Doctor’s bag.’ By Dr Edwin Kruys

Health politics and e-health. I’m living in the Sunshine Coast, Queensland, where I work as a GP. When I’m not working I spend time with my family or blog about healthcare, social media and e-health.

http://doctorsbag.net


 Follow me on Twitter: @EdwinKruysDisclaimer and disclosure notice.

An unusual ANZAC story: How my grandfather evacuated Australian troops from Timor

“ANZAC day is a time when Australians reflect on the many different meanings of war” ~ Australian War Memorial

As an immigrant I have often thought about the meaning of ANZAC day: My family and I make an effort to attend ANZAC ceremonies and pay respect to Australian men and women who fought for freedom, but somehow I always feel like an outsider. I thought this was because I don’t share a common history. I was wrong.

I recently re-discovered my grandfather’s remarkable Timor mission in 1942. It is also part of the history of Australian soldiers sent to Timor to help the Dutch defend the island against the Japanese invasion. When Timor yielded to the Japanese, about 400 Australian troops were cut off in the mountainous jungle. They refused to surrender and embarked upon a guerrilla war against thousands of Japanese soldiers.

Many of the Australian soldiers sent to Timor never came home. But those who did, I’m proud to say, were rescued by my grandfather during a hazardous navy operation.

A difficult mission

“In the night of 4 December 1942 the Dutch destroyer Tjerk Hiddes lay moored alongside the pier in Fremantle.” That’s how the report in the US Naval Institute Proceedings begins. The story, written by US Navy Admiral Gordon, reads like a novel.

My grandfather, Lieutenant Commander William Kruys, was the skipper of the vessel. That night in Fremantle he received orders to proceed, via Darwin, to the island of Timor and bring the remainder of the Australian Forces, Dutch troops and civilians back to Darwin.

My grandfather’s ship, the Dutch destroyer Tjerk Hiddes.
Image: My grandfather was Commander of the Dutch destroyer HNLMS Tjerk Hiddes.

My grandfather knew this was a dangerous mission. Torpedo planes had sunk the Australian corvette Armidale while it was attempting to evacuate troops from the island. The Australian destroyer Voyager had run aground on the Timorese coast and was damaged beyond recovery after Japanese dive bombers spotted the ship on the beach.

The Tjerk Hiddes had been under attack before by a Japanese squadron of high altitude bombers from bases on Timor. On that occasion my grandfather managed to successfully manoeuvre his ship to avoid the bombs. And now he was heading back to the Timor Sea.

Admiral Gordon’s report continues: “In Darwin he had obtained a patrol schedule, just recovered from a downed aircraft, which showed every detail of Japanese air reconnaissance in the area. The RAAF was sure that they would change the schedule at once.”

“Kruys, an old Far East hand, said, ‘When they get a good plan, they stick to it. I’ll work on this one because the Japs won’t alter it too quickly.’ His second asset was nothing more than a name on a chart. In his own words: ‘I could rely on the charts because I knew the Dutch hydrographer who made the surveys in about 1932.'”

The men of Timor

What my grandfather didn’t know was the incredible story of the Australian soldiers defending Timor against the invading Japanese troops. After many months in the jungle the soldiers of 2/2nd Independent Company, plus remnants of Sparrow Force, managed to build a radio transmitter from a broadcast receiver and a car generator, and got a signal through to Darwin which eventually led to the rescue mission.

The Tjerk Hiddes arrived at Betano in the middle of the night. My grandfather’s navigation officer, Lieutenant Keesom, used the artillery radar and ASDIC sonar to navigate the reefs and cliffs along the Timorese coast – advanced technologies at the time.

But my grandfather was just as familiar with the old sailor’s tricks: “I went ahead dead slow and ran my anchor two or three shackles out. It was actually a sounding lead hanging down and if it hit the bottom I would know that we were in shallow water.”

“Suddenly we saw ahead, on the beach, the three fires agreed as the landing beacon. We dropped the collapsible boats, while still going ahead and towed them in with our two power boats. These power boats stayed just to seaward of the surf to tow the collapsible boats back out.”

