Casterton Coleraine Medical Centre provides GP cover to the towns of Casterton and Coleraine and the outlying communities of Merino and Balmoral, with a regional population of around 6,000.
Registrars will learn to manage a range of complex medical conditions such as renal failure, heart disease and psychological problems. They will have the opportunity to extend their emergency medicine skills, manage significant cardiac failure, handle diabetes and oversee palliative care.
As a predominantly agricultural community, emergency presentations include work related injuries with fractures, stitching, foreign body removal and eye procedures all presenting regularly. Sports injuries are also common.
Leisure activities include a wide range of sports, together with walking, hiking and biking around the scenic local countryside. Casterton is also known as the birthplace of the famous Australian sheep dog, the Kelpie.
The beautiful beaches along the Great Ocean Road are only an hour away. The world-renowned Grampians National Park is also just an hours drive, featuring magnificent rugged cliffs and majestic waterfalls, or for the more adventurous, a range of extreme sports such as abseiling, rock climbing or quad-bike and horseback riding.
About the clinic
The practice holds GP clinics Monday to Friday and covers Casterton Memorial and Coleraine District Hospital for emergency cover and inpatient care. It also services residential care and nursing home places across the district (approx 130 beds) and attends weekly bush nursing centre clinics at Balmoral and Merino.
The Bush Nursing Centres are staffed by Rural & Isolated Practice Endorsed Registered Nurses (RIPERN) who are trained to triage emergencies, suture and supply certain prescription medications under authorisation from the GP. They are also qualified to take basic x-ray.
A visiting surgeon and physician attend fortnightly clinics. Community health and allied health services include audiologist, diabetic educator, social worker and psychologist. A pain clinic is held at Casterton. Visiting medical officer (VMO) rights are available at both Casterton and Coleraine hospitals.
Various referral options to specialist consultants are utilised and telehealth services are available. The practice refers to Mt Gambier for acute orthopaedics and obstetrics, Hamilton for surgery and acute medicines and Warrnambool for paediatrics, complex orthopaedics, renal medicine and oncology. Emergency retrievals are carried out by Victorian Adult Retrieval Service or by road ambulance.
A visiting radiography service is available for two hours, twice per week. GPs are qualified to do basic x-ray and read their own films. The practice has also previously funded registrars to complete a Rural Remote X-ray short course run at the University of Adelaide.
The practice provides shared care for obstetric patients, up to about 28 weeks. Following delivery, patients have the option of returning to Casterton Hospital for post-natal care.
We see a range of patients of all ages who come from the local communities in Coleraine, Casterton, Merino, Balmoral and Harrow, including farmers, sports people, the elderly and children.
After hours cover is generally a one in four roster. Registrars are fully supported by a senior GP for after hours cover.
Registrars who train at the Casterton Coleraine Medical Centre will have the opportunity to develop their skills with the assistance of their GP supervisors and a very supportive team of nurses and administration staff.
Accommodation can be negotiated with the practice owners. If you have a family, there’s formal child care in Casterton and two primary schools in both locations plus a high school in Casterton.
Leisure activities include a range of sporting options, including football, netball, tennis, hockey, basketball, golf, croquet, bowls, skate parks, outdoor swimming pools and much more.
Dr Brian Coulson
Dr Coulson recently received a lifetime recognition award from the lions club of Coleraine and has lived in the region for over 40 years. He loves the area for its outdoors lifestyle.
“We are close to the beach for surfing and fishing, the Grampians and national parks for bush walking, kayaking and everything outdoors. There is the Coonawarra for food and wine. It is not a boring spot!”
English born, with an Australian mother, Dr Coulson moved to Australia in 1966. He obtained his MBBS from Adelaide University in 1977, underwent anaesthetics training in Adelaide and the UK, completed obstetric training in Adelaide, then after general practice training in Adelaide, commenced general practice at Coleraine in 1982.
Choosing to no longer provide anaesthetics or obstetric cover, Dr Coulson reflected how GP work has changed significantly from what it was at the beginning of his career.
“In the early days things were very different – it was really independent stuff. You did appendix, hernias and all the deliveries.”
Coleraine was originally a two doctor practice. In 1999 Casterton was left without doctors, so the practice extended its service to ensure GP cover for both areas.
“There were no doctors in Casterton. The idea was to get some sort of sustainable model … because you can’t have one or two doctors in a practice – you have to have at least five or six in a group to make it viable. We have worked to keep the service here.”
Dr Coulson describes the practice as busy, varied and interesting. The patient demographic and clinical presentations cover a wide range.
