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Dr David Guest

“Isn’t it hot?”

So said John McEnroe to a linesman in one of his early matches at the Australian Open. He was deemed by the umpire to be intimidating the linesman and lost a point. As one might expect of McEnroe he was not happy but he also went on to win the match. 

This Spring North Coast residents have been confronted with a tremendous loss of property, livelihood and even lives from out of control fires. For many, the toll includes a lifetime of memories going up in smoke in minutes. For many the personal fire plan is to grab the photo album, and the pets,  and head to the nearest evacuation centre. 

Those not directly affected are reminded each day of the damage being done. Smoke is in the air and at times limits visibility to a few hundred metres. The dry earth cracks and shifts and the houses settle awkwardly. The lawns crunch underfoot and the flowers droop, turn brown and die.

As the flames rise so does the temperature of the discourse at local, state and national levels. Is it the right time to talk about the effect of climate change on the environment? Many of those directly affected are just thinking about how to get their lives back together, yet climate change is often mentioned. 

Doctors traditionally focus on the patient in front of them. However, many put their energies into improving the environment in which we all live and work. 

Sometimes this puts them at odds with society. Doctors support the “last drinks” lockout laws that have been successful in reducing alcohol related death and disability but has made Sydney dull in the process. They support pill testing to save the lives of young people at music concerts, although this remains strongly opposed by the NSW Government. They have led movements to limit the use and proliferation of nuclear power. 

In this issue of GPSpeak (pages 14-15) we report on the recent fires and the response by charities and churches, counsellors and politicians to the disaster. Some of this medical response was co-ordinated by the North Coast PHN and the local fires have been an issue of great concern to many of the doctors at the PHN’s Mid North Coast Clinical Council. Dr Ashlea Broomfield, the RACGP co-vice chair (rural), NSW ACT faculty has clearly espoused the College’s position as showing “a link between climate change and increasing drought as well as bushfires”. For the College, climate change is a public health issue.

The recently published and extensive MJA-Lancet report on health and climate change has been strongly endorsed by Doctors for the Environment for Australia (see report page 16). The report criticises “the lack of Australian national policy to address threats of climate change to health…” This, coupled with a failure to develop a national energy policy, a stagnant economy and a tight fiscal policy has led the satirists to rename the Prime Minister from ScoMo to SloMo. 

For the elderly Summer can be a dangerous time even when the fires are distant. Decreased heat tolerance, an aversion to using the air conditioning, and a combination of disease and medications with a solitary existence, sets up a potential death trap for older patients struck by gastroenteritis. On page 22 Graeme Turner, Chronic Kidney Disease Nurse Specialist reminds us of the need to keep our patients informed of the risks and the value of a Sick Day Action Plan such as those found in HealthPathways. 

As doctors we derive great professional satisfaction from curing our patients. However, it is the engineers that can take most of the credit for extending our lifespan and QALYs over the last two centuries. Improvements in water, sanitation, agriculture, transport and communication systems have been the key. In the last 30 years China has lifted 87% of its population (850 million) out of poverty with an accompanying increase in life expectancy from 43 to 75 years of age. 

In more advanced western societies most of the loss in QALYs derives from lifestyle issues, often underpinned by  adverse childhood experiences. Excess calories, illicit drugs, smoking and alcohol account for much of the disease we see every day. 

Foetal alcohol spectrum disorder results from alcohol consumption in pregnancy. It is a tragedy for the child, the mother, the family and society in general. On page 7 local paediatrician Jackie Andrews outlines the features of the disorder. On page 8 we note that the Senate is holding an enquiry into FASD that is due to report in June 2020. This follows the Commonwealth 2012 report on FASD whose recommendations were never fully acted upon. On page 6 we report on the reticence of the alcohol manufacturers to use more prominent labelling about alcohol in pregnancy.

FASD is a tragedy in the Aboriginal community. Public health campaigners like paediatricians Dr James Fitzpatrick and Professor Elizabeth Elliott have spent much of their professional careers trying to raise awareness and find a solution (page 8). If we are serious about the social determinants of health we need a community based approach. As Fitzpatrick and Elliott argue, if this is not possible from industry and government it will be up to Aboriginal communities themselves to take up the challenge. .

