Power of One

Peter E Baume
MJA 2000; 173: 643-646

Life is full of opportunities, with no time to waste

Introduction

It has been the same for me. So much to do; so little time; so many interesting things; so many choices to be made; so many possibilities at every stage. It just seems impossible to get it all into one lifetime.

Some of us are lucky enough to have several quite different careers, so we learn different skills and experience different things.

Medicine, 1955 to 1980

Politics, 1971-1991

Medical practice had become very busy and demanding for me and my family. Dobie inspired me to stand for Liberal Party preselection. After an unsuccessful tilt at one seat (Berowra, NSW), I was taken in hand by Senator John Carrick (later Sir John Carrick) and then won preselection for a Senate place in NSW.

Politics was service to people in a different, more direct way. I worked for people and my office was often the point from which they had their many problems addressed.

Of course, I never ceased to be a medical practitioner in the Parliament and I continued to publish in medical journals.^1-8

Many people needed medical care while in Canberra. I developed good relations with practitioners in Canberra but still needed to do a fair bit of work myself -- always pro bono, not least because of certain arcane provisions of the Australian Constitution, but the work was certainly varied.

People used to wander in and make it clear that they wanted to see the doctor and not the politician. My excellent staff soon got used to this. If colleagues or staffers needed routine referral or wanted pills that they had forgotten, these were organised easily enough. If it was an emergency, this usually required that I speak to one of the first-rate general practitioners or specialists in Canberra -- after a while, this became a well-practised routine.

My parliamentary career lasted 17 years (see Box 2). I began on the backbench and soon chaired a Senate Standing Committee which brought in two influential reports. The first report ("Drug problems in Australia -- an intoxicated society?"⁹) placed alcohol and tobacco centre stage as drugs -- at that time a radical suggestion outside the medical profession. Prime Minister Malcolm Fraser's response was to ask a learned judge to conduct a Royal Commission, which rejected some of our findings. The second report ("Through a glass darkly: evaluation in Australian health and welfare services"¹⁰) insisted that what we achieve is probably more important than what we do (although some public servants clearly indicated to the committee that they considered their activity more important than their results).

In 1987 a personal crisis came when I was Shadow Minister for the Status of Women, when I supported a Bill seeking equal employment opportunity for women in certain statutory bodies, such as Qantas, in spite of the decision of the Liberal Party to oppose the Bill.

When the votes came, a quarter of the Liberal senators supported me (without any lobbying on my part) on the vote.

This was a momentous decision for me and my family. But it is not even a footnote to history now. What was pleasing was the mail I received afterwards, most notably a telegram from Carmel Niland, then President of the Anti-Discrimination Board of NSW and now Director-General of the NSW Department of Community Services. Her message read simply: "Thank you. Thank you. Thank you."

But the die was cast. I was finished in the Liberal Party. It is true that one is allowed to cross the floor in the Liberal Party of Australia, but my philosophical liberal principles sat poorly with the increasingly dominant radical conservatism of others. It was time again for a change of career.

Academia, 1991-2000

I was happy to be considered among the candidates for his position. After a public and proper selection process, I was appointed.

So it happened that I left the Australian Senate in 1991 to become Professor of Community Medicine at the University of New South Wales. I led a good School with some fine academics and strong programs of teaching and research. We taught to all undergraduate medical students and to graduates in public health, epidemiology, medical ethics, biostatistics, general practice, aged and extended care, general education, drug and alcohol, women's issues, and more. Along the way I was able to pursue research interests in euthanasia,^11-21 drug policy^22-24 and evaluation.²⁵ It was also possible to do some interesting consultancies and to repay society with some pro bono work.

In 1991 I wrote a book, A question of balance,²⁶ urging reform of the drug licensing system in Australia. My proposition was that a better marriage of timeliness and safety in the licensing of therapeutic drugs was required for society to get maximum benefit. These recommendations were accepted in subsequent reforms.

I performed other consultancies for the Menzies School of Health Research in Darwin,²⁷ for the NSW and Tasmanian departments of health and for the Commonwealth on disability services.^28-30 Each consultancy was commissioned to examine purposes and structure in very different settings.

