“To sleep, perchance to dream”
- Hamlet, William Shakespeare

Sleep apnoea almost seems like an Australian invention. Its physiology was poorly understood in the 1970s and contemporary treatment owes a lot to the pioneering work of Dr Colin Sullivan on positive airway pressure (PAP) treatment at Royal Prince Alfred Hospital in Sydney.

Since then the extent  of the problem has grown considerably and reflects the increase in the body mass of Australians. Obesity, and sleep apnoea, one of its consequences, is now a major industry around the world.

The clinical significance of the problem has been debated and recent studies suggest that our current approach in Australia has led to over-treatment.

Dr Bronwyn Hudson is the founder and principal GP at the Yellow Gate Medical Clinic in Banaglow. She specialises in addiction medicine and runs an outpatient opioid treatment program.

In good news for the medication assisted treatment of opioid dependence (MATOD) in general practice, the recently updated NSW Clinical Guidelines: Treatment of Opioid Dependence 2018 provide a number of measures that make treating opioid dependence in the community more practical and flexible.

The new guidelines aim to increase access to MATOD by expanding the role that GPs play in opioid replacement therapy. The guidelines also place a greater reliance on non-government organisations as well as community pharmacies.

Paper, paper, everywhere
And there’s smudging of the ink
Paper, paper, everywhere
It’s time to change, you’d think.

Everybody wants your data. Each organisation has its own form they want completed. It’s time consuming and expensive for staff to do it, so they pass it off to the customer. It’s the modern way. The client does the work and you take the money.

In 2016 I started work at Lismore Base Hospital after moving from Royal North Shore Hospital in Sydney. Having been involved in teaching and education, particularly at the resident and registrar level, I was keen to get involved in a similar scene in Lismore. It didn’t take me long to track down my old supervisor from my time as a trainee registrar in Lismore, Dr Adam Blenkhorn, who had been evolving the Basic Physician Training  program over the years at Lismore. One of the key milestones he was keen to achieve was to run the national Physicians exam locally. This was no mean feat, but with the support of the new Department of Medicine, this aim is being achieved.

Dr Zewlan Moor

I remember reading in an interview with John Murtagh, the doyen of General Practice in Australia,  that he used to keep a list of all the masquerades up on the wall behind his patient’s head, so that he would not miss an important diagnosis. Once he had satisfied himself that he had excluded these and any other organic causes of the symptoms, he was free to sit with the patient and help them realise what it was that truly ailed them.

I do think that certain sorts of doctors get certain sorts of presentations. I have always been the sort who attracts psychosocial problems. That used to stress me, but now I’m trying to see it as my superpower. Indeed, I’m attempting to “lean in” to this superpower by opening a new private practice, called Byron Bibliotherapy.