When he started up his Karrinyup general practice about 30 years ago, John Whitelaw was borrowing more than ten books a week from the local library, a gauge of his patient load. As word-of-mouth gathered momentum, his book borrowing took a nose dive. John recently retired from his original solo-GP practice and he reflects on changes, from six-minute medicine and declining skills to computers and teaching. In earlier days it was not just family medicine.

circa 1999. John Whitelaw is pictured receiving his competition prize from Medical Forum of a first aid kit – it was in the day of metal boxes, and he still has the kit in his car. “My role was doctor, nurse, counsellor and priest. It was much more catholic than it is now,” John said recently.“I practiced in obstetrics and anaesthetics for around 15 years and GPs do very little of that now. I also did a lot of hands-on teaching with medical students and really enjoyed it. I’d often have them sitting in the consulting room with me. Again, there’ve been changes – not too many doctors have the time to mentor students anymore,” he said, adding that other GP skills tied in with old-school family medicine have changed.

“I didn’t have a practice nurse which means you’re doing things like taking blood samples and doing dressings every day. After a while you get pretty good at those procedures. And that’s one thing that’s changed markedly – some of those skills are gradually being diluted. At different times my role was doctor, nurse, counsellor and priest. It was much more catholic than it is now. ”

Then there is the consultation itself.

“The six minute consultation is highly counterproductive and some take that to extremes. I know of one doctor who doesn’t even have a chair for his patients! I had a young guy in here who’d suffered a seizure and was very worried about the consequences. He was with me for an hour – you’ve got to have the flexibility to give them the time they need.”

The gender shift in the GP medical workforce and changing attitudes to work-life balance have not impacted much on John’s work but he is aware solo urban GPs appear to be a thing of the past.

“It wasn’t so long ago that the majority of medical students were male. Now 60% of graduates are female and only about one third of them work fulltime. And what’s even more enlightening is that young male doctors seem to prefer part-time work as well.”

That shift is now so entrenched that John found it impossible give away, let alone sell, his solo Karrinyup practice, which is now closed. The surgery was a computer-free zone with all patient records on index cards written in John’s free-flowing hand.

“I probably should’ve become more in tune with computers, but financially that can be a big hole in your pocket and, quite frankly, I didn’t need it. A computer isn’t essential to running a solo-practice… patients didn’t come to see my computer skills, they came for my medical skills.”

Demand for his skills means he has had less than a handful of days off in thirty years.

“Life balance is important and attitudes are changing because the job can be stressful. Fortunately, I’m a pretty calm and ordered person and I’ve had wonderful family support.”

Working as a family GP continues for John Whitelaw, albeit under the new world order, and at a slower pace. After an emotional send-off from more than 200 of his Karrinyup patients – most of whom were extremely positive about his move – John is working part-time at the Stirling Lakes Medical Centre, a few suburbs away. He did this to help his patients transition to new doctors. It is an IPN practice where his patients have the freedom to move to other doctors and he is working a few sessions each week and is not under contract and has not received a lump payment. He says he has plenty of staff to help sort out his awkwardness with computers. He may still do some country locums.

John has three pieces of advice for budding GPs.

“First, look after your own health because if you don’t you won’t be able to look after anyone else’s. Second, always listen to what your patient says… and be aware of what they don’t say. Finally, make sure you take time off – the surgery should work for you, you don’t work for the surgery.”