Controversy surrounded my consultancy reports on veterans' compensation³¹ and on Australian surgeons for the Australian Government.³² In one case the government realised that it had a crazy system and in the other it wanted to know more about surgeons and surgical specialties. Bruce Ruxton (Victorian President of the RSL) wrote an angry letter about the Veterans' Report, and many prominent surgeons and professional bodies were outraged by my report. Over time much of the controversy has abated but few of the recommendations have been implemented.

Nineteen colleagues combined to write a book (The tasks of medicine³³) under my editorship in 1998. In it, it was possible to outline some personal beliefs and suggest some desirable directions for the future of healthcare.

After the cryptosporidium "crisis" in Sydney's water supply in 1998, the NSW government decided that someone with some knowledge of public health should be added to the Board of the Sydney Water Corporation. I accepted the position and really enjoy work on the Corporation Board. Sydney Water may get bad press, but certainly approaches issues with care and prudence. It does serve the society, trying to determine difficult issues fairly.

In 2000 I chose to leave the University of New South Wales to allow a younger person to have a turn. To give my successor a fair go, I moved to the university's Social Policy Research Centre as an honorary research associate. (See Box 3 for academic career.)

Reflections

To me, medicine was pre-eminently about helping people; going into Parliament was simply another way of helping people; and teaching was yet another way.

In all my medical teaching and writing I have tried to convey the notion that people are more important than their diseases and that the whole person is the proper focus of medical care. Medical practice required the understanding of many concepts, particularly about human structure and function, the learning of a mass of material about particular illnesses, and some fascinating learning about people and their needs. Medical practice might be even better if people realised that all paradigms are provisional and that acceptance of change is one attribute of wisdom.

Politics is quite different as regards its skills, but similar as regards the centrality of people. There is a tendency to devalue the skills of politics, but there is a set of communication and brokerage skills peculiar to that trade that must be learned by anyone wishing to do well. People who belittle politics and politicians are usually those who have no personal experience of the political life. Those who have tried politics know just how demanding and difficult it is -- particularly the need to bring others around to your own viewpoint.

It is the same in academic life. In a collegial system like a university school, one has to demonstrate leadership, rather than just give orders, if one wants people to follow. The chance to teach eager and bright young people is a privilege. To carry out this task as an agent of a wider society is a trust. To help more mature people gain extra skills is a pleasure too.

The university teaching role is something about which I continued to learn throughout all my time in academe. My sister, who taught at high school, constantly showed me how to do educational tasks better. It seems that those of us with more "technical" skills have a lot yet to learn from the educational academics, those who have the technical skills in teaching and learning.

Recently, information technology has made a huge difference in what we can offer and do. Universities like the University of Sydney which have developed a growing intranet have pointed out one new and exciting way of improving resources for students. The University of Southern Queensland, at Toowoomba, is also exploring the possibilities of using information technology more imaginatively -- and attracting positive worldwide interest in the process.

The intellectual life of a faculty of medicine is interesting too. It was the capacity to think creatively and to challenge and test existing systems of belief that I valued most highly in those doing research in the School of Community Medicine. People have only a limited time to contribute intellectually and they might as well use that time most productively. While "routine" pot-boiler surveys certainly have their proper place in research, it is thinking that forces us to re-examine or modify paradigms that carries most weight. Certainly, this is what I see at the exciting Australian National University.

We are all different and it would be churlish to think all people should value the same kind of life trajectory. But for me, the opportunities and rewards have been great, and the chances to serve, sometimes unexpected, have been ones that I have appreciated. Family support has always been important, and I can only thank my parents, wife, siblings and children for their help, counsel and understanding. It has all meant so much and has made much possible.

Now let us see what new tasks lie ahead. There is not a moment to lose.