“My first man ashore looked around with Tommy Gun ready, thinking ‘what shall I meet, Japs or whatsoever?’ It seemed a long time to him before a lone figure in the darkness made the correct recognition signal with a feeble light, and asked. ‘Did you come to pick us up?'”

“‘Yes. I came for that,’ my man replied. Then the stranger whistled and suddenly the beach was crowded with men. First they loaded the sick and wounded and about twenty women and children and sent them out to the ship.”

“At a certain moment, two of the men on the beach, one from the ship and one from shore realised that even though they were talking English, they were both Dutchmen. It was hard for these people to believe that they were being rescued by a Dutch man-of-war. When they did accept the reality, they said that Tjerk Hiddes must have been sent by God!”

The Tjerk Hiddes made three high-speed return trips, successfully evacuating over 1000 people. The ship was never sighted by a Japanese plane. Admiral Gordon reported: “Kruys had been right in his gamble that the Japanese wouldn’t change their patrol schedule. He learned years later that the patrol was finally changed in March 1943, right on schedule.”

My grandfather was awarded the Legion of Merit by President Roosevelt: ‘By his fearless determination, excellent judgment, and outstanding professional ability throughout this period, he brought to a successful conclusion an extremely difficult and perilous mission.’

After World War II my grandfather became vice-admiral in the Royal Netherlands Navy. He lived in the Netherlands until his death on 20 April 1985.

Sacrifice and freedom

As fate would have it, I had the privilege of looking after one of the Australian Timor veterans rescued by my grandfather. He was in his nineties but he spoke about how they built the radio transmitter as if it happened yesterday.

Re-discovering this story in the family archives has changed the way I think about ANZAC day. I realised that, although it’s a primarily Australian-New Zealand-British tradition, its values of sacrifice and freedom are non-exclusive, and its tragedies universal. 

With some imagination most of us can relate to the ANZAC spirit – even if we were born outside Australia or don’t have ancestors who took part in an Australian military conflict. 

In loving memory of my grandfather Willem Jan Kruys (1906-1985). Lest we forget.

Lieutenant Commander W. J. Kruys received Legion of Merit
Image: My grandfather receives the Legion of Merit in Fremantle, 1943. Article from the West Australian, 18 September 1943.

UK doctors in Australia – Why they won’t be going home any time soon

The numbers are telling: About 1,500 UK doctors move to Australia and New Zealand each year. This exodus is causing havoc in England. A GP-shortage creates high workloads and overstretched doctors, and a survey showed that over half of UK GPs plan to retire before the age of sixty. This stressful situation has prompted a coming home campaign to entice doctors to go back to the United Kingdom.

Why are doctors leaving, and, will they move back to save the NHS?

Dr Nathalie Departe is a UK-trained GP working in Fremantle, Western Australia. “I moved to Australia in 2009 for a change of scenery. I had visited Australia before and loved it, so when my husband found himself in a career hiatus, we thought we would enjoy the sunshine for a few years.”

“Working in Australia was a breath of fresh air. Patients were pleased to see me, understanding if I ran late, and I was rewarded and not penalised if I spent time with a complex patient to sort out their management. Access to pathology and radiology services was prompt, rather than a standard 6-8 week wait for an ultrasound, and access to allied health services didn’t compare – good luck trying to see a clinical psychologist on the NHS.”

“Initially it was a bit odd to bill patients and not provide free care at the point of need, but I soon came to value the transparency of the transaction. The integration between private and public care makes private care accessible and affordable in Australia, rather than in the UK where private care has to be funded in full.”

Escaping the NHS

“In Australia I can arrange imaging quickly, receive the results the next day and organise appropriate and timely care

Dr Janaka Pieris moved to Brisbane in 2010 to ‘escape’ the NHS: “When I think back to my working life as a GP in South East London, I have two overriding memories: there was never enough time in the day to do the work asked of me, and there was no means of limiting my workload. NHS General Practice is a sink for everything no-one else will take responsibility for. Many GPs feel unable to decline these demands – many of which are not NHS work and therefore unfunded – and as a result, are drowning in work.”

“When a patient presents with painless obstructive jaundice in the UK, I have no option but to refer in to hospital, because I have no access to appropriate imaging, or I cannot get it done in a timely fashion. In Australia I can arrange the imaging quickly, receive the results the next day, discuss the case with a specialist and organise appropriate and timely care. It is much more satisfying from a professional perspective.”

