The 2023 annual edition of Nordocs Magazine was the first since Dr Andrew Binns’ retirement 12 months ago, although retirement may not be the correct word, as Andrew has been instrumental once again in starting, or perhaps more accurately restarting, a medical magazine for the North Coast.
He has also been active in medical matters, not as a primary physician, but through his work with Rekindling the Spirit and the evolution of the Nimbin Collaborative. The aim of the Collaborative is to address some of the social determinants of health in the Aboriginal and Nimbin communities.
This edition of “NorMag” is a bumper edition and has been made possible by generous sponsorship from Healthy North Coast (HNC) and the North Coast Primary Health Network (NCPHN).
As a result this edition goes not only to previous readers on the Far North and Gold Coasts but also to the Mid North Coast and the Hastings/Macleay region.
The magazine is distributed through Sonic Healthcare’s subsidiaries. Sullivan and Nicolaides Pathology is a long term supporter of the magazine and has distributed it for some years. For this edition we welcome Douglass, Hanly, Moir Pathology who will be assisting in getting the magazine out in the lower half of the NCPHN’s footprint, down to Port Macquarie and Laurieton.
Australian health policy is a heavily laden ship. It takes a lot to get it moving and to nudge it in the desired direction. It takes new governments somewhere between one and three years for new policy to be implemented. The ten year plan for primary health was released 18 months ago and had bipartisan support. From 1 October 2023 we are seeing the first steps of the government’s MyMedicare primary health care policy.
- Written by: David Guest
In 1685, English physician Thomas Sydenham was the first to describe the clinical manifestations of rheumatic fever, naming the chorea "St Vitus’ Dance”, although it now bears his name.
As a medical student in the Northern Territory, I saw patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) often. To see young Australians in their teens or twenties needing or having had heart valve surgery because of a disease of poverty and poor living conditions was sad and very confronting.
Most GPs learn about the modified Jones criteria in medical school and then are unlikely to think much about them again. This was the case for me when I came to Northern NSW in 2003. But living conditions for many, if not most, Aboriginal people living in the region put them at “high risk” for ARF and the rates of ARF in Aboriginal people here are the highest rates in NSW.
While I was aware that in our Aboriginal Medical Service (AMS) we had some people with ARF and RHD, I noticed a troubling increase in cases. We had gone from about one case every year since 2010, to four cases of ARF and three cases of RHD in 2021. I was also concerned about the standard of care these people were receiving.
- Written by: Marion Tait, GP and lead clinician, Casino clinic of the Bulgarr Ngaru Medical Aboriginal Corporation
I would like to share a few “scripts” and ideas from my last decade of working with complex mental health patients and youth. The therapeutic relationship is, itself, healing. Wise words from a mentor of mine - “don’t just do something, sit there'' - remind me of the importance of silence and space within consultations with those in distress.
Suppressing the urge to “fix” and “solve” is a hard instinct to overcome. Having always the curiosity of “what has happened to you” rather than “what is wrong with you” enables engagement. For patients with high ACE (adverse childhood experience) scores your medical consultation room is sometimes their first real-life experience of unconditional regard and respect as a fellow human being. Particularly with traumatised patients safety trumps everything else. You don’t get honesty without a feeling of safety. Without honesty your history is patchy, without a good history we lose our ability to craft a useful collaborative plan of “what needs to happen next”.
Your brain is like a 3D city. Roads like nerves intertwined and crossing each other. Messages are like cars travelling all day and night. Traffic lights in the brain are chemicals that allow the cars (messages) through junctions. If you biopsy someone’s brain with psychological distress (insert diagnosis here if you are diagnosis orientated) you will find a few differences.
- Written by: Dr Nicola Holmes
Our training of prevocational doctors is about to change with a new national framework being implemented over the next two years. Part of the focus of the new framework is to incorporate primary care terms into the training of PGY1 and PGY2 doctors, with the eventual goal to have primary care experience as an integral part of prevocational training, just as medical, surgical and ED terms currently are.
We are lucky in our Richmond/Clarence Network to have had the opportunity to get ahead of things by recently having two rural generalist terms accredited for our prevocational trainees to rotate through during their time at Lismore Base Hospital.
- Written by: Dr Rik Lane
The following is an extract from Dr Binns's upcoming book.
The times “they are a’changin’” and they always have been, so that’s nothing new. What has changed, though, is the pace of change, driven by faster communication systems and everyone’s appetite to keep up to date. There’s even a condition to describe it, FOMO, “fear of missing out”. It may not be strictly diagnosable, but there’s no doubt it is affecting our wellbeing, especially that of younger people.
With today’s smartphones everyone has the equivalent of a newspaper press or a TV and radio studio in the palm of their hands. You may call social media a blessing or a curse, but the reality is that we are all e-connected, locally as well as globally, and it took a recent major telco crash, and then another outage (by the same blighted company) to realise just how much we rely on these systems.
What really matters is this pace of change. Humans are very amenable to slow change – and to the splendid ‘slow food’ movement - but not to when it becomes overly, unnervingly rapid. The best example of this is climate change which seems to be out of control now. So, what about the rate of change of primary health care? GPs are feeling the pinch now, and our patients know it. The workforce crisis, as it is now called, is upon us.
- Written by: Andrew Binns
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