Brad has had an extensive career as a GP supervisor and work within Aboriginal and Torres Strait Islander health and veterans’s health in particular. He is a proud Kamilaroi man who has also served in the Navy, and is passionate about developing more First Nations GPs, and he has played a vital role in mentoring new First Nations GPs. In 2022, he received an OAM and is running for the presidency of the RACGP.
It’s really lovely to give people coming from the hospital system and overseas an introduction to what Medicare is all about and to show them what you can do for different subsets of the population, like Aboriginal and Torres Strait Islander patients and Veterans that that we specialise in, as well as other groups. Helping them to know what’s available for your community. Also, to show them some of the challenges in General Practice about dealing with the hospital system, and registrars bring some of their skills and contacts within the public system to help bridge some of those gaps. For me it’s acknowledging that it’s a two-way street. It keeps us as GPs and GP supervisors on our toes, because when you engage in training you keep your own skills up, which flows on to the other staff who buy into the team-based approach around training. It’s really important that people going through their training understand the challenges of people answering the phone and people who are demanding and need help straight away. I have been involved as a supervisor for over 20 years, including work with ACRRM working with registrars who were most in difficulty, which was a great learning pathway for myself. I’ve really taken a lot from this journey and if you give people wonderful experiences, down the track you hear of them in other places in training programs, rural and remote medicine and some returning to my practices which is really great. If you can inspire people to consider general practice, or just as importantly to have a really good appreciation of general practice, so that if they happen to be the emergency position in Brisbane, who takes your call it two o’clock in the morning when you’re in crisis in a rural center, that’s gold. I think to be involved in that process is really exciting.
From my point of view culturally, I mean from an indigenous point of view, you think you’re culturally aware and from a veteran and first nations point of view, I I’d like to think I am, but we all have better and worse days. Certainly, dealing with a lot of our overseas trained graduates, you get a huge appreciation of a whole range of communication strategies and cultural perspectives that come into play about how they communicate with patients. If nothing else, because of the multicultural perspective of the training that I’ve been involved in over the last 20 years, I’ve certainly got a huge appreciation of the various socioeconomic and cultural perspectives that come into play. One of the things that I’m really proud about in what we do with first nations health is that if you do first nations health really well, you can’t turn those skills off. So, when you’re dealing with mainstream populations, then everyone benefits from it. I think it’s very much the same if you have a multicultural perspective. If I was to say one thing, it would be communication strategies, picking up on body language of patients. It’s not just about Aboriginal people that don’t make eye contact. Lots of people don’t make eye contact, and it can often mean different things, but it’s about picking up on awkwardness or people not wanting to be disrespectful by asking. Being comfortable enough to ask them and make sure that the message is getting across. You can think you’ve nailed it and you haven’t even touched the mark. So I think that that would be the really big lesson for me.
Mostly if there’s difficult registrar or difficult student. The good ones are easy; not easy as in, you don’t need to do anything, but because they’re passionate, they’re enthusiastic, they’re engaging. You don’t have to go looking for them. The ones that are having challenges, they’re the ones that are hiding in a busy day. It can be difficult to know that there’s a problem. Because when you’re supervising people and it’s not exactly one on one, they can be having problems behind closed doors. You are very much relying upon communication from the patient to let you know that there’s a problem. It’s being astute enough to monitor it sufficiently, to give people respect and allow them to learn, but at the same time, not letting things get out of control. I think that’s a real skill to know. The intern that I’ve got at the moment has been extraordinary from day one, amazing. She’s been doing surgery, and is a really valuable part of the team. And while they’re not here permanently, she has behaved as if she is. Because of that, it’s allowed us more time to spend together to actually do learning. Whereas a previous student was very quiet and very knowledgeable, but you wouldn’t know it. It was a real challenge because in the 12 weeks that they were here, I don’t think I truly connected with them. We tried multiple strategies as a team and talked to external parties and supervisors that they’d had in other placements to try and work through what the issues were. By the end of that 12 weeks, I felt really drained. To this day, I don’t feel that I necessarily was able to get the best out of the opportunity for them. I think that’s the real challenge for me, where it’s difficult and not straight forward to make sure you are using a learning process that gives them the best opportunity. There are really valuable opportunities in recognizing problems and exploring the difficult nature of how you actually deal with that, and not being too proud to ask for help.
