One of my patients often tells me that she used to say to my predecessor, “I don’t know how you make a living, doc, cause I’m never sick.”
Things changed when she was diagnosed with a TIA and we found an irregular heartbeat. She now often expresses her gratitude for the care available, close to home.
Like so often in life, we only value something when we perceive a need for it. Emeritus Professor Max Kamien recently reminded me of this when he quoted James Dickinson in a comment on this blog post.
Dickinson, a professor in family medicine, used to work in the Federal Department of Health. He said that health policy is devised by young, healthy, non-medical advisers who do not have a need for a personal GP and instead use impersonal walk-in practices.
They often regard these experiences as being substandard medical practice. As a result, he said, they do not understand the multiple tasks required for good quality general practice and do not perceive its relevance.
This could perhaps explain the incomprehensible decisions that often come out of the department, such as defunding ECGs in general practice (a test which was crucial in the diagnosis and management of my patient).
I sometimes wonder, is it worthwhile spending more time and effort on educating policy-makers in the department of health?
Yesterday I bumped into Emeritus Professor Max Kamien at #GP16Perth, the annual conference for Australia’s GPs. It is always a pleasure to meet Max, who is a phenomenon in West Australia and beyond. Many general practitioners, including me, have at some time during their career been taught, tutored or assessed by him.
His long career as a medical writer started when he was a medical student: “I put a blowfly in a nitric acid bottle in the chemistry laboratory and was given two months of lunchtime detention washing chemistry retorts. My supervisors were Vincent Serventy, who wrote books about fauna and flora and Douglas Stuart, a larrikin writer of West Australiana. They introduced me to the joys of witchetty grubs and writing.”
“I was also the editor of ‘The Reflex’, the WA medical students magazine. The Medical School registrar burned it. It is now a valuable collectors item. One article pointed out that most of the Nazi medical experimenters were academics. It is still quoted in the world literature, which is not bad for a student publication.”
His book has received positive reviews. Charles Guest wrote in the MJA: ‘There is (self-deprecating) humour frequently but always compassion and instruction.” Robert Reid said in Medicus: “Professor Kamien has written an enjoyable, funny, insightful and yes, valuable book (…) with hardly an issue of life or medicine that is not examined or on which Prof Kamien doesn’t have a view.”
Max recommends two stories in particular: “Bill Reid; From inequity to virtue, which is about getting to know your feared adversaries, and the other is: Let me die like a dog. This is about my miserable failure as the long-time GP of a Catholic lady who got Motor Neurone Disease and, totally paralysed, lingered on for 10 years.”
“My book makes great Christmas presents for doctors, nurses and medical students. I have had only two negative comments. A colleague said he felt short-changed since he had read some of the stories before in Australian Doctor magazine. And some people who like to bend a two page book into a one page one have managed to split the spine.”
Lastly Max’s advice to new fellows is short but sweet: “Follow the last three paragraphs of the RACGP Oath of Fellowship.”
For the record, you might want to consider the whole oath.
Max is happy to provide his book to doctors attending #GP16Perth this week; he can sometimes be found in the exhibition hall. Make sure you get a copy if you haven’t already.