A story of change and disruption

Karen Price

1/12/2020 3:16:14 PM

In her introductory speech as RACGP President, Dr Karen Price examined the past when looking to the future of Australian general practice.

Old textbook and stethoscope
Dr Price describes the history of general practice as ‘one of change and disruption. Of struggle. Of life’.

Dr Karen Price gave the below speech upon officially assuming the role of RACGP President during the college’s Annual General Meeting on Monday 30 November.
Thank you to my team, my family, the Victorian Faculty and Ayman Shenouda.
I am the 63rd President of the RACGP, but only the fifth woman to hold this noble and challenging office. Women have been ready for leadership; the question, as always, is leadership ready for women?
I hope to see more diversity as we free up our world whilst acknowledging any change is uncomfortable.
This talk is about struggle and disruption.
The ancient Greeks, in the frieze at the Parthenon, depicted struggle, where animals, humans and gods wrestled in a procession that overlooked the ancient city.
The struggle was called ‘life’ by the antiquities scholars at the Acropolis museum
In preparing for this brief talk I pondered many articles on the history of the ancient craft of medicine, but will narrow the focus to a brief history of general practice in Australia.
Some of the key dates:

  • 1958 – the establishment of the Australian College of General Practitioners
  • 1968 the RACGP introduced the first general practice exams, only recognised by the Government as an endpoint for training in 1987 
  • 1989 – vocational registration was introduced
  • 1996–2002 – recognition of general practice as a specialty
  • 1997 the Australian College of Rural and Remote Medicine (ACRRM) was established
  • 1998 – practice accreditation
  • 1998–2002 – rapid corporatisation of general practice
And so on.
The history is one of change and disruption.
Of struggle.
Of life.
I note too that Emeritus Professor John Murtagh, whose honorary room we stand above in this building [in East Melbourne], was also considered a pivotal change agent from his era. We have had many chuckles over this.
Another professor, Max Kamien, an iconoclastic figure and now an Emeritus Professor of general practice, reviewed academic general practice in medical schools and concluded that one of the major reasons for lack of progress in general practice research was a widespread conviction that general practice was an applied science rather than an academic discipline.  
The struggle goes on.
Yet, according to Aristotle, practical wisdom – or phronesis – is the highest intellectual virtue, so said when he described knowledge as consisting of techne, episteme and phronesis.
The wonderful Dr Tim Senior and I shared some reflections about ‘phronesis’ and Roger Neighbour, a British GP icon, on social media only last week.
I note that social media is progress. Dialogue was a significant part of the scientific enlightenment. The coffee houses were called the ‘penny universities’. We must remember, though, that with the dialogues comes struggle and the stress of communication, and the stress of subsequent adaption of position.
It can be challenging to change your position on ideas.
In 2019, I was fortunate to visit the Greek Peloponnese and Epidavros, an ancient site of healing in the tradition of Asclepius. The exhibition consisted of ancient surgical instruments and herbal medicines, but also of improved nutrition, of rest, of intellectual and cultural recovery, with the arts prominent a feature of healing.
It was a ‘sort of’ ancient rehabilitation hospital which, in today’s terms, would likely be only available to the very well off. The point is holistic generalist care is part of an ancient recognition of generalism, rather than the poorer categorisation of healthcare by disease. Holistic patient-centred care.
Generalism is reflected in the modern definition of health by the WHO as, ‘A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity’.
Susan Sontag was a great modern intellectual who argued against the stigma of HIV in the 1980s. She railed against the separation of wellness from disease. It’s a false separation. We know this as GPs.
The reduction of humanity to disease boxes is not healthcare.
Social prescribing is important but should not be a substitute for good public health and policy planning.

