Zero Tolerance for Zero Tolerance

Nice thoughts on bullying, angry staff and patients and reflective practice by nursing educator Paul McNamara. How Zero tolerance doesnt work so well as inviting dialogue. Not shouting in order to get the message across. Nice one Paul.


photoA while ago I wrote about my most frightening workplace experience in a post called “Emotional Aftershocks“, which included a section titled “Zero Tolerance is Unrealistic and Unfair”.

Today, via a Tweet by Nicky Lambert I am reminded of how ridiculous the “Zero Tolerance” approach in hospitals is and (more importantly) have been introduced to an evidence-based alternative strategy that has recently been launched in the UK. To cut-out the middle-man and go straight to source of this pretty-cool strategy, click on the link:

To subject yourself to my ideas and waffle, please read on…

What’s Wrong with Zero Tolerance?

A dumb, shouty poster. A dumb, shouty poster.

It is inevitable that health services, hospitals especially, will have a large percentage of patients who have cognitive and perceptual deficits due to the very medical condition that has them bought them to the health facility in the first place. About 9% of the over-65s…

View original post 657 more words

Leadership. What is it?



First of all the issue is what do we mean by Leadership?

This blog is in response to comments made on the medical forum GPs Down Under.

In  references in my article AFP Article here

I Referenced a UK Document  about a National Leadership Competency Framework for Doctors.   NHS Leadership Academy  page 9. has the five core domains of leadership.  Its a big document but page 9 is good.

Leadership was defined as a set of competencies    From the above document:  “The Medical Leadership Competency Framework (MLCF) is built on the concept of shared leadership where leadership is not restricted to people who hold designated leadership roles, and where there is a shared sense of responsibility for the success of the organisation and its services.”

We often do see leadership as a role and this may not be what is always required or desired.  So the comment from my colleague on GPDU is entirely appropriate and that is that “not everyone wants to or aspires to or can- participate in Leadership Roles. “ Very true.

The challenge in the discussion is what about those who do wish to have a voice in their profession, but who face individual, workplace or cultural barriers?  Whilst the desire to participate in leadership or not may not necessarily be a gendered issue- the barriers to express that desire may well be.

Way back in 2004 Dame Carol Black commented here about

The dangers of a feminised profession

Her comments were not unlike the recent O and G debate- stirred up controversy of course but were not anti-feminist.

Iona Heath Professor of GP ( and such an eloquent speaker) wrote  a response to Dame Carol Blacks comments.

Essentially the point of both women is that

“Continuing unequal status of women may reduce the influence of the profession”

Heath I. Women in medicine. BMJ Editorial. 2004;329(7463):412-3.

In other words:

Who argues policy and procedures for Medicine?  Will it only be from the point of view of a traditionally male stereotyped bloke who has the archetypal “wife” supporting his role and after hours political activism.    The issue is that part time medical practice is seen as a norm for “women” and not so much for men although this is changing.  Without representations form the diverse membership (and I hesitate to say female gender is part of diversity when it is 50% of the population) then diverse opinions and needs are lost. Carers are seen as “slackers” for not being full time in the work force.

It is every couples choice how they might manage this but a “choice” is a loosely used word and a National Child Care policy is long overdue in Australia.

Re thinking how we go about providing support for both men and women who are caring for others and bringing the domestic life into the work life and not the other way around would be a start.  The Domestic Life and its multitude of needs are absent and invisible in the workplace. Yet they save the country a fortune in voluntary labour and GDP.   Any gender can be unfairly  discriminated against as an individual family if domestic work creeps into the workspace too often.

So there are policy and procedures that this Country needs to have not just for the Medical Community but for all working families. Have a look at equity within the workplace as per Norway and other countries who are doing this much better than Australia.  Legislation changes discrimination.  With a national child care policy for example, we wouldn’t blame individuals and the choice would truly be one of choice and not of necessity reinforced by traditional gender roles.

I havent got time to clarify issues of

  • part time medical practice and its necessity for burnout prevention.

See here : 1.     Stevenson AD, Phillips CB, Anderson KJ. Resilience among doctors who work in challenging areas: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners. 2011;61(588):e404.

  • Nor about developing confidence for those (often women) who need practice and assistance in developing a voice.
  • Nor did I get time to say that technology can’t help women/carers attend after hours meetings if their time at home is not protected.
  • Nor did I get to discuss the role of women in politics and why that might not be a desired outcome by some supported by privilege -hence the rather aggressive at times push back against ‘feminism’.

Another blog for another day.

My point is we are all leaders and it’s important not to be silent or absent even if you don’t have a leadership role. At some time in your medical life or at home- life will ask of you to advocate.  Your privilege as an educated man or woman is to speak up on behalf of those who cannot.

GPDU: The Birth of a Community.