Dr Tim Leeuwenburg made the move in 1999, immediately after his internship in the UK. He is now a GP at Kangaroo Island in South Australia. “I was married to an Aussie and always knew I’d be coming to Australia for love and a better lifestyle.”

“That was 15 years ago. Since then I’ve vicariously witnessed the demise of UK medicine – and am anxious that Australia doesn’t make the same mistakes: Other professions trying to do doctors’ work, capitation and performance payments, privatisation, walk-in clinics, phone advice lines, revalidation. They are all seemingly good ideas, but not evidence-based and all have served to emasculate the profession and increase the number of doctors seeking to retire, locum or emigrate from the cesspit that is the NHS. None of these measures have reduced costs or increased quality.”

“The myth of the ‘fat cat’ wealthy GP laughingly enjoying his round of golf whilst poor patients helplessly waited for his attentions was regularly portrayed in the media

Departe: “Despite working in a nice area and enjoying my job, I had a growing sense of unease with the way UK general practice was going. There seemed to be ever changing targets to qualify for practice payments with increased red tape and less time for consultations.”

“There was a general loss of respect for the role of a GP; it was not unusual for patients to demand medication, tests and home visits inappropriately, then to be outraged if you questioned the need for it. The myth of the ‘fat cat’ wealthy GP laughingly enjoying his round of golf whilst poor patients helplessly waited for his attentions was regularly portrayed in the media, and I felt that general practice was being devalued in the eyes of public and politicians alike.”

Dr Mark McCartney left the UK in 2013 because he was not happy with the working conditions in the NHS, but moved back to England after 12 months because of family circumstances. “There is a huge cultural difference in Australia, where there is a mixed health economy of private and state-subsidised services. The NHS is free at the point of access for patients, and service always struggles to meet the demand and prioritise appropriately. UK hospitals are dysfunctional places and the effects of this trickle into General Practice.”

“UK GPs are mostly paid on the basis of capitation payments depending on the number of patients registered, with additional payments for reaching clinical targets and a small amount of fee for service payments. There is now a shortage of GPs and we work in an environment of running faster and harder just to meet demands, without additional incentives or resources.”

“Australian GPs have the luxury of earning a high proportion of income from fee-for-service payments, including patient fees and Medicare payments. The more patients they see and the more services they provide, the more they earn. Clinical practice is also more interesting with rapid access to x-rays and scans. It is a professionally motivating environment to work in.”

Would you move back to the UK?

Dr Pieris is sceptical about the fully funded induction and returner scheme: “Firstly, it is manifestly insulting to suggest that doctors who have worked in similar systems, such as Australia, need retraining to work in UK general practice. I do more medicine in Australia than ever I did in the UK.”

“Secondly, if people are leaving because of a failed system, a sensible approach would be address those failings, not try to tempt people back into the same environment they left.”

“To return would require most GPs to undertake 6-12 months of supervised training, and to surrender to ridiculous bureaucratic imposts

Departe: “Why would I return to a role where I am restricted in my clinical practice by financial constraints, strangled by paperwork, stressed out by time pressures, undervalued by patients and politicians and where I would earn less money for more work and more stress?”

“To return would require most GPs to undertake 6-12 months of supervised training, and to surrender to ridiculous bureaucratic imposts,” says Leeuwenburg. “The reason doctors are leaving the NHS is because of unfettered demand from patient ‘wants’ not ‘needs’, and reduced income as a result of capitation. Why on earth would you go back?”

McCartney: “Very few GPs will return, unless they have personal or family reasons. UK GPs are retiring early, but this does not seem to be the case in Australia. There are also huge barriers to doctors wishing to move back to the UK in terms of medical registration and licensing to practice. The NHS is wasting resources trying to recruit in Australia and they look foolish because of that.”

Doctor’s advice

“My message for governments,” says Departe, “would be Stop undervaluing good general practice! Good general practice has been proven to provide better value for money and a more integrated care approach than secondary care. By all means, regulate general practice to maintain appropriate standards of care but then pay us accordingly and let us get on with being general practitioners.”

