the change in medical practice over the last 40 years,

Key points

Thanks to Gavin Pogue  for inviting me to speak today at SCR, ALSO TO President Danny Hogan and Roy Hill for inviting me along to Rotary

My theme today  is the change in medical practice over the last 40 years, particularly for GP’s  and their patients in the country towns like Shepparton.

A bit of background
In 1981 Shepparton was a thriving metropolis of  24,000 people and Carlton had just sneaked a grand final. Seymour won the local grand final.  Malcolm Fraser was the PM  and Rupert Hamer was Victorian Premier. Locally we had Bruce Lloyd as our federal MP, Bill hunter as mayor and Peter Ross Edwards as the local MP. Suede flares were just out of fashion except for Shepparton weddings.

I arrived on Dec 15 1981, new baby, into a new practice and new life. General Practice then was an apprenticeship, building up patient numbers, learning from the older GP.’s as one became a family doctor. Reports were written on 5×8 cards with the barest of illegible comments. Failure to give an antibiotic to a sick child led to reproval from the others when they had to do a call out later that night when the child became more unsettled.

GP’s then were jack of all trades expected to do moderate surgery, deliveries and anaesthetics. Melbourne was over 2 1/2 hours away by road and the new Base Hospital had only just opened. Up until then GP’s had run the local hospital which had been based in Mooroopna,Ron Gwynn was the medical director.  Shepparton offered 4 small group practices which was better than the solo practice in small towns  usually working from a converted house. We were expected to do long hours on call, deliveries during the night, home visits and emergencies needing plaster or suture that dominated the life style. Wives were receptionists, backstops and substitute doctors when the doctor was out. No mobiles then , no computers,  billing systems based on trust with payments being made up to 3 months late, Patients had their own doctor and had to be sent back to them after being seen for an emergency. We had to buy into the practice with a large goodwill component and some bricks and mortar.

Roll on the years!
Every year would bring new advances in medical treatments, surgical procedures, obstetrics and psychiatry.
Plus the introduction of computers from 1980 onwards in many different ways. Epidemiology and recording and communication.
Mobile phones and faxes were introduced then the curse of e mail.
Equal opportunity and government scholarships opened the way to greater female participation in the medical workforce. Changing societal values led to shorter working hours and greater emphasis on personal values and freedoms for the general population which then moved into the medical field.

Some of the good

Medicare initially. 1975
One flew over the Cuckoos nest effective treatments 1975
Ulcer surgery replaced by Pills. 1981 Barry Marshall and Robin Warren 1985
Christian Barnard and open heart surgery. 1967 leading to CABG’S
Test tube babies and IVF. 1978
Caesarean sections.
Cryotherapy and diathermy
Good preventative medicine
Stop smoking campaigns.Skin campaigns, PAP testing.

and the bad
HIV IN 1979
Greater accountability led to the growth of specialization and the decline of active general practice. Freezing of rebates led to poorer services being offered and the growth of government supported after hour services and casualty attendance for emergencies. Economics dictated large clinics and a loss of the family doctor role which will be gone in the next 5 years.

The ugly
increased litigation.
Increased recording and regulatory demands without commonsense.
The privacy act.
Medicare

The funny.
Acupuncture.  BB story.
A patient was having an acupuncture session with her GP who was newly trained. He had put 15 needles in when called away to a phone call. As he was locking up at 6.00 he heard a plaintive cry from the acupuncture room Can I go home now. Well yes as soon as the needles were out and no a long visit was not charged.
Going halfway to Dookie to give a painkiller injection to a man with severe back pain immobilized on the kitchen floor. then finding he had a Benalla doctor who had refused to come out.

The dramatic
Real home doctoring
Out to pick up B boy after knocked of bike on cnr Balaclava and Wyndham St, beat the ambulance.
Attending a psychiatric emergency when police called to ask if I would talk to patient who had barricaded himself in his house with a gun. On arriving in the street the two policemen put bulletproof vests on and we edged along the house to the front door. The sergeant and I asked if we could come in  and talked him into putting down the gun.

The sad
For a GP. Some things never change ,having to give bad news on diagnosis.
For patients the loss of the family doctor. I saw a lot of second and third generation patients over that 35 years and built up rapport both ways. Some of you probably still have your family doctor who is nearly always there but this is becoming a rarity in Shepparton.

Life lessons
The patient is always right .
people who call late at night are genuinely sick.
You can never tell over the phone how bad an injury is.
Get a doctor who gives you time [hint they are always late and it hurts waiting but you will get the attention you need].

I retired after 35 years in general practice and had a medical career for 50 years. I would still be involved today if the regulations had not become so onerous and unwieldy. Something that affects most careers these days.

Lastly I would like to remind Rotarians that health is a field that can offer opportunities for us to help the community in.

Thank you all for listening

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