“Oh, the farmer and the cowman should be friends,
Oh, the farmer and the cowman should be friends.
One man likes to push a plough,
The other likes to chase a cow,
But that's no reason why they cain't be friends.”

Rogers and Hammerstein, Oklahoma (2009 London Cast)

Wikipedia states that “friendship has elements of affection, sympathy, empathy, honesty, altruism, mutual understanding, compassion and trust. There is also the ability to express oneself and one’s feelings without fear of judgement from the friend. As a result friends tend to share common backgrounds, occupations and interests.”

Medicine is a stressful occupation. The suicide risk amongst doctors is higher than the general population, particularly for female doctors, and has been the subject of recent reports In the newspapers and on radio. The pressures on young doctors can be overwhelming at times, resulting in these tragic events.

Rogers and Hammerstein, Oklahoma (2009 London Cast)

Support from our young colleagues is crucial and this issue of GPSpeak reports on the support our allied health care and medical students (page 21) and young hospital doctors (page 27) receive from their more experienced colleagues.

They are at a particularly stressful  time of their lives with moving away from home, establishing (and breaking up) new relationships, partnering and starting families. Add to these pressures the tasks of looking after vulnerable patients. At times they have to make life and death decisions and they do this without the wealth of experience and knowledge that more senior clinician have acquired. They need our support, particularly in these circumstances.

The NSW Health Practitioner Regulation National Law - Section 141 came into effect in 2008. It requires mandatory reporting of impaired colleagues except where such a “reasonable belief” occurs within a legal or quality assurance framework. It applies to students as well as medical practitioners.

Mandatory reporting has been listed as yet another factor in the increased risk of suicide for doctors. Not being able to seek help for depression or work related issues may prove too much for some. Doctors are fearful of reaching out for help lest their illness be seen as indicating an incapacity for the future professional roles.

All States of Australia, except Western Australia, have mandatory reporting laws and doctors are reported to have travelled to the west to seek assistance because they cannot rely on the traditional confidentiality of the doctor-patient relationship.

The UCRH has played a crucial role in the pastoral care of our young health graduates. In our lead article (page 5), Dr Jane Barker, explores this issue and suggests a GP based mentoring program as a possible solution. Conducting this as part of quality assurance program may give all participants the confidence “to express oneself and one’s feelings without fear of judgement”. The confidence that one would expect of a friend.

The profession’s response to the Federal Budget has been tepid. Scott Morrison announced the Medicare Freeze was to end ... just not yet. Doctors had hoped for a blow torch to start the thaw but saw little more than the light from the Treasurer’s iPhone.

Bill Shorten in reply promised that he would end the Medicare Freeze immediately but such promises are of little comfort to the profession, at least for the next two years.  

Local MP, Kevin Hogan has, however, been busy in the local health arena. GPSpeak reports (page 8) that the Buttery will get part of a $5.7 million package to address drug and alcohol problems, with a particular focus on “ice” users. Mr Page has also announced (page 9) that the Social Futures organisation has won the tender for the Lismore Headspace Service, that addresses youth mental health problems. It will take over from the North Coast Primary Health Network that had managed the service since its inception in 2015. The $1.4 million grant will also provide services in smaller regional towns which is crucial to the effectiveness of these programs.

Local Aboriginal Medical Services have also received a boost from the Federal government with the opening of the $4.7 million Djanangmum Health Clinic (page 18) in Casino and a $115,000 grant to train Aboriginal Mental Health First Aid staff and the expansion of the residential capacity of Namatjira Haven Drug and Alcohol Healing Centre (page 19).

Under the current Turnbull government, the North Coast Primary Health Network has a major role in commissioning essential health services for the North Coast. As discussed in the last issue of GPSpeak, commissioning of health services goes back over two centuries and can be challenging. Small businesses like most general practice surgeries are focussed on their day to day work. They have neither the time, nor the skills, to tender for possibly unsuccessful contracts.

Nevertheless commissioning is in vogue and it seems likely that the successful tenderers will come from larger health organisations and corporate medical entities. GPs see this as leading to further fragmentation of patient care and at odds with other model currently in vogue, the Health Care Home.

Dr Jayne Ingham from GPpartners, Brisbane, reports (page 29) on her first hand experience of unsuccessful tendering for a community mental health nurse. She reflects on the feedback given by the Commissioners that they were unsuccessful because they did not have a dedicated building for the nurses and had poor links with the local Mental Health Units.

Bricks and mortar seem somewhat old fashioned in this connected age but surgeries with  meetings rooms and regular meetings of practice and health service staff have found them invaluable in furthering communication and coordinated patient care.

Better communication and better integration between GPs and Mental Health Units are also urgent tasks for the future, reports Dr Richard Buss, Director of Mental Services for the Northern NSW Local Health District (page 7). Mental health issues are highly prevalent on the North Coast with 23% of the population said to have a mental health problem. Dr Buss notes that the majority of cases are mild to moderate and are handled in general practice. However, even for the more severe cases, managed in hospital, medical issues are common and often chronic. Good communication is therefore essential for these patients particularly on hospital admission and discharge.

Dr Buss also notes the “culture clash” between public and private systems which he states has historical origins. GPSpeak has seen an improvement in communication between the two systems in recent times and acknowledges that we all have to improve to achieve our common goal of “better integrated care and improved client outcomes”.

Unlikely as it once seemed, even the Campbells and the MacDonalds and the Hatfields and the McCoys have reconciled. We should all be friends.