Leeuwenburg: “Listen to grassroots doctors, not NHS managers who have destroyed the NHS and are now sprucing their wares in Australia. Nor to academics who think things like capitation and revalidation are necessary. Our Australian system is marvelous and we should be proud. Sure, there is fat in the health system that could be trimmed, mostly in hospitals and specialists, but primary care is overall incredibly efficient and GPs do a great job.”

“The UK government needs to stop attacking GPs and listen to doctors and the BMA, who have been largely ignored for the last ten years

“Ofcourse there are some outliers, but there are many more who are hard working and ethical, doing the right thing for patients and Medicare. Alienate GPs and risk the collapse of a great primary care system. It will cost more if we surrender to the failed experiments of the UK or privatise us with private health funds.”

“The UK government needs to stop attacking GPs and listen to doctors and the BMA, who have been largely ignored for the last ten years,” says McCartney. “Doctors want to work in an effective service so that they can focus on caring for patients. Learn from Australia that good access to radiology for GPs can keep people away from hospital until they really need to be there.”

Pieris: “The UK Government should let us do our jobs. Trust us. Stop interfering. No-one is saying regulation and scrutiny are not required. However, GPs are not some malign enemy. Stop treating us as if we are.”

Recommended further reading: Doctors from overseas, about my experiences as as a Dutch doctors starting Australia.

Image source: www.queensland.com

What the Dutch can teach us about private health insurance

The Dutch healthcare system has received international praise. This year the Netherlands are again topping the chart of the Euro Health Consumer Index. What makes the system so good? To get some answers, I caught up with old friends from the Netherlands.

Dutch philosophy

The country’s philosophy is to cut costs and stimulate quality by introducing regulated competition. The Dutch have attempted to create a system that ensures universal health care, offers transparency and choice for consumers, and avoids risk selection. GPs play a key role coordinating care and preventing unnecessary use of hospitals.

‎Dr Pieter van den Hombergh, GP trainer and a former senior policy adviser at the Dutch Association of General Practitioners (LHV), is full of praise:

“In 2006, the country switched to a regulated market-oriented healthcare system: Insurers got purchasing power and the Government withdrew from healthcare, but set strict regulations for insurers and providers.”

Dr Jettie Bont is a GP and former board member of the Dutch Association of General Practitioners. “The Dutch health system is accessible to anyone, rich or poor, old or young,” she says. “Patients don’t have to pay a co-payment or excess payment to see their GP and we’re making sure it stays this way.”

How does it work?

The 6 key elements of Dutch healthcare:

1. Health insurance funds are not allowed to deny coverage because of illness, age or gender. A risk-equalisation system compensates health funds for accepting high-risk individuals.

2. Healthcare covered by the compulsory basic health insurance package is the same for every insurance provider. Basic cover includes GPs, medical specialists, hospital care, basic dental care, most prescriptions, and ambulance. Additional insurance packages can be purchased.

3. All Dutch citizens and residents contribute via a flat-rate premium set by competing funds – in 2014 the average premium was €1120 ($1626) – and an income-dependent payroll tax contribution. The Government covers premiums up to the age of 18, and people who earn less than a specific amount are entitled to a tax credit.

4. People are free to choose their insurance fund and have the option to change once a year. People are free to choose their GP, but must be registered with a nominated family doctor.

5. Doctor’s fees are set, there is no co-payment or excess payment for GP-care (except for travel vaccinations). Dutch GPs are paid via an annual lump sum per patient (capitation) as well as fee-for-service payments.

6. To help consumers, the Dutch Government collects and publishes price, quality and consumer satisfaction records of insurers and providers.

What are the strengths?

According to the authors of the latest Euro Health Consumer Index report, the Netherlands has the best healthcare system in Europe. The authors feel one of its strengths is consumer participation: “The Netherlands probably has the best and most structured arrangement for patient organisation participation in healthcare decision and policymaking in Europe.”

Other positives mentioned in the report are the availability of 24/7 GP care, and the fact that ‘financing agencies and healthcare amateurs such as politicians and bureaucrats’ are not directly responsible for operative healthcare decisions. The Dutch national health budget is €71.3 billion, of which €63.8 billion is funded by insurance premiums. Various levels of Government contribute €7.5 billion.

