A small, 70 kilometre stretch of water between Palm Island and Townsville represents a huge gap in healthcare outcomes for the Island’s 2,500 residents—many of whom are Indigenous Australians.
It was this oceanic gap which drew Dr Shaun Hosein to the locality of islands—collectively known as Palm Island—to do something different during his GP training.
“One of the things I wanted to learn to do was to work in a remote community with no resources…and I wanted to get experience in working with First Nation peoples,” Shaun says.
The challenges of working in such a setting, Shaun explains, are numerous as there are still large gaps in healthcare outcomes between Indigenous Australians and non-Indigenous Australians.
“It wasn’t until I had worked on the Island for about three to four months did I realise that [cultural awareness] is actually a skill; you can’t just go to a seminar or on a road trip, you have to learn and understand the people you are with by being
“As with starting in any new community, you have to gain people’s trust by being the GP you’re trained to be—open, giving holistic care, showing compassion, not having a judgemental attitude. This is true whether it is an Indigenous community, a mining community or any other community.”
While working in a low-resourced community in isolation, personal challenges, such as burnout, can be felt more deeply.
“I started strategically using evenings on leave instead of taking a big three week holiday…we were fortunate that Palm Island is only a 20 minute flight to Townsville.”
Despite the challenges, Shaun believes training in a remote community, even for a small portion of GP training, is beneficial to any GP trainee.
“While it is very exciting to get [remote GP training] experience, make sure you know what you’re getting into. Plan to be there for six to 12 months, and then re-evaluate what you want to do.”
“Good clinical communication takes time. It is a narrative, not just a one-off conversation.”
Shaun recommends that those considering a remote placement first have a “good base” in their training to draw upon—extra skills in areas such as emergency medicine, obstetrics and gynaecology, and paediatrics are especially valuable in remote areas such as Palm Island.
“We only had x-ray—we didn’t have any CT scanners. You learn to rely on your clinical skills and judgements more so than using scanning.”
“I just don’t think anyone wants to think about death”
Leaving Palm Island behind, Shaun now works with the Geriatrics Team of Sunshine Coast University Hospital and Health Service.
With the Australian population ageing, Shaun says that now is a great time to acquire additional skills in geriatric care.
“Many people see geriatrics as delirium care—the people that they say are ‘just not there anymore’—but I see it as working with families and making reasonable decisions with patients and their families,” Shaun says.
“[In medicine] people want to talk about the fancy, exciting things. Geriatrics is a very important basic medicine that we should be providing to people…but I just don’t think anyone wants to think about death.”
According to Shaun, working in geriatric care means having a lot of difficult conversations.
“A lot of the time with delirium and dementia patients, families feel very guilty because they haven’t seen [their loved ones] for many years. Often, the families are the ones which push for things like resuscitation—which may be against the patient’s wishes.”
According to Shaun, death is often the “elephant in the room.”
“An older patient may come in with a sore knee and I can’t just spring in and say, ‘great, but let’s talk about your resuscitation wishes’.”
Shuan laughs and adds seriously, “difficult conversations are an art…an ongoing conversation and a relationship with the patient versus, unfortunately, in the hospital system, where it tends to be about the paperwork.”
“Good clinical communication takes time. It is a narrative, not just a one-off conversation, and it is about relationship building.”
Deprescribing—the planned and supervised process of dose reduction or stopping of medication that might be harmful or no longer beneficial—is Shaun’s passion.
“I see deprescribing as an optimisation of patient care…if you’re reviewing an older patient, often you’ll see a lot of medications that they are on, but there is no reason for them to be on it…but a doctor can be too afraid to deprescribe.”
Shaun’s sub-interest in geriatrics is Aboriginal geriatric care.
As the gap between the life expectancy of Indigenous Australians and non-indigenous Australians slowly closes, Shaun says GPs can expect to see more geriatric care required for Indigenous Australians.
However, much work is still needed to ‘Close the Gap’ on Palm Island—when a local resident turns 60 years old it is a big moment because it isn’t seen very often.
There is yet to be a nursing home built on Palm Island.
“As a GP you deal with anything and everything that walks through the door, and you have zero minutes of notice.”
“You get to know your patients and they know you”
“As a GP,” Shaun says, “you deal with anything and everything that walks through the door, and you have zero minutes of notice.”
“Patients will come in and could have anything from chest pains to some weird cancer, to nothing wrong with them at all, to wanting to talk about an acute psychological condition.”
The variety of presentations, along with the continuity of care, is what drew Shaun to general practice.
“You get to know your patients and they know you. It’s nice, because after you see someone at least two or three times, you can get things sorted out faster, and it’s a lot more holistic care because you’re able to know how their medical issues interact with their life.”
“That’s probably the thing people don’t really get some times—people have medical issues and there’s things going on in their lives that have influenced that. It is a lot more holistic care when we look at the psychosocial aspects.”
With numerous passions to fit into his life, including DJing and surfing, Shuan likes that he has more flexibility in his career.
“Out of all the specialties, general practice is probably the one that most facilitates a good work-life balance…you can fit in lots of things that you are interested in.”