Swan Hill Medical Group
Swan Hill Medical Group was first established in 1958. This purpose built practice has been upgraded and refurbished in stages with added facilities and new equipment to meet growing demand. The practice has 26 consulting rooms and a three bed treatment room utilised for various surgical procedures, monitoring, spirometry, dressings and wound care. The practice is supported by five nursing staff and two staff dedicated to Health Assessments and Care Plans for chronic conditions.
The practice supports a large number of visiting specialists including a rheumatologist, nephrologist, gynaecologist, urologist, cardiologist, orthopaedic specialist, paediatrician, psychiatrist, psychologist, ophthalmologist, podiatrist, dermatologist, vascular surgeon and ENT specialists and the registrars can benefit from participating in consultations with their patients.
The practice has access to allied health and community health services including those who work out of our clinic as well as those provided by the hospital including lymphedema clinic and chronic disease clinics.
The practice has 11 GPs who consult from the practice including three supervisors. Various practitioners provide anaesthetic cover for the hospital and GP Obstetric cover for private patients.
The health service has a 79 bed hospital comprising emergency department (four bed), acute care ward, midwifery unit, operating theatre, day procedure unit, renal dialysis, chemotherapy, palliative care and radiology services. Two residential aged care facilities provide 75 beds. Various allied health and community health services are available including headspace, cancer resource centre and rehabilitation facilities.
The practice is accredited for RACGP and ACRRM training. It currently hosts two AGPT Registrars with capacity to accommodate additional senior AGPT registrars if available. There is no VMO status or on call requirement associated with this registrar placement although it is available should a registrar be interested.
Swan Hill has a large cohort of various health sector trainees associated with the hospital and general practices in the town. This cohort provides both professional and social connection for registrars. Accommodation is often shared with other trainees or passed on from registrar to registrar.
SUPERVISION AND TEACHING
In addition to set time allocated for one to one teaching, registrars attend clinical meetings and case presentations and have access to training provided at the hospital. Registrars are encouraged to utilise the skills of each the practice doctors who have a wide range of experience and special interests. Registrars also have access to visiting consultants and may attend joint consults on occasion.
DR STEWART BOOTH
On graduating from Melbourne University in 1976 Dr Stewart Booth was interested in all facets of medicine. He decided however, on general practice, preferably in country Victoria and ideally in a small group practice. Dr Booth worked in various locations then a four month locum in Birchip cemented his interest in rural medicine.
“The instructions for the four months locum were to look after the ducks and the cat and not sack the receptionist! It was in the middle of a mouse plague. I was doing my own x-rays, pathology and some surgery. The policeman’s wife had a ute with a mattress in the back – she was the ambulance person. We used to do direct blood transfusions….. with the distance and no ambulance it could mean several hours before you could transfer a patient….. you were welcomed by the community – I loved it.” said Dr Stewart Booth.
Dr Booth has always had a passion for working in small towns and being part of those communities. He spent ten years as a solo practitioner in the town of Sea Lake following the Birchip experience then in 1994, Dr Booth joined the Swan Hill Medical Centre.
Dr Booth is a proceduralist general practitioner with anaesthetic and obstetric qualifications. He provides anaesthetic services for the hospital and practices as a GP Obstetrician for private patients (the hospital utilises external cover for public deliveries).
Dr Booth is an accredited AGPT Supervisor with both the RACGP and ACRRM programs and believes he learns as much from the registrars as they do from him. He encourages registrars to take advantage of the array of educational opportunities available at the practice, within the hospital and from the visiting specialists consulting from the clinic.
“The practice is not about any one individual – we have 11 GPs each with varied skills, experiences and interests. I encourage our registrars to spend time with every doctor in the practice just to see the different style of each doctor.”said Dr Booth.
With forty years of general practice experience to reflect on, Dr Booth believes his professional satisfaction comes from the long term relationships he has with colleagues, with the community and particularly with his patients and their families who he has come to know, often over several generations.
“A most moving experience was with a young women who visited me from out of town. She said “you have been my mothers’ doctor and you delivered me…. my mother told me if I ever had anything really bad, you’re the one I should come and see about it.” That is the sort of thing that makes everything you go through worthwhile” said Dr Stewart Booth.