Euro Health Consumer Index (EHCI) 2014
The Euro Health Consumer Index (EHCI) 2014 compares healthcare in 36 European countries and looks at the following domains: Patient rights and information, accessibility (waiting times), outcomes, range and reach of services, prevention, and pharmaceuticals. Image: EHCI 2014 report.

Van den Hombergh: “General Practice revenue has increased since 2006 and as a result GPs were able to invest in premises, staff and infrastructure, including ICT and communication equipment. Their personal income increased as well.”

“Along with the change to market-oriented financing the total budget for general practice rose from €1.92 billion in 2006 to €2.37 billion in 2010, an increase of 14%. In 2011 all insurers invested another 10%. Before 2006 the macro budget for general practice had been constant.”

“More group practices appeared; solo practices dropped between 2006 and 2012 from 46% to 39%. The availability of nurse practitioners for chronic disease management rose from a few percent to over 90%, managing diabetes, heart & lung disease and mental health. Diagnostic and therapeutic activities were incentivised: About €50 ($73) per service for minor surgery, spirometry, ECG, joint injections etc.”

Incentives and penalties

Until 2006 GPs received capitation payments for their public patients (about two-thirds of their patients), and fees per consultation for their private patients (about one-third), but this two-tiered system is now history. 

“GPs are paid by insurers according to a mixed payment scheme: Partial capitation plus fee-for-service for basic care.

Van den Hombergh: “Regulated competition between healthcare providers and between health insurers was introduced for specialist care, but family medicine provided in general practices was exempted from this competition. GPs are now paid by insurers according to a mixed payment scheme: Partial capitation plus fee-for-service for basic care.”

“GPs receive ancillary payments, mainly on a fee-for-service basis, for additional or special services such as care for people with chronic diseases. They are compensated on an hourly basis for care during out-of-office-hours. The incentives were negotiated with the profession and were closely aligned to professional values, which limited the risk of perverse consequences.”

“In 2008, the Dutch Association of General Practitioners accepted new benchmarks on availability and accessibility. Insurers offered €4 ($5.81) for each patient when the KPIs were met. Practices should minimally be open six hours a day, five days a week and address emergency calls by a medically trained person within 30 seconds. The GP had to visit the emergency patients within 15 minutes. It was incentivised but also checked by the Dutch Health Care Inspection and failure to meet the standard was financially penalised: Practices with more than 2500 patients could miss out on over €10,000 ($14,514). In the end, only three practices did not meet the target.”

Bont: “A combination of capitation and fee-for-service in a 40/60 or 60/40 ratio incentivises effective and efficient care. A consultation should have a financial stimulus, but not too much, and at the same time the prerequisites should be there to deliver optimal care.”

“Mandatory patient registration works well and helps GPs to coordinate care. GPs are paid to do this via an annual registration fee per patient. We have our own quality assurance system and our own national general practice guidelines.”

What are the weaknesses?

Australian politicians claim that Australian health care is too costly (9.1% of GDP), but the Dutch system is even more expensive: 11.8% of GDP is spent on health (note that the US devote 16.9% to the health sector).

Dr Marith Rebel-Volp is a GP and Member of the Dutch House of Representatives. She says: “GP-care is cheap. The total health budget is €71.3 billion and General Practice costs only €2.67 billion. At the same time GPs are dealing with the majority of health problems and act as gate keepers to more expensive parts of the health system. However, long-term chronic care is expensive and one of the reasons the system is being criticised is its costs.”

“Insurers can set the benchmarks and, as collective bargaining by GPs is not allowed, this is a problem.

The Dutch Association of General Practitioners is concerned that health insurance funds are becoming too powerful, limiting choices of doctors and patients. A survey showed that most GPs are unable to negotiate or discuss their individual contracts with insurers.

Rebel-Volp shares this concern: “Although General Practice has a relative protected position within the healthcare system, there is friction between insurers and GPs. Insurers can set the benchmarks and, as collective bargaining by GPs is not allowed, this is a problem. GPs feel pressured to sign on the dotted line. Recently, a parliamentary motion was accepted which called for re-introducing collective bargaining – this is an interesting development.”