“Less is more” is a principle in architecture and software development. Its lessons can equally be applied to medicine. A short walk each day is often better for back or major joint pain than analgesics and anti-inflammatories and the NCPHN’s osteoarthritis screening clinics have found they can delay the need for joint replacement in the short term by using simple principles. On page 29, Ballina District Hospital physician, Dr Tien Khoo outlines the approach we should all take for prescribing medication, and on page 23 community pharmacist, Alannah Mann, gives us some concrete examples in the case of UTIs in nursing home patients. 

GPSpeak has been published in hard copy since 1995 and on the web since 2013. In the last few months we have added video to its media offerings by making the presentations from the 2019 Nordocs conference available online. Video meetings have the advantage over attending conferences and night time meetings in person in that they allow busy medical practitioners to fit in their learning and CPD requirements around their clinical and family responsibilities. It also gives Northern Rivers GPs a chance to see and hear from their local specialist colleagues, to whom they refer the majority of their patients.

On page 21, specialist physician Jowita Kozlowska summarises her presentation at Nordocs 2019 on Advances in Stroke Management. Access for local clinicians to all the presentations from Nordocs is available through the Nordocs Facebook group. 

In the last two years Regional Training Hubs have helped raise awareness of the advantages of training and ultimately settling in rural Australia. Many city based young doctors have come to the North Coast, enjoying the lifestyle and staying on. Developing our rural workforce was the subject of presentations at Nordocs by surgeon Dr Sally Butchers, and doctor in training, Dr Zhi Kiat Sia

Dr Sia’s mentor, surgeon Dr Sue Velovski, has been instrumental in promoting the Rural Hub in our area. The options for specialising are numerous and finding a path for a young doctor is difficult. On page 24, we report on her initiative to help navigate the maze with another modern communication technology. The Destination Medicine podcast is a series of eight interviews that can act as a guide to those young doctors looking to escape the city and opt for the rural lifestyle. 

On page xxx (currently 35 but should be upt the front of the magazine) NRGPN Chairman Dr Nathan Kesteven reviews the past 12 months of the NRGPN’s activities. He sees a different future for the Network that extends its borders and broadens its membership. He suggests the Network refocuses its efforts on education and breaking down the silos between primary and secondary care. The ballot to enable this historic development will occur at the NRGPN Annual General Meeting on 19 December 2019 in the Education Centre of St Vincent’s Hospital, Lismore. 

GPSpeak depends on dozens of people and organisations for its regular publication. At the end of each year we acknowledge the help we have received from those groups. 

Much of the essential but unglamourous work is done by Leanne Tully, our administrative assistant, and our financial officer, Luissa Everingham. They keep the lights on as the rest of us scurry in and out. 

NRGPN is a registered charity. As such there are multiple requirements for the organisation to meet. Accountants and auditors, Thomas Noble and Russell, provide us with regular financial advice and help us maintain compliance with government regulations. I would like to extend particular thanks to Peter Morrow, Jessica Mitchell and Dorothy Chippingdale from TNR. 

GPSpeak is indebted to Sullivan and Nicolaides Pathology for the distribution of GPSpeak each quarter. The magazine now goes out to over a thousand health care professionals on the North Coast and lower Gold Coast. 

It is through the generous support of our major sponsors, Gold Coast Private Hospital and Thomas Noble and Russell, and minor sponsors, Dr Harald Puhalla, Coastal Vascular Group, Gold Coast Spine, North Coast Radiology, SNP, St Vincent’s Private Hospital, Lismore, Southside Surgical, Genesis CancerCare and the University of Wollongong, that enables GPSpeak to publish each quarter and give an independent voice on the important issues that affect the health of our community. 

Finally I would particularly like to thank the other members of the editorial team whose knowledge and skills make GPSpeak possible. Former editor and major contributor, Dr Andrew Binns has long experience of the medical issues in our area and this enables us to keep tabs on the issues of the day. Robin Osborne our editor has worked around the country in health journalism for over thirty years. It is through his skill that GPSpeak has matured and has the professional quality it has reached today. I also owe a special thanks to designer and artist, Angela Bettess, whose skills and application allows us to give GPSpeak a professional look, both in hard copy and on the web.

GPSpeak will continue in its current format for the next 12 months. Its direction thereafter will be shaped by its new Board. We look forward to reporting on the North Coast’s health issues in these exciting times. 

Best wishes for a happy and healthy holiday season 2019-2020.

David Guest
Clinical Editor