The birth of GPDU



Many people have asked me and so here it is…

GPDU is an online community of Australian and NZ GPs. It has no political or College affiliations and we are quite happy to keep it that way. GPDU is neither government, commercial or academically sponsored. It does not belong to the Colleges of ACCRM or RACGP, nor the AMA. Its actually quite nice to not have an allegiance. We cover clinical cases as well as peer support, ethical questions, quality improvement topics, leadership, politics, business management and the endless supply of queries on Medicare billing. It seems to contain the breadth of the Vocation of General Practice. There is diversity of culture, of religion, of practice locations; there are differences of opinion, there are male and female voices; there are academic researchers, educators and GP leaders. However all are GPs and I think it is demonstrative of the great strengths of Social Media and Technology. It is run by volunteer GPs and the flat hierarchy allows all to moderate and peer review.

GPDU began in the Victorian Faculty of the RACGP board room. I was then the Chair of the Women in GP with a fabulous committee. I had been active in Social Media for a few years and found the intellectual homeland of my profession on Twitter. The people on Twitter if carefully selected were highly engaged in the medical profession, innovators, intelligent and witty. They debated evidence, peer review and references that helped me keep up to date. I knew Dr Lindsay Moran Jayaram, from Twitter. Lindsay was a young GP in Leeds and I was privileged to know her first this way. I subsequently met Lindsay in Wonca 2013 Prague, at a workshop on Women’s Leadership I helped run with my now PhD supervisor Assoc Prof Lyn Clearihan. Lindsay informed me there she was emigrating to Australia and we stayed in touch to the point where she was now actively involved in the Women in General Practice Committee based in Melbourne, Victoria Faculty.

Knowing how international collegiate networks were so important we wanted to let the women of Victoria know we were there advocating for them. To the College back then in 2013 this was a no go zone. It was felt to be burdening GPs with the potential for spam. It was felt to be a high risk procedure and process that the College could not manage. We were very frustrated. It is acknowledged that the College is actively becoming familiar with this Social Media space now, but we could not wait. This was grass roots activism and a ground up need rather than a top down approach to a changing cultural paradigm.
So Lindsay suggested we do engage ourselves and I totally agreed. Lindsay asked me whether we should just restrict it to women GPs and I said; “No. Let’s expand the potential to the whole damn lot.” We had an audacious altruistic vision of GP engagement which reflected our individual experiences in the clinical world. Lindsay had been involved in the First Five movement in the UK and found that the social benefits of networking were impressive for GPs. I had seen the same in the informal communities of educative practice I had been involved with over the years. I thought we would get greater engagement using Clinical Scenarios and having a legitimate educative focus and so we went about crafting a Facebook group. It was all very much a suck it and see approach. Of course we consulted our representative Medical Defence Organisations who were enthusiastic about the reduction in GP isolation and benefits of peer education.

Jon Brown also a UK émigré had had a group in the UK facilitating transfers to Australia and he had the name GPs Down Under. He soon joined our fledgling idea and committee and up we went on the Facebook platform. Jon and Lindsay helped create the GPsDownUnder website that supports the Facebook group. Dr Penny Wilson from Western Australia, had just written a series of amazing blogs with international reach and Lindsay reached out to her. I knew of the fabulous Dr Tim Leeuewenburg of Kangaroo Island South Australia, and innovative educator on Social Media with an enormous passion for General Practice so we asked him. Dr Nicole Higgins from Mackay in Queensland, another early adopter of the benefits of Social Media and an excellent Medical Educator came on board soon after. Dr Gerry Considine from the Rural Flying Doctor Service and South Australia, whom Tim and I had known well via Social Media, also came on board after that.
There is a lot more of course about the academic; the philosophy and the facilitation. But they are the developmental years and this blog is about the birth. Jon Brown has provided me with some stats for the blog today which are posted below.

I salute my visionary fellow administrators and my wonderful GPDU colleagues. Even through the dark moments, the community is supportive, intelligent and reflective. I am so gratified that the conception and birth has resulted in such a feisty independent toddler with such great potential.


Members                                 2233
Active Members                    1482
Former Members                     139
Comments                             62168
Likes                                        30798
Posts                                           3969
Activity Score                            159.17
Engagement Score                    39.09

                                                 2000                         2011               Average
                                                                                                           Annual Increase(%)
General Practitioners        32,000               43,400                3.1
Specialists(a)                        15,900               25,400                4.8
Nurses                                   191,100              257,200               3.0
Australia                         18,769,200        21,507,700              1.4
(a) Excludes Medical Practitioners not further defined.
Source: ABS 2001 and 2011 Census of Population and Housing

We are now 5% of the Australian GP population. Noting the annual RACGP conference attracts around 1100 GPs and costs around $900 plus flight plus accommodation plus unpaid time away from practice and GPDU is free. This is not to criticise the College Conference but provides a contrast in engagement and delivery of peer led education the essence of which is #FOAMed. Google that.