Bont: “Compared to many other countries Dutch GPs are in a strong position, but our workload has increased. Sometimes the expectations are unrealistic. For example, GPs will be required to manage people with serious mental health conditions like ADHD, and we have to hire mental health workers, but I don’t have the physical space to accommodate more staff in the practice.”

“Another result of the current system is the focus on KPIs. I often don’t have time to look at my patient during a consultation as we have to register so many details for the health funds.”

Private health funds require ongoing scrutiny by watchdogs. Last year the Dutch Healthcare Authority (NZa) had to intervene to make sure insurers offered the basic package to everyone without discrimination. The mission of the Healthcare Authority is to guard quality, efficiency, market transparency, freedom of choice, access to healthcare.

“The senate blocked proposed legislation changes which would have opened the door to risk-selection by insurers,” Rebel-Volp says. Although risk selection by insurers is not allowed by law for the basic health insurance package, this doesn’t apply to complementary packages. Insurers will try to push people to take out more expensive insurance products, for example by making it harder for certain patient groups to obtain the basic package online or directing people to the expensive packages on their websites.

Rebel-Volp: “Another issue is the level of the excess payment. This is high and many GPs feel patients are avoiding specialist care as a result. Currently the Health Minister has proposed a new plan in which a lower excess payment is an option if patients choose insurer-preferred, contracted specialist care.”

Vertical integration of care, where health insurers provide health services, is a topic of political debate in the Netherlands. Although it is cost-effective, risks are loss of quality, consumer choice and professional autonomy. Doctors and consumers often argue that insurers should not interfere in the patient-doctor relationship to avoid managed care situations as seen in the US. At the moment the Dutch Health Minister and the majority of the House of Representatives do not support vertical integration.

Conclusion

It is not surprising that the Netherlands is topping the international healthcare charts. Although their system is not perfect – and still a work in progress – the Dutch have solved some major issues such as access and equity. The Government has become the regulator and withdrew from the operational side of healthcare – this appears to have been very beneficial for the industry. On the flip side, the system is not cheap, private health funds need to be watched closely, and Dutch GPs have had to sacrifice at least some of their clinical autonomy.

How to create a blog that makes a difference

“If you are working on something exciting that you really care about, you don’t have to be pushed. The vision pulls you.” ~ Steve Jobs

It’s great to see the steady increase in interest for social media in healthcare. What’s your passion? If you are keen to start a blog or further improve your blogging skills, there are amazing bloggers you should follow, like Seth Godin, Jeff Goins, Michael Hyatt.

My slideshow How to create a blog that makes a difference (above) contains quotes and tips from some of my idols in the blogosphere. I have also attempted to collect and present the (many) reasons why people start a blog in healthcare, common pitfalls, 3 steps for putting a great blog idea into action, and lots of tips for writing awesome posts.

Enjoy!

Amazing Australian GP Bloggers

What is it like to be a General Practitioner in Australia? What are Australian Family Doctors passionate about? What do they struggle with? The Amazing Australian GP Bloggers 2014 give readers a rare look behind the scene.

Bloggers like Justin Coleman, Jacquie Garton-Smith, Genevieve Yates and Penny Wilson are great storytellers with an impressive writing talent. Penny’s post Sorry… But are you really a doctor, reached number 7 in the most popular WordPress blog posts worldwide.

Then there are the GP bloggers who focus on teaching and sharing skills and knowledge, like Michael Tam, Casey Parker, Tim Leeuwenburg, Minh Le Cong and Robin Park. They are responsible for a vast amount of freely accessible medical information. Much of their work can be found via the excellent foam4gp blog.

It is good to see that some GP bloggers post valuable information for patients, such as Jo Kosterich, Brad McKay and Nick Tellis. Duncan Jefferson is creating a nice podcast collection on his blog.

Examples of posts I enjoyed: How to live to 150 in 10 easy steps, by Brad McKay; The art of uncertainty in general practice, by Marlene Pearce; When Terry Barnes and I bumped into each other on Twitter, by Tim Senior.

The stream of stories, confessions, opinions, experiences, tutorials, interviews and podcasts just goes on. It is impossible to mention everyone here, so I refer to the list below.

