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A Socio-Historical Study of Australian Doctors and Their Rival Medical Systems

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A Socio-Historical Study of Australian Doctors and Their Rival Medical Systems THE ANATOMY OF TWO MEDICAL ARCHETYPES: A SOCIO-HISTORICAL STUDY OF AUSTRALIAN DOCTORS AND THEIR RIVAL MEDICAL SYSTEMS Christine Victoria Farag Bachelor of Arts with First Class Honours in Aboriginal and Intercultural Studies (Edith Cowan University) This thesis is presented for the degree of Doctor of Philosophy of Murdoch University 2007 Declaration I declare that this thesis is my own account of my research and contains as its main content work that has not been previously submitted for a degree at any tertiary education institution ……………………………………………… Christine Victoria Farag ii This thesis is dedicated to the memory of my mother and step-father, Victoria and Peter Malouf, who were always so proud of our small achievements. iii Table of Contents Page no. List of Abbreviations ……………………………………………………………… viii List of Tables ……………………………………………………………………… xii List of Figures…………………………………………………………………… xiii List of Illustrations ………………………………………………………………… xiv List of Appendices ……………………………………………………………… xiv Acknowledgements ………………………………………………………………… xvi Abstract ……………………………………………………………………………… xv CHAPTER ONE Introduction Introduction ………………………………………………………………………… 1 How assumptions developed ……………………………………………………… 3 The migration of British doctors to Australia: an overview …………………… 5 Aim and significance ……………………………………………………………… 16 Thesis outline ……………………………………………………………………… 18 CHAPTER TWO Literature review, theory and methodology Introduction …………………………………………………………………… 20 Literature review………………………………………………………………… 21 General literature………………………………………………………… 21 Australian literature ……………………………………………………… 28 Contemporary perspectives on professionalism……………………… 33 Methodology ……………………………………………………………… 38 Conceptual framework ………………………………………………………… 41 Clinical rationality …………………………………………………………… 43 Practical rationality ……………………………………………………… 46 Substantive rationality ……………………………………………………… 48 Ethic of chivalric brotherhood ……………………………………… 48 Ethic of humanism ………………………………………………… 49 Formal rationality ………………………… ……………………………… 50 Power relations and human agency ……………………………………… 51 Conclusion …………………………………………………………………………… 52 CHAPTER THREE Jewels of Empire: the emergence of the soldier/saviour archetype Introduction ……………………………………………………………………… 54 Background ……………………………………………………………………… 55 The medical chivalric orders……………………………………………… 55 Development of military medical knowledge ………………………… 59 Tropical medicine and the health of the “public”…………………… 62 iv Effects on the civilian medical population ……………………………… 65 Creating Australian soldier/saviours ……………………………………………… 68 The role of Freemasonry…………………………………………………………… 76 The St John Ambulance Association …………………………………………… 78 St John Ambulance Brigade in NSW…………………………………………… 80 Public health administrators and ‘social’ and ‘preventive’ medicine ……… 83 Surgeon administrators …………………………………………………………… 86 Workforce considerations ………………………………………………………… 87 National institutions ……………………………………………………………… 89 School of Public Health and Tropical Medicine (SPH & TM) ……………… 94 Conclusion …………………………………………………………………………… 96 CHAPTER FOUR The generalist physicians and surgeons: their involvement in Australian medical education and patient care in Victoria and South Australia Introduction ………………………………………………………………………… 99 Background………………………………………………………………………… 100 Humanist medical traditions …………………………………………… 100 Medical career paths ……………………………………………………... 103 Developments in medical knowledge …………………………………… 105 The generalists in Australia ……………………………………………………… 109 Some accounts of early life experiences …………………… ………… 111 Statutory regulation and medical qualifications ……………………… … 115 Generalists and Australian medical schools 117 The University of Melbourne and its Medical Faculty ……………… 121 The University of Adelaide and its Medical Faculty ………………… 124 Other considerations ……………………………………………………………… 134 Ideas about the body ………………………………………………………… 134 Ideas about reproduction and sexuality ………………………………… 135 Ideas about medical intervention ………………………………………… 136 Generalist/soldier interactions…………………………………………………… 138 Knights and mere mortals! ………………………………………………… 138 Who shall reign supreme? ………………………………………………… 140 Workforce considerations …………………………………………………… 143 Conclusion …………………………………………………………………………… 146 CHAPTER FIVE “Jewels in jeopardy”: saving the nation and purging infection Introduction …………………………………………………………………… 149 Social context ……………………………………………………………………… 150 The ‘Jewels’ of the chivalric orders ……………………………………………… 154 Other developments ………………………………………………………………… 155 Cold war environment ……………………………………………………………… 156 The militarization of medical schools and hospitals …………………………… 160 Undergraduate