Wednesday, March 17, 2010

Modern doctoring with old fashioned values

Although many of the town’s present day population might not realise it, the Kilcullen Family Practice on Main Street is now 22 years on from when Dr Michael Kelly first put his name outside the door.

And it is a sign of the change in Kilcullen itself since then that the practice now comprises four doctors, a nurse, and two receptionists.

Partners in the Kilcullen Family Practice - Drs Deirdre Collins, Michael Kelly and Susanne Francke.

From last October, the practice has become a partnership between its founder and the two doctors who have worked with him the longest, Deirdre Collins and Susanne Francke.

Deirdre, daughter of well-known local community man Jim Collins and Nuala, joined Michael Kelly in 1994, after her graduation. Susanne, who was in College with Deirdre, came to the practice in 2002. And when Michael became ill in 2007 and had to take a year out, Dr Lotter de Witt was brought on board.

Eva Kelly, Michael’s wife, has been a practice nurse since the beginning, and nurse Marie Sullivan joined in 2001. Georgina Mitchell has been receptionist since the practice was founded, while Chloe Sheehan has been with them since 2002. Dayna Mitchell has recently begun working part-time.

A multi-doctor GP practice can have some odd characteristics, as Deirdre Collins found when Michael had to take a year out in 2007, and she took over some of his work. “I had already been there for 13 years, but it was amazing the number of people who asked me if I had just come,” she says with a grin.

Part of that was because many of Michael’s patients had never gone beyond his front surgery area, and didn’t realise how far back the overall facility goes. There are in fact five surgery/treatment rooms, and two waiting areas.

The whole premises has been recently refreshed, with the help of interior designer Maria Fenelon from Ballyshannon. She managed the project from October through to January of this year, juggling the work with the needs of the doctors and their patients. The result is a bright and newly-furnished facility.

“One of the things she suggested was turning a waste piece of ground in the middle into a little garden,” Deirdre says. “It isn’t something we would have thought of ourselves, but it makes such a difference to the waiting room area beside it, and relaxes patients while they wait.”

One of the reasons that the structure was changed to a partnership was the need for continuity. “There has been research which suggests that there is a problem with continuity of care in GP services these days,” says Deirdre Collins. “But if you add up the years which Michael, myself and Susanne have put in here, there’s a massive amount of time that we have spent with our patients.”

It is a matter which all concerned in the Kilcullen Family Practice are anxious to emphasise, in a time when it might be believed -- largely incorrectly -- that the close knowledge of local doctors with their patients has disappeared in the formation of so many private medical clinics.

“People need to know that we are here, that we’re not going anywhere,” says Susanne Francke. “We know them, we know their parents, we know their children. There is a continuity here that a general practice can offer uniquely, in contrast to private clinics. They can do a certain job, but they don’t offer a lifetime service.”

Michael Kelly recalls that when he started up he was expected to deal with all the myriad medical needs of his patients, in the traditional GP manner, even some which he says he mightn’t have been very good at. “One of the reasons that I wanted to expand the practice back in the mid-90s was because I needed to be able to provide the diversity of service with people who had their own special skills.”

And he quotes as the most recent example, Dr de Witt, who came from South Africa with the skills of minor surgery which are a particular feature of where he was trained.

“It is also good that by having several doctors, our patients get used to dealing with the different ones according to their specialities. So if I’m not here, they’re already likely to know Deirde, or Susanne, or Lotter. They’re now never in a situation of having to see a stranger.”

Deirdre Collins stresses that all doctors in the practice come from the GP tradition of ‘care within the family’. “It means that everyone is taken in the context of where they are in their life, in their family. There are situations where somebody presents with a particular problem, and we might already know that somebody else in their extended family might have something similar. We can pool information, and get a better result.”

As Susanne Francke puts it, ‘we don’t just treat a symptom, we deal with a whole person, because we have over time dealt with all of their problems. This gives us a unique advantage in treating somebody, because there can be other factors around that particular symptom. A hospital consultant, or a consultant in a private clinic, might not have that insight available to them. That’s the beauty of a general practice.”

The Kilcullen Family Practice offers pretty well all the services which a private clinic does, and quite often at significantly less cost. What’s not on the very comprehensive list is what comes out of the foregoing part of this piece, personal care from family knowledge.

Or, good old-fashioned community doctoring.

Brian Byrne.

This piece appeared originally on the Kilcullen Page of the Kildare Nationalist.