I would like to finish with acknowledging the hard work these doctors are putting into their blogs. From experience I know it can be a challenge to keep the momentum of writing going. Even though it is a passion, it is not always easy.

All these creative GP bloggers have inspired me, and I’m sure you will (continue to) enjoy their posts! Click on the WordPress/Blogger logo to go to a blog.


Dr Melanie Clothier

Rural GP | Always learning from my patients | Love music, good company, good food/wine/coffee. Views my own. Rural South Australia. Blogs at: WordPress.

Go to blog


Dr Justin Coleman

President, Australasian Medical Writers Assoc. GP, Inala Indigenous Health. Medical editor. Snr lecturer UQ & GU. Blogger; The Naked Doctor. Blogs at: WordPress.

Go to blog


Dr Gerry Considine

Pilot | Rural GP | = better half | Tweets/thoughts my own. Eyre Peninsula, SA. Blogs at: WordPress.

Go to blog


Dr George Forgan-Smith

Melbourne, Australia. Blogs at: WordPress.

Go to blog


Dr Jacquie Garton-Smith

GP, Clinical Lead, health communications advisor, fiction writer, wife, mum, gardener & doglover, keeps a paper diary & writes lots of lists. Blogs at: WordPress.

Go to blog


Dr Sam Heard

NT Specialist General Practitioner. Making health compute with openEHR, Australia. Blogs at: WordPress.

Go to blog


Dr Duncan Jefferson

Focus on Health. Medical Doctor: Writer: Podcaster. Founder of The Pilgrim Trail and Camino Salvado; can be a tad impish on occasion! Perth, Western Australia. Blogs at: Blogspot.

Go to Blog


Dr Joe Kosterich

An independent doctor actually talking about health. Perth, Australia. Blogs at: WordPress.

Go to blog


Dr Edwin Kruys

Husband, father, GP. I blog about healthcare, social media & eHealth. Sunshine Coast, Queensland. Blogs at: WordPress.

Go to blog


Dr Minh Le Cong

Flying Doctor, rural GP, I work in the sky, live in the tropics, love my family and dream of how to make things better. Supporter of . Cairns, Queensland, Australia. Blogs at: WordPress.

Go to blog


Dr Tim Leeuwenburg

Resuscitate-Differentiate-Prognosticate: Roadkill, Diff Awy & Checklist Fan – ATLS-EMST Director – Quality Care. Out There via & . Kangaroo Island, Australia. Blogs at: WordPress.

Go to blog


Dr Brad Mckay

Doctor & TV Presenter of Embarrassing Bodies Down Under. Skeptically Optimistic. Gadget Geek. Passionate about Health. Blogs at: own website.

Go to Blog


Dr Robin Park

GP on the Sunshine Coast QLD. Doing masters med ed through Flinders. Teaching at Deakin University Medical School. Writer for . Blogs at: WordPress.

Go to blog


Dr Casey Parker

Rural doc, author of the Broome Docs blog. Generalist, supporter and contributor blog. Broome, NW Australia. Blogs at: WordPress.

Go to blog


Dr Marlene Pearce

General Practitioner. Writer, Blogger. Blogs at: WordPress.

Go to blog


Dr Francois Pretorius

Procedural Obstetric GP; Ruralist; Passionate GP educator; Christian; Husband to 1; father to 4; wine lover and chef. Buderim, Qld, Australia. Blogs at: WordPress.

Go to blog


Dr Karen Price

GP, and Chair of Women in General Practice Committee Vic. RACGP. Interested in Most things. Melbourne. Blogs at: WordPress.

Go to blog


Dr Mark Raines

GP, photographer, kayaker, Dad…. and face painting victim…. Kangaroo Island. Blogs at: WordPress.

Go to blog


Dr Thinus van Rensburg

GP & skin cancer doctor. Fiddles with IT on the side. Canberra. Blogs at: WordPress.

Go to blog


Dr Joe Romeo

Fulltime country GP, aspiring songwriter/ worship songwriter, father of 6, follower of Jesus Christ. Narrandera, Australia. Blogs at: Blogspot.

Go to Blog


Dr Tim Senior

GP in Aboriginal health & medical education. Writer of for a crowd at & other stuff. Tharawal Nation, Australia. Blogs at: Blogspot.