It’s trying to recognise where the shortfall is. Is it a cultural perspective? Is it an interpersonal communication thing? I mean, people with similar cultures still have trouble communicating. The other thing is identifying any skills deficit that happens to be there, which is a problem in general practice. Their skillset is huge compared to our colleagues that can be specialists in a narrow field. You’ve got to, have some degree of trust in your trainee that they’re hit the mark, and I think that extends to supervisors as well. You need to have some appreciation of what’s happening behind closed doors to make sure that everyone’s safe and that good patient care outcomes are being achieved, and a learning opportunity is achieved as well. I think that can be really difficult to do. It means the whole team being onto it. I don’t think it’s the responsibility of the supervisor. I think it’s the whole team, because I’m relying upon the feedback from nursing staff and reception staff to say, “Hey, there’s a problem here.” It’s a bit like dealing with mothers when they bring their children in. We may not agree on what the problem is, but a worried mother is always right. You know, they know their children. So you have to explore that. If the reception staff say to me, there’s a problem with a registrar, then there’s a problem, even though we may not agree on what the problem is, something needs to be addressed. It’s a really complex arrangement and you add that to your day. It’s important to try and allocate some training time, but sometimes the training doesn’t fit neatly into a 15-minute slot, it’s training on the run. Opportunities to debrief and get to know people are also important. We’ve got quite a social, aspect to how we operate the practice here, which gives us time to engage with families and stuff as well, which hopefully allows people to feel more comfortable and have a different sort of engagement, but you know, it doesn’t always work. It’s a great model that’s worked for us, but it hasn’t worked all the time.
When she was health minister some years ago, Kay Patterson said that she thought it was inappropriate that first nations doctors qualify and don’t go back to their communities. But there are complexities of practicing in your own community. Like telling one of your Aboriginal elders, that they can’t have something like narcotics, or other stuff even and the need to show respect. So sometimes it’s better to go to another community down the road in another place where you can still be from a first nation’s background, but not have those community connections at the same level. But the other thing is, why does a first nations doctor not have the entitlement of a career progression equal to their colleagues? If you happen to be a neurosurgeon in New York, what an amazing message that sends back to your community about the opportunities that lay ahead for you, if you want to commit yourself.
So I think that, there is a level of ignorance, and sometimes amongst ourselves, and you’ve gotta have a lot of insight into this. The journey begins very early, it’s basically at childbirth. It’s about giving people a really good health experience. So giving a young mother a really good positive experience so that she has a healthy baby that gets born with every opportunity in a lifetime. That the baby then gets good schooling and opportunities and mentors and Australian indigenous doctors. AIDA do a lot of stuff when they have board meetings in a community, and they’ll actually engage with the community while they’re there, obviously with the aim of growing doctors, but actually it’s about inspiring the kids at school to finish school and do whatever they want. If they happen to go into the health field, that’s awesome. But it’s really about giving the opportunity to actually finish school. I think those sorts of things are really important. When people are going through the health training, it’s about allowing them to be a student. I know that when I went through, I was token a blackfella in my tutorial group. So anything that came through that had a first nations flavour to it, I became the expert. But I was paying my money. I was there as a student to learn. It assumes that I’ve got all the answers and I don’t. It is also ignorant to the fact that some of these things are talking about my family and can be very painful. When you’re talking about some of these journeys through diabetes and amputations, you know that could be my grandmother. There’s a level of ignorance about that journey that is done by people absolutely meaning well, but we get better at this as we go on. James Cook was really good at it, but nonetheless, I found myself in that scenario. A lot of first nations people often don’t necessarily get the straightforward road through. So they don’t necessarily finish high school and go into medicine. They’ll, they’ll often be an Aboriginal Health Worker, do nursing and then go into medicine.
I still remember one of my colleagues that I visited when I, went over to Broome and we went out to this remote community that he’d worked in as a nurse. Then he’d finished his medical school and he was on the AIDA board. As we drove into the community and the houses started to populate around you, you could hear these voices saying Aaron! Aaron! and the joy of the town about Aaron coming back. I just think that they’re the memories that will always hold true to me. A really good doctor going back into some communities doesn’t always inspire that sort of response. And the trick is how do you? Why can’t you? Some doctors absolutely do. If I was to say, well, what, what’s the journey look like? It’s about making sure that a baby is born healthy, free of foetal alcohol syndrome and those sorts of things, but given the best possible start to life into a family that appreciate healthcare as an opportunity that’s extended to them. Good schooling, good outcomes.
Central Queensland university are running a program with the University of Queensland called the regional pathway to medicine. It’s a three year biomedical science degree, and three first nations people started two weeks ago. The first nations people on the course are guaranteed if they pass to transition from the end of their course straight into the University of Queensland medicine degree. I’m their mentor for that seven year journey, plus we’ll have a lifetime journey of hopefully becoming friendly as I help support them in their career. If they happen to end up as a neurosurgeon in New York, I’ll have a pretty amazing phone friend. It’s about networks, absolutely. About mentoring and networks. That’s the complex nature of it, and if we do that across the spectrum, you don’t turn those opportunities off for anyone. We take that as a bit of a fundamental right in mainstream health.
