Casterton Coleraine Medical Centre
Casterton Coleraine Medical Centre provides GP cover to the towns of Casterton and Coleraine and the outlying communities of Merino and Balmoral (regional population approx 6,000).
This six doctor practice holds GP clinics Monday to Friday, covers Casterton Memorial and Coleraine District Hospital for emergency cover and inpatient care, services residential care and nursing home places across the district (@ 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, do suturing, can supply certain prescription medications under authorisation from the GP and are qualified to take basic x-ray.
A visiting surgeon and physician attend fortnightly clinics. Community health and allied health services include audiologist, diabetic educator and psychologist. Pain clinic is held at Casterton.
The towns are around 330km west of Melbourne, the closest regional centre is Hamilton (40km) or Mt Gambier (100km) and 136k to Warrnambool.
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, 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. In the past, the practice has 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.
After hours cover is generally a one in four roster. Registrars are fully supported by a senior GP for after hours cover.
DR BRIAN COULSON
Having lived in the region for nearly forty years, Dr Brian Coulson 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!” said Dr Brian Coulson.
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.” said Dr Brain Coulson.
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.” said Dr Brain Coulson.
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.” said Dr Brian Coulson.
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.” said Dr Brian Coulson.
As an accredited supervisor with both ACRRM and the RACGP, Dr Coulson has a long history in medical education and enjoys working with the younger doctors.
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. Registrars have the opportunity to develop skills around skin lesion removal, cryotherapy, dermatoscopy and microscopy.
As part of their experience, registrars 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 develop skills and awareness of the processes around the coordination and management of emergency situations.
“Registrars 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 a 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.” said Dr Brian Coulson.
DR KHALED MOUSSA
GPT3 Registrar, Dr Khaled Moussa has been with Coleraine Medical Centre for two 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 explained he 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.
Dr Moussa 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 Khaled Moussa.
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.” said Dr Khaled Moussa.
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.”said Dr Khaled Moussa.
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
Coleraine District Hospital – Western Districts Health Service: http://www.wdhs.net/coleraine/services
Casterton Memorial Hospital – http://swarh.com.au/cmh.aspx
South West Alliance of Rural Health – http://www.swarh2.com.au/Default.aspx
Balmoral Bush Nursing Centre – http://swarh.com.au/bbnc/content/doctors.aspx
Merino Bush Nursing Centre – http://www.wdhs.net/merino/services
Rural & Isolated Practice Endorsed Registered Nurses (RIPERN)
Adult Retrieval Service – https://www.ambulance.vic.gov.au/about-us/our-services/adult-retrieval-victoria/
University of South Australia – Rural & Remote X Ray – http://www.unisa.edu.au/Health-Sciences/Programs-and-Courses/Short-courses/Rural-Remote-Xray/
Visit Coleraine: http://www.visitgreaterhamilton.com.au/towns/coleraine.html