Go to Blog

Also blogs at AMS Doctor


Dr Michael Tam

Michael Tam is a Staff Specialist in General Practice at the GP Unit in Fairfield Hospital, and Conjoint Senior Lecturer at UNSW Medicine. Sydney. Blogs at: WordPress.

Go to blog


Dr Nick Tellis

Passionate about quality in General Practice. Glenelg, SA. Blogs at: WordPress.

Go to blog


Dr Arron Veltre

Palliative care trainee (QLD). Locum GP. Loud shoe wearer. Triathlete wannabe. Scribbler. 80’s skateboard collector. Part time longboard rider. Blogs at: Blogspot.

Go to Blog


Dr Penny Wilson

GP obstetrician, rural locum doctor and blogger. Interested in teaching, leadership, advocacy, quality care. Local, national, global. and . Blogs at: WordPress.

Go to blog


Dr Genevieve Yates

Doctor, medical educator, writer and musician, who believes that you can do it all, just not all at once. Supports , & . Blogs at: WordPress.

Go to blog


Social media in healthcare: Do’s and don’ts

Facebook in health care
Image: pixabay.com

‘Reputation management’ was the topic of an article in the careers-section of this month’s Medical Journal of Australia. As I have blogged about reputation management before I was asked a few questions about the way my practice has used Facebook.

I think Facebook and other social media have the potential to improve communication with our patients and colleagues and make healthcare more transparent – if used wisely of course.

Unfortunately the Australian Health Practitioner Regulation Agency (AHPRA) has scared the healthcare community with their social media guidelines. Doctors are now being told by medical defence organisations to be even more careful with social media, but I’m not sure I agree with the advice given.

Do’s & don’ts

Here are the do’s and don’ts as mentioned in the MJA article:

  • “Do allow likes and direct messaging on the practice Facebook page, but don’t allow comments. This will avoid any dangers associated with comments classed as testimonials by AHPRA. It also avoids problems such as bullying that may occur when comments are made about other comments.”
  • “Don’t respond to negative remarks online, as it risks falling into the category of unprofessional conduct if brought before the medical board.”
  • “Don’t befriend patients on Facebook if you are a metropolitan practice, Avant’s Sophie Pennington advises, so as to keep some professional distance. She says that in regional and rural areas it can be unrealistic to have this separation.”
  • “Do link your Facebook page to your website, LinkedIn and any other profiles you have set up online. This will help to ensure that these options appear higher on the search-page listings when others look for your name.”
  • “Don’t google yourself!”

Negative vs positive feedback

I think negative comments online are a great opportunity to discuss hot topics (such as bulk billing and doctors shortages) and to engage with the community in a meaningful way. Positive feedback by patients is wonderful and should not be discouraged, as long as it’s not used as a way to advertise health services.

Health practitioners should be supported to communicate safely online. But not allowing Facebook comments is defeating the purpose of social media.

Let’s stay out of where they are from and why they’re here

A long time ago I did a locum stint in an asylum seekers centre in The Netherlands.

What struck me was the vast amount of physical and mental illnesses like depression, malnourishment, and neglected chronic and infectious diseases, together with uncertainty, fear, cultural differences and challenging language barriers.

It all came back to me when I saw the people on board of the small, fragile vessel that earlier this year sailed into the Geraldton harbour.

Asylum seeker boat
When the boat sailed into the Geraldton harbour, it didn’t feel like the ‘unprecedented breach of border security’ we heard about in the media. Whatever the reason for their journey, these men, women and children should be looked after properly while they are in Australia.

The sad reality is that many asylum seekers, including children, spend many years in immigration detention facilities. This creates more (mental) health problems. AMA president Steve Hambleton said at the National Press Conference this week:

(…) let’s stay out of where they are from and why they’re here and all the other stuff. Once we are in control or once we take responsibility for people, we should be providing them with first-rate health care.

Whatever the reason for their dangerous journey, let’s hope these men, women and children will eventually find a place where they can live a safe, healthy and peaceful life.

In the meantime, while they are here, we have to take care of them. We are responsible for their health and well-being, including appropriate access to quality healthcare.