Yes, on a couple levels because I haven’t had that typical pathway into medicine. I left school in year 10 because someone said to me, it’s not all that important anymore, but I became an associate professor at Australia’s private university. I’m now a professor with a year 10 education, without a master’s degree. It’s pretty much about being in the right place at the right time when people like Bond needed desperately to have some curriculum development in that area, otherwise they wouldn’t get their registration. It’s about opportunities, but hard fought ones. I mean, no-one’s given it to me on a silver platter, I think it’s certainly the road less travelled. Professor Peter O’Mara would tell you a similar story, starting out he also left school in year 10 and became a mechanic in the mining industry and ultimately he’s now the professor of medicine at the University of Newcastle.
When I started, there were 30 Aboriginal doctors and 70 medical students, and now there’s several hundred, but the disproportion is still quite large and there’s an expectation for you to go onto committees. Everyone wants the token blackfella, and it often happens in general practice. But a lot of the committees that I’m on with say Queensland health, the Queensland health people are all remunerated, but the expectation is I’ll do it for nothing. I’m happy to do it for nothing because that’s about advancing the healthcare of my mob, but my wife is not indigenous and she is entitled to superannuation and the rewards for a life’s hard work. So every time I go and do that, that actually affects other people’s bottom lines as well. I think the expectation that we’ll keep giving for no remuneration is wrong, when everyone else around is being remunerated. No-one wants to talk about the money and it’s not about the money for me, but I’ve still got to pay to keep the business structure running here.
One of the wonderful things in our practice is that the place is full of Aboriginal artwork. I can tell you the stories behind the artists and, how it came to be here, much of it is to do with, sometimes local guys selling it out of their boot, because they were desperate for money. Others it’s because I sat in the central Australian desert with the artist and watched them paint and talked to them and shared their story. But my mainstream patients that come here know that they’ve got an Aboriginal doctor, that they’re being treated by a black fella, but they know that there’s a cultural respect that happens here that I’ve had to work hard to get and they have that trust in me. So it’s not second rate medicine, they’re coming here because it’s top notch, or I certainly think so.
Because you have an opportunity to be involved in a lot of the committees and processes, you also bring that back to the coal face. A lot of the problems that we might have in general practice today around the medical provider number or the pharmacy trial that’s in the newspapers, the fact that you have firsthand knowledge and participation around some of those issues is really valuable. I’m conscious too that sometimes when you go off and advocate for people in the profession that I’m off advocating and often not being remunerated so that I can actually help the bottom line of the guy down the road, who’s still churning through the patients making a profit. I don’t care less about that, but the concept’s not lost on me. One of the things that I love most about medicine is doing that medico political stuff, which is obviously why I put my hand up to run for the presidency of the RACGP college. Certainly to be Australia’s first ever indigenous president of any medical college would be a great message to send back to the community, to say you can achieve this. So I think there’s a level of pride and you learn to be humble. But at the same time, you still have to put yourself forward in order to get where you want to go. I think that reflects upon your role as a GP, the way that you practice medicine and the way that you supervise and teach as well.
I think it’s about being appreciative. It’s about taking every patient that walks through your door on face value and not expecting or pigeonholing them and if you do that for every patient, you’ll always be on a winner. I think that, you know, everyone’s an individual treating them as such, treating them as a whole person. And I think that’s the thing about the pharmacy trial is that it’s really difficult to piecemeal this. It’s all well and good to give them their Diaformin for their diabetes, but are you addressing the smoking issues, the obesity issues, the complexities in the home, all of those, key issues around, home hygiene and overcrowding and all those sorts of things that are drummed into us day in, day out as we go through our training. So I think those things are really important and so that when someone comes to see you, there’s an opportunity to upsell. But for us, it’s about looking at the bigger picture, not about necessarily selling them probiotics with their antibiotics. So, you know, I think for me, that’s it, it’s about the patient relationship. It’s about understanding people’s individual journeys, because not every first nations person has had the same journey socially or financially and all those sorts of things. It’s about seeing people on an individual level, treating them as such and going on a journey with them.
For me Aboriginal health is about a journey of complexity of care, treating people who are healthy and try and keep them that way. I try and avoid the emergency management in that I don’t want to just do coughs, colds and saw holes. You have a relationship with a patient who comes in occasionally for immediacy type issues, but in the main it’s about coming to see you to tell you that they’re well and to do their bloods and talk about all those things that keep them healthy. That to me is the model that I use for all my practice. All of my patients sign up for that. Even down the track, when they say, “oh, no, we don’t want to come in, there’s nothing wrong with us,” I say “Well, that’s what you signed up for. Maybe you need to consider another practice.” It’s just one model, but that’s fed by that first nations thing. It’s about taking people on a journey of healthcare and keeping them healthy and doing the other stuff that punctuates along the way, rather than making that your mainstream contact.
