The voice of primary care
Michael Kidd is the President of the World Organisation of Family Doctors
Michael Kidd is an Australian GP and academic. He is the dean of the faculty of medicine, nursing and health sciences at Flinders University, Adelaide, and in June became the Word President of the World Organisation of Family Doctors (WONCA). He has a wide range of research interests, including the management of HIV/AIDS in primary care, and is the editor in chief and founder of the Journal of Medical Care Reports.
What is WONCA and what does it aim to do?
WONCA is the global voice of general practice (family medicine), and is made up of member organisations in more than 130 countries, representing 500 000 family doctors from every region of the world. Its objectives are to ensure that high quality general practice is available to all people all around the world, and to ensure that GPs are well trained and supported. We do this through a focus on standards for clinical practice, education, and training.
At the same time, we have a focus on looking at those countries where general practice is not yet established, and assisting those countries in developing their training programmes and getting their own colleges established to set the standards in those countries. Additionally, we focus on a lot of collegial work between GPs in different countries, so that by working together we can try to expand the access to high quality primary care across the world.
Is it challenging to bring together GPs from different backgrounds, with different values and ways of practising?
It’s a challenge, but it’s also a wonderful opportunity. GPs who have an interest in a particular area might not find many people at home who are interested in what they’re interested in, but they’re bound to find a whole lot of other people if they spread right across the world. Also, the way and setting where we practice may be different, but the fundamental aspects of what we’re doing are similar—we’re providing first contact care to our patients, comprehensive and continuity of care. We have a focus on a whole person, not just a particular disease or system, and we also focus on that balance of the biological, psychological, and social aspects of health and wellbeing. You find that when two GPs come together from two different health systems, they’re still talking the same language of healthcare.
In the UK at an undergraduate level, general practice often enjoys less prestige than the hospital specialties—why is that, and what can be done to change it?
I know that there are challenges with the image of general practice, and I think it is important that people have the opportunity to get attachments in general practice while at medical school, working alongside GPs. That means that there is a responsibility for those GPs they are working with to be fantastic role models, and to let the students know what general practice is all about, and why it is such an amazing and rewarding career opportunity. No other specialty allows you the same insights into the lives of your patients and their families and communities; provides you with the opportunity to work across the breadth of clinical medicine; or allows you the opportunity to mix both direct clinical care with health promotion and preventative healthcare. It’s a great privilege to do the work that we do as GPs, and it confounds me that in countries like this, people would think that general practice might be perceived as being less than some other specialties. I feel sorry for some people who work in some of the other specialties, with the narrow scope of practice that they have—it must just become so boring after a while to be doing the same thing on the same little part of the body all the time. I hope that lots of students go out and get some experience; spend time working with GPs; and make up their own minds about the career.
I find that a lot of undergraduate training in this country is based in hospital, and you don’t get a lot of primary care experience. Do you think that this is part of the problem?
Some medical schools in some prestigious universities feel that they’re training people to be the great medical scientists of the future. Well—yes they are, but they’re also training a lot of people that are going to be working in general practice, and I think we need to work with those medical schools to try and assist them to see the light. I can say this because I’m a dean, and responsible for a medical school where a large percentage of our students spend at least half of their clinical time based in general practice, and the interesting thing is that the students who do the community based placements do better in their examinations than the students who spend all of their time based in the teaching hospitals. So it’s a bit of a revolution in medical education, but I think it’s one we need to be focusing on.
Why did you choose general practice?
I was probably like a lot of medical students in that as I was training. I had no idea what specialty I’d move into after graduation, and even as an intern I wasn’t quite sure what I wanted to do. I knew I didn’t want to become a surgeon as I had difficulty tying my own shoelaces, so that was probably not an option. But most areas of medicine I found fascinating, and after I graduated I did work in adult medicine, paediatrics, psychiatry, and obstetrics. I thought, I love working in all these different areas, how can I do all of them at once? I can do that by becoming a GP, and that’s what I did. After I finished my registrar training, like most GPs I looked around to find out what community I was going to work with. It was the late 1980s and the HIV epidemic had begun. As a gay man, I saw many of my friends and the people I cared about and loved being affected by this horrible disease, which at that time was universally fatal. So I started working as a GP at a community owned clinic, with a fantastic multidisciplinary team, all doing what we could to try and provide the best support we could to our patients, even though we knew that we weren’t going to be able to save their lives.
In the mid 1990s one of the great miracles of modern medicine occurred with the introduction of protease inhibitors and triple therapy for HIV, and all of a sudden the patients that I had who were likely to die over the coming months went on to these drug combinations and started to get better. Many of them are still alive today. And that’s been the area I’ve worked predominantly throughout the rest of my career. My patients are largely people with HIV or affected by HIV, but I still work as a GP providing the breadth of care. It’s interesting because as I’ve aged, my patients have aged, and now HIV is just one of the chronic conditions my patients have. I treat people with HIV and heart disease and diabetes and various cancers and so forth—medicine is fascinating and continues to change.Katherine Bettany, editor, Student BMJ
Correspondence to: email@example.com
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f6947