“The clinic is fully booked. We don’t see coughs and colds! The community only come for serious stuff – many won’t come unless they are sure they, or their kids are really sick.”
With 34 per cent of the region’s population being over 65 years (Victorian State average for 65+ is 15.6 per cent), the practice manages a large proportion of older patients who often have multiple complex conditions including diabetes, cardiac failure and palliative care.
For Dr Coulson, the interesting medicine often happens after hours.
“On call is where you see the interesting stuff, the trauma stuff. Or sick kids, fractures. When we have trauma or acute patients – they will be helicoptered out with the Victorian Adult Retrieval service.”
Dr Coulson explained that skin cancer screening and treatment of skin cancer and skin conditions is a major component of procedural work at the practice and that registrars have the opportunity to develop skills around skin lesion removal, cryotherapy, dermatoscopy and microscopy.
“As part of their experience, registrars also have the opportunity to extend their emergency medicine skills. In a predominantly agricultural community, emergency presentations include work related injuries with fractures, stitching, foreign body removal and eye procedures presenting regularly. Sports injuries are common. Registrars will develop skills and awareness of the processes around the coordination and management of emergency situations.
“Registrars also get to see a good range of things such as renal failure, heart disease and psychological troubles. Our older population get really interesting conditions. Our registrars will learn to manage significant cardiac failure, handle diabetes properly, manage palliative care, manage trauma and at the other extreme, see kids and babies.
“I’ve been doing this for a long time. I still find every day I learn something new. I still do a lot of study – I see a lot of sick people. I think it’s like a detective work really – there is intrigue – you have a thing and you have got to solve it.
“Coleraine offers registrars the whole variety of general practice. They are exposed to complex and very sick people at times. It gives them some hospital work, some emergency work. It gives them access to special skills like learning radiology – you interpret your own films here if you want to. We do lots of skin procedures and learning about skin conditions. Working at Coleraine allows them to continue to follow their own interests.”
In his leisure time Dr Coulson also likes to keep busy and spend time with his family.
“I enjoy a range of hobbies such as swimming, fishing, bike riding, triathlons, I love the outdoorsy lifestyle”
As an accredited supervisor with both ACRRM and the RACGP, Dr Coulson has a long history in medical education and enjoys working with registrars, so those looking to train in the clinic are in very safe and highly-qualified hands.
Dr Khaled Moussa
Dr Khaled Moussa has been with Coleraine Medical Centre for over three years. He graduated in Romania, moved to Australia and completed the AMC certificate in 2011. He has a particular interest in emergency medicine and worked at Latrobe Regional Hospital in emergency, intensive care and psychiatry.
Dr Moussa chose general practice because of the diversity it offers, the ongoing care you provide and the fact that, unlike the hospital or emergency environment, you develop longer term relationships with your patients and can see the results of the treatment you provide.
He enjoys the level of exposure to a broad range of medical conditions at Coleraine and the opportunity to maintain his emergency medicine skills. He explained there are multiple opportunities for procedural practice and patients express a preference for being treated locally if possible.
“It is a good place to work as a registrar because of the experience that you get. The work load is high, but that gives you a lot of opportunities…. you keep in touch with all the fields of medicine rather than just focusing on one part of the body or one area of medicine. The scope is very wide and you just don’t know what you’re going to see”.
Dr Moussa identified a major aspect of general practice he has come to understand is that, different to the hospital setting where things are done immediately, general practice takes time. For him, learning to identify what is urgent or not and what can wait and be followed up later, has been a significant factor in his adjustment from hospital to general practice.
“You do develop an understanding on how to concentrate your efforts – which medical problem to take on first – people come in with a number of problems, a number of issues and you need to prioritise and focus on what is more important. Figuring out how to manage your time more effectively – I think developing that skill is something you do in time.”
For Dr Moussa, seeing a good result is what makes general practice worthwhile.
“The satisfaction is in following up a patient and seeing them get better, or managing a certain problem or helping them change their lifestyle. Of course it can be difficult in some cases, but in others, seeing a good result is very satisfying.”
Dr Brian Coulson (Principal)
MBBS Uni Adelaide, 1977
1982 commenced Coleraine
Dr Khaled Moussa
2006 MD, Grigoria T Popa University, Romania
2011 AMC Certificate Australia
RACGP Rural Pathway
2015 – LaTrobe Regional Hospital Emergency Medicine
2016 – LaTrobe Regional Hospital Intensive Care / Psychiatry
2017 GPT 1 & 2 Casterton Coleraine
2018 1 GPT3 Casterton Coleraine
2018 2 Ext Skills Winda Mara Aboriginal Corporation
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