I think from my perspective, because I did six years in the Navy starting as a 15 year old, I have a shared experience with veterans. Our experiences are very unique, but we’ve all done our junior level training, the NBCD training where we go through the gas chamber and they whip the mask off at the end, and you cough and spew as you come out. So when veterans come to see me, we start on a level of shared experience and I think that’s really amazing. Not everyone necessarily gets that. We’ve got five doctors here. Two of us are Navy. I think the thing is understanding the veteran journey and you don’t have to have lived it. It’s interesting because most of the time the causes of problems are not what you think. A lot of these guys have taken people’s lives, and while no-one tells me they loved that experience, problem causes are most often around management decisions or Intel that they gave that wasn’t followed. So therefore, troops went a different way and they were involved in a bridge that was blown up and lives lost, or they had to pull out of a community early and the insurgents came in and raped and pillaged the community and other things that are outside their control. It’s actually quite interesting to talk to these guys about what their triggers are. Everyone’s experience is their own, and you go on a journey with them and you allow them time to tell their story. It took 27 years to get one fellow to actually open up to me, and all I asked is what his triggers and when do I need to keep you on my radar during the year? When are the anniversary dates so that I can just make sure I’ve got my eye on you. He then opened up and told me the lot, which wasn’t my question. I said to him, it’s not important, I know what the issues are, I just need to know when I need to keep an eye on you. Over that period of time, you get to develop that relationship.
The other thing for veterans affairs is understanding that they are a special group of people who have opportunities in healthcare that mainstream don’t have. There’s almost nothing you can’t get for them, if you can mount an appropriate evidence based response. You can get them things like sunscreen and things that aren’t available on PBS for the mainstream, you can actually get approval for on RPPs. Things like for example new diabetic injection, you can actually get for veterans for weight loss if they’ve got an accepted condition that losing weight would be beneficial for. There’s a process you can go through. We’re trying to get this information into the medical schools and across the curriculum, but the take message is that if you ring up this number, you can often find different opportunities. Knowing that their family are entitled to things like open arms counselling as well. It’s all a little bit different. Having an understanding and knowing where to phone, you can usually get some good guidance. Just generally being aware that veterans might have other opportunities that you might not get for mainstream patients, and Aboriginal veterans get a different level of care as well.
There’s been a lot of value for me meeting and talking to the staff at conferences, in those days when we were allowed to travel and have conferences. I’ve always found the team to be really good and very approachable. That was always evident. Certainly through the RTOs and other stakeholders, GPSA have always had a great presence there in the training that we’ve received as supervisors coming along and talking to us about issues relating to business management even and remuneration issues, and the importance of not necessarily negotiating with your registrar because it makes the landscape more complicated. I’ve always found that to be really useful, as well as the webinars. Even knowing that the organisation is there is invaluable, particularly if you’ve got a problem. It’s one thing to not be embarrassed to ask a friend, to extend that to the public hospital system, and interns and training providers, if you’re not sure and don’t necessarily have that relationship with the training provider and don’t want to discuss it with them, knowing that GPSA is there is really invaluable to know that you can get an independent hearing from someone with a wealth of experience on this issue. It might be my first time, but it might be a common problem with registrar training that they can help us with, so I think that’s really amazing.
Training is probably not my absolute desire or my greatest skill. We all have things that get us out of bed in the morning. But it’s certainly been an experience that’s given me a lot of joy, and to watch other people go through their careers and to grow and often have contact around the place is really a lovely experience. It valued adds to the surgery, notwithstanding sometimes it’s a bit problematic. In the main its been a really positive experience and I would encourage people to embrace it, not be afraid to ask for help, and go a journey with their colleagues. The mentors that I’ve got through the college that I’ve met, all wear similar hats. It’s been really amazing, that fact that I’ve got all these phone a friends if I’ve got a problem. I don’t always need to use it, but when I see these people it’s a really great experience it’s like catching up with long lost family, so it’s a great feeling of camaraderie in the group. I would absolutely encourage people to get involved, and ideally to get a few people within the practice involved so that you’re not doing it on your own. I think it’s a wealth of knowledge and experience and helps to optimise your own skillset and keep it current. Particularly in the digital age where a lot more resources are at your fingertips, it’s less daunting. So give it a go and don’t be afraid to reach out to GPSA and your training provider for help if you need it.
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