Dr Siobhan Clayton

I arrived in Lismore in mid-2015 to begin a 12-month rural clinical placement for Medicine from the University of Wollongong, coordinated by the University Centre for Rural Health. In August 2016 , following exams, I returned, and took up an elective surgery placement and a pre-Internship placement at Lismore Base Hospital, completing this in November.

In January this year I began the Internship program at LBH, and am hoping to continue there as a Registrar. I chose this area because it was a part of NSW,I had never visited, yet had heard so much about. The North Coast is known for its eclectic mix of people, shops and artists. It is a vibrant and unique area, with beautiful beaches, national parks and waterfalls to explore. It sounded the opposite of my home town of Bowral, a quiet, conservative ‘sleepy’ place, dubbed by locals as the retirement village of Sydney. I thought that being in my mid-twenties it would be a good time to set sail to the winds.

Robert Coote (Colonel Pickering), Stanley Holloway (Alfred P. Doolittle) and Rex Harrison (Henry Higgins) from the Broadway production of My Fair Lady.

"Why can't a woman be more like a man?", sang Rex Harrison in My Fair Lady, Lerner and Loewe's 1964 musical adaption of George Bernard Shaw's, Pygmalion

It would seem poor advice for medical practitioners, however. In this issue of GPSpeak, Dr Jane Barker reports on the significance of the recent JAMA article showing patients of female physicians in American hospitals had a lower mortality rate and were less likely to be readmitted within the month. This finding adds to previous knowledge of differences between female and male medical practitioners. 

Her Royal Highness Crown Princess Mary, Patron of Healthcare Denmark
Primary care systems vary widely in economically advanced societies around the globe. The Danish system is often touted as primary care done right. So what are the key features of the Danish general practice?


Like most western European countries Denmark has a national health service that covers the entire population and is free for all to attend. Most specialists are hospital based employees but general practitioners operate as small businesses, usually in one or two man practices. Every two years they negotiate a contract with the local health service for the primary care management of their patients. The contract states that they are responsible for the care of at least 1600 people but once this number is reached they may close their books to new patients. The contract provides more than 95% of a GP's income. 
Patients can choose any registered GP as their local doctor, if her books are open, and can optionally register on that GP's "list". This is not a requirement but it is financially advantageous to do so and 98% of the population nominates a GP for their routine care. Patients can change GPs but only once every three months. 

Davos, in the Swiss Alps
Each year the world's leaders in business, economics, politics and technology meet in the remote Swiss town of Davos in the depths of winter. They are not there for the skiing, but to contemplate what future worlds might be like. 
The World Economic Forum founder, Professor, Klaus Schwab, believes the world is entering the Fourth Industrial Revolution where the integration of digital, physical and biological technologies has a disruptive effect on society and government which will be at least as significant as the three industrial revolutions that preceded it. 
"The future is already here. It is just not very evenly distributed", wrote science fiction writer William Gibson in 1993. He is correct. 
On 12 July 1956 Dr John Sullivan reported on his first test result from his new rooms in a cottage on Wickham Terrace. Eighteen months later he was joined by Dr Nicolas Nicolaides. Sixty years later Sullivan and Nicolaides Pathology is now one of the largest pathology groups in Australia.

Dr Andrew Binns with GP registrar Dr Noah Verderio

GP1 registrars are beginning their first term in general practice training. While some will have had experience in the GP setting during their student years, a greater number will have been engaged predominantly in hospital training and had relatively little exposure to the GP environment.

Feedback indicates that transitioning from RMO placement in the supportive hospital environment, characterized by ample resources such as medical specialist skills and technology, to the primary care setting can be daunting. The registrars need to be more self-reliant on clinical skills and on developing an ability to understand a patient’s psychosocial background, family history and lifestyle practices.

Consider the difference between working in an emergency department and a general practice. In ED the requirement, often under significant time pressure, is to work out a diagnosis and treatment plan and decide whether to admit or not. In general practice a more incremental style is needed. This entails participating in a continuum involving a number of visits that may be required to diagnose and develop a management plan.