Past RACGP Acting President Associate Professor Ayman Shenouda has passed the role to Dr Price. (Image: Ayman Shenouda)

But, now, let’s leave history behind and get to the present.
So now we have yet another crucible struggle where Mother Nature has exerted her forces and our industrialised models of legislative barriers to generalist healthcare were more recently exposed.
General practice is woefully and appallingly underfunded to do the job we were trained by the community to do. The neglect of Medicare is a nonsense and remains the number one concern of the Health in the Nation report.  
Bushfires, climate health, and pandemics were Mother Nature’s calling cards for the year 2020.
Dr Penny Burns, Dr Mukesh Haikerwal and Professor Michael Kidd discussed the role of the generalist in healthcare and disaster management in the opening plenary.
Integrating the health system must be a priority and general practice does not need more evidence – it needs political will to recognise the power of the generalist.
Denmark did it and managed to close down many – not all – expensive tertiary hospitals by reinvesting in primary care. This was courageous policy.
But Mother Nature hasn’t finished with us yet, as we will now begin to see a reckoning with delayed diagnoses, with mental health and chronic disease priorities, long COVID syndrome and a major vaccination program with a new vaccine.
This, combined with a potential economic fallout, a major technological adaption to telehealth and the exposing of the federal–state funding dysfunction that exists as a major barrier to enabling Australia’s healthcare system, must be the key focus of the GP in 2021.
This change is ‘the constant’ and the struggle is real, as GPs rightfully defend the health of the nation. Our patients are our purpose.
Our focus will always be – as the RACGP and as a community of GPs – to deliver the highest standards of education, training, and accreditation of GPs to facilitate one of the best healthcare systems in the world.  
My focus for this presidency will be on the value the RACGP can bring to you as a valued and esteemed colleague delivering healthcare in a tough and struggling world.

I see you and I will continue to listen to you all – remote, rural, regional and urban GPs. It is an era of activism for all the right reasons and we must engage with it.

I can give you hope. I have committed to working collaboratively with the AMA, with ACRRM, GPSA, GPRA, and all who swim with us for the good of general practice.

My candidacy statement was all about a focus on the membership of this great profession, a focus on our ability to do the job we were trained to do.

For our patients. To enable that crucible of longitudinal care.
Not task-driven, not cross-sectional outcomes, but long-term outcomes that only a generalist achieves.
I don’t have to remind you of the work of Starfield in 2005, or of The Paradox of Primary Care by Stange, or by the WHO in reiterating the academic, intellectual, political, and ethical imperative for governments to do the brave courageous and needful.
There must be innovative contextually based funding models that allow us to independently practise. Not to leave contractors behind and not to burden practice owners. To reduce bureaucracy and the risks of techno-crazy outcomes that are templated barriers to high-performing clinicians.

Quality improvement, continuous learning, and profession-led standards will deliver a vital and wonderful career path for our doctors in training.
Our strategic plan for 2020–22 … includes a vision to deliver exceptional membership experiences, member advocacy, an educational framework for vocational learning, and to strengthen the RACGP as your organisation.
To do this we need to acknowledge the past, we need to critically appraise the present, and we need to deliver a meaningful future. We do this as a whole profession, standing together, our ancient tradition of holistic patient-centred care so under threat by commercial forces.

I will be forming a Presidential Taskforce to deliver my candidate’s priorities, and I know in two years this will be a struggle but I will lay the groundwork in partnership for many.

This job is not about any one single person. It is about all of us, the messy morass of many contexts and many different styles of general practice focused through the excellence and sacredness of a patient-centred therapeutic alliance.
This is our purpose. It has always been our purpose. It has always been our struggle as we wrestle against the politics, the powers and forces of material society the forces of Mother Nature and the imperfect humanity we are.
We are healers and our patients need us.

As it has always been and is now. Let us all take our turn in the glorious moments of rebuilding our communities, our college, ourselves as fully alive and authentic individuals participating in the struggles of a noble profession.

Leadership is never done alone and I dedicate myself to you for this time. Come along with me and stand alongside me as I lead and push forward for the necessary changes we all know we need.

President RACGP speech

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