References

1. Baume PE, Tracey M, Dawson L. Efficacy of two minor tranquilizers in relieving symptoms of functional gastrointestinal distress. Aust N Z J Med 1975; 5: 503.
2. Messer M, Baume PE. Oral papain in gluten intolerance [letter]. Lancet 1976; 2: 1022.
3. Baume PE. Medicine, men and politics throughout the ages. Aust N Z J Med 1977; 7: 229-238.
4. Baume PE, Alder S, Greig M. Study of one consulting medical practice. Aust N Z J Med 1981; 11: 255.
5. Baume PE. The Kolling Institute -- the first 50 years [editorial]. Med J Aust 1985; 143: 96.
6. Baume PE. Oration. Aust J Physiotherapy 1979; 25: 141-144.
7. Baume PE. Current medical politics and peer review. Australas Radiol 1979; 23: 4.
8. Baume PE. The great equation is wrong. Aust N Z J Psych 1980; 14: 175-178.
9. Senate Standing Committee on Social Welfare (Chair: Senator Peter Baume). Drug Problems in Australia -- an intoxicated society? Canberra: AGPS, 1977.
10. Senate Standing Committee on Social Welfare (Chair: Senator Peter Baume). Through a glass darkly: evaluation in Australian health and welfare services. Canberra: AGPS, 1979.
11. Baume PE, O'Malley E. Euthanasia: attitudes and practices of medical practitioners. Med J Aust 1995; 161: 137-144.
12. Baume PE. Voluntary euthanasia -- mercy or sin. New Doctor 1995; 63: 13-14.
13. Kuhse H, Singer P, Baume PE, et al. End-of-life decisions in Australian medical practice. Med J Aust 1997; 166: 191-196.
14. Baume PE, O'Malley E, Bauman A. Professed religious affiliation and practice of euthanasia. J Med Ethics 1995; 21: 49-55.
15. Kuhse H, Singer P, Baume P, Clark M. Medical end-of-life decisions: Australia and the Netherlands. Mature Med Can 1998; May/June: 37-38.
16. Baume P. The right to die. Hospital Healthcare 1997; December: 28-29.
17. Yuan ZF, Baume PE. Attitudes of Sydney Chinese to voluntary euthanasia. Aust N Z J Public Health 1997; 21: 106-107.
18. Kuhse H, Singer P, Baume PE, Clark M. "Muddled" commentary on end-of-life study. Aust Doctor 1997, 18 April: 23.
19. Baume PE. The euthanasia study. Quadrant 1997; September: 12.
20. Kuhse H, Singer P, Baume PE, Clark M. Medical end-of-life decisions in Australia and the Netherlands. Geriatrics Aging 1997; 167: 282-283.
21. Baume P. Voluntary euthanasia: letting people decide for themselves. Aust J Ageing 1997; 16: 8.
22. Baume P. Why drug policy reform has not happened. In Touch 1998; 15: 1-2.
23. Baume PE. Overcoming myths, hypocrisy and lies: drug law reform in Australia. New Doctor 1989; 51: 8-9.
24. Baume PE. Drug legalisation. Health System Reform -- Health Outcomes Bull 1989; 1: 4-5.
25. Baume PE. Getting the policy right: recovering the golden rules of evaluation. In Uhr J, editor. Decision making in Australian government: program evaluation. Canberra: Union, 1991: 35-38.
26. Baume PE. A question of balance -- report on the future of drug evaluation in Australia, Canberra: AGPS, 1991.
27. Baume PE. Opportunity and benefit -- report of a consultancy on relations between the Menzies School of Health Research and Aboriginal people. Darwin: Menzies School of Health Research, 1991.
28. Baume PE, Nutbeam D, NSW Health. Achieving accountability for health outcomes in the Australian health system. Sydney: Health Promotion Unit, NSW Health, 1992.
29. Baume PE, Kay K. Interim report: strategic review of the Disability Services Program. Canberra: Commonwealth Department of Human Services and Health, 1994.
30. Baume PE, Kay K. Working solution: strategic review of the Disability Services Program. Canberra: Commonwealth Department of Human Services and Health, 1995.
31. Baume PE, Bomball R, Layton R. A fair go -- report on compensation for veterans and war widows. Canberra: AGPS, 1994.
32. Baume PE. A cutting edge: Australia's surgical workforce 1994. Report of the Inquiry into supply of, and requirements for, medical specialist services in Australia. Canberra: Commonwealth Department of Human Services and Health, 1994.
33. Baume PE, editor. The tasks of medicine: an ideology of care. Sydney: Maclennan and Petty, 1998.

Author's details

Social Policy Research Centre, University of New South Wales, Sydney, NSW. Peter E Baume, AO, MD, FRACP, Honorary Research Associate, Emeritus Professor, University of New South Wales, and Chancellor, The Australian National University. Reprints will not be available from the author. Correspondence: The Honourable Professor P E Baume, 32/17 Raglan Street, Mosman, NSW 2088. p.baumeATunsw.edu.au

©MJA 2000
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