Defining Moments In Medicine

MJA 2000; 174: 9

Pharmaceutical Benefits Scheme: In the past 50 years effective drug treatment (antibiotics, oral diuretics, anxiolytics, antidepressants, antihypertensives and particularly the Pill) were all made affordable through the Commonwealth Government's Pharmaceutical Benefits Scheme.

Aboriginal health services: The first Aboriginal Medical Service was established in Redfern, Sydney, in 1971. This showed the benefits of healthcare for the people, by the people, and was the precursor of nearly 100 Aboriginal-controlled health services throughout Australia.

Academic departments of general practice: The establishment in 1974 of the first university department of general practice recognised general practice as an academic discipline in its own right, with a defined body of knowledge and a method of practice, and an overdue need for a research base and a place in undergraduate teaching.

Family Medicine Programme: The RACGP's Family Medicine Programme, set up in 1974, recognised that general practice was more than an amalgam of bits of internal medicine, paediatrics, obstetrics and surgery, and that it required a rigorous vocational training to fit the undifferentiated medical graduate for independent practice.

Medibank: In 1975, Medibank introduced the concept of equity of access to a general practitioner. In country areas it changed the status of Aboriginal and poorer patients from mendicants to discerning healthcare consumers.

GP shortages in rural Australia: As a result of ministerial reports from Western Australia and South Australia and the political activity of the newly formed New South Wales and Queensland branches of the Rural Doctors' Association of Australia, a firm commitment was made in 1987 to increase the number of GPs in rural and remote Australia.

Vocational recognition of GPs. In 1989, GPs obtained vocational recognition, defining them as belonging to a distinct discipline rather than as doctors who were not specialists.

Divisions of General Practice: Set up in 1992 and supported by the Federal Government, the Divisions encourage GPs to work together and with other health professionals to improve healthcare at the local community level. They also provide GPs with a collective local identity.

General practice textbook: The first Australian textbook on general practice, written by Professor John Murtagh and published in 1994, is now found in the consulting rooms of most Australian GPs. Its unique strength lies in the way it describes a method of diagnostic thinking, as well as conveying knowledge and practical information.

Feminisation of general practice: By 1996, half of all GPs under 35 years were women. This may result in longer, more holistic consultations, but may also affect the availability of doctors after hours and in rural areas.

National General Practice Computing Group: Formed in 1998, this group aims to improve the process and quality of general practice care by encouraging GPs to make more and better use of computers.

Ageing of the population: Longer life expectancies and the "greying" of the "baby boomers" have resulted in an increased prevalence of older patients with chronic medical conditions. This requires a change in the training of doctors and in the care they provide.

Change in practice organisation: There has been an increase in group practices, with a shift to small-business principles and, through corporatisation, large-business methods. Shareholders now have the potential to impinge on the sanctity of the doctor-patient relationship.

Great changes in general practice: From 1970 onwards, a protracted period of enormous change in general practice occurred, with gradual understanding of the huge task that general practice entails, and of the knowledge, skills and technology needed to accomplish it.

Max Kamien
Professor, and Head
Department of General Practice
University of Western Australia, Perth, WA
mkamienATcyllene.uwa.edu.au

©MJA 2001
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