Whilst studying undergraduate medicine in Belfast, Northern Ireland, Dr Damian Hannon never imagined that he would one day be a rural GP halfway across the world.
However, as one looks at the rolling green hills of Moe South, Victoria, they could almost believe that Damian had never left The Emerald Isle.
“It feels like home, which is part of the reason why it is so easy to be here,” Dr Damian Hannon says.
Despite the picturesque scenery, there are major challenges to delivering healthcare in the area.
“When you try to explain to people that general practice in rural areas is different from general practice in a metropolitan area, I don’t think they truly believe that or understand you.”
“In Eastern Victoria we’re quite lucky that we still have quite large hospitals with specialists very close, but it still presents a challenge in the sense that people have longer to wait, and that you’re managing disease for longer.”
Not only do rural areas have issues attracting doctors, they also face challenges in ensuring doctors stay—if they do stay, Damian says, everyone benefits.
“People are really grateful to have a doctor there who is interested, who
cares, and who plans to be here long-term.”
“[Locals] feel like you’re not just coming and doing your time, you’re actually making an investment in the community—that is a two way thing, because then the community invests in you and makes you feel welcome.”
“Familiarity is a concept that is really important to patients. Without that, it can leave patients who are already quite vulnerable, feeling more vulnerable.”
While Damian is very grateful for the warm welcome he has received, he says more must be done to attract home-grown doctors to rural areas.
“I don’t think it’s appropriate to have overseas trained doctors be the backbone of a [rural] health service….you’re sending your most vulnerable doctors to look after your sickest people in the remote parts of Australia. It’s potentially a recipe for disaster.”
Choosing general practice
When Damian first moved to Australia, he found himself working in the Emergency Department (ED) in rural NSW.
“I found myself living in some sort of ‘Groundhog Day’ scenario where everyday was blurring into a repeat of the day prior,” Damian says.
“I felt like I was just another phase in that patient’s journey and therefore I never actually knew what happened to them…as opposed to being the person that they could start that journey with and return to with.”
While Damian spent more time in the hospital than the average GP trainee, he doesn’t have any regrets.
“In general practice you need to know a bit about everything. Whether you’ve done three months in some obscure hospital placement that you don’t imagine is ever going to be useful, you will use that skill someday.”
The moment which pushed Damian towards general practice was when he was treating a patient with Guillain–Barré syndrome in the ED.
“I remember still following up on this patient for days and days in hospital. I was looking at his X-rays and I realised, ‘I don’t like not knowing the outcome’.”
The most attractive elements of general practice is the continuity of care and the cradle to grave care, Damian says.
“The beauty of general practice is that it allows you to practise medicine in a way that you think is correct.”
“That’s something that I got really frustrated with towards the end of my hospital time, was that I wanted my own autonomy to manage patients in a way that I thought was in their best interest.”
“I’ve been amazed the longer I’ve been doing general practice at what people will tell you and what secrets they’ve held and how vulnerable they can be with you.”
“Everyone has a story and the problem is that we as doctors often don’t let them have that opportunity to tell it—or we don’t make them feel safe enough to tell it.”
Damian’s advice to those in the hospital considering becoming a GP is practical—if you’re interested in general practice, go and spend a day with a GP.
“Please don’t base what you know about general practice on what you’ve heard your colleagues say…I don ’t think I respected general practice as much until I actually started doing it.”
“Whether you’ve done three months in some obscure hospital placement that you don’t imagine is ever going to be useful, you will use that skill someday.”
Extended skills in medical education
Damian has a passion for medical education; as well as working part-time as a GP registrar he is working as a medical educator—work which is considered as Extended Skill Training and counts towards his GP training time.
“Whenever you take a student or a younger doctor under your wing and show them how to do something and then watch them flourish, you personally get a degree of satisfaction from that,” Damian says.
Mentorship and effective medical education will go a long way in building a sustainable workforce, according to Damian.
“It is becoming really clear that junior doctors are burning out, they are stressed, they are anxious and we can’t really turn a blind eye to that anymore and say, ‘You’re just not tough enough,’ or, ‘You shouldn’t do medicine’.”
“We need to change our approach to make [junior doctors] feel like they can manage.”
Burnout isn’t exclusive to doctors in the hospital—GPs are just as susceptible, according to Damian.
“General practice is really hard and I don’t think anyone can appreciate that until they’ve done a reasonable length of time in the specialty.”
“Patients present with multiple problems at the same time that all need managing, and you’ve only got 15 minutes.”
Learning to manage uncertainty goes a long way to prevent burnout, Damian says.
“If I’m going to be thinking of a patient at home that evening, worrying about them, then I’ve made a bad decision.”
“Know your limits and know what you don’t know. That can be quite a vulnerable place to put yourself, because it’s very hard to admit to someone, ‘I don’t know what’s wrong with you’. But patients really respect when you can say that.”
In the long term, Damian is considering becoming a GP supervisor.
“If you want to help shape what the future workforce is going to look like, you need to be involved.”
“There’s no point complaining that GPs now don’t have these skills or they don’t communicate properly, if you’re not actually in at the grassroots level making sure that people learn these skills.”