Dr SHIJU MAMMEN
Dr Shiju Mammen completed an undergraduate double degree in Science and Engineering. Not sure that was where her interest lay, she completed a Diploma in Women’s Health, took the GAMSAT and commenced post graduate medical training in West Australia. She transferred to Sydney, obtained her MBBS with the University of Notre Dame completing her final year in Gippsland, then her internship and residency with Monash Health. Dr Mammen commenced AGPT training as GPT1 in 2018.
“By end of medical school I knew I wanted to do general practice. It was a no brainer for me.… For my PGY2 I honed in on the things I needed to do for general practice…. paediatrics and the child health diploma – I had already completed the Diploma in Women’s Health, that has been really useful.” said Dr Shiju Mammen.
Dr Mammen explained her choice of rural practice was made because she believes training is different in the rural areas in that, generally, you have greater levels of responsibility and with increased confidence, more opportunity to manage your patients independently.
“You are not actually just referring to a specialist – we don’t always have that option here! You have to sort them out here. The patients want to get sorted here if we can do it here. So we get to manage our patients and we liaise with the consultant rather than send a patient off as the first line of treatment.” said Dr Shiju Mammen.
In choosing a rural location, Dr Mammen admits there are disadvantages with her family being metro based, however for her, the training advantages, opportunities and scope of practice that exist in a regional area, far out weigh the disadvantage of distance.
For Dr Mammen, Swan Hill has provided a wide scope of practice and enabled her to develop her confidence and skill set for the ‘bread and butter things of general practice’.
The practice provides a varied patient mix. Presentations include chronic disease, women’s health, paediatrics and geriatrics. She describes having many opportunities to improve her knowledge in dermatology and successfully recognising BCC or SCC skin lesions. Multiple opportunities to increase her procedural skills exist including inserton and removal of Implanon devices, toe nail removal and skin excisions. She explained patients are not keen to incur the cost of a specialist visit and travel to Melbourne or Bendigo, if they can be treated locally.
Dr Mammen described her supervisor, Dr Booth, as supportive and available, being happy for her to knock on the door for assistance or a second opinion as required. Being interested in sharing interesting cases or procedures, Dr Booth utilises these situations as an opportunity for learning, skill development and clinical discussion.
Dr Mammen described the practice and the town in general as being friendly and welcoming. The town has various sporting groups, social activities and options for shopping and entertainment.
Dr Mammen recognises how difficult it can be settling in to a new place, but found the cohort of registrars and health professionals rotating through training positions in Swan Hill and across the region as a good source of professional and social support. Dr Mammen appreciates the connections with other GP registrars for study groups and exam preparation.
“Initially when I was matched with Swan Hill I had no knowledge of the region or what was on offer in Swan Hill, but I have been pleasantly surprised by the friendly welcome and the diverse training opportunities available.”said Dr Shiju Mammen.
Swan Hill Medical Group in conjunction with the local Swan Hill Sunrise Rotary Club matchs new registrars with a local “champion” who will introduce the registrar to the town and its social clubs and activities. Swan Hill Medical Group has a sponsorship arrangement with both of the city’s football / netball clubs and there are numerous local gymnasiums, swimming pools and variuos other sports facilities.
Dr Mammen enjoys general practice for the personal connectedness it provides, explaining she was never big on “large institutions and massive hospitals”. She appreciates the diverse range of options and the various areas of special interest available to her within general practice as well as the life style flexibility it affords.
Finally, the fundamental benefit of general practice for Dr Mammen is the opportunity to develop relationships with her patients and facilitate them making positive decisions regarding their life style and health.
“You can make a lot of changes at the primary level, at the community level. You can have a big impact on patient opinions about their health and if you can influence the way they approach their health choices, that can be so beneficial.” said Dr Shiju Mammen.
Swan Hill has a population of 10,000 people and services a catchment population of approximately 40,000.
Dr Stewart BOOTH
MBBS 1976 Melbourne
Senior Partner and Primary Supervisor
Dr Shiju MAMMEN
MBBS Uni Notre Dame Sydney 2015
Diploma Child Health
2016/2017 Casey Hospital,
Dandenong Hospital 2018