Drawing by Jeni Binns

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.

Who cares? 

Pretty much everyone, not least those who need to access primary health care, which, it is safe to say, is every Australian at least once a year, and in many cases, much more than that. They feel deeply let down, and understandably so, if they can’t get in to see their own GP, or at least practice, or any other for that matter, when needed. Who do they get angry with? While it may be initially, and unfortunately, be our receptionists, they do come to realise that it’s not them or the doctors who are to blame, but something amorphous, like “the system” or “the government”. And who could disagree? 

Just as frustrated, at the ‘supply end’, are the hospital administrators who are complaining that the number of presentations to their accident and emergency departments is overwhelming their system, knowing that many of these patients could and should be managed by GPs, often with better outcomes. Studies suggest that up to 40 per cent of ED presentations were more suited to GP management.

So how could this be addressed by the government, whether state or federal. More money for primary carers would help but there are other factors too. The GP profession and the many health professionals they work closely with need training and promotion to accommodate the higher numbers entering the system.

Teaching is vitally important, and it is well proven that those trained in rural areas are more likely to choose rural or remote practices to further their careers. With fewer in the system the pressures on those remaining at the coalface of general practice run the serious risk of their burning out. No chance of a “doctor, heal thyself” here.

The solution is a better work life balance, and this means GPs and other allied health professionals taking a good, strong dose of lifestyle medicine for themselves, along with recommending it to their patients. I’m sure I don’t need to preach the benefits of eating less and more healthily, going easy on the grog, taking as much exercise as the body can bear, and getting a good night’s sleep. 

There is a noticeable and accelerating trend of there being more, not less, part-time primary care practitioners doing longer hours and burning out. This seems fatal, often quite literally, the solution is not to work harder but to have a healthy lifestyle, use current efficiencies where possible and to encourage more entry into these professions.

As I have said in previous chapters, when I came to the region in 1979, if anything there was a surplus of GPs… now there is a critical shortage. The times are certainly a’changin’. 

Governments know the problem but are slow to take corrective action. There is no overnight fix for this problem. It is challenging and expensive to deal with, and proper liaison is required with the appropriate colleges.

So, what can individual practitioners do to assist and advise governments? My hit-list is to first address one’s own physical and mental health. To become involved with our communities, whether through sport, arts activities or any other activity that involves voluntary commitment which will help prevent the feeling of isolation and being disconnected, to foster a sense of belonging with the community one works and lives in.

Travel a lot and if there are opportunities to work with disadvantaged people then take up this chance though electives that are run through Australian universities in developing countries. In Australia, there are many disadvantaged people, including our own Indigenous communities, and working within Aboriginal health services may be an option.

What matters with our own mental health is our spirit and there is no better way to nurture our spirit than to help the less privileged people in our own community or in another country. Such work helps to give meaning to one’s life. Even in retirement from clinical work, life experiences gained in general practice allows one to pick up skills that could benefit others.

And there is still time for golf, bowling, cycling, travel, grandparenting or other leisure activities. Time takes on a different meaning in retirement. But boredom is an enemy to be avoided.

One of my retirement activities is with the Nimbin community as I have written about here.