medical schools…………………………………………… 161 v Changes to hospitals ………………………………………………………… 166 Postgraduate specialist training…………………………………………… 167 Planning for national emergency ………………………………………… 170 Medicalization of the wider community ………………………………………….173 Waging war on disease …………………………………………………… 173 Selling the heroic genre to the public ………………………………………175 Rubber stamping: changes to National Health legislation ……………… 178 The SPH & TM: its research blueprints ………………………………………… 181 Medical surveillance of children: a case study ………………………………… 186 NSW …………………………………………………………………………… 186 Queensland’s role …………………………………………………………… 188 Victoria and SA ……………………………………………………………… 191 Other considerations ……………………………………………………………… 193 Conclusion ………………………………………………………………………… 195 CHAPTER SIX The generalist genre: generalist (family) practitioners, medical academics and public health administrators in contemporary times Introduction …………………………………………………………………… 197 Social context ……………………………………………………………………… 201 Generalists and ‘specialists’ within medical postgraduate and undergraduate education ………………………………………………………………… 209 The RACGP and their FMP ……………………………………………… 214 Sydney Medical Faculty once again ……………………………………… 221 Newcastle Medical School ………………………………………………… 225 General Practice and Community Chairs: the ‘add-on’ solution …………… 234 A consideration of ethics ………………………………………………………… 239 Conclusion ………………………………………………………………………… 243 CHAPTER SEVEN The heroic genre: the front-line sentinels of the biomedical enterprise Introduction ………………………………………………………………………… 246 The CDOH and its health generals and lieutenants …………………………… 249 Community health, primary medical care and health promotion ………………256 NSQACA and its advisory role ……………………………………………… 262 The Australian ‘era of laboratory’………………………………………………… 266 The NHRMC ………………………………………………………………… 267 The STM & PH and ACITHIN …………………………………………… 269 Heroic imagery in contemporary medical practices …………………………… 274 St John doctors and other Knights ………………………………………… 280 Disease intelligence and surveillance …………………………………… 285 Media representation ……………………………………………………… 287 Who should be saved? …………………………………………………………… 289 Other considerations ………………………………………………… … … 290 Medical ethics ……………………………………………………………………… 293 Conclusion ………………………………………………………………………… 294 vi CHAPTER EIGHT Conclusion ………………………………………………………………………… 297 Appendices ………………………………………………………………………… 312 References ………………………………………………………………………… 314 vii List of Abbreviations AAAS Australian Association of Army Surgeons AAMWS Australian Army Medical Women’s Service AAMC Australian Army Medical Corps AANC Australian Army Nursing Corps AAAS Australian Association of Army Surgeons AAC Australian Accreditation Committee AAS Australian Association of Surgeons ACCC Australian Competition and Consumer Commission ACS Australasian College of Surgeons (later Royal) ACT Australian Capital Territory ACITHIN The Australian Centre for International and Tropical Health and Nutrition ACIMEMW Australia: Committee of Inquiry into Medical Education and Medical Workforce (also referred to as the “Doherty Report”). ACMS Australia: Committee of Medical Schools (also referred to as the “Karmel Report”). ADA Australian Defence Academy ADAS Australian Department of Administrative Services ADF Australian Defence Force ADFA Australian Defence force Academy A.F. & A.M. Antient (sic), Free and Accepted Masons AFPHM Australian Faculty of Public Health Medicine AIF Australian Imperial Forces AIH Australian Institute of Health AM Order of Australia AMA Australian Medical Association AMC Australian Medical Council AMEC Australian Medical Examining Council ANU Australian National University ANZAAS Australian and New Zealand Association for the Advancement of Science APSCARC Australian Parliament Senate Community Affairs Reference Committee ARC Australian Red Cross ASIO Australian Security and Intelligence Organization ATSIC Aboriginal and Torres Strait Islander Commission BMA British Medical Association BA Bachelor of Arts B Med.Sc, Bachelor of Medical Science BS Bachelor of Surgery BSc (Hons) Bachelor of Science with Honours CB Companion of the Most Honourable Order of Bath CBE Commander of the Order of the British Empire CDOH Commonwealth Department of Health CDOHA Commonwealth Department of Health and Ageing viii CDSO Companion of the Distinguished Service Order CES Commonwealth Employment Services ChB Bachelor of Surgery ChM Master of Surgery CMG Companion of the Order of St Michael and St George CHP Community Health Program CME Continuing Medical Education CMG Commander of the Order of Bath CO Commissioned Officer CT Cat Scan CYSS Commonwealth Youth Support Scheme DCH Diploma of Child Health DCTM Diploma of Community and Tropical Medicine1 DGMS Director General of Medical Service DIMA Department of Immigration and Multicultural Affairs DOH Department of Health DPH Diploma
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