General practice in the city / the suburbs / the country

The newly qualified man may be contemplating starting as a general practitioner in the City of Sydney and after thirty-two years' experience in [the city], I may be able to give some advice as to his taking such a step...

My advice to any young graduate thinking of general practice in the city is that of Punch to those about to take a step in another serious direction — "Don't!"

If he still persists, he must try to get some friendly society lodge work and even if successful in that he must be prepared for a long waiting period. I would say to any young medical practitioner, do your resident hospital appointments, then see something of the outside world, get into general practice in the suburbs or country...

A Maitland Gledden, Sydney, NSW

...A few years' practice in the country is an excellent preliminary to suburban work. The experience gained by the practitioner...stands him in good stead when he settles down in the suburbs...

In choosing a suitable locality the medical man should try to find one of the newer suburbs which is not too thickly populated, where there is plenty of spare ground and where buildings are constantly going up. In this type of suburb population will grow rapidly and the doctor's practice will grow with it. If he chooses one of the older suburbs, where nearly every foot of ground is built on and consequently where there is little room for increase of population, the growth of his practice will depend on the number of patients he can get away from his colleagues. This is often a long job and usually an unpleasant one. The question is often asked: "How long should a squatter be prepared to last?" The answer...Personally, I think if the squatter has not made good in three years, it would be advisable for him to "seek fresh fields and pastures new"...

The suburban practitioner has the great advantage over the country one of having specialists always available to come to his assistance either privately or at hospital...Even if the specialist is not able to do much in the way of a cure, the attendant's position is much strengthened by the specialist's opinion and advice...I would urge the suburban practitioner in cases when a pathological examination has to be made, to try to educate his patient to go to a private practitioner. Far too many patients are sent to the Board of Health or the public hospital. It will often surprise the practitioner to find how many of his lodge patients can afford one or two guineas for a special pathological report...

C H E Lawes, Petersham, NSW

...There are two types of country practitioners, those who belong to the community and become part and parcel of it; the other especially the younger men who commence because it is cheaper and there is less opposition and they can learn their work and perhaps earn enough money to commence in a bigger centre...

The first thing we have to decide is whether we will serve God or Mammon...

If we serve God, we shall serve the community faithfully. Our work will go on and on improving and our reputation with it.

If we serve Mammon, life will be more or less easy. We may make money and become the popular doctor...We shall become past masters in the art of saying and doing the right thing. We shall know exactly what the patients themselves want to do and shall advise them to do it...

The universal use of cars, good roads and the telephone have quite altered the country doctor's life. Trips which took you all day, you do now in a few hours. Patients come in much more often to see you, so that travelling is much less...Life is much easier, yet it has lost much of its charm. One misses a good pair of horses or a hack for which you have more than a kindly feeling, especially on moonlight nights, in big timber and places where the fairies dwell...

...You have to be doctor, nurse and everything that entails. The great difficulty is to teach people that orders are orders. Orders should be given in plain words and they should be quite simple ones and if the case is urgent, they should always be written down...

The question of fees is a difficult one. The main duty of us country practitioners is to serve the community. In most country districts our patients are chiefly strugglers or fighting an uphill game...It is just that we receive reward for our labour, yet it is impossible to charge for labour done. You alter a patient's whole outlook, alter the whole course of his life and perhaps charge half a guinea, you operate and save him from certain death and only charge a small fee, which is all out of proportion...

...We receive little honour as men call honour; we can earn an income, we can never get riches; we can understand and live to the meaning of Kipling's lines:

Horace Pern, Leongatha, VIC

Med J Aust 1929; 2: 276-282